The individual will report decreased nausea as experienced by the following indicators:
- Names foods or beverages that do not increase nausea
- Describes factors that increase nausea
Medication Management, Nausea Management, Fluid/Electrolyte Management, Nutrition Management, Relaxation therapy, Vomiting Management
Level 2 Extended Interventions
Take Measures to Prevent Treatment-Related Nausea
- Aggressive management before, during, and after chemotherapy can prevent nausea (Yarbro, Wujcik, & Gobel, 2018).
- Aggressively prevent nausea and vomiting in those with risk factors (*Pasero & McCaffery, 2011):
- Female gender
- Nonsmoker
- History of motion sickness/postoperative nausea/vomiting
- Use of volatile anesthetics within 0 to 2 hours, nitrous oxide, and/or intraoperative and postoperative opioids
- Duration of surgery
- Type of surgery (e.g., laparoscopic, ENT, neurosurgery, breast, plastic surgery)
- Consult with specialist to prevent nausea and vomiting intraoperatively and postoperatively (*Pasero & McCaffery, 2011).
- Use multimodal analgesics to reduce the dose of opioids to the lowest possible.
- Use multimodal antiemetics preinduction and at the end of surgery.
Promote Comfort during Nausea and Vomiting
- Protect those at risk for aspiration (immobile, children).
- Address the cleanliness of the individual and environment.
- Provide an opportunity for oral care after each episode.
- Apply a cool, damp cloth to the individual's forehead, neck, and wrists.
- Offer muscle relaxation and distraction techniques, e.g., music.
R:Evidence suggests that music-based interventions can have a positive impact on pain, anxiety, mood disturbance, and quality of life in individuals with pain (Archie, Bruera, & Cohen, 2013; Lunde, Vuust, Garza-Villarreal, & Vase, 2019).
Reduce or Eliminate Noxious Stimuli
- Plan care to avoid unpleasant or painful procedures before meals.
- Medicate for pain 30 min before meals according to physician/NP's orders.
- Provide a pleasant, relaxed atmosphere for eating (no bedpans in sight, do not rush); try a "surprise" (e.g., flowers with meal).
- Arrange the plan of care to decrease or eliminate nauseating odors or procedures near mealtimes.
- Teach or assist the individual to rest before meals.
- Teach the individual to spend minimal energy preparing food (cook large quantities and freeze several meals at a time, request assistance from others).
Odor of Food
- Teach the individual to avoid cooking odors—frying food, brewing coffee—if possible (take a walk; select foods that can be eaten cold).
- Suggest using foods that require little cooking during periods of nausea.
- Suggest trying sour foods.
Decrease Stimulation of the Vomiting Center
- Reduce unpleasant sights and odors. Restrict activity.
- Provide good mouth care after vomiting.
- Teach the individual to practice deep breathing and voluntary swallowing to suppress the vomiting reflex.
- Instruct the individual to sit down after eating, but not to lie down.
- Encourage the individual to eat smaller meals and to eat slowly.
- Restrict liquids with meals to avoid overdistending the stomach; also, avoid fluids 1 hour before and after meals.
- Loosen clothing.
- Encourage to sit in fresh air or use a fan to circulate air.
- Advise to avoid lying flat for at least 2 hours after eating. (An individual who must rest should sit or recline so that the head is at least 4 inches higher than the feet.)
- Advise to listen to music.
- Offer small amounts of clear fluids and foods and beverages with ginger.
- Offer muscle relaxation and distraction techniques to adult cancer patients.
- If qualified, use acupressure at pressure points postoperatively.
Level 2 Advanced Focused Interventions (maternal-infant)
Explain nausea during pregnancy
R:Nausea during pregnancy is usually time limited, with onset about the fifth week after the last menstrual period (LMP), a peak at 8 to 12 weeks, and resolution by 16 to 18 weeks for most women. Approximately 5% of women will have symptoms throughout pregnancy (*King & Murphy, 2009;Silbert-Flagg & Pillitteri, 2018).
Teach That Various Interventions Have Been Reported to Help Control Nausea during Pregnancy (Silbert-Flagg & Pillitteri, 2018)
- Assure her that nausea is common during pregnancy.
- Avoid fatigue and sudden movements.
- Avoid greasy, high-fat foods and strong odors.
- Eat high-protein meals and a snack before retiring.
- Chew gum or suck on hard candies.
- Eat carbohydrates (e.g., crackers, toast, sour ball candy) on arising; delay eating breakfast until nausea passes.
- Eat immediately when hungry.
- Do not go longer than 12 hours without eating.
- If nauseated, sip/consume carbonated beverages (e.g., Coke syrup, orange juice, ginger ale, and herbal teas, such as ginger).
- Try deep breaths of fresh air.
- Lie down to relieve symptoms.
- Use acupressure; refer to description under general interventions for nausea.
R:Multiple studies have shown acupressure to be effective for nausea in pregnancy (*Ezzo, Streitberger, & Schneider, 2006; *King & Murphy 2009; Forouhari et al., 2014).
Explain that ginger is an effective treatment for nausea/vomiting during pregnancy (Ding, Leach, & Bradley, 2013). Consult with obstetrician (OB) provider if small amounts of ginger or ginger ale (real ginger) are permissible.
R:Ginger has been found to be beneficial for relieving nausea. (*King & Murphy, 2009; Ding, Leach, & Bradley, 2013). Ginger can cause some blood thinning. This could be fatal if placenta separates, which would result in hemorrhage (Tiran, 2013; Silbert-Flagg & Pillitteri, 2018).
Advised to notify healthcare provider if she (Silbert-Flagg & Pillitteri, 2018):
- Vomits more than once daily
- Is losing weight
- Is not eating enough during the day
- Has decreased urine or a darker yellow-colored urine
- Must alter her lifestyle, e.g., work schedule