Nausea Nursing Diagnosis & Care Plan

Related Factors

• Gastrointestinal disorders  
  • Ulcers 
  • Cancer 
  • Gastroparesis
  • Appendicitis 
  • Paralytic ileus/bowel obstruction 
• Medications/Treatments 
  • Chemotherapy/radiation  
  • Opiates 
  • Antiarrhythmic medications 
  • Antibiotics
• Central Nervous System
  • Increased intracranial pressure
  • Seizure 
  • Motion sickness 
  • Meniere’s disease 
  • Labyrinthitis 
  • Migraine
• Metabolic 
  • Pregnancy 
  • Thyroid/adrenal disorders
  • Diabetic ketoacidosis 
• Other
  • Excessive alcohol 
  • Eating disorders 
  • Overeating 
  • Food poisoning 
  • Physical pain 
  • Anxiety 
  • Unpleasant odors and sights 

Subjective Data: patient’s feelings, perceptions, and concerns. (Symptoms)

• Reports nausea and feeling close to vomiting 
• Reports altered taste 

Objective Data: assessment, diagnostic tests, and lab values. (Signs)

• Increased heart rate and respiration 
• Sweating/clammy, cold skin
• Pale 
• Gagging 
• Increased salivation 
• Increased swallowing 
• Rejection of food 

Expected Outcome 

• The patient will report relief from nausea 
• The patient will be able to name strategies to prevent nausea 

Nursing Assessment for Nausea

Assess for the cause of nausea.  The cause for nausea can be physical, treatment-related, or situational. Knowing the reason for nausea allows for the development of an effective treatment plan. Treatment can range from non-invasive strategies such as removing the offending stimuli to invasive procedures.

Obtain the patient’s history of nausea and vomiting. Note the following characteristics.  Onset (abrupt or insidious)  Timing (before, during, or after meals; continuous)  Volume and nature of emesis (large volumes; undigested food, watery, bile)  Associated pain (specific abdominal quadrant; epigastric)  Associated symptoms (weight loss, diarrhea, vomiting, headache) Detailed documentation of history and characteristics of nausea and vomiting helps determine appropriate interventions to prevent and treat symptoms.

Assess the patient’s hydration status. Note  Mucous membranes Skin turgor  Blood pressure/ orthostasis   Intake and output  Daily weight  Nausea often causes patients to avoid eating or drinking adequate amounts of fluids. Therefore, vomiting that often ensues from nausea may cause dehydration due to fluid loss.

Monitor lab values associated with nausea and vomiting.  Electrolytes  Acidosis, alkalosis from vomiting  CBC Leukocytosis from an inflammatory process  Erythrocyte sedimentation rate Inflammatory process  Pregnancy test  Nausea due to pregnancy  Albumin/ Prealbumin  Nutrition status/malnutrition Toxicology test  Illicit drugs, alcohol  TSH  Thyroid toxicity  Testing can help to identify the underlying cause of nausea.

Nursing Interventions for Nausea

Provide routine oral care at least every four hours and as needed. Nausea is associated with increased salivation and vomiting. Oral care may make the patient feel more comfortable.

Eliminate offending smells from the room. For example, use odor-eliminating spray, and avoid strong scents such as perfume.  Strong odors can worsen nausea.

Offer ice chips or ginger ale as tolerated and as diet restrictions allow.  Ice chips help moisten mucous membranes for patients that have NPO (nothing by mouth) status. Ginger ale might help settle the stomach. Steady fluid intake as tolerated may help counteract dehydration.

Offer small frequent meals. Serve food that the patient wants to eat. Feeling nauseated, patients may be very selective about certain foods. Comfort food might make nutritional intake more tolerable.

Avoid spicy, greasy, or fried foods.  Foods that are heavily seasoned or oily food can upset one’s stomach and contribute to nausea. Crackers, broth, or Jell-O might be more tolerable.

Administer antiemetic medications. Monitor for side effects.  Antiemetics help prevent and treat nausea. Side effects may be dry mouth and constipation.

For the post-surgical patient

Identify risk factors that may make the patient suffer from postoperative nausea and vomiting (PONV).  Knowing the risk factors helps nurses to implement appropriate interventions. Nurses may use a risk scoring tool that focuses on risk factors known to increase the likelihood of nausea and vomiting after surgery. Such risk factors are  Gender  Smoking status  History of motion sickness or PONV Use of postoperative opioids These are the four variables considered in the Apfel score assessment tool, which assesses postoperative risk for nausea and vomiting.

Implement prophylactic interventions to prevent PONV. Administering antiemetic medications before surgery and providing adequate hydration can help prevent nausea after surgery. However, dehydration can cause low blood pressure, which compromises gastrointestinal perfusion, leading to possible GI upset. Since the patient most likely is made NPO (nothing by mouth) hours before the intervention, intravenous fluids may be used as ordered to maintain optimal hydration status.

Treat postoperative pain promptly.  Pain can become so intense that it may induce nausea and vomiting. Treating pain can reduce instances of nausea and vomiting. While opioids treat pain, they also may cause nausea. Therefore, anti-inflammatory medication may be added as a combination treatment to treat pain and, at the same time, decrease the risk for nausea and vomiting.

Patient Education for Nausea 

Advise the patient to take antiemetic medications as ordered. Taking the medication on schedule ensures optimal effectiveness and reduces episodes of nausea.

Teach non-pharmacological strategies to decrease nausea.  Techniques such as relaxation techniques, guided imagery, and deep breathing exercises help distract from nausea.

Educate about an appropriate diet to reduce nausea as much as possible.  Examples are Ginger containing products Ginger can be consumed as tea, chips, crystallized ginger, or ginger ale. Ginger contains properties that affect the central nervous system and stomach, reducing nausea. Crackers, toast, cereal Bland foods help avoid exposure to foods with a strong smell and exhaustive food preparations, which sometimes can lead to nausea. Broth Broth is considered a clear liquid, however, it provides hydration and electrolytes.

Teach patients to avoid preparing their own meals while nauseated.  The smell while cooking food can make nausea worse.

Teach about the importance of not lying flat while being nauseated or shortly after eating.  Lying flat after consuming a meal can interfere with digestion and worsen nausea.

More Care Plans

Vomiting Nursing Diagnosis & Care Plan

Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: More Than Body Requirements

Deficient Fluid Volume

Readiness for Enhanced Nutrition

Gastritis Nursing Diagnosis & Care Plan

References:

WebMD. 2021. Nausea and Vomiting – Common Causes. [online] Available at: <https://www.webmd.com/digestive-disorders/digestive-diseases-nausea-vomiting#1-2> 

American Nurse. 2021. Putting a stop to postop nausea and vomiting. [online] Available at: <https://www.myamericannurse.com/putting-a-stop-to-postop-nausea-and-vomiting/> 

Healthline. 2021. The 14 Best Foods to Eat When You’re Nauseous. [online] Available at: <https://www.healthline.com/nutrition/foods-to-eat-when-nauseous#TOC_TITLE_HDR_13> 

Gulanick, M., & Myers, J. (2014). Nursing care plans (8th ed.). Elsevier.

Deglin, J., Vallerand, A. and Sanoski, C., 2014. Davis’s Drug Guide for Nurses (14th ed.). 14th ed. FA Davis Company.