Nausea and vomiting

Patients receiving palliative care commonly experience nausea and vomiting. These symptoms can arise because of a pre-existing condition, the primary disease, and the disease's treatment.

Common causes of nausea and vomiting in palliative care patients include the following diseases and conditions:

Specific diseases and conditions

• Intestinal obstruction
  
• Liver failure
  
• Crohn's disease
  
• Brain tumor
  
• Gastroesophageal reflux disease (GERD)
  
• Irritable bowel syndrome
  
• Pancreatic cancer (Albert, 2017)

Treatments

• Chemotherapy
• Radiation therapy
• NSAIDs
  
• Opioids https://www.mayoclinic.org/symptoms/nausea/basics/causes/sym-20050736
  

It is essential to determine the following for patients with nausea and vomiting.

• Duration
  
• Frequency
  
• Time of day
  
• Severity
  
• Characteristics
  
• Persistent or intermittent
  
• Associated issues
  
• Reflux
  
• Gastric irritation
  
• Constipation
  
• Dyspepsia (Leach et al., 2019; Glare et al., 2011)
  

Standard treatment options for nausea and vomiting

Medications that target dopaminergic pathways

• Haloperidol (oral liquid)
  
• Risperidone (oral liquid)
  
• Metoclopramide (Reglan)
  
• Prochlorperazine (pills or suppository) (Albert, 2017)

Serotonin 5-HT3 receptor antagonists for chemotherapy/radiation therapy-induced nausea

• ondansetron (Zofran)
• palonosetron (Aloxi

Medication that can be added when needed.

• Anticholinergic medications - Scopolamine
  
• Benzodiazepines - Lorazepam (Ativan)
  
• Cannabinoids – medical marijuana
  
• Dopamine receptor antagonist – Dopamine
  
• Serotonin 5-HT3 receptor antagonist – Ondansetron (Zofran)

Vomiting can occur because of mechanical bowel obstruction. If this happens, other treatments such as a venting gastrostomy tube may be necessary.