Rectal Bleeding (Hematochezia)

Also Consider:  Abdominal Discomfort, Bruise, Constipation, Diarrhea, Nausea/Vomiting, Vomiting Blood 

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 from the rectum/anus (this guide), vagina (see Vaginal Bleeding), or urethra (see Hematuria)

• 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

• Diaphoresis: Cold, clammy, pale skin

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

• Appearance of stool, presence of occult blood or Melena (black, tarry stool)

• Rectal check for impaction, appearance of stool, presence of hemorrhoids

3. Take Action using SBAR Report:

• Presence of other, significant symptoms or signs of illness 

  • Refer to appropriate Situation-Specific Evaluation for the identified symptoms and signs.

• Immediately notify the medical staff & resident representative

  • Repeated rectal bleeding, or accompanied by diaphoresis, tachycardia, significant orthostatic BP drop

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

  • Melena, or 

  • Patient receiving anticoagulant medication (call before next dose is administered)

• Notify medical staff on the next business day 

  • Single episode of bleeding, new for patient.

• Notify medical staff at the next regular rounds 

  • Stool positive for occult blood on routine testing

4. Implement Management Plan

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

• Offer fluids frequently

• Place on Intake & Output monitoring

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

• Record all episodes of rectal bleeding

• 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

• Monitor meal acceptance

• Assure bowel regularity

• 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