Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Nausea


Medical Codes

ICD-9-CM:
787.01 - Symptoms Involving Digestive System, Nausea with Vomiting
787.02 - Symptoms Involving Digestive System, Nausea

Related Terms

  • Queasiness
  • Upset Stomach

Overview

Nausea is usually described as queasy, unpleasant sensations in the stomach leading to the urge to vomit.

The nervous system mechanism that produces the symptom of nausea is believed to be the same as that for vomiting. Various stimuli can activate this nervous system mechanism, such as disturbances in the balance center in the inner ear and irritation or pressure on the nerve endings in the stomach. Once stimulated, messages are sent to the brain to the region that controls the vomiting reflex. In addition, a wide variety of disturbances in the brain including concussion or other head injury, brain infections (encephalitis or meningitis), tumors, or migraine headaches can disturb the brain's vomiting reflex and cause nausea and/or vomiting. It is believed that nausea results when there is mild stimulation of this nervous system mechanism, while vomiting occurs with more intense stimulation of this nervous system mechanism.

Nausea is often a symptom of various disorders that may be relatively minor or quite severe. For example, nausea may be the manifestation of pregnancy, motion sickness, food allergies, food poisoning, alcohol or drugs, side effects of radiation therapy (radiation sickness) or medications, over-eating, obstruction of the intestinal tract, inflammation of the liver (hepatitis), heart attack (myocardial infarction), internal problems such as appendicitis, viruses (stomach flu), kidney failure, increased brain pressure (increased intracranial pressure), poor gastric motility (gastroparesis). It is a common side effect following general anesthesia. At times, tumors, particularly those in the brain, intestinal tract, gallbladder, or liver cause nausea.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may complain of lack of appetite or an unsettled feeling in their stomach. They may be able to correlate factors that bring on the unsettled feeling or relieve the feeling. Along with feelings of nausea, they may report associated symptoms such as fever, dizziness, cold and clammy skin, cramps, diarrhea, sweating (diaphoresis), and vomiting. The individual may report a recent, unintended weight loss, or a severe headache combined with a stiff neck. He or she may provide information about medication use, alcohol use, or other exposures or trauma that could have precipitated the nausea. Women of childbearing age may report a delay in the onset of their menstrual cycle.

Physical exam: The exam is directed at assessing the acuteness and severity of the problem as well as uncovering additional symptoms that may be clues as to the cause. The individual is evaluated for acute weight loss and dehydration, and the presence of blood in the vomitus. The abdomen is examined for abdominal pain, abnormal bowel sounds, and distention. Vital signs are taken to determine the presence of fever, rapid pulse, or low blood pressure, which may be indicative of infection, heart attack, or inflammatory conditions. An examination of the eyes, ears, and balance may provide clues about inner ear problems or brain dysfunction. The individual should also be examined for the presence of neck muscle spasms and for signs of lethargy, confusion, decreased alertness, or marked irritability, which would also indicate problems with the brain. The presence of yellow skin (jaundice) or liver enlargement may suggest nausea associated with liver dysfunction.

Tests: Laboratory testing includes blood or urine tests to rule out pregnancy, gastrointestinal x-ray studies (barium enema, upper gastrointestinal), esophagogastroduodenoscopy, stool testing, and diagnostic testing for inner ear function and balance, and head injury (CT scan, MRI).

Source: Medical Disability Advisor



Treatment

Sudden onset of nausea is usually associated with infection (especially of the GI tract as with stomach flu), ingestion of toxins (food poisoning), food intolerance, motion sickness, medications, pregnancy, head injury, brain infection, or gastrointestinal inflammation. On the other hand, chronic nausea is suggestive of a partial mechanical obstruction of the intestinal tract, brain tumor, poor stomach motility (gastroparesis), and metabolic, endocrine, or psychogenic disturbance.

Lying down can often help. Antinausea (anti-emetic) medications, taken orally or by skin patch, may be used to provide short-term relief from nausea resulting from medications, motion sickness, inner ear disturbances or gastroenteritis. Nausea from pregnancy is usually managed by taking small, frequent meals and avoiding foods that trigger symptoms. Surgery may be indicated for gallbladder disease (cholecystectomy or bile duct exploration), appendicitis, or obstructions of the intestinal tract (exploratory laparotomy with bowel resection). Small, frequent meals that are low in fat and fiber and careful timing of insulin are often helpful for those with poor gastric motility (gastroparesis) associated with diabetes. Occasionally, medications to increase gastric motility may be prescribed for these individuals. Diseases of equilibrium and chronic inflammatory conditions of the gastrointestinal tract (ulcer, heartburn, colitis) may require long-term treatment with medications and dietary modifications. Underlying metabolic or endocrine disturbances may be corrected with appropriate medications. Often any nausea associated with such disturbances disappears with proper medical intervention. Blood tests including blood cultures and scans such as CT and MRI may help determine problems with the brain. Psychogenic sources of nausea are best treated with psychological counseling and behavior modification.

Source: Medical Disability Advisor



Prognosis

Nausea associated with motion sickness usually responds well to anti-emetics and tends to completely resolve shortly after the travel has ended (i.e., when the individual gets back on stable ground). Inner ear disturbances or gastroenteritis respond well to medications (decongestants and/or antibiotics). The nausea associated with these disturbances is usually well managed with anti-emetics, and disappears when the underlying problem is resolved.

Nausea secondary to drug side effects is well managed with anti-emetics and usually disappears when the offending drug is discontinued. Nausea secondary to diseases of the gallbladder or intestinal obstructions usually resolves when the inflammation or obstruction is treated. Typically, nausea from pregnancy has no serious consequences and disappears spontaneously by the third or fourth month of pregnancy. Nausea due to problems with the brain such as infections or head injury takes longer to resolve, but symptoms may be controlled with anti-emetics.

Prolonged nausea can lead to malnutrition and weight loss.

Source: Medical Disability Advisor



Differential Diagnosis

  • Bowel obstruction
  • Dyspepsia
  • Myocardial infarction (MI)
  • Stroke (infarction)

Source: Medical Disability Advisor



Specialists

  • Emergency Medicine Physician
  • Endocrinologist
  • Family Physician
  • Gastroenterologist
  • General Surgeon
  • Internal Medicine Physician
  • Oncologist
  • Radiologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Diabetes
  • Kidney failure
  • Liver failure
  • Severe head injury
  • Terminal cancer

Source: Medical Disability Advisor



Complications

Nausea is usually accompanied by a rapid pulse (tachycardia) and can result in abnormal heart rhythms in those with heart disease. In addition, chronic conditions of nausea may result in poor dietary intake, malnutrition, and various deficiency states. If nausea is associated with vomiting, more severe complications such as dehydration, electrolyte depletion, aspiration of stomach contents (aspiration pneumonia), and tearing of the esophagus or stomach lining can occur.

Source: Medical Disability Advisor



Factors Influencing Duration

This is a vague diagnosis. The length of disability is influenced by the underlying cause of the nausea. Additional information is required regarding a specific diagnosis to determine disability duration.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions and accommodations will vary with the cause of the nausea.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual have disturbances in the balance center in the inner ear and irritation or pressure on the nerve endings in the stomach?
  • Does individual have a concussion or other head injury, encephalitis, meningitis, tumors, or migraine headaches?
  • Is individual pregnant, have motion sickness, food allergies, food poisoning, radiation sickness, overeating, obstruction of the intestinal tract, hepatitis, or heart attack?
  • Were there any side effects from medications or alcohol?
  • Does individual have internal problems such as appendicitis, stomach flu, kidney failure, increased intracranial pressure, or poor gastric motility?
  • Are there any tumors in the brain, intestinal tract, gallbladder, or liver?
  • Does individual complain of lack of appetite or an unsettled feeling in their stomach? Are fever, dizziness, cold and clammy skin, cramps, diarrhea, diaphoresis, and vomiting present?
  • Did a recent, unintended weight loss occur? Late menstrual cycle?
  • On exam, is there evidence of dehydration, blood in the vomitus, abdominal pain, abnormal bowel sounds, or distention? Jaundice?
  • Were vital signs normal or abnormal? Eyes? Ears?
  • Does individual have a severe headache, stiff neck, lethargy, confusion, decreased alertness, or marked irritability?
  • Were blood or urine tests done to rule out pregnancy? Barium enema? Upper GI series or esophagogastroduodenoscopy? Stool testing? CT or MRI?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual been given antinausea medications?
  • What is the underlying condition? Is it being treated?
  • If necessary, was individual instructed regarding dietary modifications?
  • If necessary, is individual being treated by an appropriate mental health professional?

Regarding prognosis:

  • Can individual's employer accommodate any necessary restrictions?
  • Does individual have any conditions that may affect ability to recover?
  • Have any complications occurred such as tachycardia, arrhythmias, malnutrition, dehydration, electrolyte depletion, aspiration pneumonia, or tearing of the esophagus or stomach lining?

Source: Medical Disability Advisor



References

Cited

Borgeat, Alain, Georgios Ekatodramis, and Carlo Schenker. "Postoperative Nausea and Vomiting in Regional Anesthesia: A Review." Anesthesiology 98 2 (2003): 530-547.

Gan, T. J. "Factors Affecting the Incidence of Nausea and Vomiting in Patients Who Undergo Chemotherapy or Radiotherapy." Zofran. 3 Nov. 2004 <http://www.zofran.com/ponv_factors.htm>.

Source: Medical Disability Advisor