related to stimulation of the vomiting center associated with:
the effect of cytotoxic drugs, the by-products of cellular destruction, and the foul taste created by some cytotoxic agents;
stimulation of the visceral afferent pathways resulting from inflammation of the gastrointestinal mucosa if mucositis is present;
stimulation of the cerebral cortex resulting from stress and a learned conditioned response to previous experience with nausea and vomiting after the administration of cytotoxic drugs.
The client will experience a reduction in nausea and vomiting as evidenced by:
verbalization of decreased nausea
reduction in the number of episodes of vomiting.
Nursing Actions and Selected Purposes/Rationales
Assess client for nausea and vomiting. Determine whether nausea and vomiting are acute, delayed, or anticipatory; the frequency of occurrence; what factors improve or worsen it; and if the nausea and vomiting interfere with activities.
Assess client's perception of the severity of nausea using a scale of 1-10 or the terms mild, moderate, or severe.
Implement measures to reduce nausea and vomiting:
perform actions to reduce fear and anxiety and promote psychological adjustment to the diagnosis of cancer and treatment with chemotherapy (see Diagnoses 1, action b; 10, actions c-j; and 11, action b) in order to reduce stress
convey an attitude that nausea and vomiting might not occur (not every client experiences nausea and vomiting every time)
administer the following medications as ordered 1-24 hours before initiating chemotherapy and routinely for the expected period of nausea and vomiting for the specific chemotherapeutic agents being administered: