- 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.
- The etiology of hyperemesis gravidarum is obscure; suggested causative factors include:
- High levels of hCG in early pregnancy
- Metabolic or nutritional deficiencies
- More common in unmarried white women and first pregnancies
- Ambivalence toward the pregnancy or family-related stress
- Thyroid dysfunction
- Continued vomiting results in dehydration and ultimately deceases the amount of blood and nutrients circulated to the developing fetus.
- Hospitalization may be required for severe symptoms when the client needs intravenous hydration and correction of metabolic imbalance.
- Signs and symptoms occur during the first 16 weeks of pregnancy and are intractable.
- Unremitting nausea and vomiting.
- Vomitus initially containing undigested food, bile, and mucus; later containing blood and material that resembles coffee grounds
- Weight loss
- 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.
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.
Nursing Care Plan
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
- 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
- Decreased levels of potassium, sodium, chloride, and protein
- Decreased levels of vitamin
- Increased Hb and Ht
- Fluid and electrolyte imbalances related to excessive vomiting or lack of fluid intake.
- Imbalanced Nutrition Less Than Body Requirements related to nausea, vomiting or lack of nutritional intake.
- Anxiety related to hyperemesis influence on the health of the fetus.
- Knowledge deficit related to lack of information about the treatment of hyperemesis.
- Sleep pattern disturbance related to persistent vomiting.
- Activity Intolerance related to weakness.
|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.|