Nausea in palliative care is both common and often multifactorial. Sometimes accompanied by vomiting, nausea can be either acute, or chronic.
is the unpleasant feeling of needing to vomit. It often occurs with symptoms such as sweating, feeling cold, looking pale, or tachycardia (faster than normal heart rate).
is the forceful explosion of the gastric contents through the mouth.
is similar to vomiting without the actual expulsion of gastric contents.
Nausea and vomiting are distinct concepts, often happen together but not always.
In palliative care patients, nausea can be intermittent or persistent, and either with or without vomiting.
Nurses have an important role in recognising, assessing, and managing symptoms related to nausea and vomiting. They can also help patients and families with sensitive and culturally appropriate education and support
Most of the research about nausea and vomiting in advanced disease focuses on cancer. Among patients with advanced cancer, 50% - 90% report nausea and vomiting as a symptom of disease or significant side effect of treatment. In non-cancer advanced disease, nausea occurs less frequently than pain, dyspnea, or constipation.
Prolonged nausea and vomiting can cause serious complications including dehydration, altered electrolyte levels and emotional distress.
The origins and effect of nausea and vomiting are complex, so it can be useful to consider the concept of ‘total nausea’ similar to ‘total pain’. Factors contributing to nausea and/or vomiting include:
Remember to assess nausea and vomiting as separate symptoms.
Ask the person:
Nausea is routinely assessed in Australian palliative care services using Symptom Assessment Scores (SAS).
A physical examination, with the person’s consent, may include the abdomen or the rectum if faecal impaction is considered a possible cause.
Often the cause of nausea and vomiting is multifactorial, requiring multiple interventions concurrently.
Nurses can support the person with non-pharmacological measures:
Certain foods and drinks can be easier to eat and can help with nausea. They include:
Families are often very worried about nausea and vomiting. Acknowledge their concern. Asking what concerns them most may help relieve their distress.
Families and carers can help by:
A dietitian can provide dietary recommendations for the person and their family and the care team.
This information was drawn from the following resources:
Watch the Agency for Clinical Innovation video, Managing nausea and vomiting
Go to Nausea and vomiting on the Marie Curie website
Access more Nausea and Vomiting resources
Page created 09 October 2023