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Nausea Diary Assessment — SCE Palliative Medicine MCQ

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ModerateNausea & VomitingNausea Diary AssessmentSCE Palliative Medicine

A 75‑year‑old man with advanced prostate cancer has nausea that fluctuates during the day—worse in the afternoon, better in the morning and evening—with no obvious trigger and stable medications. What assessment approach is most important?

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Reveal the answer and explanation

Correct answer: B — Keep a nausea diary for 48–72 hours documenting timing, severity (0–10), association with meals/medications/movement/posture, aggravating and relieving factors—pattern recognition guides mechanism‑based treatment

Option B is correct. UK palliative care guidance emphasizes detailed history-taking—including pattern, timing, triggers, exacerbating/relieving factors—to identify underlying mechanisms and treat nausea in a mechanism‑based fashion. For example, intermittent afternoon worsening may reflect delayed gastric emptying, meal timing, or anxiety. Structured tracking over 48–72 hours aids this analysis. Option A is not routine unless focal signs appear, per guidance restricting investigations to when results will change management. Option C is premature—polypharmacy without cause is not advised. Option D is nihilistic and contradicts guidance requiring reassessment. Option E assumes opioid causation without assessment and may harm analgesia.

Reference: Scottish Palliative Care Guidelines, Nausea and Vomiting section (2025), Scottish Palliative Care Guidelines. & Palliative Care Pain & Symptom Control Guidelines for Adults (Greater Manchester, 2019) – Assessment of nausea component. https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/symptom-management/nausea-and-vomiting/