Vomiting
Vomiting is the forceful expulsion of gastric contents through the mouth. Characteristically preceded by nausea, vomiting results from a coordinated sequence of abdominal muscle contractions and reverse esophageal peristalsis.
A common sign of GI disorders, vomiting also occurs with fluid and electrolyte imbalances; infections; and metabolic, endocrine, labyrinthine, central nervous system (CNS), and cardiac disorders. It can also result from drug therapy, surgery, or radiation.
Vomiting occurs normally during the first trimester of pregnancy, but its subsequent development may also signal complications. It can also result from stress, anxiety, pain, alcohol intoxication, overeating, or ingestion of distasteful foods or liquids.
History and physical examination
Ask your patient to describe the onset, duration, and intensity of his vomiting. What started the vomiting? What makes it subside? If possible, collect, measure, and inspect the character of the vomitus. (See Vomitus: Characteristics and causes.) Explore associated complaints, particularly nausea, abdominal pain, anorexia and weight loss, changes in bowel habits or stools, excessive belching or flatus, and bloating or fullness.
Obtain a medical history, noting GI, endocrine, and metabolic disorders; recent infections; and cancer, including chemotherapy or radiation therapy. Ask the patient about current medication use and alcohol consumption. If the patient is a female of childbearing age, ask if she is or could be pregnant or which contraceptive method she's using.
Inspect the patient's abdomen for distention and localized bulging, and auscultate for bowel sounds and bruits. Palpate for rigidity and tenderness and test for rebound tenderness. Palpate and percuss the liver for enlargement. Assess the patient's other body systems as appropriate.
During the examination, keep in mind that projectile vomiting unaccompanied by nausea may be an indication of increased intracranial pressure, a life-threatening emergency. If this occurs in a patient with CNS injury, you should quickly check his vital signs. Be alert for widened pulse pressure or bradycardia.
Medical causes
Adrenal insufficiency.Common GI findings with adrenal insufficiency include vomiting, nausea, anorexia, and diarrhea. Other findings include weakness; fatigue; weight loss; bronze skin; orthostatic hypotension; and weak, irregular pulse.
Anthrax (GI).Initial signs and symptoms after eating contaminated meat from an animal infected with anthrax include vomiting, loss of appetite, nausea, and fever. Signs and symptoms may progress to abdominal pain, severe bloody diarrhea, and hematemesis.
Appendicitis.Vomiting and nausea may follow or accompany abdominal pain from appendicitis. Pain typically begins as vague epigastric or periumbilical discomfort and rapidly progresses to severe, stabbing pain in the right lower quadrant. The patient generally has a positive McBurney's sign—severe pain and tenderness on palpation about 29 (5 cm) from the right anterior superior spine of the ilium, on a line between that spine and the umbilicus. Associated findings usually include abdominal rigidity and tenderness, anorexia, constipation or diarrhea, cutaneous hyperalgesia, fever, tachycardia, and malaise.
Cholecystitis (acute).With cholecystitis, nausea and mild vomiting commonly follow severe right-upper-quadrant pain that may radiate to the back or shoulders. Associated findings include abdominal tenderness and, possibly, rigidity and distention, fever, and diaphoresis.
Cholelithiasis.With cholelithiasis, nauseaand vomiting accompany severe, unlocalized right-upper-quadrant or epigastric pain after ingestion of fatty foods. Other findings include abdominal tenderness and guarding, flatulence, belching, epigastric burning, pyrosis, tachycardia, and restlessness.
Cholera.Signs and symptoms of cholera include vomiting and abrupt watery diarrhea. Severe water and electrolyte loss leads to thirst, weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.
Cirrhosis.Insidious early signs and symptoms of cirrhosis typically include nausea and vomiting, anorexia, aching abdominal pain, and constipation or diarrhea. Later findings include jaundice, hepatomegaly, and abdominal distention.
Electrolyte imbalances.Such electrolyte disturbances as hyponatremia, hypernatremia, hypokalemia, and hypercalcemia frequently cause nausea and vomiting. Other effects include arrhythmias, tremors, seizures, anorexia, malaise, and weakness.
Escherichia coli O157:H7. The signs and symptoms of E.coli include vomiting, watery or bloody diarrhea, nausea, fever, and abdominal cramps. In children younger than age 5 and the elderly, hemolytic uremic syndrome may develop in which the red blood cells are destroyed, which may ultimately lead to acute renal failure.
Food poisoning.Vomiting is a common finding of food poisoning, caused by preformed toxins produced by bacteria typically found in foods, such as Bacillus cereus, Clostridium, and Staphylococcus. Diarrhea and fever also usually occur.
Gastric cancer.This rare cancer may produce mild nausea, vomiting (possibly of mucus or blood), anorexia, upper abdominal discomfort, and chronic dyspepsia. Fatigue, weight loss, melena, and altered bowel habits are also common.
Gastritis.Nausea and vomiting of mucus or blood are common with gastritis, especially after ingestion of alcohol, aspirin, spicy foods, or caffeine. Epigastric pain, belching, and fever may occur.
Gastroenteritis.Gastroenteritis causes nausea, vomiting (commonly of undigested food), diarrhea, and abdominal cramping. Fever, malaise, hyperactive bowel sounds, and abdominal pain and tenderness may also occur.
Heart failure.Nausea and vomiting may occur heart failure, especially with right-sided heart failure. Associated findings include tachycardia, ventricular gallop, fatigue, dyspnea, crackles, peripheral edema, and jugular vein distention.
Hepatitis.Vomiting commonly follows nausea as an early sign of viral hepatitis. Other early findings include fatigue, myalgia, arthralgia, headache, photophobia, anorexia, pharyngitis, cough, and fever.
Hyperemesis gravidarum.Unremitting nausea and vomiting that last beyond the first trimester characterize this disorder of pregnancy. Vomitus contains undigested food, mucus, and small amounts of bile early in the disorder; later, it has a coffee-ground appearance. Associated findings include weight loss, headache, delirium, and electrolyte imbalance. Thyroid dysfunction may be associated with this condition.
Increased intracranial pressure.Projectile vomiting that isn't preceded by nausea is a sign of increased intracranial pressure. The patient may exhibit a decreased level of consciousness (LOC) and Cushing's triad (bradycardia, hypertension, and respiratory pattern changes). He may also have headache, widened pulse pressure, impaired motor movement, vision disturbances, pupillary changes, and papilledema.
Intestinal obstruction.Nausea and vomiting (bilious or fecal) are common with intestinal obstruction, especially of the upper small intestine. Abdominal pain is usually episodic and colicky but can become severe and steady. Constipation occurs early in large intestinal obstruction and late in small intestinal obstruction. Obstipation, however, may signal complete obstruction. In partial obstruction, bowel sounds are typically high pitched and hyperactive; in complete obstruction, bowel sounds are typically hypoactive or absent. Abdominal distention and tenderness also occur, possibly with visible peristaltic waves and a palpable abdominal mass.
Labyrinthitis.Nauseaand vomiting commonly occur with labyrinthitis. Other findings include severe vertigo, progressive hearing loss, nystagmus, and possibly otorrhea.
Listeriosis.After the ingestion offood contaminated with the bacterium Listeria monocytogenes, vomiting, fever, myalgias, abdominal pain, nausea, and diarrhea occur. If the infection spreads to the nervous system, meningitis may develop. Signs and symptoms may include fever, headache, nuchal rigidity, and change in LOC. The food-borne illness primarily affects pregnant women, neonates, and those with weakened immune systems.
Mesenteric venous thrombosis.Insidious or acute onset of nausea, vomiting, and abdominal pain occurs with mesenteric venous thrombosis. Other findings include diarrhea or constipation, abdominal distention, hematemesis, and melena.
Migraine headache.Nausea and vomiting are prodromal signs of a migraine headache, along with such accompanying symptoms as fatigue, photophobia, light flashes, increased noise sensitivity, and possibly partial vision loss and paresthesia.
Motion sickness.With motion sickness, nausea and vomiting may be accompanied by headache, vertigo, dizziness, fatigue, diaphoresis, and dyspnea.
Norovirus infection.Violent vomiting may occur frequently and without warning with norovirus infection. Additional symptoms include nausea, diarrhea, and abdominal pain or cramping.
Pancreatitis (acute).Vomiting, usually preceded by nausea, is an early sign of pancreatitis. Associated findings include steady, severe epigastric or left-upper-quadrant pain that may radiate to the back, abdominal tenderness and rigidity, anorexia, hypoactive bowel sounds, vomiting, and fever. Tachycardia, restlessness, hypotension, skin mottling, and cold, sweaty extremities may occur in severe cases.
Peritonitis.With peritonitis, nausea and vomiting usually accompany acute abdominal pain in the area of inflammation. Other findings include high fever with chills; tachycardia; hypoactive or absent bowel sounds; abdominal distention, rigidity, and tenderness; weakness; pale, cold skin; diaphoresis; hypotension; signs of dehydration; and shallow respirations.
Preeclampsia.Nausea and vomiting are common with preeclampsia. Rapid weight gain, epigastric pain, generalized edema, elevated blood pressure, oliguria, proteinuria, severe frontal headache, and blurred or double vision also occur.
Q fever.Signs and symptoms of Q fever include vomiting, fever, chills, severe headache, malaise, chest pain, nausea, and diarrhea. Fever may last up to 2 weeks. In severe cases, the patient may develop hepatitis or pneumonia.
Renal and urologic disorders.Cystitis, pyelonephritis, calculi, and other disorders of this system can cause vomiting. Accompanying findings reflect the specific disorder. Persistent nausea and vomiting are typical findings in patients with acute or worsening chronic renal failure.
Rhabdomyolysis.Signs and symptoms of rhabdomyolisis include vomiting, muscle weakness or pain, fever, nausea, 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 kidney's attempt to filter the myoglobin from the bloodstream.
Typhus.Initial symptoms of typhus include headache, myalgia, arthralgia, and malaise, followed by an abrupt onset of vomiting, nausea, chills, and fever. A maculopapular rash may be present in some cases.
Other causes
Drugs.Drugs that commonly cause vomiting include antineoplastics, opiates, ferrous sulfate, levodopa, oral potassium, chloride replacements, estrogens, sulfasalazine, antibiotics, quinidine, anesthetics, and overdoses of cardiac glycosides and theophylline. Syrup of ipecac is used to treat overdoses by inducing vomiting.
Radiation and surgery.Radiation therapy may cause nausea and vomiting if it disrupts the gastric mucosa. Postoperative nausea and vomiting are common, especially after abdominal surgery.
Nursing considerations
▪ Draw blood to determine fluid, electrolyte, and acid-base balance.
▪ Keep the patient's room clean smelling by removing bedpans and emesis basins promptly after use.
▪ Elevate the patient's head or position him on his side to prevent aspiration of vomitus.
▪ Monitor vital signs and intake and output (including vomitus and liquid stools).
▪ If necessary, administer I.V. fluids, or have the patient sip clear liquids to maintain hydration.
▪ Because pain can precipitate or intensify nausea and vomiting, administer pain medications promptly.
▪ Insert a nasogastric tube, as ordered.
Patient teaching
▪ Teach the patient deep-breathing exercises to ease nausea.
▪ Explain the importance of replacing fluid losses.
▪ Teach the patient about dietary restrictions and how to advance the diet.
Pictures
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.
Other Book Chapters Related to Food symptoms
Read excerpts from these other book chapters related to Food symptoms:
Medical Books Excerpts
- Vomiting
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Vomiting
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Vomiting
- "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 ]
- Vomiting
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Vomiting
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Vomiting
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Food symptoms
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NAUSEA AND VOMITING (Differential Diagnosis in Primary Care)
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