Question

Mrs. Katie Parker, a 38 year old “stay at home Mom”, has rheumatoid arthritis that has been treated with aspirin, NSAID’s and prednisone for the last 8 years. During the past few days, Mrs. Parker has been feeling increasingly weak. She is dizzy when getting up and has had an episode of syncope (fainting). A diagnostic work up reveals that she has a peptic ulcer. Omeprazole is ordered.

A few weeks later Mrs. Parker falls and breaks her ankle. She is admitted to the hospital and undergoes surgery to correct the fracture. An open reduction and internal fixation. Surgery will be followed by a period of rehabilitation and she regains her mobility. Her physician orders the following medications post operatively in addition to the medications she takes regularly.

Morphine PCA (patient controlled analgesia)

Docusate sodium (Colace) as needed once per day

Cefoxitin

Ondansetron (Zofran)

1. Not only is she at risk for constipation, but consider Mrs. Parker and why you would also want to observe for diarrhea?

2. What are some factors that might contribute to nausea and vomiting in the post operative patient?

Answer 1

1. Since Mrs. Parker is on the drug Cefoxitin which has a side effect of diarrhea I would also want to observe for diarrhea in her case. The side effects of ondansetron (Zofran) also include; diarrhea. Docusate sodium also may cause diarrhea.

2. Some factors that might contribute to nausea and vomiting in the post-operative patient include;

Administration of the drugs such as Morphine PCA (patient-controlled analgesia after the operation may have the side effect of nausea. Apart from this the side effect of the anesthesia given during surgery is nausea.