Table 3.

Nursing Care of Patients With Cirrhosis and GI Bleeding

Inpatient Care

General measures

Intravenous saline for volume resuscitation and red blood count transfusions if hemoglobin < 7 g/dL. Dextrose solutions preferred to saline solutions for initial resuscitation in patients with ascites or edema

Check blood tests, particularly hemoglobin, regularly

Check for possible infections (e.g., skin, urine, lungs, ascites)

Start oral or rectal lactulose or enemas to prevent hepatic encephalopathy

Nutrition support

Specific nursing measures

Insert large‐bore peripheral IV (16‐18 gauge)

Monitor vital signs, including EKG, arterial pressure, and heart rate

Evaluate mental status periodically

Monitor urine volume daily, usually by collection of spontaneous voiding. Bladder catheter may be useful in hemodynamically unstable patients

Monitor skin pallor and temperature

Monitor characteristics of emesis or stool if blood is present (black vs. bright red)

If varices are present, be aware of their severity while placing a nasogastric tube

Outpatient Care

General measures

Confirm all patients have an upper GI endoscopy at diagnosis of cirrhosis and at least every 2 years afterward, to check for presence and size of gastroesophageal varices

Confirm compliance with measures to prevent bleeding, either variceal band ligation or beta‐blocker therapy

Specific nursing measures

Assess patients on beta‐blocker therapy for an adequate beta‐blocker effect (i.e., reduction in baseline heart rate of 25% to a value of approximately 55‐60 bpm)

Educate patients and caregivers on how to identify GI bleeding, particularly the presence of melena, and how to monitor arterial pressure and heart rate regularly at home