i am desparate to find a modality of tx used on acute gi bleed--------

[jenifer__0__0]

  my name is jennifer--i am a critical care rn---working in icu-------i also happen to be a new nurse to critical care and am desparate here to find some info to help-----
  heres the situation that happened----ihad a patient who was having freq loose bloody stools----pretty much straight blood and was brought to icu--------she had a hgb of 7something when she came---i made the mistake of not hanging her blood as fast as i should have--she was just fine-----but i was discliplined for this--and im quite the perfectionist who was mortified at my mistake
  here are my questions:
  how many units can u hang at once----can blood be hung under pressure---and not damage the cells----and could someone please give me just some kind of list of what the orders and treatment would be for this patient from the moment she rolled in the door to the time she starts to stabilize---just even a generalized list would be great---like what labs--how often ordered  how plasma vs blood affects bringing a hgb up----how can a person have an mi when their hgb is that low---or lower--as it dropped to 5----what risk factors and treatments exist for someone with a hgb that low----im needing the immergent things u would do for a patient to get them stable------or at least get that hgb up--and how much of what ---etc---
  i know this is a lot to ask--but i have been looking thru nursing journals for days and am not finding anything helpful----pleaseee------im near quitting over this--i know if i know what to do effectively the next time i will be able to avoid this mistake again--but i need the knowledge---and i cannot seem to find it in the nursing sites and books----
  
  thank u
  
                 sincerely
                      jennifer
________
Dear Jennifer,
The response to  your question is affected by several factors including the patient's age, concurrent medical conditions (e.g. unstable angimna would be an indication for rapid transfusion, congestive heart failure for possibly slowert transfusion rate)and rate of bleeding.  If someone is unstable because of rapid blood loss, you want t o transfuse cells at a sufficeint rate to replace the losses.  This may involve having 2 large liones.  Blood can be administered rapidly under pressure without breaking the red cells (hemolysis).  IF blood loss can not be controlled, usually by therapeutic endoscopy, then surgery is needed.  If the rate of bleeding is slow or if blood loss is chronuc, then a single line for transfusion is necessary.
The first decision to make when evaluating a patient with bleeding is to determine whether it is an upper or lower source.  Soemtimes clinical history and physicial exam are diagnostic, otherwise endoscopy is needed.  Endoscopic therapy often can stop upper tract ( e.g. due to gastric or duodenal ulcer or variceal bleeding) bleeds.  In all patients you want to have  an initial hemoglobin, protime, lytes BUN and glucose.  Blood should be drawn for cross match.  Hemoglobin should be drawn regularly ( often q8 h).  Specific directions depend on the nature of the patient's condition.
This informatrion is provided for educational purposes.  
HFHSM.D.-rf
*keywords: gastrointestinal bleeding
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