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JUST NAUSEA ?OBJECTIVES
Identify the effects of Nausea on daily life
Identify those palliative patients at greatest risk of Nausea
Describe the assessment of GI distress and nausea
Describe nursing interventions to limit or prevent Nausea
Identify Pharmacological and non pharmacological treatments
WHAT IS NAUSEA?
A Subjective symptom report by the individual often described as a distressing feeling in the stomach, verbalized as rolling, squeezing, churning. Often of varying intensity
Increased intensity frequently proceeds vomiting
Side effect of many medical treatments
Symptom of disease process
Body response to change in equilibrium
WHAT IS NAUSEA?
Nausea and vomiting are controlled by stimulation of the vomiting center
The vomiting center is located medulla oblongata, near the origin of the vagus nerve
The chemoreceptor trigger zone located near the floor of the 4th ventricle reacts to chemicals mediators in the blood stream and relays information to the vomiting center to induce nausea
The vomiting center also receives descending impulses from higher centers in the brain.
Ascending impulses from GI Tract via the vagus, glossopharyngeal, and splanchnic nerves.
QUALITY OF LIFE
PhysicalDecrease appetite and food intake
Fatigue
Weight loss
Limits activity
Over sensitivity to smells
Over reaction to motion or light
PsychologicalFear of vomiting
Depression
Fear of leaving home
Spiritual/ SocialIsolation
Inability to enjoy meals
Avoidance of social engagements
Loss of work
Loss of income
CHRONIC VS. ACUTE
• Metastatic cancers of colon• Elevated ICP • Poor perfusion of GI tract in
vascular disease• End stage Lung disease or
cancer• End stage liver or renal
disease
• Pregnancy
• Motion sickness
• Viral infections
• Food reactions
• Medication reactions
ASSESSMENT
Medical history, physical exam, pattern of symptoms ,
Relieving and aggravating factors, medication history
PHARMACOLOGIGIC MEASURES
• METOCLOPRAMIDE ( D2)
• DRUG OF CHOICE FOR GASTROPARESIS, OFTEN OPIOID INDUCED
• NOT FOR USE IN BOWEL OBSTRUCTION
• HALOPERIDOL (D2)
• ALTERNATIVE TO METOLOPRAMIDE
• EFFECTIVE FOR OPIOID RELATED NAUSA
• Effective for metabolic induced nausea
• Multiple routes of administration
PHARMACOLOGIGIC MEASURES
DIPHENHYDRAMINE (H1)
HYDROXYZINE
Antihistamine
Useful in cough related nausea
Reduces secretions
Reduces anxiety
Promote rest
SCOPALAMINE
TRANSDERMAL PATCH
Effective for 3 days ease of dosing useful in patients unable to take oral meds
Reduces secretions
May cause increase delirium
PHARMACOLOGIGIC MEASURES
PROMETHAZINE (H1)
Commonly used for all causes
Can be given rectally
Less sedating than chlorpromazine
ONDANSETRON (5-HT3)
First choice for Chemo related nausea
Used for acute nausea post op
May decrease GI motility
Not good choice for opioid induced nausea
PHARMACOLOGIGIC MEASURES
CORTICOSTEROIDS/DEXAMETHASONE
Reduce tumor swelling
Helpful in GI Obstruction
Reduce ICP
Use lowest dose effective and consider tapering
Effectiveness may be time limited by disease process
PHARMACOLOGIC MEASURES
• HYCOSDINE (ARC)
• Reduce GI spasm and cramping
• Limits interstitial swelling
• Useful in obstructions
OTHER ADJUVANTS :
Proton pump inhibitors
H2 receptor antagonist
Anti-acids
Simethicone
Ativan/ Xanax
NON PHARMACOLOGICAL MEASURES
•DIET
• Small meals
• Cool foods, no extremes
• Space out solids and fluids
• Limits foods that trigger patient specific reactions
• Assess reactions to smells, and texture when planning meals
• ENVIROMENT
• Limit noise or light
• Keep room cool may need fan for personal space
• Keep HOB elevated
• Assess aspiration risk if vomiting present.
NON PHARMACOLOGICAL MEASURES
INVASIVE TREATMENTS
• Naso- gastric tube
• Decompress GI tract
• NGT limited to In-patient use is most cases, increased risk of aspiration
• peg tube to gravity or suction more easily managed in home.
• higher risks with placement/ site infection
COMPLIMENTARY THERAPIES
• Acupuncture
• Massage
• Reki
• Reflexology
• Music therapy
• Aromatherapy
CASE STUDY
• Mr. Hayes is 47 year-old with widely metastatic colon cancer. He arrives on your unit with chief complaint of intractable nausea and vomiting for 24 hours. He states he is barley able to manage any activities of daily living.
• Mr. Hayes has been found to have a non- resectable partial bowel obstruction.
• Discussion questions:
• 1. describe your assessment
• 2. what Nursing DX. Do you identify
• 3. what treatments so you expect/ plan
• 4. discuss the Suffering of Mr. Hayes