1. Chapter 25 Emetics and Antiemetics

2. Emetics p585 Agents that induce vomiting – Used in overdoses Example – Ipecac syrup Inappropriate use of emetics – Clients with bulimia Major nursing concern with vomiting is potential for aspiration of emesis.

3. Emetics p591 Emetics contraindicated: – Corrosive substances or oils – Unconscious patient Poison control: 1-800-222-1212 Primary nursing consideration when giving emetics is preventing aspiration of emesis

4. Causes of nausea and vomiting p585 Motion sickness Morning sickness Intense pain Exposure to chemicals or toxins Fear or anxiety Gallbladder disease Food poisoning Hyperacidity Decreased GI motility Odors, sights, tastes, or thoughts

5. Anticholinergics and Antihistamines Table 25-1 p 586 Anticholinergics – scopolamine blocks acetylcholine receptors Antihistamines – diphenhydramine – meclizine – promethazine

6. Anticholinergics and antihistamines cont p586 Side effects: drowsiness – anticholinergic side effects: Dry mouth Blurred vision Urinary retention Constipation Contraindications – Pt with glaucoma, enlarged prostate

7. Neuroleptic agents p586 Neuroleptic agents: not used as frequently today as antiemetics – Examples: chlorpromazine (Thorazine) droperidol (Inapsine) prochlorperazine (Compazine) – Decreased action of dopamine (potential for extrapyramidal symptoms)

8. Prokinetic agents p586 Metoclopramide (Reglan) – Blocks dopamine (potential for extra pyramidal side effects) – Stimulate acetylcholine to increase gastric emptying Used as an adjunct to anesthesia, preoperative medication to promote gastric emptying

9. Serotonin Blockers p586 Block serotonin receptors in the gastrointestinal tract and CNS emetic center – antineoplastic agents – nausea with migraine headaches – gastroenteritis – postoperative N&V – morning sickness Examples: – Ondansetron (Zofran) – Granisetron (Kytril) Adverse effects: constipation, headache

10. Nursing Process Assessment  Thorough history and physical Plan  Nurse should anticipate situations where N&V are likely and treat prophylactically  Primary nursing consideration with vomiting is prevention of aspiration Evaluation  Are the nausea and vomiting gone?