Nausea: is expressing/feeling discomfort that may or may not be followed by vomiting.
Retching: is the movement itself of the muscles during the act of vomiting, but without actual expulsion of vomitus.
Vomiting/emesis: is the expulsion of gastric content passing through the mouth.
Acute vomiting: occurs 0-24 hours from chemotherapy.
Delayed Vomiting: occurs after 24 hours after chemotherapy.
Anticipatory vomiting: happens with patients going to get chemo treatment, or with those patients who suffered from vomiting with previous sessions.
Breakthrough emesis: is when vomiting occurs even though the patient is on prophylactic antiemetics.
Refractory emesis: is when using the same antiemetic treatment that failed last session.
Risk factors contributing to patient experiencing vomiting during chemotherapy
Young female with history of motion sickness and nausea/vomiting when pregnant with poor control of nausea/vomiting in previous session.
History of chronic alcoholism (good for patients as a chronic alcohol user tends to have less nausea and vomiting during chemo)
Intravenous chemotherapy (minimal, low, moderate, high emetogenic risk)
Oral chemotherapy (prophylaxis or as needed)
Radiation therapy can also cause nausea and vomiting.
a. Mildly emetogenic: Radiation to the head and neck or to the extremities
b. Moderately emetogenic: Radiation to the upper abdomen or pelvis or craniospinal radiation
c. Highly emetogenic: Total body irradiation, total nodal irradiation, and upper-half-body irradiation
Management of chemotherapy and radiation induced nausea and vomiting
Prophylactic should be administered before moderately/high sessions.
Schedule antiemetics for delayed nausea and vomiting and rescue antiemetics should be available.
Patients need to be protected for:
a. Three days for highly emetogenic regimens
b. Two days for moderately emetogenic regimens