Objective To explore the effect of targeted nursing based on risk assessment on the rehabilitation process and nursing satisfaction of patients with acute upper gastrointestinal hemorrhage. Methods A total of 56 patients with acute upper gastrointestinal hemorrhage treated in our hospital from July 2017 to August 2019 were selected as the study objects. They were divided into two groups according to random number table method, 28 cases in each group.Routine nursing was used in the control group and targeted nursing based on risk assessment was used in the observation group. The hemostasis time, hospitalization time, hospitalization expenses, complications within 6 months and total nursing satisfaction were compared between the two groups. Results The hemostasis time was (2.36±0.60) d and hospitalization time was (6.91±3.78) d in the observation group, were shorter than those in the control group of (3.90±0.70)and (10.75±2.77) d, and the hospitalization cost was (3789.65±630.66) yuan in the obeservation group, which was lower than that in the control group of (4255.33±840.25) yuan, the differences were statistically significant (P<0.05). The total incidence of complications in the observation group was 7.14%, lower than that in the control group (32.14%), total nursing satisfaction was 92.86% in the obeservation group, higher than that in the control group (64.29%), the differences were statistically significant (P<0.05). Conclusion The targeted nursing based on risk assessment can significantly shorten the hemostasis time and hospitalization time of patients with acute upper gastrointestinal hemorrhage, reduce the hospitalization cost, reduce the incidence of complications, and improve the nursing satisfaction of patients, with high clinical application value.