Upon completion of the chapter, the reader will be able to:
Identify several causes of nausea and vomiting.
Describe the pathophysiologic mechanisms of nausea and vomiting.
Identify the three stages of nausea and vomiting.
Distinguish between simple and complex nausea and vomiting.
Create goals for treating nausea and vomiting.
Recommend a treatment regimen for a patient with nausea and vomiting associated with cancer chemotherapy, surgery, pregnancy, or motion sickness.
Outline a monitoring plan to evaluate the treatment outcomes for nausea and vomiting.
Nausea and vomiting are symptoms that can be due to a number of different causes.
To treat nausea and vomiting most effectively, it is important to first identify the underlying cause of the symptoms.
Nonpharmacologic approaches to treating nausea and vomiting include dietary, physical, and psychological changes.
For prevention of acute chemotherapy-induced nausea and vomiting (CINV) for patients receiving moderately or highly emetogenic chemotherapy, a combination of antiemetics with different mechanisms of action is recommended.
Droperidol or a 5-hydroxytryptamine (serotonin) type 3 (5-HT3) receptor antagonist should be administered at the end of surgery to patients at high risk for developing postoperative nausea and vomiting (PONV).
Nausea and vomiting affect the majority of pregnant women; the teratogenic potential of the therapy is the primary consideration in drug selection.
Because the vestibular system is replete with muscarinic type cholinergic and histaminic (H1) receptors, anticholinergics and antihistamines are the most commonly used pharmacologic agents to prevent and treat motion sickness.
Nausea and vomiting are due to complex interactions of the gastrointestinal (GI) system, the vestibular system, and various portions of the brain. Nausea and vomiting have a variety of causes that can be simple or complex. Preventing and treating nausea and vomiting require pharmacologic and nonpharma-co-logic measures tailored to individual patients and situations.
ETIOLOGY AND EPIDEMIOLOGY
Nausea and vomiting are symptoms that can be due to a number of different causes. Various disorders of the GI, cardiac, neurologic, and endocrine systems can lead to nausea and vomiting (Table 20–1).1,2, and 3 Cancer chemotherapy agents are rated according to their emetogenic potential, and antiemetic therapy is prescribed based on these ratings. Due to potentially severe nausea and vomiting, some patients are unable to complete their chemotherapy treatment regimen. Radiation therapy can induce nausea and vomiting, especially when it is used to treat abdominal malignancies.4
Table 20–1Causes of Nausea and Vomiting |Favorite Table|Download (.pdf) Table 20–1 Causes of Nausea and Vomiting
|GI or Intraperitoneal ||Cardiac ||Neurologic ||Other Causes ||Therapy Induced ||Endocrine/Metabolic |
Small bowel obstruction
Superior mesenteric artery syndrome
Inflammatory bowel diseases