Role of Nurse in Management of Chemotherapy Induced Nausea and Vomiting

This report discusses the important role of nurses in managing chemotherapy-induced nausea and vomiting. It covers assessment tools, local guidelines for pharmacological management, and the nurse's duty to provide information to patients. The report also highlights the importance of ongoing assessment and the use of evidence-based guidelines.

Role of the nurse in the management of
chemotherapy induced nausea and
vomiting

Table of Content.
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Role of the nurse in the management of chemotherapy induced nausea and vomiting...............1
Assessment tools which help nurses in assessing and management of CINV.............................3
Local guidelines for pharmacological management....................................................................5
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................6

INTRODUCTION
Chemotherapy is a treatment process in which a chemical or a combination of substances
are used especially in the treatment of cancer. During cancer treatment, the most patient
experienced nausea and vomiting as this is the most common side effect of chemotherapy. Some
other side effects may include alopecia, vomiting, anorexia, stomatitis, diarrhea, anti-emetic as
well as fatigue. To manage such chemotherapy-induced side effects, nurses play a crucial role in
prevention as well as in management. As this side effect occurs due to the absence of anti-emetic
drugs when treated with highly emetogenic chemotherapy. The report includes a discussion
about the role of the nurse in the management of chemotherapy-induced nausea and vomiting
(Clark-Snow, Affronti, and Rittenberg., 2018). The project report also discussed the tools
assessment which might be helpful for nurses in assessing as well as in the management of
chemotherapy-induced vomiting or nausea.
Role of the nurse in the management of chemotherapy-induced nausea and vomiting
Nurses are the most multidisciplinary team member who can implement the action plan,
do an assessment as well as adjust the treatment for progress (The Multidisciplinary Team (MDT)
Approach and Quality of Care, 2020). The patient may remain in contact with their nurses
throughout their treatment journey (Rha and et.al., 2018). The chemotherapy is a treatments
procedure in which the powerful chemicals or combination of substances are used to kill fast
growing cells within the body but sometimes it damages the cells while making copies and they
cause many other side effects. So in order to review such side effects the clinical review is
performed. Hence, the major purpose of clinical review before each chemotherapy is to
determine any kind of toxicities that remained previously, assess an individual's fitness to
continue the therapy as well as determine change planned in the treatment journey. A nurse
reviews the whole treatment journey to report the whole scenario to the person who possesses
knowledge about the chemotherapy. The nurse's assessment is established to determine the need
for intervention during the presence of toxicities. The nurse should build some skills such as
communication, advanced history-taking skills, and many more skills to obtain the key
information from the patient such as how they feel the nurse needs to communicate with the
patient as an assessment based only on eyes as what they tell is not helpful to gather the key
information. Whereas advanced history-taking skills are important to obtain information about
the side effects of chemotherapy (Ford and Park., 2020).
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On the other hand, a physical assessment is also essential to assess the psychological
impact of a diagnosis of cancer as well as receiving treatment. The assessment includes
assessment of the wellbeing of the patient and how well the patient is coping after receiving
cancer treatment. Some of the physical symptoms like hair loss, changes in skin texture, nail
changes, potential fatigue may confound the problems of psychological distress. Therefore, nurse
assessment is essential to record each symptom, the patient might develop (Sandset and et.al.,
2021).
An ongoing assessment often take a variety of setting or ways among the patients who
receive chemotherapy. The assessment can be done in a formal clinic setting within the hospital
to the community or by telephone. The assessment includes the use of mobile phone software
which allows the patients to input their all toxicities and these inputs are transferred to the
professionals. As the use of technology may generate alerts to the health professional who start
contacting the patient to discuss the side effect in detail or person (Juartika., 2022).
Nurses enable the patient to decide on the treatment option. As nurses enable the patient
about the whole circumstances of treatments such as the aim of treatments, side effect or their
management, expected outcomes as well as outcomes which are not proceeding with the
treatments. However, it is an ongoing process where all the multidisciplinary members have a
specific role to play. Whereas the key component role in chemotherapy is the nurse as they must
ensure both the patient and the carer that they have sufficient information to decide on the
treatments. The process of information is provided to the patient in written format and it starts at
the initial consultation while providing the knowledge about chemotherapy should be discussed
in detail (Sande, Laird, and Fallon., 2019).
The department of health may support the nurse to develop nurse-led chemotherapy
clinics (Are nurse-led chemotherapy clinics really nurse-led?, 2017). The main purpose of the
clinic is to assess the ongoing suitability of those who receive chemotherapy. Their focus is to
determine the presence of toxicities of treatments. In case of any side effects, when the patient
returns to the clinic can be resolved. Therefore, it is essential to determine the previous toxicities
and how badly they affected the person. The individual toxicities are determined by checking
history, physical assessment, evaluation of patient physiological well-being as well as
performance status. After doing a proper assessment of the patient, the nurse's role is to adjust
their chemotherapy as well as their necessary supportive medicine. There is an inconsistency in
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the level of training or in guidelines that are related to the assessment and management of CINV
in MALTA that the nurses should not prescribe the medicine or drugs for treatments. However,
the medical staff may prescribe the drug on the behalf of the nurse. As it creates a limitation for
nurses in terms of professional practices. The nurse's role is to assess all side effects of
chemotherapy according to common toxicity criteria (Yaffe Ornstein and et.al., 2022).
Chemotherapy-induced nausea or vomiting can be prevented by the use of guidelines that
recommended anti-emetic regimens in most of the most. As chemotherapy-induced nausea and
vomiting can be prevented in most patients by using the evidence-based guidelines which are
recommended anti-emetic regimens (Chemotherapy-Induced Nausea and Vomiting, 2021). The
evidence-based guidelines are regularly updated both nationally and internationally to provide a
guide for health care workers in selecting the proper antiemetic’s. The most appropriate or
relevant guidelines may include MASCC/ESMO, ASCO, and NCCN. MASCC stands for
Multinational association of supportive care in cancer/ European society of medical oncology
(Piepoli and et.al., 2016). Oncology nurses have crucial role to promote their unique position as
well as to reinforce the guidelines recommended for anti-emetic prophylaxis or enhance
healthcare providers' adherence to evidence-based guidelines recommendations. The survey is
conducted to analyse the access oncology nurse's awareness of anti-emetic guidelines and
recommendations for the prevention of CINV. Until 2016, the Oncology Nursing Society was
priorities of transferring cancer knowledge to oncology nurses to improve patient outcomes
(Research Agenda of the Oncology Nursing Society: 2019–2022, 2019). Due to being part of the
oncology nursing society, the nurses have access to practicing on the oncology nursing society
database. Hence, the nurses in the outpatient setting may be stated that they enhance their
confidence as well as their knowledge (Shih and et.al., 2021).
Assessment tools that help nurses in assessing and management of CINV
Effective anti-emetic and non-pharmaceutical management can reduce the incidence of
chemotherapy-induced nausea and vomiting but some clinical problems may still exist. Some
studies found that patient outcomes are improved when nurses take a central role in the
management of CINV. To assess and management of CINV the nurse collect sample and setting.
As this is the descriptive cross-sectional design. The data are collected in the oncology
department within the public hospitals. Hospitals are a place where all registered or enrolled
nurses are working in the oncology department (Lavdaniti., 2019).
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The nurses are more often involved in CINV assessment. Their assessment distinguished
between nausea and vomiting, there is a report which noticed that the assessment of CINV is
done by using the assessment tool. The international guidelines noted that the assessment of the
occurrence of CINV is done by responding to samples as well as the use of local guidelines or
protocols. Whereas the management of chemotherapy induces vomiting and nausea are done by
using both strategies as pharmacological strategies or non-pharmacological strategies. The
pharmacological management of CNIV may include some use of drugs such as 5-HT3 receptor
antagonists, corticosteroids, antihistamines, benzamides as well as benzodiazepines. Whereas the
non-pharmacological management of CINV includes distraction, relaxation, visualization,
massage, acupressure, aromatherapy, acupuncture as well as reflexology (Sande, Laird, and
Fallon., 2019).
The present study specified that the role of a nurse-delivered behavioural intervention
may design in such a way as to prevent anticipatory nausea and vomiting. The intervention
methods include relaxation as well as meditation techniques as this is a high-intensity method
whereas the low-intensity intervention includes listening to music to relax. before administration
of chemotherapy, the trained oncology nurse must deliver the intervention to prevent the side
effects (). Whereas before any subsequent treatment the patient was directed to use the recorded
session as a booster. The intervention is embedded within the normal chemotherapy protocol to
maximize convenience as well as clinical generalization. The intervention attempts to increase
interpersonal engagement between the patient and the treatment team (Ko et.al., 2022).
Nurse training- the manual treatment is developed as a standard intervention.
Mindfulness relaxation is consisting of exercise, imagery as well as relaxation practices. The
practice's duration is for about 20 minutes and this practice is repeated throughout chemotherapy
(A Systematic Review: Mindfulness Intervention for Cancer-Related Pain, 2019). The oncology
nurses from the community clinical oncology program may be trained in providing intervention
(Hunter and at.al., 2020). After following the training session, each nurse prepared a master
recording of mindfulness relaxation exercises to use on their patient (The effectiveness of
mindfulness meditation for nurses and nursing students, 2018). Before starting the
chemotherapy, the patient first meets the oncology nurse to get knowledge about the
chemotherapy. The nurses take an individual session to provide basic mindfulness relaxation
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methods. They also provide a copy of the session to their patient for practising at home (Salama,
Elmotasem, and Salama., 2020).
Relaxing music- is identical to mindfulness relaxation, it is advised to those patients who did not
contain any specific instruction on relaxation or meditation. It contains the relaxing music of
nature's sounds or vocal tracks.
Standard care- The patient receives general information about the management of symptoms
related to chemotherapy. The same appeared to the individual throughout the session. The
instrument used to measure the primary outcomes is the MANE (marrow assessment of nausea
and emesis). The MANE is a probe, it measures the incidence, severity as well as duration of
both anticipatory or post-chemotherapy nausea and vomiting. The measures of nausea or
vomiting are assessed at the midpoint or the end of treatment (Pei-Hua and et.al., 2018).
Local guidelines for pharmacological management
Most nurses are confident or very confident in their knowledge related to emetogenic.
The respondents familiar with ASCO antiemetic guidelines but is less aware of those guidelines
which are developed by the institution and by MASCC, NCCN. Most of the respondents use
institutional guidelines, only a few respondents are using ASCO or MASCC guidelines. Whereas
in the highly emetogenic chemotherapy setting, the guidelines recommended for all patients use
of triplet combination of NK1 RA+ 5-HT3 RA+ DEX. The guidelines recommend using the
combination of DEX, 5-HT3, and NK1 RA or NEPA on the first-day administration whereas
during the delayed phase, the common user agent is DEX,5-HT3 Ras, and metoclopramide
(Lyman and et.al., 2018).
Barrier and Approaches to improve adherence to antiemetic guidelines -The predominant
barrier preventing the staff from using the recommended guidelines of antiemetic prophylaxis are
physician preference. The other barriers may include medication as well as product cost. Due to
that most patient does not report CINV, this scenario is noticed by the nurse. These nurses
recommend some solutions to improve adherence to the guidelines in the HEC setting. The
guidelines adherence includes increasing the education of healthcare providers as well as patient
education (Hamai et.al., 2019).
CONCLUSION
From the given report, it is concluded that the nurse plays a key component role in
chemotherapy-induced nausea and vomiting. There is the nurse's duty to assess the patient
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throughout the treatment journey. There is the nurse's duty to provide basic or clear information
about the chemotherapy before receiving the chemotherapy. The project report concluded that
nurse does their duty under the set guidelines of the community or the institution. The project
report concludes that MANE is the assessment tool that the nurse should use for chemotherapy
induce nausea and vomiting.
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