nausea and vomiting for adult health deborah alex

Nausea and Vomiting` : 

Nausea and Vomiting` Nursing 8800 Spring 2010

What is nausea and vomiting : 

What is nausea and vomiting Unpleasant feeling of dizziness may end up in vomiting or not Nausea and Vomiting Also called: Emesis Nausea is an uneasy or unsettled feeling in the stomach together with an urge to vomit. Nausea and vomiting, or throwing up, are not diseases. They can be symptoms of many different conditions

Causes : 

Causes Transient – no other associated causes GI disorders Other variable developments Medication Increased ICP Pregnancy Infection Head injury Depending on the classification treatment may be simple or complex

“Help I’m sick” : 

“Help I’m sick”

Upper GI Endoscopy : 

Upper GI Endoscopy

Upper GI endoscopy : 

Upper GI endoscopy Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see inside the upper GI tract. The upper GI tract includes the esophagus, stomach, and duodenum—the first part of the small intestine.

When to use a upper GI endoscopy : 

When to use a upper GI endoscopy Upper GI endoscopy can be used to determine the cause of abdominal pain nausea vomiting swallowing difficulties gastric reflux unexplained weight loss anemia bleeding in the upper GI tract

GI Disorders : 

GI Disorders Nausea & vomiting are common complaints among many individuals with GI disorders. Nausea –to have an unpleasant feeling that may include dizziness, a vague discomfort in the abdomen and a sensation of need to vomit. Vomiting –is the forceful ejection /expulsion of the stomach that propels its contents up the esophagus and out the mouth. about 25% of those affected consult their general practitioner, but this still accounts for 1-2% of all consultations in general practice Nausea – inclination to vomit

Slide 9: 

Copyright ©2001 BMJ Publishing Group Ltd. Spiller, R C BMJ 2001;323:1354-1357 Possible reasons for nausea, and vomiting

Nausea and/or vomiting : 

Nausea and/or vomiting Either condition may occur transiently with no other associated signs or symptoms. However these conditions also maybe only part of a more complex clinical presentation. In addition to identifying conditions associated with nausea & vomiting, it is important to address the specific causative medical problem. Because the variable etiologies of these problems, management maybe simple or detailed and complex.

Slide 11: 

Copyright ©2001 BMJ Publishing Group Ltd. Spiller, R C BMJ 2001;323:1354-1357 Causes of anorexia, nausea, vomiting, and gastrointestinal pain

Conditions that accompany nausea & vomiting : 

Conditions that accompany nausea & vomiting In addition to GI disease, either or both (nausea & vomiting) may accompany Pregnancy, cardiovascular disease (MI-CHF/) -A neurologic process (increased ICP/migraine H/A) -metabolic disorders (Addison’s disease/ diabetic ketoacidosis) -operative procedures, certain medications, psychiatric causes (psychogenic vomiting/ anxiety/ anorexia), drug withdrawal-therapy induced (radiation, antibiotics, chemotherapy, Etiology may also vary with age. Newborn VS adults.

Slide 13: 

Copyright ©2001 BMJ Publishing Group Ltd. Spiller, R C BMJ 2001;323:1354-1357 Algorithm for management of nausea and vomiting

Treatment options for N & V : 

Treatment options for N & V include drug & non drug approaches. The overall goal of anti emetic therapy is to prevent or eliminate N & V. With out any adverse effect or with acceptable clinical adense effect The goal maybe accomplished easily in a pt with simple N&V, or require greater assistance with a pt with more complex problems. You always want to consider appropriate cost issues. Tx are based Patient economic status what they can afford to pay age

Algorithmic approach to nausea and vomiting : 

Algorithmic approach to nausea and vomiting

Non-pharmcologic managment : 

Non-pharmcologic managment Non-pharmacologic management may include dietary, physical or psychological changes. Including behavioral interventions (relaxation, biofeedback, self hypnosis, cognitive distraction & guided imagery) ie focus on something else Non Plan include Remove the cause – eg milk – stop taking it Physical - remove the stimulus Behavioral intervention (See Above)

Commonly used antiemetics : 

Commonly used antiemetics Antacids – eg Tums Gastric acid neutralization. Magnesium/ aluminum or calcium salts. Histamine-2 Receptor Antagonists Simple nausea & vomiting. Antihistamine-Anticholinergic Interrupts visceral afferent pathways.

Antiemetics : 

Antiemetics Antacids (PO) contain magnesium & aluminum hydroxide and or calcium carbonate. Eg tums One or more small doses of single or mult agent usually is sufficient for simple n&v. This allows approximately 40-180meq of neutralizing capacity. Adverse effect-usually related to the presence of magnesium/aluminum or calcium salts. May get osmotic diarrhea /constipation But for the most part usually does not produce serious toxicities. H2 receptor antagonist-(PO)(tagamet/pepcid/zantac)used in low doses to manage simple N&V associated with heart burn or gastroesophogeal reflux. Individual doses may be used for brief purposes. Few side effects when used for episodic relief.-only Cimetidine-(tagamet)has the potential for drug/drug interaction. Antihistamine-Anticholenergic –(PO/IM/IV/PATCH/SUPP)( benadryl/vstaril/tigan) interrupt various visceral afferent pathways that stimulate n&v. Adverse reaction includes:drowsiness, confusion.blurred vision, dry mouth, urinary retention or possible tachycardia. All especially in the elder population. Pt with narrow-angle glaucoma, prostatic hyperplasia or asthma at greater risk of complications. Simple nausea and vomiting – use minimal therapy – med used in small infrequent dose – single agent are used Complex N/V – eg Chemo patient – may require multiple agent combination therapy

Commonly used antiemetics : 

Commonly used antiemetics Phenothiazines Block dopamine receptors in the CTZ. Most practical for long term treatment. Butyrophenones Block dopaminergic stimulation of the CTZ. metoclopramide Block dopaminergic receptors centrally in the CTZ.

Antiemetics : 

Antiemetics Phenothiazines-(thorazine/compazine/phenergan) PO/IV/IM/SUPP.)most widely prescribed antiemetic agent. Blocks dopamine receptors in the CTZ(chemo receptor trigger zone) most useful with simple n/v. Array of dosage forms, with rectal a reasonable alternative. Adverse effects: extra pyramidal reactions, excessive sedation. Butyrophenones(haldol/droperidol)-(PO/IM/IV)-blocks dopaninergic stimulation of the CTZ. Black box warning recently added due possible QT prolongation & or torsades. Should be reserved for pt’s who fail to respond to other treatments. Complete baseline 12 lead. Metoclopramide(reglan)-(PO)-block the dopaminergic receptors in the CTZ. Increase lower esophageal sphincter tone. Aids in gastric emptying and accelerates transit through the small bowel through the release of acetylcholine. Used mostly in patients with gastro paresis and delayed N/V with chemo. With esophagus sphincter tone Decreased release of Acetylcholne

Commonly used antiemetics : 

Commonly used antiemetics corticosteroids Management of chemotherapy induced and postoperative. cannabinoids Reserved for use when other treatments fail. Selective Serotonin Receptor Inhibitors. Block pre synaptic serotonin receptors. Most successful in management of chemo/radiation & postoperative N/V.

Other antiemtics : 

Corticosteroids-(methyl & dexamethazone)-most successful in management of chemotherapy induced & postoperative N/V either as single agent or combined. Not usually indicated for simple N/V. Cannabinoids(marinol/cesamet)-(cap)-adverse affects include euphoria,drowsiness,sedation,depression, hallucinations & paranoia. Reserved for use when other treatments fail. SSRI-(zofran/kytril/anzemet)-block presynaptic serotonin receptors on vagal fibers in the gut wall. Most successful in management of chemo/radiation/postoperative n/v. Most common adverse affect is constipation & h/a. Other antiemtics http://www.youtube.com/watch?v=T_5k5zEAthE