HYPEREMESIS GRAVIDARUM (PERNICIOUS VOMITING ) INTRODUCTION The wait to bring a new life surfacing out of our body is that all of us must aspire to experience at least once in our life time. This period is called pregnancy. Responsibilities & growing concern for the new life now plays a significant role as we set foot on the path that transmutes one from a woman into a mother. Among these is our duty to the life i.e. yet to be & how we can give of ourselves, in body & spirit, to form & nurture the new life that we seek to bring into existence. Giving life is powerful. It is vital therefore, that we prepare our body to become a suitable environment for the baby to grow in while staying happy & healthy emotionally & mentally as well. Pregnancy an incredible journey. A women body has a great deal to do during pregnancy. Sometimes the changes takes place will cause irritation & discomfort & on occasions they may seem quite alarming. Pregnant women may have many health
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HYPEREMESIS GRAVIDARUM(PERNICIOUS VOMITING)
INTRODUCTION
The wait to bring a new life surfacing out of our body is that all of us
must aspire to experience at least once in our life time. This period is called
pregnancy. Responsibilities & growing concern for the new life now plays a
significant role as we set foot on the path that transmutes one from a woman
into a mother. Among these is our duty to the life i.e. yet to be & how we can
give of ourselves, in body & spirit, to form & nurture the new life that we seek
to bring into existence. Giving life is powerful. It is vital therefore, that we
prepare our body to become a suitable environment for the baby to grow in
while staying happy & healthy emotionally & mentally as well. Pregnancy an
incredible journey.
A women body has a great deal to do during pregnancy. Sometimes the
changes takes place will cause irritation & discomfort & on occasions they
may seem quite alarming. Pregnant women may have many health complaints
of varying degrees throughout their pregnancies. One such common complaint
that pregnant women are plagued with is morning sickness, (that is mild form
of nausea & vomiting), which is particularly observed during the first
trimester of pregnancy.
The cause is usually unknown. Most researchers believe it’s a
combination of the many physical changes taking place in the body such as the
higher levels of hormones during early pregnancy. Normal nausea & vomiting
may be an evolutionary protective mechanism. It may protect the pregnant
women & her embryo from harmful substances in food, such as pathogenic
micro organisms in meat products & toxins in plants, with the effect being
maximal during embryogenesis (the most vulnerable period of pregnancy).
This is supported by studies showing that women who had nausea &
vomiting were less likely to have miscarriage & still births. Some researchers
have found that women who are more likely to have nausea from birth control
pills, migraines or hormone replacement therapy. A continuous spectrum of
the severity of nausea & vomiting ranges leads to severe disorders of
hyperemesis Gravidarum.
Pernicious vomiting of pregnancy: Medically known as Hyperemesis
gravidarum, this is excessive vomiting in early pregnancy. Hyperemesis
Gravidarum is a severe form of morning sickness, with unrelenting, excessive
pregnancy-related nausea and/or vomiting that prevents adequate intake of
food and fluids. Hyperemesis is considered a rare complication of pregnancy
but, because nausea and vomiting during pregnancy exist on a continuum,
there is often not a good diagnosis between common morning sickness and
hyperemesis.
MEANING
Hyperemesis gravidarum is the Latin for excessive vomiting in
pregnancy. Hyper means "over"; emesis means "vomiting"; and gravidarum
means "pregnant state." Nausea & vomiting of pregnancy commonly termed
‘morning sickness’ is a common phenomenon in pregnancy, occurring in about
Subjective:hypersalivationnausea & vomitingObjective:-Irritated-(+) nausea and vomiting-(+) hypersalivation-(+) dry skin-Vital signs taken as follows:BP: 90/70CR: 80bpmRR: 22cpmT: 37°C
Deficient fluid volume related to hyperemesis gravidarum as manifested by hypersalivation, vomiting and dry skin.
After the shift of nursing interventions, the patient will decreased the possibility in vomiting, hypersalivation decreased and skin becomes moisturized. And irritability will diminish.
-Established rapport to the patient and to the S.O.-Monitored vital signs and recorded.-Monitored IVF drip and its patency.-Maintained quiet environment.-Provided comfort measures.-Administered and documented medications (METOCLOPRAMIDE) given as ordered by the physician.-Encouraged patient to increase oral fluid intake.-Encouraged patient to eat dry toast foods.
-To gather information.-For Baseline data.-To prevent overload of the fluid. And IVF can help for the hydration of the patient.-For relaxation of the patient.-To prevent irritation/ discomfort of the patient.-To provide wellness to the patient. And to prevent patient from vomiting.-For hydration of the patient.-Dry toast foods inhibit the urge of vomiting and at the same time the patient will be refilled to prevent gastric ulcer.
Goal met: After the shift of nursing interventions the patient was able to perform changes in her status.
Objective:-9/10 pain scale-Irritable-Grimacing-Guarding behavior-Vital signs taken as follows:BP: 90/70CR: 80bpmRR: 22cpmT: 37°C
Acute pain related to hyperemesis gravidarum as manifested by verbal report and guarding behavior.
After 4 hours of nursing intervention, the patient will relieve from pain.The patient can perform activities (sitting, standing, walking and etc.) comfortably.Pain scale will decelerate to 5/10.
-Established rapport to the patient and to the S.O.-Monitored vital signs and recorded.-Monitored IVF drip and its patency.
-Maintained quiet environment.
-Provided comfort measures.-Positioned the patient to her comfortable state.-Massage patient.
-Instructed S.O. not to leave the patient.
-To gather information.
-For Baseline data.-To prevent overload of the fluid.
-For relaxation of the patient.
-To lessen the pain felt by the patient.
-To decreased pain.
- To alleviate suffering from perceived pain. -To prevent from fall.
Goal met: After 4 hours of nursing intervention the patient was relieved from pain, can do things comfortably and report pain scale to 5/10.
Assessment Diagnosis Planning Intervention Rationale EvaluationSubjective:The patient verbalizes that orthopneaObjective:-Irritated-Orthopnea-Alterations in depth of breathing-Nasal flaring-Vital signs taken as follows:BP: 90/70CR: 80bpmRR: 22cpmT: °C
Ineffective breathing pattern related to pain as evidenced by orthopnea, alterations in depth of breathing and nasal flaring.
After 3 hours of nursing intervention the patient will be able to breathe properly.
-Established rapport to the patient and to the S.O.-Monitored vital signs and recorded.-Monitored IVF drip and its patency.
-Maintained quiet environment.-Provided comfort measures.-Positioned patient to orthopneic position.
-Provided air to patient.-Instructed S.O. to massage chest and back of the patient.
-To gather information.
-For Baseline data.
-To prevent overload of the fluid.
-For relaxation of the patient.-To prevent irritation/ discomfort of the patient.-Helps in the breathing pattern of the patient. It helps the patient to breathe properly.-For proper ventilation.
-It helps the patient’s breathing pattern.
Goal met: After 3 hours of nursing intervention the patient can perform proper breathing pattern and can breathe properly.
Assessment Diagnosis Planning Intervention Rationale EvaluationSubjective:Objective:-Irritability-Facial tension-Trembling-Restlessness-Vital signs taken as follows:BP: 100/80CR: 89bpmRR: 22cpmT: 37°C
Anxiety related to perceived proximity of death as manifested by the verbal report, irritability, facial tension, trembling, and restlessness.
After 3 hours of nursing intervention the will no longer feel the proximity of death.
-Established rapport to the mother.-Monitored vital signs and recorded.-Monitored IVF drip and its patency.
-Taught patient and S.O. about the condition of the patient.
-To gather information.
-For Baseline data.-To prevent overload of the fluid.
-For relaxation of the patient.
-To prevent irritation/ discomfort of the client.-Promotes relaxation and ability to deal with situations.-For the patient be filled with faith and hope.
-For them to be clarified about the situation of the patient.
Goal met: After 3 hours of nursing intervention, the patient was filled with hope.
II. NURSING INTERVENTIONS
1. Maintaining fluid volume
a. Establish an IV line, and administer IV fluids as prescribed.
b. Monitor serum electrolytes, and report abnormalities.
c. Medicate with antiemetics as prescribed. Administer
intramuscularly (IM) or by rectal suppository to avoid loss of dose
through vomiting.
d. Maintain NPO status except for ice chips until vomiting has
stopped.
e. Assess intake and output, urine specific gravity and ketones, vital
signs, skin turgor, and fetal heart tones as indicated by condition.
2. Encouraging adequate nutrition
a. Advice the woman that oral intake can be restarted when emesis
has stopped and appetite returns.
b. Begin small feedings. Suggest or provide bland solid foods; serve
hot foods hot and cold foods cold; do not serve lukewarm.
oAvoid greasy, gassy, and spicy foods.
oProvide liquids at times other than meal times.
c. Suggest or provide an environment conducive to eating.
oKeep room cool and quiet before and after meals.
oKeep emesis pan handy, yet out of sight.
3. Strengthening coping mechanisms
a. Allow patient to verbalize feelings regarding this pregnancy.
b. Encourage patient to discuss any personal stress that may have a
negative effect on this pregnancy.
4. Allaying fears
a. Explain the effects of all medications and procedures on maternal
as well as fetal health.
b. Accentuate the positive signs of fetal well-being.
c. Praise mother for attempts at following nutritious diet and
healthy lifestyle.
5. Patient education and health maintenance
a. Educate the woman about proper diet and nutrition in pregnancy.
b. Educate the woman about health weight gain in pregnancy.
c. Educate the woman on the need for child care during the periods
of severe nausea and vomiting.
d. Encourage the woman to move slowly, avoiding quick changes of
position. Quick changes in position can cause vertigo and then
nausea and vomiting.
e. Educate the woman on the need to take antiemetics during the
nausea phase before vomiting occurs.
f. Educate the woman on tips to assist with hyperemesis
gravidarum:
oEat dry toast or crackers before rising from bed or anytime
nausea begins.
oGet fresh, outside air daily; lie down in a semi-prone
position.
oDrink spearmint or peppermint tea.
oTake vitamin B6 50-100mg daily.
oAvoid food odors.
oEat smaller, frequent meals.
HEALTH EDUCATION
Drink lots of fluids to avoid dehydration.
Drink small amounts of fluid often.
Small frequent feeding rather than having heavy meals.
Increase oral fluids and food intake at the time of the day when you feel
least nauseated.
Avoid fatty, hot and spicy foods.
Avoid foods with smell that makes you feel nauseated.
Early morning nausea may be helped by eating dry crackers before
getting out of bed.
Avoid having empty stomach.
Lie down when nauseated.
Have enough rest and sleep.
JOURNAL ABSTRACT
1. Hyperemesis gravidarum is a miserable condition for patients and a
frustrating one for the staff caring for them. While nausea and vomiting are
common and expected in early pregnancy, the syndrome of hyperemesis
gravidarum, which can be defined as persistent vomiting starting in the first
trimester, is relatively uncommon. A study in 1992 found that among 9,088
pregnancies 35 had hyperemesis of sufficient severity to require intravenous
rehydration (Spiller, 1992).
2. Dodds, Linda PhD; Fell, Deshayne B. MSc; Joseph, K S. MD, PhD; Allen,
Victoria M. MD, MSc; Butler, Blair MD conducted a study on Outcomes of
Pregnancies Complicated by Hyperemesis Gravidarum with an objective
to evaluate maternal and neonatal outcomes among women with hyperemesis
during pregnancy. A population-based retrospective cohort study was
conducted among women with singleton deliveries between 1988 and 2002.
Hyperemetic pregnancies were defined as those requiring one or more
antepartum admissions for hyperemesis before 24 weeks of gestation.
Severity of hyperemesis was evaluated according to the number of antenatal
hospital admissions (1 or 2 versus 3 or more) and according to weight gain
during pregnancy (< 7 kg [15.4 lb] versus ≥ 7 kg). Maternal outcomes
evaluated included weight gain during pregnancy, gestational diabetes,
gestational hypertension, labor induction, and cesarean delivery. Neonatal
outcomes included 5-minute Apgar score of less than 7, low birth weight,
small for gestational age, preterm delivery, and perinatal death. Logistic
regression was used to generate adjusted odds ratios for all outcomes, and the
odds ratios were converted to relative risks. The results of this study suggest
that the adverse infant outcomes associated with hyperemesis are a
consequence of, and mostly limited to, women with poor maternal weight
gain.
3. Levine MG, Esser D conducted a study on Total parenteral nutrition
for the treatment of severe hyperemesis gravidarum: maternal