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    Learning About Your Health

    Upper Gastrointestinal (GI) Bleed: Your Care in the Hospital and at Home

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    Welcome to California Pacific Medical Center.

    Please review this information about your health condition. We want you to be involved in the decisions affecting your care. If you have family members, caregivers, or friends caring for you, please have them read this information.

    Each person has a unique health condition. If you have any questions, please ask the doctors, nurses, and therapists caring for you.

    Your Hospital Stay

    Most people stay in the hospital for 1 to 4 days.

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    Understanding Your Medications

    Acid-Blocking Medications (e.g., Pepcid, Protonix)
    These medications keep your stomach from making gastric acid that can make an ulcer worse. Some common acid-blocking medications are Pepcid and Protonix. You may receive these medications through an intravenous (IV) line, or in a pill form if you are able to eat without difficulty.

    Report Any Side Effects
    The most common side effects are headache and diarrhea. Please report any side effects to your doctor and/or nurse.

    Note: Be sure to tell your doctor and/or nurse if you are taking any non-prescription medications such as aspirin, herbal medications, homeopathic preparations, and/or vitamins.

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    Managing Your Pain

    Your condition does not usually cause pain. However, you may experience some discomfort, or you may have pain from another existing condition. If you are having pain, it is important to take action to control your pain as soon as the pain starts. Managing pain early and adequately is key in effective pain control. Please let your doctor or nurse know if you are having pain.

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    Tips for Your Recovery

    Stop Smoking
    Smoking slows the healing of existing ulcers and also contributes to ulcer recurrence. If you want suggestions on how to quit smoking while you are here, talk with your doctor and nurse. You can ask to speak with the Clinical Nurse Specialist who counsels patients on how to stop smoking. Also, visit the Community Health Resource Center located at 2100 Webster, Lobby Level, (415) 923-3155 for more information how to stop smoking.

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    Planning Your Activity

    Safety & Your Activity
    Your activity level will depend on how much blood you have lost, and if you are still bleeding. Your doctor and nurses will tell you what is safe for you to do. If you have stopped bleeding, and you are not dizzy or too tired, you may sit up in a chair or walk short distances. Generally, you are encouraged to slowly increase your activity by sitting in a chair or walking.

    Taking a Bath or Shower
    If you become easily tired or are dizzy, you should take a bath or shower with the assistance of a nurse and/or therapist.

    Check with your Doctor About Your Activity at Home
    Because each person's condition is different, check with your doctor before you leave the hospital about returning to your usual activities and/or work.

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    Your Treatments & Tests

    Intravenous Line (IV) for Fluid Replacement and Medications
    You will have an intravenous (IV) line to replace the fluids you have lost and to give you medications. The (IV) will be taken out before you go home.

    Blood Pressure & Heart Rate (Pulse)
    Checking your blood pressure and heart rate (pulse) in 3 different positions (lying down, sitting, and standing) is another way for your doctor and nurses to determine how much blood you have lost.

    Blood Tests (Hemoglobin/Hematocrit)
    You will have your blood drawn at your bedside to check two blood tests (Hemoglobin (Hgb) and Hematocrit (Hct). Based on the results of these two blood tests, your doctor and nurses will know how much blood you have lost.

    Possible Blood Transfusion
    If you have lost a lot of blood, you may need a blood transfusion. Your doctor will talk with you about this first.

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    Having an Endoscopy

    Preparing for the Endoscopy:

    • Upper Endoscopy is a procedure performed by a highly trained doctor called a gastroenterologist. Upper endoscopy is used to find, evaluate, and treat abnormalities such as bleeding or polyps.

    • It is important that your stomach be completely empty: For this procedure, it is important that your stomach be completely empty. Note: PREP instructions will be given to you by your doctor and will include food, fluid, and medication restrictions.

    • Absolutely nothing to eat or drink after midnight: Before your scheduled endoscopy, you cannot eat or drink anything after midnight, unless otherwise instructed by your doctor.

    • IV medication to keep you comfortable: You will receive intravenous medication that will allow you to be comfortable during the procedure. Your doctor may also spray your throat with an anesthetic to help lessen the discomfort.
    During the Endoscopy:
    • During this procedure, the doctor is able to look inside the upper part of your gastrointestinal (GI) tract by inserting a flexible tube into your mouth and passing it into the esophagus, stomach, and upper intestine.

    • Through this tube, your doctor can see the site of the bleeding, and stop it if needed. Also, tissue samples (biopsy) can be taken for testing.

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    About Your Diet

    • You may not eat or drink anything if you are still bleeding.

    • When the bleeding stops, you may first try drinking fluids and then start eating your regular diet.

    • When you leave the hospital, you may return to your regular diet. Avoid foods that may irritate your stomach such as caffeine, alcohol, and spicy foods.

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    Getting Support from the Medical Team

    • Doctors and nurses are available to listen to your concerns and feelings, as well as case managers, social workers, and chaplains.

    • Case managers are available to assist you with getting ready to go home.

    • Case managers and social workers are available to assist with concerns related to finance and home situation.

    • Social workers are available to help in emergencies or particularly difficult situations. They can also give you information about community resources for assistance over the long term.

    • Financial counselors are available should you have questions or concerns about your health insurance.

    • Chaplains are available at all times. Please let your doctor or nurse know if you would like us to arrange for visit.

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    Your Checklist for Going Home

    Carefully review this checklist before you go home. If you have any additional questions, please ask your doctor, nurse, or therapist.

    • Schedule the date for your next doctor’s appointment.

    • Know how to obtain your medication, what medication to take, its purpose, and possible side effects.

    • Ask your doctor about how active you should be and when to resume your regular activity.

    • Recognize the danger signals related to your illness, and/or recent procedures. Call your doctor if you experience any of these symptoms before your next appointment.

    • Know how to change your dressing (if you have one).

    • Know your dietary restrictions if you have any.

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    Making a Follow-up Appointment

    Call your doctor to make a follow-up appointment about one week after leaving the hospital.

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    Your Medications at Home

    Medications to Avoid: Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
    Do not take non-steroidal anti-inflammatory drugs (NSAIDS), unless they have been ordered by your doctor.

    NSAIDS may cause you to bleed again.

    • Aspirin

    • Ibuprofen (Motrin, Advil)

    • Naproxen (Aleve)

    • Over-the-Counter Medications: Non-steroidal, anti-inflammatory drugs are also present in many over-the-counter medications used to treat fever, headache, and minor aches and pains.
    General Medication Instructions
    • Your doctor will usually order new medications for you when you go home. These medication orders should be filled the day you leave the hospital.

    • Take your medication as directed. If you are told to take your medication once a day, take each pill at the same time.

    • If you are instructed to take your medication 2,3, or 4 times a day, try to space them out evenly during the day while you are awake.

    • If you think you may be having an unusual reaction to your medication, such as hives, rash, swelling, or itching, call your doctor immediately and stop taking the medication.

    • The staff will give you general instructions about your medications before you go home. Your pharmacist will give you specific instructions, such as possible side effects to report and how to take your medications.

    • If you are seeing more than one doctor, make sure that each doctor knows all of the medications you are taking (including any over-the-counter medications). Take a list of all your medications with you when you visit your doctor.

    • Some medications may be expensive and insurance coverage varies. Let your doctor know if you have difficulty filling your prescriptions. There may be alternative medications available that are less expensive.

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    Recognizing Danger Signals

    Call Your Doctor Before Your Next Appointment If You:

    • Feel sick to your stomach or vomit blood or coffee-ground looking material

    • Have black or bloody bowel movements

    • Have sharp pains in your stomach

    • Feel dizzy

    • Feel short of breath
    If you are not able to reach your doctor, go to the Emergency Room or CALL 911.

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    More Ways to Learn

    • Watch the Patient Video Education Channel in your hospital room. Anyone can use the video channel by following these instructions:

      • Tune to channel 60 on the television set, and follow
        the on-screen directions.

      • Pacific Campus patients dial ext. 78888, California Campus patients dial ext. 21000, and Davies Campus patients dial ext. 33600

      • Order videotape for viewing according to category or title by listening to information given over the telephone.
    • Visit Our Community Health Resource Center at 2100 Webster Street, San Francisco, (415) 923-3155. Services include classes, and written information on a wide variety of health topics.

    Produced by the Center for Patient and Community Education in association with the staff and physicians at California Pacific Medical Center. Date: 7/02.

    Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

    Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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