Peppermint and Nausea – A case study: End of Life Care

Client hx and presenting problems: Marie was admitted to the nursing facility with advanced, end stage breast cancer. Marie had a history of resolved breast cancer, that later returned. Rather than be pushed for treatments, Marie choose to not tell her family that the cancer had returned. As her condition progressed, she was experiencing increased weakness. Marie ended up in the hospital at that point. Continued to choose no treatment. Was admitted to the nursing facility as a hospice client. Marie’s biggest problem as her condition progressed was nausea. She was given Zofran for the nausea with limited success. Pain was managed. Nausea was her biggest complaint.

Aim or goals of treatment: Goal of treatment was to determine which essential oil could be safely added to current medication regime and help eliminate the nausea and improve her ability to rest comfortably without a feeling of nausea/sickness. Marie was given samples of ginger, peppermint and spearmint to determine which essential oil would best reduce her nausea.

Care Plan: Peppermint essential oil was Marie’s oil of choice. Staff and family were instructed to put 3-4 drops of peppermint onto a tissue and tuck into the color or Marie’s gown to allow for inhalation of the essential oil as she requested. Bottle was left in Marie’s nightstand for quick access to use of the oil as Marie requested. Marie was informed she could ask for the oil on a tissue as needed for the nausea. Hospice team was also educated on Marie’s request for peppermint added to prescribed nausea medication.

Client Response/Results: Marie frequently choose to have the peppermint on the tissue. Anytime I would stop in the room she would point to her tissue and put her hand to her nose signaling that she needed more peppermint. Needed frequent monitoring as she was not using the call light to request peppermint. Would wait until staff, family or her hospice team stopped in her room to request the peppermint.

Subsequent treatment: No further treatment was required. Marie’s condition was terminal and very end stage. She died 2 months after admission. Family was very happy with Marie’s end of life care and the addition of the peppermint to complement her prescribed medication regime. Marie was able to rest and the nausea/throwing up was greatly reduced.

Results: Improved quality of life during Marie’s final days at the nursing facility. She was able to stop keeping the basin next to her in bed with the combination nausea therapy of Zofran and peppermint.

Discussion:
I have frequently relied on peppermint essential oil in the past years for nausea and terminal restlessness at end of life. Have also used peppermint for fevers that occur at end of life and contribute to restlessness. Peppermint can reduce a fever in less than 15 minutes and almost instantly calm terminal restlessness. This has been a blessing to families who are sitting with their loved one and are stressed and many times frightened when watching the process of terminal restlessness. Peppermint appears to relax blood vessels. As the body is shutting down and blood vessels constrict, restlessness occurs. Peppermint relaxes these blood vessels and the individual almost instantly relaxes and rests comfortably. Has been a blessing and families are amazed at the quick response to peppermint essential oil. Reduction of fevers also promotes improved relaxation at end of life.

Peppermint on a tissue for inhalation is sufficient. Have also used peppermint as a foot massage, which helps with fever reduction and relaxation. Can also apply a drop to pulse points, across forehead by the hair line, at base of head, behind ears etc to help with relaxation and fever reduction. I typically avoid any hand massages with the peppermint. When restless it is best to avoid putting any essential oil on the hand in the event the person moving about should touch their eyes. Many are unaware of any safety issue at this point.

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