INTEGRATIVE TREATMENT OF POSTOPERATIVE NAUSEA AND VOMITING: A BEST PRACTICE APPROACH

Abstract

The purpose of this thesis was to create best practice recommendations to treat postoperative nausea and vomiting (PONV) during the first 24 postoperative hours in patients undergoing general anesthesia. PONV is a multifaceted and unpleasant phenomenon, increasing length and cost of stay. Pharmacotherapy is most often used to treat PONV though it may not be the most cost-effective intervention nor patient preference . The literature review was conducted through CINAHL, Embase and PubMed. The keywords used to search were PONV, postoperative nausea and vomiting, aromatherapy, P6 acupuncture, supplemental oxygen, supplemental fluid therapy, intravenous fluid therapy, pharmacotherapy, ondansetron, and 5HT3 antagonists. Dates of publication were limited to 2008 to 2018. The literature revealed evidence to support using acupuncture on the P6 acupoint site (N = 5), supplemental intravenous fluids with crystalloids (N = 4) and the use of ondansetron as a first line antiemetic in combination with dexamethasone (N = 4). Based on these results, a best practice recommendation for integrative nursing to treat PONV includes a bundle of interventions of controlled breathing, acupuncture of the P6 acupoint, intraoperative supplemental intravenous fluid of 30 mL/kg/hour crystalloid solutions, and the use of ondansetron as a first line antiemetic therapy combined with dexamethasone.