Definition

Nausea refers to a feeling of sickness and wanting to vomit.

History

Quality

What is the nausea like?

Severity

What does it stop you from doing?

Time Course

Onset-Offset

Did it start suddenly?

Duration

How long does it last?
How long has it been a problem for?

Temporal Profile

Is the nausea there all the time?
Is it getting worse?
Is the nausea worse at a particular time of day?
Have you had this problem before?

Context

Can you think of anything that may have caused it?
Have you been traveling recently?
Have you been in contact with anybody who has been sick?

Aggravating Factors

Is there anything that makes the nausea worse?

Relieving Factors

Is there anything that makes it better?

Associated Features

Have you noticed anything else apart from the nausea?
Have you had:

Past History

Have you ever had:

Medications

Do you take any regular medications?
Do you take: (may need to be expanded)

Family History

Are there any medical conditions that run in your family?
Has anybody in your family ever had:

Social History

Can you tell me about you where you live?
Where do you work?
What are your hobbies?
Do you smoke?
Do you drink alcohol?

Examinations and Investigations

Examinations

Bloods

Imaging

  • Erect Abdominal X-ray
  • Endoscopy
  • Head CT (if neurological)

Differential Diagnosis

Neurological

Abdominal

Infectious

Cardiac

Renal

Substance

Endocrine

Other

Red Flags

Management

  • Pre-operative anti-emetics to prevent nausea
  • Try anti-emetic via oral route first
  • IV fluids (if oral route not possible)
  • Disease specific management
  • Referral to General Surgery, General Medicine, Neurosurgery, Neurology, Nephrology, Endocrinology

See also

BMJ Best Practice - Assessment of Nausea and Vomiting
Merck Manual - Nausea and Vomiting
Oxford Handbook of Clinical Medicine - 9th edition p240
Headache, Vision Loss (Bitemporal hemianopia), Acromegaly, Weight Gain, Nausea, Hypothyroidism symptoms