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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the causes and risk factors for nausea and vomiting

  • Identify the goals of therapy for nausea and vomiting

  • Develop and recommend an appropriate treatment for patients with nausea and vomiting associated with cancer chemotherapy and surgery

  • Implement a monitoring plan for nausea and vomiting

  • Properly educate a patient taking antiemetics

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PATIENT PRESENTATION

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Chief Complaint

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"I feel nauseated and it feels like I need to vomit."

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History of Present Illness

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JM is a 60-year-old Caucasian woman with complaints of nausea and vomiting after a laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy for staging and initial treatment of ovarian cancer.

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Prior to her procedure, JM had been given dexamethasone 4 mg IV for prophylaxis of nausea and vomiting (N/V) and received the institution's standard anesthesia protocol with thiopental 4.5 mg/kg, atracurium 0.5 mg/kg, and fentanyl 0.05 mg followed by tracheal intubation along with 75% nitrous oxide, 0.5–2% isoflurane, and oxygen therapy.

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The procedure results indicated stage III ovarian cancer. JM seemed to have tolerated the procedure well except that she felt nauseated and vomited once despite antiemetic prophylaxis. She has been given hydrocodone/acetaminophen 7.5/750 mg four times a day, which is adequately controlling her pain associated with the procedure. For N/V, she received dexamethasone again postoperatively that failed to control her symptoms. For the new diagnosis of stage III ovarian cancer, she will be started on cisplatin and paclitaxel in the oncology clinic 1 week following surgery.

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Past Medical History

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HTN × 8 years

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DM × 5 years

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GERD × 3 years

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Family History

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Mother died of breast cancer at the age of 65. Father is alive at age 70 with HTN and diabetes. She has one sister who also has diabetes.

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Social History

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Lives at home with husband. Works as a paralegal.

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Tobacco/Alcohol/Substance Use

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Drinks one glass of wine every night; occasionally smokes tobacco, negative for illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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No known drug allergies (NKDA)

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Medications Prior to Admission (PTA)

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HCTZ 25 mg PO daily

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Glyburide 5 mg PO twice daily

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Metformin 500 mg PO twice daily

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Omeprazole 20 mg PO daily

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Acetaminophen 650 mg PO PRN for HA

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Medications (Current)

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HCTZ 25 mg PO daily

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Glyburide 5 mg PO twice daily

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Metformin 500 mg PO twice daily

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Pantoprazole 40 mg PO daily

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Review of Systems

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Occasional headaches relieved ...

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