Protocol for Management of Chemotherapy Induced Nausea
and Vomiting


Definitions

Nausea:
unpleasant sensory sensation in the epigastrium and in the back of the throat that may or may not culminate in vomiting.
Vomiting:
forceful expulsion of the contents of the stomach, duodenum and jejunum through the oral cavity as a result of changes in the intrathoracic positive pressure.

Signs and Symptoms

History:

  1. Timing, frequency and duration of nausea/vomiting
  2. Date of last chemotherapy
  3. Medication utilized to control thus far
  4. Reports of dry mucous membranes, lightheaded when arising, weight loss, excessive thirst, decreased urine output, appearance of vomitus, any blood.
  5. Note age of patient, history of motion sickness, cigarette or alcohol use, history of nausea/vomiting with pregnancy.
Physical:
Dry mucous membranes, poor skin turgor, bowel sounds – hypo or hyperactive, abdominal exam.

Evaluations

  1. Basic metabolic panel

Treatment Guidelines

Attachments
Guidelines for BCC – Chemotherapy Induced Emesis
Memorandum 3-26-2001
Antiemetics by physician
  1. 1. Consult with physician for all cases of severe nausea and vomiting – patient not able to tolerate any oral intake > 24 hours duration.

  2. Additional antiemetics, especially for breakthrough nausea/vomiting with standard approach or age less than or equal to 45 years.
    1. Decadron: 4 – 8 mg BID x 3 days for delayed nausea/vomiting
    2. Add rectal suppository – Phenergan 25 mg or Compazine 25 mg every 4 hours prn.
    3. Change to Emend (Aprepitant) for next courses.

  3. Severe nausea/vomiting
    • IV Fluids – NS 1-2 liters. Add electrolytes based on lab values.
    • IV Antiemetics
      • Zofran 10-12 mg IV
      • Decadron 8 mg. IV
      • Ativan 1 mg IV prn anxiety

Reviewed: 7/1/04, 1/25/06
Richard Elledge, M.D.
Medical Director

Suzanne Perez, RN, BSN, OCN
Manager, Clinical Operations

Mari Rude, RN, ANP, AOCN
Nurse Practitioner/Care Coordinator