You promote hemodynamic stability in a patient with upper GI bleeding by:
A. Encouraging oral fluid intake.
B. Monitoring central venous pressure.
C. Monitoring laboratory test results and vital signs.
D. Giving blood, electrolyte, and fluid replacement.
Correct Answer: D. Giving blood, electrolyte, and fluid replacement.
To stabilize a patient with acute bleeding, NS or LR solution is given I.V. until BP rises and urine output returns to 30ml/hr. Two large-caliber (18-gauge or larger) peripheral I.V. catheters or a central venous catheter should be inserted. For patients who are hemodynamically unstable, two 16-gauge I.V. catheters should be inserted.
Option A: Nurses should expect to administer isotonic fluids, such as normal saline or lactated Ringer’s solution, as well as any necessary blood products. Coagulopathies should be corrected with fresh frozen plasma and vitamin K. If necessary, more rapid reversal of anticoagulation can be achieved via prothrombin complex concentrate infusions; this is the preferred approach for patients with serious or life-threatening bleeding. Platelets should be administered for patients with thrombocytopenia or a platelet count below 50,000/mcL (normal, 150,000 to 450,000/mcL).
Option B: Closely monitor the patient’s clinical status, including airway, vital signs, cardiac rhythm, urine output, and nasogastric output if a nasogastric tube is in place. Initial treatment goals are focused on airway maintenance and volume resuscitation. Endotracheal intubation should be considered for those with ongoing hematemesis or altered respiratory or mental status.
Option C: After initial fluid resuscitation, patients may require a blood transfusion, depending on their signs and symptoms and overall clinical presentation. A hemoglobin level maintained above 7 g/dL (normal, 13.5 to 17.5 g/dL in men) is recommended, but transfusions may be necessary for patients who are clinically unstable despite their hemoglobin levels.
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