Managing the multiple causes of nausea and vomiting in the patient with cancer

PURPOSE/OBJECTIVES: To review the multiple causes of nausea and vomiting in the patient with cancer. Pharmacologic and nonpharmacologic management strategies are provided to deal with each type, and selected clinical nursing research is discussed. DATA SOURCES: Scholarly and professional published articles. DATA SYNTHESIS: Nausea and vomiting may result from chemical, visceral, central nervous system, and vestibular causes at any time during the disease process of the patient with cancer. Investigation of possible causes beyond adverse chemotherapeutic effects is necessary prior to initiating antiemetic therapy. Anticipation of potential related problems and proactive pharmacologic and nursing management are advisable. Further nursing research is needed related to nonpharmacologic management methods such as aerobic exercise, guided imagery, progressive relaxation, and acupressure. CONCLUSIONS: Proper diagnosis and targeted intervention are essential to effectively manage cancer-related nausea and vomiting. IMPLICATIONS FOR NURSING PRACTICE: Healthcare providers must thoroughly assess and reassess the patient's disease status and current treatment interventions to effectively manage nausea and vomiting. Nurses can participate in this assessment and provide the appropriate drug therapies as well as continue to develop non-pharmacologic intervention methods that the patient can implement independently.     

Management of cancer pain

Primary care clinicians treat patients with cancer and cancer pain. It is essential that physicians know how to effectively manage pain including assessment and pharmacologic and nonpharmacologic treatment modalities. Barriers to adequate assessment of pain must be recognized and overcome. Pharmacologic regimens are based on the World Health Organization's "ladder of analgesia," beginning with nonopioid medications and adding the opioid narcotics and adjuvant medications as necessary. Inclusion of nonpharmacologic treatments, physical and psychological are important for effective management.     

Pharmacologic treatment of exercise-induced asthma

Exercise-induced asthma (EIA) is a complex disorder affecting a sizeable minority of athletes. Proper pharmacologic management allows most every athlete at any level to participate with EIA. This article briefly addresses the pathophysiology, diagnosis, and basic treatment principles, including nonpharmacologic management for EIA. Most of the article details the current treatment strategies and provides information on experimental treatments being investigated. In addition, ergogenic concerns and problems in treating elite athletes are discussed.     

The changing focus of chronic temporomandibular disorders: management within a hospital-based, multidisciplinary pain centre

Despite evidence to the contrary, many dentists still cling to outdated beliefs and practices regarding the aetiology and management of chronic temporomandibular disorders (TMDs). Chronic pain disorders require a multidisciplinary approach with a strong focus on psychological factors. Treatment failures and relapse are likely if such factors are not considered. Most chronic temporomandibular pain problems are extracapsular and of myofascial origin. Mechanistic or invasive treatments in such cases may be inappropriate and can cause harm. Conservative measures used for other types of chronic muscular pain are generally recommended. All health practitioners who deal with acute and chronic pain should be aware of recent major advances in the understanding of pain mechanisms. Along with psychosocial considerations, these must be emphasised in undergraduate and continuing education programmes.     

Diagnosis and treatment of rheumatoid arthritis

Rheumatoid arthritis is a chronic, inflammatory, connective-tissue disease that has well-defined clinical and laboratory characteristics. The management of rheumatoid arthritis requires an aggressive multidisciplinary treatment combining both pharmacologic and nonpharmacologic measures. Using this approach, most patients with rheumatoid arthritis can maintain their functional capacity while having their pain and suffering relieved.     

The role of laparoscopy in the management of pelvic pain in women of reproductive age

OBJECTIVE: To review the diagnostic and therapeutic roles of laparoscopy in women of reproductive age with acute and chronic pelvic pain. DATA IDENTIFICATION: Studies relating to the use of laparoscopy in women with acute and chronic pelvic pain were identified through the literature and MEDLINE searches. CONCLUSION(S): Laparoscopy has an important place in the management of conditions that cause acute pelvic pain in women of reproductive age, including ectopic pregnancy, pelvic inflammatory disease, tubo-ovarian abscess, and adnexal torsion. The procedure frequently facilitates the diagnosis and provides the necessary access for surgical treatment. Prompt diagnosis and effective management prevent complications and help preserve fertility. The role of laparoscopy in women with chronic pelvic pain is more controversial and limited, but abnormal laparoscopic findings are detected in approximately 60% of those who have undergone a multidisciplinary investigation and received a tentative clinical diagnosis. The access provided by laparoscopy permits the effective surgical treatment of many of the conditions encountered, including endometriosis, pelvic adhesions, ovarian lesions, and symptomatic uterine retroversion.     

The efficiency of alprazolam for seasonal affective disorder (SAD, autumn/winter type)]

Tricyclic antidepressants, or "tricyclics" as they are commonly called, are effective in reducing pain in chronic neurological and musculoskeletal disorders. Tricyclics appear to be effective in the control of chronic orofacial pain of non-inflammatory origin, and include amitriptyline, doxepin, nortriptyline and desipramine. Daily doses of the medications are smaller for the management of pain than doses typically used in the treatment of depression. Certain medical conditions may contraindicate tricyclic trials, while others may warrant starting at a lower dose with more conservative dose adjustments. Common side effects include dry mouth, sedation, constipation and orthostasis. Tricyclics are just one therapeutic modality which can be considered in the management and treatment of chronic refractory orofacial pain that is suspected to arise from neurogenic or myofascial etiologies.     

Binding characteristics of anti-atrazine monoclonal antibodies and their fragments synthesised in bacteria and plants

OBJECTIVES: The objective of this study was to assess the potential effects of motor vehicle accident impact and injury characteristics on post-motor vehicle accident temporomandibular disorders in terms of presenting signs and symptoms, diagnoses, treatment regimens, and outcomes. STUDY DESIGN: A retrospective chart review of 50 patients with post-motor vehicle accident temporomandibular disorders from a private oral medicine practice was undertaken. Various demographic data and data related to temporomandibular disorders and motor vehicle accident impact and injury characteristics were collected. Chi-square and Fisher exact tests and multiple regression analyses were performed. RESULTS: Patients involved in front-end collisions or motor vehicle accidents resulting in severe vehicle damage reported more direct orofacial injury. However, those in rear-end collisions or accidents resulting in minimal vehicle damage required more treatment. Direct head or orofacial injury was therefore not a prognostic indicator. From multiple regression analyses, indicators of a poorer prognosis were minimal vehicle damage, lack of headrest use, driver position, and settlement of insurance claim. CONCLUSIONS: In this patients group several prognostic indicators for patients with post-motor vehicle accident temporomandibular disorders were identified; these indicators may influence the management approach for this patient population.     

Anti-arrhythmia agents in the prevention of sudden cardiac death after myocardial infarct

Heart rhythm disturbances represent one of the most important causes of cardiovascular mortality and, in particular, sudden cardiac arrhythmic death. The persistent actuality of arrhythmias is currently characterized by: 1) better knowledge of pathogenetic mechanisms of arrhythmias and their modulating factors, 2) improved diagnostic possibilities of arrhythmias, 3) availability of a large number of effective antiarrhythmics, as well as of nonpharmacologic therapeutic approaches too. Despite the narrowing spectrum of indications to pharmacologic treatment, both chronic and prophylactic antiarrhythmic therapies have nor become less complicated, but on the contrary they are even more problematic. The most actual and at the same time most controversial question of everyday clinical practice is the long-term antiarrhythmic prevention of sudden cardiac death. The author's aim is to review: 1) survey of studies which have influenced in a more decisive manner the management of patients after myocardial infarction and preventive antiarrhythmic therapy, 2) current antiarrhythmic prevention of sudden cardiac death, 3) the importance of programmed ventricular stimulation regarding the antiarrhythmic therapy and risk stratification in patients after myocardial infarction.     

The pain and discomfort of labor and birth

One unique aspect of childbirth is the association of this physiologic process with pain and discomfort. However, the experience of pain during labor is not a simple reflection of the physiologic processes of parturition. Instead, labor pain is the result of a complex and subjective interaction of multiple physiologic and psychological factors on a woman's individual interpretation of labor stimuli. An understanding of labor pain in a multidimensional framework provides the basis for a woman-centered approach to labor pain management that includes a broad range of pharmacologic and nonpharmacologic intervention strategies.     

Dysfunctional patients with temporomandibular disorders: Evaluating the efficacy of a tailored treatment protocol.

Forty-eight dysfunctional patients (i.e., high levels of pain, interference, and affective distress and low levels of perceived control) with temporomandibular disorders (TMDs) were randomly assigned either to a treatment consisting of an intraoral appliance (IA) and stress management with biofeedback (SM) plus nondirective, supportive counseling (SC)—IA?+?SM?+?SC—or to a customized treatment that included cognitive therapy (CT) with the IA and SM—IA?+?SM?+?CT. Both treatment groups reported statistically significant reductions on a set of physical, psychosocial, and behavioral measures posttreatment and at a 6-month follow-up. However, the intervention that included CT demonstrated significantly greater reductions in pain, depression, and medication use. Only the groups receiving the treatment that included the CT demonstrated continued improvements to the follow-up on pain associated with muscle palpation, self-reported pain severity, depression, and use of medications. These results support the efficacy of the tailored treatment for dysfunctional TMD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressives'' future-event schemas and the social inference process

Atrial fibrillation (AF) is the most common, sustained, symptomatic tachyarrhythmia that clinicians are called upon to manage. Management strategies include ventricular rate control coupled with anticoagulation, versus restoration and maintenance of sinus rhythm. Rate control may be achieved pharmacologically, with agents that impair AV nodal conduction directly and/or by increasing parasympathetic/sympathetic balance, or by modifying or ablating the AV nodal region anatomically. Rhythm control may be achieved by electrical or pharmacologic conversion followed by maintenance of sinus rhythm by pharmacologic (or occasionally ablative) therapies. This article will present current approaches to rate and rhythm control issues in atrial fibrillation. Parts 1 and 2, published previously, dealt with rate control and with the restoration of sinus rhythm. Part 3, the current article, details the selection process of choosing a therapy to maintain sinus rhythm, including the likelihood of success, the risks of therapy, and individualization of therapy as dependent upon the nature of the structural heart disease present. It also discusses nonpharmacologic approaches that have been recently developed or are undergoing development. One suggested drug selection algorithm is provided.     

Sleep and rheumatic disease

Patients with rheumatic diseases often exhibit sleep disturbance. Identification of primary sleep disorders; medical, neurologic, and psychologic illnesses; circadian factors; and the use and effect of medications, drugs, and alcohol will provide a strong basis for pursuing both pharmacologic and nonpharmacologic intervention. Recent clinical research confirms the frequent comorbidity of sleep disturbance, pain, fatigue, stress, and mood disturbance in patients with rheumatic disease. It is essential for effective management to recognize these "symptom syndromes" that are often responsive to treatment (suggesting a common biologic action and effect of the drugs used) despite a continuing presence of underlying chronic disease. The pathophysiologic relationships of these comorbid symptoms are mostly unknown, so this is an area for further study.     

Pharmacologic pain. Management for cancer patients at home

Pain management is one of the most important responsibilities of the home care nurse serving cancer patients. Patients and caregivers often fear uncontrolled pain, and need frequent reassurance that effective pain control can be achieved. This article discusses the etiology and types of cancer pain, pain assessment, pharmacologic pain management interventions, and evaluation of pain management for home care patients.     

-Anesthesia and analgesia practice patterns in French obstetrical patients-

OBJECTIVES: To review current management of individuals with metastases to the central nervous system and brachial nerve plexus, and to provide a scientific basis for nursing management of the effects of the disease and treatment. DATA SOURCES: Published articles, book chapters, clinical trial data, and experience from nursing literature. CONCLUSIONS: Central nervous system metastases are events that may create oncologic emergencies with neurologic impairment and pain. Treatment of patients with central nervous system metastases is generally palliative regardless of the type of the primary cancer. Early diagnosis and treatment improve the chances for optimal recovery of neurologic function and pain management. IMPLICATIONS FOR NURSING PRACTICE: Central nervous system metastases may develop in patients with systemic disease. Disease and treatment effects present challenges to patients, family, and care providers. Nurses have a responsibility in educating the patient/family and in providing supportive care.     

Small cell lung cancer: pathophysiologic mechanisms and nursing implications

PURPOSE/OBJECTIVES: To review current incidence and treatment perspectives for small cell lung cancer (SCLC). DATA SOURCES: Published articles, book chapters, American Cancer Society materials. DATA SYNTHESIS: SCLC constitutes 20%-30% of lung cancer cases and accounts for 40,000 deaths annually. Characterized by rapid cell division, SCLC is very sensitive to radiation and chemotherapy; however, long-term survival rates are very low. A number of paraneoplastic syndromes are associated with this disease, thereby increasing the medical and nursing management challenges. CONCLUSIONS: Because SCLC usually is diagnosed late in the disease process and survival rates are poor, quality of life and palliation of metastatic symptoms (e.g., pain, breathing difficulties) are important focuses of care. Smoking deterrence and cessation programs, as well as early detection of lesions, are key to reducing incidence and mortality. IMPLICATIONS FOR NURSING PRACTICE: Nursing care focuses on promoting comfort and preventing and managing disease and treatment complications. Nursing diagnoses include ineffective airway clearance, impaired gas exchange, pain, altered nutrition, activity intolerance, and ineffective coping. A patient care standard is presented.     

Temporomandibular disorders: what the neurologist needs to know

Temporomandibular disorders are a complex group of conditions which are common causes of orofacial pain and are frequently associated with headaches. Because a wide variety of diseases can ultimately cause symptoms that result in dysfunction of the masticatory system, it is important for the clinician to establish an accurate diagnosis and rule out any serious neurologic pathology. Serious extra-articular conditions often can simulate the nonspecific symptoms of a temporomandibular joint disorder. A careful history and clinical examination of the head, neck, and cranial nerves are important in establishing a differential diagnosis. Diagnostic imaging and consultation with specialists in several disciplines are often necessary to establish an accurate diagnosis and develop an appropriate therapeutic regimen.     

Treatment of sexual disorders in the 1990s: An integrated approach.

Marked changes have occurred in the formulation and treatment of sexual disorders in the past 2 decades. Emphasis has shifted to the role of biomedical and organic factors in the etiology of sexual dysfunction, along with the growing use of medical and surgical treatment interventions. Multidimensional assessment models are widely used, particularly in the evaluation of male erectile dysfunction and sexual pain disorders. Integrated treatment approaches have also been developed, as cognitive-behavioral and couples' therapy procedures are increasingly combined with traditional sex therapy techniques. This article reviews existing data regarding the etiology and treatment of male and female sexual dysfunctions. Despite the conceptual and technological sophistication of current approaches, treatment outcome is less than satisfactory in several areas. Further research is needed on the etiology and treatment of sexual disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Orofacial pain mechanisms and their clinical application

This article has discussed the peripheral and central mechanisms of the various orofacial pain conditions, including musculoskeletal disorders, neurogenic inflammation, and neuropathic pain. To make an accurate diagnosis of orofacial pain and render treatment, all organ systems need to be considered and evaluated. Central sensitization was discussed as it relates to musculoskeletal disorders and neuropathic pain. It has been suggested that treatment of these disorders be problem oriented, addressing both peripheral and central mechanisms if present. Musculoskeletal disorders are characterized by pain that is provokable with function and manipulation. Neurovascular pain is episodic with pain-free periods between attacks. The pain is not related to or provoked by jaw function. Neuropathic pain is more continuous and may be aggravated by light touch. Neuropathy with peripheral involvement responds variably to local anesthetics but may need to be treated with topical or local agents as well as centrally acting agents. Neuropathic pain that does not respond to topical or local agents is more profoundly centralized. These conditions need to be treated with centrally acting agents. In addition, if there is no response to medications, sympathetic involvement needs to be ruled out with sympathetic ganglion blockade.