N/V Flashcards
Etiology
- Motion sickness
- Pregnancy
- Drug-induced
- Infectious disease
- Overindulging
- Food poisoning
- Psychogenic-induced
- Pathology-induce
Vomiting Process
• Involves CNS and GI tract
• Vomiting center receives impulses
o CTZ, GI and/or labyrinth apparatus in ear
• Many types involve stimulation of the chemoreceptor trigger zone (CTZ), which elicits nausea and vomiting
• Overstimulation of labyrinth apparatus
• Morning sickness: unknown MOA
Treatment Goals
- Identify and correct underlying cause
* Symptomatic relief may not be possible unless this is done
Non-pharm: pregnancy
- Fresh air
- Crackers
- No sudden movements
- 4/5 small meals a day
- No fluids or soups at meal time
- Small sips of carbonated drinks or fruit juice
- Avoid greasy foods
- Eat chilled foods
Pharm treatments: pregnancy
- Pyridoxine (B6) – 25mg q8h
- Antacids
- Acupressure
- Acustimulation
- Ginger – Cat. B
- Preggie Pop Drops (Citric Acid)
Avoid: preganacy
- Antihistamines (30-60min before travel)
- H2RA
- PPI
- Bismuth
Motion Sickness Treatments
- Antihistamines
- Acupressure – applies continuous pressure on the P6 point on each wrist using a plastic stud
- Acustimulation – mild electrical stimulation of acupuncture points
Meclizine
> 12 y.o.
25-50mg 1h before travel
• Drowsiness
• Possible hyper-activity in children
Cyclizine
> 6 y.o. 25mg q6-8h
12 y.o. 50mg 30min before travel, then 1T 4-6h prn
• Drowsiness
• Possible hyper-activity in children
Diphenhydramine
> 6 y.o. 12.5-25mg q4h
> 12 y.o. 25-50mg q4h
• Drowsiness
• Possible hyper-activity in children
Diphenhydrinate
> 6 y.o. 25-50mg q6-8h
> 12 y.o. 50-100mg q4-6h
• Drowsiness
• Possible hyper-activity in children
Overindulgence
- Antacids start here
- H2RAs or here
- Omeprazole
- Bismuth
Nauzene
for overindugence
Dextrose-Glucose 968mg-Anti-nausea
Levulose-Fructose 175mg-Anti-nausea
Sodium Citrate Dihydrate-230mg-Antacid
Food Poisoning
• F&E replacement therapy o Sodium o Potassium o Chloride o Dextrose o Fructose • Diet
Viral Gastroenteritis
• Phosphorated carbohydrate solution (Emetrol)
o Cherry
o Levulose/Dextrose/Phosphoric acid
o 1-2 TBSP q 15min until vomiting ceases
o Max 5 doses/hr
o Not for use in diabetics
o Use sparingly if already have diarrhea levulose can cause diarrhea
Misc. Therapies
- Preggie Pop Drops (citric acid)
- Preggie Pops (cirtic acid)
- Queasy Pops
- Motion Eaze (100% natural blend of herbal oils)
- Cola Syrup (sugar)
- Hyland’s Motion Sickness
Chamomile
- Spasmolytic properties
* Gastric complaints
Ginger
- N&V (chemo-C, surgery-C)
- N&V (pregnancy-B)
- Motion Sickness – C
Lemon Balm
- Spasmolytic and carminative effects
* GI complaints including vomiting
Peppermint - C
- Spasmolytic properties
* Dyspepsia
When to refer adults?
- Diabetic with high blood glucose or urine ketones plus dehydration
- Suspected food poisoning continuing >12 hours
- Blood in vomitus
- Severe right upper, middle, or lower quadrant abdominal pain – appendicitis
- Suspected to be caused by undiagnosed pregnancy (missed period)
- Pregnant female whose n/v is unresponsive to non-drug measures
When to refer adults cont
- Lactating females
- Yellow skin/eye discoloration, wt. loss, and dark urine
- Stiff neck, headache, light sensitivity
- Head injuries accompanied by n/v, blurred vision or numbness
- N/V >48 hours – possibility of dehydration
- Dehydration/wt. loss >5% of BW
When to refer children
- Wt. loss/sings of dehydration present
- <1 year of age
- Child refuses to drink
- Child has not urinated in past 8-12 hours
- Child appears lethargic, sleepy, or is crying
- Stiff neck
- Vomiting occurs with each feeding
When to refer children cont.
- Projectile or continuous vomiting >8 hours
- Vomitus contains red, black, or green fluid
- Associated with diarrhea, distended abdomen, fever, or severe headache
- Vomiting occurs following head injury
- Suspected poisoning
- Recurrent, severe abdominal pain
- N/V continues >24-48 hours
Treatment Opt: lactating
o All except antihistamine are OK
Treatment Opt: Advanced Age
o Phosphorated carbohydrate solution Caution diabetes o Acupressure OK o Acustimulation No if pacemaker o Antihistamine Caution with SE o Antacids, H2RAs, PPIs, Bismuth Caution about drug interactions
Treatment Opt: Children
o Antihistamines Side effects o Phosphorated carbohydrate solution 2-12 same dose as adults <2 – smaller dose o Oral rehydration solutions Sips every few minutes for 15 min If they are able to keep that down, increase the volume
Avoid: Children
o Antacids, H2RAs, PPIs –NO
o Bismuth – NO (Reye’s Syndrome)
