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Nausea, Vomiting and Diarrhea
Self-Assessment Checklist

Print off this checklist or check the appropriate box on-screen as you answer the questions.

General Information and Definitions
Self-Assessment Checklist

General Information and Definitions

Definitions:

Diarrhea (acute): Frequent, loose, watery, or unformed stool resulting in fluid loss and electrolyte mal-absorption. Diarrhea may be associated with mild abdominal cramping. It may be caused by:
 
  • viral infection
  • bacterial infection
  • parasitic infection
  • inflammatory reactions
  • toxic or chemical exposure
  • stress
  • poor absorption
  • laxative abuse
  • Nausea and Vomiting: Often caused by a virus in young adults. Frequently called gastroenteritis or "stomach flu". Other causative factors include:
     
  • increased intra-cranial pressure
  • systemic infection
  • drugs and alcohol use or misuse
  • reaction to pain or anxiety
  • Recurrent vomiting is often associated with a more chronic problem or the gastrointestinal system such as ulcer of the stomach or duodenum or gallbladder disease. It may also be be associated with neurological or psychological disorders. All patients with persistent, recurrent vomiting should be referred for medical evaluation.

    If you have a chronic illness such as diabetes, heart disease, or inflammatory bowel disease, or are immuno-compromised, or taking immuno-supressant medications, you should seek medical attention promptly.

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    Self-Assessment Checklist

    Now rate yourself by answering the following questions:

    Check the box in Column A or Column B that most closely fits your symptoms.

    Symptom Column A Column B
    1. Nausea only?   No or less than 2 days   More than 2 days
    2. Vomiting?    1 to 2 times in 24 hours   Unable to retain clear liquids more than 6 hours
    3. Blood in vomit or bowel movement?   No   Yes
    4. Diarrhea only? (liquid stools)   1 to 3 days   3 to 5 days and not improving with self-care
    5. Rt lower abdominal pain?   No   Yes
    6. Fever? (more than 100.5)   Less than 48 hours   More than 48 hours
    Vomiting following stomach or head injury?      Yes
    Diabetic or Immunosupressed?   No   Yes
    9. Headache?   No or mild   Moderate to severe
    10. Ability to touch chin to chest?   Yes   No
    11. Dizziness or lightheadedness?   Mild   Moderate to severe
    12. Dehydration?   Urinating every 5 to 7 hours   Infrequent urination (no urine for 8 hours)
    13. Drowsiness and/or weakness?   Mild to moderate   Excessive
    14. Alcohol intake?   Yes   No
    15. Recent travel, camping, or hiking?   No   Yes

    Rating: If you have any checks in Column B, please make an appointment to see a Health Care Provider by calling (814) 863-0774. Or you can contact the Advice Nurse at (814) 863-4463.

    If all of your check marks are in Column A, please refer to the Self-Care information at the following 2 links:
    Diarrhea, Nausea and Vomiting
     

    Disclaimer: The information found on this site is intended as educational information only. You SHOULD NOT rely on the information to make any medical or other decisions for treatment. Any medical or other decisions should be made in consultation with your health care provider. University Health Services will not be liable for any complication, injuries or other medical accidents arising from or in connection with the use of or reliance upon any information on the Web.

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