History of Present Illness Template for Nausea and Vomiting
A comprehensive HPI for nausea and vomiting should include specific details about onset, duration, pattern, associated symptoms, and exacerbating/alleviating factors to guide proper diagnosis and treatment.
Core Components
Symptom Characteristics
- Onset and duration: When symptoms began, whether acute (<7 days) or chronic (≥4 weeks) 1
- Pattern: Continuous vs. intermittent/cyclic, stereotypical episodes 2
- Severity: Using standardized assessment (e.g., Motherisk PUQE score for pregnancy) 2
- Hours of nausea in past 12 hours
- Number of vomiting episodes
- Number of retching/dry heaves
Emesis Characteristics
- Frequency: Number of episodes per day/week
- Timing: Relationship to meals, time of day (e.g., early morning episodes common in cyclic vomiting) 2
- Volume and content: Small vs. large volume, presence of blood, bile, undigested food
- Force of vomiting: Projectile vs. non-projectile
Associated Symptoms
- Prodromal symptoms: Presence of warning signs before vomiting (e.g., sense of doom, anxiety) 2
- Abdominal pain: Location, character, severity, timing in relation to nausea/vomiting
- Constitutional symptoms: Fever, weight loss, fatigue
- Neurological symptoms: Headache, visual disturbances, dizziness, mental fog 2
- Autonomic symptoms: Diaphoresis, flushing, bowel changes 2
Modifying Factors
Triggers and Exacerbating Factors
- Dietary triggers: Specific foods, alcohol, caffeine
- Environmental factors: Odors, motion
- Psychological stressors: Both negative and positive stress events 2
- Physical triggers: Sleep deprivation, fasting, intense exercise 2
Alleviating Factors
- Positional changes: Sitting up, lying down
- Dietary modifications: Small meals, BRAT diet (bananas, rice, applesauce, toast) 2
- Self-remedies: Hot showers/baths (particularly relevant for cannabinoid hyperemesis) 2
- Medications: Response to previous antiemetics
Medical Context
Medication and Substance Use
- Current medications: Particularly those known to cause nausea (opioids, antibiotics)
- Substance use: Cannabis (duration, frequency, and pattern of use) 2
- Over-the-counter remedies: Use of antacids, herbal supplements, ginger
Relevant Medical History
- GI conditions: History of gastroparesis, GERD, inflammatory bowel disease
- Neurological conditions: History of migraines, vestibular disorders 2
- Endocrine disorders: Diabetes, thyroid dysfunction
- Pregnancy status: Last menstrual period, possibility of pregnancy 2
Impact on Function
- Daily activities: Effect on work, school, social activities
- Nutritional impact: Weight changes, ability to maintain hydration
- Sleep disturbances: Nocturnal symptoms affecting sleep quality
- Quality of life: Overall impact on well-being 1
Special Considerations
For Cyclic/Episodic Patterns
- Episode frequency: Number of episodes per year
- Episode duration: Typical length of each episode
- Inter-episodic health: Presence of symptoms between episodes 2
- Family history: Particularly of migraine or similar vomiting disorders 2
For Pregnancy-Related Nausea/Vomiting
- Gestational age: Weeks of pregnancy
- Severity indicators: Weight loss, ketonuria, electrolyte abnormalities
- Impact on pregnancy: Ability to take prenatal vitamins, maintain nutrition 2
This structured approach ensures comprehensive documentation of nausea and vomiting symptoms, facilitating accurate diagnosis and appropriate management strategies based on the underlying cause and severity of symptoms.