This Case Study Question & Answer Guide (With Explanation)

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Key Explanation

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Original Question

This case study relates to the care of Amelia Flowers and her perioperative journey. Amelia is a 44 year old woman admitted to the surgical ward at a local regional hospital in preparation for a laparoscopic cholecystectomy and intraoperative cholangiogram (IOC) tomorrow afternoon. Amelia has been admitted at 1300 hours on the day prior to theatre for management of pain and dehydration prior to surgery. Over the past week Amelia has been unable to eat or drink due to increasing episodes of severe right upper quadrant pain that has been nonresponsive to simple analgesics. Pain has been well controlled on admission with regular endone and paracetamol administered orally. An IV cannula has been inserted and fluids commenced at an 8/24 rate overnight. The plan is for Amelia to fast from 2400 hours tonight. There is no other relevant medical past history. However, the anaesthetist has reviewed her tonight and expressed concern that her BMI is 34 and she smokes approximately 20 cigarettes a day. Amelia has reported feeling anxious about surgery tomorrow as she is worried about pain and how soon she can return to work Amelia has returned to the ward following laparoscopic cholecystectomy and IOC under general anaesthesia. You attend to her routine post-operative observations and find that Amelia is hemodynamically stable and her pain is well controlled with patient-controlled analgesia of morphine 1mg per bolus. However, Amelia is noted to be very drowsy and is vomiting every time she administers a morphine bolus. She is reluctant to continue with her pain management regimen. Discuss evidence-based management of post-operative nausea and vomiting. In your answer describe what factors may have predisposed Amelia to experience postoperative nausea and vomiting.

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