Symptomatic management: non-pharmacological

Nutritional advice

Recommend the following to the patient:

• eat what he/she tolerates well and appreciates the taste of
• use frequently small meals and snacks to prevent an empty stomach (if there is no gastric retention)
• consider cold meals, if the aroma of food leads to complaints
• use meals and snacks at moments that the complaints are less intense; take advantage of good moments
• take sufficient fluids (at least 1.5 l/day)
• consider drinking cola (carbonated or uncarbonated)
• consider sucking on an ice cube or popsicle pieces of frozen/cooled fruit sometimes works well
• consider dietary supplements, if maintaining or improving nutritional status is desired. Consulting a dietician is essential for this.

Lifestyle advice

Recommend the following to the patient:

• sit in an upright position for 30 - 45 minutes after eating
• maintain a quiet environment and fresh air
• practice good oral hygiene and care
• make sure there is a container and enough tissues and water to rinse the mouth

Advise the patient to avoid:

• the smell and sight of food, if this leads to complaints. Remove food immediately if it has not/will not be used
• fatty, very spicy, too hot or too strongly smelling meals
• cold drinks
• constricting clothing
• strong perfume

Administration of fluids and electrolytes

If there are indications of (threatening) dehydration based on the patient history, physical examination and any laboratory analysis, parenteral fluid administration can be considered, depending on the life expectancy and the wishes of the patient. In the case of hypokalaemia, supplemental potassium may be given intravenously.

Gastric drainage

Gastric drainage may be considered if there is severe vomiting as a result of a total obstruction of the pylorus or the duodenum, an ileus or an untreatable gastroparesis. In these situations, a nasogastric or existing PEG tube can be used to drain stomach contents, thereby preventing vomiting.

Acupuncture and acupressure

There are indications that acupuncture and/or acupressure (in the form of pressure massage or a special wristband) are effective in the case of nausea and/or vomiting, particularly after surgery and after chemotherapy.

Complementary forms of care and psychological techniques

Complementary forms of care and psychological techniques are used to manage nausea and/or vomiting primarily when psychogenic factors (anxiety and stress) and conditioning (with anticipatory nausea and/or vomiting) play an important role. These types of nausea and/or vomiting respond poorly to antiemetics. These techniques act through relaxation, distraction, and/or a feeling of self-control. In first instance, instruction from a physiotherapist or psychologist is necessary. In most cases, a physician, nurse, or even the patient can generally apply the technique on their own after this.
The techniques listed below have primarily been researched with nausea and/or vomiting resulting from chemotherapy:

• massage of feet, hands or the face
• aromatherapy (alone or in combination with massage)
• relaxation exercises (progressive muscle relation), alone or with guided fantasy exercises
• listening to music

The approach used must be tailored to the patient. Some patients will benefit more from a physical approach aimed at relaxation, while others may respond to a more active approach involving behavioural therapy.