Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:
· Synthroid 100 mcg daily
· Nifedipine 30 mg daily
· Prednisone 10 mg daily
There are many causes of nausea and vomiting, most commonly these symptoms are caused by ingestion of substances or drugs, gastrointestinal disorders or metabolic disorders (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). In this particular case study it is important to take into consideration the factors that could be contributing to the nausea, vomiting and diarrhea in patient HL. The patient has a history of drug abuse. With that being said, drug withdraw can be a factor in the cause of nausea, vomiting and diarrhea. Treatment for this type of cause would be dependent on what type of drug that patient was withdrawing from. The next factor would be medications the patient is currently taking. All three of these medications have nausea and vomiting as potential side effects. If this is the cause of the patient’s chief complaint, changing the medications could be an appropriate response. The last consideration would be the patient’s diagnosis of possible Hepatitis C. The most common symptoms of Hepatitis C include nausea, vomiting, and diarrhea (Franciscus, 2015). It would be hard to diagnosis the cause of this episode of nausea vomiting without other information such as aggravating and relieving factors, how long these symptoms have been occurring and if any other symptoms are associated with these. First line treatment of nausea and vomiting include phenothiazines such as promethazine. Promethazine can be given in 12.5-25mgs every four to six hours as needed. Contraindications include hypersensitivity, seizure disorders and Parkinson’s disease. Adverse effects include sedation, agitation, dry mouth and blurred vision (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Second line therapy would be to add an antihistamine or anticholinergic such as diphenhydramine. This medication is dosed from 25-50mg every six to eight hours as needed. Adverse effects include drowsiness, confusion and dry mouth. Contraindications include asthma, hypersensitivity and narrow-angle glaucoma (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). If this persists the patient needs to reevaluate for other causes. Alternative therapies including herbal therapies such as vitamin b6 , ginger and even gum chewing are linked to the relief of nausea and vomiting (Darvall, Handscombe & Leslie, n.d.).
References:
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. (2017). Pharmacotherapeutics for Advanced Practice (Vol. 4). Philadelphia: Wolters Kluwer.
Darvall, J. N., Handscombe, M., & Leslie, K. (n.d.). Chewing gum for the treatment of postoperative nausea and vomiting: a pilot randomized controlled trial. BRITISH JOURNAL OF ANAESTHESIA, 118(1), 83–89. https://doi-org.ezp.waldenulibrary.org/10.1093/bja/aew375
Franciscus, A. (2015). HCV Advcocate. Retrieved from HCSP Fact Sheet : http://hcvadvocate.org/hepatitis/factsheets_pdf/SEM_Nausea.pdf
