Nursing Care Plan (NCP) for Vomiting / Diarrhea

Lesson Objectives for Vomiting/Diarrhea

• Definition and Differentiation:
  • Define vomiting and diarrhea as gastrointestinal symptoms characterized by the forceful expulsion of stomach contents and the frequent passage of loose or liquid stools, respectively.
• Common Causes:
  • Identify common causes of vomiting and diarrhea, including infections (viral, bacterial, or parasitic), gastrointestinal disorders, dietary indiscretion, medications, and emotional stress.
• Clinical Manifestations:
  • Recognize the clinical manifestations associated with vomiting and diarrhea, such as dehydration, electrolyte imbalances, abdominal cramping, and general weakness.
• Complications and High-Risk Groups:
  • Understand potential complications, especially in vulnerable populations such as infants, elderly individuals, and those with chronic medical conditions. Complications may include dehydration, electrolyte disturbances, and nutritional deficiencies.
• Management and Nursing Interventions:
  • Outline effective nursing interventions and management strategies to alleviate symptoms, prevent complications, and promote the patient’s comfort and well-being during episodes of vomiting and diarrhea.

Pathophysiology of Vomiting/Diarrhea

Vomiting Pathophysiology:

• Vomiting, or emesis, is a complex reflex involving the coordination of multiple systems. It typically involves stimulation of the vomiting center in the brainstem, triggered by various stimuli such as toxins, infections, or disturbances in the vestibular system.

• Gastrointestinal Irritation:
  • Irritation of the gastrointestinal (GI) mucosa, whether due to infections, toxins, or other factors, can activate the vomiting reflex. This irritation sends signals to the vomiting center, leading to the forceful expulsion of stomach contents.
• Neurotransmitter Involvement:
  • Neurotransmitters such as serotonin, dopamine, and acetylcholine play a role in the vomiting reflex. Disruptions in these neurotransmitter pathways can contribute to vomiting.

Diarrhea Pathophysiology:

• Diarrhea results from an increased frequency and fluidity of bowel movements. It can be caused by increased secretion of fluids into the intestine, decreased absorption of fluids by the intestine, or a combination of both.

• Inflammatory Processes:
  • Infections, inflammation, or irritants in the GI tract can disrupt the normal absorption and secretion processes, leading to an imbalance and resulting in diarrhea.

Etiology of Vomiting/Diarrhea

• Infections:
  • Viral, bacterial, and parasitic infections are common causes of vomiting and diarrhea. Pathogens can directly irritate the GI mucosa or produce toxins that lead to symptoms.
• Gastrointestinal Disorders:
  • Conditions such as gastroenteritis, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and gastroesophageal reflux disease (GERD) can contribute to chronic or recurrent episodes of vomiting and diarrhea.
• Dietary Indiscretion:
  • Consumption of contaminated food or water, excessive alcohol intake, or intolerance to certain foods can result in gastrointestinal upset, leading to vomiting and diarrhea.
• Medications:
  • Some medications, especially antibiotics, certain chemotherapy drugs, and laxatives, can disrupt the normal balance of the GI tract, causing vomiting and diarrhea as side effects.
• Psychological Factors:
  • Emotional stress, anxiety, and psychological factors can influence the gastrointestinal system and contribute to symptoms of vomiting and diarrhea, particularly in functional gastrointestinal disorders.

Desired Outcome for Vomiting/Diarrhea

• Fluid and Electrolyte Balance:
  • Restore and maintain fluid and electrolyte balance to prevent dehydration and electrolyte imbalances.
• Symptomatic Relief:
  • Alleviate symptoms of vomiting and diarrhea to improve the patient’s comfort and well-being.
• Identification of Underlying Cause:
  • Identify and address the underlying cause of vomiting and diarrhea, whether infectious, inflammatory, dietary, or medication-related.
• Prevention of Complications:
  • Prevent complications such as dehydration, electrolyte disturbances, and nutritional deficiencies associated with prolonged vomiting and diarrhea.
• Patient Education:
  • Educate the patient on self-care measures, dietary modifications, and signs of worsening symptoms to empower them in managing and preventing future episodes.

Vomiting / Diarrhea Nursing Care Plan

 

Nursing Interventions and Rationales

 

• Assess patient for the degree of vomiting: mild (1-2x/day), moderate (3-7x/day) or severe (8 or more or vomits everything consumed)

• Obtain history and information from the patient’s parent or caregiver

• Assess vital signs

• Assess for blood in stool or emesis

• Assess abdomen for distention, hyperactive bowel sounds  and cramping

• Monitor Intake and Output

• Obtain samples of stool for culture

• Provide perineal care following diarrhea

• Encourage oral hydration; Administer oral rehydration solution (ORS) as necessary or IV fluids as appropriate

• Educate patient and family on BRAT diet (Bananas, Rice, Applesauce, and Toast)

• Administer medications as appropriate

• Provide patient and family education to manage and prevent symptoms

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References

• https://www.aafp.org/afp/2001/0215/p775.html
• http://www.seattlechildrens.org/medical-conditions/symptom-index/vomiting-with-diarrhea/