Mod 2.1 Nausea, Vomiting & HG Flashcards
1
Q
general nursing measures for nausea & vomiting
A
Cold cloth, mouth care
2
Q
Antihistamine examples
A
Gravol - Dimenhydrinate
3
Q
Actions of antihistamines
A
Block histamine & Ach receptors.
Vitamins B 6 with histamines is used for preganancy
4
Q
Anticholinergics examples
A
Scopalamine Transdermal Ear Patch
5
Q
What do Anticholinergics/schopalamine do
A
Effects vestibular nuclei controls balance - Ach & norepinephrine
6
Q
nursing considerations of antihistamines
A
Causes drowsiness
Safest
Good in pregnancy hyperemesis gravidarum
7
Q
what are antihistamines best for??
A
Motion sickness
8
Q
What are anticholinergics (Scopalamine) for
A
PONV & Motion sickness
9
Q
Nursing considerations of anticholinergics (scopolamine)
A
Causes dizziness, drowsiness, dry mouth, tachycardia
10
Q
who should you avoid scopalamine in
A
Older adults
11
Q
What is an example of a serotonin antagonist
A
Ondansetron
12
Q
What does serotonin antagonist do? (Ondansetron)
A
Affects CTZ, Blocks 5-HT3 Receptors in the GI, CTZ
13
Q
Serotonin antagonist (ondansetron) uses
A
Great for PONV & CINV, Hyperemesis after gravel did not work
14
Q
Nursing alerts for Serotonin antagonists (ondansetron)
A
Watch pt.’s with cardiac/electrolytes imbalance. Watch brady & QT.
15
Q
Dopamine antagonist example
A
Proclorperazine
16
Q
Dopamine antagonist (Prochlorperazine) action
A
Blocks Dopamine in the CTZ
17
Q
Prochlorperazine (dopamine antagonist) nursing implications
A
hypotension, tachycardia, extrapyramidal, dry eyes, increased risk of death in elderly.
18
Q
Prochlorperazine ways to give
A
IM. Do not give subCut b/c damaging.
Can cause extravasation in IV
19
Q
Prokinetic agents name
A
Metoclopramide
20
Q
Metoclopramide action
A
Promote movement through GI /Increase Gi motility
21
Q
Nursing considerations for metoclopramines
A
Good for PONV & CINV.
Contraindicated with GI small bowle obstruction.
Watch in elderly.
Hypotension, dry mouth, achy
22
Q
Benzodiazepine
A
Lorazepam
23
Q
when is lorazepam used
A
used when anxiety plays role, sedation, suppression & amnesia, Good adjunct for anticipatory CINV, avoid use for older adults
24
Q
Cannabinoids Examples
A
Nabilone, Dronabinol
25
Action of cinabinoidis
TCH major component causes drowsiness, works on CNS & GI
26
Cannabinoids nursing considerations
Good for CINV
| Stimulates appetite for patients with HIV & chemotherapy
27
what is nausea
Wave like sensation, flushing or pallor, epigastric & subjective
28
N&V
Vomiting is a defence mechanism of the body to get rid of toxic substances & neurostimulation.
29
where is most of the stimulation for nausea & vomiting
the vomiting centre in the medulla
30
complications of N&V
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Aspiration pneumonia
Dehydration
Malnutrition
Electrolyte embalance
Dehisecence, eviseration
Distruption of the surgical site
Metabolic disturbances
Increased ICP
Stress/Anxiety
Esophaghagitis
Hypoalbuminemia
```
31
Who is most at risk fo aspiration pneumonia
Stroke, Uncontious petition, MS/ALS, seizures, Dysphagia. Geriatric are at higher risk
32
Electrolyte imbalance & malnutritoion
PO intake is limited & compromised., Hypoalbuminemia.
33
what are the 4 pathways to the vomiting centre
1) Chemreceptor trigger zone
2) GI tract
3) Labyrinth (inner ear)
4) Cerebral cortex
34
Some GI triggers for N/V
1) Distension
2) Obstruction
3) Infection
35
NT in GI tract
Serotonin, Dopamine & prostaglandin
| SPD
36
anytime you have GI infection which NT increases
prostaglandins
37
What are the visceral efferent vibes of the GI tract
Impulses from the viscera to the CNS
| also how pain is experienced
38
Things that can trigger GI tract
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Overeating
Indigestion
Small bowel obstruction
lots of gases
Gastritis
IBC
Any infection of the GI tract
sometimes unpleasant odors & Smells
```
39
Where is the chemoreceptor trigger zone
outside the blood brain barrier --> Highly selective barrier separates the blood from the brains extracellular fluid
THIS IS THE SITE OF SYSTEMIC triggers of vomiting
40
Triggers for the chemoreceptor trigger zone
Drugs, Hormones, Toxins, Metabolic abnormalities
| activated by hormones or toxic substances
41
NT in CTZ
Dopamine, serotonin
| DS
42
How does the CTZ work
activated then communicates with other structures within the vomiting centre to intimate vomiting.
THIS IS NOT DIRECTLY CAUSING VOMITING. It is just communicating. IT IS NOT THE VOMITING CENTER. but it is nearby.
43
the CTZ:
Recognizes a threat to the health or system & communicates & allows you to feel sick
44
Vestibular is stimulated by:
1) Motion sickness, Vertigo
| 2) Opiods exert some influence on this route
45
NT for Vestibular
Histamine & Acetylcholine
| HA
46
How does the vestibular route work
Alterations to the fluid of the inner ear leads to activation of the labyrinth --> CTZ trigger `
47
What does the cerebral cortex do
Psychological component of nausea
48
Triggers for cerebral cortex
1) Emotion
2) smells
3) anticipatory nausea from memory
4) Taste
5) Gag reflex
6) sights?
49
How does the cerebral cortex work
input from the higher neurological centres including the other cranial nerves as well
50
Holistic & alternative Nausea & vomiting modalities
1) Gentle BRAT Diet (Bananas, Rice, apple sauce, Toast)
2) Ginger, Pepermint - flat
3) Relaxation, music distraction
4) Cool clothes
5) Positioning - SIDE LYING
6) TENS - Transcutaneous electrical nerve stimulation
7) Acupressure, Acupunctrue
51
Anticholinergics mechanism
Blocks ace receptors in the vestibular nuclei & in the reticular formation
52
Anticholinergic use
Motion sickness & PONV
53
Side effects of Anticholinergics
Sedation, dry mouth & constipation
54
which pathway is anticholinergics
VESTIBULAR PATHWAY.
Most common motion sickness med
SIDE EFFECT OF THE MED IS TOXINS which can lead to activation of the CTZ pathway
55
Antihistmines (H1 receptor antagonists) mechanism
Nlocks H1receptors, preventing Ach from binding to receptors in the vestibular nuclei
56
Uses of anthistamines
Motion sickness, non-productive cough, sedation, rhinitis, allegies
57
which pathway is antihistamines
labyrinth
58
Dopamine antagonists (D2 Receptors mechanism)
Block dopamine in the CTZ and may also block Ach. Calms CNS
59
Uses for dopamine antagonists
N/V from Chemo, Radiation, Psychotic disorders, Intractable hiccups
60
Side effects of dopamine antagonists
Orthostatic hypotension, extrapyramidal symptoms, dyskineasia, headache, dry eyes & mouth, constipation, urinary
61
Pathway of dopamine antagonists
CTZ & GI
62
Extrapyramidal symtpoms
motor control issues --> Tardive dyskinesia --> movement of the jaw, sucking or chewing or lip smacking or blinking.
63
Akathesia
feeling of restlessness
64
Prokinetics mechanism
stimulates peristalsis. Blocks Dopamine receptors in the CTZ, desensitizing it to impulses from the GI tract
65
uses of PRokinetics
Delayed gastric emptying, GERD, NV from chemo & PONV
66
Side effects of prokinetics
Hypotension, Sedation, Headache, Dystonia, Dry mouth, Diarrhea
67
Pathways of pro kinetics
CTZ, & GI
68
what is dystonia
involuntary muscle movement
69
Serotonin Antagonist ( 5-HT3 Receptor) mechanism
Block serotonin receptor in the GI, CT & vomiting centre
70
uses of Serotonin antagonist
NV from CA Tx, PONV
71
Side effects of serotonin antagonist
Headache, Diarrhea, Rash, prolonged, QT Interval
72
pathways of Serotonin antagonist
CTZ & GI
73
what is the QT interval
time heart takes to recharge before taking text contraction cause cause palpitations & fainting
74
THC mechanism
inhibitor effects on the reticular formation, thalamus & cerebral cortex
75
THC pathway
cerebral
76
Benzodiazepines
Depreses the CNS. Used as an adjunct to manage the N.V triggers from the cerebral cortex. Sedation & amnesia
77
corticosteroid for N/V
usually not given alone, but given with those that help with CINV
78
What is hyperemesis gravidarum
Severe, debilitating N/V
Greater than 5% weight loss in early pregnancy
usually nausea is just in the first trimester. Affects many aspects of life
79
what causes HG
Unknown but believed to be linked to higher than usual human chorionic gonadotropin levels
80
HG symptoms & complications
Dehydration, Malnuatioion --> Wernickes enchelalopathy, metabolic disorder (ketosis), stress & extreme fatigue, fetal growth restriction, DVT - because dehydration, bedrest, concentrated blood is more viscous with increased hematocrit.
81
Holistic & interdisciplinary interventions for HG
may need hospitalization
therapeutic communication & active listening & presence
Reduce doors, noises, fresh air, move slowly
avoid isolation & depression
Monitor weight & electrolytes, nutritional statuc
PICC line? infection? bacteriemia
82
Treatment for HG
1) IV rehydration - Electrolytes (Especially NA & K) B1 (thiamine) B6 (Pyridoxine) added. May require enteral feeding or TPN in severe cases
2) Medication - Antiemetics, Folic acid, Thiamine, LWMH
GRAVOL IS THE SEFEST BUT MAY NOT BE MOST EFFECTIVE. Ondansetron may be used with gravel but it's a big of a risk. Thalidomide very teratogenous
83
Explain Preganayc Risk A
Adequate, well controlled studies in pregnant women have not shown the risk of fetal abnormalities
84
Explain pregnancy risk B
Animal studies have revealed no evidence of harm to the fetus: but not studies in pregnant women
85
Explain pregnancy risk C
Animal studies have show an adverse effect & there are no adequate well controlled pregnant women studies
86
Explain pregnancy risk D
Studies have demonstrated a risk to the fetus but the benefits may outweigh the potential risks
87
Explain pregnancy risk X
Studies, Adequate, well controlled & observational in animals or pregnancy women have demonstrated positive evidence of fetal abnormalities.
Contraindicated in women who ar or may become pregnant.
88
Ondansetreeon mechanisme
Serotonin antagonist - block serotonin in the GI, TZ and in the VC
89
Use of ondansetron
Nausea from chemotherapy, radiation, PONV, HG after tother preferred meds
90
Ondansetron Side effects
Headache, diarrhea, constipation, prolonged QT interval
91
Dimenhydrinate class & mechanism
Antihistamine - blocks H1 receptors preventing ACH from binding receptors in the vestibular nuclei
92
Deminehydrinate uses
Motion sickness & vertigo
93
side effects of dimenhydrinate
Sedation, dry mouth, urinary retention, blurred vision
94
MEtoclopramide mechanism / class
Stimulates peristalsis, accelerates gastric emptying. Blocks dopamine receptors in the CTZ. Desentizing it to impulsive of the GI tract
95
Use of metoclopramide
N/V related to chemo, PONV, delayed gastric emptying, GERD
96
Side effects of metoclopramide
Extrapyramidal symptoms risk of tar dive dyskinesia, hypotension, sedation, dry mouth, diarrhea
97
Contraindications of metoclopramide
Mechanism GI obstruction, perforation or hemorrhage, history of DF or other meds that increase extrapyramidal symptoms
98
the emetic response
Emesis is the complex reflex by activiting the vomiting centre, a nucleus of neurons in the medulla oblongata (direct or indirect)
99
Describe Direct vomiting stimuli
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Cerebral cortex (anticipation or fear)
Sensory organs (Upsetting sights, noxious doors, pain)
vestibular apparatus (inner ear)
```
100
Indirect stimuli of vomiting
First activate the chemoreceptor trigger zone which then activates the vomiting centre.
This occurs in 2 ways: By signals form the stomach & sm. Intestine (Vagal afferents) and by direct action of the emetogenic compounds (Anticancer drugs, opioids) that are carried to the CTZ in the blood.
The vomitin centre then signal that stomach, diaphragm & abdominal muscles to expel gastric contents
101
Vomiting messengers
Serotonin, Glucocorticoids, Supstance Pm Neurokininm Dopaminem Acetylechoine, Histamine
102
Complications of NAusea/vomiting and important nursing assessments & interventions for each
```
Cardiac dyrhthmias
URinary output less than 30 ml for 2-3 consecutive hours
muscle weakness
parenthesis
hypotension
anorexia
drowsiness
skin irritation
aspiration pneumonia
Dehydration
Malnutrition
Surgical site dehiscence
Increased ICP - neurovitals
stress & anxiety
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