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
Assess hydration status including
Urine output
Mucous membranes
Thirst
Skin turgor
Capillary refill
Blood glucose level
Obtain MSU and complete urinalysis if positive leucocytes or nitrites send for MCS as per local protocols
Consider obtaining a stool sample & send for MCS & OCS as per local protocols
Commence fluid balance chart
Additional History
Social / infectious contacts history
Management Principles
Gastroenteritis clinical practice guidelines (paediatric or adult) should be used in conjunction with this NMG
Commence trial of fluids using a recommended oral rehydration solution (ORS) e.g. Gastrolyte® or Hydralyte™ as per Standing Orders
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
Document assessment findings, interventions, investigations and outcomes
References / Further Resources
Patient Factsheet - Diarrhoea and Vomiting
NSW Health (2014) Infants and children: Management of Acute Gastroenteritis (4th Ed.) NSW Kids and Families, Sydney
NSW Ministry of Health (2012) Gastroenteritis in an institution: Control Guideline for Public Health Units, NSW Ministry of Health, Sydney
Furyk, J.S,. Meek, R.A., Egerton-Warburton D. (2015) Medicines in the treatment of emergency department nausea and vomiting. The Cochrane Collaboration, London.