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Symptom Management - Nausea & Vomiting

The following content is from A Caregiver's Guide: A Handbook about End-of-Life Care. It has been reproduced here with permission from The Military and Hospitaller Order of Saint Lazarus of Jerusalem and the Canadian Hospice Palliative Care Association.

Nausea means feeling sick to the stomach and vomiting means throwing up. Nausea can happen even when a person is not thinking about food. Vomiting can occur even if nothing has been eaten or there has been no nausea.

Many things can cause nausea and vomiting. These can include the illness, medications, irritation of the digestive system, certain foods, constipation, pain, bowel obstruction, infection, anxiety, movement, and some treatments. Sometimes the cause has nothing to do with the illness, and is as simple as having the flu.

What you need to know

Everyone experiences nausea and vomiting at some point. For a person with an advanced illness, the difference may be the frequency and intensity, made worse by the weakness that accompanies the illness.

  • The person may feel sick and unable to eat.
  • Vomiting may happen occasionally or often.
  • Medications taken by mouth may be vomited.
  • The person may be comfortable at rest but feel sick with movement.

Important Points

  • If vomiting occurs in bed, position the person on one side so that vomit will not be inhaled and cause choking.
  • Keep a record of how often and how much the person vomits.
  • Depending on the cause of the nausea or vomiting, the doctor will order appropriate medications or interventions to try.

Ask for help if:

  • vomiting occurs more than three times an hour for three or more hours.
  • blood or material that looks like coffee grounds appears in the vomit.
  • the person has been eating and drinking well, but nausea and vomiting no longer allows it.
  • medications are vomited.
  • the person now feels unusually weak and dizzy.
  • the person suddenly becomes unresponsive.

How you can offer comfort and care

The comfort you can offer is aimed mostly at reducing any triggers that might cause nausea and/or vomiting, and providing doctor-ordered medications by different routes to try to ease or relieve it. If and when it does ease:

  • Try offering small amounts of favorite foods and fluids as tolerated.
  • Try cold foods because they have less odour.
  • Keep a supply of clear fluids, ice chips, frozen juice chips, and ginger ale to offer in small quantities.
  • Cooking smells may stimulate nausea. Try to keep these away from the sick person.
  • Do not offer greasy or spicy foods. Try bland foods such as crackers, toast, angel food cake, soft fruits and yogurt.
  • Encourage the person to take the anti-nausea medication regularly, as directed by the home care nurse or doctor.
  • Freshen the mouth with a non-alcohol based mouthwash or club soda.
  • Always keep clean basins close by. If vomiting occurs, replace the basin right away.
  • Open windows or use a fan to see if air helps to reduce the sensation of nausea.
  • Help the person to rest sitting up for an hour to aid digestion after meals.
  • Encourage anyone who will be close to the person to avoid using perfumes, aftershaves or deodorants with strong fragrances.
  • Ask your doctor, home care nurse or pharmacist if complementary care suggestions such as herbal remedies might help (see Herbal Remedies, page 108).​​