Assiut Scientific Nursing Journal http://asnj.journals.ekb.eg http://www.arabimpactfactor.com Vol , (8) No, (22) September, 2020, pp (198 -208 ) 198 Effect of Nursing Guidelines in Clinical Outcomes for Haematemesis Patients on Intensive Care Unit at Alrajhy Liver Hospital Asmaa S. Mohamed 1 , Mervat A. Abdelaziz 2 & Asmaa A. Mahgoub 3 . 1. Specialist nursing at Alrajhy Liver Hospital, Assuit University, Egypt. 2. Assistant professor of critical care and emergency nursing, faculty of nursing, Assuit University, Egypt. 3. Assistant professor of critical care and emergency nursing, faculty of nursing, Assuit University, Egypt. Abstract Many patients with hematemesis had multiple complications as hypovolemic shock than death. Patient in ICU need special nursing guidelines to improve their outcomes. Aim of the study: to evaluate the effect of nursing guidelines in clinical outcomes for haematemesis patients at gastroenterology intensive care unit. Research design: quasi experimental research design was utilized in this study. Which was carried out in gastroenterology ICU at alrajhy liver hospital at Assiut University. The study sample consisted of study group (50 patients) who received the nursing guidelines and control group (50 patients) who received routine care. The following tools were utilized for data collection: Tool I haematemesis assessment sheet Tool II evaluation through different score, Tool III patient outcome and complication. Tools were applied in 3 phases; preparatory, implementation and evaluation phase. method record and document patient social and medical data, hemodynamic, respiratory, and cardiovascular status, assessment of blood transfusion, laboratory data, assess the patient status using different scale, and finally complications, Results: The majority of control group developed hepatorenal syndrome but (2.0%) patients in the study group had developed hepatorenal syndrome with higher in percentage in complication in control group than study group with significance difference (P<0.05). Conclusion: nursing guidelines leads to significant improvement in Patients outcomes for haematemesis patients. Recommendations suggest to emphasize the importance of accurate assessment of the patient with haematemesis Keywords: Effect, Nursing Guidelines, Patient's Outcomes & Hematemesis. Introduction Haematemesis is a common medical emergency characterised by acute upper gastrointestinal bleeding. massive haemorrhage from the upper GI tract may be associated with brighter rectal bleeding. haemodynamic instability may also feature, with patients presenting with dizziness, syncope or in hypovolaemic shock. (Reintam, et al., 2014) Complications among patients with haematemesis such as liver failure, ascites, myocardial infarction, sedation related complications, hepatorenal failure, anemia, cerebrovascular stroke, pulmonary embolism, deep venous thrombosis, septicemia, heart failure and acute pulmonary edema due to over infusion. (Gado, et al., 2012). The critical care nurse should be focused, in order to identify sources and complications of bleeding, abnormal vital signs can be used to identify patient in shock from haematemesis, skin, conjunctiva, and oral mucosa should be assessed for cyanosis, pallor which may indicate underlying liver disease, and head, eye, ear, nose, and throat examination should assess for sources of bleeding, the abdomen should be examined for surgical scars, hepatosplenomegaly, or any other signs that indicate the possibility of liver disease and cirrhosis, abdominal tenderness can indicate underlying peptic ulcer disease perforation or other intra-abdominal pathology; however, there is signifcant variability. (Smith, 2014) The initial stabilization must include the evaluation of the airways, respiration and circulation, venous access, and the collection of laboratory exams, in addition to, when indicated, the administration of fluids, blood transfusion, cardiorespiratory support, and treatment of diseases, such as sepsis or acute myocardial infactions. In patients that present respiratory insufficiency or hemodynamic instability, the endoscopy should be delayed until the patient is adequately resuscitated and stabilized. (Kwan, Norton 2017) Initial laboratory tests include measurement of hemoglobin, hematocrit, blood urea nitrogen, and creatinine; platelet count; prothrombin time; international normalized ratio; liver function tests; and type and crossmatch. Patients with active bleeding and coagulopathy should be considered for transfusion with fresh frozen plasma, and those with active bleeding and thrombocytopenia should be considered for transfusion with platelets. Blood transfusions generally should be administered to those with a hemoglobin level of 7 g per dL (70 g per L) or less; hemoglobin level should be maintained at 9 g per dL (90 g per L). (Jairath, et al., 2010)