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Chapter 59, Antiemetic AgentsOlusola AkiwowoWritten Assignments 1. Explain two ways that antiemetics reduce the hyperactivity of the vomiting center. Drugs used in managing nausea and vomiting are called antiemetics. All of them work by reducing the hyperactivity of the vomiting reﬂex in one of two ways: locally, to decrease the local response to stimuli that are being sent to the medulla to induce vomiting, or centrally, to block the chemoreceptor trigger zone (CTZ) or suppress the vomiting center directly. The locally acting antiemetics may be antacids, local anesthetics, adsorbents, protective drugs that coat the gastrointestinal (GI) mucosa, or drugs that prevent distention and stretch stimulation of the GI tract. These agents are often reserved for use in mild nausea. Centrally acting antiemetics can be classified into several groups: phenothiazines, nonphenothiazines, anticholinergics/antihistamines, serotonin (5-HT3) receptor blockers, substance P/neurokinin 1 receptor antagonist, and a miscellaneous group. 2. What is the antiemetic of choice for children? Why is this drug the best choice? What nursing considerations are essential when giving antiemetics to children? Include the rationale for all nursing considerations.
3. What safety measures are needed when giving antiemetics to adults and older adults? Why are these safety measures necessary? 4. You are caring for a 39-year-old patient who returned from an appendectomy 4 hours ago. The patienthas an order for ondansetron (Zofran) IV PRN for nausea and vomiting. What nursing considerations are important for this patient? What teaching needs to be done? Include rationale for all nursing considerations and teaching. It is often impossible to pinpoint an exact cause of a patient’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 shouldbe 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 rectal 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