Nausea and Vomiting Flashcards

Flashcards covering key terms and concepts related to nausea and vomiting, including its causes, symptoms, treatment, and special population considerations.

Nausea

Subjective feeling of the need to vomit/throw-up

Vomiting

Forceful expulsion of GI tract contents (aka emesis)

Motion sickness

More common in females and children 2-15 years of age

Nausea and vomiting of pregnancy (NVP)

Affects ~70-80% of pregnant women; Generally most common from 9-16 weeks

Acute viral gastroenteritis

Usually self-limiting; Most commonly d/t rotavirus or norovirus

Upset stomach

Due to overeating or indigestion

Signs and symptoms of dehydration

Dry mouth, decreased skin turgor, excessive thirst, limited/no urine output, dizziness or lightheadedness, fainting, reduced blood pressure

Exclusions for self-treatment of N/V - Adults

Urine ketones +/- high blood glucose with signs of dehydration in patients with diabetes, head injury with N/V, blurry vision, numbness, or tingling, suspected food poisoning persisting > 24 hours, etc.

Exclusions for Self-Treatment - Children

Signs of severe dehydration are present, caregiver is unable/unwilling to manage child’s N/V at home, N/V accompanied by at least 1 of the following: stiff neck, <6 months of age OR weight <17.6lb (8kg), etc.

Goals of Self-Treatment of Nausea and Vomiting

Provide symptomatic relief, identify and correct the underlying cause, prevent and correct complications, prevent future occurrences

Nonpharmacologic Recommendations for dehydration and electrolyte imbalance

Commercial oral rehydration solutions (ORS)

Acupressure (P6 point)

Three finger widths from the middle crease of the wrist; Can be used continuously or as needed; May be used for prevention of motion sickness and NVP

Nonpharm measures for prevention of NVP

Take prenatal for at least 1 month before conception, Avoid excessive heat and humidity, Before getting out of bed, eat several crackers and relax in bed for 10-15 minutes, etc.

Nonpharm measures for prevention of motion sickness

Avoid reading during travel, Sit where motion is least experienced, Focus line of vision straight ahead, Avoid strong odors, Avoid excess food or alcohol before or during travel, Drive vehicle if possible

Mechanism of Action of Antihistamines (antiemetics)

Histamine-1 blockers in GI tract, blood vessels, respiratory tract; blocks chemoreceptor trigger zone; decreases vestibular stimulation/labyrinthine function

Antihistamines (antiemetics)

Approved for the prevention of N/V and dizziness d/t motion sickness

Adverse Effects of Antihistamines

Most common AE: drowsiness, dry mouth, confusion, dizziness, constipation. Paradoxical stimulatory reaction can occur in some patients

Mechanism of Action of Phosphorated carbohydrate solution

Directly act on GI tract wall to decrease smooth muscle contraction and delay gastric emptying

Phosphorated carbohydrate solution (antiemetic)

Relief the nausea associated with upset stomach

Geriatrics/Older Patients Considerations

More likely to have concomitant disease states or multiple medications; More susceptible to AE

Pediatrics/Younger Patients Considerations

Vomiting should be distinguished from regurgitation; Moderate to severe dehydration must be referred

Pregnancy Considerations

Pregnancy commonly associated with N/V, particularly in the first trimester

Lactation Considerations

Consideration needs to be given to whether medication is excreted in breast milk

Active Ingredients of Antihistamines

Dimenhydrinate (dramamine), Diphenhydramine (benadryl), Meclizine (bonine,antivert)

Active Ingredients/Formulations of Phosphorated carbohydrate solution

Solution: 5 mL contains dextrose 1.87 g, fructose 1.87 g, and phosphoric acid 21.5 mg

Additional counseling points of Antihistamines

Take 30-60 minutes prior to travel, do not use more than the recommended dosage, avoid tasks that require concentration, may cause excitability in children

Additional counseling points of Phosphorated carbohydrate solution

Take 15-30 minutes before meals if related to morning sickness. If your first dose does not resolve your nausea, you may repeat the dose every 15 minutes. Do not use the maximum dose for more than 1 hour

Preferred Treatments for Pregnancy

Acupressure, Ginger, or Antihistamines

Treatments to avoid for Geriatrics/Older Patients

First generation antihistamines, due to their anticholinergic effects

Preferred Treatments for Pediatrics/Younger Patients

Commercial oral rehydration solutions (ORS)

Treatments to Avoid for Pediatrics/Younger Patients

Antihistamines (Specifically Dimenhydrinate) in patients < 2 years old