NAUSEA AND VOMITING

Introduction diorders including the etiologies;

What is nausea and vomiting?
Nausea and vomiting are not diseases, but rather are symptoms of many different conditions,
such as infection ("stomach flu"), food poisoning, motion sickness, overeating, blocked intestine,
illness, concussion or brain injury, appendicitis and migraines. Nausea and vomiting can
sometimes be symptoms of more serious diseases such as heart attacks, kidney or liver disorders,
central nervous system disorders, brain tumors, and some forms of cancer.

POSSIBLE CAUSES
What causes nausea or vomiting?
The causes of nausea and vomiting are quite similar. Many things can bring on nausea. Some
common causes are:

 Seasickness and other motion sicknesses

 Early pregnancy
 Intense pain
 Exposure to chemical toxins
 Emotional stress (fear)
 Gallbladder disease
 Food poisoning
 Indigestion
 Various viruses
 Certain smells or odors

ASSESSMENT FINDINGS
 Determine causes of nausea and vomiting
 Assess nausea and vomiting characteristics:
 History
 Duration
 Frequency
 Severity
 Precipitating factors
 Medications
 Measures used to alleviate the problem
 Record the patient’s hydration status, daily weights, BP, intake and output, and assessing
skin turgor. -

CLINICAL MANIFESTATION
A person with nausea has the sensation that vomiting may occur. Other signs that you are about
to vomit include gagging, retching, choking, involuntary stomach reflexes, the mouth filling with
saliva (to protect the teeth from stomach acid), and the need to move or bend over.

LABORATORY AND DIAGNOSTIC TEST

Doctors use lab tests, upper GI endoscopy, and imaging tests to rule out other diseases and
conditions that cause nausea and vomiting. Once other diseases and conditions have been ruled
out, a doctor will diagnose cyclic vomiting syndrome based on the pattern or cycle of symptoms.
PATHOLOGY

NURSING DIAGNOSIS AND INTERVENTIONS

Nausea and Vomiting related to irritation of the gastrointestinal system as evidenced by

abdominal cramping and abdominal pain secondary to food poisoning

nursing actions;
Determine the cause of nausea and vomiting (e.g., food poisoning). Determine the food source
that caused nausea and vomiting
Document each episode of nausea and/or vomiting separately, as well as the effectiveness of
interventions. Use of an assessment tool is needed for the consistency of evaluation

Identify and eliminate contributing causative factors. This would include the elimination of the
food source that has been identified as the cause of the nausea and vomiting

Implement appropriate dietary measures such as nothing by mouth (NBM or NPO) status when
appropriate; instituting small frequent meals; and implementing low-fat meals. It is beneficial to
avoid foods that are spicy, fatty, or highly salty.

Recognize and implement interventions and monitor complications associated with nausea and
vomiting. This may include the administration of intravenous fluids and electrolytes

Administer appropriate antiemetics, according to emetic cause, by most effective route, with a
consideration of the side effects of the medication, and with attention to and coverage for the
timeframes that the nausea and vomiting is anticipated

Nursing Diagnosis: Nausea and vomiting related to active fluid volume loss secondary to
gastroenteritis

Watch for early signs of hypovolemia, including thirst, restlessness, headaches, and inability to
concentrate

Recognize symptoms of cyanosis, cold clammy skin, weak thready pulse, confusion, and oliguria
as late signs of hypovolemia

Monitor pulse, respiration, and blood pressure of patients with deficient fluid volume every 15
minutes to 1 hour for unstable patients and every 4 hours for stable patients

Check orthostatic blood pressure with the patient standing, sitting, and lying.

Note the skin turgor over bony prominences such as the hand or shin
Weigh the patient daily and watch for sudden decreases, especially in the presence of decreasing
urine output or active fluid loss

Monitor total fluid intake and output every 4 hours or every hour for unstable patients.

Provide fresh water and oral fluids preferred by the patient

Administer pharmacologic interventions such as antibiotics, antivirals, antidiarrheals, and

antiemetics as ordered and appropriate

Nursing Diagnosis

Diarrhea
May be related to Bacterial, viral or parasitic infections. Possibly evidenced byAbdominal
cramping.
Ask the client about a recent history of:

 Drinking contaminated water.

 Eating food inadequately cooked.
 Ingestion of unpasteurized dairy products.

Evaluate pattern of defecation.

Assess for abdominal pain, abdominal cramping, hyperactive bowel sounds, frequency, urgency,
and loose stools.

Submit client’s stool for culture.

Teach the client about the importance of hand washing after each bowel movement and before
preparing food for others.

Educate the client about perianal care after each bowel movement.

Encourage increase fluid intake of 1.5 to 2.5 liters/24 hour plus 200 ml for each loose stool in
adults unless contraindicated.

Encourage the client to restrict the intake of caffeine, milk and dairy products.

Encourage the client to eat foods rich in potassium.

Administer antidiarrheal medications as prescribed.

PHARMACOLOGICAL
Bismuth salts,
kaolin, and
pectin which are adsorbent 

ALTERNATIVE THERAPIES
Acupuncture can sometimes relieve nausea and vomiting. Very fine needles are inserted
through the skin at special points in your body and are left in position for a short time. This
shouldn't be painful. Acupuncture may be helpful for nausea and vomiting associated with
chemotherapy and may work for up to 12 hours.

 Eat Ginger. Ginger is a popular natural remedy commonly used to treat nausea. ... 
 Peppermint Aromatherapy. ... 
 Try Acupuncture or Acupressure. ... 
 Slice a Lemon. ... 
 Control Your Breathing. ... 
 Use Certain Spices. ... 
 Try Relaxing Your Muscles. ... 
  Take a Vitamin B6 Supplement.
HEALTH EDUCATION

There are things that you can do to feel better:

 Get enough fluids, to avoid dehydration. If you are having trouble keeping liquids down,
drink small amounts of clear liquids often.
 Eat bland foods; stay away from spicy, fatty, or salty foods
 Eat smaller meals more often
 Avoid strong smells, since they can sometimes trigger nausea and vomiting
 If you are pregnant and have morning sickness, eat crackers before you get out of bed in
the morning

NUTRITION AND DIET THERAPY

Eat poultry or soy. Try turkey, chicken, or soy foods
Eat dry foods, such as crackers, toast, dry cereals, or bread sticks.
Eat cool foods instead of hot, spicy foods. Consider non-fat yogurt, fruit juice, sherbet, and
sports drinks.
Don't eat foods that are very sweet, greasy, or fried. Consider baked, boiled, or mashed potatoes;
rice; cream soups made with low-fat milk; fruit-flavored gelatin; pretzels; or low-fat pudding.

MEDICAL MANAGEMENT

Your treatment may include:

 Medication: Taking anti-nausea and anti-anxiety medications may help relieve your
symptoms.
 Medical nutrition therapy: Working with experts from Nutrition Services who
specialize in helping patients with gastrointestinal disorders, may find foods that are less likely
to trigger nausea. You may also need to start eating smaller meals and bland foods.
 Oral rehydration therapy: Drinking a rehydration solution can help you replace lost
minerals and body fluids, if your nausea causes frequent vomiting.
 Total parenteral nutrition: Getting all the nutrition you need from special fluids you
receive through a catheter (thin, spaghetti-like tube) in your vein, total parenteral nutrition can
help you if your intestines need time to heal or your stomach has lost its ability to absorb
nutrients from food taken by mouth.
 Tube feeding: Helping you get adequate nutrition when your body is not getting enough
nutrients from food by mouth, tube feeding works by delivering specially formulated liquid
nutrition directly to your stomach through a special tube, also known as a percutaneous
endoscopic gastrostomy (PEG) tube.

Many people are able to feel better with simple remedies, such as:

SURGICAL MANAGEMENT

Conclusion: Women and those patients with surgery lasting greater than 2 hours should be
assessed for nausea in the postoperative period more frequently. Assessments need to be done
during the first 2 hours after surgery, at 7-8 hours after surgery, and when there is an increase in
activity, such as the first time out of bed. Nurses do not routinely document assessments for
postoperative nausea. In addition, some misconceptions exist. Formal and informal education for
nurses, physicians, and patients on the incidence, predisposing factors, and treatment options for
postoperative nausea needs to occur. This should include reflection on the misconceptions, the
need for ongoing patient assessment, and a review of drug and nondrug therapies.