Kristen Nii-Jensen

Weekly evaluation 4
Fall 2014 NURS 260
NURS 360 Health & Illness III
Reflective Journal Instructions

Week 4: Evaluate and apply the facts and principles of biological, psychological,
sociological, cultural and spiritual functioning while providing nursing care to clients with
needs resulting from altered states of wellness throughout the lifespan.
Address the question listed below:

a.

Evidence Based Practice

The antiemetic promethazine is commonly ordered for postoperative nausea and vomiting
(PONV) despite common side effects such as sedation, dry mouth, hypotension and IV
extraversion due to its rapid onset and relative long duration. Due to the risk of side effects and
patient hesitancy in taking oral doses of promethazine, Pellegrini, DeLoge, Bennett, & Kelly
(2009) sought to test the efficacy of the use of non-pharmacological interventions, in this case
the use of 70% isopropyl alcohol (IPA) aromatically. In this study, the population sample
consisted on patient who underwent general anesthesia for more than 60 minutes with 2/4 risk
factors of PONV (female, nonsmoker, history of PONV, or motion sickness). This study
excluded those with URIs, allergies to IPA, ondansetron, promethazine, and other comorbidities
that increased risk for nausea and vomiting and/or aspiration.
The control group for this study received 12.5-25mg of promethazine for complaints of
PONV in the post-anesthesia care unit (PACU). The experimental group received the treatment
of inhaled 70% IPA. Base line nausea was rated using the verbal numeric rating scale (VNRS)
for nausea from 0-10, with 0 meaning no nausea, and 10 being worst possible nausea.

Kristen Nii-Jensen
Weekly evaluation 4
Fall 2014 NURS 260

Of the 85 patient who participated in this study, those who had IPA experienced a 50%
faster reduction in nausea and vomiting compared to the promethazine control group. In addition,
both groups rated a median 4 (satisfied) rating for both nausea and vomiting interventions.
However, in the discussion portion Pellegrini, DeLoge, Bennett, & Kelly (2009) cite
research that have found that IPA is not more effective than other aromatic therapies or having a
patient take several deep breath of ambient air. This study was contradicted by later findings
showing IPA resulted in complete cessation of nausea and vomiting with no resolution in the
control group utilizing normal saline. However, their study adds to the body indicating that IPA
prophylaxis is effective in treating PONV as promethazine with a faster onset, and express
confidence in recommending this treatment.
The findings of Pellegrini, DeLoge, Bennett, & Kelly (2009) back my rationale in
utilizing non-pharmacologic interventions first before contemplating the use of promethazine,
though I utilized the intervention of taking several deep calming breaths, which prior studies
have confirmed as effective, the use of IPA is another intervention to consider in the future
depending on facility policy. However, this research shows that a trial run in a facility that does
not recommend IPA may be indicated due to the risk of side effects associated with
promethazine.
Work Cited:
Pellegrini, J., DeLoge, J., Bennett, J., & Kelly, J. (2009). Comparison of inhalation of isopropyl
alcohol vs promethazine in the treatment of postoperative nausea and vomiting (PONV)
in patients identified as at high risk for developing PONV. AANA Journal, 77(4), 293299.