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.
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 Diagnosis for Nausea and Vomiting
Nursing Care Plan for Nausea and Vomiting 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.Nursing Interventions for Nausea and Vomiting Rationale 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 foods To 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 for Nausea and Vomiting 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.Nursing Interventions for Nausea and Vomiting Rationale 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 foods To 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 for Nausea and Vomiting 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 vomitingNursing Interventions for Nausea and Vomiting Rationale Determine the cause of nausea and vomiting (e.g., food poisoning). Determine the food source that caused nausea and vomiting Nausea 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 evaluation A 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 vomiting Elimination 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 electrolytes Recognizing 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 anticipated Antiemetic 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 for Nausea and Vomiting 4
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.Nursing Interventions for Nausea and Vomiting Rationale Educate the patient about other possible causes that trigger nausea and vomiting during pregnancy. Aside from the HCG hormone that causes the nauseous feeling, it may also be caused by a particular food, odor, or maybe due to low blood sugar that the pregnant patient usually experiences. If the patient knows the factors contributing to nausea and vomiting during pregnancy, hyperemesis gravidarum will be prevented. Educate the patient that persistent and severe vomiting is an emergency case for pregnant women as it may cause dehydration and could be fatal for the baby. Vomiting is normal for some pregnant patients but not to the extent that it happens continuously and severely. This intervention aims to educate the patients when it is the right time to seek medical attention. The patients must learn to recognize whether the vomiting they are experiencing is just because of the hormone or it is already hyperemesis gravidarum. Educate the patient about the signs and symptoms of hyperemesis gravidarum, such as severe and persistent nausea and vomiting, dehydration, thirst, tiredness, dizziness, or lightheadedness. Knowing the typical clinical manifestations of hyperemesis gravidarum can prevent the condition from further complications. Motivate the patient to eat small frequent meals every 2 hours rather than having big meals three times a day. This intervention is one of the best ways to alleviate nausea and vomiting during pregnancy. Educate the patient about different ways to manage dehydration when persistent nausea and vomiting arise. This intervention aims to prevent severe dehydration that could be fatal both for the mother and the baby.
Nursing Care Plan for Nausea and Vomiting 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.Nursing Interventions for Nausea and Vomiting Rationale Watch for early signs of hypovolemia, including thirst, restlessness, headaches, and inability to concentrate Thirst 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 hypovolemia These 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 patients Changes 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 shin For 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 loss Body 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 patient To promote hydration Administer pharmacologic interventions such as antibiotics, antivirals, antidiarrheals, and antiemetics as ordered and appropriate To 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. (2022). 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. (2020). 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
