Nausea and vomiting Flashcards by Kelsey Con

what is nausea accompanied by

increased perspiration 
salivaion 
tachycardia
increased respiration rate
lack of appetite
headache

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what is the other word for vomiting

emesis

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what is retching

strong involuntary and unsuccessful urge to vomit

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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

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

histaminic

acetylcholine

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what is nv associated with

motion sickness
postchemotherapy 4
pregnancy 
postoperative 
medication

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what are causes of visceral afferent stimulation

mechanical obstruction 
motility disorders
peritoneal irritation 
infections
topical GI irritants

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CNS disorders that cause nv

vestibular diorders
increased intracranial pressure
infections
psychogenic - bulemia

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causes of irritation of the CTZ (chemoreceptor trigger zone)

drugs

systemic disorders

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differential diagnosis for motion sickness

vestibular disease
gastroenteritis
metabolic disorders
toxin exposures
mountain sickness

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complications of vomiting

dehydration 
aspiration 
malnutrition 
electrolyte imbalance 
acid base imbalance
dental caries
esophageal rupture

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signs and symptoms of dehydration in adults

increased thirst
decreased urination 
weak
dry mouth/tongue 
light headed

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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

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simple nv

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

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complex nv

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

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ages motion sickness is common

ages 3-12

under 2 are immune

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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 ```