PONV Flashcards

1
Q

What is the general incidence of N/V after surgery

A

30%

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2
Q

N&V can result in what complications

A
  1. aspiration
  2. wound disruption
  3. impaired healing
  4. increased surgical bleeding
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3
Q

Autonomic stimulation as a result of nausea and vomiting results in:

A
  1. Salivation
  2. Cutaneous vasoconstriction
  3. Tachycardia
  4. Mydriasis
  5. inhibition of gastric parietal cell secretion of acid, and altered gastric motility.
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4
Q

What are risk factors for PONV?

A

female, children, Hx PONV, motion sickness, non-smoker, opiate use, anxiety, obesity, long surgeries,

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5
Q

What detects motion stimuli from histamine or Ach receptors that can cause PONV?

A

The labyrinthine or vestibular apparatus and auricular branch of the tympanum of the ear

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6
Q

How can organs such as bladder, gallbladder, or uterus cause N/V?

A

Mechanoreceptors detect overdistention and disordered gastric motility

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7
Q

How does the vagus nerve reach the brain to stimulate N/V?

A

It signals histamine, cholinergic, or enkephalin receptors in the nucleus tracts solitaries or other centers in the area postrema and area subpostrema

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8
Q

What can stimulate the cortex and limbic system of the brain to cause N/V?

A

emotions, smells, sights, or thoughts

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9
Q

What is considered the vomiting center of the brain?

A

Medulla

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10
Q

What is located in the area postrema on the 4th ventricle of the brain and may identify absorbed toxins or disturbances such as hypotension or metabolic acid-base changes?

A

The Chemoreceptor trigger zone (CRTZ)

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11
Q

Where can H2 (histamine) receptors be found in the body?

A

Stomach (gastric)
CNS
heart

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12
Q

What does stimulation of H2 in the stomach result in?

A

an increased cAMP which activates the proton pump of gastric parietal cells which secrete H ion

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13
Q

What is the goal of given H2 blockers (Zantac, Pepcid)?

A

reduction of acidity of potentially aspirated gastric content

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14
Q

What is a potential side effect with the use of H2 blockers?

A

one concern is that H2 block causes unopposed H1 stimulation potentially resulting in bronchoconstriction

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15
Q

What can be used to treat the extrapyramidal side effects of Compazine?

A

Anticholinergics such as Benadryl

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