Nausea and Vomiting
Nausea and Vomiting Nausea is the subjective feeling that may or may not be accompanied by vomiting. Vomiting is the forceful contraction of the abdominal muscles, resulting in expulsion of stomach contents. Nausea and vomiting are common and often distressing side effects of cancer treatment. They are also seen in persons with constipation, obstipation, or impaction; electrolyte imbalances such as hypercalcemia or uremia; and increased intracranial pressure secondary to metastatic disease to the brain.
- Assessment Nausea and vomiting can be subjectively assessed, like all symptoms, by using the PQRSTU mnemonic (see Symptom Assessment) or other numeric scales such as the ESAS (see Symptom Assessment). Further assessment information should include causative factors, as they will help guide treatment. For instance, if a person is experiencing severe constipation causing nausea and/or vomiting, an aggressive bowel regimen should be initiated.
- Treatment Treatment should be based on causative factors. For instance, if a person is experiencing nausea associated with increased intracranial pressure, a trial of steroids such as dexamethasone may be helpful. Other medications used in the treatment of nausea and vomiting include metoclopramide (Reglan), prochlorperazine (Compazine), and odansetron (Zofran). Nonpharmacologic management can include small frequent meals, bland foods, ginger tea or candy, and sour foods such as lemons or hard sour candies. Consult an evidence-based guideline for further information in the palliative treatment of nausea and vomiting. Referral to a palliative care specialist should be considered for persons with difficult to manage nausea/vomiting despite conservative treatment.