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Purpose
Nausea and vomiting are unpleasant and potentially distressing symptoms that are commonly experienced by patients. This is especially the case for individuals receiving perioperative care, during pregnancy and childbirth, receiving chemotherapy and in the advanced stages of a disease or at the end of life (Dye, 2017; Leach, 2019). Nausea and vomiting can also be a sign of more serious impairment, emotional distress or an adverse reaction to therapeutic treatments (Keeley, 2019).
The potential impact of nausea and vomiting on an individual's wellbeing and quality of life can vary and will depend on the length and severity of the specific episodes, but in some cases can be so severe that individuals may decide to stop treatment (Brooker and Waugh, 2013; Kelly and Ward, 2013).
Prolonged nausea and vomiting can result in physiological complications, psychological changes and social difficulties that could have short- or long-term consequences for health. The most frequent
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Assessment
Terminology
An understanding of the medical terminology associated with nausea and vomiting is important for reliable and effective assessment and management of patients' symptoms (Table 1).
| Table 1. Medical terminology associated with nausea and vomiting | |
| Terminology | Definition |
| Nausea |
- Subjective experience of feeling sick - Unpleasant feeling, often leading to vomiting - Commonly associated with symptoms of hypersalivation and tachycardia |
| Retching |
- Movements associated with vomiting without the expulsion of gastrointestinal contents - Often begins with deep inspiration |
| Emesis |
- Vomiting |
| Vomiting |
- The forceful emptying of stomach contents through the mouth - Usually associated with nausea and follows retching |
| Emetic symptoms |
- Nausea, retching and vomiting |
| Emetogenic potential |
- Ability of a treatment, eg chemotherapy, to cause nausea, retching and vomiting |
| Antiemetics |
- Medication used to treat nausea, retching and vomiting |
| Projectile vomiting |
- Spontaneous vomiting not preceded by nausea or retching - Normally associated with direct neurological |
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Procedure
Effective management of nausea and vomiting not only influences a patient's symptom response, it also improves patient compliance with therapeutic treatments. However, because there is a vast array of possible management strategies, depending on the quality of the assessment and the resources available, it is essential that health professionals involve the patient in the decision-making process, and use a multimodal approach that incorporates both pharmacological and non-pharmacological management methods (Collis and Mather, 2015; Dye, 2017; Lister et al, 2020).
Pharmacological management
The most common intervention used in today's healthcare system is the administration of medication, because it is often a safe and effective way of managing the signs and symptoms of diseases (National Institute for Health and Care Excellence (NICE), 2015).
Concerning the nausea and vomiting, antiemetics (anti-sickness) medication should be prescribed only when the specific cause of nausea and vomiting are known, because antiemetics vary in their mechanism(s) of
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Risks and complications
Mouth care
Following episodes of vomiting, bile and acids from the stomach can cause damage to teeth, gums and throat, and result skin irritation around the mouth. To ensure that the structures and tissues of the mouth remain healthy it is essential to assist patients with oral mouth care and ensure that they have access to equipment to perform oral hygiene (Burns et al, 2019). Removing the taste through oral hygiene can also help with reducing nausea (Nicol et al, 2012).
Privacy and dignity
Close curtains to provide privacy and promote comfort by keeping clothes clean and ensure that tissues and vomit bowls are easily accessible (Nicol et al, 2012; NICE, 2021).
Fluid balance
Vomiting and nausea can change a patient's hydration status, putting them at risk of dehydration. It is therefore important to keep an accurate record of the patient's fluid balance and,
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NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 1: Procedures for assessing people’s needs for person-centred care
1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages
Part 2: Procedures for the planning, provision and management of person-centred nursing care
5.5 identify, respond to and manage nausea and vomiting
11. Procedural competencies required for best practice, evidence-based medicines administration and optimisation
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Resources
British National Formulary. Nausea and labyrinth disorders. 2023. https://bnf.nice.org.uk/treatment-summaries/nausea-and-labyrinth-disorders/ (accessed 1 November 2023)
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