INTEGRATIVE TREATMENT OF POSTOPERATIVE NAUSEA AND VOMITING: A BEST PRACTICE APPROACH

The purpose of this thesis was to create best practice recommendations to treat postoperative nausea and vomiting (PONV) during the first 24 postoperative hours in patients undergoing general anesthesia. PONV is a multifaceted and unpleasant phenomenon, increasing length and cost of stay. Pharmacotherapy is most often used to treat PONV though it may not be the most cost-effective intervention nor patient preference . The literature review was conducted through CINAHL, Embase and PubMed. The keywords used to search were PONV, postoperative nausea and vomiting, aromatherapy, P6 acupuncture, supplemental oxygen, supplemental fluid therapy, intravenous fluid therapy, pharmacotherapy, ondansetron, and 5HT3 antagonists. Dates of publication were limited to 2008 to 2018. The literature revealed evidence to support using acupuncture on the P6 acupoint site (N = 5), supplemental intravenous fluids with crystalloids (N = 4) and the use of ondansetron as a first line antiemetic in combination with dexamethasone (N = 4). Based on these results, a best practice recommendation for integrative nursing to treat PONV includes a bundle of interventions of controlled breathing, acupuncture of the P6 acupoint, intraoperative supplemental intravenous fluid of 30 mL/kg/hour crystalloid solutions, and the use of ondansetron as a first line antiemetic therapy combined with dexamethasone

Compaction of tool steels by pulsed electric current (PECS) sintering process

This study had two major purposes: the microstructural investigation of High Chromium White Iron (HCWI) sintered with Pulsed Electric Current Sintering (PECS) and the evaluation of the abrasion resistance of high chromium white iron mixed with different amounts of Hadfield Steel. The objective was to obtain dense high chromium white iron compacts with fine and uniform carbide and grain structure. The materials included in the study were gas atomized high chromium white iron (2.60 wt% C, 19.48 wt% Cr, 1.02 wt% Nb) and Hadfield steel (1.95 wt% C, 4.09 wt% Cr, 13.87 wt% Mn).The experimental procedure involved preparation and characterization of the starting powders, consolidation of the powders by pulsed electric current sintering process, and characterization of the resulting compacts. Microstructural studies were carried out to establish a relationship between processing conditions and the resulting microstructure. Abrasion testing was conducted (dry sand rubber wheel test) to investigate the effect of Hadfield additions to the wear performance of the material.The optimal sintering parameters for obtaining dense high chromium white iron included sintering the material at 1050 °C for 5 minutes, heating rate being 100 °C/min and compaction pressure 50 MPa. The resulting microstructure contained fine chromium carbides dispersed in a martensitic steel matrix. The modification of dwell time and the heating rate did not influence the microstructure to any significant degree. In the abrasion tests the high chromium white iron performed noticeably better (~20% lower weight loss) than the material mixed with Hadfield steel in the abrasion test. The performance of the Hadfield steel was only slightly worse (~7% higher wear loss) than that of the high chromium white iron

Barack Obama, 44th President of the United States

Change doesn\u27t come from Washington. Change comes to Washington, Union, Grenadines of St. Vincent, Sheet of 6 stamps. The President Obama International Stamp Collection. No date given

President Obama, 50th Birthday Celebration

Grenada, sheet of 3 stamps. The President Obama International Stamp Collection. No date given

Barack Obama, 2009 Nobel Peace Prize

Grenada Carriacou & Petiti Martinique, sheet of 4 stamps, The President Obama International Stamp Collection

U.S. President Barack Obama

Washington D.C. – April 20, 2012, President Obama signs a proclamation in the Oval Office of the White House, Mustique, Grenadines of St. Vincent, sheet of one stamp. The President Obama International Stamp Collection

U.S. President Barack Obama invites Mexican President Felipe Calderon to the White House

Grenada, sheet of 4 stamps. The President Obama International Stamp Collection

U.S. President Barack Obama, Portland, OR

U.S. President Barack Obama speaks at a campaign fundraiser at the Oregon Convention Center , Mustique, sheet of 4 stamps, The President Obama International Stamp Collection