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Clinical > Nausea and vomiting > Flashcards

Nausea and vomiting Flashcards

1
Q

what is nausea accompanied by

A 
increased perspiration 
salivaion 
tachycardia
increased respiration rate
lack of appetite
headache
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2
Q

what is the other word for vomiting

A

emesis

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3
Q

what is retching

A

strong involuntary and unsuccessful urge to vomit

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4
Q

explain the pathophysiology of vomiting

A

vomit center recieves and integrates afferent impulses and stimuli then sends efferent impulses to salivation center, rep center, pharyngeal, GI, and ab muscles

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5
Q

what are the 2 main neurotransmitters and receptors involved in nausea and vomiting

A

histaminic

acetylcholine

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6
Q

what is nv associated with

A 
motion sickness
postchemotherapy 4
pregnancy 
postoperative 
medication
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7
Q

what are causes of visceral afferent stimulation

A 
mechanical obstruction 
motility disorders
peritoneal irritation 
infections
topical GI irritants
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8
Q

CNS disorders that cause nv

A

vestibular diorders
increased intracranial pressure
infections
psychogenic - bulemia

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9
Q

causes of irritation of the CTZ (chemoreceptor trigger zone)

A

drugs

systemic disorders

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10
Q

differential diagnosis for motion sickness

A 
vestibular disease
gastroenteritis
metabolic disorders
toxin exposures
mountain sickness
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11
Q

complications of vomiting

A 
dehydration 
aspiration 
malnutrition 
electrolyte imbalance 
acid base imbalance
dental caries
esophageal rupture
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12
Q

signs and symptoms of dehydration in adults

A 
increased thirst
decreased urination 
weak
dry mouth/tongue 
light headed
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13
Q

signs and symptoms of dehydration in children

A 
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
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14
Q

simple nv

A

occasional episodes
selflimiting relieved by min use of anti-emetic
not related to admin or exposure to noxious agent

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15
Q

complex nv

A

not relieved by single antiemetic
severe consequences
caused by noxious agents or psychogenic event

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16
Q

ages motion sickness is common

A

ages 3-12

under 2 are immune

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17
Q

signs and symptoms of motion sickness

A 
vomiting 
yawnign 
restless, warm 
drowsy 
belching 
excessive salivation 
flatulence
cold sweat 
headaches
migraines 
loss of appetite
18
Q

risk factors for motion sickness

A 
more common in females
type of travel 
stimulus intensity and frequency 
duration of directional change 
smoke 
poor ventilation 
individual predisposition
19
Q

treatment goals for motion sickness

A

eliminate or decrease symptoms of nausea
prevent or decrease frequency of vomiting
prevent complications of nv

20
Q

how does dimenhydrinate and diphenhydramine work

A

blocks H1 receptors in vomiting center and on vestibular afferents
block ach receptors in the vestibular apparatus

21
Q

how does scopolamine work, can it be used for treatment of motion sickness

A

blocks ach in vestibular apparatus

no only prevention

22
Q

how should dimenhydrinate and diphenhydramine be taken

A

1-2 hours before departure, at least half an hour

23
Q

how do you apply scopolamine patches

A

wash hands before and after!
one patch behind the ear 12 hours before antiemetic effect required
switch patch after 72 hours

24
Q

how should ginger root be used

A

prevention: 2 tb 30min before
treatment: 2 tab every 4 hours 1-3 times daily

25
Q

side effects of anti-emetics except ginger

A 
drowsy 
dissy 
blurred vision 
dry mouth 
urinary retention and constipation 
may inhibit lactation
26
Q

special side effect of dmh and dephenhydramine

A

paradoxical stimulation

27
Q

special side effect of scopaolamine

A

skin irritation

eye irritation if get in eyes

28
Q

side effects of ginger root

A

can exacerbate symptoms in patients with acute inflammatory skin diseases
contact dermatitis

29
Q

drug interactions

A

alcohol

sedative, CNS and anticholinergic meds

30
Q

contraindications

A 
seizure disorder
resp condition 
BPH 
narrow angle glaucoma 
obstuctive bowel disease
31
Q

drug for children

A

dimenhydrinate

32
Q

treatment for pregnant women

A

refer to doctor

33
Q

what is promethazine used for

A

prevention and treatment of motion sickess used as an alternative in patients with refractory nausea or dmh ineffectice

34
Q

mechanism of action for promethazine

A

anti-emetic

anti-histamine

35
Q

dosing of promethazine

A

25mg first dose 30-60 min before departure and repeat 8-12 hours

36
Q

drug interactions with promethazine

A

cns depressants

37
Q

contraindications of promethazine

A

lower resp tract symptoms

38
Q

side effects of promethazine

A

sedation, extrapyramidal symptoms
dry mouth
constipation
blurred vision

39
Q

non pharms for motion sickness

A

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

40
Q

monitoring treatment

A

monitor when exposed to stimulus
ensure endpoint achieved where minimal or non NV
side effects of medication

41
Q

red flags for adults

A 
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
42
Q

red flags for children

A 
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

Clinical (16 decks)

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