Clinical Findings

Neuro: Dizziness, mental status changes.

Resp: Shortness of breath.

CV: S/S of hypovolemic shock (acute bleed): HR >110; SBP <100 mm Hg; orthostatic drop in SBP of >16 mm Hg; oliguria; cold, clammy extremities; mental status changes. Chest pain(chronic bleed).

Skin: Pallor, coolness, clammy extremities.

GI/GU: Frankly bloody or melanotic stool or stool tests positive for occult blood, abdominal cramping.

MS: Fatigue.

Labs: Anemia.

Possible Causes: Diverticulitis, GI polyps, anal fissures, hemorrhoids, ulcerative colitis, Crohn’s disease, ischemic colitis, upper GI bleed.

Collaborative Management

• Assess VS (check for orthostasis).
• Notify HCP STAT if bleeding is copious.
• Monitor LOC, orientation, and oxygen saturation, and UO.
• Assess skin color, moistness, and temperature; assess capillary refill.
• Assess abdomen (distention, tenderness, pain, bowel sounds).
• Establish IV (consider starting two large-bore IVs), and administer IVF or blood products as ordered.
• Use fecal occult blood tester to determine whether blood is present. Some foods and medications can make stools appear melanotic.
• Obtain detailed GI history (history of tarry stools, use of NSAIDs, associated symptoms).
• Check if Pt has been previously typed and crossmatched and if any blood products are available in blood bank.
• Prepare Pt for immediate transfer to ICU if unstable; monitor VS frequently (every 5 min if unstable).
• For stable Pts who do not require immediate ICU care, initiate more frequent monitoring of Pt status, initiate any new procedures, and administer all newly ordered medications.
• Record frequency and character of stools.
• Check recent CBC and obtain or order laboratory tests, including coagulation studies (platelet count, PT, PTT, INR), electrolytes, BUN, creatinine, serial Hgb and Hct; type and crossmatch.
• Insert a urinary catheter, and monitor UO.
• Insert NGT, and check aspirate for blood; remove if negative.
• Prepare Pt for or assist with colonoscopy.