Nausea and vomiting pose significant challenges in patient care, impacting their comfort and condition. Addressing these symptoms requires a comprehensive nursing approach that involves understanding the underlying causes, implementing tailored interventions, and providing empathetic support.
Utilize this comprehensive nursing care plan and management guide to provide effective care for patients experiencing nausea and vomiting. This resource will equip nurses with knowledge of nursing assessments, interventions, goals, and nursing diagnoses specifically tailored to address and alleviate symptoms of nausea.
Table of Contents
- What is Nausea and Vomiting?
- Causative Factors
- Nursing Care Plans and Management
- Nursing Problem Priorities
- Nursing Assessment
- Nursing Diagnosis
- Nursing Goals
- Nursing Interventions and Actions
- 1. Assessment for Nausea and Vomiting
- 2. Managing Chronic and Acute Nausea and Vomiting
- 3. Provide Interventions for Pregnant Clients with Nausea and Vomiting
- 4. Managing Postoperative Clients with Nausea and Vomiting
- 5. Providing Care for Chemotherapy-Induced Nausea and Vomiting
- 6. Client and Caregiver Education
- Recommended Resources
- See also
- References and Sources
What is Nausea and Vomiting?
Nausea is a distressing sensation that may or may not lead to vomiting. It can have various causes, including medication side effects, chemical stimulation, gastrointestinal issues, or psychological factors. Pregnancy-related nausea, also known as morning sickness, is a common experience for many women. Nurses play a crucial role in identifying the causes of nausea, administering antiemetic medications, assessing their effectiveness, and communicating relevant information to healthcare providers for necessary treatment adjustments.
Vomiting or emesis is a physical event and is the forceful expulsion of intestinal and gastric contents through the mouth. Stimuli that can evoke vomiting include chemotherapy, toxins, viruses, fungi, food poisoning, radiation, medications, and motion. Vomiting is frequently accompanied by nausea, but not always (Zhong et al., 2021).
Understanding the underlying causes of nausea and vomiting is important to identify the appropriate nursing assessments, interventions, and management strategies to alleviate this distressing symptom. Here are common reasons that can cause nausea and vomiting:
Nausea can have various causes, including treatment-related factors such as gastric distention, certain medications, postoperative recovery, and tube feeding.
- Gastric distention. Abdominal bloating or swelling leads to a feeling of fullness and discomfort in the stomach.
- Medications. Certain drugs, such as painkillers, HIV treatment, aspirin, opioids, and chemotherapy agents, can cause nausea as a side effect.
- Postoperative. Nausea experienced after surgery, often due to the effects of anesthesia or the body’s response to the surgical procedure.
- Stomach upset. Discomfort in the stomach is caused by factors like alcohol consumption, drug use, gastrointestinal bleeding, or iron supplements.
- Tube feeding. Nausea results in feeding intolerance when feeding is given too quickly.
- Bowel obstruction. Blockage in the intestines disrupts normal digestion and leads to nausea.
- Cardiac pain. Chest discomfort or angina is caused by inadequate blood supply to the heart.
- Cancer. Nausea can be a symptom of cancer, especially in advanced stages or during chemotherapy.
- Cough. Persistent or severe coughing can trigger nausea due to increased pressure and irritation in the chest and abdomen.
- Gastrointestinal diseases. Various conditions like gastritis, gastroenteritis, or peptic ulcers can cause inflammation in the digestive system and result in nausea.
- Increased ICP. Nausea can be associated with increased intracranial pressure, often caused by conditions like head trauma, brain tumors, or cerebral edema.
- Infections. Nausea can occur as a response to infections, such as viral gastroenteritis or urinary tract infections.
- Motion sickness. Nausea and dizziness are caused by the sensory mismatch between what the eyes see and the body feels during motion or travel.
- Peritonitis. Inflammation of the lining of the abdominal cavity leads to severe abdominal pain, tenderness, and nausea.
- Pregnancy. Nausea and vomiting are commonly experienced during early pregnancy, often referred to as morning sickness.
- Uremia. The buildup of toxins in the bloodstream due to kidney dysfunction, leads to nausea and other symptoms.
- Toxins. Ingestion or exposure to harmful substances, such as chemicals or certain foods, can cause nausea.
- Tumors. Nausea can be associated with the presence of tumors in various parts of the body, depending on their location and impact on organ function.
- Vestibular problems. Disorders affecting the inner ear or balance system can result in dizziness and nausea, such as labyrinthitis or Meniere’s disease.
Nursing Care Plans and Management
Nursing care plan management plays an important role in effectively addressing the needs of clients dealing with nausea and vomiting. Nursing care plans allow for tailored interventions that consider these factors, promoting personalized care that maximizes comfort and relief. These are developed based on evidence-based practices and clinical guidelines that ensure interventions are grounded in research and have a higher likelihood of being effective in managing symptoms, therefore enhancing client outcomes.
Nursing Problem Priorities
The following are the nursing priorities for clients with nausea and vomiting:
- Fluid and electrolyte imbalance. Prolonged vomiting can lead to dehydration and electrolyte imbalances. Maintaining fluid and electrolyte balance is a priority to prevent further complications.
- Deficient nutrition. Nausea and vomiting can lead to inadequate oral intake and malnutrition. Addressing nutritional deficits through appropriate dietary modifications or alternative feeding methods is essential.
- Risk of aspiration. Clients experiencing frequent vomiting are at risk of aspirating gastrointestinal contents, leading to aspiration pneumonia. Preventing aspiration through proper positioning, suctioning, and monitoring respiratory status is crucial.
- Client and caregiver education. Educating the client and their family about the causes of nausea and vomiting, potential triggers, and strategies for managing symptoms is a priority.
Nursing assessment for clients with nausea and vomiting is essential in understanding the cause, severity, and impact of symptoms, guiding the development of effective care plans, and monitoring the client’s progress and well-being. Nausea and vomiting are characterized by the following signs and symptoms.
- Allergy to food. Nausea can be a response to an allergic reaction triggered by certain foods, as the body’s immune system releases chemicals that can cause gastrointestinal discomfort.
- Excessive salivation. Excessive salivation, also known as hypersalivation or sialorrhea, can occur as a reflex response to the body’s attempt to protect the digestive tract from potential irritants, contributing to the sensation of nausea.
- Gagging sensation. The sensation of gagging can accompany nausea as the body’s natural defense mechanism to prevent the intake of potentially harmful substances, such as when encountering strong odors or tastes.
- Increased swallowing. The swallowing reflex can be heightened during episodes of nausea as the body attempts to clear the gastric contents and alleviate the discomfort.
- Reports of nausea. Clients experiencing nausea may report a subjective feeling of unease or discomfort in the upper abdomen or throat, indicating the presence of this symptom.
- Sour taste in the mouth. The sensation of a sour taste in the mouth can occur as stomach contents reflux into the esophagus, leading to gastroesophageal reflux disease (GERD) or acid regurgitation, which can be associated with nausea.
Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with nausea and vomiting based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.
The following are the common goals and expected outcomes for nausea and vomiting:
- The client will report decreased severity or elimination of nausea and vomiting.
- The client will be able to manage the symptoms effectively and improve the quality of life.
- The client will be able to prevent the development of complications, such as aspiration and dehydration.
- The client will improve their nutritional intake and gain or maintain appropriate weight.
Nursing Interventions and Actions
The nursing interventions for clients with nausea and vomiting focus on symptom management, maintaining fluid and electrolyte balance, providing dietary modifications, educating the client and family, and collaborating with the healthcare team. The following are the therapeutic nursing interventions for nausea that can be used for the development of nursing care plans:
1. Assessment for Nausea and Vomiting
Proper assessment is the foundation for the development of effective care plans and interventions. Information gleaned from thorough assessment guides the urgency of interventions and helps healthcare professionals monitor the client’s progress over time.
1. Determine causes of nausea and vomiting.
Assessing the client with the causes of nausea will guide the choice of interventions to be used. Treatment may not be needed if the stimulus is eliminated. The differential diagnosis for nausea and vomiting is broad and includes a number of pathological, anatomic, and metabolic disorders, which need to be considered in the evaluation process (Cangemi & Kuo, 2019).
2. Assess the client’s vital signs.
A postural decrease in blood pressure and an increase in pulse rate with standing suggest significant dehydration; a decrease in blood pressure without any change in pulse rate suggests autonomic neuropathy.
3. Auscultate the client’s abdominal area.
Auscultation may demonstrate increased bowel sounds in obstruction or absent bowel sounds in the ileus. A succession splash detected by listening over the epigastrium while shifting the abdomen side to side suggests gastroparesis or gastric outlet obstruction.
4. Assess nausea characteristics including duration, frequency, severity, precipitating factors, medication history, and previous measures used to relieve the problem.
A thorough assessment and evaluation of nausea can help determine interventions to lessen or ease the problem. With most chemotherapeutic agents, the acute phase begins one to two hours after IV administration, is most severe during the following eight hours, and then gradually improves. Delayed nausea and vomiting can occur 24 hours or more after administration of chemotherapy.
5. Record the client’s hydration status, daily weights, intake, and output, and assess skin turgor.
Nausea is usually correlated with vomiting which can change a client’s hydration status because of fluid loss. Severe vomiting can lead to symptomatic dehydration and electrolyte abnormalities. Chronic vomiting can result in undernutrition, weight loss, and metabolic abnormalities (Gotfried & Katz, 2022).
6. Assist the client in diagnostic testing preparation.
A series of tests may be used to determine the contributing factor (e.g., upper gastrointestinal tract study, abdominal computed tomography scan, ultrasonography). All females of childbearing age should have a urine pregnancy test. Clients with severe vomiting, vomiting lasting over one day, or signs of dehydration on examination should have other laboratory tests, such as electrolytes, BUN, creatinine, glucose, urinalysis, and liver function tests.
7. Review the prenatal vitamins the client is taking, if pregnant.
Having too much iron may cause nausea, and switching to a different vitamin could help. Guidelines state that pregnant women should be prompted to discontinue iron-containing supplements during the first trimester of pregnancy and substitute them with folic acid or vitamins low in iron. Reports on improvement in the severity of nausea and vomiting supported this intervention (Tsakiridis et al., 2019).
8. Review medications that the client takes.
Several dopamine-based agonists developed for the treatment of schizophrenia, Parkinson’s disease, ADHD, depression, and restless leg syndrome evoke nausea and vomiting as common impending adverse effects. Clinically used drugs that prevent the metabolism of acetylcholine such as choline esterase inhibitors also evoke vomiting.
9. Perform a brief neurological exam as appropriate.
A neurologic examination may include assessing carnival nerves (checking for ocular movements suggesting mitochondrial cytopathy, pupillary responses to light, or nystagmus), and observing the client’s gait. Cranial nerve abnormalities and/or long tract signs suggest a CNS cause. Brainstem tumors may present with vomiting and may be accompanied by long tract or cranial nerve signs, although these may be rare.
11. Evaluate the client for eating disorders.
When an underlying cause has not been found after a careful history, physical examination, and testing, clients with persistent symptoms of nausea and vomiting should be evaluated for an eating disorder. Clients at high risk may include young women, competitive athletes, those with a first-degree family member with an eating disorder, and those with significant anxiety, depression, body image disorder, or sexual orientation/ gender expression disorders.
2. Managing Chronic and Acute Nausea and Vomiting
Chronic nausea and vomiting are defined by a symptom duration of 4 weeks or longer, in contrast to acute nausea and vomiting, generally defined by a symptom duration of 7 days or less. This distinction is important, as most cases of acute nausea and vomiting represent a transient medical condition, a self-limited somatic disorder, or a medication side effect (Lacy et al., 2018).
1. Provide an emesis basin within easy reach of the client.
Nausea and vomiting are closely related. Keep the emesis basin out of sight but within the client’s reach if nausea has a psychogenic component. An emesis basin helps contain vomit in a controlled area, minimizing the risk of contamination and making it easier to clean up afterward.
2. Educate and assist the client with oral hygiene.
This is associated with anorexia and excessive salivation. Oral hygiene helps alleviate the condition and facilitates comfort. Emesis is also acidic and can erode tooth enamel, leading to dental cavities and sensitivity. Regular oral hygiene helps remove acidic residues and prevents the buildup of harmful bacteria that contribute to tooth decay. Maintaining oral hygiene also improves the client’s comfort and removes the unpleasant smell and taste of it in the mouth.
3. Eliminate strong odors from the surroundings (e.g., perfumes, dressings, emesis)
Strong and noxious odors can contribute to nausea. The chemoreceptor trigger zone in the brain is sensitive to various stimuli, including strong odors. This zone is closely connected to the vomiting center in the brainstem, and the stimulation of this zone can lead to the initiation of the vomiting reflex.
4. Maintain fluid balance in clients at risk.
Sufficient hydration before surgery or chemotherapy has been shown to reduce the risk of nausea in these situations. It has been suggested that perioperative fluid status is an important risk factor for the development of postoperative nausea and vomiting. A recent meta-analysis looking into laparoscopic cholecystectomy reported that carbohydrate beverage before surgery was associated with a significantly lower risk of postoperative vomiting (Jin et al., 2020).
5. Allow the client to use nonpharmacological nausea control techniques such as relaxation, guided imagery, music therapy, distraction, or deep breathing exercises.
These methods have helped clients alleviate the condition but need to be used before it occurs. Complementary and alternative medical therapies (CAM) are also increasingly being used by clients for a variety of conditions including nausea and vomiting. These may be for refractory symptoms or for clients who wish to avoid allopathic treatment.
6. Introduce cold water, ice chips, ginger products, and room temperature broth or bouillon if tolerated and appropriate to the client’s diet.
These aid hydration. Ginger helps relieve nausea whether in ginger ale, ginger tea, or chewed as crystallized ginger. The antiemetic effects of ginger are mediated by its constituent chemicals gingerol, shogaol, and zingerone, which act through serotonin and NK1 receptors in the central and peripheral pathways of nausea and vomiting. Fluids that are too cold or hot may be difficult to tolerate.
7. Give frequent, small amounts of foods that appeal to the client.
This approach will help maintain nutritional status. For some clients, an empty stomach exacerbates nausea. Crackers or toast before rising are especially known to be effective for pregnancy-related nausea. Clients may also endure bland, simple foods such as broth, rice, bananas, or Jell-O. They should attempt to consume more when nausea is absent.
8. Advise the client to avoid foods and smells that trigger nausea.
Strong and noxious odors can contribute to nausea. Some individuals are more sensitive to strong odors due to genetic factors or past experiences. These individuals may be more prone to experiencing nausea and vomiting in response to strong smells. Intense odors can overwhelm the olfactory system and lead to sensory overload, which can trigger physiological responses.
9. Position the client upright while eating and for 1 to 2 hours post-meal
This can be helpful in reducing the risk of aspiration. Being upright helps gravity guide food and liquids down the esophagus and into the stomach, reducing the risk of aspiration. Staying upright after meals also helps prevent stomach contents from flowing back into the esophagus, reducing the risk of gastroesophageal reflux disease.
10. Keep rooms well-ventilated. If possible, assist the client to go outside to get some fresh air.
A well-ventilated room or having a fan close by promotes easier breathing. Proper ventilation also helps remove strong and lingering odors from the room, creating a more tolerable and hygienic environment. Ventilation also removes airborne particles, allergens, and pollutants from the room. This is especially important for clients with immunocompromised systems or medical conditions.
11. Administer antiemetics as ordered.
Most antiemetics work by increasing the threshold of the chemoreceptor trigger zone to stimulation. Drugs with antiemetic actions include antihistamines, anticholinergics, dopamine antagonists, serotonin (5-HT3) receptor antagonists, and benzodiazepines. Glucocorticoids and cannabinoids are useful to treat chemotherapy-induced nausea and vomiting. For the preoperative client, administration of antiemetics prior to surgery has been shown to reduce postoperative nausea and vomiting.
12. Evaluate the client’s response to antiemetics or interventions to alleviate the condition.
This approach is helpful in determining the effectiveness of such interventions. Transdermal scopolamine improves symptoms in some clients with chronic nausea and vomiting, but some clients note the side effects of visual changes and a dry mouth. These agents may retard gastric emptying by their antimuscarinic effects and should be avoided in clients with gastroparesis.
13. Apply Acustimulation bands as ordered, or apply acupressure.
Stimulation of the Neiguan P6 acupuncture point on the ventral surface of the wrist has been found to control nausea at some points. This has been found to be helpful for clients who experience motion-related nausea. Acustimulation with wristbands for nausea of various etiologies has reports of positive effects on nausea. Most studies compared the acustimulation bands to a placebo band in the wrong location and no band at all (Bishop et al., 2019).
For clients with gastrointestinal disorders
1. Identify medications that should be discontinued and refer them to the healthcare provider.
Medications that decrease gastrointestinal motility should be discontinued, such as opioids, dopamine agonists, calcium channel blockers, alpha2-adrenergic blockers, and muscarinic cholinergic antagonists. In clients with diabetic gastroparesis, pramlintide, and GLP-1 analogs should be avoided, as they decrease gastric emptying. NSAIDs and aspirin should ideally be stopped in clients with esophagitis, gastritis, and/or peptic ulcer identified on endoscopy.
2. Provide adequate oral nutrition as recommended.
Poor oral intake may result in deficiencies in calories, vitamins, and minerals. The stomach empties at a rate of up to 2.5 kcal/min. Clients with gastroparesis should consume small, frequent meals, low in fat and fiber, since high-fat and non-digestible fiber may delay gastric emptying. Blenderized solids or nutrient liquids can be used since gastric emptying of liquids is usually preserved in gastroparesis.
3. Instruct the client to remain on NPO as indicated.
A client with acute gastritis should be instructed to take no food or fluids by mouth for a few days until acute symptoms subside, thus allowing the gastric mucosa to heal. After symptoms subside, the nurse may offer ice chips followed by clear liquids.
4. Encourage the client to avoid intake of caffeinated beverages and alcoholic drinks. Promote smoking cessation.
Caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion. The nurse should also discourage alcohol use and cigarette smoking. Smoking and alcohol can delay gastrointestinal transit. Additionally, nicotine reduces the secretion of pancreatic bicarbonate, which inhibits the neutralization of gastric acid in the duodenum.
5. Monitor the client’s intake and output.
Daily fluid intake and output are monitored to detect early signs of dehydration (minimal fluid intake of 1.5 liters per day, minimal urine output of 0.5 mL/kg/hour). If food and oral fluids are withheld, IV fluids usually are prescribed and a record of fluid intake plus caloric value needs to be maintained.
6. Recommend the use of ginger to relieve nausea and vomiting.
Ginger, in a variety of forms (powder, oils, tea, candied, crystallized, pickled) has been used for the treatment of nausea and vomiting. The precise action of its antiemetic function is still unknown, however. A systematic review of ginger found that ginger when used as a supplement to other antiemetic drugs, provided some further relief of symptoms.
7. Administer enteral nutrition as indicated.
As long as small bowel function is normal, jejunal feeding improves symptoms and reduces hospitalizations while maintaining nutrition. Enteral feeding is preferred over parenteral nutrition due to lower potential for complications and cost, and greater ease of delivery.
8. Administer the appropriate medication for the client’s underlying disease/disorder.
There is a broad category of agents used to treat nausea and vomiting caused by gastrointestinal disorders, with the caveat that most of the data used to support clinical decision-making is from studies of gastroparesis.
These agents promote the movement of luminal contents through increased contractility of the GI tract. Erythromycin was the most effective on gastric emptying, while both erythromycin and domperidone improved overall symptoms.
- Dopamine receptor antagonists
These agents theoretically accelerate gastric emptying. Metoclopramide is the only FDA-approved medication for gastroparesis. Metoclopramide is available in tablet form, orally disintegrating, liquid, and injectable form, as well as nasal spray. Domperidone is as efficacious as metoclopramide but may cause prolonged QTc, cardiac arrhythmias, and sudden cardiac death.
- Motilin receptor agonists
Macrolide antibiotics are motilin receptor agonists that stimulate enteric cholinergic neurons and smooth muscle directly. Erythromycin and azithromycin stimulate gastric emoting and antral pressure activity.
Antiemetics are required for the management of nausea and vomiting. Commonly prescribed agents include phenothiazines, antihistamines, or 5-HT3 receptor antagonists. Scopolamine competitively inhibits muscarinic receptors for acetylcholine and exerts central sedative, antiemetic, and amnestic effects. However, scopolamine must be avoided in clients with gastroparesis because it may retard gastric emptying.
9. Provide pain management interventions as appropriate.
Abdominal pain is reported by 90% of clients with gastroparesis and may contribute to symptoms of nausea and vomiting. Mirtazapine helped ameliorate symptoms, especially nausea and vomiting, in individual reports of diabetic or non-diabetic gastroparesis. Low-dose gabapentin may improve visceral pain in some clients and also improve symptoms of nausea.
10. Prepare the client for surgical interventions.
When evaluating clients with chronic nausea and vomiting, mechanical and/or anatomical causes may be identified. These should be corrected surgically, as indicated. A client who has persistent symptoms of nausea and vomiting and gastroparesis and is resistant to all standard and experimental therapy may benefit from total gastrectomy.
11. Assist in inserting an NG tube for decompression.
In treating the client with gastric outlet obstruction, the first consideration is to insert an NG tube to decompress the stomach. Confirmation that obstruction is the cause of the discomfort is accomplished by assessing the amount of fluid aspirated from the NG tube. A residual of more than 400 mL suggests obstruction.
12. Prepare the client for electrical stimulation of the stomach as indicated.
Low-frequency stimulation has been shown to normalize gastric dysrhythmias and entrain gastric slow waves and accelerate gastric emptying with minimal effects on subjective nausea and vomiting. High-frequency stimulation employs short pulse duration at a higher frequency and can be delivered either continuously or at intervals while utilizing less energy. It has been shown to significantly reduce symptoms of nausea and vomiting in gastroparesis clients.
3. Provide Interventions for Pregnant Clients with Nausea and Vomiting
Nausea and vomiting is an extremely common pregnancy disorder that ranges from mild to moderate; severe nausea and vomiting are the second most common indications for pregnancy hospitalization and are considered pathological. Symptoms usually peak between 10 and 16 weeks of pregnancy and usually disappear on their own (Liu et al., 2021).
1. Monitor the client’s symptoms using validated survey tools.
Scores from the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE), a validated survey tool, have been found to be clinically useful since the scores are associated with quality of-life measurements (Ogunyemi & Isaacs, 2022).
2. Provide small, frequent meals.
During the antenatal period, frequent small meals every one to two hours to avoid a full stomach are recommended. Instruct the client to eat when they are hungry, regardless of normal meal times as long as it is not a full meal.
3. Instruct the client to avoid intake of spicy and fatty foods.
Pregnant women should be advised to avoid spicy and fatty foods; a study showed that protein meals were more likely to alleviate symptoms of nausea and vomiting in pregnancy than carbohydrate or fatty foods. The client may also increase their intake of bland or dry foods.
4. Recommend acupuncture or acupressure. Instruct significant other on the appropriate location of pressure points.
Methods of treating nausea and vomiting in pregnant women by acting on PC-6 (Neguian) acupoint include acupuncture and acupoint pressing. PC-6 acupoint is a traditional Chinese medicine point, located two cm above the transverse crease of the wrist, between the tendons. Acupuncture is an effective nonpharmacological method of treating HG by inserting needles into the PC-6 acupoint. Acupressure is an effective nonpharmacological method to relieve nausea and vomiting symptoms by applying pressure at the PC-6 acupoint to stimulate the median nerve.
5. Promote the use of ginger for the relief of nausea and vomiting.
Ginger therapy is a simple, easily available, convenient, and effective method for the treatment of nausea and vomiting during pregnancy. Ginger helps improve nausea and vomiting by stimulating the movement of the gastrointestinal tract and the flow of saliva, bile, and gastric secretions. The safe treatment of 1000 mg of ginger per day for four days can improve the symptoms of nausea and vomiting in pregnant women.
6. Initiate intravenous rehydration for hyperemesis gravidarum (HG).
Intravenous fluid rehydration is usually recommended for clients with HG who have severe dehydration or ketonuria. Rapid maternal hydration usually relieves many symptoms of HG. In a study, glucose saline may be associated with better improvement than normal saline in moderate to severe cases.
7. Provide adequate prenatal vitamin and mineral supplementation.
Several studies have proven that women who received a multivitamin at the same time of conception were less likely to need medical attention for vomiting. Hence, the consumption of vitamin supplements for one month before pregnancy is recommended because it can reduce the incidence and severity of nausea and vomiting in pregnancy.
8. Advise the client to discontinue iron therapy.
According to the American College of Obstetrics and Gynecology (ACOG) guidelines, pregnant women should be prompted to discontinue iron-containing supplements during the first trimester of pregnancy and substitute them with folic acid or adults’ or children’s vitamins low in iron. A Canadian cohort study also found that the majority of women who discontinued iron supplements reported improvements in the severity of nausea and vomiting.
9. Administer pharmacologic treatment as prescribed.
It is known that combining antiemetics with different mechanisms of action can improve the antiemetic effect during systematic therapy.
- 9.1. Ondansetron
Ondansetron is a selective 5-HT3 receptor antagonist that has been approved for the treatment of nausea and vomiting related to pregnancy. A meta-analysis and review of ondansetron and the risk of major congenital malformations reported no increased rate of major or selected subgroups of malformations.
- 9.2. Pyridoxine
Pyridoxine is considered to be effective in relieving the severity of nausea in early pregnancy. A combination of pyridoxine and metoclopramide was found to be superior to either monotherapy in the treatment of nausea and vomiting in pregnancy.
- 9.3. Promethazine
Promethazine is primarily an antihistaminergic medication and also acts as a weak dopamine antagonist. It is effective in treating nausea and vomiting in pregnancy but has significant maternal side effects including dystonia, sedation, and decreased seizure threshold.
10. Provide enteral tube nutrition as recommended.
If antiemetic medications and fluids are insufficient to reduce nausea and vomiting, ketonuria persists, and the client is unable to improve nutritional intake, additional nutritional therapy should be considered. Tube feeding is preferred when long-term nutritional therapy is required. Enteral tube feeding may be given by a gastric tube or jejunal tube positioned by gastroscopy.
4. Managing Postoperative Clients with Nausea and Vomiting
Postoperative nausea and vomiting (PONV) remain a common and distressing complication of surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor. Although these complications of treatment are usually self-limiting and are seldom life-threatening, the deleterious effects on nutritional status and quality of life can be substantial.
1. Identify the client’s risk for PONV.
Client-specific risk factors for PONV in adults include the female sex, a history of PONV and/or motion sickness, nonsmoking status, and young age. Certain types of surgery may be associated with an increased risk of PONV including laparoscopic, bariatric, gynecological surgery, and cholecystectomy. PONV risk factors should be used for risk assessment and to guide PONV management (Gan et al., 2020).
2. Place the client in a side-lying position.
At the slightest indication of nausea, the nurse should turn the client completely to one side to promote mouth drainage and prevent aspiration of vomitus, which can cause asphyxiation and death.
3. Recommend the use of an aromatherapy inhaler.
Nurses working with postoperative clients should be aware that alternatives to pharmacologic intervention are available to control postoperative nausea and vomiting. An aromatherapy inhaler is client-controlled, and it appears to present an effective postoperative nausea treatment.
4. Suggest chewing gum postoperatively with consent from the healthcare provider or surgeon.
Chewing gum is showing promise for the treatment of PONV, with one small pilot study suggesting that chewing gum was not inferior to ondansetron for the treatment of PONV in female clients who underwent laparoscopic or breast surgery under general anesthesia.
5. Initiate IV fluid therapy.
Adequate hydration is an effective strategy for reducing the risk of PONV. this can be achieved by minimizing perioperative fasting time or using supplemental IV fluid to maintain clinical euvolemia. A recent Cochrane review showed that supplemental crystalloids reduce the risk of both early and late PONV as well as the need for rescue antiemetics.
6. Administer medications as indicated.
Many medications are available to control postoperative nausea and vomiting without oversedating the client; they are commonly given during surgery as well as in the PACU.
- 6.1. Metoclopramide
This acts by stimulating gastric emptying and increasing GI transit time. The administration is recommended at the end of the surgical procedure.
- 6.2. Prochlorperazine
This is indicated for the control of severe nausea and vomiting and can be given via the oral, sustained-release,, rectal, IM, and IV forms.
- 6.3. Dimenhydrinate
This is indicated for the prevention of nausea, vomiting, or vertigo of motion sickness.
- 6.4. Hydroxyzine
This can be given for control of nausea and vomiting and as an adjunct to analgesia preoperatively and postoperatively to allow decreased opioid dosage.
- 6.5. Scopolamine
This is used to prevent and control nausea and vomiting associated with motion sickness and recovery from surgery.
- 6.6. Ondansetron
This can be administered as prevention of postoperative nausea and vomiting. This has a few side effects and is frequently the drug of choice.
7. Avoid the administration of opioids as appropriate.
Opioid-free anesthesia is defined as “the absolute avoidance of opioids from induction of anesthesia until complete emergence”; and opioid-free analgesia as “the absolute avoidance of opioids in the pre and postoperative periods”. Avoidance of opioids in the postoperative period eliminates the risk of any opioid-related adverse events, including PONV.
5. Providing Care for Chemotherapy-Induced Nausea and Vomiting
Nausea and vomiting are common impending side effects of cancer cytotoxic chemotherapeutics. The emetic action of these cytotoxic drugs initiates within the gastrointestinal tract.
1. Encourage the client to perform relaxation activities (acupuncture acupressure).
Some studies have shown that relaxation methods are effective in controlling all types of CINV and not just anticipatory CINV. specifically, acupuncture has gained popularity as a potential alternative treatment. There is currently a trial examining the effect of acupuncture, nausea and vomiting, and quality of life (Gupta et al., 2021).
2. Recommend the use of medicinal plants with approval from the healthcare provider.
Medicinal plants such as Citrus aurantium, Hypericum perforatum, L. Achillea millefolium iL, and Zingiber officinale have successfully treated CINV, with Zingiber officinale shown to be superior to other compounds. Ginger supplementation may also lead to improved CINV-related quality of life and less fatigue.
3. Encourage adequate food intake. Avoid oily and fatty foods.
Diet modifications have also been demonstrated to improve the gastrointestinal side effects. Nausea has been linked to oils and vomiting has been shown to have an inverse correlation with the intake of energy, fat, protein, carbohydrates, B group vitamins, vitamin D, phosphorus, and zinc. If experiencing nausea, the American Cancer Society recommends eating bland foods, such as dry toast and crackers; avoiding fatty, fried, spicy, or very sweet foods; using butter, oils, syrups, sauces, and milk to raise calories, and eating food cold or at room temperature to decrease its smell and taste, thereby minimizing nausea.
4. Offer small, frequent meals.
Eating smaller, more frequent meals can prevent the stomach from becoming too full, which can trigger nausea. Also, providing non-greasy and east-to-digest foods can help minimize gastrointestinal irritation.
5. Administer antiemetic agents as prescribed.
Several families of drugs with antiemetic activity have been identified. When used as single agents, only the 5-HT3 receptor antagonists and the NKI receptor antagonists show marked activity against highly emetogenic chemotherapy.
- 5.1. 5-HT3 receptor antagonists
These agents are the most effective family of antiemetic agents in the treatment of acute emesis. These agents block the serotonin type 3 receptors and are thought to exert their antiemetic activity primarily through peripheral blockade in the small intestine. The first three agents in the US were ondansetron, granisetron, and dolasetron.
- 5.2. NKI receptor antagonists
The addition of these agents to a standard antiemetic combination regimen improves the control of acute and delayed CINV. these agents include aprepitant, fosaprepitant, and rolapitant.
- 5.3. Corticosteroids
The antiemetic mechanism of corticosteroids is unclear. However, because of their moderate efficacy, corticosteroids should be used as single agents only in the prophylaxis of mildly emetogenic chemotherapy. Caution must be used in treating clients with diabetes or other conditions predisposing them to difficulties with steroids.
- 5.4. Olanzapine
Several single-institution trials suggested antiemetic activity, particularly in reducing delayed nausea and vomiting. Olanzapine is also effective in reducing breakthrough nausea and vomiting. The major side effect is sedation, which occurs commonly and can be severe.
6. Client and Caregiver Education
Empowering clients and their significant others with knowledge enables them to actively participate in their care and make informed decisions that can help improve the client’s quality of life.
1. Educate the client or caregiver about appropriate fluid and dietary options for nausea.
Clients and caregivers can promote adequate hydration and nutritional status by acknowledging dietary points to consider when nauseated. Anorexia may occur in clients undergoing chemotherapy because these clients develop early satiety after eating only a small amount of food. Whenever possible, every effort is made to maintain adequate nutrition through the oral route.
2. Educate the client to take prescribed medications as ordered.
Following the prescribed schedule for medications reduces episodes of nausea. Medications used in the management of acute nausea and vomiting consist of antiemetics (agents that suppress nausea and prevent vomiting by central action) and prokinetics (agents that act peripherally by modulating gastrointestinal motility).
3. Educate the client about the importance of changing positions slowly and calmly.
Abrupt or gross movements may aggravate the condition. Rapid changes in positions, such as standing quickly, can cause sudden shifts in blood pressure. This abrupt change can worsen feelings of dizziness, lightheadedness, and nausea. A gradual change allows the body to adjust to new positions, minimizing the likelihood of triggering or worsening nausea and vomiting.
4. Educate the client or caregiver on the use of nonpharmacological nausea control techniques such as relaxation, guided imagery, music therapy, distraction, aromatherapy, or deep breathing exercises.
Teaching the client and caregiver methods to control nausea increases the sense of personal efficacy in managing nausea. An aromatherapy inhaler is client-controlled, and it appears to present an effective postoperative nausea treatment.
5. Inform the client or caregiver to seek medical care if vomiting develops or persists for longer than 24 hours.
Persistent vomiting can result in dehydration, electrolyte imbalance, and nutritional deficiencies. Prolonged vomiting can lead to dehydration and imbalances in electrolytes, such as potassium, sodium, and chloride. These imbalances can affect heart function, muscle contractions, and body fluid balance.
6. Educate the client or caregiver on how to apply Acustimulation bands or acupressure.
Clients and caregivers may desire to proceed with intervention if it is found useful and effective. The most commonly used point in the literature on nausea and vomiting in pregnancy is pericardium 6 (PC6), located four fingerbreadths from the crease of the wrist in between two tendons. This is the location where acupressure wristbands are placed.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
References and Sources
References and sources used for this nursing diagnosis guide for nausea and vomiting.
- Bishop, K. C., Ford, A. C., Kuller, J. A., & Dotters-Katz, S. (2019). Acupuncture in Obstetrics and Gynecology. Obstetrical & Gynecological Survey, 74(4).
- Cangemi, D. J., & Kuo, B. (2019). Practical Perspectives in the Treatment of Nausea and Vomiting. Journal of Clinical Gastroenterology, 53(3).
- Gan, T. J., Belani, K. G., Bergese, S., Chung, F., Diemunsch, P., Habib, A. S., Jin, Z., Kovac, A. L., Meyer, T. A., Urman, R. D., Apfel, C. C., Ayad, S., Beagley, L., Candiotti, K., Englesakis, M., Hendrick, T. L., Kranke, P., Lee, S., Lipman, D., … Philip, B. K. (2020). Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesthesia & Analgesia, 131(2).
- Gotfried, J., & Katz, L. (2022). Nausea and Vomiting – Gastrointestinal Disorders – MSD Manual Professional Edition. MSD Manuals.
- Gupta, K., Walton, R., & Kataria, S.P. (2021). Chemotherapy-Induced Nausea and Vomiting: Pathogenesis, Recommendations, and New Trends. Cancer Treatment and Research Communications, 26.
- Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s Textbook of Medical-surgical Nursing. Wolters Kluwer.
- Jin, Z., Gan, T. J., & Bergese, S. D. (2020). Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies. Therapeutics and Clinical Risk Management, 16.
- Lacy, B. E., Parkman, H. P., & Camilleri, M. (2018). Chronic nausea and vomiting: evaluation and treatment. American Journal of Gastroenterology.
- Liu, C., Zhao, G., Qiao, D., Wang, L., He, Y., Zhao, M., Fan, Y., & Jiang, E. (2021). Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities. Frontiers in Medicine, 8.
- Niederhuber, J. E., Armitage, J. O., Doroshow, J. H., Kastan, M. B., & Tepper, J. E. (2019). Abeloff’s Clinical Oncology (J. E. Niederhuber, J. O. Armitage, J. H. Doroshow, M. B. Kastan, & J. E. Tepper, Eds.). Elsevier.
- Ogunyemi, D. A., & Isaacs, C. (2022, April 12). Hyperemesis Gravidarum: Practice Essentials, Background, Pathophysiology. Medscape Reference.
- Tsakiridis, I., Mamopoulos, A., Athanasiadis, A., & Dagklis, T. (2019). The Management of Nausea and Vomiting of Pregnancy: Synthesis of National Guidelines. Obstetrical & Gynecological Survey, 74(3).
- Zhong, W., Shahbaz, O., Teskey, G., Beever, A., Kachour, N., Venketaraman, V., & Darmani, N. A. (2021). Mechanisms of Nausea and Vomiting: Current Knowledge and Recent Advances in Intracellular Emetic Signaling Systems. International Journal of Molecular Sciences, 22(11).