Nausea, characterized by an unpleasant sensation in the throat, epigastric region, or abdomen, is a common symptom encountered across various patient populations. While often described as the feeling of wanting to vomit, nausea does not always culminate in emesis. As a subjective experience, it can significantly impact patient comfort and overall well-being. In the context of conditions like gastroparesis, where delayed gastric emptying is a hallmark, nausea becomes a particularly pertinent and challenging symptom to manage. This article delves into the nursing diagnoses associated with nausea, providing a framework for effective assessment, intervention, and patient care, especially in scenarios such as gastroparesis.
Nausea can stem from a multitude of factors, ranging from gastrointestinal disturbances—such as infections, overeating, acid reflux, or obstructions—to systemic issues like metabolic and cardiovascular disorders. It is also frequently linked to anxiety, medication side effects, pregnancy, motion sickness, and central nervous system problems. In conditions like gastroparesis, the underlying delayed gastric emptying contributes significantly to persistent nausea. Understanding the diverse etiologies of nausea is crucial for accurate diagnosis and targeted interventions.
Prolonged nausea, especially when accompanied by vomiting, can lead to severe complications. Dehydration, electrolyte imbalances, extracellular fluid volume loss, and circulatory failure are significant risks that necessitate prompt and effective nursing care. Therefore, managing nausea effectively is not only about alleviating discomfort but also about preventing serious physiological consequences.
This guide provides a comprehensive overview of nursing diagnoses related to nausea, offering insights into assessment, expected outcomes, and evidence-based interventions. It aims to equip nurses and healthcare professionals with the knowledge and tools necessary to provide holistic and effective care for patients experiencing nausea, including those with complex conditions like gastroparesis.
Nursing Process in Managing Nausea
Effective management of nausea hinges on a systematic nursing process. This involves identifying and addressing the underlying cause, managing associated complications, and providing symptomatic relief. A thorough assessment is paramount to pinpoint causative factors. In situations where nausea is anticipated, such as in patients undergoing chemotherapy or those with known gastroparesis, proactive measures, including premedication and patient education on nonpharmacologic strategies, are essential to mitigate discomfort.
Nurses play a pivotal role in not only managing nausea but also in educating patients about preventative and therapeutic self-management techniques. This empowers patients to actively participate in their care and enhances overall treatment outcomes.
Nursing Care Plans for Nausea and Vomiting
Nursing care plans are indispensable tools for prioritizing assessments and interventions for patients experiencing nausea and vomiting. They provide a structured approach to care, outlining both short-term and long-term goals. The following sections present examples of nursing care plans for various nursing diagnoses associated with nausea and vomiting, particularly relevant in conditions like gastroparesis where gastrointestinal motility and nutritional balance are often compromised.
Dysfunctional Gastrointestinal Motility
Disrupted gastrointestinal motility, whether increased or decreased, can manifest in a spectrum of symptoms, including nausea, vomiting, dyspepsia, bloating, abdominal cramps, abdominal distension, and early satiety. In the context of gastroparesis, decreased gastric motility is a primary concern, often leading to persistent nausea.
Nursing Diagnosis: Dysfunctional Gastrointestinal Motility
Related to:
- Disease process (e.g., gastroparesis, diabetic gastroparesis)
- Anxiety
- Stressors
- Changes in eating habits
- Malnutrition
- Unpleasant sensory stimuli
- Enteral feedings
- Unsanitary food preparation
As evidenced by:
- Food aversion
- Increased salivation
- Gagging sensation
- Increased swallowing
- Sour taste
- Abdominal cramping
- Abdominal pain
- Acceleration or delay of gastric emptying (delay is more pertinent in gastroparesis)
- Abdominal distention
- Regurgitation
- Altered bowel sounds
- Nausea/vomiting
Expected outcomes:
- Patient will demonstrate bowel sounds within normal limits.
- Patient will exhibit normal eating habits without experiencing nausea, vomiting, abdominal discomfort, dyspepsia, bloating, and early satiety. Specifically for gastroparesis, symptom management will be optimized to improve quality of life.
Assessment:
1. Assess causative factors contributing to the patient’s nausea and vomiting experience, especially considering gastroparesis.
Various factors can alter gastrointestinal motility. In patients with known or suspected gastroparesis, it is vital to assess factors exacerbating symptoms, such as dietary indiscretions, medication effects, or changes in disease status. Understanding these factors guides tailored interventions.
2. Assess the patient’s food intake and dietary patterns, particularly concerning foods known to exacerbate gastroparesis symptoms.
Food can be a significant trigger for nausea and vomiting, particularly in gastroparesis. Assess for specific food triggers, meal timing, and portion sizes. Documenting a detailed dietary history is crucial for nutritional management.
3. Assess the characteristics of the patient’s emesis.
Emesis characteristics can provide clues to underlying conditions. In gastroparesis, emesis may contain undigested food from several hours prior, reflecting delayed gastric emptying. Note the volume, frequency, color, and presence of bile or blood.
Interventions:
1. Keep the patient on NPO as ordered, especially during acute exacerbations of nausea and vomiting associated with gastroparesis.
NPO status allows the gastrointestinal tract to rest and can help to reduce nausea and vomiting, particularly when related to dysfunctional motility. This is often a short-term measure during symptom flares.
2. Insert and secure a nasogastric tube as indicated, particularly for severe or intractable nausea and vomiting or suspected gastric outlet obstruction in the context of gastroparesis complications.
A nasogastric tube can decompress the stomach, relieving pressure and reducing nausea and vomiting. Ensure proper securement to minimize discomfort and prevent further nausea stimulation.
3. Administer IV fluids and electrolyte replacement therapy.
Dehydration and electrolyte imbalances are common complications of persistent vomiting. Intravenous fluids are essential to maintain hydration and correct electrolyte deficits, which can further impair gastrointestinal motility.
4. Encourage the patient to avoid foods and beverages that are gastric irritants and known to worsen gastroparesis symptoms.
Dietary modifications are crucial in managing gastroparesis-related nausea. Advise patients to avoid high-fat foods, carbonated beverages, and large meals, which can delay gastric emptying and exacerbate nausea.
5. Consult with a dietician, especially for patients with gastroparesis requiring specialized dietary management.
A registered dietician can provide tailored dietary recommendations to manage gastroparesis symptoms, optimize nutrition, and minimize nausea and vomiting. This may include recommendations for small, frequent meals, low-fiber diets, and liquid nutritional supplements.
Imbalanced Nutrition: Less than Body Requirements
Nausea frequently impairs nutritional intake, leading to inadequate nutrient and fluid consumption. Food aversion and appetite loss are common, posing risks for dehydration and malnutrition, particularly in chronic conditions like gastroparesis.
Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements
Related to:
- Altered taste perception
- Food aversion
- Inadequate interest in food
- Difficulty swallowing
- Gastroparesis-related symptoms impacting oral intake
As evidenced by:
- Food intake less than recommended daily allowance (RDA)
- Nausea and vomiting
- Body weight below ideal weight range for age and gender
- Hypoglycemia
- Lethargy
- Pale mucous membranes
- Abdominal discomfort
- Hyperactive or hypoactive bowel sounds
- Abnormal nutritional lab values
Expected outcomes:
- Patient will exhibit balanced nutrition as evidenced by the absence of malnutrition.
- Patient will regain and maintain adequate body weight for age and gender, or maintain weight within acceptable parameters given the constraints of gastroparesis.
Assessment:
1. Assess and monitor the patient’s weight, particularly in the context of chronic nausea associated with gastroparesis.
Weight loss is a significant concern in patients with persistent nausea and vomiting. Regular weight monitoring helps to identify nutritional deficits and the effectiveness of interventions.
2. Assess and monitor for signs of malnutrition.
Malnutrition can develop insidiously. Assess for signs such as unintentional weight loss, fatigue, weakness, poor wound healing, brittle nails, and hair loss. In gastroparesis, malnutrition can be compounded by malabsorption.
3. Assess for oral health issues such as tooth decay or thrush.
Vomiting can erode tooth enamel and irritate the oral mucosa. Oral discomfort can further reduce appetite and nutritional intake.
Interventions:
1. Provide calorie-dense and nutrient-rich foods that are well-tolerated, considering gastroparesis dietary restrictions.
Small, frequent meals of calorie-dense, easily digestible foods are often better tolerated in gastroparesis. Focus on nutrient-rich options like smoothies, soups, and soft cooked vegetables.
2. Create a pleasant and comfortable environment conducive to eating.
Minimize strong odors and environmental distractions during mealtimes. Ensure a relaxed and unhurried atmosphere.
3. Premedicate with antiemetics as prescribed, especially before meals, for patients with chronic nausea like in gastroparesis.
Antiemetics can help reduce nausea and improve appetite, making it easier for patients to eat and maintain nutritional intake. Administering them proactively, before meals, can be particularly beneficial.
4. Implement tube feedings or parenteral nutrition if oral intake remains insufficient to meet nutritional needs, especially in severe gastroparesis.
Enteral or parenteral nutrition may be necessary for patients with persistent nausea and vomiting who cannot maintain adequate nutrition orally. This is a more aggressive intervention for severe cases.
Impaired Comfort
Nausea is inherently an uncomfortable sensation, causing significant distress and impacting overall well-being. It can disrupt daily activities and diminish quality of life, especially in chronic conditions like gastroparesis.
Nursing Diagnosis: Impaired Comfort
Related to:
- Disease process (e.g., gastroparesis)
- Lack of sleep
- Anxiety
- Insufficient control over symptoms
- Noxious environmental stimuli
As evidenced by:
- Restlessness
- Expresses discomfort
- Expresses psychological distress
- Irritable mood
- Reports altered sleep-wake cycle
- Fatigue
- Reports hunger (but aversion to eating)
- Abdominal discomfort
- Abdominal pain
- Nausea and vomiting
Expected outcomes:
- Patient will verbalize two strategies to reduce nausea and improve comfort.
- Patient will express improved comfort as evidenced by improved sleep and mood.
Assessment:
1. Assess the persistence and severity of nausea and vomiting.
Chronic and severe nausea significantly impacts quality of life. Assess the frequency, duration, and intensity of nausea episodes and their impact on daily functioning and emotional well-being.
2. Assess the possible cause of nausea and vomiting.
Identifying the underlying cause is essential for targeted interventions. In patients with known gastroparesis, assess for exacerbating factors and complications.
3. Assess the patient’s history of comfortability and coping strategies.
Understanding the patient’s usual comfort levels and coping mechanisms helps tailor comfort measures. Explore past strategies that have been effective in managing nausea.
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Interventions:
1. Create a relaxing and soothing environment.
Reduce environmental stimuli that can exacerbate nausea, such as strong odors, bright lights, and excessive noise. Ensure a cool and well-ventilated room.
2. Encourage ginger or peppermint tea.
Ginger and peppermint have antiemetic properties and can help soothe stomach upset. These natural remedies can be beneficial adjuncts to medical treatments.
3. Encourage foods that have little to no odor.
Strong food odors can trigger nausea. Suggest bland foods with minimal aroma, such as crackers, plain toast, or applesauce.
4. Encourage alternative ways to alleviate discomfort, such as meditation, deep breathing exercises, music therapy, and guided imagery.
These nonpharmacologic approaches can help patients manage nausea and promote relaxation and comfort. Deep breathing exercises, in particular, can be easily practiced and provide immediate relief.
5. Encourage the patient to take OTC or prescription remedies for nausea and vomiting as indicated.
Antiemetics, both over-the-counter and prescription, are often necessary to manage nausea effectively. Ensure patients understand proper medication use and potential side effects.
6. Use acupressure, specifically targeting the P6 (Neiguan) point.
Acupressure at the P6 point on the wrist has been shown to reduce nausea. Acupressure bands can be a convenient nonpharmacologic option.
Nausea
Nausea as a nursing diagnosis focuses on addressing the symptom itself, often as secondary to a primary medical condition like gastroparesis or other underlying issues.
Nursing Diagnosis: Nausea
Related to:
- Gastrointestinal problems (e.g., gastroparesis)
- Anxiety
- Noxious taste or smell
- Unpleasant sensory stimuli
- Exposure to toxins
- Alcohol intoxication
- Medication side effects
- Treatment or procedure like chemotherapy or radiation
- Pregnancy
- Motion sickness
- Increased intracranial pressure
- Pain
As evidenced by:
- Verbalization of nausea and urge to vomit
- Increased heart rate and respiration
- Cold, clammy skin
- Food aversion
- Increased swallowing
- Increased salivation
- Sour taste
- Gagging sensation
Expected outcomes:
- Patient will verbalize relief from nausea.
- Patient will be able to demonstrate strategies that prevent nausea.
Assessment:
1. Assess the possible causes and characteristics of nausea.
Determine the onset, duration, frequency, and triggers of nausea. Identifying the cause guides appropriate management strategies.
2. Assess the patient’s hydration status.
Nausea, especially when accompanied by vomiting, increases the risk of dehydration. Assess for signs of dehydration, such as dry mucous membranes, decreased skin turgor, and concentrated urine.
Interventions:
1. Provide the patient with routine oral care as needed.
Oral care helps remove unpleasant tastes and odors, which can exacerbate nausea. Regular mouth rinsing and oral hygiene are important.
2. Eliminate offending smells from the room.
Strong odors can worsen nausea. Ensure a well-ventilated environment free from strong smells.
3. Offer ginger ale and dry snacks.
Ginger can help settle the stomach, and dry, bland snacks like crackers can be easily tolerated and help absorb stomach acid.
4. Encourage the patient to eat small frequent meals.
Large meals can distend the stomach and worsen nausea, especially in gastroparesis. Small, frequent meals are generally better tolerated.
5. Encourage the patient to avoid spicy and greasy foods.
These foods can irritate the stomach and exacerbate nausea.
6. Administer antiemetics as indicated.
Antiemetics are often necessary to control nausea. Administer medications as prescribed and monitor for effectiveness and side effects.
7. Advise against taking medications on an empty stomach if nausea is a side effect.
Taking medications with food can sometimes reduce medication-related nausea, unless contraindicated.
Risk for Deficient Fluid Volume
Patients experiencing nausea, particularly with vomiting, are at high risk for fluid volume deficit and electrolyte imbalances.
Nursing Diagnosis: Risk for Deficient Fluid Volume
Related to:
- Nausea and vomiting
- Difficulty meeting increased fluid volume requirement
- Inadequate knowledge about fluid needs
- Insufficient fluid intake
- Gastroparesis-related delayed gastric emptying impacting fluid absorption
As evidenced by:
A risk diagnosis does not have defining signs and symptoms, as the problem has not yet occurred. Interventions are focused on prevention.
Expected outcomes:
- Patient will maintain hydration as evidenced by adequate intake and output, stable vital signs, and normal skin turgor.
Assessment:
1. Assess the patient’s fluid status.
Monitor for signs of fluid volume deficit, such as poor skin turgor, dry mucous membranes, sunken eyes, hypotension, and tachycardia.
2. Assess and monitor the patient’s intake and output.
Accurate intake and output monitoring is crucial to assess fluid balance.
3. Assess and monitor vital signs.
Hypotension and tachycardia are indicators of fluid volume deficit.
4. Monitor lab values, particularly electrolytes, BUN, and creatinine.
Abnormal lab values can reflect dehydration and electrolyte imbalances.
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Interventions:
1. Administer fluids intravenously as indicated.
IV fluids are necessary for patients with significant fluid volume deficit or when oral intake is insufficient.
2. Offer high-water content foods and fluids.
Soups, popsicles, fruits, and electrolyte-replacement drinks can help replenish fluids and electrolytes.
3. Administer antiemetics as indicated.
By reducing nausea and vomiting, antiemetics help prevent further fluid loss.
4. Encourage small sips of fluids or ice chips.
Small amounts of fluids may be better tolerated than larger volumes when nausea is present.
