Jose Reyes Memorial Medical Center Rizal Ave.

, Manila

A Case Study On

Upper Gastrointestinal bleeding, secondary to bleeding peptic ulcer disease

Presented by: Micah Jonah B. Elicao

INTRODUCTION
Upper gastrointestinal (GI) bleeding occurs when the inner lining (mucosa) of the esophagus, stomach, or proximal small intestine (duodenum) is injured, exposing the underlying blood vessels, or when the blood vessels themselves rupture. Upper gastrointestinal bleeding (UGIB) is defined as hemorrhage that emanates proximal to the ligament of Treitz. It is a common and potentially life-threatening condition. More than 350,000 hospital admissions are attributable to UGIB, which has an overall mortality rate of 10%. Although more than 75% of cases of bleeding cease with supportive measures, a significant percentage of patients require further intervention, which often involves the combined efforts of gastroenterologists, surgeons, and interventional radiologists. Clinically, UGIB often causes hematemesis (vomiting of blood) or melena (passage of stools rendered black and tarry by the presence of altered blood). The color of the vomitus depends on its contact time with the hydrochloric acid of the stomach. If vomiting occurs early after the onset of bleeding, it appears red; with delayed vomiting, it is dark red, brown, or black. Coffee-ground emesis results from precipitation of blood clots in the vomitus. Hematochezia (red blood per rectum) usually indicates bleeding distal to the ligament of Treitz. Occasionally, rapid bleeding from an upper GI source may result in hematochezia. Upper gastrointestinal bleeding (UGIB) is a significant and potentially life-threatening worldwide problem. Despite advances in diagnosis and treatment, mortality and morbidity have remained constant. Bleeding from the upper gastrointestinal tract (GIT) is about 4 times as common as bleeding from the lower GIT. Typically patients present with bleeding from a peptic ulcer and about 80% of such ulcers stop bleeding. Increasing age and co-morbidity increase mortality. It is important to identify patients with a low probability of re-bleeding from patients with a high probability of re-bleeding. Upper GI bleeding can range in severity from clinically inapparent (insignificant) to large-volume, life-threatening bleeding. A variety of conditions can cause GI bleeding, and effective treatment depends on identification of the source of the bleeding and expeditious administration of therapy. Upper GI bleeding can be divided into two broad categories: variceal bleeding and nonvariceal bleeding. Varices are dilated blood vessels found most frequently in the esophagus and stomach. Non-variceal upper gastrointestinal bleeding can be caused by a variety of conditions. Peptic ulcer is the most common cause. An ulcer bleeds when the blood vessels at the base of the ulcer are disrupted. Ulcers are most likely to occur in the stomach and duodenum and less

frequently in the esophagus. Ulcers are caused most commonly by an infection with the bacterium Helicobacter pylori or use of nonsteroidal anti-inflammatory drugs. Indeed, I choose this case because I want to learn why gastrointestinal bleeding occurs. To enhance my knowledge about GI bleeding. And as a health care provider I need to know more about the disease in order for me to establish rapport to my patient and how to deal with it.

OBJECTIVES
General objectives: This case study focuses on the advancement of my skills in managing and administering the extensive range of my intervention to my client with Upper Gastrointestinal Bleeding (UGIB). This study will further help me to expand my knowledge about the said disease. Specific objectives: 1. To established good rapport to the client and to get the physical assessment. 2. To define what is Upper Gastrointestinal Bleeding (UGIB). 3. To trace the pathophysiology of UGIB. 4. To enumerate the different signs and systems of UGIB. 5. To formulate and apply necessary nursing care plans utilizing the nursing process.

Biographic Data

Name: Age: Birthdate: Birthplace: Religion: Nationality: Admission Date: Attending Physician: Chief Complaint: Admitting Diagnosis:

Client D.M.D. 77 yrs old July 5, 1936 Quezon Province Roman Catholic Filipino July 3, 2013 Dr. Adraneda Melena and Abdominal pain Upper Gastro Intestinel Bleeding problem secondary to Bleeding Peptic Ulcer Disease

HISTORY OF PRESENT ILLNESS Two weeks prior to admission the client experienced melena 1-2 episode per day amounting approximately 20-30cc per stool. The client experiences persistent vomiting and passage of black tarry stool for 2 weeks. Thus, medical consultation was done at Medical City hospital found decrease hemoglobin and admitted there for four days transfused with 5 units of PRBC. One week prior to admission the client consulted at bulacan hospital. Colonoscopy and endoscopy found to be normal however, no document available still prsistence of melena. Thus, consultation at Jose Reyes Memorial Medical Center had made.

PAST HEALTH HISTORY Clinet D.M.D. has no previous hospitalization. She never undergoes any procedure. She has no allergies in foods and medication. She is hypertensive and not diabetic. But she is a smoker and can consume 1/2 packs of cigarette a day. She also stated that before she drinks alcohol occasionally. Upon assessment, the following data was obtained from Client D.M.D.. BP= 120/80 mmHg; Temp. = 37.7C; Pulse rate= 101 bpm; Respiratory rate= 23 cpm

HEALTH- PERCEPTION/ HEALTH MANAGEMENT PATTERN The patient is almost generally the same as how every Filipino seeks health assistance. Without any problem regarding her health, she would not approach health workers not unless it is life threatening. Patient complaints pain a year ago but tolerated it. She is pale to look at.

NUTRITIONAL/ METABOLIC PATTERN The patient eats three times a day but wasnt able to finished the served meal given to her. She stated, unti lang ang nauubos kong pagkain mga wala pa sa kalahati. She said that she usually eat foods with soup like sinigang and nilaga so that she can easily swallow the food. The patient consumed whole share of food with fair appetite. She usually drinks 5-6 glasses of water per day. She said she frequently drinks coffee. ELIMINATION PATTERN According to the patient, when he is at home, he had difficulty in defecating and when he push to do so, he has a black-tary color of stool. He said that every time he defecates, his stool has a blood. During his hospitalization he defecates three to four times a day. He urinates an average of 850 cc per shift (8 hours) with yellowish colored urine.

ACTIVITY/ EXERCISE PATTERN He spent most of his time doing things on the farm, and sometimes talk with friends and family. He said he drinks alcohol everytime he wants especially when some of his friends invite him after farming. He sometimes spends his time doing his usual household chores as his exercise. During his confinement his leisure time is talking to his daughter. SLEEP- REST PATTERN The patient sleeps for an average of 8 hours per day before his confinement. During his hospital stay, he usually sleeps for 5-6 hours and takes nap in the morning and afternoon. He said he had difficulty in sleeping because of the pain he felt in his abdomen.

SELF-PERCEPTION/ SELF-CONCEPT PATTERN

pobre gihapon, pero malipayon. Problima sa ibayad as verbalized. The patient verbalized that being hospitalized was not a change for him, but it affects to his family since they had a big problem financially.

COGNITIVE/ PERCEPTUAL PATTERN

Patient X is conscious, well oriented to time, place and person and is in a calm emotional state. He exhibited appropriate behavior and response when communicating and has not experienced any dizziness or tingling sensation.

ROLE/RELATIONSHIP PATTERN Patient X is married, a farmer and has 3 children. The eldest is married and the two are helping him in farm.
The patient lives with his family in Salay, Misamis Oriental and as for his hospitalization expenses, his family especially his son find ways just to pay the bill. His family feels worried about the situation, his wife wants to stay with him as well as his children but they cant because they need to work to earn money for his hospitalization.

COPING/ STRESS-TOLERANCE PATTERN

kapoy mag puyo ug hospital labi na ug wla kay kwarta ika bayad as verbalized. His vital support group is his family and significant others.

VALUE/ BELIEF PATTERN

Patient X is a Roman Catholic. He always goes to church every Sunday with his family. He thinks that God is vital to everyone and he trusts in God on whichever turn his

condition will be. He says that hospitalization truly interferes, as he cant go to church because of his illness.