Nausea and Vomiting + B12 deficiency

What is nausea?

Discomfort in the epigastric area with a conscious desire to vomit

What is vomiting?

Forceful ejection of partially digested food and secretions from the upper GI tract

What are the causes of n/v?

• Infection

• Med SE (including general anesthesia)

• Pregnancy

• Gi disorders

• CNS problems

• CVD

• Stress, fear

What is the nursing care for n/v? Assessment wise

• Assess and describe emesis

• Assess for precipitating factors

• Assess fluid balance (monitor I+Os, UO should be >30ml/hr, electrolytes)

• Assess for changes in mentation

What is the nursing care for n/v? Implementation

• Put in NG tube and secure it

• take steps to prevent aspiration (HOB > 30, frequent oral care)

• Place patient on BRAT diet (bananas, rice, applesauce, toast)

• Educate about avoiding sudden changes in positioning

What is given to treat dehydration from n/v?

• IV fluids

• IV electrolytes

What can be given to reduce n/v r/t motion sickness?

• Give one or both:

  • Antihistamines

  • Scopolamine patches

What meds are given for mild-moderate n/v?

• prochlorperazine

• promethazine

• reglan

What is given for severe or refractory n/v?

• 5HT3 antagonists

• neurokinin-1 receptor agonists

What are the potential complications for n/v?

• Aspiration, pneumonia

• metabolic alkalosis

• Dehydration

• Anorexia, weight loss, malnutrition

• fluid-electrolyte imbalances

• circulatory failure

What acid-base disorder is associated with vomiting?

metabolic alkalosis

• d/t throwing up acid (only base is left beind)

Why does Vitamin B12 deficiency occur?

• usually from lack of intrinsic factor (body does not make enough or parietal cells are damaged)

• may also be d/t poor diet - this is more rare

What are the s/s of B12 deficiency?

• Neuro symptoms:

  • tingling of hands or feet

  • balance issues

  • mental confusion

• megaloblastic anemia

What are the complications of a B12 deficiency?

• Diarrhea

• pernicious anemia

• megaloblastic anemia

• Neuropathy

What are the types of emesis?

• clear - saliva

• green/yellow - bile

• orange - partially digested food

• pink tinged/red/coffee ground look - blood

• projectile emesis - forceful vomiting that travels a distance

• fecal odor + brown - fecal matter

What is the diagnostic value of emesis?

• the color, odor, and how the vomiting occurred can be used to narrow potential causes/diagnoses:

  • emesis w/partially digested food after hours - gastric outlet obstruction or delayed emptying

  • fecal odor + bile - intestinal obstruction below pilors

  • some disease processes specifically have regurgitation or projectile vomiting as a sign/symptom

• Emesis (vomiting) may monitor electrolytes and cause metabolic acidosis