Risk for Bleeding Nursing Diagnosis & Care Plan

Care plan for patients at risk for bleeding may be informed by the information in this article. A frequent definition of bleeding risk is the possibility of a dangerously low blood volume. Interventions to avoid and easily diagnose bleeding problems, as well as risk assessments for bleeding, may improve patient outcomes.

You can download the pdf form of this nursing care plan on risk for bleeding by clicking on the download button at the end of the post.

Risk for bleeding Care Plan in picture form is given below to help students:

Scenario of Patient:

A 62 year old female who was admitted for post-operative care following a total Knee replacement. The patient has a history of hypertension, Type 2 Diabetes and is overweight. Post-Surgery, the patient has been started on Anticoagulant therapy (Low molecular weight Heparin) to prevent Deep Vein Thrombosis (DVT). However, the patient reports mild dizziness, minor bruising at injection site and has an INR (International Normalized Ratio) of 3.2, which indicates increased Risk for Bleeding. The patient has an indwelling catheter and surgical drains, raising concerns for potential internal and external bleeding.

Education on Patient with Risk for Bleeding

Definition of Risk For Bleeding:

“Risk for Bleeding” refers to the potential for a decrease in the body’s ability to form clots, leading to abnormal blood loss from various sources of body, such as surgical sites, trauma, or invasive procedures leading to serious complications. This can occur due to anticoagulants therapy, coagulation disorders, or other underlying medical conditions.

Risk Factors of Bleeding:

The risk of bleeding might increase due to many medical conditions and medications; hence, it is crucial to closely monitor and check on the patient. The likelihood of bleeding increases when the body’s coagulation systems are impaired, which might happen as a result of certain medications, procedures, or treatment-related adverse effects. If you are aware of these potential dangers, you may take measures to stay healthy and get treatment quickly if you do become ill.

Risk factors for Nursing Care Plan of Risk For bleeding includes following:

• Aneurysm
• Circumcision
• Deficient knowledge
• Disseminated intravascular coagulopathy
• History of falls
• Gastrointestinal disorders (e.g., gastric ulcer disease, polyps, varices)
• Impaired liver function (e.g., cirrhosis, hepatitis)
• Inherent coagulopathies (e.g., thrombocytopenia)
• Postpartum complications (e.g., uterine atony, retained placenta)
• Pregnancy-related com-plications (e.g., placenta previa, molar pregnancy, placenta abruption)
• Trauma
• Treatment-related side effects (e.g., surgery, medications, administration of platelet-deficient blood products, chemotherapy)

Sign and symptoms of Bleeding:

The early detection of bleeding indicators is crucial in preventing serious outcomes. Patients at risk of bleeding may exhibit overt signs including bruising, persistent bleeding, or the presence of blood in the urine or stool. Hypotension, vertigo, or paralysis might be the outcomes of hemodynamic instability, which can be caused by more serious cases of internal bleeding. The propensity to bleed and the capacity to clot may be assessed by keeping an eye on test values like INR and PT.

These are the sign and symptoms reported in the given scenario

• Bruising or ecchymosis at injection or IV sites
• Bleeding gums or nosebleeds
• Blood in urine, stool(hematuria, melena)
• Prolonged bleeding from surgical sites
• Dizziness or hypotension(due to blood loss)
• Increased INR or PT
• Weakness
• Fatigue
• Heavy Menstrual Periods

Complications of Bleeding:

Uncontrolled hemorrhage leads to a serious risk to one’s life. Organ function may be compromised by hemorrhage, hypovolemic shock, or anemia, all of which can occur as a consequence of excessive blood loss. Prolonged hemorrhage may lead to permanent harm to organs or even mortality in the worst-case scenario.

The risk for bleeding may cause the following complications

• Hemorrhage( internal or external)
• Hypovolemic shock
• Anemia due to blood loss
• Organ damage( especially kidneys, brain) if bleeding is severe
• Death in extreme cases

Comprehensive Assessment for Patient with Risk for Bleeding:

Assess History of patient in Risk for Bleeding Nursing Diagnosis:

• How to perform: Gather a thorough history of any previous bleeding episodes, anticoagulants use, any family or personnel history of bleeding disorders.
• Rationale: A thorough history helps identify underlying conditions, medications, or genetic factors that increase bleeding risk, Which help to develop the possible nursing diagnosis of risk for bleeding used in appropriate nursing care plan for bleeding.

Assess the patient physically for any signs of Risk For Bleeding.

• How to perform: Inspect for signs of bruising, petechiae, bleeding gums, or blood in urine/stool. Monitor surgical sites for excessive bleeding or oozing.
• Rationale: Physical assessment helps allowing prompt intervention to prevent complications associated with risk for bleeding.

Monitor Laboratory and Coagulation Tests

• How to perform: Monitor INR, PT, aPTT (Activated Partial Thromboplastin Time), hemoglobin and hematocrit levels.
• Rationale: Monitoring helps assess clotting function and detect abnormalities early, ensuring timely intervention for patients at risk for bleeding.

Monitor Vital signs:

• How to perform:  Check for Signs of hypertension or tachycardia every 4 hourly
• Rationale: Tachycardia and hypotension may indicate active bleeding and circulatory collapse, which increase the risk for bleeding.

Assess Neurological status:

• How to perform: Assess Level of consciousness, Pupil size, orientation and limbs strength.
• Rationale: Neurological assessment helps detect signs of intracranial bleeding, enabling early intervention in patients at risk for bleeding.

Nursing Diagnosis for Patient with Bleeding:

Post knee replacement, the patient faces risks from anticoagulant therapy, limited mobility, and comorbidities. These are the possible five nursing diagnoses related to risk for bleeding.

1. Risk for Bleeding related to anticoagulant therapy, post-operative status, and invasive devices as evidenced by bruising at the injection site, mild dizziness, and an increased INR of 3.2.
2. Risk for Infection related to the presence of an indwelling catheter, surgical drains, and post-operative status.
3. Impaired Physical Mobility related to post-surgical pain, overweight status, and knee joint restriction.
4. Risk for Impaired Skin Integrity related to reduced mobility, presence of surgical drains, and obesity.
5. Risk for Falls related to post-operative dizziness, anticoagulant use, and impaired mobility.

Goals for Patient with Risk for Bleeding:

Short-Term Goals:

1. Within 24 hours, the patient will demonstrate no active signs of bleeding (e.g., no oozing from surgical site or bruising).
2. Within 48 hours, the patient’s INR and PT will remain within the therapeutic range.
3. Within 48 hours, the patient will verbalize understanding of signs and symptoms of bleeding and will any abnormalities to staff.

Long-Term Goals:

1. Within 7 days, the patient will remain free from complications related to bleeding such as hemorrhage or hypovolemic shock.
2. Within 2 weeks, the patient will demonstrate compliance to anticoagulant therapy and understand bleeding precautions.

Nursing Interventions for Patient with Risk for Bleeding

Assess Surgical and IV sites regularly for signs of bleeding (e.g., oozing, bruising)

• Rationale: Early detection of abnormal bleeding can prevent complications such as hemorrhage.
• How to perform: Be a Vigilant inspector. check every 4 hours for any bruising, oozing or swelling and document every detail.

Apply pressure to bleeding or injection sites for at least 5 minutes.

• Rationale: Prolonged pressure can help stop superficial bleeding, especially in Anticoagulated patients.
• How to perform: When bleeding appears, act fast and press with a sterile gauze firmly for 5 minutes. Have a strong control and sharp reflexes.

Administer medications (e.g., Vitamin K, fresh frozen plasma) as prescribed in case of anticoagulant overdose.

• Rationale: These medications can reverse the effects of anticoagulants and restore normal clotting function.
• How to Perform: Carefully administer the prescribed reversal agents to restore balance and prevent bleeding. Watch for quick responses.

Avoid invasive procedures or limit them when possible( e.g., unnecessary injections, catheterizations)

• Rationale: Minimizing invasive procedures reduces the Risk of inducing bleeding in high risk patients.
• How to perform: Whenever Possible, Skip unnecessary procedures to keep risks low and avoid triggering bleeding.

Monitor Vital signs every 4 hours or as needed.

• Rationale: Changes in blood pressure or heart rate can indicate internal bleeding or hemorrhage.
• How to perform: Attach the monitor and keep a close eye on the blood pressure and heart rate. Changes can be the first sign of trouble.

Monitor laboratory values (INR, PT, aPTT, hemoglobin, and hematocrit) daily.

• Rationale: Ensures the patient’s blood levels remain within the therapeutic range without increasing the risk for bleeding.
• How to perform: Stay updated with the Lab results to ensure blood levels are safe.

Educate the patient on signs of bleeding (e.g., nosebleeds, blood in urine/stool) and when to report them.

• Rationale: Empowering the patient to recognize the early signs of bleeding can lead to prompt interventions and reduce complications.
• How to perform: Empower your patient. Teach them the signs of bleeding and make sure they know when to speak up.

Use Soft-bristled toothbrushes, electric razors and activities that can cause injury.

• Rationale: Reducing trauma prevents unnecessary bleeding in Anticoagulated patients.
• How to perform: Advising and reminding the patient that gentle habits prevent unnecessary injuries.

Ensure infection control practices, Proper hand washing before and after touching to the patient.

• Rationale: These techniques will help in preventing the patient from infection because the patient is at risk of acquiring these.
• How to perform: Follow hand washing procedure recommended by the WHO Guidelines or follow the hospital protocol.

Evaluation for Patient with Risk for Bleeding:

1. The patient didn’t exhibit any active signs of bleeding such as brushing, oozing from surgical or IV sites, blood in urine/stool.

2. The patient Laboratory values (e.g., INR and PT) remained within the therapeutic range and bleeding risk was minized and anticoagulant therapy was well-managed.

3. The patient successfully verbalized the understanding of the signs and symptoms of bleeding (e.g., nosebleeds, blood in urine/stool) and was able to demonstrate knowledge of when to report these symptoms.

4. By the two week follow up, the patient demonstrated compliance with anticoagulant therapy and was following the recommended precautions(e.g., using Soft-bristled toothbrush and avoiding injury). No signs of internal kr external bleeding were reported at the follow up visit.

Here you can download the PDF file of nursing care plan on Risk for bleeding.

References:

1. Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H. (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. Lippincott Williams & Wilkins.

2. NANDA International (2023). Nursing Diagnoses: Definitions and Classification 2023-2025.
3. American Society of Hematology (2023). Guidelines on Bleeding Disorders and Coagulation Management.
4. Mayo Clinic (2023). Thrombocytopenia: Symptoms, Causes, and Treatment.
5. World Health Organization (WHO). (2023). Management of Patients with Bleeding Risks.
6. Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2017). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. Elsevier.