N/V Flashcards
motion sickness prevention
- easier to prevent than treat
- drive vehicle straight if possible
- focus vision straight ahead
motion sickness, minimizing motion
sit near:
- front of car
- near wings of plane
- mid-ship, pref on deck
motion sickness, avoid:
strong odors, excess food/alcohol before travel/reading during travel
motion sickness treatment
antihistamine anti-emetics
acupuncture P6 point (okay for >2 yo)
antihistamine anti-emetics list
- meclizine (FDA approved)
- doxylamine
- dimenhydrinate
- diphenhydramine
antihistamine anti-emetics instructions
- take 30-60 min prior
- sedating, avoid driving/operating machinery
N/V pregnancy treatment, waking up
- fresh air
- dry crackers/toast 15 min before getting up
- rise slowly
- 4-5 small meals a day
- lay down if symptoms occur
N/V pregnancy treatment, diet
- little data on diet change
- BRAT diet
teeth treatment
vomit-> erosion of tooth enamel
- rinse w/tsp baking soda in cup of water
- some women cannot handle taste; good to suggest but mention caveat
pregnancy vitamins
PNV’s may cause gagging
N/V pregnancy treatment, pharm
- ginger root 250 mg po QID, NTE 1 gm/day
- pyridoxine 10-25 mg po TID
- doxylamine 12.5 mg po TID
- combo pyridoxine/doxylamine?
food poisoning/viral gastroenteritis treatment
- bland diet
- NPO if excessive diarrhea/vomiting
- phosphorated carbohydrate solution
- anti-emetics if requested (usually unnecessary)
food poisoning/viral gastroenteritis treatment, resetting diet
- after treatment, reassess in 24 hours
- stop all feeding for 1 hour
- restart feeding as tolerated
- restart clear fluids if vomiting occurs
don’t recommend phosphorated carbohydrate solution to
diabetics
N/V and breastfeeding
continue breastfeeding through symptoms
N/V associated with food/beverages treatment
- avoid triggers (coffee, EtOH)
- avoid smoking
- reduce stress
- weight loss if overweight
- H2 blockers for indigestion
- Peptobismol approved for nausea (some benefit)
- phosphorated carbohydrate solution has insufficient data
anti-emetics not for <6 yo
cyclizine
anti-emetics not for <12 yo
meclizine
monitoring
follow-up after 24 hours
- N/V diminished?
- residual symptoms?
- signs of dehydration?
- vitals?
- determine referral if needed
antihistamine side effects
anti-cholinergic effects (suppress parasympath/rest&digest processes)
- dry mouth/eyes
- confusion
- constipation
- urinary retention
- dizziness
- drowsiness
- rapid heart rate (caution in people with CHF, arrhythmia, angina)
antihistamine side effects, avoid concurrent use of:
other CNS depressants (EtOH, opioids, benzodiazepines)
approved as sleep aid
doxylamine
ginger side effects
heartburn, diarrhea, mouth irritation, anticoag effect, hypotensive effect
pyridoxine side effects
generally well tolerated, large doses may result in weakness/lethargy
avoid when breastfeeding
Peptobismol, bismuth subsalicylate, type of salicylate, incr risk of Rye’s if they have a viral illness
diphenhydramine drug interxns
mild-mod CYP2D6 inhibitor
avoid antihistamines in:
geriatrics
sedation can cause fall risk, urinary retention, cognitive impact
acupressure bands should not be used in:
patients with pacemakers
anti-emetics for children
Diphenhydramine and dimenhydrinate FDA approved in children 2-6 years, but multiple deaths from improper dosing->cardiac arrhythmias, respiratory depression
signs of dehydration (besides the obvious)
- unusual lethargy
- irritability
- body floppy
- no tears when crying
- hypotension
- fainting
- severe- difficulty waking up child
dehydration treatment
oral rehydration solution
oral rehydration solution recipe
- 1/2 tsp salt
- 6 tbsp sugar
- 1 L water
- refridgerate
dehydration treatment, children should avoid
- sugary drinks like soda, juices, ginger ale, gatorade
- draws additional water into GI tract, makes dehydration worse
phosphorated carbohydrate solutions not that effective for
N/V associates with food/beverages
