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Hyperemesis Gravidarum

Brief Review

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What is hyperemesis gravidarum (HG)?

• HG is characterized by severe, persistent


nausea and vomiting associated with
ketosis and weight loss (>5% of pre-
pregnancy weight).

• HG may lead to volume depletion,


electrolytes and acid-base imbalances,
nutritional deficiencies, and even death.

• Severe hyperemesis requiring hospital


admission occurs in 0.3-2% of
pregnancies.

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Risk factors for hyperemesis gravidarum may include the following

• Previous pregnancies with HG


• Greater body weight
• Multiple gestations
• Trophoblastic disease
• Nulliparity
• Maternal age younger then 20
• Vit B deficiencies

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Diagnostic Labs
• Urinalysis looking for ketones

• Elevated specific gravity

• Electrolyte imbalance
• Low Na, K, Cl
• Acidosis for excessive vomiting

• Elevated hematocrit due to hemoconcentration

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Treatment for Mild HG
• Small, frequent meals and eating dry
foods such as crackers may help
relieve uncomplicated nausea.

• Encourage increasing fluids during


the times of the day when the client
feels least nauseated.

• Seltzer or other sparkling waters


may be helpful.

• May be taking anti-emetics and


vitamin B supplements

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In some cases of HG the client may need to be hospitalized

• Hospital treatment may include


some or all of the following:
– Intravenous fluids

• Enteral feeding:
– Nasogastric
– Percutaneous endoscopic
gastrostomy

• Medications such as
metoclopramide, antihistamines,
and antireflux medications

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Nursing Assessments
Nursing assessments Nursing interventions
• Monitor I&O • NPO
• Vomiting • IV fluids usually lactated
• Dehydration including labs
Ringers
• Weight loss
– In severe cases TPN or
• Output
enteral nutrition
• Vital signs
• Vitamin B supplements if
• Hypotension
tolerated
• Tachycardia
• Skin Turgor • Antiemetics

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Good Work

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