Symptom: Gas (Flatulence)

Initial Grading Reminder

CTCAE grading of gas:

Grade 1: Mild symptoms; intervention not indicated
Grade 2: Moderate; persistent; psychosocial sequelae

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had any problems with gas in the past? Is this a new or worsening symptom? When did it start or get worse? Were you gassy before? How much worse is it now? Has it developed gradually or suddenly?

“Suddenly” would be more consistent with peritoneal signs.

Grade the symptom

Ask the patient:

How frequently do you pass gas? Is it causing you any distress? Do you ever soil yourself with the passage of gas?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Normally, how many bowel movements do you have per day/week? How many bowel movements do you have now? Is there blood and mucus in your stool? Do you have any abdominal (belly) pain, bloating, nausea or fever?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Gaseousness itself is not a cause for an office visit but may be a marker of GI toxicity. If patients are incontinent, they should be seen.

    Patients with symptoms of GI toxicity or GI red flags should be seen.

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    Nursing Assessment of Potential Causes

    [tab category='GI' header="GI Toxicity - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize'][tab category='Hepatotoxicity' header="Hepatotoxicity - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize']

    Differential Diagnosis

    What do you suspect is the cause of the patient’s flatulence?