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The case of the uncontrolled nausea and vomiting.

Caroline is a 29-year-old woman with ovarian cancer who received her first dose of paclitaxel and cisplatin yesterday. She had been premedicated with prochlorperazine, diphenhydramine, and lorazepam. Today she calls the office complaining of severe nausea and states that she has vomited four times since last night.

What Would You Do?

Cisplatin is a highly emetogenic chemotherapy, and symptoms can last for three days or longer, depending on the regimen (Wilkes & Barton-Burke, 2011). Although often viewed together, nausea and vomiting are separate entities and may exist independently. Research has proposed that a combination of mechanisms is responsible for nausea and vomiting. Stimulation of the vomiting center can occur from the release of serotonin from enterochromaffin cells in the gastrointestinal tract by chemotherapy. Other neurotransmitters such as substance P and dopamine can also contribute to symptoms (Wilkes & Barton-Burke, 2011).

Caroline has a higher risk of experiencing nausea and vomiting because of her gender and age (Fu, McDaniel, & Rhodes, 2007). A combined antiemetic regimen consisting of a 5H[T.sub.3] receptor antagonist, dexamethasone, and aprepitant is useful for preventing nausea and vomiting in patients receiving cisplatin and other highly emetogenic agents (Eaton & Tipton, 2009). Lorazepam, a benzodiazepine with mild antiemetic properties, may be particularly useful for Caroline as it can help prevent anticipatory nausea, a likely scenario based on her initial experience with this chemotherapy regimen.

Eaton, L.H., & Tipton, J.M. (Eds.). (2009). Chemotherapy-induced nausea and vomiting. In Putting Evidence Into Practice: Improving Oncology Patient Outcomes (pp. 63-83). Pittsburgh, PA: Oncology Nursing Society.

Fu, M.R., McDaniel, R.W., & Rhodes, V.A. (2007). Nausea and vomiting. In J.S. Fulton, S.E. Otto, & M.E. Langhorne (Eds.), Oncology Nursing (pp. 701-717). St. Louis, MO: Mosby.

Wilkes, G.M., & Barton-Burke, M. (2011). Oncology nursing drug handbook. Boston, MA: Jones and Bartlett.

[By Seth Eisenberg, RN, OCN [R], Contributing Editor]
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Title Annotation:what would you do?
Author:Eisenberg, Seth
Publication:ONS Connect
Geographic Code:1USA
Date:Apr 1, 2011
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