NAUSEA AND VOMITING 1 P a g e Vomiting center in brainstem which receives input from various stimuli Chemoreceptor trigger zone CTZ in brainstem responds to chemical stimuli of drugs and toxins GI tract is irritated excited or distended to rid body of irritating foods and liquids NAUSEA AND VOMITING P 963 968 Most common symptom of GI diseases Etiology and Pathophysiology Metabolic disorders DM Addison s renal fail Pregnancy Infection CNS disorders meningitis tumor Cardiovascular problems MI HF Side effects of medication treatment o Chemotherapy o Opioids o Digitalis Physiologic factors o o Stress Fear Nausea Anorexia Dehydration Electrolyte imbalances Clinical Manifestations Metabolic alkalosis loss of gastric hydrochloric acid Metabolic acidosis contents of small intestine vomited Weight loss Pulmonary aspiration place patient side lying Collaborative Care Determine and treat cause Provide symptomatic relief Emesis Drug Therapy DESCRIPTION diminishes sensitivity of the chemoreceptor trigger zone to irritants alleviates nausea and vomiting prevent and control emesis and motion sickness TYPES OF ANTIEMETICS 1 Centrally acting agents a Ondansetron HCl Zofran b Prochlorperazine Compazine 2 Agents for motion sickness and control a Dimenhydrinate Dramamine 3 Agents that promote gastric emptying act on dopamine receptors a Metoclopramide Reglan MAJOR SIDE EFFECTS o o o o o o partially digested food several hours after a meal gastric outlet obstruction delayed gastric emptying fecal odor and bile intestinal obstruction below pylorus bile obstruction coffee ground gastric bleed bright red blood active bleeding r t Mallory Weiss tear disruption of lining varices ulcer neoplasm early morning vomit pregnancy NAUSEA AND VOMITING 2 P a g e CNS depression CNS Hypotension vasodilation via central mechanism Dry mouth anticholinergic Blurred vision anticholinergic Incoordination extrapyramidal r t dopamine antagonism NURSING CARE WITH MEDICATION Observe vomitus characteristics Provide oral hygiene Eliminate noxious substances in diet and environment Administer before chemotherapy Sugar free gum to promote salivation Change positions slowly Nutritional Therapy IV fluid with electrolyte and glucose replacement NG tube to suction and decompress stomach Oral nutrition with clear liquids when symptoms subside Dry toast or crackers for alleviation Sipping small amounts of fluid Diet high in carbs and low in fatty foods Baked potato Plain gelatin o o o Cereal with milk and sugar o Hard candy Take fluids between meals rather than with meals NURSING MANAGEMENT Nursing Assessment Subjective Data Poorly tolerated foods Spicy foods o Coffee o o Highly acidic foods o Strong odors Non drug Therapy Acupressure Acupuncture Herbs Breathing exercises Changes in body position Ginger GI disorders chronic indigestion food allergies pregnancy infection CNS disorders recent travel bulimia PMH metabolic disorders cancer cardiovascular disorders renal disease Medications use of antiemetics digitalis opioids NAUSEA AND VOMITING 3 P a g e ferrous sulfate aspirin aminophylline alcohol antibiotics general anesthesia chemotherapy Surgery recent surgery Nutritional amount frequency character color of vomit dry heaves anorexia weight loss Activity exercise weakness fatigue Cognitive abdominal tenderness pain Integumentary pallor dry mucus membranes poor skin turgor GI Urinary decreased output concentrated urine Nursing Assessment Objective Data General lethargy sunken eyeballs amount frequency character content and color of vomit Possible Diagnostic Findings altered serum electrolytes esp hypokalemia Nursing Diagnoses Imbalanced Nutrition Less than Body Requirements Monitor recorded intake for nutritional content and calories to evaluate nutritional status Encourage eating small amounts of food that are appealing to the nauseated person Give cold clear liquid and odorless and colorless food Provide information about nausea such as causes and how long it will last Nausea r t multiple etiologies AEB reports of N V Perform complete assessment of nausea including frequency duration severity precipitating factors Reduce or eliminate personal factors that precipitate or increase the nausea Use frequent oral hygiene Ensure antiemetics or given Teach use of nonpharmacologic techniques relaxation guided imagery music therapy distraction acupressure Promote adequate rest and sleep NAUSEA AND VOMITING 4 P a g e Deficient Fluid Volume r t prolonged vomiting and inability to ingest digest or absorb food and fluids AEB decreased urine output increased urine concentration increased pulse rate hypotension decreased intake decreased skin turgor dry skin and mucus membranes Maintain IV solution containing electrolytes at constant flow rate Assess patient s buccal membranes sclera skin Keep accurate record of I O Promote oral intake Obtain lab specimens for monitoring of altered fluid and electrolyte balances Nursing Implementation Acute Intervention Monitor vital signs NPO status until diagnosis is confirmed IV fluids NG tube connected to suction for persistent vomiting Secure NG tube to prevent movement Provide explanation with diagnostic tests or procedures performed Record I O Position patient high fowlers to prevent aspiration Assess for signs of dehydration Home and Ambulatory Care Provide instructions on o Managing unpleasant sensation of nausea o Methods of preventing nausea and vomiting o Strategies to maintain fluid and nutritional intake Keep immediate environment quiet free of odors and well ventilated Avoid sudden changes of position and unnecessary activity Use of relaxation techniques frequent rest periods effective pain management Clean face with cool washcloth and provide mouth care Notify HCP if medication is suspected to cause nausea and vomiting