HYPEREMESIS GRAVIDARUM

SIGNS AND SYMPTOMS

1. Signs of dehydration and ketoacidosis
2. Dry coated tongue
3. Sunken eyes
4. Acetone smell in breath
5. Tachycardia and Raise in temperature
6. Postural hypotension
7. Excess vomiting & retching day & night.
8. Epigastric pain
9. Constipation
10.Fatigue
11.Anorexia.
MANAGEMENT
1. Monitor the vitals 
2. Open IV line and correct fluids 
3. Send for relevant investigations
4. Maintain an intake-output chart
5. Monitor urine output (catheterize the patient) 
6. Test the urine periodically for ketone bodies.
DRUGS
1. Antiemetic:
 Pro-methazin -25mg IM BD or TDS
 Tri-fluopromazine:10mg IM
 Meta-chlopromide: 10mg IM
2. Hydro-cortisone: 100mg IV in drip
3. Prednisolone orally
4. Nutritional support:
 Vitamin B1, vitamin B6, vitamin B12 & vitamin C.
QUESTIONS:
1. List out the signs and symptoms of hyperemesis gravidarum?
2. What are the drugs used to treat hyperemesis gravidarum?
3. What is the general nursing management?
4. What are the adverse effects of severe vomiting?
5. What for urine analysis is done?
 PUERPERAL SEPSIS
ORGANISMS RESPONSIBLE FOR PUERPERAL SEPSIS:
 Doderlein’s bacillus
 Candida albicans
 Staphylococcus aureus
 Streptococcus
 Escherichia coli
 Bacteroides group
 Clostridium.
PREDISPOSING FACTORS:
1. Antepartum factors:
 Malnutrition and anaemia
 Preterm labour
 PROM
2. Intrapartum factors:
 Repeated vaginal examination
 Prolonged rupture of membranes
 Traumatic operative delivery
 Haemorrhage- antepartum and postpartum
 Retained bits of placenta tissue and membranes.
 Lscs.
SIGNS AND SYMPTOMS:
 Local infection
 Uterine infection
 Spreading of infections
1. LOCAL INFECTION:
 rise of temperature
 generalized malaise
 Headache
 PRISH (pain, redness, immobility, swelling, heat)
 Pus
 Chills and rigor
2. UTERINE INFECTION
 Rise in pulse
  Normal lochia discharge
 Lochial discharge becomes offensive and copious
 Subinvolution of uterus
 Measure lochia
 lochiometra
3. SPREADING INFECTION:
 Parametritis
 Pelvic peritonitis
 General peritonitis
 Thrombophlebitis
 Septicaemia
MANAGEMENT:
 Isolation of the patient
 Adequate fluid and calorie
 Correcting Anemia
 Indwelling catheter
 A chart is maintained to record vitals, lochial discharge, and fluid intake
and output
 Ensure that wound is cleaned with sitz bath several times a day and is
dressed with an antiseptic ointment.
 Dehiscence of episiotomy or abdominal wound following cesarean
section is managed by scrubbing the wound twice daily, debridement of
all necrotic tissue and then closing the wound with secondary suture.
TREATMENT:
1. Medical management
2. Surgical management
Medical management:
 Antibiotics: Ideal antibiotic regimen should depend on the culture and
sensitivity report.
 Gentamicin (1.5mg/kg/8 hourly) + Clindamycin (900mg/8 hourly)
 Metronidazole (500mg/12 hr) + Penicillin (5 million units/6 hr)
 Clindamycin + aztreonam (2 gm/8hr)
 Ampicillin (2gm/6hr) + gentamycin
 Antibiotic Regimens-A combination of either piperacillin-tazobactam or
carbapenem
  Women with MRSA (Methicillin-resistant S. aureus) infection should be
treated with vancomycin or teicoplanin.
Surgical management:
 Stitches of the perineal wound
 Surgical evacuation
 Colpotomy
 Laparotomy
 Hysterectomy.
QUESTIONS:
1. What are the common causes of puerperal sepsis?
2. What is puerperium and what is sepsis?
3. What is the medical management for sepsis?
4. What are the micro-organisms responsible for puerperal sepsis?
5. What are the predisposing factors for puerperal sepsis?