Cyclical vomiting syndrome Cyclical vomiting syndrome - pg.5 | allnurses

Cyclical vomiting syndrome - page 5

Anybody encountered a patient with this diagnosis? I had a pt come in the other day, report of vomiting x23 during past 4 hours, severe pain 10/10 in abdomen, letter from GI doctor stating she was... Read More

  1. Visit  danagrams profile page
    #52 0
    I've encountered this before, because I have been dating this person with cvs for the past year. I hope you're not some nurse from Houston, because I would hate to know that the people I deal with here secretly think these things about my girlfriend. I assure you, she's not a junkie, and it's pretty much her worst nightmare. Yes, the drugs feel good. But they make her sick later if she's on them too long, so no, she does not just go to the hospital pretending to be sick. In fact, it pretty much ruins her life, and she would really prefer to stay OUT of the hospital for as long as possible. The fact that no medical staff is willing to believe her conditions has made her life even worse, when she ended up tearing a hole in her esophagus and had to get surgery for it. Now she has strictures that form from this and imhas to get dilations periodically to just eat. She's also diabetic. It's really serious and very depressing at times for her, to the point where she has contemplated suicide. It would be irresponsible for any one of you to make this sort of judgment call on a person just because they ask for dilaudid by name. It's just that it works really well at stopping the vomiting. The phenergan is there to knock her out. That's the point—to stop the pain and knock her out.

    Quote from thelema13
    Anybody encountered a patient with this diagnosis? I had a pt come in the other day, report of vomiting x23 during past 4 hours, severe pain 10/10 in abdomen, letter from GI doctor stating she was diagnosed with cyclical vomiting syndrome and gastroparesis. Pt was begging for phenergen and dilaudid. Pt had previous rx for dilaudid 2mg PO, phenergen 25mg PO, and reglan 10mg PO. I gave her phenergen IV and IM, bentyl IM, protonix IV, tigan IM. Pt seemed to calm down but still begging for pain medication, asking for dilaudid by name. Became irritated when ED doc explained dilaudid may increase n/v and would not be given. (ED doc did not believe report of pain and flagged pt as drug seeker). Pt would only wretch and dry heave when I left the room or when doc was in room talking to pt. She was good enough to walk around and keep asking for pain medication. I witnessed vomiting x3 during 2.5 hour stay, watery undigested food, no bile. Im not sure what to think...........

    Any input greatly appreciated.
  2. Visit  Lxxrx profile page
    #53 0
    I am a preceptor in a small ED and will be starting a residency in another ED right after graduation. I have been able to participate in the care of a few patients with this diagnosis and was honestly shocked by the stigma that surrounds it. My son was diagnosed with CVS at 4, he is obviously not a seeker. I know exactly what dose of medications will work to help stop an attack. Heck, he could say "ondansetron" with a sweet little lisp when getting triaged at our local children's hospital. We are lucky to have a GI that has found the right preventative medication which keeps him mostly attack free and out of the hospital. But, he also tells us that these medications are less successful the older the person gets. Gosh, I just hope that as an adult he is met with nonjudgmental compassion when he arrives at the ED.
  3. Visit  BostonFNP profile page
    #54 0
    Quote from Lxxrx
    I am a preceptor in a small ED and will be starting a residency in another ED right after graduation. I have been able to participate in the care of a few patients with this diagnosis and was honestly shocked by the stigma that surrounds it. My son was diagnosed with CVS at 4, he is obviously not a seeker. I know exactly what dose of medications will work to help stop an attack. Heck, he could say "ondansetron" with a sweet little lisp when getting triaged at our local children's hospital. We are lucky to have a GI that has found the right preventative medication which keeps him mostly attack free and out of the hospital. But, he also tells us that these medications are less successful the older the person gets. Gosh, I just hope that as an adult he is met with nonjudgmental compassion when he arrives at the ED.
    From my professional experience, CVS in children and CVS in adults are different, remember CVS is a constellation of disorders. I have never seen an adult patient with CVS that had onset in childhood. Best of luck with your son.
  4. Visit  AZQuik profile page
    #55 1
    Quote from Lxxrx
    I am a preceptor in a small ED and will be starting a residency in another ED right after graduation. I have been able to participate in the care of a few patients with this diagnosis and was honestly shocked by the stigma that surrounds it. My son was diagnosed with CVS at 4, he is obviously not a seeker. I know exactly what dose of medications will work to help stop an attack. Heck, he could say "ondansetron" with a sweet little lisp when getting triaged at our local children's hospital. We are lucky to have a GI that has found the right preventative medication which keeps him mostly attack free and out of the hospital. But, he also tells us that these medications are less successful the older the person gets. Gosh, I just hope that as an adult he is met with nonjudgmental compassion when he arrives at the ED.
    Not likely. As a parent of a child whose onset was 7 y/o and an ED nurse, my kid was labeled as a drug seeker and "behavioral" pt by 12.

    No such luck here with a good gi doc, and I spend most of my kids admissions arguing with "doctors". We have been threatened numerous times to have the states "child safety" called on us. My response is always the same, " if you think I'm neglecting or abusing my child, and you threaten me with reports but never make them, you should lose your license" very very frustrating.
  5. Visit  NurseT88 profile page
    #56 0
    No mention of concurrent drug use - especially marijuana from the posts. Are any of your departments doing drug screens to assess for a drug related component?
    What I'm finding with the patients being seen in the departments I'm working in is all these patients are chronic marijuana users.
    We throw every anti-emetic at these patients, including Haldol, yet all that seems to ease the symptoms (other than a threat to use only non-parenteral approaches) is a narcotic - which miraculously works the second it is pushed like a switch has been thrown. Certainly leads one to identify these patients as seekers.
  6. Visit  WKShadowRN profile page
    #57 0
    Quote from NurseT88
    No mention of concurrent drug use - especially marijuana from the posts. Are any of your departments doing drug screens to assess for a drug related component?
    What I'm finding with the patients being seen in the departments I'm working in is all these patients are chronic marijuana users.
    We throw every anti-emetic at these patients, including Haldol, yet all that seems to ease the symptoms (other than a threat to use only non-parenteral approaches) is a narcotic - which miraculously works the second it is pushed like a switch has been thrown. Certainly leads one to identify these patients as seekers.
    We haven't routinely done drug screens but do educate the patients about the relation between THC and cyclic vomiting syndrome.
  7. Visit  hherrn profile page
    #58 1
    Quote from WKShadowRN
    We haven't routinely done drug screens but do educate the patients about the relation between THC and cyclic vomiting syndrome.
    I find that the pot smokers just don't believe it. It can't possibly be the weed, it must be a coincidence.
  8. Visit  canoehead profile page
    #59 0
    If 2mg dilaudid does the trick, I don't think we're talking drug seekers. Real seekers will go for repeated doses, and some to take home. I'd happily give a dose of dilaudid to prevent hours of retching, and prevent a dozen doses of ineffective meds.

    I'm thanking my lucky stars that I don't have any diseases that require an opiate. Anyone with a problem that can't be verified by lab or Xray is subject to doubt from professionals, especially during horrible stressful shifts. I know I tend to question patients' stories when beds are tight, and I'm starting to feel guilty about not being able to get people treated. I think it's a defense mechanism, if I have to neglect them, I'm more likely to minimize their pain. Sad, but true, and I have to be aware of it.
  9. Visit  LV3677 profile page
    #60 0
    Had one of these recently in the ED. Patient had a home medication regimen of the standard antiemetics that weren't resolving symptoms. The patient asked for Emend, which is an anti nausea medication used to premeditate for chemo patients. It worked beautifully for this patient, and was able to discharge home with a script for it.
  10. Visit  mecsjh1 profile page
    #61 0
    The information found here is invaluable to me. I have CVS that began 5 years ago, but has just been diagnosed. I absolutely do not like going to the ED, but will have to until we figure out what works for me. I am also a pain patient (since multiple back surgeries in 1995), but am on an extended release medication. My episodes typically present about one hour after rising for the day. I rarely vomit up my pain meds, so when I get to the ER I could care less sbout them, or anything else except getting fluids, stopping the violent vomiting (never dry heaves, but a lot of bile), and getting cleaned up. Unfortunately, for me and my nurses, I become bowel incontinent 80% of the time. I typically get compassionate care, but I spend all my energy in between vomiting, apologizing to any professional that provides any care. I apologize for the mess as well. I feel so bad for anyone who has to help me get cleaned up. My last ED visit happened when they were slow. In fact, I was stunned to fine the ED waiting room completely empty at 8:35 am in a Thursday. The woman caring for me was mad at me for sending my husband away. He has a weak immune system and, as our sole provider, I need him well so I make him leave. Everyone has always understood this, but this last visit she was mad! So mad, after cleanung up my mess & changing the sheet & gown once, she left me sitting in a lot of my waste for well over an hour. Sent me to get an abdominal ultrasound in it, as well as sending me upstairs when I was admitted. Left it to the regular hospital nurses to take care of. All of these other people were astonished this happened to me and, very graciously and with compassion, cleaned me up each time. I feel for the people who have CVS that posted here, and for those who may be unfairly labeled. Once my doctor(s) find what works for me, I assumed if I did have to go to the ED on occasion, that telling them what has worked in the past would be the smart thing to do. However, after reading all of this, I will get a letter from the doc stating what works, or what they are currentky giving me so I can hand it over at the ED to avoid any misconceptions. Thank you to all the nurses and other pros who either do or are trying to understand this horrible illness.

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