Vomiting Nursing Diagnosis & Care Plan


Contents

Causes: 

  • Pregnancy 
  • Malignancy 
  • Food poisoning 
  • Intoxication 
  • Eating disorders 
  • Gastrointestinal pathology (gastroparesis, bowel obstruction, appendicitis) 
  • Pain 
  • Trauma 
  • Medical interventions 

Nursing Diagnosis for Vomiting 


Nausea r/t gastrointestinal infection(stomach bug); anesthesia; pain; chemotherapy; food poisoning

Deficient Fluid Volume r/t volume loss due to vomiting

Imbalanced Nutrition: Less Than Body Requirements r/t inability to absorb nutrients secondary to inability to ingest food

Risk for Electrolyte Imbalance: Risk factor: loss of stomach content containing electrolytes secondary to vomiting

Nursing Care Plans for Vomiting 

Nausea r/t gastrointestinal infection; anesthesia; pain; chemotherapy; 

Expected Outcome: The patient will experience an absence of nausea by discharge and describe strategies to avoid and treat nausea. 

Obtain a thorough health history. 

The patient’s current health status and health history provide information about the possible cause of nausea and vomiting. This information can be used to determine an appropriate plan of care. 

Note characteristics of nausea and vomitus if present. 

Timing of nausea and appearance, such as color, consistency, and amount of emesis, helps physicians identify the origin of nausea and vomiting. 

Identify precipitating factors and alleviating factors. 

Paying close attention to activities close before or after episodes of nausea and vomiting might identify triggers that can be avoided. 

Once the underlying cause is known, collaborate with the physician and establish a treatment plan to treat the source of nausea and vomiting. 

Nausea and vomiting are symptoms of pathological factors or medical interventions. Therefore, while it is helpful for the patient to treat nausea and vomiting, it should be the aim to treat the underlying cause of these symptoms.

Consult a dietitian to adjust the patient’s diet appropriately. 

An NPO status might be appropriate for some patients, whereas others may only need modifications to their diet. Small frequent meals, non-spicy foods might help avoid gastric irritation. Bland foods such as unsalted crackers or ginger ale may help settle the stomach. It may already be a challenge to get the patient to eat. Favorite foods and comfort food may help increase food intake.

Administer antiemetic medications as ordered. 

Treating nausea and preventing possible vomiting helps to maintain a certain amount of food and fluid intake. In addition, timing these medications with meal times ensures at least relief from nausea while eating. 

Teach the patient non-pharmacological strategies. 

Deep breathing exercises, guided imagery, and relaxation techniques might help direct the patient’s focus away from the feeling of nausea. 

Keep emesis basin and oral care articles within reach. 

Nausea often goes along with vomiting, which sometimes occurs very suddenly. Therefore, it is helpful to have supplies readily at hand. In addition, oral care helps remove the taste and smell of vomitus and thus avoid further stimulation to vomiting.

Keep the patient’s head elevated to at least thirty degrees at all times while nauseated. 

Vomiting may pose a risk for aspiration if the patient is lying flat. 

Deficient Fluid Volume r/t volume loss due to vomiting

Expected Outcome: The patient will be euvolemic with the absence of vomiting

Assess the patient’s fluid status. 

Note that non-elastic skin turgor, sunken eye appearance, dry skin, and mucus membranes, tachycardia, hypotension, and low urine output may be signs of a fluid volume deficit. 

Monitor daily weights. 

Sudden weight loss or gain could be due to fluid imbalances. Therefore, watching a trend in sudden weight changes provides information about the patient’s fluid status. 

Record intake and output at regular intervals (even hourly in critical care settings). 

Charts that convert cups into mL may be helpful to record accurate intake. Output should be a minimum of 30mL/hour. Concentrated urine indicates dehydration. In addition, the healthcare team may consider the use of a urinary catheter to measure correct urine output. 

Monitor vital signs closely. 

Blood pressure 
Hypotension and orthostasis may indicate a low vascular volume. 

Heart rate 
The heart rate may increase as a compensatory mechanism of low blood pressure to maintain adequate cardiac output. 

Temperature
Fever may be a sign of dehydration. 

Monitor BUN and creatinine. 

Increased values from the patient’s baseline may indicate dehydration.

Administer fluids intravenously as ordered. 

IV fluids may be necessary if oral fluid intake is inadequate due to vomiting. 

During rehydration, monitor for signs of fluid volume overload. 

Note increasing generalized edema and crackled lung sounds, decreased urine output, full and bounding pulses, and rapid weight gain. 

Administer antiemetic medications as prescribed. 

Antiemetics aid in suppressing the feeling of nausea and therefore help prevent vomiting. This will help reduce fluid loss. 

Teach the family and patient when to call the doctor. 

Dehydration can become a severe condition if not treated promptly. Professional medical help may prevent further complications from dehydration.

Imbalanced Nutrition: Less Than Body Requirements r/t inability to absorb nutrients secondary to inability to ingest food and fluids.

Expected Outcome: The patient will exhibit balanced nutrition by being able to ingest food and fluids to maintain an adequate body weight 

Note the patient’s weight and monitor trends.

Many patients lose weight suddenly and unintentionally during vomiting. Sustained vomiting can cause the body to lose nutrients that are important for cell nourishment. With the patient not being able to keep food in his or her stomach long enough to digest and absorb nutrients, the body will lose weight. 

Monitor for signs of malnutrition. 

Patients who have trouble eating because of an upset stomach are at risk for malnutrition. Signs of malnutrition may be a BMI below 18.5, rapid unintentional weight loss, weakness, fatigue, mental deficits such as poor concentration, and signs of low immunity such as slow wound healing.

Offer oral fluids as tolerated in small increments and consider patient preferences.

Oral fluids may be more tolerable if the patient likes the type of beverage. In addition, small sips of liquid and bites of food consistently throughout the day may help the patient keep food and fluids down. 

Provide calorie-dense foods. 

Food high in calories helps increase overall calorie intake and can be helpful when the patient can only ingest small amounts of food. 

Anticipate intravenous fluid administration in severe cases of dehydration. 

Additional IV fluids may help with consistent rehydration. 

Eliminate strong odors during mealtime. Create a pleasant environment as much as possible.

Strong, offensive odors may induce nausea and eventually cause vomiting. 

Emphasize the importance of the timing of antiemetic medications. 

Giving antiemetics before meals may help reduce episodes of nausea and vomiting. 

Anticipate the need for enteral feedings if the patient is unable to eat after 24 to 48 hours. 

Starting feedings early may reduce further complications of malnutrition and help maintain current weight and muscle mass. 

Risk for Electrolyte Imbalance: Risk factor: loss of stomach content containing electrolytes secondary to vomiting

Risk factors: 

  • Vomiting 
  • Dehydration 
  • Inability to take in food 
Monitor serum electrolyte levels and note signs and symptoms for imbalances.

Sodium 135 – 145 mEq/L 

Signs of hyponatremia (low sodium) are

-generalized skeletal muscle weakness 
-diminished reflexes 
-headache 
-lethargy 
-confusion 
-nausea 
-dry mucus membranes 
Potassium 3.5 – 5.0 mEq/L 

Signs of hypokalemia (low potassium) are 

-dysrhythmias
-weakness of skeletal muscles 
-cramps in the legs 
-paresthesia 
-decreased gastric motility 
-EKG changes: ST depression; inverted T wave; prominent U wave
Calcium 8.6 – 10 mg/dL

Signs of hypocalcemia (low calcium) are 

-muscle twitches, cramps, seizures 
-muscle spasms in the calves 
-positive Trousseau’s  and Chvostesk’s signs
-increased gastric motility; gastric cramping 
Magnesium 1.6 – 2.6 

Signs of hypomagnesemia (low magnesium) are 

-tachycardia 
-muscle twitches
-tetany; seizures 
-irritability; confusion 
-EKG changes: tall T waves; depressed ST segments 

Because stomach content contains many electrolytes, persistent vomiting may cause an imbalance and lead to other possible complications.

Provide fluids that contain electrolytes. 

Electrolyte replacement with oral fluids helps reduce electrolyte loss during episodes of vomiting.

Anticipate treating electrolytes intravenously per order. 

Often oral electrolyte replacement might not be sufficient. Therefore, treating electrolytes via IV line helps reduce side effects from electrolyte imbalances such as cardiac dysrhythmias and muscle weakness.

Assess the patient’s mental status at regular intervals. 

Decreased serum electrolytes and dehydration can cause impaired mentation. 



More Care Plans:

Deficient Fluid Volume

Nausea

Imbalanced Nutrition: Less Than Body Requirements

Gastritis Nursing Diagnosis & Care Plan

Fatigue

Readiness for Enhanced Nutrition 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>

Ignatavicius, D., & Workman, M. (2016). Medical-surgical nursing (8th ed.). Elsevier.


Silvestri, L. (2014). Saunders comprehensive review for the NCLEX-RN examination. Elsevier/Saunders.

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