A comparison of two differing doses of promethazine for the treatment of postoperative nausea and vomiting.

PURPOSE: To compare the use of promethazine 6.25 mg intravenous (IV) (experimental group) with promethazine 12.5 mg IV (control group) among adult ambulatory surgery patients to control established postoperative nausea or vomiting (PONV). DESIGN/METHODS: In a double-blind, randomized controlled trial (n = 120), 59 subjects received promethazine 6.25 mg and 61 subjects received promethazine 12.5 mg to treat PONV. Study doses were administered postoperatively if the subject reported/exhibited nausea and/or vomiting. Outcomes for experimental and control groups were compared on the basis of relief of PONV and sedation levels. FINDINGS: Ninety-seven percent of subjects reported total relief of nausea with a single administration of promethazine at either dose. Sedation levels differed between groups at 30 minutes post-medication administration and at the time of discharge to home. CONCLUSIONS: Promethazine 6.25 mg is as effective in controlling PONV as promethazine 12.5 mg, while resulting in less sedation.

New perspectives on advanced practice nursing case management for aging patients.

Providing case management for older individuals is challenging in that this group rarely fits any DRG or managed-care mold. Because many people are living healthier and longer lives, intergenerational family dynamics such as that observed in Sophie and Leo's case may become more the norm than the exception. Well-intentioned family members, lacking the guidance of an experienced gerontologic APN case manager, may inadvertently place their aged loved ones at risk by attempting to arrive at health care, social, and housing solutions on their own. Even though 82-year-old Sophie stated subjectively that she "felt better than ever", an objective clinical assessment revealed that she still was in a convalescent period following major abdominal surgery at the same time that she was faced with providing in-home care for Leo, her 102-year old father. Sophie may have experienced response shift, or a reconceptualization of her own health state, in the aftermath of serious illness. The advanced practice knowledge and skills, systems acumen, talents, and creativity of two APN case managers in two different states contributed to successful health and social outcomes for two "master survivors," whose longevity and clinical presentations exceeded expectations. The value of APNs as case managers is clear: APNs possess the proficiency, tenacity, knowledge base, and nursing confidence needed to make a positive contribution toward individualizing care for members of the greatest generation.