Nausea and Vomiting

Question 1

Why does nausea occur?

Answer 1

the activity in the vomiting centre located in the medulla oblongata increases.

Question 2

what induces the vomiting reflex?

Answer 2

information is received in the GI and parts of the nervous system reach a threshold value that induces vomiting

further input is received in the chemoreceptor trigger zone

Question 3

What are the clinical features?

Answer 3

pallor, cold sweats triggered by travel, by air, by sea, road or water - FOR motion sickness

Question 4

What questions would you ask the pt ?

Answer 4

1. Does the pt have any abdominal pain? - could be at risk of appendicitis/cholecystitis etc
2. time of N/V? - pregnancy if morning, after food suggests gastritis, peptic ulcers if vomiting begins after 1 or more hours after food
3. signs of infection? fever? diarrhoea? etc

Question 5

When would you refer?

Answer 5

1. if infants are vomiting
2. Suspected pregnancy - offer pregnancy test
3. children who fail to respond to OTC
4. unexplained vomiting
5. moderate to severe abdominal pain

Question 6

In which pts should you be cautious when giving medication for N/V?

Answer 6

pts taking TCA’s, haloperidol, phenothiazines as it increases anticholinergic side effects

Question 7

Tx options for pts with motion sickness?

tx option of N/V?

Answer 7

Anticholinergics - hyoscine
Antihistamines - cinnarizine, promethazine

Stugeron, Joy-rides, kwells, Phenergan

prochlorperazine >18 years S/E drowsiness

Question 8

What is a natural remedy that can be taken for pts that have travel sickness and/or pregnant women?

Answer 8

ginger