Responding To Nausea & Vomiting Symptoms PDF

RESPONDING TO SYMPTOMS: GASTROINTESTINAL PROBLEMS NAUSEA & VOMITING LEARNING OUTCOMES Be able to discuss: The epidemiology, aetiology, symptoms and treatment of ○ Nausea & Vomiting  NAUSEA & VOMITING Nausea  Symptom of feeling near to the point of vomiting Vomiting...

RESPONDING TO SYMPTOMS: GASTROINTESTINAL PROBLEMS NAUSEA & VOMITING LEARNING OUTCOMES Be able to discuss: The epidemiology, aetiology, symptoms and treatment of ○ Nausea & Vomiting  NAUSEA & VOMITING Nausea  Symptom of feeling near to the point of vomiting Vomiting  Process by which stomach contents are expelled through the mouth Retching  Effort of vomiting but nothing is expelled  Regurgitation  Reflux OTHER SYMPTOMS  Sweating and cold sweats  Increased saliva production  Headaches  Feeling cold  Going pale (pallor)  Feeling weak NAUSEA & VOMITING - EPIDEMIOLOGY Common, especially in childhood Any age group can be affected Are symptoms of other conditions therefore epidemiology determined by the condition Most common cause is gastroenteritis  Norovirus (50%)  Rotavirus (20%, children)  Adenovirus  Astrovirus NAUSEA & VOMITING - AETIOLOGY  The chemoreceptor trigger zone (CTZ) in brain  Toxic substance may stimulate its chemoreceptors  Vomiting centre in brainstem receives nerve signals from CTZ and other pathways e.g. gut, liver signals  Vomiting centre sends impulses to pharynx, larynx, gut etc. to cause n & v plus other symptoms NAUSEA & VOMITING - CAUSES Causes are varied:  Gastrointestinal (food poisoning, acute appendicitis, GORD, blockage, overindulgence)  Metabolic (diabetic ketoacidosis, hyperCa2+)  Neurological (head injury, meningitis, migraine i.e. Pain, stress)  Ear disorder (labyrinthitis, infection)  Drug and chemical (chemotherapy)  Postoperative (general anaesthetic)  Psychiatric (bulimia nervosa)  Pregnancy  Movement (motion/mountain sickness) PREGNANCY  Usually begins between week 4 -7  Peaks between week 9 – 16  Usually resolves week 16 – 20  “Morning sickness” = misnomer  Hyperemesis gravidarum PREGNANCY - CAUSES  hCG  Placental origin  Oestrogen  Increased levels  Evolution  Prevent person eating potentially harmful foods  Gastric dysfunction  Increased progesterone level causes smooth muscle relaxation which impairs small bowel motility (therefore delayed gastric emptying)  Multifactorial  More common in multiple pregnancy, history of nausea MOTION SICKNESS  Caused by repeated movements  going over bumps in a car  moving up and down in a boat, plane or train or rides  going in circles  Inner ear sends different signals to your brain from those your eyes are seeing  Confusing messages cause nausea  All people can be affected by intense motion  More common in children and women  Usually throughout journey but can continue post-motion – “mal de debarquement” N & V – QUESTIONS & RELEVANCE Age  Common in children  Under 1 year - refer  Very young/old – risk of dehydration Onset  Gastroenteritis ○ Within 48hours of eating infected food ○ Can be within hours Abdominal pain  Gastroenteritis – cramping  Severity – refer N & V – QUESTIONS & RELEVANCE Timing  Early morning – pregnancy  Immediately after food – gastritis  1-2 hours after eating – gastroenteritis, peptic ulcer Other symptoms  Viral infection  Presence of blood  Tinnitus/dizziness – middle ear  Headache/aura – migraine REFERRAL  Symptoms of heart attack with nausea/vomiting  Chest pain, radiating pain, shortness of breath  Pregnancy  Hyperemesis suspected  Suspected GI bleed  Blood in vomit  Bilious vomiting  Dark green = possible GI obstruction  Suspected abdominal issue e.g. appendicitis  Moderate – severe dehydration  Potential serious secondary cause e.g. head injury, sepsis, eating disorder  VOMITING - TREATMENT Not much once started Stay hydrated  Rehydration therapy may be indicated Treatment depends on causality  Sometimes be harmful if cause not known Anti-emetics P-meds Other OTC treatments e.g. Pepto-Bismol (aspirin- like salicylates - claimed to relieve nausea & stomach upsets) POMs ANTIEMETICS  Prochlorperazine  Dopamine antagonist (phenothiazine)  Buccal tab for n&v associated with migraine only for P med  Can be prescribed otherwise  ANTIEMETICS – MOTION SICKNESS Prophylaxis  Hyoscine  Antimuscarinic with central and peripheral action  Several forms and brands e.g. Joy-Rides®, Kwells®  Patches = POM  ADRs?  Drowsiness  Sedating antihistamines  Cinnarizine (Stugeron®), promethazine (Phenergan®), cyclizine  Slightly less effective than hyoscine  Better tolerated than hyoscine PRACTICAL MEASURES (NAUSEA) What to do What not to do  Fresh air  Eat or cook strong-  Distractions e.g. smelling food music, TV  Eat hot, fried, greasy  Regular sips of cold food drink  Eat too quickly  Ginger or peppermint  Have a large drink with tea meals  Ginger foods  Lie down soon after  Smaller, more eating frequent meals  Wear tight clothes  Avoid strong smells around waist or tummy N & V - TREATMENT  Motion sickness  Prevention  Strategies  Sit in front of car/middle of boat  Not reading or watching film  Look at fixed point ahead on horizon  Close eyes/sleep  Focus on your breathing (slow)  Fresh air (open window)  Avoid heavy meals or alcohol  Break up long journeys to get fresh air/drink water/take a walk  Antiemetics  Acupressure or ginger  No strong clinical evidence  N & V - TREATMENT Pregnancy  Usually resolve  Strategies  Rest  Drink and eat little but frequently  Eat plain biscuits/crackers in morning  Bland, small, protein-rich meals low in carbohydrates and fat  Avoid caffeine, alcohol or foods/smells which trigger nausea  Ginger  Acupressure e.g. Sea-Bands®  Refer?  First-line prescribed treatment includes cyclizine or promethazine (antihistamines) or Xonvea® (doxylamine/pyridoxine) SUMMARY Be able to discuss: The epidemiology, aetiology, symptoms and treatment of Nausea & Vomiting REFERENCES AND FURTHER READING  https://cks.nice.org.uk/topics/nausea-vomiting-in- pregnancy/  https://www.nhs.uk/conditions/feeling-sick-nausea/  https://patient.info/digestive-health/nausea-and- vomiting  https://www.nhs.uk/conditions/motion-sickness/  Blenkinsopp A. Et al. Symptoms in the Pharmacy  Addison B et al. Minor illness or major disease. 5 th ed 2012  Alan Nathan. Non-prescription medicines.