A nurse is planning care for a client who has upper gastrointestinal bleeding due to a peptic ulcer.
Which of the following actions should the nurse plan to take?
A.
Ensure that the client has a 22-gauge IV line in place.
B.
Provide ketorolac for abdominal pain.
C.
Administer nitroprusside IV based on the client’s weight.
D.
Insert a large-bore nasogastric tube.
The correct answer and Explanation is :
The correct answer is D. Insert a large-bore nasogastric tube.
Explanation
When managing a client with upper gastrointestinal (GI) bleeding due to a peptic ulcer, the primary objectives are to stabilize the patient, control the bleeding, and facilitate the removal of blood and gastric contents that might be contributing to the bleeding.
Inserting a large-bore nasogastric (NG) tube is an essential intervention in this scenario. The NG tube serves several critical purposes:
- Decompression: It helps decompress the stomach by removing gastric acid and blood, which can relieve pressure and potentially decrease further bleeding.
- Monitoring: It allows for the monitoring of the type and amount of gastric output, which can provide valuable information about the bleeding’s severity and the patient’s response to treatment.
- Prevention of Aspiration: By draining the stomach contents, it reduces the risk of aspiration, which is particularly important if the patient is at risk of vomiting blood.
Other options:
- A. Ensure that the client has a 22-gauge IV line in place: While intravenous access is critical, a 22-gauge line is typically not sufficient for rapid fluid resuscitation in a case of significant upper GI bleeding. Larger-bore IV access is preferred to administer fluids and blood products effectively.
- B. Provide ketorolac for abdominal pain: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID), which can actually exacerbate bleeding by affecting platelet function and gastrointestinal mucosa. It is contraindicated in cases of GI bleeding.
- C. Administer nitroprusside IV based on the client’s weight: Nitroprusside is a potent vasodilator used to manage severe hypertension, not typically for upper GI bleeding. Its use in this context could be inappropriate without careful consideration of the overall clinical scenario and blood pressure management.
In summary, inserting a large-bore NG tube is a direct and effective way to manage the complications associated with upper GI bleeding, while the other options either don’t address the immediate needs or could worsen the condition.