| INTRODUCTION

Upper gastrointestinal (GI) bleeding occurs when the inner lining (mucosa) of
the esophagus, stomach, or proximal small intestine (duodenum) is injured,
exposing the underlying blood vessels, or when the blood vessels themselves
rupture. Upper gastrointestinal bleeding (UGIB) is defined as hemorrhage that
emanates proximal to the ligament of Treitz. It is a common and potentially lifethreatening condition. More than 350,000 hospital admissions are attributable
to UGIB, which has an overall mortality rate of 10%. Although more than 75% of
cases of bleeding cease with supportive measures, a significant percentage of
patients require further intervention, which often involves the combined efforts
of gastroenterologists, surgeons, and interventional radiologists.
Clinically, UGIB often causes hematemesis (vomiting of blood) or melena
(passage of stools rendered black and tarry by the presence of altered blood).
The color of the vomitus depends on its contact time with the hydrochloric acid
of the stomach. If vomiting occurs early after the onset of bleeding, it appears
red; with delayed vomiting, it is dark red, brown, or black. Coffee-ground emesis
results from precipitation of blood clots in the vomitus. Hematochezia (red blood
per rectum) usually indicates bleeding distal to the ligament of Treitz.
Occasionally, rapid bleeding from an upper GI source may result in
hematochezia.
Upper gastrointestinal bleeding (UGIB) is a significant and potentially lifethreatening worldwide problem. Despite advances in diagnosis and treatment,
mortality and morbidity have remained constant.1 Bleeding from the upper
gastrointestinal tract (GIT) is about 4 times as common as bleeding from the
lower GIT. Typically patients present with bleeding from a peptic ulcer and about
80% of such ulcers stop bleeding. Increasing age and co-morbidity increase
mortality. It is important to identify patients with a low probability of re-bleeding
from patients with a high probability of re-bleeding. Upper GI bleeding can
range in severity from clinically in apparent (insignificant) to large-volume, lifethreatening bleeding. A variety of conditions can cause GI bleeding, and
effective treatment depends on identification of the source of the bleeding and
expeditious administration of therapy.
Upper GI bleeding can be divided into two broad categories: variceal bleeding
and non-variceal bleeding. Varices are dilated blood vessels found most
frequently in the esophagus and stomach. Non-variceal upper gastrointestinal
bleeding can be caused by a variety of conditions. Peptic ulcer is the most
common cause. An ulcer bleeds when the blood vessels at the base of the ulcer
are disrupted. Ulcers are most likely to occur in the stomach and duodenum and
less frequently in the esophagus. Ulcers are caused most commonly by an
infection with the bacterium Helicobacter pylori or use of nonsteroidal antiinflammatory drugs.
Indeed, I choose this case because I want to learn why gastrointestinal bleeding
occurs. To enhance my knowledge about GI bleeding. And as a health care
provider I need to know more about the disease in order for me to establish
rapport to my patient and how to deal with it.

1 | Page

| PATIENT PROFILE
PATIENT NAME: Patient X
GENDER: Female
RELIGION: Roman Catholic
CATEGORY: DEP EDM
CIVIL STATUS: Widow
ADDRESS: Bulsa San Juan Batangas
AGE: 80 years old
RACE: Brown
DATE ADMITTED: August 16, 2015
DATE OF BIRTH: May 05, 1935
PLACE OF BIRTH: Batangas
TYPE OF ADMISSION: Direct
TIME OF ADMISSION: 7:00 A.M.
CHIEF COMPLAINTS:
This a care of 80 year old EDM who care in due to episodes of hematomesis
HISTORY OF PRESENT ILLNESS / ACTIVE PROBLEMS:
History of present illness, started 2 weeks prior to admission. When the patient
noted to be losing her appetite with occasional epigastric pain burning in
character. Patient had no cough, no colds, no fever, and was still able to sleep
well at night no consult has done. No medication taken.
In the interim, decrease in appetite was persistent with usual bottle of milk
cannot be consumed completely. Patient also presented with decrease urine
output evident by the decrease in the output per diaper when the patient
usually consumes (2 fully soaked/day) to less than half of mildly soaked at time.
Few hours PTC, patient had episodes (>10) of hematomesis approximately
measuring - 1 ap. Hence, patient was brought for consult.
BP: 140/80 OR: 88 RR: 22 T: 36.5
Conscious, coherent not in distress
INITIAL DIAGNOSIS:
Upper Gastrointestinal Bleeding probably secondary to bleeding Peptic Ulcer
Disease clinically diagnosed Pulmonary Tuberculosis Uresepsis Acute Kidney
Injury s/p Lacunar syndrome sensorimotor (2013) Hypertensive Cardiovascular
disease FC II

2 | Page

| PHYSICAL ASSESSMENT
ASSESSMENT DATA

ASSESSMENT FINDINGS

EARS

Normal
shape
Round

Hearing
Color

CanNormocephalic
hear whispered voice
Moist and pallor

Tinnitus
Temperature

None
Symmetrical
37.7
C

Vertigo
Turgor

No
vertigo
None
Supple

Ear
aches
Texture

No
ear aches
Rough

Infection
Lesion

No
infection
(-) Rash

Discharges
Integrity

No
discharges
Intact

SKIN

NN NECK
NAILS
NOSE AND SINUSES
Symmetry
Color
Frequent colds
Condition of trachea Thyroid
Texture
Nasal stiffness
Lymph nodes
Shape
Nose bleed

Symmetrical
Pale
None
Midline
Smooth
None
(-) nonpalpable
Concave
None

Capillary
refill
Sinus trouble

4Sinuses
secondsare non tender

LUNG
HAIR
MOUTH & THROAT
Symmetry
Color
Condition of teeth
A: P diameter
Texture
Bleeding gums
Shape of chest
Distribution
Tongue
Number of breaths
Quantity
Throat

Symmetrical
Black
Missing teeth
1:2
Coarsely
dry
No bleeding
Barrel
Evenly
Midlinedistributed
23 cpm
Thin
Non-tender

Hoarseness
HEAD

(-) Hoarseness

Mucous membrane
Shape

Pallor

Gums
Size

Pallor

Configuration
AUSCULTATION:
HEAD
AND NECK:
Headache
ABDOMEN:
Character
of respiration
Facial muscle
symmetry
Configuration
Swelling
HEART AND NECK VESSELS:
Bowel Sounds
Scars
Apical Pulse
Percussion :
Discoloration
Cardiac Sounds
Palpation :
Weakness
Apical/Radial pulse data
Usual urinary pattern:
ROM
Blood pressure
Excess perspiration/ nocturnal sweats
Posterior
neck cervical spine
Pulse pressure

(+)
Crackles
Symmetrical
Globular
None
Hypoactive
None
55
bpm
Dullness (3 clicks)
None
(-)
Murmurs
Muscle guarding
(-)bpm
Weakness
55
850 cc/shift
Can turn
head from side to side
130/90
mmHg
None
Non-tender
60
mmHg

Muscle
spasm
Any special
procedure done

(-) Spasm
None

Crepitus

(-) Crepitus heard

3 | Page

| ANATOMY AND PHYSIOLOGY

The digestive tract (also known as the alimentary canal) is the system of organs

within multicellular animals that takes in food, digests it to extract energy and
nutrients, and expels the remaining waste. The major functions of the GI tract
are ingestion, digestion, absorption, and defecation. The picture to the right
doesn't show the Jejunum. The GI tract differs substantially from animal to
animal. Some animals have multi-chambered stomachs, while some animals'
stomachs contain a single chamber. In a normal human adult male, the GI tract
is approximately 6.5 meters (20 feet) long and consists of the upper and lower
GI tracts. The tract may also be divided into foregut, midgut, and hindgut,
reflecting the embryological origin of each segment of the tract.The first step in
the digestive system can actually begin before the food is even in your mouth.
When you smell or see something that you just have to eat, you start to salivate
in anticipation of eating, thus beginning the digestive process. Food is the
body's source of fuel. Nutrients in food give the body's cells the energy they
need to operate. Before food can be used it has to be broken down into tiny
little pieces so it can be absorbed and used by the body. In humans, proteins
need to be broken down into amino acids, starches into sugars, and fats into
fatty acids and glycerol.
During digestion two main processes occur at the same time:
* Mechanical Digestion: larger pieces of food get broken down into smaller
pieces while being prepared for chemical digestion. Mechanical digestion starts
in the mouth and continues in to the stomach.
* Chemical Digestion: several different enzymes break down macromolecules
into smaller molecules that can be more efficiently absorbed. Chemical
digestion starts with saliva and continues into the intestines.
4 | Page

Esophagus
The esophagus (also spelled oesophagus/esophagus) or gullet is the muscular
tube in vertebrates through which ingested food passes from the throat to the
stomach. The esophagus is continuous with the laryngeal part of the pharynx at
the level of the C6 vertebra. It connects the pharynx, which is the body cavity
that is common to both the digestive and respiratory systems behind the
mouth, with the stomach, where the second stage of digestion is initiated (the
first stage is in the mouth with teeth and tongue masticating food and mixing it
with saliva).
After passing through the throat, the food moves into the esophagus and is
pushed down into the stomach by the process of peristalsis (involuntary
wavelike muscle contractions along the G.I. tract). At the end of the esophagus
there is a sphincter that allows food into the stomach then closes back up so
the food cannot travel back up into the esophagus.

The GI System
The gastro-intestinal system is essentially a long tube running right through the
body, with specialised sections that are capable of digesting material put in at
the top end and extracting any useful components from it, then expelling the
waste products at the bottom end. The whole system is under hormonal control,
with the presence of food in the mouth triggering off a cascade of hormonal
actions; when there is food in the stomach, different hormones activate acid
secretion, increased gut motility, enzyme release etc. etc.
Nutrients from the GI tract are not processed on-site; they are taken to the liver
to be broken down further, stored, or distributed.

The Stomach
The stomach is a 'j'-shaped organ, with two openings- the oesophageal and the
duodenal- and four regions- the cardia, fundus, body and pylorus. Each region
performs different functions; the fundus collects digestive gases, the body
secretes pepsinogen and hydrochloric acid, and the pylorus is responsible for
mucus, gastrin and pepsinogen secretion.
The stomach has five major functions;

Temporary food storage

Control the rate at which food enters the duodenum

Acid secretion and antibacterial action

Fluidisation of stomach contents

Preliminary digestion with pepsin, lipases etc.

The Small Intestine

5 | Page

The small intestine is the site where most of the chemical and mechanical
digestion is carried out, and where virtually all of the absorption of useful
materials is carried out. The whole of the small intestine is lined with an
absorptive mucosal type, with certain modifications for each section. The
intestine also has a smooth muscle wall with two layers of muscle; rhythmical
contractions force products of digestion through the intestine (peristalisis).
There are three main sections to the small intestine;

The duodenum forms a 'C' shape around the head of the pancreas. Its
main function is to neutralise the acidic gastric contents (called 'chyme') and to
initiate further digestion; Brunner's glands in the submucosa secrete an alkaline
mucus which neutralises the chyme and protects the surface of the duodenum.

The jejunum

The ileum. The jejunum and the ileum are the greatly coiled parts of the
small intestine, and together are about 4-6 metres long; the junction between
the two sections is not well-defined. The mucosa of these sections is highly
folded (the folds are called plicae), increasing the surface area available for
absorption dramatically.

The Pancreas
The pancreas consists mainly of exocrine glands that secrete enzymes to aid in
the digestion of food in the small intestine. the main enzymes produced are
lipases, peptidases and amylases for fats, proteins and carbohydrates
respectively. These are released into the duodenum via the duodenal ampulla,
the same place that bile from the liver drains into.
Pancreatic exocrine secretion is hormonally regulated, and the same hormone
that encourages secretion (cholesystokinin) also encourages discharge of the
gall bladder's store of bile. As bile is essentially an emulsifying agent, it makes
fats water soluble and gives the pancreatic enzymes lots of surface area to work
on.
Structurally, the pancreas has four sections; head, neck, body and tail; the tail
stretches back to just in front of the spleen.
The Large Intestine
By the time digestive products reach the large intestine, almost all of the
nutritionally useful products have been removed. The large intestine removes
water from the remainder, passing semi-solid feces into the rectum to be
expelled from the body through the anus. The mucosa (M) is arranged into
tightly-packed straight tubular glands (G) which consist of cells specialised for
water absorption and mucus-secreting goblet cells to aid the passage of faeces.
The large intestine also contains areas of lymphoid tissue (L); these can be
found in the ileum too (called Peyer's patches), and they provide local
immunological protection of potential weak-spots in the body's defences. As the
gut is teeming with bacteria, reinforcement of the standard surfacedefences
seems only sensible.
Gallbladder
The gallbladder is a pear shaped organ that stores about 50 ml of bile (or "gall")
until the body needs it for digestion. The gallbladder is about 7-10cm long in
6 | Page

humans and is dark green in appearance due to its contents (bile), not its
tissue. It is connected to the liver and the duodenum by biliary tract.
The gallbladder is connected to the main bile duct through the gallbladder duct
(cystic duct). The main biliary tract runs from the liver to the duodenum, and
the cystic duct is effectively a "cul de sac", serving as entrance and exit to the
gallbladder. The surface marking of the gallbladder is the intersection of the
midclavicular line (MCL) and the trans pyloric plane, at the tip of the ninth rib.
The blood supply is by the cystic artery and vein, which runs parallel to the
cystic duct. The cystic artery is highly variable, and this is of clinical relevance
since it must be clipped and cut during a cholecystectomy.
The gallbladder stores bile, which is released when food containing fat enters
the digestive tract, stimulating the secretion of cholecystokinin (CCK). The bile
emulsifies fats and neutralizes acids in partly digested food. After being stored
in the gallbladder, the bile becomes more concentrated than when it left the
liver, increasing its potency and intensifying its effect in fats.

7 | Page

| PATHOPHYSIOLOGY
EC
R
P
C
A
F
A
T
IP
: IN
S
R
O
G
D ie
w
a
t:R
d fo
fo
d
y s
ic
,p
s
rile
,g
dd
fo
.
s
mo
S
:A
g
in
k
lc 2
a
p
ec
B
lic
o
h
d
a
s
k
rg y
e
v
s
e
r in
d
r
e
k

Pe
A
F
G
P
IS
D
E
r:R
d
n
OM
T
C
IN
S
O
le
a
: G
Ag
y /o
3
:5
e

D isru
n
to
p
c fu
m
ri e
a
sb
r
In fl
ma
a
r y
to
ea
g
tric
s
on
e
ff
U lc
rs
e
r ro
u
b
s
w

8 | Page

ea
W
n in
e
k
g
nd
a
ec
n
a
ite s
s
ro
o
l f
a
ev
D
lo p
e
me
n
to fp
eu
s
do
nu
a
ry s
e
ms

ea
W
n
e
k
we
d
l
p tu
ra
re s

peripheral

Pale nail beds.

>4 sec

UGIB
Body
weakness

BP= 130/90
RR= 22
PR=55

9 | Page

| DIAGNOSTIC PROCEDURES and LABORATORY RESULTS

HEMATOLOGY REPORT
TEST
WBC
RBC
Hemoglobin
Hematocrit
MCV
MCH
MCHC
RDW-CV
PDW
MPV
DIFFERENTIAL
COUNT
Lymphocyte %
Neutrophil %
Monocyte %
Eosinophils %
Basophils %
Bands/stabs %
PLATELET

RESULT
13.8
5.52
10.6
33.4
60.5
19.2
31.7
19.0
10.9
9.3

UNIT
10^3/uL
10^6/uL
g/dL
%
fL
Pg
g/dL
%
fL
fL

REFERENCES
5.0-10.0
4.2 -5.4
12.0 16.0
37.0 47.0
82.0 98.0
27.0 31.0
31.5 35.0
12.0 17.0
9.0 16.0
8.0 12.0

17.9
54.9
5.5
21.6
0.1

%
%
%
%
%
%
10^3/uL

17.4 48.2
43.4 76.2
4.5 -10.5
1.0 3.0
0.0 2.0
1.0 2.0
150 400

605

10 | P a g e

INTERPRETATION:
RESULT
11.4
5.72
11.5
35.9
62.8
20.1
32.0
21.9
10.4
8.6

An elevated WBC count occurs in infection, allergy,

systemic illness, inflammation, tissue injury, and
leukemia.
A Low hemoglobin and hematocrit level indicates
anemia. A low MCV number in a patient with a
positive stool guaiac test (bloody stool) is highly
suggestive of GI cancer. A low MCH indicates that
cells have too little hemoglobin. This is caused by
deficient hemoglobin production
ULTRASOUND REPORT

16.8
53.0
8.1
22.0
0.1

FINDINGS:
The liver appears normal in size but with slightly
increased parenchymal echogenicity. No mass or
calcification seen. Intrahepatic bile ducts and
common bile duct are non-dilated.

517
Gallbladder is normal in size. Its wall is not thickened. No intraluminal mass
or lithiasis seen.

Pancreas, spleen and abdominal aorta are unremarkable. Right and left
kidneys measure 8.6 cm x 3.9cm and 9.0cm x 4.7cm, both with parenchymal
thickness of 1.5cm. Central echocomplexes are intact. At least 3 tiny
calcifications with the largest measuring 0.5cm is seen in the left renal
cortex. No stones, mass nor calfectasia noted.
Urinary bladder is moderately filled. Its wall is thickened to 4.0mm. No
intraluminal mass or lithiasis seen.
Prostate measures 3.6cm x 2.6cm approximately 15 grams.
DIAGNOSIS:
1. Fatty liver, grade 1
2. Cortical calcifications, left
3. Non-remarkable ultrasounds findings in the gallbladder, pancreas,
spleen, abdominal aorta, right kidney, urinary bladder and prostate.

FECALYSIS

PHYSICAL CHARACTERISTICS:
Color and character:
Consistency:

Brown
Formed

ABNORMAL FEATURES:
Occult blood:
WBC:
RBC:
Fecal

DRUG
ORDER
(Generic name,
brand name,
classification,
dosage, route,
frequency)

MECHANISM OF
ACTION

positive

INDICATIONS

CONTRAINDICATIO
NS

ADVERSE EFFE
OF THE DRU

Gastric acid-pump short-term

inhibitor.
treatment of
Suppresses
active
gastric
acid
duodenal
BRAND NAME:
secretion
by
ulcer
Losec
specific inhibition
of the hydrogen- Treatment of
CLASSIFICATION:
potassium ATPase
heartburn or
Antisecretory
enzyme
system
symptoms of
drug
at the secretory
GERD
Proton
pump surface of the
inhibitor
gastric
parietal Short-term
cells; blocks the
treatment of
DOSE:
final stage of acid
active benign
20 g
production.
gastric ulcer
GENERIC NAME:
omeprazole

Contraindicated
CNS:
head
dizziness,
ast
with
vertigo,
inso
hypersensitivity to
apathy, anxiety
omeprazole or its
components.
GI:
dia
abdominal
nausea,
vom
constipation,
mouth,
to
athropy

Respiratory:
symptoms,
c
epistaxis

ROUTE:
PO
FREQUENCY:
BID

DRUG ORDER
(Generic name,
brand name,
classification,
dosage, route,
frequency)

MECHANISM OF
ACTION

INDICATIONS

CONTRAINDICATIO
NS

ADVERSE EFFE
OF THE DRU

GENERIC NAME:
sucralfate
BRAND NAME:
Carafate
CLASSIFICATION:
Antiulcer drug
DOSE:
1 gram
ROUTE:
PO

Forms an adherent short-term

complex
at
treatment of
duodenal
ulcer
active
sites
protecting
duodenal
the ulcer against
ulcer up to 8
acid, pepsin and
weeks
bile salts, thereby
promoting
ulcer maintain
healing;
also
therapy
for
inhibits
pepsin
duodenal
activity in gastric
ulcer
at
ulcer.
reduced
dosage after
healing.

Contraindicated
with
allergy
to
sucralfate, chronic
renal
failure
or
dialysis ( buildup of
aluminum
may
occur
with
aluminumcontaining product.

FREQUENCY:
QID

DRUG ORDER
(Generic name,
brand name,
classification,
dosage, route,
frequency)
GENERIC NAME:
rebamipide
BRAND NAME:
Mucosta
CLASSIFICATION:
Antigastric ulcer
DOSE:
100 mg
ROUTE:
PO
FREQUENCY:
TID

CNS:
dizz
sleeplessness,
vertigo

GI:
constip
diarrhea,
na
indigestion, g
discomfort,
mouth

Dermatologic
rash, pruritus

Other: back

MECHANISM OF
ACTION

INDICATIONS

A
mucosal Acute gastric
protective agent
and
acute
and postulated to
exacerbation
increase
gastric
of
chronic
blood
flow,
gastritis
prostaglandin
biosynthesis and
decrease
free
oxygen radicals.

CONTRAINDICATIO
NS

ADVERSE EFFE
OF THE DRU

Contraindicated Constipation
with
allergy
to Bloating
Diarrhea
rebamipide
Nausea
Vomiting
Rash
pruritus

ASSESMENT
DATA
(Subjective &
Objective
Cues)

Subjective Cue:

NURSING
DIAGNOSIS
(Problem and
Etiology)

Acute
related
pagtumatae ako underlying
sobrang
sakit. condition
as verbalized.

Objective Cues:
pain
scale=
7/10
sleep
disturbance
irritability
restless

GOALS AND
OBJECTIVES

NURSING
INTERVENTIONS

pain After 8 hours of INDEPENDENT:

to nursing
intervention
the Teach the use of
patient
will
be
nonable to ;
pharmacologic
techniques such
report pain is
as relaxation.
relieved/
controlled
follow
prescribed
pharmacologic
Instruct client to
al regimen
demonstrate
perform
deep
breathing
use
of
exercises
relaxation skills
and diversional
Encourage
activities.
Decrease
in
adequate rest
pain scale from
7/10 to 5-6/10
COLLABORATIVE:
Administer pain
reliever
as
ordered.

ASSESMENT
DATA

NURSING
DIAGNOSIS

(Subjective &
Objective
Cues)

(Problem and
Etiology)

GOALS AND
OBJECTIVES

.us
inv
me
inc
rel
en
en
the
eff
rel
To
an
rel
To

To

NURSING
INTERVENTION
S

Subjective Cue:

Hyperthermia
related
to
mainit
yong inflammatory
katawan ko as response
verbalized.
secondary
to
disease process

Objective Cues:
Temp = 37.7
Flushed skin
Restless

ASSESMENT
DATA
(Subjective &
Objective Cues)

NURSING
DIAGNOSIS
(Problem and
Etiology)

After 30 minutes INDEPENDENT:

of
nursing
intervention
the provide
tepid H
patient will be able
sponge bath
te
to ;
promote surface H
maintain
cooling by means
ra
temperature
of understanding
co
within
normal
range (37.5)
Maintain bed rest
To
After 8 hours of DEPENDENT:
m
nursing
Administer
de
intervention
the
antipyretic
patient will be able
medications
as To
to:
ordered
ci
Remain free of COLLABORATIVE:
&
complications
Administer
such
as
replacements of
irreversible
fluid
and U
brain/neurologi
electrolytes.
ph
cal damage.
m
de
free of seizure
te
activity

GOALS AND
OBJECTIVES

NURSING
INTERVENTIONS

Subjective Cue:
Nahihira
pan
akong
tumae.
as
verbalize
d.

Constipation
related
to
irregular
defecation habit

Objective Cues:
Hard,
formed
stool
Hypoactive
bowel sounds
Abdominal
tenderness
Distended
abdomen

After 8 hours of
nursing
intervention
the
patient will be able
to:
Establish/
regain normal
pattern
of
bowel
functioning
Participate
in
bowel program
a indicated
Demonstrate
behavior
or
lifestyle
changes
to
prevent
recurrence
of
problem

INDEPENDENT:
Determine fluid To
intake
cl
st
Instruct
the Pr
patient to void if
theres a feeling
of urgency
Note
general Th
oral/dental
di
health
DEPENDENT:
Apply lubricant

COLLABORATIVE:
Encourage
To
treatment
of
fu
underlying
causes.

| DISCHARGE PLAN
MEDICATION

ECONOMIC STATUS

Discuss/instruct to
the
patient
with
their
significant
other
the
importance
as
prescribe by the
physician.

Emphasize
on
compliance
to
therapeutic
and
medication regimen
and the information
regarding side effect
of the medications.

To

Patient with their

significant
other
need to understand
the occurrence of
the drug effects in
order to when, what
and whom to report
on any symptoms
present.

Pinpoint the patient

their capability to
purchase
the
medications.

This is to make sure

that the compliance
of the medication
will be achieved.

The
patient
accessibility to the
agency and should

To have immediate
interventions when
signs and symptoms

be considered with
regards to follow-up.

TREATMENT

It is important to
know patient ability
to
afford
the
expected expenses.

Encourage patient
to have a vitamins
supplements.

Compliance
to
medication regimen.

Instruct
the
significant others to
assess the patients
incision
and
drainage system.

occur.

To
ensures
the
patient
adherence
instructions.

To have a fast
recovery
and
to
prevent
complications.

To monitor
healing

To promote
recovery.

To monitor any signs

of infection.

To

HEALTH TEACHINGS

OUT-PATIENT

Encourage
the
patient to prevent
the stressful activity
and have adequate
rest.

wound

early

Instruct the client and

the significant others
to monitor presence
of
infection
and
report immediately if
signs and symptoms
of infection occurs
such as redness, foulsmelling
drainage,
temperature greater
than 38.4 C.

Emphasize

the

monitor

any

patients to schedule
for regular follow-up
appointment,
and
discuss
the
importance
of
regular check up
care.
DIET

SPIRITUALITY

alternations in the
patients status and
ensure compliance
to
medication
regimen.

Instruct patient to
eat high in protein
such as meat

For tissue repair and

faster
wound
healing.

Instruct patient to
eat
high
in
carbohydrate.

For energy

Instruct patient to
take vitamin K

To prevent
clot.

Allow the patient to

pray if possible all
the time to God.

To
provide
and
optimistic approach
towards
her
problem.

Have faith in God.

blood