Upper gastrointestinal bleeding: Nursing strategies that family members must know!

Author: Nie Xuanxuan, The Fifth Medical Center, PLA General Hospital

Reviewer: Jin Bo, Chief Physician, Fifth Medical Center, PLA General Hospital

Upper gastrointestinal bleeding is one of the common diseases that endanger the life safety of contemporary people. When blood flows out from the esophagus, stomach, duodenum and other parts of the upper gastrointestinal tract, it not only means that the balance inside the body is broken, but also indicates that a race against time for treatment is about to begin. However, faced with sudden illness, the patient's family members are often at a loss, and the nursing process is full of doubts: Why do patients need oxygen during bleeding? What is the significance of ECG monitoring? Can the patient get out of bed and move around? How should diet and drinking be arranged? These questions are like checkpoints in the fog, testing the wisdom and determination of family members. The negligence of every detail may become a stumbling block to the patient's recovery. Therefore, it is necessary for us to explore in depth the nursing methods of upper gastrointestinal bleeding, provide a detailed and practical guide for the patient's family members, and jointly protect the patient's life and health.

1. Why do we need oxygen during upper gastrointestinal bleeding?

Red blood cells have the function of carrying oxygen. After massive bleeding in the digestive tract, a large number of red blood cells are lost, which can lead to anemia. Oxygen inhalation is to increase the oxygen concentration in the blood and prevent the body from hypoxia caused by the decrease of oxygenated hemoglobin in the blood due to massive bleeding, so as to relieve uncomfortable symptoms such as dizziness and vertigo.

Do not adjust the oxygen flow at will during oxygen therapy.

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2. Why should ECG monitoring be used during upper gastrointestinal bleeding?

The purpose of using ECG monitoring during upper gastrointestinal bleeding is mainly to monitor the patient's heart rate, blood pressure, blood oxygen saturation and respiration in real time, and to detect changes in the condition in a timely manner.

The normal values ​​of each monitoring indicator of ECG monitoring are as follows.

1. Heart rate: 60-100 beats/min.

2. Blood pressure: systolic pressure 90~139 mmHg, diastolic pressure 60~89 mmHg.

3. Finger pulse oxygen: ≥95%.

4. Respiratory rate: 16-20 times/min.

If any indicator is found to be abnormal, medical personnel should be notified in time for examination.

3. Why do you need to stay in bed during upper gastrointestinal bleeding? Why do you need to raise your lower limbs 15° to 30°? Can you turn over?

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During upper gastrointestinal bleeding, the effective blood volume in the body decreases. On the one hand, symptoms such as palpitations, fatigue, sweating, dizziness, and blackouts may occur. On the other hand, the body is in a state of hypoxia after blood loss. Absolute bed rest can not only reduce the body's oxygen consumption, but also avoid accidents such as falls/falling out of bed due to exhaustion.

Raising both lower limbs 15° to 30° can increase the amount of blood returning to the heart, thereby reducing intra-abdominal pressure and ensuring adequate blood supply to the heart and brain.

People who are bedridden for a long time need to change their body position regularly and should not maintain the same position for a long time, especially those with high risk factors for pressure injuries. If necessary, they need to change their body position once an hour and turn over slowly to avoid dragging, pulling, and tugging to prevent the occurrence of pressure injuries.

4. How to prevent pressure injuries during absolute bed rest?

Pressure injuries are localized injuries to the skin and/or soft tissues over bony prominences, medical or other devices, and usually present as intact skin or open sores that may be painful. The injury is caused by intense and/or prolonged pressure or pressure combined with shear. Therefore, preventing pressure injuries is key.

1. Keep the patient's skin clean: bathe once a day. If conditions permit, take a shower, but the water temperature should not be too high. For those with dry skin, apply a proper amount of moisturizer or Saifu Run.

2. Ensure that the patient has adequate nutrition.

3. Continue to pay attention to the patient's ability to control urination and defecation; for those with urinary and fecal incontinence, timely skin care should be provided to keep the perianal skin clean.

4. Patients should be placed in a suitable position when resting in bed to reduce pressure on bony prominences. Avoid prolonged pressure on the heels, elbows, head or ears when sitting or lying.

5. Bedridden patients need to change their body position every 1 to 2 hours, and wheelchair-bound patients should perform decompression activities once an hour if conditions permit.

(1) Lifting the body to relieve pressure: This can completely relieve hip pressure, but it is only suitable for patients with sufficient arm strength and trunk control.

(2) Leaning forward to relieve stress: This can reduce the weight on the ischial tuberosity.

(3) Lateral decompression: You can release the pressure on the opposite side, alternating between the two directions.

Note: Patients with limb dysfunction that affects their mobility should not sit for more than 30 minutes; patients who cannot transfer weight independently need assistance from others to change their position every hour.

6. Use soft pillows or sponge-like padding to maintain the patient's position. Do not use ring-shaped cushions.

7. For bedridden patients, the angle of the head of the bed should be raised to less than 30°, and the time the head of the bed is raised should be shortened as much as possible.

8. Use equipment such as a support sheet or hanger to help the patient lift his body, and avoid dragging, pulling, and tugging.

9. For patients with limited mobility and bedriddenness, limb function exercises should be given regularly to maintain muscle activity and prevent muscle atrophy.

10. Avoid rubbing or kneading the reddened area of ​​the bony prominence. If necessary, you can use anti-pressure injury products to protect the skin, such as foam dressings, hydrocolloid dressings, and anti-pressure sore mattresses.

5. Why do you need to fast and drink water during upper gastrointestinal bleeding? What should you do if you have dry mouth or thirst?

During upper gastrointestinal bleeding, you should strictly fast and drink water to avoid stimulating gastrointestinal motility and increasing the risk of rebleeding. When you feel dry mouth or thirst, you should not drink water blindly. You can wet your lips with a wet cotton swab or rinse your mouth with warm water. In addition, in addition to fasting and drinking water, other factors should also be considered for dry mouth and thirst symptoms that may be caused by insufficient blood volume.

6. Can I brush my teeth and wash my hair during upper gastrointestinal bleeding?

Avoid vigorous activities during bleeding to reduce the risk of bleeding. Patients with obvious fatigue should be given oral care by medical staff and rinse their mouths with sodium bicarbonate mouthwash 4 times a day (after meals and before bedtime). Medical staff can help patients wash their hair in bed, wipe with alcohol or use a disposable shampoo cap.

See the picture below for how to use the no-rinse shampoo cap.

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