Nausea at End of Life

Nausea is the unpleasant sensation of needing to vomit; vomiting is the forceful emptying of stomach contents and may occur with or without preceding nausea. Either symptom can undermine comfort, oral intake, medication use, sleep, and a person’s sense of control. At end of life, more than one contributor may be present, and the contributors may change as illness progresses. Potentially reversible contributors include constipation, dehydration, infection, gastrointestinal disease or obstruction, metabolic disturbances, medications, central nervous system disease, vestibular dysfunction, anxiety, and cancer treatment. Opioids and other recently changed medicines deserve particular attention. Patterns help organize the assessment without giving the nurse independent diagnostic or prescribing authority. Fullness, reflux, early satiety, or nausea after meals may suggest delayed gastric emptying. Nausea linked to movement or dizziness may suggest a vestibular contribution. Constipation, abdominal distension, colicky pain, reduced or absent flatus, or feculent vomiting requires immediate notification of the prescriber or nurse practitioner for suspected bowel obstruction. Comfort remains the central aim, while reversible contributors are addressed when doing so fits the person’s wishes and goals of care.