Nursing Diagnosis for Hematemesis - Melena


Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis (coughing up blood), although the latter is more common.

  • Signs of the onset of hematemesis may include:
  • A history of excessive alcohol use or liver disease
  • Any esophago-gastric symptoms, such as nausea or vomiting
  • Brown or black vomit
  • Vomit that looks like coffee grounds
  • Dark colored, tar-like stools (a condition known as melena)


Causes can be:
  • Prolonged and vigorous retching (may cause a tear in the small blood vessels of the throat or the esophagus, producing streaks of blood in the vomit, and is called Mallory-Weiss syndrome).
  • Irritation or erosion of the lining of the esophagus or stomach
  • Bleeding ulcer located in the stomach, duodenum, or esophagus
  • Vomiting of ingested blood after hemorrhage in the oral cavity, nose or throat
  • Vascular malfunctions of the gastrointestinal tract, such as bleeding gastric varices or intestinal varices
  • Tumors of the stomach or esophagus.
  • radiation poisoning
  • Viral hemorrhagic fevers
  • Gastroenteritis
  • Gastritis
  • Peptic ulcer
  • Chronic viral hepatitis
  • Intestinal Schistosomiasis (caused by the parasite schistosoma mansoni )
  • History of Smoking


In medicine, melena or melaena refers to the black, "tarry" feces that are associated with gastrointestinal hemorrhage. The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.


The most common cause of melena is peptic ulcer disease. Any other cause of bleeding from the upper gastro-intestinal tract, or even the ascending colon, can also cause melena. Melena may also be a sign of drug overdose if a patient is taking anti-coagulants, such as warfarin. It is also caused by tumours, especially malignant tumors affecting the esophagous, more commonly the stomach & less commonly the small intestine due to their bleeding surface. However,the most prominent and helpful sign in these cases of malignant tumours is haematemesis. It may also accompany hemorrhagic blood diseases (e.g. purpura & hemophilia). Other medical causes of melena include bleeding ulcers, gastritis, esophageal varices, and Mallory-Weiss syndrome.
Some causes of "false" melena include Iron supplements, Pepto-Bismol, Maalox, and lead, blood swallowed as a result of a nose bleed (epistaxis), and blood ingested as part of the diet, as with the traditional African Maasai diet, which includes much blood drained from cattle.
Melena is usually not a medical emergency because the bleeding is slow. Urgent care however is required to rule out serious causes and prevent potentially life-threatening emergencies.
A less serious, self-limiting case of melena can occur in newborns two to three days after delivery, due to swallowed maternal blood.

Nursing Diagnosis for Hematemesis - Melena

1. Fluid volume deficit related to bleeding (loss of actively)

2. Ineffective Tissue Perfusion related to hypovolemic because of bleeding.

3. Ineffective breathing pattern related to ascites and decreased the development of the diaphragm.

4. Risk for Infection related to reduction in white blood cells.

5. Acute pain related to a sense of heat / burning on the gastric mucosa and oral cavity or abdominal wall muscle spasm.

6. Deficient knowledge related to the lack of information about the disease.

7. Anxiety related to illness.

Nursing Diagnosis

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