I have a question for PACU nurses: do you ALWAYS medicate PONV, or do you wait some time interval and reassess? Twice this week I have had patients who complained of nausea near the end of their PACU stay, then stated they felt better prior to actually leaving the PACU, then were incredibly nauseated when they got to their inpatient units.
When patients complains of pain, I medicate it as long as their respiratory effort is safe. I expect that waiting will make the pain worse; I do not expect post-op pain to improve on its own. However, nausea seems different. Some patients get nauseated because they are starving, and it resolves when they have a cracker. Some get nauseated because their blood pressure is dropping, so we give fluids or meds, and the nausea goes away. Some don't improve, and I give them anti-emetics. Others improve and stay that way!
I don't want my patients to aspirate or feel like crap, and I don't want the floor nurses to think that we aren't attending to our patients' needs. Nearly every patient has an order for phenergan or zofran, and barring any interference with other meds (e.g., phenergan increasing the CNS depression of analgesics), I could in theory medicate every case of PONV as soon as it starts. But should I? Do you?
I prefer to be very aggressive re: PONV. I personally absolutely hate feeling that way, and figure most patients share that view.You also lose style points if your patient is puking all over the place post discharge from the PACU.I will give one antiemetic and see how the patient does, but if the nausea is severe I will typically give two very close together. If a patient gets nauseated just chilling in the bed, odds are it will recur if you don't give an antiemetic. Barring significant contraindication, I have a very low threshold for medicating for nausea. If the patient gives even the slightest indication of being nauseated I will medicate. Even if there is a contraindication for some antiemetics it's usually OK to give a different class. It is generally better to over-treat some than to under-treat. Particularly in patients that should not vomit due to risk for complication or exacerbated pain (e.g. neck surgery patients).I don't know if you ever do outpatients, but it is also important to be aggressive with that population. They need to be able to get up and move around some when it's time to go, hopefully without puking all over.
Last edit by Perpetual Student on Nov 3, '12
: Reason: formatting issues r/t posting from phone