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29 Cards in this Set
- Front
- Back
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what is skin turgor?
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Sign commonly used to assess degree of dehydration. Refers to abnormality in skin’s ability to change shape and return to normal
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common causes of nausea and vomiting
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Motion sickness
Pregnancy Viral gastroenteritis Foods (overeating, food poisoning) Medication-related --Chemotherapy, narcotics, NSAIDs, antibiotics --Digoxin and theophylline toxicity **For other causes see table 20-1 in textbook |
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treatment goals of N/V
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Identify and correct underlying cause
Treat symptoms Prevent complications |
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complications of N/V
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Dehydration*
Electrolyte Abnormalities* Acid-Base Abnormalities Aspiration Malnutrition Weight loss Mallory Weiss Tear |
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Mallory Weiss Tear
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tear in the mucus membrane of the lower esophagus
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exclusions for self care in adults
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N/V associated with severe abdominal pain
Blood in vomit N/V with fever and/ or diarrhea Suspected food poisoning that is severe Pregnancy (moderate to severe symptoms) or breastfeeding Drug-induced Moderate to severe dehydration N/V associated with head injury N/V with yellowing of skin, eyes, dark urine N/V associated with chronic disease such as GERD, diabetes |
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N/V related to motion sickness
non-pharm |
Avoid reading
Look straight ahead Have light snack before travel Avoid excess food or alcohol Stay where motion is least experienced Avoid strong odors Acupressure bands and acustimulation band |
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sea-bands
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Acupressure wrist bands (Sea Band)
For nausea symptoms related to motion sickness, pregnancy Stimulation of P6 point located on the inner forearm three finger widths from the first wrist crease Note: there is also a battery-powered acustimulation band approved FDA (ReliefBand NST) Evidence? - some evidence that it works - use right before and when symptoms start |
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Pharmacologic therapy
antihistamines (products): |
Dimenhydrinate (Dramamine), meclizine (Bonine, Dramamine Less Drowsy), cyclizine (Bonine for Kids), diphenhydramine (Benadryl)
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Pharmacologic therapy
antihistamines (indications): |
Treatment of nausea, vomiting, or dizziness associated with motion sickness
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pharmacologic therapy
antihistamines (MOA) |
competitively antagonizes effect of histamine on H1 receptors; anticholinergic effects inhibit vestibular stimulation associated with motion sickness
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antihistamines (warnings)
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Do not use in children < 2 yrs, avoid alcohol-containing products, do not drive, avoid in patients with respiratory conditions, glaucoma, difficulty with urination
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antihistamines (DI)
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: other CNS depressants
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antihistamines (side effects)
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Drowsiness, anticholinergic side effects, paradoxical reactions (insomnia, nervousness, irritability)
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antihistamines (dosing)
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Take 30-60 minutes before travel and continue during travel
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antihistamines in the elderly
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Increased risk for adverse effects: Drowsiness, risk of falls
Anticholinergic side effects Blurred vision Dry mouth Urinary retention Constipation Confusion- instant Alzheimer’s Drug interactions |
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anticholinergic "poem"
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can't see
can't spit can't pee can't shit |
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antihistamines in children
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Do not use in children < 2 years
Different OTC products have different age-specific limits --Meclizine: Do not use in children < 12 years --Cyclizine: Do not use in children < 6 years --Dimenhydrinate and diphenhydramine are FDA-approved for children ages 2-6 years…CAUTION Paradoxical reactions such as insomnia, nervousness, and irritability |
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nausea and vomiting of pregnancy
NVP: |
Severe form of NVP called hyperemesis gravidarum less than 1% get this and is not self treatable.
Subsides by week 16 to 18 |
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non pharm therapy for pregnancy
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Acupressure wrist bands or acustimulation
Reassurance Fresh air Avoid triggers Eat crackers in bed before getting up and get out of bed slowly Eat 4-5 small meals per day Take prenatal vitamins before bed with snack rather than in AM Do not drink fluids with meals. Drink between meals Avoid greasy, spicy or acidic foods Eat chilled foods |
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nausea and vomiting in children
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Viral gastroenteritis is most common cause
Risk for serious dehydration, electrolyte abnormalities Can happen quickly Can be fatal |
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what are the most common viruses in nausea and vomiting in children
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Rotavirus and
Norovirus are the most common types of viral gastro in children and adults |
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signs and symptoms of dehydration in children
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Dry mouth and tongue
Sunken and/ or dry eyes Absence of tears Sunken fontanelle Decreased urine output (dry diapers) Fast heartbeat Decreased skin turgor (prolonged skin ‘tenting’ when pinched) Mental status changes --Unusual sleepiness, decreased alertness --Body is ‘floppy’ --Difficulty waking up Weight loss Dark urine |
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exclusions for self care in children
N/V with one of the following: |
Stiff neck or severe headache
< 6 months or < 8 kg Refusal to drink or vomiting with each feeding Lack of urination 8-12 hours Lethargic, unusually sleepy, listless, crying Severe abdominal pain Projectile vomiting Vomit has black, green, or red Vomiting with fever |
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exclusions for self care in children
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Signs of moderate to severe dehydration
Vomiting after head or abdominal injury Suspected poisoning Child is at high risk due to underlying medical conditions |
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what to do for children with N/V
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Oral rehydration solutions (Pedialyte)-We will discuss this in detail in next lecture
Continue breastfeeding, bottle feeding, diet as tolerated Educate parents about signs and symptoms of dehydration |
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Nausea and Vomiting Associated with Overindulgence or Disagreeable Foods
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Bismuth subsalicylate
Antacids Histamine-receptor antagonists |
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nausea and vomiting associated with medications
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Taking some medications with food may decrease N/V
N/V may be a transient side effect that will resolve with continued use Contact primary care provider to possibly decrease dose or change to different medication ** theophylline and digoxin (toxicity) |
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Phosphorated Carbohydrate Solution
( emetrol) |
Mixture of fructose, dextrose and phosphoric acid
Decreases nausea and vomiting by decreasing smooth muscle contractions in the GI tract Dosed every 15 minutes until vomiting stops. Do not take for more than 1 hour or more than 5 doses Avoid in patients with diabetes Avoid in patients with hereditary fructose intolerance |
