Hyperemesis

Hyperemesis
Gravidarum
Gravidarum
 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 *
Pathophysiology
Clinical 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
 Identification
,Unlike morning sickness
hyperemesis gravidarum: is a
complication of pregnancy
characterized by persistent
uncontrollable nausea and vomiting that
. persists beyond the 20th week of pregnancy
 Hyperemesis gravidarum is extreme, •
persistent nausea and vomiting during
pregnancy. It can lead todehydration,
weight loss, and electrolyte
.imbalances
•
 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
 Pathophysiology
Elevated 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
 Complication
Weight loss 
Dehydration 
Metabolic acidosis from starvation 
Alkalosis from loss of HCL 
Hypokalemia (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
 Nursing Assessment
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
 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 depletion
Urine 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
 Diagnosis
Fluid & electrolyte
imbalance
Impaired 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 care
Pay 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 supplement
Avoid 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