Nausea and Vomiting

In patients with nausea and vomiting, the physician should first look for a reversible cause such as constipation or gastritis from NSAIDs. If increased intracranial pressure is the cause, the patient may require steroids. Overfeeding may be the problem if a nasogastric or gastrostomy tube is in place. Metoclopramide (Reglan) is the agent of choice when an enormous liver limits gastric emptying or slow motility is causing early satiety. Many patients whose nausea and vomiting have not responded to prochlorperazine (Compazine) or promethazine (Phenergan) will be relieved by haloperidol (Haldol), 0.5 to 2 mg orally or subcutaneously every 8 hours. Effective and expensive preparations (usually unnecessary for hospice patients) that are approved for the treatment of nausea associated with chemotherapy include ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet), and palonosetron (Aloxi).

As with persistent pain, persistent nausea should be treated with regularly scheduled antiemetics. Combinations of anti-emetics that have different modes of action may be needed. A combination of haloperidol with metoclopramide or dexamethasone may be effective. When oral antiemetics cannot be tolerated, rectal suppositories can be tried but rarely provide adequate control for persistent nausea and vomiting unless they are compounded from the potent agents just mentioned. Continuous subcutaneous infusions of meto-clopramide, haloperidol, and the required opioid are more effective (Baines, 1988). Even vomiting associated with complete bowel obstruction can be controlled without a nasogas-tric tube or gastrostomy with a continuous subcutaneous infusion of narcotics, antiemetics, and anticholinergic agents (Baines et al., 1985). Octreotide (Sandostatin) has also been extremely effective.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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