Napao, Camelle Ann C.

2BSN4
Napao, Camelle Ann C.
2BSN4

TABLE OF CONTENTS

(Health Condition)

Maternal 8. Sudden Infant Death Syndrome

1. Hyperemesis Gravidarum 9. Atrial Septal Defect
2. Abortion 10. Patent Ductus Arteriosus
3. Ectopic pregnancy 11. Tetralogy of Fallot
4. H. Mole 12. Rheumatic Fever
5. Incompetent Cervix 13. Endocarditis
6. Placenta Previa/ Abruptio 14. Kawasaki Disease
Placenta 15. Cardiomyopathy
7. Oligohydramnios/Polyhydramni 16. Hydrocephalus
os 17. Microcephaly
8. Premature rupture of membrane 18. Spina Bifida
9. Preterm Labor 19. Sickle Cell Anemia
10. Gestational Diabetes 20. Hemophilia
11. Pre-eclampsia/Eclampsia 21. Thalassemia
12. Cephalopelvic Disproportion 22. Acute Lymphocytic Leukemia
13. Postpartum Hemorrhage (ALL)
14. Disseminated Intravascular 23. Cerebral Palsy
Coagulation 24. Hirschsprung’s Disease
15. Puerperal Infection 25. Irritable Bowel Syndrome
16. Mastitis 26. Meckel Diverticulitis
27. Crohn's Disease
Pediatric 28. Intussusception
1. Tonsillitis 29. Galactosemia
2. Otitis Media 30. Phenylketonuria
3. Bronchitis 31. Biliary Atresia
4. Pneumonia 32. Acute Gastroenteritis
5. Asthma 33. Congenital Hypothyroidism
6. Acute Respiratory Distress 34. Congenital Adrenal Hyperplasia
Syndrome 35. Burns
7. Hyperbilirubinemia
Napao, Camelle Ann C.
2BSN4
HYPEREMESIS GRAVIDARUM

Description

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting that occurs
during pregnancy. It is not uncommon for pregnant women to experience some degree of nausea
and vomiting, especially during the first trimester, but HG is much more severe and persistent.
The exact cause of HG is not fully understood, but it is thought to be related to the increase in
pregnancy hormones, particularly human chorionic gonadotropin (hCG), estrogen, and
progesterone. These hormones can cause the digestive system to slow down and the stomach to
empty more slowly, leading to nausea and vomiting. Although HG can be a challenging and
debilitating condition, most women with HG recover completely after delivery. However, some
may experience ongoing digestive problems or mental health issues related to their experience
with HG. Women with a history of HG are also at increased risk for the condition in subsequent
pregnancies.

Signs and Symptoms

1. Severe and persistent nausea: HG causes intense and ongoing feelings of nausea, which
may be present all day long.
2. Vomiting: Women with HG may vomit multiple times a day, which can lead to
dehydration and malnutrition.
3. Weight loss: Due to the persistent vomiting, women with HG may experience significant
weight loss, and in severe cases, may become malnourished.
4. Dehydration: Vomiting can cause significant fluid loss, leading to dehydration.
Symptoms of dehydration may include dry mouth, decreased urine output, and feeling
dizzy or lightheaded.
5. Fatigue: Due to the persistent nausea, vomiting, and dehydration, women with HG
may feel fatigued, weak, or have difficulty concentrating.
6. Headache and dizziness: These symptoms can occur due to dehydration and lack of
nutrients.
7. Fainting: Severe dehydration and malnutrition may cause fainting or loss of
consciousness.
8. Food aversions: Women with HG may develop strong aversions to certain foods, or even
to all types of food.
9. Increased salivation: Some women with HG may experience excessive salivation,
which can exacerbate nausea.
10.
Napao, Camelle Ann C.
2BSN4
Diagnostic and Laboratory Test
> Not fully understood

Risk Factors

1. History of HG: Women who have had HG in a previous pregnancy are at increased risk
of developing it in future pregnancies.
2. Multiple gestation: Women carrying multiples (twins, triplets, etc.) are at higher risk for
HG.
3. First-time pregnancy: Women who are pregnant for the first time are at higher risk for
HG.
4. Age: Women who are younger than 20 or older than 35 may be at higher risk for HG.
5. Obesity: Women with a high body mass index (BMI) before pregnancy may be at
increased risk for HG.
6. Gestational Trophoblastic Disease: Women with Gestational Trophoblastic Disease
(GTD) are at higher risk for HG.
7. Migraines: Women with a history of migraines may be more likely to develop HG.
8. Psychiatric disorders: Women with a history of depression, anxiety, or other psychiatric
disorders may be at higher risk for HG.
9. Motion sickness: Women who are prone to motion sickness may be more likely to
develop HG.
10. Vitamin deficiencies: Women who have low levels of certain vitamins, such as vitamin
B6, may be at higher risk for HG.

Pathophysiology

The exact pathophysiology of hyperemesis gravidarum (HG) is not fully understood, but
it is thought to be related to the increase in pregnancy hormones, particularly human chorionic
gonadotropin (hCG), estrogen, and progesterone. These hormones can cause changes in the
gastrointestinal tract, including slowing down the digestive system and decreasing the rate at
which food moves through the stomach and intestines. This can lead to nausea and vomiting.
Additionally, high levels of hCG have been shown to stimulate the thyroid gland, which can
contribute to nausea and vomiting.
Napao, Camelle Ann C.
2BSN4

Nursing Diagnoses by Priority (3 with rationale)

Here are three nursing diagnosis for hyperemesis gravidarum (HG) with their
corresponding rationales, listed in order of priority:

1. Fluid volume deficit related to persistent vomiting and decreased oral intake.

Rationale: HG can lead to severe dehydration and electrolyte imbalances, which can cause
serious health complications for both the mother and the developing fetus. Maintaining adequate
fluid balance is a top priority in the management of HG.

2. Imbalanced nutrition: less than body requirements related to persistent vomiting

and decreased oral intake.

Rationale: HG can lead to significant weight loss and malnutrition, which can affect the health
of the mother and fetus. Providing adequate nutrition is important for preventing complications
and promoting optimal fetal development.

3. Anxiety related to uncertainty about the pregnancy, fear of harm to the fetus, and
discomfort from persistent nausea and vomiting.

Rationale: Women with HG may experience significant psychological distress and anxiety due
to the uncertainty and discomfort associated with the condition. Addressing these psychological
concerns can help to improve the woman's overall well-being and may also help to alleviate
some of the physical symptoms of HG.

Nursing Management/ Intervention

The nursing management and interventions for hyperemesis gravidarum (HG) may vary
depending on the severity of the symptoms and the woman's individual needs, but here are some
general interventions that may be helpful:

1. Monitoring vital signs and laboratory values: Women with HG are at risk for
dehydration and electrolyte imbalances, so it is important to monitor vital signs, such as
blood pressure and heart rate, as well as laboratory values, such as electrolyte levels and
renal function.
2. Administering antiemetic medications: Antiemetic medications, such as ondansetron or
promethazine, can be helpful in reducing nausea and vomiting in women with HG. These
medications should be prescribed by a healthcare provider and administered according to
the prescribed dosage and frequency.
3. Nutritional support: Women with HG may have difficulty maintaining adequate oral
intake, and may require nutritional support in the form of enteral or parenteral nutrition.
Napao, Camelle Ann C.
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Nurses can work with a registered dietitian to develop an appropriate nutrition plan based
on the woman's individual needs.
4. Psychological support: Women with HG may experience significant psychological
distress and anxiety related to their symptoms and the impact on their pregnancy. Nurses
can provide emotional support, as well as referrals to mental health professionals if
needed.
5. Patient education: Educating women about HG, its causes, and management strategies
is an important part of nursing care. Women should be taught how to monitor for signs of
dehydration and electrolyte imbalances, how to manage their symptoms at home, and
when to seek medical attention if their symptoms worsen.

Medical/ Surgical Management

The medical/surgical management for hyperemesis gravidarum (HG) may vary

depending on the severity of the symptoms and the woman's individual needs, but here are some
general interventions that may be helpful:

1. Antiemetic medications: Antiemetic medications, such as ondansetron or promethazine,

are often prescribed to manage nausea and vomiting in women with HG. These
medications can be given orally or intravenously.
2. Intravenous fluids and electrolyte replacement: Women with severe HG may require
intravenous fluids and electrolyte replacement to manage dehydration and maintain fluid
and electrolyte balance. This may be done in the hospital setting or through home health
services.
3. Nutritional support: Women with HG may have difficulty maintaining adequate oral
intake and may require nutritional support in the form of enteral or parenteral nutrition. In
severe cases, a nasogastric tube may be placed for enteral feeding.
4. Hospitalization: In severe cases of HG, hospitalization may be required to manage
dehydration, electrolyte imbalances, and provide necessary nutritional support. This may
also allow for close monitoring of the woman and the developing fetus.

Drug Analysis ( MOA, Indication, Side Effects and Nursing Responsibility)

Drug Mode of Indication Side Effects Nursing

Action Responsibility

Ondansetron A serotonin Used to treat Common side Nurses should

(Zofran) receptor nausea and effects include monitor for
antagonist that vomiting headache, signs of allergic
works by associated with constipation, and reactions, such
blocking the hyperemesis dizziness. Rare as rash or
action of gravidarum, side effects difficulty
Napao, Camelle Ann C.
2BSN4
serotonin in the chemotherapy, include allergic breathing, and
gut, reducing and surgery. reactions, report any
nausea and abnormal heart adverse
vomiting. rhythm, and reactions to the
seizures. healthcare
provider. Nurses
should also
monitor for
constipation and
encourage the
patient to
increase fluid
intake and
engage in
regular physical
activity to
prevent
constipation.

Drug Mode of Indication Side Effects Nursing

Action Responsibility

Metoclopramide A dopamine Used to treat Common side Nurses should

(Reglan) receptor nausea and effects include monitor for
antagonist that vomiting drowsiness, signs of
works by associated restlessness, movement
increasing the with and diarrhea. disorders, such
movement of hyperemesis Rare side as tremors or
food through gravidarum, effects include muscle
the stomach chemotherapy, allergic stiffness, and
and intestines, and surgery. reactions and report any
reducing movement adverse
nausea and disorders. reactions to the
vomiting. healthcare
provider. Nurses
should also
monitor for
dehydration and
electrolyte
imbalances due
to diarrhea, and
encourage the
patient to
Napao, Camelle Ann C.
2BSN4
increase fluid
intake to
prevent
dehydration.

Drug Mode of Indication Side Effects Nursing

Action Responsibility

Dexamethasone A Used to treat Common side Nurses should

corticosteroid severe nausea effects monitor for
that works by and vomiting include signs of
reducing associated with increased infection, such
inflammation hyperemesis appetite, as fever or
and gravidarum. insomnia, and chills, and
suppressing the mood report any
immune changes. Rare adverse
system, side effects reactions to the
reducing include healthcare
nausea and allergic provider. Nurses
vomiting. reactions and should also
increased risk educate the
of infection. patient on the
importance of
taking the
medication as
prescribed and
not abruptly
stopping the
medication.