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Managing care at the end of life
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Nausea and vomiting are common symptoms in people who are at the end of life. The cause of nausea and vomiting can be challenging to identify; common causes include gastric stasis, bowel obstruction, medication and metabolic disorders such as hypercalcaemia and renal failure. However, when a person is actively dying, it may be difficult to investigate the cause or can be inappropriate to do so (Garbutt 2018). In these circumstances, broad-spectrum anti-emetics such as cyclizine and levomepromazine can be given via a subcutaneous injection and/or subcutaneously, via a syringe driver over 24 h to manage the symptoms (Mitchell and Elbourne 2020).
Nausea/Vomiting of Pregnancy and Hyperemesis Gravidarum
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Prevention is better than treatment; that is, intervening early in nausea/vomiting is helpful in preventing worsening symptoms [25]. HG is a diagnosis of exclusion: See Table 9.1 for differential diagnosis. N/v tends to be undertreated by both some physicians and some patients, although safe and effective therapies exist. Approximately 10% of patients with n/v during pregnancy will require medication [3].
Disorders of Consciousness
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Clinical assessment includes: Normal rate and depth of respiration, pupillary reactions, muscle tone, deep tendon and abdominal reflexes, and downgoing plantar responses.Forced resistance of eye opening.Slow, roving eye movements and oculocephalic reflex are not present due to suppression from an intact cortex.Optokinetic nystagmus may be present.Irrigation of the ears with ice-cold water is noxious and evokes nystagmus with the fast component beating away from the side of the irrigated ear. Associated nausea with vomiting may occur.
A pharmacological overview of aprepitant for the prevention of postoperative nausea and vomiting
Published in Expert Review of Clinical Pharmacology, 2023
Andrew Padilla, Ashraf S Habib
A recent network meta-analysis included data from 585 studies and 97,516 patients. The primary outcome of this analysis was postoperative vomiting. In this review, there was high certainty evidence for the clinical efficacy of aprepitant in reducing post-operative vomiting, alongside with other four antiemetics (ramosetron, granisetron, dexamethasone and ondansetron). When ranking the antivomiting efficacy compared with placebo, fosaprepitant ranked first and aprepitant third, while another NK1 antagonist (casopitant) ranked second. Of note, casopitant is not currently approved or available for the management of PONV. The review identified that combination of drugs was generally more effective than monotherapy in the prevention of vomiting. The review also suggested that, in comparison to combinations of dexamethasone-ondansetron, dexamethasone-granisetron, and droperidol-ondansetron, aprepitant alone had comparable efficacy for reducing post-operative vomiting. There was no apparent dose response for the antivomiting efficacy of aprepitant. However, the review identified aprepitant’s anti-nausea effects as modest with uncertainty. Other agents in the D2 antagonist and 5-HT3 antagonist class demonstrated better anti-nausea efficacy compared with the NK1 antagonists [12].
The Effects of Perioperative Probiotics on Postoperative Gastrointestinal Function in Patients with Brain Tumors: A Randomized, Placebo-Controlled Study
Published in Nutrition and Cancer, 2023
Mengyang Jiang, Xiaoyu Zhang, Yiqiang Zhang, Yang Liu, Ran Geng, Haixia Liu, Yongxing Sun, Baoguo Wang
Postoperative gastrointestinal function was evaluated by a series of indicators including the time of first stool and flatus after surgery, the number of spontaneous bowel movements a week after surgery, diarrhea, nausea, and vomiting (15,16). Time of solid diet administration was also recorded. The primary outcome was the time of first stool after surgery. The secondary outcomes included assessments of the time of first flatus, spontaneous bowel movements, diarrhea, nausea, and vomiting, changes in gastrointestinal permeability and clinical outcomes. The time of first stool after surgery was defined as the time between the end of operation and the first spontaneous bowel movement. Spontaneous bowel movement was defined as a stool not induced by rescue medication (17). Diarrhea was defined as the condition of having at least three loose, liquid, or watery bowel movements each day (18). Vomiting was defined as episodes of expulsion of gastric content within 24 h, postoperatively (19). Intensity of nausea was measured using the Numeric Rating Scale with values ranging from 0 to 10 (0: no nausea; 10: worst nausea) (20). Gastrointestinal function was evaluated by researchers who were trained by experienced physicians. Data were obtained from daily interviews (between 8 am and 5 pm) with patients and/or their caregivers.
The efficacy and safety of midazolam with fentanyl versus midazolam with ketamine for bedside invasive procedural sedation in pediatric oncology patients: A randomized, double-blinded, crossover trial
Published in Pediatric Hematology and Oncology, 2022
Chalinee Monsereenusorn, Wanwipha Malaithong, Nawachai Lertvivatpong, Apichat Photia, Piya Rujkijyanont, Chanchai Traivaree
Nausea was defined as a score from 0 to 3; 0 = no nausea, 1 = nausea with loss of appetite without alteration in eating habits, 2 = nausea with decreasing oral intake without significant weight loss, dehydration or malnutrition, and 3 = nausea with retching with or without vomiting, contributing inadequate caloric intake, dehydration, or hospitalization.29 Vomiting was defined as vomiting episodes. The pain was assessed using a face, legs, activity, cry, consolability (FLACC) scale for patients aged 3 months to 7 years and a visual analog scale (VAS) for children > 7 years,5,30 and scored from 0 to 10 (Supplementary Table 1). Satisfaction was defined as a score from 0 (very dissatisfied) to 10 (very satisfied). Hypotension and hypertension were defined as a state of blood pressure <5th and >99th percentile, respectively according to age. Laryngospasm was defined as a partial or complete upper airway obstruction with oxygen desaturation.31 Desaturation was defined as a state of oxygen saturation <94% in room air.