Nausea and vomiting Flashcards
what is nausea accompanied by
increased perspiration salivaion tachycardia increased respiration rate lack of appetite headache
what is the other word for vomiting
emesis
what is retching
strong involuntary and unsuccessful urge to vomit
explain the pathophysiology of vomiting
vomit center recieves and integrates afferent impulses and stimuli then sends efferent impulses to salivation center, rep center, pharyngeal, GI, and ab muscles
what are the 2 main neurotransmitters and receptors involved in nausea and vomiting
histaminic
acetylcholine
what is nv associated with
motion sickness postchemotherapy 4 pregnancy postoperative medication
what are causes of visceral afferent stimulation
mechanical obstruction motility disorders peritoneal irritation infections topical GI irritants
CNS disorders that cause nv
vestibular diorders
increased intracranial pressure
infections
psychogenic - bulemia
causes of irritation of the CTZ (chemoreceptor trigger zone)
drugs
systemic disorders
differential diagnosis for motion sickness
vestibular disease gastroenteritis metabolic disorders toxin exposures mountain sickness
complications of vomiting
dehydration aspiration malnutrition electrolyte imbalance acid base imbalance dental caries esophageal rupture
signs and symptoms of dehydration in adults
increased thirst decreased urination weak dry mouth/tongue light headed
signs and symptoms of dehydration in children
dry mouth and tongue sunken eyes and fontanelle decreased urine output dark urine fast heartbeat thirst absence of tears when crying decreased skin turgor unusual listless, sleepiness, decreased alertness weight loss
simple nv
occasional episodes
selflimiting relieved by min use of anti-emetic
not related to admin or exposure to noxious agent
complex nv
not relieved by single antiemetic
severe consequences
caused by noxious agents or psychogenic event
ages motion sickness is common
ages 3-12
under 2 are immune
signs and symptoms of motion sickness
vomiting yawnign restless, warm drowsy belching excessive salivation flatulence cold sweat headaches migraines loss of appetite
risk factors for motion sickness
more common in females type of travel stimulus intensity and frequency duration of directional change smoke poor ventilation individual predisposition
treatment goals for motion sickness
eliminate or decrease symptoms of nausea
prevent or decrease frequency of vomiting
prevent complications of nv
how does dimenhydrinate and diphenhydramine work
blocks H1 receptors in vomiting center and on vestibular afferents
block ach receptors in the vestibular apparatus
how does scopolamine work, can it be used for treatment of motion sickness
blocks ach in vestibular apparatus
no only prevention
how should dimenhydrinate and diphenhydramine be taken
1-2 hours before departure, at least half an hour
how do you apply scopolamine patches
wash hands before and after!
one patch behind the ear 12 hours before antiemetic effect required
switch patch after 72 hours
how should ginger root be used
prevention: 2 tb 30min before
treatment: 2 tab every 4 hours 1-3 times daily
side effects of anti-emetics except ginger
drowsy dissy blurred vision dry mouth urinary retention and constipation may inhibit lactation
special side effect of dmh and dephenhydramine
paradoxical stimulation
special side effect of scopaolamine
skin irritation
eye irritation if get in eyes
side effects of ginger root
can exacerbate symptoms in patients with acute inflammatory skin diseases
contact dermatitis
drug interactions
alcohol
sedative, CNS and anticholinergic meds
contraindications
seizure disorder resp condition BPH narrow angle glaucoma obstuctive bowel disease
drug for children
dimenhydrinate
treatment for pregnant women
refer to doctor
what is promethazine used for
prevention and treatment of motion sickess used as an alternative in patients with refractory nausea or dmh ineffectice
mechanism of action for promethazine
anti-emetic
anti-histamine
dosing of promethazine
25mg first dose 30-60 min before departure and repeat 8-12 hours
drug interactions with promethazine
cns depressants
contraindications of promethazine
lower resp tract symptoms
side effects of promethazine
sedation, extrapyramidal symptoms
dry mouth
constipation
blurred vision
non pharms for motion sickness
avoid exposure to percipitating factors
avoid eating large meal wihtin 3 hours of travel
avoid dairy products and foods hihg in protein, calories, sodium before travel
avoid alcohol, smoking, and disagreeable odors
improve ventilation
avoid stimuli that precipitate motion sickness during travel
focus on stable external object
stay central location of a boat
sit in front seat with a clear forward view
use a headrest
monitoring treatment
monitor when exposed to stimulus
ensure endpoint achieved where minimal or non NV
side effects of medication
red flags for adults
fever or diarrhea suspected food poisoning severe ab pain over 3 days severe dehydration head trauma altered consciousness stiff neck sensitive to light diabetes- urine ketones, high blood glucose blood in vomit weight loss dark urine induced by drug, chronic disease, psychogenic patients with glaucoma, BPH, chronic bronchitis, emphysema, asthma pregnancy breastfeeding
red flags for children
under 2 dehydration vomiting greater than 6 hours child refuses to drink lack of urination stiff neck weight loss altered consiousness vomit red, black, green vomit with each feeding diarrhea, distended abdomen, fever, severe head injury poisoning high risk child- DM, CNS disease, hernia
