NAUSEA MANAGEMENT
Systemic Causes
Systemic Causes
Treat Underlying Cause Supportive care to reduce anxiety, underlying stress: • Behavior modification • Guided imagery • Hypnosis If during chemotherapy • Prophylactic antinauseants • Modify dose of chemotherapy If during radiation therapy • Prophylactic antinauseants • Modify dose of radiation If other medications, e.g., opioids, anticholinergics • Prophylactic antinauseants • or stop responsible medications If due to systemic infections / sepsis: • Treat underlying infections • Reduce fever
Treat Nausea Diffuse effect: Centrally acting medications
Treat Underlying Cause
Treat Nausea CTZ: 1.DA antagonist 2.H 1 antagonist
13.
10. Mentation, e.g., anxiety, stress
If hypercalcemia due to metastases: • Rehydrate with NaCl; diurese with furosemide • Dexamethasone • Bisphosphonates, e.g., pamidronate, zoledronic acid; if cause is treatable If hyponatremia due to dehydration: • Stop diuretics, including alcohol & caffeine, e.g. coffee, tea • Rehydrate with NaCl containing fluids: - Orally: soups, sport drinks, red vegetable juices - Parenterally: 0.9 NaCl If liver failure, reduce toxins with lactulose, rifaximin, neomycin If renal failure, dialyze to reduce toxins
Metabolic
11.
See Chemotherapy Emetogenicity Table Emetogenicity Table CTZ: 1.DA antagonist 2.H 1 antagonist See Radiation
Medications / Treatments
12. Microbes
CTZ: 1.DA antagonist 2.H 1 antagonist
18 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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