Hyperemesis Gravidarum Nursing Care Plan & Management

Notes

Description
  • Hyperemesis gravidarum is severe and excessive nausea and vomiting during pregnancy, which leads to electrolyte, metabolic, and nutritional imbalances in the absence of the medical problems.
Etiology
  • The etiology of hyperemesis gravidarum is obscure; suggested causative factors include:
    1. High levels of hCG in early pregnancy
    2. Metabolic or nutritional deficiencies
    3. More common in unmarried white women and first pregnancies
    4. Ambivalence toward the pregnancy or family-related stress
    5. Thyroid dysfunction
Pathophysiology
  1. Continued vomiting results in dehydration and ultimately deceases the amount of blood and nutrients circulated to the developing fetus.
  2. Hospitalization may be required for severe symptoms when the client needs intravenous hydration and correction of metabolic imbalance.
Assessment Findings
  • Signs and symptoms occur during the first 16 weeks of pregnancy and are intractable.
1. Clinical manifestations include:
  • Unremitting nausea and vomiting.
  • Vomitus initially containing undigested food, bile, and mucus; later containing blood and material that resembles coffee grounds
  • Weight loss
2. Other common signs and symptoms include:
  • Pale, dry skin
  • Rapid pulse
  • Fetid, fruity breath odor from acidosis
  • Central nervous system effects, such as confusion, delirium, headache, and lethargy, stupor, or coma.

Nursing Management

1. Promote resolution of the complication.

  • Make sure that the client is NPO until cessation of vomiting.
  • Administer intravenous fluids as prescribed; they may be given on an ambulatory basis when dehydration is mild.
  • Measure and record fluid intake and output.
  • Encourage small frequent meals and snacks once vomiting has subsided.
  • Administer antiemetics as prescribed.

2. Address emotional and psychosocial needs. Maintain a non judgmental atmosphere in which the  client and family can express concerns and resolve some of their fears.

 

Exam

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Nursing Care Plan

Nursing Assessment

1. Main complaint:

  • Severe vomiting
  • Nausea, vomiting in the morning and after meals
  • Epigastric pain
  • Feeling thirsty
  • No appetite
  • Vomiting of food / liquid acid

2. Predisposing factors

  • Maternal age <20 years
  • Multiple gestation
  • Obesity
  • Trophoblastic Disease

3. Physical Examination

  • Metabolic acidosis is characterized by headache, disorientation
  • Tachycardia, hypotension, vertigo
  • Conjunctival jaundice
  • Impaired consciousness, delirium

Signs of dehydration:

  • Dry skin, mucous membranes dry lips
  • Slow return of skin turgor
  • Sunken eyelids
  • Weight loss
  • Increase in body temperature
  • Oliguria, ketonuria
  • Concentrated urine

Laboratory data:

  • Proteinuria
  • Ketonuria
  • Urobilinogen
  • Decreased levels of potassium, sodium, chloride, and protein
  • Decreased levels of vitamin
  • Increased Hb and Ht
Nursing Diagnosis
  1. Fluid and electrolyte imbalances related to excessive vomiting or lack of fluid intake.
  2. Imbalanced Nutrition Less Than Body Requirements related to nausea, vomiting or lack of nutritional intake.
  3. Anxiety related to hyperemesis influence on the health of the fetus.
  4. Knowledge deficit related to lack of information about the treatment of hyperemesis.
  5. Sleep pattern disturbance related to persistent vomiting.
  6. Activity Intolerance related to weakness.
Nursing Interventions Rationale
Assess for signs of dehydration improve fluid balance, and maintain a homeostatic mechanism, is the basis for the mother and fetus to maintain balance.
Assess vital signs temperature, pulse rate increased and decreased BP are signs of dehydration and hypovolemia.
Give parenteral fluids: electrolytes, glucose and vitamins according to program This fluid will provide or meet the needs of the body’s acid-base balance, electrolytes and hypoavitaminosis.
Provide nutrition in small but frequent portions. feeding gradually or slowly may help.
Monitor the provision of fluids and food in 24 hours as well as expenditures and recorded fluid intake. the provision of fluids and electrolytes is a way to deal with persistent vomiting, this recording will be able to assess the balance of electrolytes are given, while the number of how many calories can already be given.
Review of edema in the legs or elsewhere. the edema may also occur due to lack of albumin or renal failure.
Assess the presence of ketones in the urine. presence of ketones in the urine indicates maternal fat supplies for energy use due to inadequate caloric intake.
Do collaborations with other teams for the administration of antiemetic drugs. usually to cope with vomiting.
Give the food a light, when it is allowed in small portions and frequent (liquid and solid)  the provision of solid and liquid foods in small portions and often may reduce vomiting.
Increase feeding of this, if the client is able to accept (tolerance). an increase in feeding demonstrate efficacy in the treatment.
Monitor FHR and fetal activity. FHR and fetal movement is an indication that the fetal / fetus in good condition.
Monitor symptoms of morning sickness. hormonal changes, maternal Hypoglycemia and decreased gastric motility, emotional and cultural factors.
Examine the skin: the texture and turgor. dry skin and poor turgor is a sign of dehydration.
Encourage clients to multiply the rest.
Create a comfortable environment.

 

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