Vomiting and Diarrhoea Nurse Management Guidelines

Red Flag Exclusion Criteria

  • Child at risk of significant harm

  • Suspected non-accidental injury

  • Unplanned repeat ED presentation

  • Child ≤ 2 years

  • Adult ≥ 65 years

  • Hydration status in adults assessed as moderate (≥ 5%) or severe (≥ 10%) dehydration

  • Children assessed as having mild (3%) dehydration who have failed Trial of Oral Fluid

  • Blood in vomit or stool

  • Green in vomit

  • Vomiting without diarrhoea

  • Abdominal tenderness or distension

  • Increasing / worsening abdominal pain

  • Diabetes

  • Immunocompromised

  • Altered level of consciousness / agitation

  • History of workplace injury

  • Yellow or Red Zones observations or additional criteria outlined in the NSW Health Standard Observations Charts

Additional Observations

  1. Assess hydration status including

  • Urine output

  • Mucous membranes

  • Thirst

  • Skin turgor

  • Capillary refill

  1. Blood glucose level

  2. Obtain MSU and complete urinalysis if positive leucocytes or nitrites send for MCS as per local protocols

  3. Consider obtaining a stool sample & send for MCS & OCS as per local protocols

  4. Commence fluid balance chart

Additional History

Social / infectious contacts history

Management Principles

  1. Gastroenteritis clinical practice guidelines (paediatric or adult) should be used in conjunction with this NMG

  2. Commence trial of fluids using a recommended oral rehydration solution (ORS) e.g. Gastrolyte® or Hydralyte™ as per Standing Orders

  3. Consider administration of an antiemetic as per Standing Orders

Ondansetron 4mg tablet / wafer

OR

For adult patients ≥ 20 years only, administer metoclopramide with the following considerations:

  • Tablet: if patient has not vomited in the past hour and is tolerating small frequent amounts of oral fluid

  • Parenteral: if patient is currently vomiting and unable to tolerate small amounts of oral fluid

  1. Document assessment findings, interventions, investigations and outcomes

References / Further Resources

  1. Patient Factsheet - Diarrhoea and Vomiting

  2. NSW Health (2014) Infants and children: Management of Acute Gastroenteritis (4th Ed.) NSW Kids and Families, Sydney

  3. NSW Ministry of Health (2012) Gastroenteritis in an institution: Control Guideline for Public Health Units, NSW Ministry of Health, Sydney

  4. Furyk, J.S,. Meek, R.A., Egerton-Warburton D. (2015) Medicines in the treatment of emergency department nausea and vomiting. The Cochrane Collaboration, London.

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