Vomiting

Short and Crispy disease condition guide for DGNM, B.Sc Nursing & M.Sc Nursing Students .. regarding vomiting. Highly Recommended for II B.Sc Nursing Students.

1. VOMITING Mr. Aby Thankachan , M.Sc (N), PGDSH Senior Nursing Tutor Dept. of Medical Surgical Nursing KMCH Con, Coimbatore

2. DEFINITION Vomiting  is the involuntary, forceful expulsion of the contents of one's  stomach through the mouth and sometimes the  nose Nausea is an uneasiness of the stomach that often comes before vomiting. 

3. CAUSES Motion sickness or seasickness Early stages of pregnancy (nausea occurs in approximately 50%-90% of all pregnancies; vomiting in 25%-55%) Medication-induced vomiting Intense pain Emotional stress (such as fear) Gallbladder disease Food poisoning Infections (such as the "stomach flu") Overeating

4. A reaction to certain smells or odors Heart attack Concussion or brain injury Brain tumor Ulcers - Gastritis Some forms of cancer Bulimia or other psychological illnesses 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

5. Color of vomit Bright red in the vomit suggests bleeding from the esophagus Dark red vomit with liver-like clots suggests profuse bleeding in the stomach, such as from a perforated ulcer Coffee-ground-like vomit suggests less severe bleeding in the stomach because the gastric acid has had time to change the composition of the blood Yellow vomit suggests bile, indicating that the  pyloric valve  is open and bile is flowing into the stomach from the duodenum (this is more common in older people)

6. Treatment An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of medications such as opioids and chemotherapy. Antiemetics act by inhibiting the receptor sites associated with emesis. Hence, anticholinergics , antihistamines, dopamine antagonists, serotonin antagonists, and cannabinoids are used as antiemetics .

7. 5-HT3 receptor antagonists block serotonin receptors in the central nervous system and gastrointestinal tract, eg : Ondansetron Dopamine antagonists act on the brainstem and are used to treat nausea and vomiting associated with cancer, radiation sickness, opioids, cytotoxic drugs and general anaesthetics .  Eg : Domperidone , Metoclopramide NK1 receptor antagonist : Aprepitant Antihistamines (H 1  histamine receptor antagonists ) : Diphenhydramine Cannabinoids  : Sativex   Benzodiazepines (GABA receptor agonists ) : Midazolam  , Lorazepam Anticholinergics : Atropine , Diphenhydramine Steroids- Dexamethasone

8. There are several ways to try and prevent nausea from developing: Eat small meals throughout the day instead of three large meals. Eat slowly. Avoid hard-to-digest foods. Consume foods that are cold or room temperature if nauseated by the smell of hot or warm foods. Rest after eating with head elevated about 12 inches above feet. Drink liquids between meals rather than during meals. Try to eat when feel less nauseated.

9. When the patient begin to feel nauseated, the vomiting may be able to prevent by: Drinking small amounts of clear, sweetened liquids such as soda or fruit juices (except orange and grapefruit juices, because these are too acidic) Resting either in a sitting position or in a propped lying position; activity may worsen nausea and may lead to vomiting.