NAUSEA, Reference: CNE, M. M., Jeffrey Kwong, D., Roberts, D., Hagler, D.,…
Feeling of discomfort in epigastrium with conscious desire to vomit
Nausea and Vomiting commonly occur alongside one another
There is a "vomiting center" in the Medulla that coordinates the multiple components involved in vomiting. This center receives signals from various stimuli. Neural impulses reach vomiting center via autonomic nervous system. When stimulated the receptors relay info to vomiting center which initiates vomiting reflex
Receptors for the neurons are found in GI tract, kidney, heart, and uterus.
Signs & Symptoms:
Most common symptom of GI disease
Signs of pregnancy, infections
Nausea is subjective to pt
Lethargy, sunken eyes, pallor, dry mucous membranes, poor skin turgor, pain, stomach aches, abdominal rigidness
Antiemetics :block the neurochemicals that trigger nausea and vomiting.
Herbs: Ginger, Peppermint oil
Medication is based on what the underlying condition is, before giving an antiemetic it is best to know the underlying condition and treat that as well
Antihistamines: Dramamine, Diphenhydramine (block histamine receptors that trigger nausea)
Anticholinergics: Scopolamine transdermal (block cholinergic pathway to vomit center)
Central Nervous System disorders/problems (meningitis, tumor, head trauma)
Cardiovascular Disease (myocardial infarction, heart failure)
Metabolic Disorders and Psychologic Factors (stress, fear)
Post anesthesia effects/drug side effect
Mental/Psychological Disorders: Anorexia, Bulimia
Pregnancy - hyperemesis gravidarum
Priority Nursing Assessment:
Fluid imbalance / Hydration status: Dehydration
Level of Consciousness
Electrolyte Imbalance: A drop in Chemistry values (K, Na, Cl, Hydrogen)
Content of emesis
Emesis with partially digested food several hours post meal = gastric outlet obstruction or delayed gastric emptying.
Fecal odor and Bile after prolonged vomiting = intestinal obstruction below the level of the pylorus.
Bile in the emesis = obstruction below the ampulla of Vater.
Independent Nursing Interventions:
Recognize underlying cause of nausea, Provide relief
Encourage pt to journal when vomiting occurs, how long, how often
If vomiting induce by stress, teach pt breathing and relaxation techniques
Teach patient how to manage nausea, how to prevent nausea and vomiting, and ways to maintain fluid and nutritional intake
Eliminate odors, odor and/or food triggers, closing door, provide comfortable lighting for calm setting
Collaborative Nursing Interventions:
Order Chemistry for: Electrolytes and Hydration status, pH levels
Order: NPO, IV fluids, increase fluids
If underlying condition is psychological, it is best to have a Psychologist or Spiritual care counselor or chaplain
Order for possible NG tube
UAP= Provide relief by help pt change positions and breathing techniques, report changes in vitals, report any vomiting or changes in urinary output, provide/empty/monitor emesis basins
Reference: CNE, M. M., Jeffrey Kwong, D., Roberts, D., Hagler, D., & Dnp, C. R. (2019). Lewis's medical-surgical nursing E-book: Assessment and management of clinical problems (11th ed.). Elsevier Health Sciences.