PONV Case Studies

Sometimes the anaesthetist may order that a patient’s normal everyday medications be withheld the day of surgery. This is to ensure that the effect of any sedatives, tranquillisers, anticholinergics or antihistamines for surgery aren’t affected by the patient’s usual medication (Berman, Kozier and Erb, 2012). These surgery medications must be given at the scheduled time or when notified by the operating room to do

The pre-operative stage is an important phase in patient’s surgery process. This is the time where the patients is experiencing a lot of anxiety issues and have questions regarding the impending procedure. To help ensure good patient outcomes, it is imperative to provide complete preoperative instructions and discharge instructions (Allison & George, 2014). It is the nurses’ duty to safe guard and protects the patient’s welfare during the surgical experience. Effective preoperative preparation is known to enhance postoperative pain management and recovery. Health professionals need to be cognizant of the contextual factors that influence patients’ preoperative experiences and give context appropriate care (Aziato & Adejumo, 2014).

I am concerned with the drug to drug interaction with Mrs. Cynthia. She has hypertension, type II diabetes, and she is old. Her body mechanism metabolism the medication at a slower rate or it may metabolism too quickly. Cynthia labs result closely because she is also diabetic and is taking Lisinopril. I am concerned with her taking a potassium-sparing diuretic, potassium supplement, and aspirin. Patients who are taking potassium-sparing diuretics, potassium supplements, potassium-containing salt substitutes should not be placed on Lisinopril (mmm ) Lisinopril is

Dr. Sharon Hertz is a trained neurologist who is currently a supervisory medical officer with the Food and Drug Administration. She works in the Division of Anesthesia, Analgesia, and Addition Products (DAAAP) in the Center for Drug Evaluation and Research. By having background in clinical practice, as well as nearly 15 years with the FDA, she as a unique perspective on public health that includes both individual treatment as well as broad public policies. In her position in DAAAP, Dr. Hertz acts as a deputy director of the division and a direct supervisor for ten physicians and oversees the work of chemists, animal pharmacologists and toxicologists, clinical pharmacologists, physicians, and statisticians. The division as a whole provides

According to surveys, up to 80% of patients reported moderate to severe post-surgical pain, which can sometimes be left undertreated (Sinatra et al., 2005). Postoperative pain is generally managed with opioids, which carry numerous side effects. Side effects can be bothersome and possibly cause a delay in the postoperative healing process (Beard, Leslie, & Nemeth, 2011). IV acetaminophen can possibly decrease opioid consumption, minimize side effects, increase patient satisfaction, and decrease costs (Wininger et al., 2010). The purpose of this paper is to dive further into the research to present data on the effectiveness of IV acetaminophen in decreasing opioid usage and whether it produces an additive effect causing more effective pain management in the postop patient.

Whether or not the patient has had a previous hyper-sensitivity reaction to cephalosporins or a previous reaction to penicillins must be questioned. Caution should be used when prescribing amoxicillin to patients with renal failure or patients who are pregnant (EMC, n.d.). Amoxicillin does not treat viral infections or leukemia. Both of these should be ruled out if treatment is not successful.

Patients can become hypertensive during induction, positioning, or tumor resection (12). Chronic catecholamine excess causes volume contraction and patients can become severely hypotensive, as in this case, if adequate volume resuscitation is not performed (12). It is prudent to evaluate for adverse events following hypertensive and hypotensive episodes. Serial neurological evaluations, CT brain, electrocardiograms, or serial cardiac enzymes may be warranted. Complications of surgery are primarily due to severe preoperative hypertension, high secretion tumors, or repeat intervention for recurrence (13). In one study, adverse perioperative events occurred in 32 percent of cases (14). The most common adverse event was sustained hypertension in 25 percent of the patients. There were no perioperative deaths, myocardial infarctions, or cerebrovascular events. Despite premedication of most patients with phenoxybenzamine and a beta-blocker, varying degrees of intraoperative hemodynamic lability occurred

The author describes different comorbidities that affect many patients and why these comorbidities may affect the different drugs that they can have postoperatively. For instance, patients with liver or kidney issues, such as renal failure, can have difficulty clearing the drugs from their system. This can build up the drug amount in their body and can lead to overdosing (Ward, 2015).

Between the years 2008 and 2010, the VHA hospitals and outpatient clinics that participated in the MOVE! program, screened for obesity and had 66% to 95% eligible patients within that time span. The number of patients attending the first session for the program has doubled. Approximately two-thirds of the 114,541 patients that attended the MOVE! treatment in 2010 said it was their first time attending. The other third has been participating in the program for years. The number of participants joining the MOVE! program has increased within the past few years.

According to the systematic review covered by Apfel, Turan, Souza, Pergolizzi & Hornuss, 2013 there is a significant reduction in postoperative nausea and vomiting and opioid use when using intravenous acetaminophen. The reviewers used Medline and Cochrane databases to conduct their search along with a hand search of abstracts to identify randomized-controlled trials using intravenous acetaminophen. The review was to determine if the acetaminophen was going to have a significant decline in nausea and vomiting following surgical procedures as

Ketamine may be used for postoperative pain management. Low doses of ketamine reduce morphine use and nausea and vomiting after surgery. High quality evidence in acute pain is insufficient to determine if ketamine is useful in this

Pain is formally identified as a problem of global proportions by WHO and postoperative pain is one of the most common types of pain that has raised a public health concern by various societies in Australia, USA and Europe. It affects roughly 40% of surgical patients who experiencing a moderate to severe pain. It is important that graduate RNs have the knowledge and clinical skills to care for these patients as management of acute post-op pain has posed a significant challenge in surgical specialities for the past 50 years.

Post-Operative Nausea and Vomiting (PONV) is defined as any nausea, retching or vomiting occurring during the first 24 hours after surgery (Oxford Journals). It is an uncomfortable and unpleasant experience for the patient and can adversely affect the post recovery outcome by causing dehydration, electrolyte imbalance, aspiration, wound dehiscence, increasing length of stay (LOS), unanticipated admission, and increased healthcare costs, not to mention a top concern and great dissatisfier for the patient (JPN, Hodgens). Since approximately 30% of all post-operative patients

The management of postoperative pain has received much interest nowadays. The intensity of postoperative pain depends on many factors such as type and duration of the surgery, type of anesthesia and analgesia used, and the patient’s mental and emotional status (11).

Medications that can cause interactions include anticoagulants, probenecid, bisphosphonates, angiotensin-converting enzyme (ACE) inhibitors, anticoagulants (Warfarin), antiplatelet medicines (Clopidogrel), aspirin, corticosteroids (Prednisone), heparin, other NSAIDs (Ibuprofen), Rivaroxaban, or Selective Serotonin Reuptake Inhibitors (SSRIs) (Fluoxetine) due to the risk of stomach bleeding may be increased. Bisphosphonates (Alendronate), Cyclosporine, Hydantoins (Phenytoin), Lithium, Methotrexate, Quinolones (Ciprofloxacin), Sulfonamides (Sulfamethoxazole), and Sulfonylureas (Glipizide) side effects may be increased by Naproxen. The effectiveness of Angiotensin-converting enzyme (ACE) inhibitors (Enalapril), Beta-blockers (Propranolol), or diuretics (Furosemide, Hydrochlorothiazide) may be decreased by Naproxen (Lexi-Comp,