INTRODUCTION
People at end of life can experience nausea and vomiting and this can have an adverse effect on the person’s physical, psychological and social well-being and significantly impair their quality of life.
DEFINITION
Definition of nausea:
A feeling of sickness in the stomach characterized by an urge but not always leading to vomit.
Definition of vomiting:
The forcible voluntary or involuntary emptying of the stomach contents through the mouth.
ASSESSMENT
- Knowledge of the physiology of nausea and vomiting will promote a rational choice of treatment
- History of symptom and previous management, pharmacological and other
- Assess the cause and treat reversible causes if possible and appropriate such as constipation
- Review regularly, minimum of four hourly
MANAGEMENT
- Eliminate sights and smells that cause nausea & vomiting e.g. foods, deodorants, air fresheners, body odour and bowel motions
- Well ventilated room, fresh air with fan or open window
- Loose fitting cool clothing
- Optimise oral hygiene, may use 1/2 tsp baking soda, 1/2 tsp salt in 250mls water as a mouthwash, alternatively there are many other mouth wash preparations available
- Offer sour candy ice chips made from lemon / pineapple based juice, ginger ale or fruit as per individual preference if person is still able to tolerate
- Some people may prefer peppermints or peppermint tea
- If the person is still eating, offer small amounts of bland foods, fluids and snacks at room temperature
- When eating or drinking the upper body should be elevated where possible
- Liaise with doctor / medical cover if person already has NG tube insitu and on free drainage
Other therapies that may already be in place (taught or audio) if nausea has been a problem:
- Guided imagery/visualization: teaches the person to mentally remove themselves from the present and imagine that they are in another place. This can mentally block the feeling of nausea.
- Music therapy: Using music therapy can relive stress and anxiety and give a sense of well-being
- Distraction: Many different forms of distraction can be used e.g. discussing family memories, routines, DVDs, photos
- Acupressure points: A form of traditional Chinese techniques using pressure. This can be done by the person or a family member/friend. Acupressure bands are also available.
