NAUSEA MANAGEMENT
Causes Below Neck Treat Underlying Cause
Causes Below Neck Treat Underlying Cause Treat Nausea 7. Mechanical
Treat Nausea CTZ: 1. DA antagonist 2. H 1 antagonist
If extraluminal compression, e.g., adhesions, tumor: • Dexamethasone to inflammation / edema • If tumor, treat to mass effect • Surgery to stent or bypass • Octreotide to intestinal • Volume • Nitrates to angina • Optimize oxygenation / cardiac perfusion • Opioid analgesics to intractable pain If 1st trimester, estrogen & progesterone gastric emptying • Eat small, frequent low-fat meals If 3rd trimester, mass effect mechanical obstruction of bowel • Reposition • Keep stool soft / moving with stimulant ± osmotic laxatives
6. Mucositis
If due to gastric H + ; gastric pH with: • Liquid antacid • H 2 blocker • Proton Pump Inhibitor If due to ASA or NSAIDs ( Prostaglandin E relative ischemia mucous production): • Ensure well hydrated • Misoprostol (Prostaglandin E analogue) to perfusion • Proton Pump Inhibitor to gastric pH If due to infection, e.g., H. Pylori, Candida, CMV, Herpetic gastric erosions: • Treat infection • gastric pH with H 2 blocker or Proton Pump Inhibitor If intraluminal obstruction, e.g., constipation or obstipation: • Relieve impaction with enemas, disimpaction • constipation with stimulant ± osmotic laxatives
CTZ: 1.DA antagonist 2.H 1 antagonist
Obstruction (continued)
8. Myocardial infarction
CTZ: 1.DA antagonist 2.H 1 antagonist
9. Maternity
Possibly
Ondansetron
Most other
antinausea medications are not indicated as they may be teratogenic
7. Mechanical Obstruction
CTZ: 1. DA antagonist 2. H 1 antagonist
17 NB: These Reference Cards do not replace careful clinical judgment specific to each patient / family situation. PCIC: Palliative Care Interdisciplinary Curriculum is a collaborative effort of OhioHealth, The Ohio State University Wexner Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio, USA, and other contributors. Permission to reproduce any or all of these PCIC Reference Cards is granted for non-commercial educational purposes only, provided that the attribution statement and copyright are displayed. To reproduce for all other purposes, contact Frank D. Ferris at info@pallmed.us. Copyright © Frank D Ferris 2013-2024. All rights reserved. V14.1, 2024
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