RCMANALON

Hyperemesis
Gravidarum
description

Hyperemesis gravidarum is persistent,

uncontrolled vomiting that begins
in the first weeks of pregnancy and
may continue throughout
pregnancy. Unlike morning
sickness, hyperemesis can have
serious complications, including
severe weight loss, dehydration,
and electrolyte imbalance.
 CAUSES

None known
Theories:
-Endocrine theory high levels of hCG
& estrogen during pregnancy
-Metabolic theory Vitamin B
deficiency
-Psychological theory psychological
stress increasing the symptoms
 RISK FACTORS

Young age
Nausea & vomiting with various pregnancy
History of intolerance of oral contraceptives
Multiple gestation
Emotional or psychological stress
Gastroesophageal reflux disease
Primigravida status
Obesity
Hyperthyroidism
 Clinical manifestations

Symptoms of HG include, but not limited to:

Disturbed nutrition
Severe vomiting
Electrolyte imbalance
Ketosis
Acetonuria
Weight loss greater than 5% of body mass
 CLINICAL
MANIFESTATIONS

If it progresses untreated, it may cause:

Neurologic disturbance
Renal disease
Retinal hemorrhage
Death
 diagnostic studies

Liver Enzymes elevation of aspartate

aminotransferase (AST) and alanine
aminotransferase (ALT) usually present.
CBC elevated levels of RBCs and hematocrit
denoting dehydration
Urine Ketones positive when the body breaks
down fat to provide energy in the absence of
inadequate intake
Blood, urea, nitrogen (BUN) increased in the
presence of salt and water depletion
 diagnostic studies

Urine Specific Gravity greater than 1.025,

possibly indicating concentrated urine linked
to inadequate fluid intake or excessive fluid
loss
Serum electrolytes decreased levels of
potassium, sodium nd chloride resulting from
excessive vomiting and loss of hydrochloric
acid in stomach
(SWEARINGEN, 2004)
 Medical Management

The client is usually hospitalized and

intravenous fluids D5LR with vitamins and
electrolytes added.
Oral food and fluids are withheld for the first
24 to 48 hours to allow the GI tract to rest
Medications are administered orally or rectally
Pharmacological
Management

A sedative may be given, but

medications are kept to a minimum
because of potential teratogenic
effects to the fetus.
Medications Used for HG
Diet

The client is kept NPO until all vomiting

has stopped for 48 hours.
Small amounts of dry foods are then
offered with slow progression to a
regular diet.
If the client is unable to eat without
vomiting, total parenteral nutrition may
be initiated.
 NURSING MANAGEMENT

Identify the duration and course of the womans

nausea & vomiting, medications or treatment
used and their efficacy
Anorexia, indigestion, abdominal pain or
distension, and passage of blood or mucus
rectally
Daily weight, comparing pre pregnancy weight
with current weight to determine total loss
Dietary intake by requesting a diet recall for past
week
Activity tolerance through job activities or daily
exercise routine
 NURSING MANAGEMENT
Knowledge of basic four food group and typical
consumption patterns that may or may not trigger GI
distress
Intake and output for the previous 24 hours
Type and amount of nutritional supplements taken
Laboratory and diagnostic test results to validate
dehydration and electrolyte imbalances
Pain-precipitating factors the woman may be
experiencing
Clients perception of situation and future needs
Support systems available to the client that can offer
help
 Nursing Interventions

Nursing interventions focus on controlling

the womans nausea and vomiting,
promoting adequate nutrition, improving
the clients fluid and electrolyte balance,
and providing comfort and support during
this time.
 Nursing Interventions

Administer antiemetics as ordered and assess their

effectiveness.
Administer and maintain IV fluid and electrolyte
replacements as ordered; monitor rate and sites of IV
therapy to prevent complications.
Monitor intake and output, including oral food and
fluid intake when allowed.
Evaluate the results of laboratory studies to
determine effectiveness of treatment
 Nursing Interventions

Provide physical comfort measures,

including environmental, hygiene (such as
keeping the area free from pungent
odors), and oral care.
Reassure the client that treatment plan is
in the best interest for the family unit.
Encourage therapeutic lifestyle changes,
such as avoiding stressors and fatigue that
may trigger nausea and vomiting.
 Nursing Interventions
Offer ongoing support and encouragement,
empowering the client and her family with
knowledge and choices.
Involve the client and family in all decisions
concerning care.
Listen to concerns and feelings, and answer
all questions asked honestly.
Educate about the probable etiology of her
condition and treatment options.
Refer the client to a spiritual leader or
counseling as needed.
Activity

Bed rest is usually maintained until

the condition begins to improve.
Visitors may be restricted for a few
days to allow the client to rest.
Nursing Management

NURSING PROCESS
Assessment
SUBJECTIVE DATA
Especially important is the clients emotional
state and her feelings about the pregnancy, the
fetus, and her mate. Ask what triggers her nausea.
OBJECTIVE DATA
Check the amount and character of all
emesis, intake and output, and FHR.
Note signs of jaundice and vaginal bleeding.
Nursing Diagnosis 1:
Imbalanced Nutrition: Less Than
Body Requirements related to
persistent vomiting

Planning/Outcomes:
The client will stop vomiting
 Nursing Interventions:
1. Maintain relaxed, quiet environment.
2. Monitor amount and character of all
emesis, and maintain accurate I&O
record.
3. Ensure good oral hygiene after each
vomiting episode.
4. When vomiting stops, provide dry
foods, then bland foods and oral fluids
as ordered.
Nursing Diagnosis 2:
Deficient Fluid Volume related to
decreased fluid intake and
excessive fluid loss

Planning/Outcome:
The client will have fluid balance
 Nursing Interventions
1. Administer IV fluids as ordered.
2. Monitor laboratory results for
electrolyte levels.
3. Assess skin turgor and mucous
membranes.
4. Provide small amounts of oral fluids
when tolerated.
5. Maintain accurate I&O record
Nursing Diagnosis 3:
Fear related to fetal well-being

Planning/outcome:
The client will discuss fears with
health caregivers.
 Nursing Interventions:
1. Provide opportunities for client to
express concerns.
2. Show acceptance of clients
perceptions.
3. Assist client to identify personal
strengths.
4. Listen to the clients concerns.
5. Help client identify sources of support.