Ex: 6 - Nausea/Vomiting (68) Flashcards
Nausea
Sickness at the stomach; an inclination to vomit
Vomiting
The ejection of matter forcibly from the stomach through the esophagus and mouth
Retching (arcadas)
Making movements of vomiting w/o effect
What are other symptoms associated with nausea and vomiting
Pallor
Tachycardia
Diaphoresis
Etiology of nausea and vomiting: GI disorders
Influenza
-Intestinal pathogen
-food poisoning
Ulcers; GERD
Pancreatitis
Cholecystitis
Obstruction
Tumors
DM gasteoparesis
Etiology of nausea and vomiting: CNS disorders
Anxiety tumors HA
Etiology of nausea and vomiting: Pain
Acute or chronic
Etiology of nausea and vomiting: Excessive intake of just about anything… pregnancy
Intake:
Man vs Food
Alcohol
Pregnancy
-80% of pregnant women
Treatment-induced causes of nausea and vomiting
Cancer chemotherapy
-Varies with agent and dose
Radiation therapy
-CNS and abdominal
Anesthesia (~30%)
-Varies greatly with type
NV associated w/procedures
-Especially abdominal
Drug-induced causes of NC cont: Anti-neoplastic agents
Opioids
Aspirin, NSAIDs, etc
Iron
Some antibiotics
-Tetracycline; erythromycin
Estrogens
-High doses
Anti-parkinson meds
SSRIs
Complications of NV
Patient discomfort
Dehydration (K+, Na+, Cl-)
Malnutrition
Aspiration Pneumonia
Anxiety; anticipatory NV
Compromise therapy
Decreased QOL
Assessment of NV
Number of episodes
Onset
Duration of symptoms
Evidence of dehydration
Severity of nausea
-Visual analog scale
0-10
Questions to ask patients:
How long have you had NV?
What color
How often
Is the vomiting related to eating?
-If so, what foods/ and how soon after eating
-Do you have nausea w/o vomiting?
Is the NV associated with…
-Abdominal pain
-Constipation
-Diarrhea
-A loss of appetite
-A change in color of your stool
-A change in color of your urine
-Fever
-Chest pain
-HA
-Hearing loss
Pathophysiology of NV
Cortex
-Sensory input
-Anxiety and memory
-Meningeal irritation
-Increased ICP
CTZ
-Drugs, metabolic
Dorsal vagal complex
Multiple receptors
GI
-Serotonin release from mucosal enterochromaffin cells
-obstruction
-stasis
-inflammation
Vestibular
-Motion
-CNS lesions
-Opioids
-aggravates most nausea
when we have agents that impact receptors at multiple places, tend to be more efficacious
Patho of NV cont: Site of drug action
Dopamine receptors [D2]
Histamine receptors [H1 and H2]
Muscarinic - cholinergic receptors [M1]
Serotonin receptors [5-HT3]
Neurokinin receptors [NK-1]
Often use antihistamines/antimuscarinics to treat NV