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The In's and Out's of Nausea and Vomiting

Nausea is an unpleasant feeling in the stomach that may or may not be followed by vomiting. Vomiting is the sudden, forceful expulsion of the stomach contents which may or may not be preceded by nausea. They very often occur together but can can also occur independently of each other.

Nausea is very common as a patient moves toward the end of life. It is most common in patients with terminal cancer with more than half reporting this symptom. It is also common in patients with other diagnosis. It almost goes without saying that nausea and vomiting are distressing symptoms but, more importantly, they can prevent a patient from taking in adequate hydration and nutrition as well as important medications.

Causes

There are several causes of nausea and vomiting. Noxious odors, tastes, or sights can sometimes trigger this response. Certain medications such as opioid analgesics (narcotic pain meds), NSAID’s, antibiotics, and chemotherapeutic agents can cause nausea as well. Physical changes in the gastrointestinal tract such as constipation or a bowel obstruction are yet other examples of causes. Your healthcare provider will do a thorough assessment to try to determine the cause as treatments may vary for each.

Treatment

Treatment will begin with identifying the cause, and reversing it if possible. This may include removing or avoiding noxious stimuli, discontinuing unnecessary medications, and treating constipation. Medications to treat nausea and vomiting may be used when the cause is irreversible or the symptoms persist despite treatment. Medications may include:

• Anit-emetics like Phenergen and Compazine
• Anti-anxiety drugs like lorazepam
• Metoclopramide (Reglan)
• Haloperidol (Haldol)
• Diphenhydramine (Benadryl)

There are many different ways to administer most of the common medications to treat nausea and vomiting, which is especially important if pills are poorly tolerated. Some patients may be given a liquid form of the medicine if they can keep it down. Sometimes medication will be given as a suppository (in the rectum) or even as a topical gel on the skin.

There are many other treatment that can be given along with medication or while your waiting for a medication to arrive. Provide fresh air and loosen the patients clothing. Apply a cool compress to the patients forehead. I have found that applying a cool compress to the neck and the wrists of a patient can help dramatically as well. Also, avoid odors that can trigger an episode; avoid cooking heavily odored food and don’t wear perfume or after-shave when you will be in contact with the patient.

Offer small meals and limit drinks served with each one. Offer liquids at other times during the day but drinking too much with food can cause vomiting. Serving food cold will limit the odor of the food that can make a patient nauseated.

As with any symptom, be sure to inform your healthcare provider immediately. Prompt treatment will help ensure that the patient gets comfortable as soon as possible.