JUST NAUSEA ?Symptom management

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

CONSTIPATION

CHEMO THERAPY Radiation therapy

INTRACTABLE COUGHING Hiccups

METABOLIC CAUSESHyperkalemia, uremia, infection, drug reactions

VESTIBULAR DISTURBANCE

ASSESSMENT

ASSESSMENT

Medical history, physical exam, pattern of symptoms ,

Relieving and aggravating factors, medication history

PERSON AT RISK

PREVENTION

TREATMENT

CORRECT THE UNDERLYING PROBLEM

DOPAMINE, SEROTONIN, HISTAMINE, AND CHOLINERGIC PATHWAYS

DRUG THEREPY

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

Q AND A

AGNES PELOSA RN, CHPN

RNAdvantage1 @gmail.com

THANK YOU