Hyperemesis Hyperemesis GravidarumGravidarum

Learning objective•Identify Hyperemesis Gravidarum

•Differentiate between morning sickness and Hyperemesis Gravidarum

•Describe the complications of Hyperemesis Gravidarum

•Explain management of Hyperemesis Gravidarum

•Discus nursing role of Hyperemesis• Gravidarum

Outline: * Introduction

Hyperemesis Gravidarum *Introduction

PathophysiologyClinical Manifestations

Complications Diagnostic Evaluation

Management

Introduction

Hyperemesis Gravidarum

At lest 80% of women experience nausea &vomiting. The term morning sickness is often used to describe this condition when symptoms usually disappear after the first trimester. this mild form affects he quality of life of women &her family where the sever form hyperemesis gravidarum results in dehydration ,electrolyte imbalance and the need for hospitalization

IdentificationUnlike morning sickness ,hyperemesis gravidarum: is a complication of pregnancy characterized by persistent uncontrollable nausea and vomiting that persists beyond the 20th week of pregnancy.

Pathophysiology

Causes :

numerous theories abound, but few studies have produced scientific evidence to identify the etiology of this condition it is likely that multiple factors contribute to it.

PathophysiologyElevated Level OF HCG are present in all pregnant women during early pregnancy, usually declining after 12 week .this corresponds to the usual duration of morning sickness .in hyperemesis gravidarum ,the

Pathophysiology decrease fluid intake&

prolonged vomiting cause dehydration which increase serum concentration of hCG;

Pathophysiology

Endocrine theory :high levels of hCG & estrogen during pregnancy

Metabolic theory :vitamin B6 deficiency

Psychological theory : Psychological stress increase the symptoms

ComplicationWeight lossDehydration

Metabolic acidosis from starvation Alkalosis from loss of HCLHypokalemia (electrolyte

imbalance)

Nursing Role

Nursing Assessment

•Health history &physical examination:

asking the client about the onset, duration ,and course of her nausea and vomiting

Ask her about any medication or treatments she used and how effective they were in relieving her nausea and vomiting

obtain a diet history from the client including a dietary recall for the past week

Note the client’s knowledge of nutrition &need for appropriate nutritional intake

Also ask about any complaints of ptyalism.

Ask if she has any noticed any blood or mucus in her stool

Weight the client.

Nursing Assessment

Inspect the mucous membranes for dryness &check skin turgor for .

Assess blood pressure for changes.

Note any complaints of weakness ,fatigue, activity intolerance ,dizziness, or sleep disturbance

Nursing Assessment

Laboratory & Diagnostic test Liver enzyme: elevation of (AST) &

(ALT) are usually present.CBC: elevated level of RBC &

hematocrite indicating dehydration.Urine ketones: positive when the

body breaks down fat to provide energy in the absence IIT

Laboratory & diagnostic test BUN :increase in the presence of salt

&water depletionUrine specific gravity :grater than

1.025indicating concentrated urine linked to inadequate fluid intake

Serum electrolyte decrease levels of k, Na, Cl

Ultrasound :evaluation for molar or multi pregnancy

DiagnosisFluid & electrolyte

imbalanceImpaired nutrition intake

Knowledge deficit

Intervention

Maintain NPO status to allow GI tract to rest

Administer antiemetic drugs like : promethazine,prchlorperazine,odanse-tron.

Administer IV fluid like 5% dextrose in lactated ringer

Administer electrolyte replacement therapy

Hygiene measures and oral carePay special attention to the

environment making sure to keep the area free of pungent odors

As the Client's nausea and vomiting subside .gradually introduce oral fluid

&foods in small amounts Monitor intake and output

Offer reassurance that all intervention are directed toward promoting positive pregnancy outcomes for both women fetus

Provide information about the expected plan of care

Listen to here concerns &feeling by answering all here questions

Teach the client about therapeutic life style changes like avoid stressors& fatigue

Avoid noxious stimuli

Avoid tight waistband Eat small frequent meals (6 meals)

Separate fluid from solid by consuming fluid In between meals

Use high protein supplementAvoid lying down for at least 2 hours

after eating Avoid food high in fat drink herbal

tea eat food that settle the stomach

such as toast or soda

References

From this book•Susan scote ricci & terri Kyle.

(2009) Maternity and pediatric nursing ,chapter19, pregnancy related complication , page 567-569