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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 27, Nausea and Vomiting.

KEY CONCEPTS

KEY CONCEPTS

  • imageNausea and/or vomiting is often a part of the symptom complex for a variety of gastrointestinal (GI), cardiovascular, infectious, neurologic, metabolic, or psychogenic processes.

  • imageNausea or vomiting is caused by a variety of medications or other noxious agents.

  • imageThe overall goal of treatment should be to prevent or eliminate nausea and vomiting regardless of etiology.

  • imageTreatment options for nausea and vomiting include drug and nondrug modalities such as relaxation, biofeedback, and hypnosis.

  • imageThe primary goal with chemotherapy-induced nausea and vomiting (CINV) is to prevent nausea and vomiting throughout the entire risk period; the emetic risk of the chemotherapeutic regimen is a major factor to consider when selecting a prophylactic regimen.

  • imagePatients undergoing radiation therapy (RT) to the upper abdomen or receiving total body or craniospinal irradiation should receive prophylactic antiemetics for radiation-induced nausea and vomiting (RINV).

  • imagePatients at high risk of vomiting should receive prophylactic antiemetics for postoperative nausea and vomiting (PONV).

  • imageBeneficial therapy for patients with balance disorders can most reliably be found among the antihistaminic–anticholinergic agents.

PATIENT CARE PROCESS

Patient Care Process for Nausea and Vomiting

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Collect

  • Patient characteristics (eg, age, sex, pregnancy status, triggers)

  • Patient medical history (personal and family), history of NV

  • Social history (eg, tobacco/ethanol/cannabis use) and dietary habits

  • Current medications including prescription and nonprescription medications, herbal products, dietary supplements

  • Objective data (eg, QTc prolongation, BP/pulse, complete metabolic panel, CBC, liver function, weight, skin turgor, urine output)

Assess

  • Duration, frequency, severity of nausea and vomiting

  • Ability/willingness to pay for treatment options

  • Emotional status (eg, presence of anxiety, depression)

  • Assess ability of the patient to use oral, rectal, injectable, or transdermal medications

  • Success of previous antiemetic regimens

  • For CINV: Assess emetic risk of chemotherapy (see Table 52-7)

  • For PONV: Assess risk factors for developing PONV (see Table 52-6)

Plan*

  • Drug therapy regimen including specific antiemetic(s), dose, route, frequency, and duration (see Table 52-4 and Table 52-7)

  • Monitoring parameters including efficacy (eg, reduction in symptoms, resolution of lab abnormalities, resumption of normal oral intake) and safety (eg, QTc prolongation, drug–drug interactions); frequency and timing of follow-up

  • Patient education (eg, purpose of treatment, dietary and lifestyle modification, invasive procedures, drug-specific information, medication administration technique)

  • Self-monitoring for resolution of symptoms, when to seek emergency medical attention

  • Referrals to other providers when appropriate (eg, gastroenterologist, dietitian, OBGYN, oncologist, anesthesiologist)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up, adherence assessment

Follow-up: Monitor and Evaluate

  • Resolution of nausea and vomiting symptoms

  • Need for rescue antiemetics

  • Presence of adverse effects

  • Patient adherence to treatment plan

*Collaborate with patient, caregivers, and other healthcare professionals.

PRECLASS ACTIVITY

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