{
  "name": "Nausea & Vomiting",
  "slug": "nausea-vomiting",
  "url": "https://nursingplex.com/care-plans/nausea-vomiting",
  "category": "Gastrointestinal",
  "summary": "Symptom control with antiemetics, hydration, oral care and trigger avoidance.",
  "nursing_diagnoses": [
    "Nausea",
    "Deficient fluid volume",
    "Imbalanced nutrition"
  ],
  "overview": [
    "Nausea is the unpleasant conscious sensation that vomiting may occur; vomiting is the forceful expulsion of gastric contents driven by the vomiting center in the medulla. The two are triggered by an enormous range of stimuli — drugs, chemotherapy, anesthesia, pregnancy, motion, infection, bowel obstruction, raised intracranial pressure, pain, anxiety and metabolic derangements — so nursing care starts with finding the cause rather than reaching for the same antiemetic every time.",
    "The consequences matter as much as the symptom. Repeated vomiting produces dehydration, hypokalemia, hypochloremia and metabolic alkalosis, weight loss, dental erosion and, in the vulnerable, aspiration. Anticipatory nausea — nausea triggered by the sight or smell of the treatment setting — is a learned response and is best prevented by controlling the very first episode well.",
    "Effective management pairs the right drug class to the right receptor pathway with practical nursing measures: environment, oral care, food texture, timing, positioning and rest."
  ],
  "key_facts": [
    {
      "label": "Electrolyte pattern",
      "text": "Prolonged vomiting causes hypokalemia, hypochloremia and metabolic alkalosis."
    },
    {
      "label": "Drug matching",
      "text": "5-HT3 blockers for chemotherapy, antihistamines/anticholinergics for motion, dopamine blockers for gastric causes, dexamethasone as an adjunct."
    },
    {
      "label": "Prevention beats rescue",
      "text": "Scheduled prophylactic antiemetics before emetogenic chemotherapy prevent anticipatory nausea later."
    },
    {
      "label": "Red flags",
      "text": "Projectile vomiting with headache (raised ICP), bilious or feculent vomit (obstruction), coffee-ground emesis (bleeding)."
    },
    {
      "label": "Aspiration risk",
      "text": "Position the vomiting patient upright or in a side-lying position, never flat on the back."
    }
  ],
  "nursing_priorities": [
    "Identify and treat the underlying cause.",
    "Prevent dehydration and correct electrolyte and acid-base imbalance.",
    "Protect the airway from aspiration.",
    "Prevent anticipatory nausea by controlling the first episode.",
    "Maintain nutrition and comfort, including oral hygiene."
  ],
  "assessment": {
    "subjective": [
      "Onset, duration, timing and triggers of nausea",
      "Relationship to meals, medication doses, movement or specific smells",
      "Reported thirst, dizziness, weakness or lightheadedness on standing",
      "Fear, dread or nausea triggered by the treatment room itself"
    ],
    "objective": [
      "Volume, color, and content of emesis: bilious, bloody, coffee-ground or feculent",
      "Dry mucous membranes, poor skin turgor, sunken eyes and concentrated urine",
      "Orthostatic hypotension, tachycardia and reduced urine output",
      "Weight loss and decreased oral intake",
      "Hypokalemia, hypochloremia, elevated bicarbonate and rising BUN",
      "Abdominal distention, absent bowel sounds or a surgical abdomen"
    ],
    "related_factors": [
      "Chemotherapy, radiation, opioids, antibiotics and anesthesia",
      "Gastrointestinal irritation, obstruction or delayed gastric emptying",
      "Pregnancy, motion or vestibular disturbance",
      "Increased intracranial pressure",
      "Pain, anxiety and noxious odors",
      "Metabolic causes such as uremia, ketoacidosis and hypercalcemia"
    ]
  },
  "goals": [
    "The client will report nausea reduced to a tolerable level within the ordered treatment window.",
    "The client will have no vomiting episodes over 24 hours.",
    "The client will maintain hydration with stable vitals, moist mucous membranes and urine output above 30 mL/hr.",
    "The client will maintain baseline weight and meet nutritional intake goals.",
    "The client will remain free of aspiration."
  ],
  "interventions": [
    {
      "title": "1. Assessing and treating the cause",
      "points": [
        "Take a focused history covering medication changes, chemotherapy timing, last bowel movement, pregnancy status and head symptoms.",
        "Review the medication list for emetogenic drugs and ask the provider about substitution or dose timing.",
        "Assess bowel sounds and distention; treat suspected obstruction with NPO status and decompression, not with prokinetics.",
        "Consider raised intracranial pressure when vomiting is projectile and unaccompanied by nausea."
      ]
    },
    {
      "title": "2. Giving antiemetics effectively",
      "points": [
        "Give antiemetics on a schedule rather than as needed during high-risk periods; a prevented episode is worth several treated ones.",
        "Administer 30–60 minutes before meals, procedures or chemotherapy so peak effect matches the trigger.",
        "Match the class to the mechanism and combine classes for chemotherapy-induced nausea as ordered.",
        "Monitor for side effects: QT prolongation with ondansetron, extrapyramidal symptoms with metoclopramide and promethazine, sedation with antihistamines.",
        "Use the IV or rectal route while the patient cannot keep oral medication down."
      ]
    },
    {
      "title": "3. Preventing dehydration and imbalance",
      "points": [
        "Track strict intake and output including emesis volume, and weigh daily.",
        "Offer small sips of cool clear fluids or ice chips once vomiting stops; large volumes restart it.",
        "Give IV fluid with potassium replacement as ordered and monitor electrolytes and bicarbonate.",
        "Watch for orthostatic changes before ambulating."
      ]
    },
    {
      "title": "4. Comfort, environment and nutrition",
      "points": [
        "Remove strong odors: food trays, perfumes, wound dressings and cleaning agents.",
        "Offer cool, bland, dry foods — crackers, toast, plain rice — and avoid greasy, spicy or very sweet items.",
        "Serve small frequent portions and let the patient avoid the room while food is prepared.",
        "Provide oral care after each episode to remove the taste and protect enamel; rinse rather than brush immediately after vomiting.",
        "Add non-drug measures with evidence: acupressure at P6, ginger, controlled breathing, distraction and a cool cloth to the forehead."
      ]
    },
    {
      "title": "5. Protecting the airway",
      "points": [
        "Position upright or side-lying during and after vomiting, especially in sedated, post-anesthesia or neurologically impaired patients.",
        "Keep suction available at the bedside for high-risk patients.",
        "Assess breath sounds and oxygenation after any witnessed aspiration and report promptly."
      ]
    }
  ],
  "patient_teaching": [
    "Take antiemetics before nausea peaks, not after — waiting makes them far less effective.",
    "Sip clear fluids slowly and frequently; advance to bland solids as tolerated.",
    "Avoid strong smells, greasy foods and lying flat right after eating.",
    "Report vomiting for more than 24 hours, blood or coffee-ground emesis, severe abdominal pain, or signs of dehydration such as no urine for 8 hours.",
    "Rinse your mouth with water or a baking-soda solution after vomiting and delay brushing for 30 minutes.",
    "Keep a symptom diary during chemotherapy so the antiemetic plan can be adjusted before the next cycle."
  ]
}