End of life care
A CPD article improved Naomi Forsyth’s knowledge of nausea and vomiting in patients with advanced cancer.
A CPD article improved Naomi Forsyth’s knowledge of nausea and vomiting in patients with advanced cancer
What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice?
The article explained how to conduct a systematic assessment of patients with nausea and vomiting who have cancer and are at the end of life. It also discussed the available treatment options for these patients, such as antiemetic drugs.
What did you learn from the CPD activity, feedback and/or event and/or experience in your practice?
There is no gold standard diagnostic test for nausea and vomiting, so patient assessment is crucial, and should include patient history, physical assessment and clinical investigations. Nausea and vomiting should be assessed individually to identify the underlying cause, for example infection, side effects from medicines or pain.
In patients experiencing vomiting, the absorption of oral medicines can be compromised, so the use of subcutaneous injections or a continuous subcutaneous infusion by a syringe pump should be considered. I am aware that the antiemetic drugs metoclopramide and domperidone should not be given concurrently with haloperidol because of the increased risk of extrapyramidal side effects.
The article emphasised that nurses should be aware that nausea and vomiting can be distressing for patients and can affect their quality of life.
How did you change or improve your practice?
The article was relevant to my practice, since the patients I care for require end of life care at home. Reading the article has encouraged me to examine the multifactorial nature of nausea and vomiting, and to address potential exacerbating factors, such as anxiety, unpleasant odours and constipation.
To assist in identifying the cause of nausea and vomiting, I will ensure that appropriate investigations are undertaken, such as blood glucose levels, urine analysis, and abdominal X-rays and computed tomography scans.
The article encouraged me to systematically assess the causes of nausea and vomiting before developing an action plan. I intend to use the information provided in the article to produce an assessment tool for community nurses who may be required to assess nausea and vomiting.
How is this relevant to the Code? Select one or more themes: Prioritise people, Practise effectively, Preserve safety, Promote professionalism and trust
The Code theme of prioritising people states that nurses must meet the changing health and care needs of people during all life stages, including end
of life care.
As part of this theme, nurses must ensure that people’s physical, social and psychological needs are assessed. The article emphasised the importance of nurses developing their assessment skills to determine the cause of nausea and vomiting.
Understanding the risks associated with suboptimal drug absorption and low sodium levels has also assisted me to preserve patient safety.
Naomi Forsyth is a community staff nurse at Balmore Park Surgery, Reading
This reflective account is based on NS918 Webb A (2017) Management of nausea and vomiting in patients with advanced cancer at the end of life. Nursing Standard. 32, 10, 53-61.
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