N&V

Question 1

Nursing management for N&V

Answer 1

Nausea, the unpleasant sensation of being about to vomit, can occur alone or can accompany vomiting. Vomiting is the expulsion of gastric contents through the mouth.

Most palliative care patients have multiple causes of N&V.

Treat of the underlying cause if possible.

There are specific guidelines on chemotherapy-induced nausea and vomiting (CINV).

Check the chemotherapy agent that the patient is having and speak to the oncologist.

Question 2

What are the causes of N&V?

Answer 2

• Gastritis
• Compression of the stomach
• Intestinal obstruction
• Severe constipation
• Medications
• Chemotherapy/radiotherapy
• Electrolyte imbalances (e.g. hypercalcaemia, uraemia)
• Increased intracranial pressure (e.g. brain tumours)

Question 3

Non-pharmaco management
for N&V

Answer 3

General Care

• Small frequent meals
• Avoid strong smell
• Avoid known triggers

Question 4

Guideline for Pharmaco Treatment for N&V

How many types/ approaches are there?

Answer 4

Mechanistic Approach to pharmacological treatment

If the underlying cause cannot be reversed or the cause is uncertain, identify the likely mechanism of nausea and vomiting and treat with an agent targeting the mechanism.

Question 5

How to treat C&V caused by central cause?
(brain metastasis, anxiety)

Answer 5

Haloperidol

metoclopramide
olanzapine
Loraezpam

steroids

Question 6

CINV

think OAS

Answer 6

Ondansetron
Aprepitant
Steroids

Question 7

GI tract induced N&V

Think MOD

Answer 7

Metoclopramide
Domperidone
Ondansetron/granisetron

Question 8

N&V caused by Vestibular

Answer 8

Prochlorperazine
Cinnarazine

Question 9

Opioid induced N&V

Answer 9

Haloperidol
Metoclopramide
Domperidone