Acute Gastrointestinal Bleeding2

G-general examination:
assess the patient`s general appearance; vital signs; mental status(including restlessness); and skin signs such as pallor, moisture ,telangiectasia, and petechiae. also, perform a cardiac and pulmonary examination to assess for abnormal heart or lung sounds that indicate cardiac dysfunction.

H-PERFORM ABDOMINAL EXAMINATION:
inspect the abdomen for any skin changes (ie, telangiectasia, ecchymoses or old surgical scars). auscultate for any bruits that may indicate an aneurysm. palpate for tenderness, mass, or hepatosplenomegaly.
I-PERFORM RECTAL EXAMINATION:
Inspect the anus and rectum for evidence of hemorrhoids or fissure. obtain stool for hemoccult testing.

J-PERFORM BLADDER CATHETERIZATION:
If a patient is in shock or insert Foley catheter into the bladder to monitor urinary output.

K-INSERT NASOGASTRIC OR OROGASTRIC TUBE:
place a nasogastric tube, and lavage with cold fluids until aspirate is clear. persistent bleeding during lavage indicates potential life-threatening upper GI bleeding, the patient should be in the left lateral decubitus position with the bed in the Trendelenburg position. Lavage until the return is clear.
L-WITHHOLD ALL FLUIDS AND ANTACIDS:
patienta waiting for endoscopy should receive nothing by mouth. do not administer fluids or antacids because they may impair adequate visualization during endoscopy.