C H A P T E R 5 9
Antiemetic agents
933
CRITICAL THINKING SCENARIO
Handling postoperative nausea and vomiting
THE SITUATION
A.J. is a 16-year-old boy who has undergone reconstructive
knee surgery after a football injury. After the surgery,
A.J. complains of nausea and vomits three times in
2 hours. A.J. becomes increasingly agitated. Intravenous
prochlorperazine (
Stemetil
) is ordered to relieve the
nausea, to be followed by an oral order when tolerated.
The prochlorperazine is somewhat helpful in relieving the
nausea.
CRITICAL THINKING
What are the important nursing implications in this case?
What other measures could be taken to relieve A.J.’s nausea?
DISCUSSION
It is often impossible to pinpoint an exact cause of a
person’s nausea and vomiting in a hospital setting. For
example, the underlying cause may be related to the
pain, a reaction to the pain medication being given, or
a response to what A.J. described as the “awful hospital
smell”. A combination of factors should be considered
when dealing with nausea and vomiting. A.J., as a teenager,
may become increasingly agitated by the discomfort and
possible embarrassment of vomiting. The administration of
prochlorperazine may “take the edge off” the nausea. A.J.
will have to be reminded that the drug he is being given
may make him dizzy, weak or drowsy and that he should
ask for assistance if he needs to move.
Once the nausea and vomiting diminish somewhat,
it will be possible to try other interventions to help stop
the vomiting reflex. One such intervention is removing
the offending odour that A.J. described, if possible,
because doing so may relieve a chemical stimulus to the
chemoreceptor trigger zone (CTZ). Administration of pain
medication, as prescribed, may relieve the CTZ stimulus
that comes with intense pain. Other interventions include
providing a serene, quiet environment and encouraging
A.J. to take slow, deep breaths, which stimulate the
parasympathetic system (vagus nerve) and partially
override the sympathetic activity stimulated by the CTZ
to activate vomiting. For many people, mouth care, ice
chips or small sips of water may also help to relieve the
discomfort and ease the sensation of nausea.
CARE GUIDE FOR A.J.: ANTIEMETICS
Assessment: History and examination
Assess A.J.’s health history for allergies to any antiemetic,
coma, CNS depression, severe hypotension, liver
dysfunction, bone marrow depression, epilepsy and
concurrent use of alcohol, anticholinergic drugs,
barbiturate anaesthetics and guanethidine. Determine
the type and amount of anaesthesia used.
Focus the physical examination on the following areas:
Neurological: orientation, affect
Skin: colour, lesions
Cardiovascular: pulse, blood pressure, orthostatic blood
pressure
Gastrointestinal: abdominal and liver evaluation
Laboratory tests: haematological, full blood count, liver
function tests
Implementation
Administer antiemetics only as a temporary measure.
Provide comfort and safety measures, including assistance
with mobility, access to bathroom, safety precautions,
mouth care and ice chips.
Monitor A.J. for dehydration and provide remedial measures
as needed.
Provide support and reassurance for coping with drug
effects and discomfort.
Provide teaching regarding drug name, dosage, adverse
effects, precautions and warnings to report.
Evaluation
Evaluate drug effects, for example, relief of nausea and
vomiting.
Monitor for adverse effects, including GI alterations,
orthostatic hypotension, dizziness, confusion, sensitivity
to sunlight and dehydration.
Monitor for drug–drug interactions as appropriate.
Evaluate the effectiveness of the teaching program and
comfort and safety measures.
TEACHING FOR A.J.
• The drug that has been prescribed for you is called
prochlorperazine
.
It belongs to a class of drugs called
antiemetics. An antiemetic helps to prevent nausea and
vomiting and the discomfort they cause.
• Common effects of this drug include:
•
Dizziness, weakness
: Change positions slowly. If you
feel drowsy, avoid driving or dangerous activities for
at least 24 hours after the last dose of this drug (such
as the use of heavy machinery or tasks requiring
coordination).
•
Sensitivity to the sun
: Avoid exposure to the sun and
ultraviolet light because serious reactions may occur.
If exposure cannot be prevented, use sunscreen and
protective clothing to cover the skin.
