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Nausea and vomiting in palliative care. Katharine house hospice 2008. General principles. There is a single cause in 66% cases. Optimise non-pharmacological measures. Reverse the reversible. Diagnose a cause before initiating drug treatment.

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nausea and vomiting in palliative care

Nausea and vomiting in palliative care

Katharine house hospice

2008

general principles
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.
non pharmacological measures
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 N&V is a conditioned response.
food presentation
Food presentation
  • Small portions, carefully prepared and presented.
  • The following foods may be appreciated:
    • Cold, bland or sour foods
    • Clear liquid diets
    • Tonic water
slide7

Gastric stasis

GI obstruction

Chemo & RT

slide8

Gastric stasis

GI obstruction

D2 + 5HT3 + 5HT4

slide10

Gastric stasis

GI obstruction

Levomepromazine

Ondansetron

slide11

Gastric stasis

GI obstruction

Levomepromazine

D2 + 5HT3 + 5HT4

Ondansetron