TRANSITIONS: Real-world symptom management: Nausea
Harleah G. Buck PhD, RN, CHPN

March 2012 
Volume 42  Number 3
Pages 18 - 19
  PDF Version Available!

NAUSEA IS A DISTRESSING symptom at end of life. One of my patients described it as "feeling seasick on dry land." Nausea may precede vomiting or it can occur alone. It also can accompany various other symptoms, such as anorexia.As nurses, we're often the first line of defense in symptom management for people at end of life. In this article, I'll discuss what causes nausea, how to assess it, and how to intervene.The National Library of Medicine defines nausea as an "uneasy or unsettled feeling in the stomach together with an urge to vomit."1 This captures the seasick feeling described by my patient.Persistent nausea clearly increases suffering and decreases quality of life. If accompanied by vomiting, it can also lead to serious complications, such as electrolyte imbalances, dehydration, and malnutrition.Nausea can have physiologic, psychological, and disease- or treatment-related causes. A detailed assessment is vital because your interventions depend on the underlying cause. (See Common causes of nausea at end of life.) The End of Life/Palliative Education Resource Center provides a tool to help you keep causes of nausea and vomiting at your fingertips. Use the acronym VOMIT to help you target your assessment.2V-vestibularO-obstruction of bowelM-dysmotility of upper gutI-infection, inflammationT-toxins.After reviewing the patient's medical record for diagnostic study results and clinicians' documentation, obtain a health history, including medication reconciliation and a focused assessment of the patient's nausea. (See Performing a focused assessment.) Next, perform a systematic physical assessment. Further nursing assessments will be guided by the subjective and objective data you collect. For example, if you suspect an underlying gastrointestinal (GI) problem, assess for fecal impaction. Determine frequency and other characteristics of bowel movements and document the patient's history of laxative use. If you suspect central nervous system involvement, assess for

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