Postoperative Nausea

The preoperative phase begins when the decision to have surgery is made. It is used to assess the patients suitability for surgery, identify potential risk factors, educate the patient on avoiding complications of surgery and anaesthesia, and plan to meet the patients needs for a safe and sustained recovery upon discharge (Berman, 2014, p. 1015). This process includes addressing all parameters on the preoperative checklist. Fasting is an important part in the preoperative phase. Preoperative fasting is the practice of a patient abstaining from oral food and fluid intake for a certain amount of time before a surgical procedure is performed. This is intended to prevent pulmonary aspiration of stomach contents during general anaesthesia. When

The dosage was to high for the patient because the chart started going over the regular normal level

On 01/27/2016, I observed about 22 patients in Postanesthesia Care Unit. Some of the patients were observed after surgeries while others were observed after endoscopy. During my shift, I observed patients awaiting recovery for removal of kidney stones, malignant melanoma (removal of moles), Endometrial Biopsy (EBX), superficial femoral artery (SFA), Hernia repair, Oophorectomy (ovary removal surgery), Cardiorrhaphy (Ventricular repair), Cystolithalopaxy (bladder stone removal), gall stone removal, Ectopic pregnancy surgery, and leg surgery.

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

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).

by Nurse J. After five minutes, the diazepam had no effect so Dr.T ordered two milligrams of hydromorphone IVP given at 4:15 in the afternoon. The patient received another two milligrams of hydromorphone IVP and five milligrams diazepam IVP at 4:20 p.m. because Dr.T was not satisfied with the patient’s level of sedation. When the patient appeared to be sedated at 4:25 in the afternoon, the reduction of his left hip took place. At 4:35 p.m., Mr. B’s BP is 110/62 and his oxygen saturation is 92%. The “conscious sedation” policy was not followed. He did not have supplemental oxygen and his ECG and RR were not monitored. Then, Mr.B’s oxygen saturation dropped to 85%. The LPN adjusted the alarm and repeated the BP reading. Nurse J and the LPN were very busy taking care of the other patients during this time. At 4:43 p.m., Mr. B was not breathing, had no pulse, BP is 58/30 and oxygen saturation is 79%. The stat code was called.

He tells her that she believes that the patient has two issues on hand. The first being that the he has been taking too much Acetaminophen and the second the Oxycodone in the Percocet and the high amounts of Diphenhydramine Hcl in his sinus medication is causing increased sedation. According to www.fda.gov the recommended amount of Acetaminophen in 24 hrs is not more that 4000mg or 4 grams. (Use a conversion factor) Taking more that this has been linked to liver disease, which could be the reason for the yellow skin color. Jt has been taking 325mg of Acetaminophen in his Percocet every 4 hrs as well as 650mg of Acetaminophen in his Equate allergy. In combination this places his Acetaminophen dosage at 5,850mg a day which is 1,850mg over the recommended maximum dose. Jt has also been taking 50mg of Diphenhydramine or Benadryl every 4 hrs as well as the narcotic Oxycodone in the Percocet. Both medications are known to make people sleeping, but in combination there will be as increased risk of sedation. While the doctor waits for the lab results he has the staff start and IV and infuses Normal Saline 1000ml over 1 hrs to help dilute the medication in his

In the last five years, Enhanced Recovery After Surgery (ERAS) pathways for colorectal resection have been thrust into spotlight with evidence of expedited recovery time and improved postoperative outcomes1–5. However, there exists little uniformity in the recommendations and results of published ERAS pathways, and there is some evidence suggesting that the wrong cocktail of bundle elements can increase Surgical Site Infection (SSI) rates6. This inconsistency can be attributed to a lack of consensus on the efficacy of some common bundle elements, such as preoperative antibacterial showering, maintenance of normothermia, and high intraoperative Fraction of Inspired Oxygen (Fi02) 7–15. Such dissonance in studied ERAS efforts

In this paper I will be discussing preoperative fasting time for patients undergoing elective surgery with general anaesthesia. In clinical setting, nothing by mouth (NPO) after midnight is required on the day before scheduled surgery to prevent vomiting and aspiration of gastric content into the lungs. There are different preoperative fasting guidelines established by anaesthesiologist associations, for example the Canadian Anaesthesiologist’s Society (CAS) and American Society of Anaesthesiologists (ASA) (Tosun, B., Yava, A., & Açıkel, C. 2015). With these guidelines, fasting intervention is not just as simple as NPO after midnight. There was no evidence that showed shortened fast period increased patient’s risk for aspiration or

Despite recent advances in information regarding perioperative care, postoperative pain continues to go undermanaged. Postoperative pain is the pain patients experience after a surgical procedure. According to Gan, 80% of all people who undergo surgeries experience postoperative pain, and 75% of them rate their pain at a moderate, severe, or extreme level (as cited by Cooney, 2016). Furthermore, inadequately managed pain can lead to patient dissatisfaction, decreased patient outcomes, and overall higher cost of care (Penprase, Brunetto, Dahmani, Forthoffer & Kapoor, 2015). In order to provide higher quality pain management,

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

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).

A systematic review undertaken by Smetana (2009) identifies postoperative respiratory failure as an example of cascade iatrogenesis i.e. serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event. In this case, Mrs Hilton’s open cholecystectomy is that first event. Smetana (2009) points out that: when an older patient with postoperative pain is over-sedated, a decline in respiratory function occurs, that if not recognized, can result in respiratory failure that requires mechanical ventilation, that again, if not managed properly can culminate in ventilator-associated pneumonia and even sepsis and death (p.1529). After her upper abdominal surgery Mrs Hilton may have difficulty with deep breathing and coughing due to pain however both are essential interventions for prevention and treatment of respiratory infections and complications. Brown et al. (2008) recommend that when Mrs Hilton is awake, turning, coughing and deep breathing should be encouraged every one to two hours as this aids in the removal of secretions and prevents mucous plugs. They also encourage mobility when possible to increase respiratory excursion. Moreover, as Mrs Hilton

The Ciba-Geigy method resulted from a number of expert consensus meetings. Experts used their clinical judgment to assess events and assign causality on a VAS. This method was updated and replaced with a checklist of 23 questions, split into three sections: (i) history of present adverse reaction, (ii) patient’s past adverse-reaction history and (iii) monitoring-physician’s experience. This updated method was found to have a high degree of agreement (62%) when compared with evaluator’s

Prolonged bed rest is not essential for full recovery but patients feel better with restricted physical activity. A high calorie diet is a good idea and because many patients have nausea late in the day, the major caloric intake is best given in the morning. Intravenous feeding is necessary if the patient has continuos vomiting. Isolation of the patient to a single room and bath room is unnecessary, however the patient and other people in contact should be