LECTURE 68 - nausea & vomiting Flashcards
(32 cards)
Define nausea
Sickness at the stomach, an inclination to vomit
Define vomiting
The ejection of matter forcibly from the stomach through the esophagus and mouth
Define retching
Making movements of vomiting without effect
List CNS disorders that could cause N/V
Influenza
Intestinal pathogen
Ulcers; GERD
Pancreatitis
Cholecystitis
Obstruction
Tumors
DM gastroparesis
List CNS disorders that could cause N/V
Anxiety
Tumors
HA
List treatment-induced causes of N/V
- cancer chemotherapy
- radiation therapy
- anesthesia
- procedures (esp. abdominal)
List drug-induced causes of N/V
- Anti-neoplastic agents
- Opioids
- Aspirin, NSAIDs, etc
- Iron
- Some antibiotics (tetracycline, erythromycin)
- Estrogens (high doses)
- Anti-Parkinson’s meds
- SSRIs
List possible complications of N/V
- Patient discomfort
- Dehydration (K, Na, Cl)
- Malnutrition
- Aspiration Pneumonia
- Anxiety (anticipatory N/V)
- Compromise therapy
- Decreased QOL
What should be considered when assessing N/V?
- Number of episodes
- Onset
- Duration of symptoms
- Evidence of dehydration
- Severity of nausea (visual analog scale → 0-10)
Describe the first steps for treating N/V
Determine the cause
Put the gut to rest:
Clear liquid diet
IV hydration
What dietary recommendations should be given to a pt experiencing N/V?
Avoid fatty, fried, sweet & spicy foods
Eat food that is cold or at room temp
What are some physical non-pharm options to “treat” / prevent N/V?
- Avoid unpleasant sights, sounds & odors that may aggravate NV
- Fresh air
- Avoid sudden movements
- Dim lights
ReliefBand
Describe the ReliefBand
- Acupressure
- 3 fingers above the wrist
- Helps the stomach return to a normal rhythm of 3 cycles/min
- Pregnancy, chemotherapy
What is key to the treatment of motion sickness?
PREVENTION
List treatment options for motion sickness
- Transderm-Scop (scopolamine)
- Dramamine (dimenhydrinate 50 mg)
- Bonine, Dramamine Less Drowsy, Zentrip (meclizine 25 mg)
Describe the dosing for Transderm-Scop (scopolamine)
Apply patch BEFORE needed
Duration = 72 hours
Describe the dosing for Dramamine (dimenhydrinate 50 mg)
Use 30-60 minutes BEFORE needed
Oral
Describe the dosing for Bonine, Dramamine Less Drowsy, Zentrip (meclizine 25 mg)
Use 30-60 minutes BEFORE needed
Oral
List treatment options for N/V secondary to gastroenteritis / pain
treat the symptoms while treating the cause
Ondansetron
Promethazine
Describe ondansetron as a treatment option for N/V secondary to gastroenteritis / pain
4-8 mg IV/ODT/PO
q8-12h PRN
Describe promethazine as a treatment option for N/V secondary to gastroenteritis / pain
12.5 - 25 mg IV/IM/PO
q4-6h PRN
What pt specific factors contribute to post-op n/v (PONV)?
F > M
Non-smoking status
Hx of PONV
Hx of motion sickness
List risk factors for PONV
Intra-operative use of volatile anesthetic
(less with propofol)
Use of nitrous oxide
Types of surgery:
Laparoscopy
Craniotomy
ENT
