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N233 > Mod 2.1 Nausea, Vomiting & HG > Flashcards

Mod 2.1 Nausea, Vomiting & HG Flashcards

1
Q

general nursing measures for nausea & vomiting

A

Cold cloth, mouth care

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2
Q

Antihistamine examples

A

Gravol - Dimenhydrinate

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3
Q

Actions of antihistamines

A

Block histamine & Ach receptors.

Vitamins B 6 with histamines is used for preganancy

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4
Q

Anticholinergics examples

A

Scopalamine Transdermal Ear Patch

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5
Q

What do Anticholinergics/schopalamine do

A

Effects vestibular nuclei controls balance - Ach & norepinephrine

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6
Q

nursing considerations of antihistamines

A

Causes drowsiness
Safest
Good in pregnancy hyperemesis gravidarum

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7
Q

what are antihistamines best for??

A

Motion sickness

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8
Q

What are anticholinergics (Scopalamine) for

A

PONV & Motion sickness

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9
Q

Nursing considerations of anticholinergics (scopolamine)

A

Causes dizziness, drowsiness, dry mouth, tachycardia

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10
Q

who should you avoid scopalamine in

A

Older adults

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11
Q

What is an example of a serotonin antagonist

A

Ondansetron

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12
Q

What does serotonin antagonist do? (Ondansetron)

A

Affects CTZ, Blocks 5-HT3 Receptors in the GI, CTZ

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13
Q

Serotonin antagonist (ondansetron) uses

A

Great for PONV & CINV, Hyperemesis after gravel did not work

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14
Q

Nursing alerts for Serotonin antagonists (ondansetron)

A

Watch pt.’s with cardiac/electrolytes imbalance. Watch brady & QT.

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15
Q

Dopamine antagonist example

A

Proclorperazine

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16
Q

Dopamine antagonist (Prochlorperazine) action

A

Blocks Dopamine in the CTZ

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17
Q

Prochlorperazine (dopamine antagonist) nursing implications

A

hypotension, tachycardia, extrapyramidal, dry eyes, increased risk of death in elderly.

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18
Q

Prochlorperazine ways to give

A

IM. Do not give subCut b/c damaging.

Can cause extravasation in IV

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19
Q

Prokinetic agents name

A

Metoclopramide

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20
Q

Metoclopramide action

A

Promote movement through GI /Increase Gi motility

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21
Q

Nursing considerations for metoclopramines

A

Good for PONV & CINV.
Contraindicated with GI small bowle obstruction.
Watch in elderly.
Hypotension, dry mouth, achy

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22
Q

Benzodiazepine

A

Lorazepam

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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

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24
Q

Cannabinoids Examples

A

Nabilone, Dronabinol

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25
Q

Action of cinabinoidis

A

TCH major component causes drowsiness, works on CNS & GI

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26
Q

Cannabinoids nursing considerations

A

Good for CINV

Stimulates appetite for patients with HIV & chemotherapy

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27
Q

what is nausea

A

Wave like sensation, flushing or pallor, epigastric & subjective

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28
Q

N&V

A

Vomiting is a defence mechanism of the body to get rid of toxic substances & neurostimulation.

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29
Q

where is most of the stimulation for nausea & vomiting

A

the vomiting centre in the medulla

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30
Q

complications of N&V

A 
Aspiration pneumonia
Dehydration 
Malnutrition 
Electrolyte embalance 
Dehisecence, eviseration 
Distruption of the surgical site 
Metabolic disturbances 
Increased ICP 
Stress/Anxiety 
Esophaghagitis
Hypoalbuminemia
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31
Q

Who is most at risk fo aspiration pneumonia

A

Stroke, Uncontious petition, MS/ALS, seizures, Dysphagia. Geriatric are at higher risk

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32
Q

Electrolyte imbalance & malnutritoion

A

PO intake is limited & compromised., Hypoalbuminemia.

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33
Q

what are the 4 pathways to the vomiting centre

A

1) Chemreceptor trigger zone
2) GI tract
3) Labyrinth (inner ear)
4) Cerebral cortex

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34
Q

Some GI triggers for N/V

A

1) Distension
2) Obstruction
3) Infection

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35
Q

NT in GI tract

A

Serotonin, Dopamine & prostaglandin

SPD

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36
Q

anytime you have GI infection which NT increases

A

prostaglandins

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37
Q

What are the visceral efferent vibes of the GI tract

A

Impulses from the viscera to the CNS

also how pain is experienced

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38
Q

Things that can trigger GI tract

A 
Overeating
Indigestion 
Small bowel obstruction
lots of gases 
Gastritis 
IBC 
Any infection of the GI tract 
sometimes unpleasant odors & Smells
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39
Q

Where is the chemoreceptor trigger zone

A

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

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40
Q

Triggers for the chemoreceptor trigger zone

A

Drugs, Hormones, Toxins, Metabolic abnormalities

activated by hormones or toxic substances

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41
Q

NT in CTZ

A

Dopamine, serotonin

DS

42
Q

How does the CTZ work

A

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
Q

the CTZ:

A

Recognizes a threat to the health or system & communicates & allows you to feel sick

44
Q

Vestibular is stimulated by:

A

1) Motion sickness, Vertigo

2) Opiods exert some influence on this route

45
Q

NT for Vestibular

A

Histamine & Acetylcholine

HA

46
Q

How does the vestibular route work

A

Alterations to the fluid of the inner ear leads to activation of the labyrinth –> CTZ trigger `

47
Q

What does the cerebral cortex do

A

Psychological component of nausea

48
Q

Triggers for cerebral cortex

A

1) Emotion
2) smells
3) anticipatory nausea from memory
4) Taste
5) Gag reflex
6) sights?

49
Q

How does the cerebral cortex work

A

input from the higher neurological centres including the other cranial nerves as well

50
Q

Holistic & alternative Nausea & vomiting modalities

A

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
Q

Anticholinergics mechanism

A

Blocks ace receptors in the vestibular nuclei & in the reticular formation

52
Q

Anticholinergic use

A

Motion sickness & PONV

53
Q

Side effects of Anticholinergics

A

Sedation, dry mouth & constipation

54
Q

which pathway is anticholinergics

A

VESTIBULAR PATHWAY.
Most common motion sickness med
SIDE EFFECT OF THE MED IS TOXINS which can lead to activation of the CTZ pathway

55
Q

Antihistmines (H1 receptor antagonists) mechanism

A

Nlocks H1receptors, preventing Ach from binding to receptors in the vestibular nuclei

56
Q

Uses of anthistamines

A

Motion sickness, non-productive cough, sedation, rhinitis, allegies

57
Q

which pathway is antihistamines

A

labyrinth

58
Q

Dopamine antagonists (D2 Receptors mechanism)

A

Block dopamine in the CTZ and may also block Ach. Calms CNS

59
Q

Uses for dopamine antagonists

A

N/V from Chemo, Radiation, Psychotic disorders, Intractable hiccups

60
Q

Side effects of dopamine antagonists

A

Orthostatic hypotension, extrapyramidal symptoms, dyskineasia, headache, dry eyes & mouth, constipation, urinary

61
Q

Pathway of dopamine antagonists

A

CTZ & GI

62
Q

Extrapyramidal symtpoms

A

motor control issues –> Tardive dyskinesia –> movement of the jaw, sucking or chewing or lip smacking or blinking.

63
Q

Akathesia

A

feeling of restlessness

64
Q

Prokinetics mechanism

A

stimulates peristalsis. Blocks Dopamine receptors in the CTZ, desensitizing it to impulses from the GI tract

65
Q

uses of PRokinetics

A

Delayed gastric emptying, GERD, NV from chemo & PONV

66
Q

Side effects of prokinetics

A

Hypotension, Sedation, Headache, Dystonia, Dry mouth, Diarrhea

67
Q

Pathways of pro kinetics

A

CTZ, & GI

68
Q

what is dystonia

A

involuntary muscle movement

69
Q

Serotonin Antagonist ( 5-HT3 Receptor) mechanism

A

Block serotonin receptor in the GI, CT & vomiting centre

70
Q

uses of Serotonin antagonist

A

NV from CA Tx, PONV

71
Q

Side effects of serotonin antagonist

A

Headache, Diarrhea, Rash, prolonged, QT Interval

72
Q

pathways of Serotonin antagonist

A

CTZ & GI

73
Q

what is the QT interval

A

time heart takes to recharge before taking text contraction cause cause palpitations & fainting

74
Q

THC mechanism

A

inhibitor effects on the reticular formation, thalamus & cerebral cortex

75
Q

THC pathway

A

cerebral

76
Q

Benzodiazepines

A

Depreses the CNS. Used as an adjunct to manage the N.V triggers from the cerebral cortex. Sedation & amnesia

77
Q

corticosteroid for N/V

A

usually not given alone, but given with those that help with CINV

78
Q

What is hyperemesis gravidarum

A

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
Q

what causes HG

A

Unknown but believed to be linked to higher than usual human chorionic gonadotropin levels

80
Q

HG symptoms & complications

A

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
Q

Holistic & interdisciplinary interventions for HG

A

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
Q

Treatment for HG

A

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
Q

Explain Preganayc Risk A

A

Adequate, well controlled studies in pregnant women have not shown the risk of fetal abnormalities

84
Q

Explain pregnancy risk B

A

Animal studies have revealed no evidence of harm to the fetus: but not studies in pregnant women

85
Q

Explain pregnancy risk C

A

Animal studies have show an adverse effect & there are no adequate well controlled pregnant women studies

86
Q

Explain pregnancy risk D

A

Studies have demonstrated a risk to the fetus but the benefits may outweigh the potential risks

87
Q

Explain pregnancy risk X

A

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
Q

Ondansetreeon mechanisme

A

Serotonin antagonist - block serotonin in the GI, TZ and in the VC

89
Q

Use of ondansetron

A

Nausea from chemotherapy, radiation, PONV, HG after tother preferred meds

90
Q

Ondansetron Side effects

A

Headache, diarrhea, constipation, prolonged QT interval

91
Q

Dimenhydrinate class & mechanism

A

Antihistamine - blocks H1 receptors preventing ACH from binding receptors in the vestibular nuclei

92
Q

Deminehydrinate uses

A

Motion sickness & vertigo

93
Q

side effects of dimenhydrinate

A

Sedation, dry mouth, urinary retention, blurred vision

94
Q

MEtoclopramide mechanism / class

A

Stimulates peristalsis, accelerates gastric emptying. Blocks dopamine receptors in the CTZ. Desentizing it to impulsive of the GI tract

95
Q

Use of metoclopramide

A

N/V related to chemo, PONV, delayed gastric emptying, GERD

96
Q

Side effects of metoclopramide

A

Extrapyramidal symptoms risk of tar dive dyskinesia, hypotension, sedation, dry mouth, diarrhea

97
Q

Contraindications of metoclopramide

A

Mechanism GI obstruction, perforation or hemorrhage, history of DF or other meds that increase extrapyramidal symptoms

98
Q

the emetic response

A

Emesis is the complex reflex by activiting the vomiting centre, a nucleus of neurons in the medulla oblongata (direct or indirect)

99
Q

Describe Direct vomiting stimuli

A 
Cerebral cortex (anticipation or fear) 
Sensory organs (Upsetting sights, noxious doors, pain) 
vestibular apparatus (inner ear)
100
Q

Indirect stimuli of vomiting

A

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
Q

Vomiting messengers

A

Serotonin, Glucocorticoids, Supstance Pm Neurokininm Dopaminem Acetylechoine, Histamine

102
Q

Complications of NAusea/vomiting and important nursing assessments & interventions for each

A 
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

N233 (11 decks)

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