Columban College

College of Nursing
Barretto, Olongapo City

Introduction

Nausea and vomiting are said to be common to all pregnant women, however
there is an incidence that severe nausea and vomiting occurs. Hyperemesis gravidarum
sometimes called as “pernicious vomiting”, is nausea and vomiting of pregnancy that is
prolonged past week 12 of pregnancy or is so severe that dehydration, ketonuria, and
significant weight loss occur within the first 12 week. The main cause of this illness is
unknown but there are certain theories which explained the possible cause of prolonged
nausea and vomiting in a pregnant woman. Many are postulated that nausea and vomiting
are protective in pregnancy to reduce exposure to potentially teratogenic materials,
however there are factors that makes this symptoms prolonged. And as I mentioned
above, prolonged nausea and vomiting may results in dehydration of the mother, and this
condition can be danger for the fetus life. Because a dehydrated mother has decrease
blood volume, the fetus may not receive essential nutrients and oxygen which may results
in preterm or IGR (Intrauterine Growth Restriction).

To prevent this to happen, the patient must be hooked into IVF or intravenous
fluid. Proper care was needed for the patient with Hyperemesis gravidarum especially in
monitoring her intake and output. The goal of the nursing management or interventions is
to assured that the client must be free of any signs and symptoms of dehydration.
 Columban College
College of Nursing
Barretto, Olongapo City

Clinical Manifestations:

History

• Nausea and vomiting occur in early pregnancy and are nonresponsive to

simple measures, such as reassurance and dietary changes.
• Fever and abdominal pain are not characteristic of hyperemesis gravidarum.
• If vomiting begins after 9 weeks' gestation, other causes should be
investigated.
• Other common symptoms include ptyalism (excessive salivation), fatigue,
weakness, and dizziness.
• Patients may experience the following:
o Sleep disturbance
o Hyperolfaction
o Dysgeusia
o Decreased gustatory discernment
o Depression
o Anxiety
o Irritability
o Mood changes
o Decreased concentration

Physical

Findings at physical examination may include the following:

• Weight loss
• Dehydration
o Decreased skin turgor
 Columban College
College of Nursing
Barretto, Olongapo City

oDry mouth or mucous membrane

oPostural changes in blood pressure (BP) and pulse
• Abdominal tenderness, fever, and goiter likely indicate another process.

Diagnostic Procedures & Findings:

Laboratory Studies:

• Urinalysis

• Serum electrolytes and ketones

• Elevated liver Enzymes and bilirubin

• Elevated Hematocrit, TSH, free thyroxine

Imaging Studies:

• Obstetric Ultrasonography

• Upper Abdominal Ultrasonography

• Abdominal CT Scan / MRI

Therapeutic Management:
 Columban College
College of Nursing
Barretto, Olongapo City

• Hospitalization for about 24 hours to monitor intake, output, and blood

chemistries and prevent dehydration.

• IVF of 3000 mL Ringers’ Lactate with added vitamin B

• All oral food and fluids are usually with held; if there is no vomiting after
the first 24 hrs of oral restriction, small amounts of clear fluids will be
gone and the woman may be discharged with a referral of home care; if
she continue to take clear fluids, small quantities of dry toast, crackers, or
cereal may be added every 2 to 3 hrs, then she can be gradually advanced
to a soft diet, then to a normal diet.

Pharmacological Treatment:
 Columban College
College of Nursing
Barretto, Olongapo City

METOCHLOPROMIDE
Brand name: reglan
Indication:
• acute and recurrent diabetic gastro paresis, gastro esophageal reflux
• to improve lactation, nausea and vomiting due to various causes, including
vomiting during pregnancy and labor, gastric ulcer, anorexia nervosa.
• facilitate small vowel intubation, stimulate gastric emptying, and increase
intestinal transit of barium to aid in radiology examination of stomach and
small intestine.
Dosage:
For adult: 10 to 15 mg per day 30 minutes before meals at bed time. If symptoms
occur only intermittently, single doses up to prior to the provoking situation may
used.
Contra Indication:
• Gastro intestinal hemorrhage, contraction or perforation; epilepsy; clients
taking drugs likely to cause extra pyramidal symptoms such a phenothiazines;
Pheochromocytoma.
Side effects:
CNS: Restlessness, fatigue, dizziness, headaches, extra pyramidal symptoms.
GI: Nausea, bowel disturbances (diarrhea).
Nursing Considerations:
• Do not confuse metoclopromide with metoprolol ( a beta-adrenergic blocker)
or with metolazone ( a thiazine diuretic )
• Take tablets as directed. May dilute syrup in water, juice or carbonated
beverage just before taking.
• Report lack of response or any persistent side effects so they can be properly
evaluated and counteracted.
 Columban College
College of Nursing
Barretto, Olongapo City

• Avoid alcohol and any other CNS depressants.

• Extra pyramidal effects should be reported; may be treated with IM
diphenhydramine.

Pathophysiology:

Unknown Cause

Theories: women with elevated Thyroid-stimulating properties of HCG

with infection of Helicobacter pylori (peptic ulcer)

Prolonged NAUSEA and VOMITING

Loss of appetite severe wt. loss inability of the body Hypokalemia

to retained fluids Hyponatremia
Hypochoremia
Vitamin B deficiency
(Thiamine) Hemoconcentration DEHYDRATION
 Columban College
College of Nursing
Barretto, Olongapo City

Insufficient supply
POLYNEURITIS of essential nutrients for
Elevated hct normal fetal growth
Low intake of CHO

Utilizing Fats & CHON PRETERM/IGR

As source of energy
Poor skin turgor,
Dry mouth or mucous
Membrane
KETONURIA
 Columban College
College of Nursing
Barretto, Olongapo City

Case Study: Hyperemesis Gravidarum

Submitted In Partial Fulfillment

Of the Requirement for the Degree of Bachelor of Science in Nursing

Submitted by: Group H

Ana Edralyn Tarusan
Anabelle Candila
Angela Gabrielle Romero
Clara May Wenceslao
Leanne Mendegorin
Mary ann Ventura
Vilma Moreno
Alvin Roca
Jarvis Tacson
Joed Quiambao
Kent Pangan
 Columban College
College of Nursing
Barretto, Olongapo City

Submitted to:
Ms. Charmaine Abdon, RN
Clinical Instructor

ANATOMY AND PHYSIOLOGY OF ENDOCRINE SYSTEM

 Columban College
College of Nursing
Barretto, Olongapo City

The endocrine system affects bodily activities by releasing chemical

messages, called hormones, into the bloodstream from exocrine and
endocrine glands. The function of hormones is to:

• Control the internal environment by regulating its chemical

composition and volume
• Respond to environmental changes to help the body cope with
emergencies - infection, stress etc
• Help regulate organic metabolism and energy balance
• Contribute to the management of growth and development

Hormones are chemicals that cause certain changes in particular parts

of the body. Their effects are slower and more general than nerve
action. They can control long-term changes such as rate of growth,
rate of activity and sexual maturity.

The endocrine or ductless glands secrete their hormones directly into

the blood stream. The hormones are circulated all over the body and
reach their target organ via the blood stream. When hormones pass
through the liver, they are converted by the kidneys. Tests on such
hormonal products in urine can be used to detect pregnancy.
 Columban College
College of Nursing
Barretto, Olongapo City

The endocrine system consists of a series of glands that secrete

hormones; they are found throughout the body and include the
pituitary, thyroid, parathyroid, thymus, supra-renal or adrenal glands,
part of the pancreas and parts of the ovaries and testes. Although
these glands are separate, it is certain that they are functionally
closely related because the health of the body is dependent upon the
correctly balanced output from the various glands that form this
system.

The Pituitary Gland (Hypophysis)

This gland has been described as the leader of the endocrine

orchestra. It consists of two lobes, anterior and posterior. The anterior
lobe secretes many hormones, including the growth-promoting
somatotropic hormone which controls the bones and muscles and in
this way determines the overall size of the individual. Over secretion of
the hormone in children produces gigantism and under secretion
produces dwarfism. The anterior lobe also produces gonad tropic
hormones for both male and female gonad activity. Thyrotrophic
hormones regulate the thyroid and adrenocorticotropic hormones
regulate the adrenal cortex. It also produces metabolic hormones.

The posterior lobe produces two hormones - oxytocin and vasopressin.

Oxytocin causes the uterine muscles to contract; it also causes the
ducts of the mammary glands to contract and, in this way, helps to
express the milk that the gland has secreted into the ducts.
Vasopressin is an anti-diuretic hormone that has a direct effect on the
tubules of the kidneys and increases the amount of fluid they absorb
so that less urine is excreted. It also contracts blood vessels in the
heart and lungs and so raises the blood pressure. It is not certain
whether these two hormones are actually manufactured in the
posterior lobe or whether they are produced in the hypothalamus and
passed down the stalk of the pituitary gland to be stored in the
posterior lobe and liberated from there into the circulation.
 Columban College
College of Nursing
Barretto, Olongapo City

The Thyroid

The right and left lobes of this gland lie on either side of the trachea
united by the isthmus. Average size of each lobe is 4cm long and 2cm
across but these sizes may vary considerably. The secretion of this
gland is thyroxin and tri-iodothyronine. Thyroxin controls the general
metabolism. Both hormones contain iodine but thyroxin is more active
than thyroxin. Under-secretion of this hormone in children produces
cretinism; the children show stunted growth (dwarfism) and fail to
develop mentally. Under secretion in adults results in a low metabolic
rate. Over secretion in adults gives rise to exophthalmia goiter and the
metabolic rate is higher than usual. Such persons may eat well but
burn up so much fuel that they remain thin. This is usually
accompanied by a rapid pulse rate. This gland, therefore, has a
profound influence on both mental and physical activity.

The Parathyroid Glands

There are four of these glands, two on either side lying behind the
thyroid. Their secretion is parathormone - the function of which is to
raise the blood calcium as well as maintain the balance of calcium and
phosphorus in both the blood and bone structures. Under secretion
gives rise to a condition known as testacy in which the muscles go into
spasm, and over secretion causes calcium to be lost to the blood from
the bones giving rise to softened bones, raised blood calcium and a
marked depression of the nervous system.

The Thymus Gland

This gland lies in the lower part of the neck and attains a maximum
length of about 6cm. After puberty, the thymus begins to atrophy so
that in the adult only fibrous remnants is found. Its secretion is thought
to act as a brake on the development of sex organs so that as the
thymus atrophies, the sex organs develop. Recent research into the
activity of this gland reveals that it plays an important part in the
 Columban College
College of Nursing
Barretto, Olongapo City

body's immune system by producing T lymphocytes - the T standing

for thymus derived.

The Suprarenal or Adrenal Glands

These are two in number, triangular and yellow in color. They lay one
over each kidney. They are divided like the kidney into two parts -the
cortex and the medulla. The cortex is the outer part of the gland and
produces a number of hormones called corticosteroids. Their function
is to control sodium and potassium balance, stimulate the storage of
glucose and affect or supplement the production of sex hormones. The
medulla or inner layer produces adrenaline, a powerful vasoconstrictor.
Adrenaline raises vessels and raised the blood sugar by increasing the
output of sugar from the liver. The amount of adrenaline secreted is
increased considerably by excitement, fear, or anger, which has
caused the adrenals sometimes to be referred to as the glands of fright
and fight.

The Gonads or Sex Glands

These glands are naturally different in men and women because they
serve different, though, in many respects, complementary functions. In
the female the gonads are the ovaries and in the male the testes.
Female sex hormones are estrogen and progesterone. The male sex
hormone is testosterone, though each sex produces a small quantity of
the opposite hormone. The female hormones are responsible for
developing the rounded, feminine figure, breast growth, pubic and
auxiliary hair and all the normal manifestations of femininity and
reproduction. Male hormone is responsible for voice changes,
increased muscle mass, development of hair on the body and face and
the usual development of manliness.

Pancreas

The endocrine part of the pancreas consists of clumps of cells called

islets of Langerhans that secrete insulin. Insulin regulates the sugar
level in the blood and the conversion of sugar into heat and energy.
Too little insulin results in a disease known as diabetes mellitus. This
 Columban College
College of Nursing
Barretto, Olongapo City

disease is divided into one form, juvenile onset, which occurs before
the age of 25, and another form that begins in maturity. It is a very
common disease. It is known that some half million people in the
United Kingdom suffer from it sufficiently badly to need treatment but
is has been estimated that there are many more people in whom the
disease exists at a sub-treatment level.