Tarry Tara — Upper GI Bleed & Peptic Ulcer Disease
Black tarry stools, coffee-ground emesis, dropping BP — airway first, then fluids
Tara has taken ibuprofen daily for years for her arthritis, and lately her stools have turned black and sticky. Tonight she vomits something that looks like coffee grounds and feels suddenly dizzy standing up.
Tara's chronic NSAID use erodes her gastric mucosa into a bleeding ulcer. Melena — black, tarry, foul-smelling stool — signals digested blood from an upper GI source, and coffee-ground emesis reflects blood already altered by stomach acid. As bleeding continues, tachycardia and hypotension appear before hemoglobin fully drops, so vital signs and airway protection come before waiting on lab confirmation.
Read Tarry Tara's full story →The story arc
The setup
Years of daily NSAID use erode the protective mucosal lining of Tara's stomach, and an ulcer quietly forms.
The turn
Tara notices her stools have turned black, tarry and foul-smelling over the past two days.
The crisis
Tara vomits coffee-ground emesis, becomes lightheaded on standing, her heart rate climbs to 124, and her blood pressure drops to 88/54.
The save
The nurse positions Tara to protect her airway, establishes large-bore IV access for fluid and possible transfusion, keeps her NPO, and prepares her for emergent upper endoscopy while trending vital signs closely.
NCLEX study section — Upper GI Bleed & Peptic Ulcer Disease
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Gastrointestinal & Renal
Take this chapter into practice questions on the same topic.