Gastrointestinal (GI) Bleed Concept Map

Nursing Clinical 360

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Nursing Concept Map Template (Cheatsheet)

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Outline

Overview

Concept maps
1. Many types, variations, layouts
2. Primary diagnosis
  1. Typically in center of maps
  2. Connects to
    1. Contributing factors
    2. Medications
    3. Labwork
    4. Patient education
    5. Nursing diagnoses
      1. Interventions
      2. Evaluations

Nursing Points

General

Nursing diagnosis
1. Risk for deficient fluid volume
  1. Administer parenteral fluids
    1. Appropriate vital signs
  2. Administer blood products
    1. Appropriate labwork (CBC)
  3. Plan daily activity
    1. Energy conserved
    2. Patient participates in care
2. Risk for knowledge deficit
  1. Provide learning environment
    1. Patient focus on new information
  2. Provide environment of trust/respect
    1. Patient open to learning
  3. Provide clear/understandable information
    1. Patient has basic understanding
    2. Patient asks questions
3. Risk for anxiety
  1. Familiarize patient with new environment, people, situations
    1. Patient anxiety decreases with knowledge
  2. Maintain a quiet/calm environment
    1. Patient shows decrease in panic
  3. Allow patient to speak about anxiety
    1. Patient expresses decrease in anxiety

Assessment

Contributing factors
1. Upper GI bleed
  1. Peptic ulcers
  2. Esophageal varices
  3. Esophagitis
  4. Cancer
2. Lower GI bleed
  1. Diverticulitis
  2. Irritable bowel disease
  3. Polpys
  4. Tumors
  5. Hemorrhoids

Therapeutic Management

Labwork
1. CBC
  1. Shows extent of bleeding/anemia
  2. Stool – occult blood
2. Other diagnostic testing
  1. Abdominal CT
  2. Upper/lower GI series
3. Procedures
  1. Gastric lavage
  2. Colonoscopy/Endoscopy
Medications
1. Upper GI bleed
  1. Proton pump inhibitor
    1. Pantoprazole 40 mg IV
    2. Omeprazole 20-40 mg IV
2. Large amount of blood in stomach
  1. Metoclopramide 10 mg IV
3. Treat varices
  1. Ocreotide acetate 25-100 mcg IV bolus, infusion 25-50 mcg/hr

Nursing Concepts

Clinical judgment
Fluid and electrolyte balance
Functional ability

Patient Education

Explain informed consent
1. If procedure
2. Obtained by provider
Bed rest
1. If active bleed
Liquid diet

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Transcript

Hey guys! Lets take a look at the concept map for gastrointestinal or GI bleed!

So in this lesson we will take a look at the components of a concept map including contributing factors, medications, lab work and the significance, patient education, and associated nursing diagnoses with interventions and evaluations!

Ok so here is a basic example of a concept map, guys there are many different variations and this is just one example. First, we start with the primary diagnosis typically in the center of the concept map which leads to nursing diagnoses and interventions and also contributing factors, medications, labwork, and patient education which are associated with the primary diagnosis. Lets jump in! If your patient has a GI bleed it could either be an upper or lower bleed. Upper bleeds are commonly due to peptic ulcers, esophageal varices, or esophagitis, and cancer while lower bleeds can be caused by diverticulitis, inflammatory bowel disease, polyps, tumors, or hemorrhoids.

In this next circle right here we might see medications associated with a GI bleed. Ok so if your patient has an upper GI bleed they may be given a proton pump inhibitor to reduce the amount of acid in the stomach like pantoprazole 40 mg IV or omeprazole 20 – 40 mg IV. If your patient has a large amount of blood in their stomach they may be given metoclopramide (10 mg IV administered over 1 to 2 minutes) which is a prokinetic agent which helps to empty the stomach. If your patient has a small bleeding vessel or variceal they may be given octreotide acetate (25-100 mcg IV bolus, then continuous IV fusion 25-50 mcg/hr 2-5 days) because it reduces splanchnic blood flow and portal venous pressure.

Ok additional information included in a concept map is commonly patient education and significant labwork. So in this circle here lets add important patient education information for when your patient is in the hospital. If a procedure like a colonscopy or endoscopy is necessary teach a patient informed consent will be obtained before the procedure takes place. Teach your patient to remain in bed and rest until bleeding is controlled. It might be necessary to be on a liquid diet for a few days so be sure to explain this to your patient. As for labwork, a CBC will completed to show the extent of the bleeding or the level of anemia and a stool test to show any occult blood. Keep in mind your patient could also possibly undergo a gastric lavage, endoscopy, colonscopy depending on the extent and location of bleeding. Imaging tests are also common to determine the cause of the bleed including abdominal CT and lower and upper GI series.

Finally, in the three circles that are left we will add nursing diagnoses with interventions and evaluations for a GI bleed. Risk for deficient fluid volume is an appropriate nursing diagnosis for GI bleed with interventions, depending on the location and severity including administering parenteral IV fluids and evaluating by monitoring vital signs. Administration of blood products is another intervention as they may be necessary to correct the losses from the active GI bleed, this will be evaluated by monitoring labwork. Fluid volume deficit can cause energy deficits within the patient so plan daily activities to conserve energy evaluated by the patient able to participate in care.

What is another appropriate nursing diagnosis? Risk for knowledge deficit is very appropriate as this is most likely a new condition the patient is experiencing. Interventions utilized could be provide a peaceful environment so the patient can focus evaluated by the patient being able to concentrate on information, provide an environment of trust and respect as patients are more likely to be open to learning and understanding when they trust the provider. Finally, provide clear and understandable information to the patient which will be evaluated by the patient having a basic understanding of disease process and able to ask questions.

Ok guys there are plenty of nursing diagnoses for GI bleed but one last diagnosis that we will talk about here is risk for anxiety related to a new diagnosis. What inteventions can we apply? Familiarize the patient with the new environment, new people, and new experiences they may be encountering which can decrease anxiety evaluated by a decrease in patient anxiety. Maintain a quiet and calm environment to decrease panic in the patient, patient will express lessened anxiety. Finally, allow the patient to speak about their anxiousness which can reduce patient anxiety.

Here is a look at the completed concept map for GI bleed!

We love you guys! Go out and be your best self today! And as always, Happy Nursing!

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