Vomiting Blood (Hematemesis) 

Also Consider:  Abdominal Discomfort, Constipation, Diarrhea, Nausea/Vomiting, Rectal Bleeding 

1. Take Vital Signs

• Temperature:

• Blood Pressure lying:

• Blood Pressure standing:

• Heart Rate lying:

• Heart Rate standing: 

• Respiratory Rate:

• Oxygen Saturation:

2. Evaluate Symptoms and Signs

• Determine if blood is associated with vomiting (this guide) or with coughing (see Hemoptysis)

• If Pain:  exact locations, pain scale, description (sharp, dull, burning), persistent or intermittent

• Acute mental status change

• Not eating or drinking as much as usual

• Acute decline in ADL abilities

• Fainting, dizziness or lightheadedness when standing up

• Cold, clammy, pale skin

• Jaundice

• Respiratory: New cough, abnormal lung sounds

• GI: Nausea, vomiting, diarrhea, constipation, abdominal distention or tenderness, rebound tenderness, bowel sounds

• GU: New or worsened incontinence, pain with urination, blood in urine, scrotal pain

• Appearance of any vomited material (blood streaks, clots, coffee grounds)

• Estimated amount of blood

• Rectal check for impaction, bleeding, appearance of stool (melena - black, tarry stool)

3. Take Action using SBAR Report:

• Immediately notify the medical staff & resident representative

  • Vomiting blood with clots or coffee-ground appearance, or 

  • Vomiting blood accompanied by change in vital signs or new orthostatic changes, or 

  • Vomiting blood  patient is on an anticoagulant.

• Notify medical staff & resident representative within the next 16 hours. 

  • Isolated episode of blood-streaked emesis without other symptoms.

4. Implement Management Plan

• Monitor vital signs, fluid intake/urine output every 4-8 hrs for 2-3 days

• Offer fluids frequently if nausea/vomiting allow

• Place on Intake & Output monitoring

• Place on 24-hour report for 2-3 days

• Record all episodes of vomiting

• Obtain lab results (if ordered), and notify medical as needed of:

  • Significantly abnormal values in blood count or metabolic panel (refer to appropriate Situation)

  • Abnormal X-ray results

• Resume normal diet when symptoms are resolved

• Update care plan regarding  fall risk, pressure ulcer prevention, assistance needed with ADLs, supervision for safety, restorative needs

• Review status and plan of care with designated representative daily

2025-04-27