Nausea and vomiting in palliative care

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Nausea and vomiting in palliative care

• Katharine house hospice
• 2008

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General principles

• There is a single cause in 66 cases.
• Optimise non-pharmacological measures.
• Reverse the reversible.
• Diagnose a cause before initiating drug
  treatment.
• Give the most suitable drug by the most suitable
  route.
• When multiple drugs are required, they should
  have different modes of action.
• Review at least every 24 hours.

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Causes of nausea vomiting
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Non-pharmacological measures

• Fresh air.
• Good oropharyngeal hygiene.
• Suitable distractions.
• Nurse in the upright position.
• Avoidance of emetogenic smells and foods.
• Avoidance of situations in which NV is a
  conditioned response.

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Food presentation

• Small portions, carefully prepared and presented.
• The following foods may be appreciated
• Cold, bland or sour foods
• Clear liquid diets
• Tonic water

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Gastric stasis GI obstruction Chemo RT
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Gastric stasis GI obstruction
D2 5HT3 5HT4
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Gastric stasis GI obstruction
Levomepromazine
Ondansetron
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Gastric stasis GI obstruction
Levomepromazine
D2 5HT3 5HT4
Ondansetron