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Article Excerpt
Nurses on a gynecologic unit will note that many of their patients experience nausea and vomiting after surgery. However, do these nurses also understand why their patient population is at a high risk for postoperative nausea and vomiting (PONV)? Three risk factors for developing PONV are female gender, having gynecologic surgery, and using postoperative opioids for pain management (Papadimitriou et al., 2001). Because nurses play a major role in the treatment of PONV, they should have a level of knowledge based on evidence rather than tradition. A PONV learning project for nurses at St. Boniface General Hospital (SBGH), a tertiary care hospital in western Canada, is described in this article.
The Literature
Postoperative nausea and vomiting affect 20%-30% of patients in a low-risk population (having fewer than two risk factors for PONV) and can affect as much as 70%-80% of persons in a high-risk population or with three or more risk factors (Hooper & Murphy, 2006; Murphy, Hooper, Sullivan, Clifford, & Apfel, 2006). Patients often are more concerned about PONV than any other aspect of their recovery (Macario, Weinger, Carney, & Kim, 1999). In addition to causing patient discomfort and dissatisfaction, PONV frequently adds to medical costs through delays in transfer from the recovery room, medical complications, increased nursing workloads, prolonged hospitalization, and unanticipated hospital re-admissions (Nygren, Thorell, & Ljungqvist, 2007; Rahman & Beattie, 2004). Adding to this clinical challenge are the facts that nausea is not well understood and the exact nature of vomiting pathways remains unclear (Tramer, 2003). Moreover, clear clinical practice guidelines and a gold standard for the prevention and treatment of PONV have been slow to emerge despite the significance of the problem (Gan et al., 2003; Islam & Jain, 2004).
Some recent practice changes have led to an improvement in the prevention and treatment of PONY (Gan, 2002; Tramer, 2003, 2004a, 2004b). Risk factors for patients likely to suffer from PONV have been identified (Murphy et al., 2006; Tramer, 2004a, 2004b). Prophylactic use of antiemetics is more common (White, 2004). Newer antiemetic agents such as the 5-***HT3 receptor antagonists (ondansetron [Zofran[R]], granisetron [Kytril[R]], dolasetron [Anzemet[R]]) have been introduced (Wilhelm, Dehoorne-Smith, & Kale-Pradhan, 2007). Short-acting interventions such as regional blocks have been incorporated into modern anesthetic techniques (Golembiewski, Chernin, & Chopra, 2005). Treatment recommendations have become available with the publication of both consensus guidelines and evidence-based clinical practice guidelines for managing post-operative nausea and vomiting (Gan et al., 2003; Hooper & Murphy, 2006; McCracken, Houston, & Lefebvre, 2008).
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