Question

Catherine is a 35 year old mother of three young children. She was admitted to the hospital with multiple enterocutaneous fistulas 3 weeks ago, at which time she weighed 52 kg (116lbs). She is 165 cm (5ft 5in) tall. Catherine has a history of recurrent cervical cancer for which she had a hysterectomy 4 months before admission. During chemotherapy that followed, she had regular bouts with nausea and anorexia. Surgery was performed again. Her fistulas continued to drain for 2 weeks postoperatively, during which she tolerated clear liquids only. An intravenous drip of 10% glucose and 45% normal saline was ordered to supplement fluids and kcal. This week she developed peritonitis and has had a fever with a maximum temperature of 39 C (102 F) over the past 24 hours. Her weight has dropped to 41 kg (90lbs); drainage from the fistulas has become odorous. The patient was placed in isolation today and was advised by her physician that he intended to start her on total parenteral nutrition (TPN) and conduct some more tests to determine her progress.

Questions for Analysis:

Why did Catherine develop nausea and anorexia during chemotherapy? What are the implications of this for recovery? Outline a plan for evaluating and controlling nausea and vomiting in patients undergoing chemotherapy.

Answer 1

The development of nausea and anorexia during chemotherapy are due :

• The chemotherapeutic drugs trigger certain areas of brain.
• It also can stimulate some areas of the esophagus , stomach, small intestine, and large intestine.The chemotherapeutic agents  are sensed in the gastric or intestinal mucosa and cause stimulation of vagal afferents that interact with the hindbrain of the central nervous system , resulting in efferent vagal action that leads to an emetic response
• Chemo therapy increases levels of TNF and interleukin-1, resulting in anorexia and weight loss

Chemotherapy induced nausea and vomiting can be classified as acute (occurring within 24 hours of therapy), delayed (persisting for 6–7 days after therapy), or anticipatory (occurring prior to chemotherapy administration). The occurance of vomiting is influenced by the emetogenic potential of the administered chemotherapy, patient variables.The emetogenic potential of the drugs depends on the chosen cytotoxic agent, the dose given, and the administration schedule.

Evaluate and contol nausea and vomiting in patients with chemotherapy

1. Check for the degree of dehydration

• Provide small amount of fluids throughout the day like water and juice.   
• in case of sevee vomiting replacement of fluids via IV.
• Don't drink fluids while having meals.

2. Check the amount of food intake

• Eat small and frequent meals
• Eat before getting too hungry.
• Eat dry foods such as dry cereal, toast immediately getting up from the bed.
• Avoid heavy and high fat meals before chemotherapy.
• Avoid caffeine and smoking.
• Suck on hard candy, or ice during chemotherapy.

3. Evaluate the cleanliness of the surroundings:

• Avoid bad odors in the suroundings.  
• Rest by sitting up or reclining with your head elevated atleast two hours after eating

4. Check for the ways of Distraction during chemotheapy:

• Relax and the keep the mind free during chemotherapy.
• Listen to music, watch a funny film,get company of a good friend duing chemotherapy.