Transcript Guidelines for a Palliative Approach in Residential Aged Care

Nausea and Vomiting
A Palliative Approach to Care
Nausea and vomiting
• Nausea is the unpleasant feeling of the need to
vomit.
• Vomiting is the expulsion of stomach contents
from the mouth
• Distinction helps with accurate assessment and
management
Causes of Nausea and Vomiting
• Iatrogenic - medications, chemotherapy,
radiotherapy
• Metabolic - hypercalcaemia, urinary tract
infection, altered taste
• Organic - constipation, bowel obstruction
Causes of Nausea and Vomiting
• Psychological - anxiety, anticipatory
• Other - odour from food or wounds
• Cause is often unknown at end of life
Constipation and nausea
• Constipation – a major cause
Due to:
– Reduced fluid intake
– Low fibre diet
– Decreased mobility
– Medication
Other Causes of N & V
• Medications which slow gastrointestinal
motility due to colonic slowing or
gastroparesis
• Poor neuromuscular coordination may
affect residents with diabetes, stroke
• Positional changes in neck due to weight
loss
Assessment history
• Establish whether the resident is vomiting
• Description of the vomiting
• What precipitates nausea and vomiting?
• Is there a pattern?
• What eases the nausea and vomiting?
• Check for constipation
Non-pharmacological therapy
• Correct reversible causes
• Environmental factors - fresh air, absence of
offensive smells
• Offer non-odourous foods, eat slowly & small
amounts frequently
• Avoid lying flat before and after meals
• Diversional therapies - relaxation
Oral care
• Maintain good mouth care is important part of
management:
– water and toothpaste
– small soft brush
– soaking dentures in weak non-toxic solution
– artificial saliva eg. oralbalance
Pharmacological management
General guidelines include:
• Determine the most likely cause
• Identify contributing factors
• Select an appropriate anti-emetic
• Consider possibility of toxicity
• Possible benefit of treatment versus potential
burden
Pharmacological management
Pharmacological interventions:
• ensure patient compliance
• evaluate regularly
• give prophylactically
• select appropriate route for drug administration
Pharmacological management
If cause is gastrointestinal – poor gastric emptying,
use of:
• Prokinetic agent
• Metroclopromide
• Cisapride
• Domperidone
Pharmacological management
If cause is affected by psychological issues:
• diazepam
• alprazolam
• lorazepam
may block physical manifestations of anxiety
Pharmacological management
If cause is intracranial with pressure related
to tumour
• dexamethasone
• haloperidol
• cyclazine
Hyperacidity
• Hyperacidity can cause nausea and or vomiting
• Can produce heartburn, acidity or bitter taste
• Treatment – non absorbable antacids
• Histamine H2-receptor antagonist (ranitidine)
• Proton pump inhibitor (omeprazole)
Summary
• Nausea and vomiting can occur independently
• Important to identify and treat reversible causes
• Constipation a major cause of nausea in RACF
• Pharmacological and non-pharmacological
therapies