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Symptom Management

Gastrointestinal Symptoms

Gastrointestinal symptoms include such problems as nausea (feeling queasy or sick to one's stomach), vomiting (throwing up), constipation or diarrhea, anorexia (loss of appetite), and cachexia (severe weight loss). These difficulties can be caused by a number of illnesses, treatments, medications, and other factors, including:

cancer, AIDS, and other diseases
radiation therapy
certain foods
opioids, antibiotics, and other drugs
lactose (milk) intolerance
emotional distress and anxiety
taste changes

What You Can Do to Help


Encourage the patient to take prescribed antinausea medication
Fix the patient frequent light meals throughout the day
Serve foods cool or at room temperature
Avoid fried foods, dairy products, and acidic foods (e.g., citrus fruits, citrus juice, and vinegar)
Stay away from spicy foods; stick to bland foods, such as dry crackers
Make sure the patient's mouth is kept clean
Offer chewing gum or hard candy
Take the patient outside or open a window for fresh air
Encourage rest and relaxation
Make sure the patient drinks enough clear liquids, sipped slowly, to prevent dehydration
Avoid unpleasant or strong odors
Distract the patient with music, television, or other activities

When to Call the Doctor for Nausea and Vomiting:

If there is blood or material that looks like coffee grounds in the vomit
If vomit shoots out for a distance (projectile vomiting)
If two doses of prescribed medications are not taken or kept down because of nausea or vomiting
If the patient cannot keep liquids or food down
If weakness or dizziness occur
If severe stomach pains occur with vomiting


Discuss the use of laxatives and stool softeners with the doctor and follow a regular schedule as directed
If the doctor agrees, give the patient foods high in fiber (whole grain cereal and bread, dried fruit, nuts, beans, and raw fruits and vegetables)
Make sure the patient drinks enough liquids (up to 6-8 glasses per day)
Offer prune juice, hot lemon water, tea, or coffee, which may stimulate the bowels
Encourage daily exercise, such as walking (in keeping with the doctor's advice)

When to Call the Doctor for Constipation:

If the patient has not had a bowel movement in many days
If constipation occurs with severe abdominal pain
If constipation worsens and is followed by vomiting


Give medicine for diarrhea as directed by the doctor
Replace lost fluids and nutrients by offering clear liquids (clear juices, water, broth), often and in between meals (2-3 quarts per day)
Serve foods low in fiber and high in potassium and protein (eggs, bananas, applesauce, mashed potatoes, rice, and dry toast)
Serve many small meals throughout the day rather than 3 big meals
Avoid serving foods that may increase bloating (vegetables, beans, fruits)
Avoid serving fatty or acidic foods (fatty meat, fried food, spicy food)
Limit caffeine intake (coffee, tea, soda with caffeine, and chocolate)
Avoid serving dairy or milk products

When to Call the Doctor for Diarrhea:

If the patient is losing a lot of fluid from severe diarrhea
If there is blood in the diarrhea
If diarrhea is oily in the toilet
If there is a fever
If the patient does not drink any liquids for more than 2 days

Loss of Appetite/Weight Loss

Do not force-feed the patient
Do not get angry if the patient does not want to eat
Prepare familiar favorite foods
Try light exercise or walking before meals
Encourage eating meals at the table with others
Serve meals over a prolonged period of time in a relaxed environment
Place meals on smaller plates with smaller servings more frequently
Cover up unpleasant odors
Serve a glass of wine before meals to stimulate appetite (as per MD's advice)
Offer frequent high protein, high calorie snacks (pudding, ice cream, milk shakes)
Try new spices or flavorings for foods
Prevent early feelings of fullness by: serving beverages between meals, not with meals; eating slowly; and avoiding too many vegetables and carbonated drinks

When to Call the Doctor for Appetite/Weight Loss:

If the patient reduces normal food intake for a long time
If the patient loses 5 pounds or more in a short time
If there is pain with chewing and/or swallowing
If the patient experiences dizziness upon standing
If the patient does not urinate for an entire day, or does not move the bowels for many days


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