N/V history & prescribing

Question 1

HPC general questions

Answer 1

volume + frequency + overriding concern (nausea vs vomiting)

recent drug changes

Question 2

distinguish underlying cause

Answer 2

gastric stasis - large vomits (provide relief), little nausea, early satiety

drugs + electrolytes - more prominent nausea with little vomits, drowsy/confused

++ICP - headache upon lying down, neurology

Question 3

HPC associated symptoms

Answer 3

pain
change in bowel habits
fever
polydipsia/polyuria (hypercalcaemia)

Question 4

HPC cancer symptoms

Answer 4

blood
recent weight loss
anorexia (diet + intake)

Question 5

HPC tried anything?

Answer 5

what was it
route (PO/SC?)
how long did they take it for?

Question 6

PMH Qs

Answer 6

cancer - type, date of diagnosis, treatment

mood

Question 7

Mx principles

Answer 7

treat reversible cause

consider alternative routes for med delivery (patch, syringe drivers)

suitable antiemetic

review in 7 days

Question 8

suitable antiemetics for different causes are

Answer 8

gastric stasis/functional bowel obstruction - metoclopramide (mechanical - cyclizine)

drugs/electrolytes - haloperidol

raised ICP - dexamethasone

Question 9

if nausea overriding then ask

Answer 9

frequency
constant?
relationship to vomiting
relationship to food

Question 10

if vomiting overriding then ask

Answer 10

volume, colour, frequency
relationship to nausea
does it relieve nausea?