EVALUATION OF THE IMPLEMENTATION OF FLUID FULFILLMENT IN THE PONV PATIENTS AFTER ABDOMINAL SURGERY

Background. Nausea and vomiting are problems that almost some patients often complain about after surgery. Some patients claim to experience nausea and vomiting after regaining consciousness from surgery. Tujuan dari penelitian ini In this study using quantitative methods with crossectional. The sample used in this study was respondents who were willing or willing to consciously follow this study, aged 17 years over and had been operated on after 12 hours. The exclusion criteria in this study were patients who did not have complaints of nausea vomiting. This research was conducted from March – August 2022. In this study the variables used were age, sex, duration in surgery, smoking history, post op history, pain post op. Results. the frequency distribution of respondents is several variables. In the most age variables at the age of 51-75 years as much as 63.4%, in the sex variable more than half of men as much as 63.4%. The next variable was more than half the duration of surgery at a duration of 1 hour 77.7% with those who had a history of smoking as much as 56.7% and did not have a history of PONV more than half. Based on the variable incidence of PONV as many as 60% who experience mild PONV events and moderate postoperative pain as much as 60%. It can be seen that the P Value value is 0.000 on the age and gender variables. Seen p value of surgical duration 0.004; History of smoking with a p value of 0.001; Post op history with p value 0.003 and post op pain with p value 0.010. It can be concluded that there is an association between age, sex, duration of surgery, smoking history, post op history and post op pain with PONV. Conclusion . The conclusion in this study is that there is an association between age, sex, duration of surgery, smoking history, postoperative history, post op pain with PONV .


INTRODUCTIONS
Abdominal surgery is a condition that is often encountered in most cases but is a serious condition that requires proper treatment from a doctor.
Establishing the diagnosis and etiology of abdominal abscesses presents a challenge and increases the risk of injury in surgical interventions and postoperative complications aggravated by comorbidities, such as geriatrics.In this case report, we aim to describe the treatment of anesthesia in geriatric patients with abdominal abscesses undergoing laparotomy (Jatmiko & Mochamat, 2022;Pradhana et al., 2023) Nausea and vomiting are problems that almost some patients often complain about after surgery.Some patients claim to experience nausea and vomiting after regaining consciousness from surgery.
However, there are also patients who just feel nausea when they get home.Nausea after surgery will cause discomfort, not infrequently this even affects your appetite.Of course, this will cause pain in the surgical incision wound, especially if you do surgery in the abdomen (Panji, 2023).
Postoperative nausea and vomiting (PONV) continue to be a common complication after general anesthesia, which can lead to high levels of patient distress and dissatisfaction.After elective surgery, PONV is believed to be caused by intestinal ischemia, secondary to hypovolemia resulting from overnight fasting.A number of risk factors have been identified for PONV.This includes patient-related factors, anesthesia, surgical procedures, and postoperative factors.Current approaches to the prevention and treatment of PONV are limited, and 25% of patients continue to develop PONV within 24 hours of surgery.
Nonetheless, universal pharmacological PONV prophylaxis appears to be cost-ineffective, and may be Background.Nausea and vomiting are problems that almost some patients often complain about after surgery.Some patients claim to experience nausea and vomiting after regaining consciousness from surgery.Tujuan dari penelitian ini In this study using quantitative methods with crossectional.The sample used in this study was respondents who were willing or willing to consciously follow this study, aged 17 years over and had been operated on after 12 hours.The exclusion criteria in this study were patients who did not have complaints of nausea vomiting.This research was conducted from March -August 2022.In this study the variables used were age, sex, duration in surgery, smoking history, post op history, pain post op.Results. the frequency distribution of respondents is several variables.In the most age variables at the age of 51-75 years as much as 63.4%, in the sex variable more than half of men as much as 63.4%.The next variable was more than half the duration of surgery at a duration of 1 hour 77.7% with those who had a history of smoking as much as 56.7% and did not have a history of PONV more than half.Based on the variable incidence of PONV as many as 60% who experience mild PONV events and moderate postoperative pain as much as 60%.It can be seen that the P Value value is 0.000 on the age and gender variables.Seen p value of surgical duration 0.004; History of smoking with a p value of 0.001; Post op history with p value 0.003 and post op pain with p value 0.010.It can be concluded that there is an association between age, sex, duration of surgery, smoking history, post op history and post op pain with PONV.Conclusion.The conclusion in this study is that there is an association between age, sex, duration of surgery, smoking history, postoperative history, post op pain with PONV.associated with increased adverse events (Pradhana et al., 2023) There are many factors that cause nausea and vomiting that you feel after surgery, which are often used in assessing risk factors for nausea and vomiting, one of which is the APFEL Score (Nakatani et al., 2023) The assessment included four risk factors: female gender, nonsmoking status, history of PONV or motion sickness, and opioid use after surgery.Although nausea can heal on its own, this condition will make patients feel discomfort and can cause some complications (Zhou et al., 2023) For example, dehydration, electrolyte imbalance, tension in the area of surgical stitches, or even the opening of the edges of the suture scar, bleeding, and shortness of breath (Chen & Chang, 2020) Postoperative nausea and vomiting (PONV) is one of the complex and significant issues in anesthesia practice, with an increasing trend towards outpatient surgery and child care.This review focuses on pathophysiology, pharmacological prophylaxis, and rescue therapy for POVEN (Feri et al., 2023) The search used Medline and PubMed's databases for articles published in English from 1991 to 2014 when writing this review using "postoperative nausea and vomiting, PONV, nausea-vomiting, PON prophylaxis, and rescue" as keywords.
PONV is influenced by many patient-related, surgical, and anesthetic factors before, intra, and postoperatively.PONV risk can be assessed using scoring systems such as the simplified Apfel scoring system which is based on four independent risk predictors.PONV prophylaxis is administered to patients at moderate and high risk based on this scoring system.New drugs such as neurokinin-1 receptor antagonists (aprepitants) are used along with serotonin receptor antagonists (5-hydroxytryptamine subtype 3), corticosteroids, anticholinergics, antihistamines, and butyrophenones for PONV prophylaxis.Combinations of drugs of different classes with different mechanisms of action are administered to optimize efficacy in adults at moderate risk for PONV.
A multimodal approach with a combination of pharmacological and nonpharmacological prophylaxis and interventions that reduce initial risk is used in patients with a high risk of PONV (Juartika, 2022).
The incidence of postoperative nausea and vomiting can cause medical complications, psychological effects, inhibit the overall therapy process so as to reduce the recovery rate of postoperative patients and have an impact on increasing the burden of treatment costs during patient hospitalization (Hendro et al., 2018) Postoperative nausea and vomiting can occur in 80% of patients undergoing surgery and anesthesia, a major concern in recovery room care and a priority scale for anesthesiologists.The general prevalence of postoperative nausea and vomiting in all surgical procedures is more than 30%.However, the highest incidence among several surgical procedures is found in procedures such as tonslectomy, strabismus surgery, laparatomy (Latha et al., 2023).
Perioperative risk stratification and intervention according to the level of risk is essential in the prevention and management of PONV.There are many practical guidelines for PONV, but they can be difficult to implement in resource-limited settings because there is no established consistent supply of drugs for prophylaxis and rescue management.So, the goals of these systemic reviews and guidelines can help improve patient satisfaction by reducing the prevalence of postoperative nausea and vomiting and their complications (Pradhana et al., 2023) In Indonesia, the number of postoperative  threshold for nausea vomiting and the risk of PONV will be higher than older patients.However, until now there has been no definite research on age and its effect on the incidence of PONV (Karnina & Ismah, 2021).

Gender with PONV
The results of this study were male sex as much as 63.4%.This is different from the results of the study (Karnina et al., 2021) where in this study it was found that 61 patients experienced Postoperative Nausea and Vomiting events consisting of 18 male patients and 43 female patients.Therefore, according to the results of the study, more female patients experienced PONV.
This is because men / men are too silent and unable to express their feelings.In women this happens because in women, the hormone estrogen is the main hormone and this hormone can concentrate dopamine receptors on CTZ.This causes nausea and vomiting stimuli one of which is from the blood circulation will be more easily channeled using dopamine receptors because in this case dopamine has been centized with the presence of estrogen in the blood so that the incidence of nausea vomiting after surgery will increase (Yi et al., 2018).

Duration of Operation with PONV
Results of this study pada durasi > 1 jam sebanyak 77,7%.Based on the results of the study (Karnina & Salmah, 2021) it was found that the length of surgery in patients after laparatomy digestive surgery with general anesthesia was mostly with a time of > 60 minutes, which was 60.6% from 104 samples.This is not in line with previous research at Yogyakarta City Hospital, data were obtained that the duration of surgery ≤ 60 minutes as much as 78.6% and > 60 minutes as much as 21.4%.The incidence of PONV in this study was found to be more at the length of surgery > 60 minutes compared to the length of surgery ≤ 60 minutes.Research conducted by Hendro et al, reported that the incidence of PONV was 2.8% in exposure to anesthesia for ≤30 minutes and increased to 13-17% in the duration of surgery for 90-150 minutes.This means that the longer the operation, the more the percentage of PONV occurs.

Smoking history with PONV
In the results of this study, it was seen that as many as 56.7% had a history of smoking.This is in line with (Chimbiria &;Sweeney, 2000)  to postoperative complications such as atelectasis and respiratory infections.We showed a marked increase in the incidence of coughing, straining, and desaturation among smokers.It is generally temporary and in all cases can be controlled either by deepening the level of anesthesia or by the use of small doses of succinylcholine.In addition, there were no postoperative respiratory complications resulting in delayed discharge (Chimbiria & Sweeney, 2000).

Post op history with PONV
Based on the results of this study, as many as 93.4% did  [11; 14] (269/ 2144)] and prescribed after surgery and at home.

Fulfillment of Fluid Needs
Patients undergoing arthroscopic surgery are given crystalloid fluid at 10 mL/kgbb, ideally given intravenously 30 minutes before preloading surgery, can maintain hemodynamic stability and prevent postoperative vomiting.
Preoperative fluid emberian (colloidal and crystalloid) in the 6 articles is effective in reducing the incidence of postoperative nausea.Fluids and electrolytes that enter the body make the balance of fluids and electrolytes mean a normal distribution of total body water and electrolytes into all parts of the body.The composition of fluids and electrolytes in the body has been arranged in such a way that the balance of vital organ functions can be maintained (Rahmawati et al., 2020).
Adequate fluids can reduce and prevent postoperative nausea, vomiting.Fluids and electrolytes that enter the body make the balance of fluids and electrolytes mean a normal distribution of total body water and electrolytes into all parts of the body.The composition of fluids and electrolytes in the body has been arranged in such a way that the balance of vital organ functions can be maintained (Gan et al., 2020).

CONCLUSION AND RECOMENDATIONS
The conclusion in this study is that there is an association between age, sex, duration of surgery, smoking history, postoperative history, post op pain with PONV.It is recommended to conduct further research and fulfill fluid needs according to patient needs.Fluid needs must be met as it prevents the occurrence of complications and other nursing problems.
vomiting nausea has not been clearly recorded.The incidence of nausea and vomiting was 31.25% in postoperative laparatomy gene, and 31.4% in postoperative mastectomy.Postoperative nausea and vomiting complicate post-surgery discomfort and on an outpatient basis increase costs by about 0.1 -0.2 percent due to the incidence of readmission to the hospital.The incidence of postoperative nausea vomiting can be caused by pharmacological factors such as the use of certain types of anesthesia or the effects of a drug.While from non-arthracological factors, the incidence of nausea vomiting can come from the patient's own factors.The study aims to analyze the relationship between age, age, sex, length of surgery, history of nausea vomiting in previous operations, history of smoking, postoperative pain to the incidence of postoperative vomiting nausea (Type et al., 2023).Although some advocate prophylactic antiemetic therapy for high-risk patients, with antiemetic-saving treatment for episodes of PONV, the optimal approach remains unclear.There is still a need to develop cost-effective strategies, ideally nonpharmacological strategies to reduce the incidence of PONV.PONV.Administering sufficient amounts of intravenous fluids during perioperative to correct fasting hour deficits can effectively prevent PONV, without the cost or potential side effects seen with pharmacological approaches.The replacement of assumed preoperative deficits, in addition to the substitution of a lot of unfounded sweating, increasing, and loss of third space, plays an important role in the current perioperative fluid regimen.Application of perioperative fluids has been a topic of debate in recent years.Therefore, the potential efficacy of intravenous fluid therapy in reducing PONV remains to be conclusively proven (Pradhana et al., 2023) During postoperative recovery, the body experiences an increased need for fluids.Lack of fluids can have an impact on dehydration.Where dehydration has complications in the patient's own body.Based on the results of research (Juartika, 2022) using white drinking water with lukewarm temperatures that can meet body fluids after nausea vomiting.Supported by the results of previous research (Lee et al., 2008) that meet the needs of liquids by using temperatures that are in accordance with those needed.This evaluation needs to be carried out by nurses, in evaluating the use of interventions to meet fluid needs so that the desired goals are achieved and nursing care services can improve the health status of postoperative patients.Therefore, research on the evaluation of the implementation of fluid fulfillment in PONV patients after abdominal surgery.METHODS In this study using quantitative methods with crossectional.The sample used in this study was respondents who were willing or willing to consciously follow this study, aged 17 years over and had been operated on after 12 hours.The exclusion criteria in this study were patients who did not have complaints of nausea vomiting.This research was conducted from March -August 2022.In this study the variables used were age, sex, duration in surgery, smoking history, post op history, pain post op.History of nausea, vomiting as well as history of smoking, postoperative pain.This study was the incidence of postoperative nausea, vomiting .Data on the incidence of postoperative nausea and vomiting in patients were obtained from interviews and direct observation of patients using the nausea vomiting questionnaire from the Rhodes Index of Nausea, Vomiting and Retching (Rhodes INVR) in patients after 12 hours postoperatively.Measurements using the Rhodes INVR instrument total the smallest score is 0 and the highest score is 32.The categories are 0 = normal, scores 1-8 mild vomiting, scores 9-16 = moderate vomiting, scores 17-24 = severe vomiting, and scores 25-32 = very severe vomiting nausea (Rhodes & Roxanne, 1990).In this study also took into account the output and input of the fluids used while in Rawat.Univariate analysis researchers use descriptive analysis that describes the characteristics of respondents in the form of percentage tables.As for bivariate analysis, the author uses statistical tests carried out are pearson, sprearman tests and contingency coefficient correlation tests, which are selected and adjusted to the scale of the research data.

Table 2 . Analysis of the relationship between age, sex, duration of surgery, smoking history, history of PONV and postoperative pain with PONV events Dependent Variables Independent Variables P Value
be due to the fact that they are more likely to complain about PONV than older patients.It is also possible that younger patients may have high autonomic tone and respond worse to anesthetic and analgesic agents including opioids.PONV can be caused by various kinds of stimuli, namely chemicals and movement.In younger patients, afferent neurons are more sensitive to these stimuli and signals from these stimuli are relayed to the vomiting center in the brainstem and nausea vomits.So that young patients have a lower not have a history of Post op.Just like the previous