N/V

Question 1

motion sickness

Answer 1

larger inter-individual variability; rarely occurs in children < 2 yoa; women are more susceptible than men

Question 2

NVP

Answer 2

occurs in 50-80% of women; typically subsides by 20th week of pregnancy

Question 3

hyperemesis gravidarum

Answer 3

very severe form of NV which occurs in less than 1% of women but may require rehydration and hospitalization

Question 4

viral gastroenteritis

Answer 4

inflammation of stomach/small intestines presenting with acute vomiting and diarrhea; most commonly caused by rotovirus and norovirus; usually self-limiting can be serious in pediatrics

Question 5

upset stomach

Answer 5

indigestion, distention, overeating

Question 6

complications of N/v

Answer 6

dehydration, electrolyte abnormalities, aspiration, malnutrition, diaphragmatic herniation, esophageal tears

Question 7

s/sx of dehydration

Answer 7

dry mouth, decreased skin turgor, excessive thirst, little/no urination, dizziness, lightheadedness, fainting, and reduced blood pressure

Question 8

self care exclusions in adults

Answer 8

1. diabetes
2. suspected food poisoning
3. severe abdominal pain in middle/right lower quadrant
4. fever or diarrhea
5. severe right upper quadrant pain
6. blood in vomit
7. jaundice
8. stiff neck or sensitivity to light
9. head injury
10. glaucoma, BPH, bronchitis, emphysema, asthma
11. pregnancy or breastfeeding
12. chemotherapy, radiation
13. drug induced
14. eating disorder
15. chronic disease induced

Question 9

exclusions for self care in children

Answer 9

1. severe dehydration
2. stiff neck
3. < 6 mos of age or weight <8kg
4. vomited clear fluids 3 times, watery diarrhea
5. lack of urination 8-12hrs
6. lethargic, unusually sleepy
7. vomiting w each feeding
8. continued > 8 hours
9. vomit is red, black, or green
10. <1 mo age with 3 diarrhea
11. < 12 weeks with fever
12. < 12 weeks vomited twice
13. < 1 year with 8 diarrhea
14. severe headache > 2 years

Question 10

nonpharm treatment

Answer 10

ORS, acupressure wristbands, battery-powered acustimulation band

Question 11

ORS

Answer 11

more effective than just water, doses according to age and weight of patient, 10 minutes after last episode of vomiting in small increments

Question 12

acupressure wristband

Answer 12

prevent motion sickness, stimulate p6 point, used in children as young as 2 years

Question 13

acustimulation bands

Answer 13

stimulates p6 point via electricity, may be used before onset or when symptoms occur

Question 14

non pharm for motion sickness

Answer 14

avoid reading during travel, focus vision straight ahead, avoid excess food or alcohol before/during travel, avoid strong odors

Question 15

non pharm for pregnancy NV

Answer 15

fresh air at all times, crackers rising/breakfast, eat 4-5 small meals daily, no fluids at meals, try carbonated drinks, avoid greasy, spicy, or acidic foods

Question 16

antihistamine examples

Answer 16

cyclizine, dimenhydrinate, diphenhydramine, meclizine, , doxylamine

Question 17

cyclizine

Answer 17

not recommended for less than 6 yoa

Question 18

dimenhydrinate

Answer 18

use cautiously in children 2-6

Question 19

diphenhydramine

Answer 19

not recommended for less than 6 yoa and can mildly inhibit CYP2D6

Question 20

meclizine

Answer 20

not recommended for less than 12 yoa

Question 21

doxylamine

Answer 21

typically used in pregnancy with or without pyridoxine; 12.5 tid

Question 22

administration of antihistamines

Answer 22

take 30-60 min prior to beginning the activity and continued during travel

Question 23

avoid antihistamines in

Answer 23

respiratory conditions, glaucoma, prostate issues, and lactating women

Question 24

antacids in NV

Answer 24

marginal efficacy, symptom relief

Question 25

BSS and NV

Answer 25

approved indicated for nausea associated with overeating/indigestion

Question 26

phosphorated carbohydrate solution MOA

Answer 26

works to decrease smooth muscle contraction and delay gastric emptying

Question 27

PCS indicated

Answer 27

nausea associated with intestinal influenza and food or drink indiscretions

Question 28

PCS is composed of

Answer 28

fructose, glucose, and phosphoric acid

Question 29

adult dosing in PCS

Answer 29

15-30 mL every 15 minutes until vomiting ceases, do not take for more than 1 hour or exceed 5 doses

Question 30

children dosing in PCS

Answer 30

5-10 mL every 15 minutes

Question 31

pyridoxine

Answer 31

first line with doxylamine and 10-25 mg tid

Question 32

ginger

Answer 32

more effective as placebo

Question 33

dosing of ginger

Answer 33

250 mg qid or 500mg bid

Question 34

ae of ginger

Answer 34

heartburn or worsening colic in those with gallstones

Question 35

pregnancy first line treatment

Answer 35

non pharm recommendations

Question 36

pregnancy and MVI

Answer 36

take MVI for at least 3 months prior to conception to decrease severity of NVP

Question 37

elderly and antihistamines

Answer 37

used with caution

Question 38

elderly and PCS

Answer 38

option for patients that don’t have diabetes or hereditary fructose intolerance

Question 39

lactation and antihistamines

Answer 39

avoided in breastfeeding, and bss cautiously bc salicylate could excrete in milk

Question 40

lactation and pyridoxine

Answer 40

excreted in breastmilk and can inhibit prolactin

Question 41

pediatric and ORS

Answer 41

mild-moderate cases can be treated