Nausea & Vomiting

cdunbar4's version from 2016-11-03 21:54

General GI

Question Answer
Rebound tenderness and what does it usually signal?pain response (sharp pain) upon withdrawal of deep palpation. Inflammation (peritonitis).
Rule of thumb if you suspect any inflammation in abdomen?Do NOT palpate because you can perforate any already damaged and inflamed area.
Epigastric areaabove umbilicus & b/t costal margins
Suprapubic areaabove symphysis pubic
McBurney's pointlocalized pain halfway b/t umbilicus & right iliac crest→appendicitis
normal percussion of abdomentympanic (gas) and dull (full bladder)
How long should you auscultate before charting absent bowel sounds?4-5 minutes
BROAD STROKES REST BOWEL; symptomatic relief (IV fluids, nutrition); stabilize; treat underlying cause

N/V Etiology, CC, Tx

Question Answer
nauseaSUBJECTIVE, feeling of discomfort in epigastrium with a conscious desire to vomit
vomitingOBJECTIVE forceful ejection of partially digested food and secretions; protective mechanism to rid body of spoiled foods/liquids.
projectile vomiting is usually due to what 2 thingsbrain injury or obstructive injury
Site of action used to induce vomiting in brain?CTZ: chemoreceptor trigger zone: responds to stimuli of drugs and toxins
Causes of n//vSE of drugs; GI disorders; pregnancy; infectious diseases; CNS disorders; CV problems; metabolic disorders
Manifestations that occur with n/vanorexia (↓ appetite); dehydration (loss of fluid and electrolytes)
pH shiftloss of HCl from stomach causes metabolic alkalosis
pH shift from losing NaHCO3 from small intestines?metabolic acidosis (less common)
PC of n/v → nursing intervention?pulmonary aspiration due to ↓ gag reflex → place in side lying position
Collaborative care for finding underlying causecareful HH; any precipitating factors?
Mallory-Weiss teartear and bleeding in esophagus
treatment and drugs depends onthe cause of the problem
5 anti-emetics usedphenothiazine; anticholinergic; antihistamine; prokinetic; serotonin antagonist
phenothiazines: Prototype & MOAthorazine; acts on CNS to block trigger
anticholinergics: prototype and MOAscopolamine; usually a "bladder" drug but has antichoinergic effect
antihistaminesphenergan; anticholinergic
prokineticsreglan; dopamine receptors
serotonin antagonistszofran; effective with cancer chemotherapy treatments
Anticholinergics are contraindicated with some patients: glaucoma, BPH, biliary or bladder neck obstruction

N/V Nutritional Therapy

Question Answer
IV fluids replace fluid and electrolytes
NG tube, why?"rest bowel" decompression of gastric....the rest of the bowel is still working, need to give nutrtion
Advance dietno temperature extremes: clear, full, bland/soft, regular
Fluidsbetween meals, small amounts and with meals
High carbs & low in fateasier to digest: potatoes, cereal, hard candy, plain gelatin
Foods to avoid: coffee, spicy or odorous foods, highly acidic foods
manifestations of dehydrationdizzy, tenting, dry mucous membranes, dark/scant urine, ↑ HR,

N/V Gerontological Consideration

Question Answer
Older patients are more likely to have _______ or _______ insufficiency that places them at greater risk when fluid and electrolyte balance is altered.cardiac and renal
If someone has CHF, what intervention should be implemented with caution?fluid replacement
↑ risk for aspiration in someone who is ↓ ??LOC
unintended weight loss may indicate cancer or depression
swallow studyxray camera, give something like yogurt to swallow as well as barium to watch where it goes.

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