related to stimulation of the vomiting center associated with:
  1. the effect of cytotoxic drugs, the by-products of cellular destruction, and the foul taste created by some cytotoxic agents;
  2. stimulation of the visceral afferent pathways resulting from inflammation of the gastrointestinal mucosa if mucositis is present;
  3. 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.
Desired Outcome
The client will experience a reduction in nausea and vomiting as evidenced by:
  1. verbalization of decreased nausea
  2. reduction in the number of episodes of vomiting.
Nursing Actions and Selected Purposes/Rationales
  1. 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.
  2. Assess client's perception of the severity of nausea using a scale of 1-10 or the terms mild, moderate, or severe.
  3. Implement measures to reduce nausea and vomiting:
    1. 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
    2. convey an attitude that nausea and vomiting might not occur (not every client experiences nausea and vomiting every time)
    3. 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:
      1. serotonin antagonists (e.g. dolasetron, granisetron, ondansetron)
      2. phenothiazines (e.g. prochlorperazine)
      3. butyrophenones (e.g. droperidol, haloperidol)
      4. gastrointestinal stimulants (e.g. metoclopramide)
      5. benzodiazepines (e.g. lorazepam, diazepam) to decrease anxiety and/or induce amnesia in order to lessen the possibility of client's developing a conditioned response to chemotherapy
      6. corticosteroids (e.g. dexamethasone)
    4. administer intravenous cytotoxic drugs slowly unless contraindicated to decrease stimulation of the vomiting center
    5. if feasible, administer the cytotoxic drugs at night so client will sleep and experience less nausea
    6. provide sour, hard candy for client to suck on if he/she can taste the drug
    7. eliminate noxious sights and odors from the environment (noxious stimuli can cause stimulation of the vomiting center)
    8. encourage client to take deep, slow breaths when nauseated
    9. encourage client to change positions slowly (rapid movement can result in chemoreceptor trigger zone stimulation and subsequent excitation of the vomiting center)
    10. provide oral hygiene after each emesis and before meals
    11. provide carbonated beverages for client to sip if nauseated
    12. delay meals until 3-4 hours after chemotherapy administration
    13. avoid serving foods with an overpowering aroma; remove lids from hot foods before entering room
    14. provide small, frequent meals; instruct client to ingest foods and fluids slowly
    15. encourage client to eat dry foods (e.g. toast, crackers) and avoid drinking liquids with meals if nauseated
    16. instruct client to avoid foods/fluids that irritate the gastric mucosa (e.g. spicy foods; caffeine-containing beverages such as coffee, tea, and colas)
    17. encourage the use of nonpharmacologic measures (e.g. self-hypnosis, relaxation, biofeedback, imagery, acupressure, music therapy) to control nausea.
  4. Consult appropriate health care provider (e.g. oncology nurse specialist, physician) if above measures fail to control nausea and vomiting.