Nausea and vomiting are the most common manifestations of gastrointestinal (GI) diseases. Although nausea and vomiting can occur independently, they are usually closely related and treated as one problem.

1. Dr.Vinoli.S.G
Professor Cum HOD Medical Surgical Nursing Dept
Universal College of Nursing
Bangalore

2. INTRODUCTION
Nausea and vomiting are the most
common manifestations of gastrointestinal
(GI) diseases. Although nausea and
vomiting can occur independently, they are
usually closely related and treated as one
problem.
2Dr.Vinoli.S.G

3. MEANING
• Nausea is a feeling of discomfort in the
epigastrium with a conscious desire to
vomit.
• Vomiting is the forceful ejection of partially
digested food and secretions (emesis) from
the upper GI tract.
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4. • Vomiting is a complex act that requires the coordinated activities
of several structures:
– closure of the glottis,
– deep inspiration with contraction of the diaphragm in the inspiratory
position,
– closure of the pylorus,
– relaxation of the stomach and lower esophageal sphincter (LES), and
– contraction of the abdominal muscles with increasing intra
abdominal pressure.
• These simultaneous activities force the stomach contents up
through the esophagus, into the pharynx, and out the mouth.
MEANING
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5. ETIOLOGY
• Pregnancy
• Infection
• Central nervous system (CNS) disorders (e.g., Meningitis,
tumor);
• Cardiovascular problems (e.g., Myocardial infarction, heart
failure);
• Metabolic disorders (e.g., Diabetes mellitus, addison’s disease,
renal failure)
• Postoperatively after general anesthesia
• Side effects of drugs (e.g., Chemotherapy, opioids, digitalis)
• Psychologic factors (e.g., Stress, fear); and
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6. • Conditions in which the GI tract becomes overly irritated,
excited, or distended. It includes
– Food poisoning
– Infections (such as the "stomach flu")
– Overeating
– A reaction to certain smells or odors.
– Gastroparesis or slow stomach emptying (a condition that can be
seen in people with diabetes)
– Ingestion of toxins or excessive amounts of alcohol
– Bowel obstruction
– Appendicitis
– Ulcers
ETIOLOGY
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7. PATHOPHYSIOLOGY
Stimuli involved in the act of vomiting. CTZ, Chemoreceptor trigger zone. 7Dr.Vinoli.S.G

8. Receptors for these afferent fibers are located in the
GI tract, kidneys, heart, and uterus. When stimulated,
these receptors relay information to the vomiting
center, which then initiates the vomiting reflex
Neural impulses reach the vomiting center via
afferent pathways through branches of the
autonomic nervous system
A vomiting center in the brainstem coordinates
the multiple components involved in vomiting.
This center receives input from various stimuli
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9. Parasympathetic stimulation causes relaxation of the LES, an
increase in gastric motility, and a pronounced increase in
salivation
Sympathetic activation produces tachycardia, tachypnea, and
diaphoresis
This action activates the autonomic nervous system, resulting
in both parasympathetic and sympathetic stimulation
Once stimulated, the CTZ transmits impulses directly to the
vomiting center
The chemoreceptor trigger zone (CTZ) located in the brainstem
responds to chemical stimuli of drugs, toxins, and labyrinthine
stimulation (e.g., motion sickness).
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10. CLINICAL MANIFESTATIONS
• Nausea
• Anorexia
• dehydration
• Water and essential electrolytes (e.g., potassium, sodium, chloride,
hydrogen) are lost.
• As vomiting persists, the patient may have severe electrolyte
imbalances, loss of extracellular fluid volume, decreased plasma
volume, and eventually circulatory failure
• Metabolic alkalosis can result from loss of gastric hydrochloric (HCl)
acid.
• When contents of the small intestine are vomited, metabolic
acidosis can occur.
• Weight loss 10Dr.Vinoli.S.G

11. MANAGEMENT
The goals of collaborative care are to
determine and treat the underlying cause of
the nausea and vomiting and to provide
symptomatic relief.
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12. Assessment
• Assess the patient for precipitating factors, and
describe the contents of the emesis.
– It is important to differentiate among vomiting,
regurgitation, and projectile vomiting.
– Regurgitation is an effortless process in which partially
digested food slowly comes up from the stomach.
– Projectile vomiting is a forceful expulsion of stomach
contents without nausea and is characteristic of CNS
(brain and spinal cord) tumors
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13. • Emesis containing partially digested food
several hours after a meal is indicative of
gastric outlet obstruction or delayed gastric
emptying.
• The presence of fecal odor and bile after
prolonged vomiting suggests intestinal
obstruction below the level of the pylorus.
• Bile in the emesis may suggest obstruction
below the ampulla of Vater.
Assessment
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14. • Vomitus with a “coffee ground” appearance is
related to gastric bleeding, where blood changes
to dark brown as a result of its interaction with
HCl acid.
• Bright red blood indicates active bleeding. This
could be due to a Mallory-Weiss tear (disruption
of the mucosal lining near the esophagogastric
junction), esophageal varices, gastric or
duodenal ulcer, or neoplasm.
Assessment
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15. DRUG THERAPY
• Phenothiazines (eg; chlorpromazine (Thorazine),
promethazine (Phenergan))
– Act in the CNS level of the CTZ
– Block dopamine receptors that trigger nausea and
vomiting.
• Antihistamines (eg; hydroxyzine (Vistaril)
diphenhydramine (Benadryl))
– Block the histamine receptors that trigger nausea and
vomiting
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16. • Prokinetic Agents (eg; domperidone (Motilium)
metoclopramide (Reglan))
• Inhibit action of dopamine ↑ Gastric motility and
emptying
• Serotonin (5-HT3) Antagonists (eg; dolasetron
(Anzemet) ondansetron (Zofran))
• Block the action of serotonin (substance that
causes nausea and vomiting)
DRUG THERAPY
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17. • Anticholinergic (Antimuscarinic) (eg;
scopolamine transdermal)
– Blocks the cholinergic pathways to the vomiting
center
• Butyrophenone (eg; droperidol (Inapsine))
– Blocks the neurochemicals that trigger nausea and
vomiting
• Others
– dexamethasone (Decadron)
– trimethobenzamide (Tigan)
DRUG THERAPY
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18. Nutritional Therapy
• IV fluid therapy with electrolyte and glucose
replacement until able to tolerate oral intake.
• In some cases a nasogastric (NG) tube and
suction are used to decompress the stomach.
• Start oral nutrition beginning with clear liquids
once symptoms have subsided.
• Broth and Gatorade are high in sodium, so
administer them with caution.
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19. • Water is the initial fluid of choice for
rehydration by mouth. Sipping small amounts
of fluid (5 to 15 mL) every 15 to 20 minutes is
usually better tolerated than drinking large
amounts less frequently.
• As the patient’s condition improves, provide a
diet high in carbohydrates and low in fat.
• Avoid Coffee, spicy foods, highly acidic foods,
and those with strong odors.
Nutritional Therapy
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20. • Tell the patient to eat food slowly and in
small amounts to prevent over distention of
the stomach.
• Liquids taken between meals rather than
with meals also reduce over distention
• Consult a dietitian regarding appropriate
foods that have nutritional value and are
well tolerated by the patient.
Nutritional Therapy
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21. Nondrug Therapy
• Acupressure or acupuncture at specific
points is effective in reducing postoperative
nausea and vomiting.
• Some patients use herbs such as ginger and
peppermint oil
• Relaxation breathing exercises, changes in
body position, or exercise may be helpful for
some patients.
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22. NURSING DIAGNOSES
• Nausea related to multiple etiologies
• Deficient fluid volume related to prolonged
vomiting
• Imbalanced nutrition: less than body
requirements related to nausea and
vomiting
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23. PLANNING
• The overall goals are that the patient
with nausea and vomiting will
(1) experience minimal or no nausea and
vomiting,
(2) have normal electrolyte levels and
hydration status, and
(3) return to a normal pattern of fluid balance
and nutrient intake.
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24. Nursing interventions
• Provide explanations regarding diagnostic tests or
procedures performed.
• Record intake and output
• Position the patient to prevent aspiration
• Monitor vital signs.
• Assess for signs of dehydration, and observe for
changes in the patient’s physical comfort and
mentation.
• Provide physical and emotional support, and
maintain a quiet, odor-free environment.
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25. • Teach the patient and the caregiver
– how to manage the unpleasant sensation of nausea,
– methods to prevent nausea and vomiting, and
– strategies to maintain fluid and nutritional intake
• keep the immediate environment quiet, free of noxious odors,
and well ventilated.
• Advise to avoid sudden changes of position and unnecessary
activity.
• Cleansing the face and hands with a cool washcloth
• Provide mouth care between episodes increase the person’s
comfort level.
Nursing interventions
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