Nausea and Vomiting

Nausea and Vomiting 5 Nursing Care Plans

Nausea and Vomiting NCLEX Review Care Plans

Nursing Care Plans on Nausea and Vomiting

Nausea is a subjective complaint defined as the sensation of vomiting or the urge to vomit. It may precede vomiting but may sometimes stand alone. Vomiting, also called emesis, is the ejection of stomach contents through the mouth.

Both nausea and vomiting are not considered illnesses but may be signs and symptoms of underlying conditions or may be secondary to triggers.

Nursing Stat Facts

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Nursing Stat Facts

These triggers include odors, activity, medication, or food intake. Likewise, vomitus also varies; it may contain undigested food particles, blood, or other materials mixed with gastric juices.

Causes of Nausea and Vomiting

The physiology behind vomiting lies in the nervous system. In the medulla oblongata is what we call a ‘vomiting center.’ When stimulated, the vomiting center triggers nausea and/or vomiting.

It can be activated during stimulation of the organs of balance, as in motion sickness, and it can be activated by diseases involving the vestibular nerve, as in Meniere’s disease.

Complications of Nausea and Vomiting

Despite not being an illness, vomiting has numerous negative effects to the body. Diminished digestion due to vomiting may lead to malnutrition, dehydration, and eventually hypovolemia.

Acid-base imbalance and electrolyte imbalance also occur. The effect of the reflux of acid includes gastric rupture, esophageal tears, dental caries, mucosal irritation, and aspiration pneumonia.

Factors Related to Nausea / Vomiting

  • Biochemical disorders, such as uremia, diabetic ketoacidosis
  • Pregnancy
  • Localized tumors, brain tumors, bone metastases by the skull
  • Intraabdominal tumors
  • Toxins
  • Esophageal or pancreatic disease
  • Gastric distention
  • Gastric irritation
  • Motion sickness, Meniere’s disease, labyrinthitis
  • Increased intracranial pressure, meningitis
  • Pain
  • Gag reflex triggers
  • Blockage of gastric outlet or intestine
  • Exposure to radiation
  • Noxious odors, visual stimulation
  • Anxiety
  • Alcohol
  • Medication intolerance
  • Heat intolerance, dehydration
  • Infection
  • Food intolerance, indigestion, food poisoning
  • Chemical toxins


Treatment for Nausea and Vomiting

Treatment of vomiting is difficult due to the various possible causes of the illness. Often, treating the primary cause of vomiting treats vomiting as well. For example, removing a motion sick person from a moving vehicle relieves the person of his/her nausea and vomiting.

Post-pregnancy, a woman stops experiencing morning sickness. After rest and hydration, an alcohol-intoxicated person is relieved of nausea.

Resting and avoiding solid food until the vomiting has passed are straightforward ways to treat vomiting. Hydrating and avoiding fried and greasy foods also help in avoiding another vomiting episode.

Vomiting secondary to treatment, i.e., surgery, radiation therapy, and medications, is treated with drug therapy. Antiemetics are a classification of drugs that are prescribed to treat nausea and vomiting.

For motion sickness, antihistamines like dimenhydrinate are used. For cases of stomach flu or gastroenteritis, bismuth-subsalicylate is used. Other antiemetics include dopamine antagonists, serotonin receptor antagonists, and corticosteroids.

Nursing Care Plans on Nausea and Vomiting

Nursing Care Plan 1

Cancer with Ongoing Chemotherapy

Nursing Diagnosis: Nausea and Vomiting related to chemotherapy status secondary to cancer as evidenced by reports of nausea, vomiting, and gagging sensation.

Desired Outcome: The patient will manage chronic nausea, as evidenced by maintained or regained weight.

InterventionRationale
Assess the extent of nausea, vomiting, and limited food and fluid intake.To provide baseline data and determine the need for hydration and nutritional support.
Encourage to try dry foods (crackers, toast) when nausea occurs.To decrease discomfort and enhance intake.
Encourage ice chips, sips of cold water and ginger products when nauseous.To promote hydration and decrease the discomfort associated with nausea.
Promote a bland diet and decrease intake of greasy and spicy food and caffeinated beverages. Avoid milk/dairy products, overly sweet, fried, and fatty foodsTo reduce gastric acidity, improve nutrient intake, and prevent further nausea and vomiting.
Administer antiemetics regularly before, during, and after administration of antineoplastic agents.To prevent and control side effects of the antineoplastic medications, including but not limited to nausea and vomiting.
 Monitor weight regularly.To monitor nutritional status throughout the chemotherapy, and address malnutrition and dehydration if present.
Discuss possible complications with the healthcare team.Timely recognition of possible complications leads to timely solutions.
Educate patient to avoid foods and smells that trigger nausea.To decrease the occurrence of nausea and vomiting.
Advise the patient on nonpharmacologic ways to reduce nausea, such as guided imagery, deep breathing exercises, and relaxation.To control and manage nausea, and to promote independence.
Inform the patient and the caregiver to seek professional assistance if vomiting persists for more than 24 hours.Persistent vomiting has serious consequences. Timely assessment may prevent complications brought about by this condition, i.e. dehydration, electrolyte imbalance, and nutritional deficiencies.

Nursing Care Plan 2

Gallbladder Disease

Nursing Diagnosis: Nausea and Vomiting related to intestinal blockage secondary to gallbladder disease and intestinal obstruction as evidenced by nausea, vomiting, and gagging sensation.

Desired Outcome: The patient will be free of nausea.

InterventionRationale
Prepare the patient for diagnostic testing. To determine the etiology of the nausea and vomiting.
Maintain oral hydration and start intravenous hydration as ordered.To prevent dehydration and hypovolemia.
Encourage to try dry foods (crackers, toast) when nausea occurs.To decrease discomfort and enhance nutritional intake.
Encourage ice chips, sips of cold water and ginger products when nauseous.To promote hydration and decrease the discomfort associated with nausea.
Promote a bland diet and decrease intake of greasy and spicy food and caffeinated beverages. Avoid milk/dairy products, overly sweet, fried, and fatty foodsTo reduce gastric acidity, improve nutrient intake, and prevent further nausea and vomiting.
Advise the patient on nonpharmacologic ways to reduce nausea, such as guided imagery, deep breathing exercises, and relaxation.To control and manage nausea, and to promote independence.
Administer antiemetics as needed, as ordered by the healthcare provider.To halt vomiting and prevent further vomiting episodes.
Administer pain medications as needed, as ordered by the healthcare provider.Pain may exacerbate vomiting episodes. Administering pain medications decreases the risk of further episodes.
Monitor the patient for signs and symptoms of complications.Timely recognition of complications leads to timely solutions.
Educate patient to avoid foods and smells that may trigger nausea.To decrease the occurrence of nausea and vomiting.
Prepare the patient for pharmacologic and/or surgical interventions.To effectively alleviate the nausea and vomiting being experienced by the patient.
Maintain the patient on a low-fat diet.Preventing gallstone formation prevents further episodes of nausea and vomiting due to gallbladder disease.

Nursing Care Plan 3

Food Poisoning

Nursing Diagnosis: Nausea and Vomiting related to irritation of the gastrointestinal system as evidenced by abdominal cramping and abdominal pain secondary to food poisoning

Desired Outcome: The patient will be able to state relief of nausea and will be able to explain methods that can be used to decrease nausea and vomiting

InterventionRationale
Determine the cause of nausea and vomiting (e.g., food poisoning). Determine the food source that caused nausea and vomitingNausea and vomiting are clinically identifiable symptoms, it is essential for the cause to be determined and appropriate plan and interventions be developed
Document each episode of nausea and/or vomiting separately, as well as the effectiveness of interventions. Use of an assessment tool is needed for the consistency of evaluationA systematic approach can provide consistency, accuracy, and measurement needed for the direction of care. It is important to recognize that nausea is an experience that is subjective.
Identify and eliminate contributing causative factors. This would include the elimination of the food source that has been identified as the cause of the nausea and vomitingElimination of these contributing causative factors may provide the patient relief from stimulus that causes the nausea and vomiting
Implement appropriate dietary measures such as nothing by mouth (NBM or NPO) status when appropriate; instituting small frequent meals; and implementing low-fat meals. It is beneficial to avoid foods that are spicy, fatty, or highly salty.Implementing an NPO status gives the gastrointestinal system of the patient time to recover from nausea and vomiting and implementation of the different feeding arrangements ensure adequate nutritional status of the patient
Recognize and implement interventions and monitor complications associated with nausea and vomiting. This may include the administration of intravenous fluids and electrolytesRecognizing the complications of nausea and vomiting is critical in the prevention and management of the complications of dehydration, electrolyte imbalance, and malnourishment. Adequate hydration also corrects imbalances and reduces further emesis
Administer appropriate antiemetics, according to emetic cause, by most effective route, with a consideration of the side effects of the medication, and with attention to and coverage for the timeframes that the nausea and vomiting is anticipatedAntiemetic drugs are effective at different receptor sites and treat the different causes of nausea and vomiting. A combination of medications may be more effective than a single drug.

Nursing Care Plan 4

Pregnancy

Nursing Diagnosis: Nausea and vomiting related to pregnancy as evidenced by aversion to food and gagging sensation

Desired Outcome: The patient will be able to state relief of nausea and be able to explain methods the patient can use to decrease the incidence of nausea and vomiting

InterventionRationale
Early recognition of pregnancy induced nausea and vomitingEarly recognition and conservative measures are recommended for the successful management of nausea and vomiting caused by pregnancy, and to prevent the progression to hyperemesis gravidarum. 
Implement dietary and lifestyle modifications first before the implementation of pharmacological interventionsThe fetus is highly sensitive to pharmacological interventions. Dietary and lifestyle options should be tried first.
Avoidance of aversive odors or foods is recommendedTo avoid the stimulation of nausea and vomiting
Eating multiple small meals per dayTo ensure adequate nutrition and to have food in the stomach at all times, thereby preventing hypoglycemia and gastric overdistention
Drinking smaller volumes of liquids at multiple times throughout the dayEnsures adequate hydration without the stimulation of nausea and vomiting
Assess and manage symptoms of heartburn, belching, and indigestionDue to the high incidence of coexisting gastroesophageal reflux disease (GERD) during pregnancy, it is important to manage these symptoms should they occur
Testing for Helicobacter pyloriHelicobacter pylori is associated with hyperemesis gravidarum. It is recommended to test for Helicobacter pylori if there are persistent symptoms of nausea with pregnancy, prolonged symptoms of GERD, or a previous history of Helicobacter pylori infection
Timely diagnosis and treatment of anxiety and depressionCoexisting psychosocial factors may also influence the severity of nausea and vomiting during pregnancy. Symptoms of anxiety and depression can occur in early pregnancy, especially when the nausea and vomiting is severe and this can make the treatment of nausea and vomiting more challenging and even ineffective
Administration of oral pyridoxine hydrochloride and doxylamine succinateThis combination is the first-line treatment for nausea and vomiting of pregnancy

Nursing Care Plan 5

Gastroenteritis

Nursing Diagnosis: Nausea and vomiting related to active fluid volume loss secondary to gastroenteritis

Desired Outcome: The patient will be able: to maintain a urine output of 0.5 mL/kg/hour or at least more than 1300 mL/day; maintain normal blood pressure, heart rate, and body temperature; maintain elastic skin turgor, moist tongue, and mucous membranes, and orientation to person, place, and time.

InterventionRationale
Watch for early signs of hypovolemia, including thirst, restlessness, headaches, and inability to concentrateThirst is often the first sign of dehydration. Heart rate increases due to fluid restriction along with increased urine specific gravity, darker urine color, and increased thirst. Decreased alertness, increased sleepiness, fatigue, and confusion is also experienced
Recognize symptoms of cyanosis, cold clammy skin, weak thready pulse, confusion, and oliguria as late signs of hypovolemiaThese symptoms occur after the body has compensated for fluid loss by removing fluid from the interstitial space into the vascular compartment
Monitor pulse, respiration, and blood pressure of patients with deficient fluid volume every 15 minutes to 1 hour for unstable patients and every 4 hours for stable patientsChanges in vital signs seen with fluid volume deficit include tachycardia, tachypnea, decreased pulse pressure, hypotension, decreased pulse volume, and decreased or increased body temperature
Check orthostatic blood pressure with the patient standing, sitting, and lying.A decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within 3 minutes of standing compared with blood pressure from the sitting position is considered as orthostatic hypotension
Note the skin turgor over bony prominences such as the hand or shinFor the assessment of the level of dehydration  
Weigh the patient daily and watch for sudden decreases, especially in the presence of decreasing urine output or active fluid lossBody weight changes of 1 kg represent a fluid loss of 1 L
Monitor total fluid intake and output every 4 hours or every hour for unstable patients.To monitor the patient’s hydration status
Provide fresh water and oral fluids preferred by the patientTo promote hydration
Administer pharmacologic interventions such as antibiotics, antivirals, antidiarrheals, and antiemetics as ordered and appropriateTo treat the cause of the gastroenteritis

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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