Nausea and vomiting are common complaints in the correctional environment.  Typically the result of gastrointestinal (GI) infections, nausea and vomiting may also be the result of other infections, metabolic disorders, central nervous system disorders, the ingestion of certain drugs, pain, pregnancy and psychiatric disorders. 

Nausea is an unpleasant sensation vaguely referred to the epigastrium and abdomen, with a tendency to vomit.  Nausea may be a symptom of a variety of disorders, ranging from benign to serious.  Nausea is usually felt when nerve endings in the stomach and other parts of the body are irritated.  The irritated nerves send messages to the center in the brain that controls the vomiting reflex.  When the irritation gets to a certain level, vomiting results.  Because the nausea-vomiting mechanism is part of the autonomic nervous system, nausea and vomiting may be instigated from nerve signals in many different parts of the body.  The North American Nursing Diagnosis Association (NANDA) defines nausea as “an unpleasant, wave-like sensation in the back of the throat or epigastrium, or throughout the abdomen that may or may not lead to vomiting”.  

Vomiting is defined as the forcible voluntary or involuntary emptying of the contents of the stomach through the mouth.  

As with the assessment of all patient complaints, the evaluation should begin with a thorough history. 

The Abdominal Nausea/Vomiting History 

It is important that a thorough history be obtained from the patient. If the patient is experiencing abdominal pain, the nurse should ascertain its location, duration, intensity, exacerbating factors, and mitigating factors.  Questions to ask about the nausea and vomiting include the following: 

• What does the patient mean by “nausea” – loss of appetite, queasiness, feeling of imminent vomiting, or retching
• Meals, offensive odors, motion, position changes, pain
• Is there anything that relieves the symptoms, Including self-treatments?
• Is there a time-association with meals, activity, movement, time of day? 
• Has the patient been in contact with anyone else who is ill? 
• Any history of co-morbid conditions that are associated with nausea – renal failure with metabolic disturbances, diabetes with gastroparesis, cancer treatments, pregnancy?
• Are there any associated symptoms, like fever, diarrhea, diaphoresis, syncope, or pain? 
• What medication does the patient take?  Have there been any changes to their medication regimen (new meds or meds discontinued), including prescribed, over-the-counter, illicit/recreational drugs, and alcohol?
• If the patient has vomited, ascertain color, amount, presence of bile or undigested food, and frequency/number of episodes. 

In our next post, we will discuss potential causes for nausea and vomiting, including their typical signs and symptoms.

All information is from The Correctional Nurse Educator classes about Abdominal Pain and Assessment.

Please share any experiences you have had with unusual cases of nausea and vomiting in your Correctional Nursing career.