Nausea/Vomiting

Nausea is an uneasy feeling in the stomach that may or may not be followed by vomiting, in which the contents of the stomach are expelled through the mouth. Although many people connect nausea and vomiting with eating, nausea can happen even when a person is not thinking about food; and a person can vomit even when they have not eaten. The most common causes of nausea and vomiting are eating something that disagrees with you, or an infection or virus. In cancer patients, nausea and vomiting can also be caused by the cancer itself (especially cancers of the gastrointestinal tract such as the stomach, liver, and colon), by cancer treatments, especially chemotherapy and radiation therapy, or by other medications that may be given to cancer patients.

If nausea progresses to vomiting that cannot be controlled with the prescribed medications, notify the doctor or nurse immediately!

What Can I Do to Prevent Nausea and Vomiting?

There are a variety of things that you can do to prevent or minimize nausea and vomiting, such as:

• Prevent nausea by taking the antinausea medication prescribed by your doctor. Please follow the directions. Some medications are given to prevent nausea while others are prescribed to treat nausea.
• If you experience continual nausea, take your medication around the clock on a regular schedule.
• Eat lightly 1 – 2 hours before and after your treatment.
• Be sure to prevent or treat constipation or diarrhea. Some patients will become nauseated when their bowel is distressed. Notify the doctor or nurses if you are having problems with either one.

• Eat small amounts of food 5-6 times throughout the day, instead of three large meals. Keep crackers or bread within reach or at the bedside.
• Realize that taste changes may occur. DO NOT force yourself to eat favorite foods when you are nauseated. This could cause a permanent dislike of those foods.
• If you find that you do not like the taste of red meats, eat other high protein foods such as chicken and fish, cheese and eggs. Serve foods at room temperature to decrease the smell, which often contributes to nausea and vomiting.
• Eat foods with long lasting, pleasant smells such as lemon drops or mints. Using Ginger (hard candy, ginger root, ginger tablets, and ginger tea) may also alleviate nausea.
• Avoid foods that are sweet, fatty, salty, spicy or have strong odors because they may make the nausea and vomiting worse.
• If nausea and/or vomiting occur during your treatment, DO NOT eat for 1 to 2 hours before each scheduled treatment. If it occurs after your treatment, DO NOT eat for 2 to 3 hours after your radiation or chemotherapy treatment.

• Try to drink 8 to 10 ounce glasses of fluid per day, unless your doctor or nurse tells you not to do so. This will help to prevent dehydration and malnutrition, which can be caused by nausea and vomiting. Specific points to keep in mind include:
  • Drink clear liquids (liquids that you can see through when in a glass), including clear fruit juices (apple, cranberry, grape), ginger ale, and water. Sip the fluids slowly.
  • Popsicles, jello, ice chips and frozen juice chips are also excellent sources of liquid that are tolerated well because they are absorbed slowly.
  • Drink sports drinks, such as Gatorade®, which helps to replace certain electrolytes lost with vomiting.

• Maintain a quiet, restful environment whenever possible.
• If nausea and vomiting occur in anticipation of a visit to the doctor, or to receive a treatment, such as chemotherapy or radiation therapy, you may be experiencing “anticipatory nausea and vomiting”. This means that you have formed a connection in your mind between the event (seeing the doctor or receiving a treatment) and the nausea and vomiting. If this occurs, talk to your doctor or nurse, who will work with you to help prevent this from happening again.

• Maintain a quiet, restful environment whenever possible.
• Rest after meals. Sitting up for about an hour after meals is usually very helpful to lessen nausea.
• Take rest periods and naps throughout the day.
• Listen to soft music, watch television, read, or use any other form of distraction.
• Perform good mouth care frequently, especially after episodes of vomiting.

• DO NOT force yourself to drink fluids during periods of vomiting.
• DO NOT lie flat on your back during periods of vomiting. If you are unable to get out of bed, turn onto your side so that the vomit will not be inhaled or aspirated into the lungs.
• If vomiting frequently, do not eat for 4 to 6 hours, and then start with clear liquids.
• Since you should not take any over-the-counter medications while receiving chemotherapy unless approved by your doctor or nurse, DO NOT use over-the-counter anti-nausea medications (e.g., Pepto-Bismol®) until you have spoken to them. If your nausea and vomiting continues after trying these suggestions, contact your doctor or nurse so they can recommend additional steps.

Do not attempt to eat or drink if you are severely nauseated. Wait until your nausea is under control with the antinausea medications then attempt clear liquids.

When Should I Call My Doctor?

Nausea and vomiting should not be ignored since they can lead to dehydration and other complications, and can be uncomfortable. Call your doctor immediately if you have any one or more of the following:

• Blood in the material vomited.
• The material vomited looks like coffee grounds.
• You are concerned that some of the material vomited has been inhaled or aspirated into the lungs.
• You are not able to take more than 4 cups of fluid or ice chips in 24 hours, or are not able to take any solid foods for more than 2 days.
• You are not able to keep your medications down.
• You become weak or dizzy.
• You lose consciousness