The Management of Nausea at the End of Life

Gayathri S. Moorthy, PhD, BSc, RN; MariJo Letizia, PhD, MSN, BSN

Disclosures

Journal of Hospice and Palliative Nursing. 2018;20(5):442-449. 

In This Article

Abstract and Introduction

Abstract

The evaluation and management of nausea in patients near the end of life can be more challenging than that of nausea in patients undergoing antineoplastic therapies. Unlike in the oncology setting in which nausea is primarily managed using antiemetic regimens that have been developed with the neuropharmacology and emetogenic potentials of chemotherapy agents in mind, many patients receiving end-of-life care have nausea of multifactorial etiology. Patients also may be older with reduced physiologic ability to metabolize and clear drugs. Therefore, typical antiemetics in regimens initially selected for oncology patients may be ineffective. In this article, the prevalence, manifestation, and pathophysiology of nausea experienced by patients near and at the end of life will be reviewed, with a focus on pharmacological and nonpharmacological interventions that have been found to effectively manage this symptom in this patient population.

Introduction

Nausea is defined as an "unpleasant sensory and emotional experience"[1] (p88) associated with the feeling of fullness in the epigastric and upper abdominal area, with or without a need to vomit.[1,2] Dry heaving or retching can also occur as a result of spasmodic contraction of the abdominal muscles against a closed glottis. Nausea with vomiting can be a protective reflex to rid the body of an offending agent.[2]

The management of nausea experienced by patients near and at the end of life can present more challenges than other populations. Unlike in the oncology setting where nausea is managed using antiemetic regimens that have been developed in accordance with the neuropharmacology and emetogenic potential of chemotherapy, patients at the end of life may experience nausea because of a multitude of factors. In addition, patients who are older may have a reduced physiologic ability to metabolize and clear drugs.[3] In these populations, the use of the typical antiemetics recommended in regimens for oncology patients may be ineffective.

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