Nausea is an unpleasant sensation in the throat, epigastric area, or abdomen that may cause a conscious desire to vomit but doesn’t always lead to vomiting.
Nausea may occur in relation to gastrointestinal problems like infection, overeating, acid reflux, obstruction, and more. Nausea may also be related to anxiety disorders, as a side effect of medications, pregnancy, or motion sickness. Central nervous system problems, metabolic disorders, and cardiovascular disorders can also cause nausea.
Nausea is subjective and is usually accompanied by anorexia or a lack of appetite. When nausea and vomiting occur for an extended period, dehydration and other complications can occur causing severe electrolyte imbalances, extracellular fluid volume loss, and circulatory failure.
Nursing Process
In managing nausea, it is important to determine and treat its underlying cause, manage complications, and promote symptomatic relief.
A thorough assessment must be conducted to determine causative factors. Nurses can anticipate nausea in instances of chemotherapy and premedicate to prevent discomfort. Nurses can also educate patients on nonpharmacologic interventions to prevent and treat nausea.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for nausea and vomiting, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for nausea and vomiting.
Dysfunctional Gastrointestinal Motility
Gastrointestinal motility may increase or decrease and both conditions can cause symptoms including nausea, vomiting, dyspepsia, bloating, abdominal cramps, abdominal distension, and early satiety.
Nursing Diagnosis: Dysfunctional Gastrointestinal Motility
Related to:
- Disease process
- 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 of gastric emptying
- 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.
Assessment:
1. Assess causative factors contributing to the patient’s nausea and vomiting experience.
Various factors can cause changes in gastrointestinal motility, including gastrointestinal disorders, food allergies, chronic indigestion, pregnancy, CNS problems, eating disorders, cancer, medications, and other medical conditions. Identifying possible causative factors can help determine appropriate treatment and interventions.
2. Assess the patient’s food intake.
In most cases, food can be a precipitating cause of nausea and vomiting. It is vital to assess and identify the specific food that triggered the experience, prior history with the food, and whether anyone else got sick from eating the food.
3. Assess the characteristics of the patient’s emesis.
The characteristic of the emesis may pinpoint conditions associated with the patient’s nausea and vomiting. Emesis containing partially digested food can indicate gastric outlet obstruction or delayed gastric emptying, and the presence of bile or fecal odor after prolonged vomiting can indicate intestinal obstruction below the level of the pylorus. The color of emesis can also indicate if there is bleeding in the gastrointestinal tract.
Interventions:
1. Keep the patient on NPO as ordered.
The patient who experiences nausea and vomiting is kept on NPO until a diagnosis is confirmed. This allows the gastrointestinal tract to rest and correct motility problems.
2. Insert and secure a nasogastric tube as indicated.
A nasogastric tube is often indicated to help decompress the stomach in patients experiencing persistent nausea and vomiting, possible bowel obstruction, or paralytic ileus. The tube must be secured to prevent it from stimulating nausea and vomiting because of frequent tube movement in the nose and at the back of the throat.
3. Administer IV fluids and electrolyte replacement therapy.
Patients who experience nausea and vomiting can experience dehydration along with electrolyte imbalance. Dehydration can cause the gastrointestinal tract to contract slower and the bowels to become slow and sluggish.
4. Encourage the patient to avoid foods and beverages that are gastric irritants.
If the patient is allowed to eat, encourage the patient to avoid foods and beverages that are gastric irritants. Gastric irritants can worsen dysfunctional gastrointestinal motility and cause persistent nausea and vomiting.
5. Consult with a dietician.
A nutritional consult can offer diet recommendations depending on delayed or increased gastric motility.
Imbalanced Nutrition: Less than Body Requirements
Nausea tends to limit the adequacy of nutritional intake. Aversion to food and loss of appetite can mean that the patient is not getting enough fluids through food sources which can lead to dehydration and malnutrition.
Nursing Diagnosis: Imbalanced Nutrition
Related to:
- Altered taste perception
- Food aversion
- Inadequate interest in food
- Difficulty swallowing
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 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
Assessment:
1. Assess and monitor the patient’s weight.
Many patients tend to lose weight unintentionally and suddenly during vomiting. Sustained vomiting may cause the body to lose important nutrients.
2. Assess and monitor for signs of malnutrition.
Patients who suffer from nausea may not eat nutritionally-balanced meals and are at risk for malnutrition. Signs of malnutrition include rapid unintentional weight loss, fatigue, weakness, poor concentration, brittle hair and nails, and decreased immunity.
3. Assess for tooth decay or thrush.
Nausea and subsequent vomiting may cause painful mouth sores, throat irritation, or tooth decay that makes eating uncomfortable.
Interventions:
1. Provide calorie-dense foods.
Patients who can only ingest small amounts of food can benefit from eating foods they prefer that are high in calories to increase overall caloric intake.
2. Create a pleasant environment conducive to eating.
Strong and offensive odors can cause nausea and vomiting. Provide uninterrupted time to eat and do not rush.
3. Premedicate with antiemetics.
Patients undergoing chemotherapy or radiation may require premedication to prevent the common side effect of nausea.
4. Implement tube feedings.
Patients unable to eat due to nausea may require enteral or parenteral nutrition to obtain necessary nutrients.
Impaired Comfort
Nausea is an unpleasant sensation that affects the abdomen, epigastric area, and throat, causing the patient significant discomfort and the urge to vomit.
Nursing Diagnosis: Impaired Comfort
Related to:
- Disease process
- 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
- 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.
Persistent and severe nausea and vomiting can cause the patient physical but emotional distress if the symptoms prevent role performance or activities of daily living.
2. Assess the possible cause of nausea and vomiting.
Nausea and vomiting are not medical conditions but symptoms related to various health conditions. Identifying the cause of the symptoms, whether it is an underlying medical condition, food allergy, eating disorder, stress, pregnancy, or medications, can help plan appropriate interventions and care.
3. Assess the patient’s history of comfortability and coping strategies.
The patient’s perception of comfort and history can influence comfort during recovery and healing. How the patient copes can also contribute to the patient’s perceived discomfort.
Interventions:
1. Create a relaxing environment.
Excessive environmental stimuli like lighting and hot temperatures can aggravate feelings of nausea. Ensure that the environment is cooler and the lights are dimmed during mealtimes to promote the patient’s comfort and reduce the incidence of nausea and vomiting. Strong smells can also be aggravating.
2. Encourage ginger or peppermint tea.
Ginger is an effective remedy in alleviating nausea and vomiting and promoting comfort. It has anti-nausea compounds like shogaols and gingerols and anti-inflammatory, anti-ulcer, and antioxidant effects. Peppermint tea can also help soothe stomach upset and reduce feelings of nausea.
3. Encourage foods that have little to no odor.
Strong odors can aggravate nausea and vomiting. Foods with little to no odor, like cereals and crackers, should be encouraged.
4. Encourage alternative ways to alleviate discomfort.
Meditation, deep breathing exercises, music, and guided imagery enable the patient to relax and significantly reduce discomfort associated with nausea and vomiting. Deep breathing performed slowly and steadily can help ease nausea and promote mindful meditation and comfort.
5. Encourage the patient to take OTC remedies for nausea and vomiting.
Dramamine, an anti-nausea medication, is an effective OTC medication that helps block the vomiting reflex, reduce dizziness, and promote comfort. It is important to take these medications before the first bout of nausea.
6. Use acupressure.
Pressure to the P6 (Neiguan) point on the wrist (center of wrist, three finger-breadths from the wrist crease) is thought to prevent nausea. Motion sickness bands can be worn on the wrists to avoid nausea.
Nausea
Nausea is a nursing-focused diagnosis as it is usually a secondary cause of a primary diagnosis.
Nursing Diagnosis: Nausea
Related to:
- Gastrointestinal problems
- 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.
The cause of nausea can be treatment-related, physical, or situational. Establishing the reason for nausea can help with the development of an effective treatment plan.
2. Assess the patient’s hydration status.
Nausea causes aversion to food and fluids, thus there is a tendency for dehydration to occur due to fluid loss, especially if it is accompanied by vomiting.
Interventions:
1. Provide the patient with routine oral care as needed.
Nausea is often associated with increased salivation and vomiting. Establishing routine oral care will decrease unpleasant feelings and odors in the mouth.
2. Eliminate offending smells from the room.
Strong odors can make nausea worse.
3. Offer ginger ale and dry snacks.
Ginger helps with settling the stomach. Bland foods such as crackers are likely to be tolerated and prevent nausea from an empty stomach.
4. Encourage the patient to eat small frequent meals.
Nauseated patients may not be able to tolerate large meals and they can be selective with the foods that they can tolerate. Small frequent meals can stabilize blood sugar levels, satisfy appetites, and provide nutrients throughout the day.
5. Encourage the patient to avoid spicy and greasy foods.
Heavily seasoned foods can irritate the stomach and contribute to nausea.
6. Administer antiemetics as indicated.
Antiemetic medications such as ondansetron or promethazine can help treat and prevent nausea.
7. Do not take medications on an empty stomach.
Educate patients that if their medications are causing nausea, try taking them with food if not contraindicated.
Risk for Deficient Fluid Volume
Patients with nausea are at risk for deficient fluid volume as this symptom is often accompanied by vomiting. With vomiting, electrolyte imbalances can occur.
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
As evidenced by:
A risk diagnosis is not evidenced by any signs and symptoms, as the problem has not occurred yet and the nursing interventions will be directed at the prevention of symptoms.
Expected outcomes:
- Patient will maintain hydration as evidenced by adequate intake and output, vital signs, and skin turgor
Assessment:
1. Assess the patient’s fluid status.
Signs of fluid volume deficit include non-elastic skin turgor, dry skin and mucous membranes, sunken eye appearance, hypotension, tachycardia, and low urine output.
2. Assess and monitor the patient’s intake and output.
Monitoring intake and output is one way for the nurse to assess adequate fluid intake.
3. Assess and monitor vital signs.
Hypotension can indicate a low vascular volume. An increase in heart rate can indicate a compensatory mechanism for low blood pressure. Fever can cause dehydration.
4. Monitor lab values.
Monitor electrolytes, hemoglobin and hematocrit, BUN, and creatinine as abnormalities in these labs can signal hydration issues.
Interventions:
1. Administer fluids intravenously as indicated.
Intravenous fluids may be indicated if oral fluid intake is inadequate in patients suffering from nausea and vomiting.
2. Offer high-water content foods.
Soups, popsicles, fruits, jello, and electrolyte-replacement drinks not only replace fluids but contain sodium, glucose, and other electrolytes.
3. Administer antiemetics as indicated.
Antiemetic medications can suppress the feeling of nausea, prevent vomiting, and will ultimately reduce fluid loss.
4. Encourage small sips of fluids or ice chips.
Nausea may cause a strong aversion to food and fluids, but small sips or ice chips may be tolerated.
References
- Everything You Should Know About Nausea. Healthline. Medically reviewed by Saurabh Sethi, M.D., MPH — Written by Rachel Nall, MSN, CRNA — Updated on April 30, 2019. https://www.healthline.com/health/nausea
- Feeling sick (nausea). NHS. Page last reviewed: 12 May 2021. https://www.nhs.uk/conditions/feeling-sick-nausea/
- Nausea. Johns Hopkins Medicine. 2022. https://www.hopkinsmedicine.org/health/conditions-and-diseases/nausea
- Nausea and Vomiting. WebMD. Medically Reviewed by Minesh Khatri, MD on December 06, 2020. https://www.webmd.com/digestive-disorders/digestive-diseases-nausea-vomiting
- Takov V, Tadi P, Doerr C. Motion Sickness (Nursing) [Updated 2021 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568771/
