Nausea
Nausea: Excerpt from Nursing: Interpreting Signs and Symptoms
Nausea is a sensation of profound revulsion to food or of impending vomiting. Typically accompanied by autonomic signs, such as hypersalivation, diaphoresis, tachycardia, pallor, and tachypnea, it's closely associated with anorexia and vomiting.
Nausea, a common symptom of GI disorders, also occurs with fluid and electrolyte imbalance; infection; metabolic, endocrine, labyrinthine, and cardiac disorders; and as a result of drug therapy, surgery, and radiation. Commonly present during the first trimester of pregnancy, nausea may also arise from severe pain, anxiety, alcohol intoxication, overeating, or ingestion of distasteful food or liquids.
History and physical examination
Begin by obtaining a complete medical history. Focus on GI, endocrine, and metabolic disorders; recent infections; and cancer and its treatment. Ask about drug use and alcohol consumption. If the patient is a female of childbearing age, ask if she is or could be pregnant. Have the patient describe the onset, duration, and intensity of the nausea as well as what causes or relieves it. Ask about related complaints, particularly vomiting (such as color and amount), abdominal pain, anorexia and weight loss, changes in bowel habits or stool character, excessive belching or flatus, and a sensation of bloating.
Inspect the skin for jaundice, bruises, and spider angiomas, and assess skin turgor. Next, inspect the abdomen for distention, auscultate for bowel sounds and bruits, palpate for rigidity and tenderness, and test for rebound tenderness. Palpate and percuss the liver for enlargement. Assess other body systems as appropriate.
Medical causes
Adrenal insufficiency.Common GI findings in adrenal insufficiency include nausea, vomiting, anorexia, and diarrhea. Other findings include weakness; fatigue; weight loss; bronze-colored skin; hypotension; a weak, irregular pulse; vitiligo; and depression.
Anthrax (GI).Initial signs and symptoms of GI anthrax include nausea, vomiting, loss of appetite, and fever. Signs and symptoms may progress to abdominal pain, severe bloody diarrhea, and hematemesis.
Appendicitis.With acute appendicitis, a brief period of nausea may accompany the onset of abdominal pain. Pain typically begins as vague epigastric or periumbilical discomfort and rapidly progresses to severe stabbing pain localized in the right lower quadrant (McBurney's sign). Associated findings usually include abdominal rigidity and tenderness, cutaneous hyperalgesia, fever, constipation or diarrhea, tachycardia, anorexia, moderate malaise, and positive psoas (increased abdominal pain occurs when the examiner places his hand above the patient's right knee and the patient flexes his right hip against resistance) and obturator signs (internal rotation of the right leg with the leg flexed to 90 degrees at the hip and knee with a resulting tightening of the internal obturator muscle that causes abdominal discomfort).
Cholecystitis (acute).With acute cholecystitis, nausea commonly follows severe right upper quadrant pain that may radiate to the back or shoulders, usually following meals. Associated findings include mild vomiting, flatulence, abdominal tenderness and, possibly, rigidity and distention, fever with chills, diaphoresis, and a positive Murphy's sign.
Cholelithiasis.With cholelithiasis, nausea accompanies attacks of severe right upper quadrant or epigastric pain after eating fatty foods. Other associated findings include vomiting, abdominal tenderness and guarding, flatulence, belching, epigastric burning, tachycardia, and restlessness. Occlusion of the common bile duct may cause jaundice, clay-colored stools, fever, and chills.
Cirrhosis.Insidious early signs and symptoms of cirrhosis typically include nausea and vomiting, anorexia, abdominal pain, and constipation or diarrhea. As the disease progresses, jaundice and hepatomegaly may occur with abdominal distention, spider angiomas, palmar erythema, severe pruritus, dry skin, fetor hepaticus, enlarged superficial abdominal veins, mental changes, and bilateral gynecomastia and testicular atrophy or menstrual irregularities.
Diverticulitis.Besides nausea, diverticulitis causes intermittent crampy abdominal pain, constipation or diarrhea, a low-grade fever, and commonly a palpable, tender, firm, fixed mass.
Escherichia coli O157:H7. Signs and symptoms of E. coli infection include nausea, watery or bloody diarrhea, vomiting, fever, and abdominal cramps. In children younger than age 5 and in the elderly, hemolytic uremic syndrome—in which red blood cells are destroyed—may develop. This may ultimately lead to acute renal failure.
Gastritis.Nausea is common with gastritis, especially after ingestion of alcohol, aspirin, spicy foods, or caffeine. Vomiting of mucus or blood, epigastric pain, belching, fever, and malaise may also occur.
Gastroenteritis.Usually viral, gastroenteritis causes nausea, vomiting, diarrhea, and abdominal cramping. Fever, malaise, hyperactive bowel sounds, abdominal pain and tenderness, and possible dehydration and electrolyte imbalances may also develop.
Heart failure.Heart failure may produce nausea and vomiting, particularly with right-sided heart failure. Associated findings include tachycardia, a ventricular gallop, profound fatigue, dyspnea, crackles, peripheral edema, jugular vein distention, ascites, nocturia, and diastolic hypertension.
Hepatitis.Nausea is an insidious early symptom of viral hepatitis. Vomiting, fatigue, myalgia and arthralgia, headache, anorexia, photophobia, pharyngitis, cough, and fever also occur early in the preicteric phase.
Hyperemesis gravidarum.Unremitting nausea and vomiting that persist beyond the first trimester are characteristic of hyperemesis gravidarum. Vomitus ranges from undigested food, mucus, and bile early in the disorder to a coffee-ground appearance in later stages. Associated findings include weight loss, signs of dehydration, headache, and delirium.
Intestinal obstruction.Nausea commonly occurs, especially with high small-intestinal obstruction. Vomiting may be bilious or fecal; abdominal pain is usually episodic and colicky, but can become severe and steady with strangulation. Constipation occurs early in large-intestinal obstruction and later in small-intestinal obstruction; obstipation may signal complete obstruction. Bowel sounds are typically hyperactive in partial obstruction and hypoactive or absent in complete obstruction. Abdominal distention and tenderness occur, possibly with visible peristaltic waves and a palpable abdominal mass.
Labyrinthitis.Nausea and vomiting commonly occur with labyrinthitis. More significant findings include severe vertigo, progressive hearing loss, nystagmus, tinnitus and, possibly, otorrhea.
Listeriosis.Signs and symptoms of listeriosis include nausea, vomiting, diarrhea, fever, myalgia, and abdominal pain. If listerosis spreads to the nervous system and causes meningitis, signs and symptoms include fever, headache, nuchal rigidity, and a change in the level of consciousness (LOC).
Ménière's disease.Ménière's disease causes sudden, brief, recurrent attacks of nausea, vomiting, vertigo, tinnitus, diaphoresis, and nystagmus. It also causes hearing loss and ear fullness.
Mesenteric venous thrombosis.An insidious or acute onset of nausea, vomiting, and abdominal pain occurs with mesenteric venous thrombosis, along with diarrhea or constipation, abdominal distention, hematemesis, and melena.
Metabolic acidosis.Metabolic acidosis may produce nausea and vomiting, anorexia, diarrhea, Kussmaul's respirations, and decreased LOC.
Migraine headache.Nausea and vomiting may occur in the prodromal stage of a migraine headache, along with photophobia, light flashes, increased sensitivity to noise, light-headedness and, possibly, partial vision loss and paresthesia of the lips, face, and hands.
Motion sickness.With motion sickness, nausea and vomiting are brought on by motion or rhythmic movement. Headache, dizziness, fatigue, diaphoresis, hypersalivation, and dyspnea may also occur.
Myocardial infarction (MI).Nausea and vomiting may occur with an MI, but the cardinal symptom is severe substernal chest pain that may radiate to the left arm, jaw, or neck. Dyspnea, pallor, clammy skin, diaphoresis, altered blood pressure, and arrhythmias also occur.
Norovirus infection.Acute gastroenteritis from noroviruses commonly causes infected individuals to experience nausea. Common accompanying symptoms include vomiting, diarrhea, and abdominal pain or cramping. Less commonly, individuals may develop low-grade fever, headache, chills, muscle aches, and generalized tiredness.
Pancreatitis (acute).Nausea, usually followed by vomiting, is an early symptom of pancreatitis. Other common findings include steady, severe pain in the epigastrium or left upper quadrant that may radiate to the back; abdominal tenderness and rigidity; anorexia; diminished bowel sounds; and fever. Tachycardia, restlessness, hypotension, skin mottling, and cold, sweaty extremities may occur in severe cases.
Peptic ulcer.With peptic ulcer, nausea and vomiting may follow attacks of sharp or gnawing, burning epigastric pain. Attacks typically occur when the stomach is empty or after the ingestion of alcohol, caffeine, or aspirin; they're relieved by eating food or taking an antacid or antisecretory. Hematemesis or melena may also occur.
Peritonitis.With peritonitis, nausea and vomiting usually accompany acute abdominal pain localized to the area of inflammation. Other findings include a high fever with chills; tachycardia; hypoactive or absent bowel sounds; abdominal distention, rigidity, and tenderness (including rebound tenderness); positive obturator sign and obturator weakness; pale, cold skin; diaphoresis; hypotension; shallow respirations; and hiccups.
Preeclampsia.Nausea and vomiting commonly occur with preeclampsia along with rapid weight gain, epigastric pain, oliguria, a severe frontal headache, hyperreflexia, and blurred or double vision. The classic diagnostic triad of signs include hypertension, proteinuria, and edema.
Q fever.Signs and symptoms of Q fever include nausea, vomiting, diarrhea, fever, chills, severe headache, malaise, and chest pain. In severe cases, the patient may develop hepatitis or pneumonia.
Rhabdomyolysis.Signs and symptoms of rhabdomyolysis include nausea, vomiting, muscle weakness or pain, fever, malaise, and dark urine. Acute renal failure is the most commonly reported complication of the disorder. It results from renal structure obstruction and injury during the kidneys'attempt to filter myoglobin from the bloodstream.
Typhus.With typhus, an abrupt onset of nausea, vomiting, fever, and chills follows the initial symptoms of headache, myalgia, arthralgia, and malaise.
Other causes
Drugs.Common nausea-producing drugs include antineoplastics, opiates, ferrous sulfate, levodopa, oral potassium chloride replacements, estrogens, sulfasalazine, antibiotics, quinidine, anesthetics, cardiac glycosides, theophylline (overdose), and nonsteroidal anti-inflammatory drugs.
Radiation and surgery.Radiation therapy can cause nausea and vomiting. Postoperative nausea and vomiting are common, especially after abdominal surgery.
Nursing considerations
▪ If the patient is experiencing severe nausea, prepare him for blood tests to determine fluid and electrolyte status and acid-base balance.
▪ To prevent aspiration, elevate the patient's head or position him on his side.
▪ Because pain can precipitate or intensify nausea, administer pain medications promptly, as needed.
▪ If possible, give medications by injection or suppository to prevent exacerbating nausea.
▪ Be alert for abdominal distention and hypoactive bowel sounds which may indicate gastric retention.
▪ Be prepared to insert a nasogastric tube, as needed.
▪ Prepare the patient for such procedures as a computed tomography scan, an ultrasound scan, endoscopy, and colonoscopy.
▪ Consult the nutritionist to determine the patient's need for parenteral nutrition.
Patient teaching
▪ Teach the patient to breathe deeply to ease his nausea.
▪ Discuss triggers for nausea and how to avoid them.
▪ Teach the patient the importance of aspiration precautions.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
More About Morning sickness
More Medical Textbooks Online about Morning sickness
Review other book chapters online related to Morning sickness:
Medical Books Excerpts
- Nausea
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Nausea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Nausea and Vomiting
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Nausea
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Nausea
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: NAUSEA AND VOMITING (Differential Diagnosis in Primary Care)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
