1. What factors increase this patient’s risk for GI bleed?
According to Sole, Klein, and Moseley (2013), the factors that increase this patient’s risk for GI bleed are alcoholism, smoking, excessively use of NSAIDs, and infection of helicobacter pylori. 2. What are the differences between an upper and lower GI bleed?
There are many differences between an upper GI and lower GI bleed including causes and physical presentation. For upper GI bleeding, the causes are a duodenal and gastric ulcer, gastric varices, and Mallory-Weiss tear (Sole, Klein, & Moseley, 2013). The causes of lower GI bleeding include cancer, hemorrhoids, polyps, an inflammatory disorder, diverticulosis, and vascular ectasias (Sole, Klein, & Moseley, 2013). The significant sign and symptom that differentiate between upper and lower GI bleeding are the color of the blood. In upper GI bleeding, the blood appears dark and coffee grounds which called hematemesis. In the opposite, the lower GI bleeding has the bright red blood appearance. Other signs and symptoms of upper GI bleeding include hypovolemic shock, discomfort of the abdominal, and black-foul stool which called melena (Sole, Klein, & Moseley, 2013). 3. How are these conditions diagnosed?
The diagnostic tests include CBC, serum electrolyte, hematology, ABGs, and gastric aspirate (Sole, Klein, & Moseley, 2013). The diagnostic tests will show the increase of WBC, platelet, potassium, sodium, BUN and creatinine. The arterial blood gasses will show respiratory alkalosis or metabolic acidosis (Sole, Klein, & Moseley, 2013). There is also a decrease of Hgb levels which there is a presence of hypoxemia. 4. What are the nursing implications associated with the administration of blood?
According to Vera (2013), blood transfusion is important involving in the implementation of a nurse which include the management and implementations before, during, and after administration of blood. Before administer the blood to the patient, the nurse needs to make sure to verify the doctor’s order, explain the purpose of the therapy to the patient, check the compatibility of the blood with the patient, have another the nurse or the doctor to check the label (blood type, expiration date, serial number, Rh factor, blood component, and screening test, patient’s identification), and assess the patient’s vital signs. During the infusion, it is important for the nurse to stay at the patient’s bedside to obtain the temperature for 15 to 30 minutes, frequently check the patient’s vital signs and assess for an adverse effect of the transfusion. Most important, there is no other solution that mixing with blood transfusion except 0.9% normal saline which administers before, during, and after the blood transfusion (Vera, 2013). 5. What should the nurse consider when giving a morphine IV push?
The nurse needs to consider about the patient’s vital signs such as blood pressure, heart rate, and respiration rate with morphine IV push (Sole, Klein, & Moseley, 2013). Another consideration is to infusion slowly and administers fluid as indicate. 6. What are the nursing implications associated with the administration of IV pantoprazole?
After the administration of IV pantoprazole, the nurse needs to assess for renal function, allergy such as skin reaction, and signs and symptoms of angioedema (Sole, Klein, & Moseley, 2013). 7. If the patient continues to bleed, what further diagnostic/treatment options are available?
The transjugular intrahepatic portosystemic shunt is the treatment for reoccurring of bleeding (Sole, Klein, & Moseley, 2013). This method is a nonsurgical treatment that helps with uncontrolled bleeding with the first-line treatment. Furthermore, esophagogastric tamponade is the balloon tamponade therapy that controls the bleeding if there is still bleeding despite other therapy (Sole, Klein, & Moseley, 2013). 8. What should the teaching plan for this patient include?
According to Gastrointestinal Bleeding (2011), the education plan for this patient is to teach the patient to limit of alcohol taking, the risk of taking aspirin and other NSAIDs medications, high diet in vitamin K, eat in small and frequent meals. Avoid any type of foods that upset the GI such as caffeine, coffee, spicy foods or hot foods, and citric fruits. The nurse also needs to teach the patient to avoid drinking milk because it increases the secretion of gastric acid.

References:
Gastrointestinal Bleeding. (2015). Retrieved from http://www.nurseteachings.com/tag/gastrointestinal-bleeding
Sole, M. L., Klein, D. G., Moseley, M. J. (2013). Introduction to Critical Care Nursing, 6th Edition. St. Louis, MO: Elsevier Inc.
Vera, M. (2013). Blood Transfusion Therapy. Retrieved from http://nurseslabs.com/blood-transfusion-therapy-nursing-management/