Poster Presentation
Water's Edge Ballroom (Hilton Waikoloa Village)
Wednesday, July 13, 2005
9:30 AM - 10:00 AM
Water's Edge Ballroom (Hilton Waikoloa Village)
Wednesday, July 13, 2005
2:30 PM - 3:00 PM
This presentation is part of : Poster Presentations
Clinical Care Guidelines for Postoperative Nausea and Vomiting: Utilization of Best Evidence
Maria Teresa Tet Ontoy, BSN, RN, 5 Main, Christus St. Joseph Hospital, Houston, TX, USA and Shyang-Yun P. K. Shiao, PhD, RN, FAAN, School of Nursing, Univesity of Texas Health Science Center at Houston, Houston, TX, USA.
Learning Objective #1: Describe the mechanisms of nausea and vomiting occurring after different surgeries
Learning Objective #2: Discuss current best evidence of various intervention strategies to reduce postoperative nausea and vomiting

At many as 90% of patients could experience postoperative nausea and vomiting (PONV). Preventing PONV could be significant for care outcomes for early recovery, shorter hospital stay, and saving care costs. PONV involves stimulation of pathophysiologic pathways including vomiting center in the medulla, vestibular neurofibers, afferent visceral parasympathetic fibers, and the chemoreceptor trigger zone. Interventions to treat PONV include pharmacological, non-pharmacological, and complementary treatments.

The choices of anti-emetic drugs depend not only on the patient status and the severity of PONV, but also on the potential adverse side effects and available routes of administrations for therapies. Five major categories of drugs include serotonin antagonist (longer lasting with fewer adverse effects), dopamine antagonist (for mild and moderate PONV), antihistamine (blocking histamine type-1 receptors for vestibular apparatus, good for ear surgeries), Phenergan (for motion sickness affecting vestibular apparatus when patients are transferred between units), and dopamine (higher dose for anxiety and agitation). A recent meta-analysis of 17 trials on combination therapy with multiple drugs indicated the need for more severe patients.

Non-pharmacological interventions for PONV include dietary and behavioral interventions. Clear liquid diet before the surgery and diet of easy-for-digestion are better choices with relaxing meal times. Relaxation and music therapies reduced PONV. The most effective alternative treatments include acupressure and acupuncture therapy on Pericardium 6 meridian point. There is a growing body of literature on other complementary therapies including ginger, peppermint, supplemental oxygen, isopropyl alcohol inhalation, intravenous fluid administration, slow movement, repositioning, deep breathing, cool washcloths, and mouth care. Complementary therapies are inexpensive and some are every effective, thus carry great promises for future research and practice. A clinical care guideline in a modern surgical unit will be presented including preoperative and postoperative assessment for PONV based on the best evidence to improve care outcomes.