Managing Postoperative Nausea and Vomiting (PONV)

Scenario

Your postoperative patient in the recovery room reports nausea and begins retching.
They received opioid analgesia 20 minutes ago and are still drowsy from anesthesia.
Their SpO₂ is 93% on 2 L O₂, and the surgical incision is abdominal.

Question: What are your priority actions to manage PONV while maintaining patient safety?

Best Practice Answer

1. Ensure Airway Safety First:

   • Position the patient in lateral (recovery) position to prevent aspiration.
   • Keep suction equipment at bedside and clear the airway if gagging or secretions occur.
   • Elevate head of bed to 30°–45° if tolerated to reduce risk of aspiration.
   • Monitor SpO₂ continuously; apply additional oxygen if SpO₂ < 94%.

2. Assess and Identify Contributing Factors:

   • Review recent anesthesia type, opioid use, and pain level — all can trigger nausea.
   • Note abdominal distension or delayed gastric emptying post-surgery.
   • Determine timing and severity of symptoms and any prior antiemetic use.

3. Administer Pharmacologic Interventions:

   • Notify provider and anticipate orders for antiemetics, such as:
     • Ondansetron (Zofran) 4 mg IV — serotonin antagonist.
     • Metoclopramide (Reglan) for gastric motility.
     • Promethazine or dimenhydrinate if symptoms persist.
   • Use slow IV push to minimize sedation or hypotension.
   • Avoid giving oral meds until nausea resolves.

4. Implement Non-Pharmacologic Comfort Measures:

   • Provide cool compress and slow deep breathing techniques.
   • Offer clear fluids or ice chips only once fully awake and nausea subsides.
   • Maintain a quiet, low-stimulation environment to reduce triggers.
   • Encourage gradual reintroduction of diet, starting with clear liquids.

5. Ongoing Monitoring and Documentation:

   • Reassess symptom relief within 15–30 minutes after intervention.
   • Document episodes of emesis, antiemetic administration, and patient response.
   • Report persistent vomiting — risk of wound dehiscence or electrolyte imbalance.
   • Reinforce airway monitoring if patient remains sedated.

Real-World Application

PONV is one of the most common post-anesthesia complications, and prompt management prevents aspiration, wound stress, and hypoxia.
This scenario tests your ability to:

• Prioritize airway protection over comfort
• Recognize anesthesia-related risk factors
• Combine pharmacologic and non-pharmacologic strategies
• Maintain meticulous documentation

It’s especially relevant for PACU, med-surg, and surgical floor interviews.

Tip: In interviews, say —
“For postoperative nausea, I’d protect the airway first, position laterally, apply oxygen, administer prescribed antiemetics, and document patient response.”
That concise, safety-focused answer demonstrates clinical readiness and judgment under sedation-related risk.