Symptom Management of Vomiting

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Table of Contents

Introduction
Vomiting and the need for management
Symptom management of vomiting
Conclusion
References

Introduction

Gastroenteritis is some form of inflammation caused by a pathogen. The pathogens may include bacteria, viruses, or parasites (European Society for Paediatric Infectious Diseases [ESPID], 2008). This inflammation occurs in the intestinal lining and may cause vomiting or diarrhea (World Health Organization [WHO], 2009). Tygat (2007) suggests that other signs and symptoms include cramping and pains in the abdomen. This condition is known to be caused by the rotavirus especially if a child is involved (Dalby-Payne & Elliott, 2009). However, there are different causative agents when it comes to adults. The main ones include the norovirus and the campylobacter (Mrukowicz, Szajewska, & Vesikari, 2008). Galanis (2007) argues that parasites and bacteria also cause the condition. However, this is usually a rare occurrence.

The major symptoms of this condition are vomiting and diarrhea. At times, they may both occur concurrently. However, either one of them may occur on the victim. For example, one could only experience vomiting, which may be severe. When one contracts the infectious agent, the symptoms appear after a specific period. This could be a matter of few hours or as many as three days (Dennehy, 2011). This paper will look at the nursing management and interventions for vomiting as one of the major symptoms of gastroenteritis.

Vomiting and the need for management

By definition, vomiting is whereby an individual’s stomach content is forced out. It mainly exits through the stomach or the nose. The causes include food poisoning, gastritis and other related conditions such as gastroenteritis (Nyachuba, 2010). Vomiting may be deadly on some occasions and this is whereby proper symptom management is required. For example, if the contents of the stomach enter the air pipe, this may be dangerous. Some reflex actions including the gag reflex normally help reduce the risk of choking. However, these reflexes may be influenced if the victim is under the influence of alcohol. Another danger is asphyxiation. One may also suffer from aspiration pneumonia.

Other effects of vomiting that require symptom management include dehydration and electrolyte imbalance. The electrolytes that are most influenced due to vomiting are potassium and sodium. When sodium levels in the body are elevated, this could be dangerous. This condition is referred to as hypernatremia. On the other hand, the levels of potassium may become dangerously low. When this occurs, it is referred to as hypokalemia. In cases where vomiting is severe and persistent, there may be the depletion of water in the body. This may lead to dehydration. This may also lead to the alteration of the electrolyte status. This is mainly because of the fact that the acids and chlorine in the stomach are lost in the process. Hypochloremic metabolic alkalosis is also a likely occurrence. An indirect effect of vomiting is hypokalemia. It occurs indirectly as an attempt to compensate for the lost acids. Although metabolic acidosis is a likely occurrence, it occurs less frequently. This occurs when the intestinal content is drawn back to the stomach.

Recurrent and excessive vomiting has also been determined to cause the erosion of the food pipe (Lawrence, Dobmeier, Bechtel, & Holstege, 2007). In other cases, small tears may occur in the region. This is referred to as Mallory-Weiss tear. Research also indicates that repeated and profuse vomiting can affect the teeth. The enamel of the teeth can be destroyed in the process. This is mainly due to the acid that is present in the contents vomited. Some of the enzymes that are vomited might also cause issues in the mouth. In particular, they affect the gum tissue. All these complications may be caused if vomiting (symptom) is not properly managed. Therefore, several nursing interventions may be undertaken in order to manage the symptom effectively.

Symptom management of vomiting

For effective management and treatment of the symptom, the exact cause of vomiting must be established. In the case where vomiting is caused by gastroenteritis, there are various interventions. One of the dangers that come with excessive vomiting is dehydration (Baumgart, 2011). This loss of fluids may also cause electrolyte disturbances. This is the imbalance in the body salts such as potassium. Dehydration is also referred to as deficient fluid volume. It is referred to this term especially when the loss of excess fluid is not accompanied by changes in sodium (salts) levels. This condition requires the intervention of the nurse, which includes the performing of lab experiments in order to ascertain the hydration status of the patient (Canavan & Arant, 2009). One of the signs includes the increase in the volume of the packed erythrocytes. This indicates that the plasma volume has significantly reduced hence causing the packing of the erythrocytes. This reduction in body fluids also causes the increase in the protein level in the plasma. One of the experiments may also include the assessment of the victim’s urine to check the specific gravity of urine. An individual showing the conditions will pass urine with increased specific gravity. The nurse should also lookout for a dry mucous membrane.

One of the easiest ways of managing dehydration and electrolyte imbalance due to vomiting is through the replacement of the fluids and the lost minerals. These elements may be taken by mouth (Britt & Fahridin, 2007). However, in severe cases, the patient may not be able to take it by mouth and this would only mean that they would be taken through intravenous fluid administration (Hartling, Bellemare, Wiebe, Russell, Klassen, & Craig, 2007). One of the solutions used for rehydration purposes includes the Oral Rehydration Solution (ORS).This has been used in the treatment of severe cases of gastroenteritis that lead to excessive and repeated vomiting. This solution is usually pre-packaged and available. However, this solution may not be found readily available in homes in case an emergency intervention is required. Therefore, several readily available solutions have been proposed as a remedy for dehydration due to gastroenteritis (Tintinalli, 2010). The common one is clean water. This may be used to rehydrate the patient. Other solutions may include lightly salted soup, green coconut water or water previously used for cooking cereals, among many others.

The use of salted water should be done in such a way as to avoid making the situation worse. This is because fluids with excess salt or sugar may cause the drawing of more water from the body in case the patient is also experiencing diarrhea due to gastroenteritis (Gregorio, Gonzales, Dans, & Martinez, 2009). It has been recommended that only a little salt and sugar should be mixed in water and used for rehydration. This means that the water should only have the concentration of salt almost similar to that of the tears.

The medical treatment that has been proposed by Mehta and Goldman (2006) for the treatment of dehydration is ondansetron. This has been used previously in children with mild or moderate levels of dehydration (Telmesani, 2010). This significantly controlled vomiting and it helped to avoid the use of intravenous fluid administration on the victim. Therefore, it was economical and efficient since it also helped avoid the hospitalization of the victim.

Vomiting that arises from acute gastroenteritis often occurs in children and individuals in the adolescent stage (Elliott, 2007). The treatment of the symptom in children with the disease has proven to be problematic. Clinicians have constantly debated on the issue concerning treatment with the use of antiemetics (Alhashimi, Al-Hashimi, & Fedorowicz, 2009). This is partly due to the possible side effects associated with the drug. However, the research by Decamp and colleagues (2008) has provided evidence to support the use of antiemetics in the treatment of the symptom in children. Such medications should only be taken as the physician instructs.

Previous research had indicated that oral ondansetron was effective in reducing vomiting (Amir, 2007). It also helped greatly in the facilitation of oral rehydration. This research had been done to investigate the medication that could help children with acute gastroenteritis. Amir (2007) argued that many physicians only used this kind of medication on patients undergoing chemotherapy and those who were from undergoing an operation in order to avoid vomiting. However, few have investigated its use in treatment of the symptom in the case of gastroenteritis.

Another issue that is brought about by vomiting is the changes in the acid-base balance (Sharon, 2008). It is important for the nurses to be aware of such changes and provide proper therapies. This balance is essential to the body in order to ensure that the primary function of the respiratory system is maintained. This process is the supply of adequate quantities of oxygen and the removal of carbon dioxide. The kidneys, on the other hand, perform the excretion of excess bases or acids. In severe vomiting, alkalosis is a likely result. This occurs when there is a drop in circulating fluid volumes. In order to correct this anomaly, venous administration is necessary. A weak acid is normally used to restore the lost balance. Alkalosis may also be a result of the intake of too many drugs. In such a case, the intervention includes the reduction of the intake in order to restore equilibrium.

It is also important for the nurse to understand that an individual who has experienced excessive and repeated vomiting may not be able to eat solid foods immediately since the gut may have been greatly affected. Such an individual needs to avoid any kind of solid food. Instead, one should sip lukewarm water frequently or go for a sports drink. The nurse could then provide the patient with a liquid diet for the stomach to be able to digest it. After the nurse is sure that the individual can digest the liquids properly, then he or she may start to administer light solid foods.

Conclusion

Gastroenteritis has been determined to show several symptoms including vomiting, which may turn out to be severe and dangerous (Szajewska & Dziechciarz, 2010). The dangers include dehydration, electrolyte imbalance and an alteration of the acid-base balance. Other indirect effects include hypokalemia. Proper symptom management of vomiting is required to ensure that vomiting does not cause further damage (Ray, Seetha, Juan, & Nissar, 2009). These include rehydration, use of supplements and medication. The nurse needs to ensure that the patient’s symptoms are well managed to avoid risks and to ensure a quick recovery.

References

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Baumgart, D.C., (2011). Viral gastroenteritis in adults. Recent Patents on Anti-infective Drug Discovery, 6(1), 54–63.

Britt, H., & Fahridin, S. (2007). Presentations of nausea and vomiting”. Aust Fam Physician, 36(9), 673–784.

Canavan, A., & Arant, S. (2009). Diagnosis and management of dehydration in children. Am Fam Physician, 80(7), 692–696.

Dalby-Payne, J., & Elliott, E. (2009). Gastroenteritis in children. BMJ Clinical Evidence, 9(1), 314.

DeCamp, L.R., Byerley, J.S., Doshi ,N., & Steiner, M.J. (2008). Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis. Arch Pediatr Adolesc Med, 162(9), 858–865.

Dennehy, P.H. (2011). Viral gastroenteritis in children. The Pediatric Infectious Disease Journal, 30(1), 63–64.

Elliott, E.J. (2007). Acute gastroenteritis in children. BMJ, 334(7583), 35–40.

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Galanis, E (2007). Campylobacter and bacterial gastroenteritis. Journal of Canadian Medical Association, 177(6), 570–571.

Gregorio, G.V., Gonzales, M.L., Dans, L.F., & Martinez, E.G. (2009). Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database Syst Rev, 1(2), 65-69.

Hartling, L., Bellemare, S., Wiebe, N., Russell, K., Klassen, T.P., & Craig, W. (2007). Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Evidence-Based Child Health, 2(1), 163-218.

Lawrence, D.T., Dobmeier, S.G., Bechtel, L.K., & Holstege, C.P. (2007). Food poisoning. Emergency medicine clinics of North America, 25(2): 357-373.

Mehta, S., Goldman, R.D. (2006). Ondansetron for acute gastroenteritis in children. Can Fam Physician, 52(11), 1397–1398.

Mrukowicz, J., Szajewska, H., & Vesikari T. (2008). Options for the Prevention of Rotavirus Disease Other Than Vaccination. Journal of Pediatric Gastroenterology and Nutrition. 46(2008), 32-37.

Nyachuba, D.G. (2010). Foodborne illness: is it on the rise. Nutrition Reviews, 68(5), 257-69.

Ray, P., Seetha, C., Juan, R., & Nissar, A. (2009). Ablation of Least Shrew Central Neurokinin NK1 Receptors Reduces GR73632-Induced Vomiting. Behavioural Neuroscience, 123(3), 701–706.

Sharon, E. (2008). Pathophysiology of acid base balance: The theory practice relationship. Intensive and Critical Care Nursing, 24(1), 28-40.

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Szajewska, H., & Dziechciarz, P (2010). Gastrointestinal infections in the pediatric population. Current opinion in gastroenterology, 26(1), 36–44.

Telmesani, A.M. (2010). Oral rehydration salts, zinc supplement and rota virus vaccine in the management of childhood acute diarrhea.” Journal of family and community medicine, 17(2), 79–82.

Tintinalli, J.E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies.

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