Vomiting
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Outline
Overview
- Vomiting is the involuntary, forceful expulsion of the contents of one’s stomach through the mouth
Nursing Points
General
- The vomiting child is at risk for:
- Dehydration
- Aspiration
- Metabolic alkalosis (↑pH, ↑HCO3)
Assessment
- Identify the cause of the vomiting
- Infection
- ↑ ICP
- GI obstruction
- Pyloric Stenosis
- Infants 2-7 weeks
- Thickened pylorus
- Food unable to enter the small intestine
- Projectile vomiting
- Treated with surgery
- Intussusception
- Foreign body
- Pyloric Stenosis
- Gastroesophageal Reflux
- Infants 4-12 months
- Regurgitating feeds
- Assess for aspiration
- Chest pain
- Foul smelling breath
- Difficulty swallowing
- Green sputum
- Shortness of Breath
- Frequent chest infections
- Cyanosis (late)
- Assess for fluid & electrolyte imbalances
- Frequency, amount of vomiting
- Fluid status
- Sodium & Potassium imbalances
- Assess for Metabolic alkalosis (↑pH ↑HCO3)
- Lethargy
- Neuromuscular excitability
- Tetany
- Seizures
Therapeutic Management
- ABCs
- Maintain patent airway
- Prevent aspiration
- Evaluate total fluid loss
- Evaluate electrolyte imbalances
- Rehydrate as tolerated
- Long-term considerations for chronic reflux
- Nissen Fundoplication
- Reduce risk for aspiration pneumonia
- NG/G-tube
- Nissen Fundoplication
Nursing Concepts
- Gastrointestinal/Liver Metabolism
- Fluid & Electrolyte Balance
- Nutrition
Patient Education
- Keep the child sitting up
- Call 911 if any signs of aspiration
References:
Hockenberry, M., Wilson, D. & Rodgers, C. (2017). Wong’s essentials of pediatric nursing (10th ed.) St. Louis, MO: Elsevier Limited.
Lissauer, T. & Carroll, W. (2018). Illustrated textbook of pediatrics (5th ed.) Europe: Elsevier Limited.
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Vomiting
Transcript
Hey guys, in this lesson we are going to talk about vomiting. So you already know a lot about vomiting as a symptom of illness. The point of this lesson isn’t to just repeat what you will already have learned in your adult lessons, what I want to do is just point out a few things that will be a little different in our pediatric patients.
SSo we are just going to jump right in to looking at possible causes of vomiting in our pediatric patients.
Infection is the most common cause and a lot of times this is a virus or maybe bacterial from food poisoning. Rotavirus is a common cause of both vomiting and diarrhea in children and used to be the cause for a lot of hospital admissions for kids because of severe dehydration and electrolyte abnormalities, but now we have an immunization for this and we are seeing a lot fewer admissions for this.
Increased ICP can also cause vomiting. So this may occur in children with brain tumors as the tumor increases in size there may be an increase in ICP which may cause the vomiting. You can also see vomiting due to increased ICP in trauma situations where there is a bleed in the head.
GI obstructions can happen in children as well. Two diagnosis that are specific to the pediatric population are pyloric stenosis and intussusception. Pyloric stenosis is an obstruction in the upper gi system just above the small intestines where the the pyloric sphincter is controlling the flow of food out of the stomach. The sphincter is narrowed blocking food from entering the small intestines. This usually occurs in infants 2 weeks -7 weeks and it causes kids to forcefully vomit their feeds back up. This is treated with surgery. Intussusception can cause an obstruction in the lower GI tract. We have a lesson on this for you so take a look at it if you aren’t sure what intussusception is. Foreign body ingestion can also cause GI obstruction. I’ve seen an abdominal xray of a child with 6 bouncy balls blocking up their intestines! The child thought they were candy! And remember lower gi obstruction usually causes kids (and adults) to vomit up green bile from the stomach.
Our assessment of a patient that’s vomiting is focused on the 3 biggest complications we see with vomiting and they are aspiration, dehydration and electrolyte abnormalities.
Your assessment should really start by assessing their level of consciousness. A patient that has a lower level of consciousness is at greater risk for aspirating and compromising their airway. Signs that they have aspirated are coughing, shortness of breath, foul smelling breath and hypoxia.
Then we need to move on to find out how often they are vomiting, how much is coming up and what the contents look like. This information is important because it can help us figure out how dehydrated they are. Check out the lesson on dehydration for more details on how to assess fluid status and how to treat dehydration.
The most common electrolyte imbalance to be on the look out for is low potassium or hypokalemia – and this is true for any patient that is losing a lot of fluid through their GI system.
Metabolic alkalosis can occur with excessive vomiting because hydrogen ions are being lost everytime the patient vomits up the acidic stomach content. This creates a less acidic more alkaline environment in the body. If this goes untreated the patient will become lethargic and confused. They may experience neuromuscular excitability and can even have seizures. Check out our lessons on ABG’s for more information on acid-base imbalances like metabolic alkalosis.
Therapeutic management is really all about preventing or treating the complications we just talked about. We start with ABC’s to make sure we are keeping that airway protected. So remember a patient with decreased LOC is at a greater risk for aspirating so it’s best to lay the patient on their left side to help prevent the vomit from going into their airway.
Next for management is making sure we are keeping an eye on fluid and electrolyte status- monitoring for dehydration and metabolic alkalosis. If they are in need of fluids we need to rehydrate either with oral rehydration solution or with IV Fluids.
I mentioned earlier that some kids can have a lot of problems secondary to having chronic reflux and most of the time this problem is frequent chest infections from aspirating. If this is the case,they may be a candidate for a procedure called a Nissen Fundoplication. This procedure reinforces that top of the stomach to prevent reflux. You can see in the photo here what that looks like. This severe of reflux is also often associated with poor feeding and weight loss so a lot of times a g-tube is placed when the Nissen is done. I’m sure you’ll come across this during your clinicals as is a really common procedure for our pediatric patients who are living with chronic illnesses.
Your priority nursing concepts for a pediatric patient with comint are gastrointestinal/liver metabolism, fluid and electrolyte balance and nutrition.
Okay guys, remember vomiting in children isn’t all that different from vomiting in adults. There are a few diagnoses to be aware of that you probably won’t come across in your adult patients and those are rotavirus, pyloric stenosis, Intussusception and Reflux.
Primary complications to be on the look out for are aspiration, dehydration and electrolyte imbalances. Our treatment of vomiting centers on these 3 complications- so we are helping maintain a clear airway and providing fluids and electrolytes as needed.
Keep in mind that kids who are chronically ill may have long-term issues from dealing with chronic reflux. These patients are at risk for losing weight and aspirating so they may need a procedure called a nissen fundoplication to stop the reflux from happening all together.
That’s it for our lesson on vomiting in pediatric patients. Make sure you check out all the resources attached to this lesson, as well as the lesson on dehydration and the fluids and electrolyte course. All of those topics should be linking in with this information on vomiting! Now, go out and be your best self today. Happy Nursing!
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Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
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Causes of Poor Gas Exchange Nursing Mnemonic (All People Can Value Lungs)
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Complications of Spinal Cord Injuries Nursing Mnemonic (ABCDEFG)
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GERD causes Nursing Mnemonic (Reflux Is Probably Mean)
Global Symptoms for Brain Tumors Nursing Mnemonic (HAS)
Gluten Free Diet Nursing Mnemonic (BROW)
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hemodynamics
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Hemorrhagic Stroke Risk Factors Nursing Mnemonic (HATS)
Hiatal Hernia Symptoms Nursing Mnemonic (Her Belly Really Hurts Following Dinner)
High Pressure Vent Alarms Nursing Mnemonic (Kings Eat Big Cakes)
High Risk Behavior Nursing Mnemonic (HEADSS)
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hyperkalemia – Causes Nursing Mnemonic (MACHINE)
Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperkalemia – Signs and Symptoms Nursing Mnemonic (Murder)
Hypernatremia – Causes Nursing Mnemonic (MODEL)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
IADLS (Instrumental Activities of Daily Living) Nursing Mnemonic (SCUM)
Increase MAP Nursing Mnemonic (VAK)
Inflammation- Signs and Symptoms Nursing Mnemonic (HIPER)
Insulin Mnemonic (Ready, Set, Inject, Love)
Interventions for Aphasia Nursing Mnemonic (PROP)
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Lidocaine Toxicity – Signs and Symptoms Nursing Mnemonic (SAMS)
Low Pressure Vent Alarms Nursing Mnemonic (Cake Everyday)
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Management of Lyme Disease Nursing Mnemonic (BAR)
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications for Pancreatitis Nursing Mnemonic (Please Make Tummy Better)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Mnemonic for Organ Systems (MR DICE RUNS)
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Murmur locations Nursing Mnemonic (hARD ASS MRS. MSD)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Myocardial Infarction Nursing Mnemonic (MONATAS)
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OLD CARTS Mnemonic (OLD CARTS)
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Nursing Care and Pathophysiology for Parkinsons
Asthma
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pharmacokinetics Nursing Mnemonic (ADME)
Planning Community Health Interventions Nursing Mnemonic (PRECEDE-PROCEED)
Pneumonia Risk Factors Nursing Mnemonic (VENTS)
Pneumothorax Signs and Symptoms Nursing Mnemonic (P-THORAX)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Hemorrhage (PPH)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Outcomes Nursing Mnemonic (GTPAL)
Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Prostate Nursing Mnemonic (FUN)
Proton Pump Inhibitors
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Pupil Reactions Nursing Mnemonic (PERRLA)
Reactivation of Herpes Zoster Nursing Mnemonic (FICA)
Reasons for a Bronchoscopy Nursing Mnemonic (Please Assess His Weird Bronchoscopy Results)
Reasons for Chest Tube Nursing Mnemonic (Don’t Ever Fail)
Restrictive Lung Disease Causes Nursing Mnemonic (PAINT)
Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Risk Factors for Osteoporosis Nursing Mnemonic (ACCESS)
Safety Check Nursing Mnemonic (MADLE)
SBAR Communication Nursing Mnemonic (SBAR)
Schizophrenia
Scleroderma Symptoms Nursing Mnemonic (CREST)
Seizure Causes Nursing Mnemonic (VITAMIN)
Seizure Documentation Nursing Mnemonic (TDOC)
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Signs of Osteoarthritis Nursing Mnemonic (OSTEO)
Sprains and Strains – Nursing Care Nursing Mnemonic (RICE)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Stages of Hepatitis Nursing Mnemonic (PIP)
Steps in the Nursing Process 1 Nursing Mnemonic (ADPIE)
Steps in the Nursing Process 2 Nursing Mnemonic (AAPIE)
Steps In The Nursing Process 3 Nursing Mnemonic (SOAPIE)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoke Assessments Nursing Mnemonic (FAST)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Symptoms of Nephrotic Syndrome Nursing Mnemonic (NAPHROTIC)
Symptoms of Wernicke’s Encephalopathy Nursing Mnemonic (COAT)
TB Drugs Nursing Mnemonic (RIPE)
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Triage Nursing Mnemonic (START)
Two pathways of the peripheral nervous system Nursing Mnemonic (SAME)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Types of Hemorrhoids Nursing Mnemonic (Pie)
Ulcerative Colitis – Assessment Nursing Mnemonic (MADE 10)
Umbilical Cord Vasculature Nursing Mnemonic (2A1V)
Vascular Disease – Deep Vein Thrombosis Nursing Mnemonic (HIS Leg Might Fall off)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasospasm Therapy Nursing Mnemonic (Triple H Therapy)
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)
Vitamins – Fat Soluble Nursing Mnemonic (All Dogs Eat Kibble)
Vitamins – Water Soluble Nursing Mnemonic (Birth Control)
Walkers Nursing Mnemonic (Wandering Wilma Always Late)
Who Needs Dialysis Nursing Mnemonic (AEIOU)