Summary: Advanced Practice Nursing Intervention Plan

3. Referring the patient to a cardiology for further evaluation.
Advanced Practice Nursing Intervention Plan for
Gastrointestinal Hemorrhage, Unspecified
The patient has a heme positive test, which means that there is blood contaminate in his stool sample. This result indicates that he may be suffering from gastrointestinal (GI) hemorrhage or gastrointestinal (GI) bleeding. According to NIDDK (2016), gastrointestinal (GI) bleeding is any type of bleeding in digestive tract. There are two type of GI bleeding: upper GI bleeding and lower GI bleeding (Buttaro et al, 2013). Signs of upper GI bleeding include coffee ground emesis, hemoptysis, tarry stool; whereas, signs of lower GI bleeding such as dark or tarry stool or dark blood or bright red blood mixed in stool (National Library of Medicine, 2016). Other signs include abdominal pain or cramping, dizziness, generalized weakness, and
pale skin (NIDDK, 2016). There are many conditions that can cause GI bleeding; for example, peptic ulcer, hemorrhoid, gastritis, or colon polyps, to name just a few. Treatments of GI bleeding depends on what cause the bleeding. The patient seems to be asymptomatic at this point because his lab tests did not indicate that he is anemic. An intervention plan for GI bleeding for this patient include:
1.
Taking a personal and family medical history as well as a history of presenting symptoms such as if he observes any blood in his stool, gets tired easily, or feels pain in abdominal area. Vital signs are taken because the signs of GI bleeding can manifest via abnormality of vital sign such as tachycardia and hypotension due to volume depletion (Buttaro et al., 2013). A through physical examination is performed including auscultation, percussion, and palpitation on all abdominal quadrants.
2. Investigating his medication regimen including over-the-counter medications. Some over-the-counter medications can cause GI bleeding such as ibuprofen and naproxen.
3. Prescribing lab tests; these include repeat fecal occult blood test (FOBT) three times to make sure that there is blood from GI tract in stool samples; CBC with platelet count can determine the hemoglobin and hematocrit level, which can indicate whether or not this patient is anemic; CMP to evaluate electrolyte, BUN, creatinine, liver function; coagulation studies (APTT, PT, INR); and H. pylori screening (Buttaro et al,
2013).
4. Further diagnostic tests are also prescribed, which include X-ray of abdomen, CT of abdomen and pelvis, barium swallow test, and bleeding scan. If suspect that the patient may be upper GI bleeding, an endoscopy is prescribed; whereas, a colonoscopy is prescribed if lower GI bleeding is suspected.
5. Instructing the patient to stop taking medication that may cause GI bleeding such as aspirin, ibuprofen, or naproxen. Sucralfate oral suspension is prescribed to manage symptoms while results from laboratory and diagnostic tests are pending.
6. If lab tests and diagnostic studies indicates that patient is positive for GI bleeding, a referral for further evaluation and consultation from a gastroenterologist is prescribed.