Hyperemesis Gravidarum - Nursing Case Study

by - June 15, 2020

DESCRIPTION:
Hyperemesis Gravidarum is an uncontrolled vomiting during pregnancy. It is also called as pernicious, persistent, frequent, or extended vomiting that continues past week 16 of pregnancy that depletes the nutritional supply available for the fetus. The cause of this condition is unknown but studies reveal that it is associated with Helicobacter pylori. This condition is dangerous for pregnancy in which the woman needs an additional therapy like antiemetic medication or nutrition supplemented by total parenteral nutrition or enteral feeding.
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS):
A pregnant women who is experiencing hyperemesis gravidarum might note the following subjective cues like nausea, dizziness, weakness, fatigue, food or smell aversions, headache and confusion while the healthcare provider will be able to observe its objective signs like vomiting, dehydration, fainting, jaundice, hypotension, and tachycardia.

DIAGNOSTIC AND LABORATORY TEST:
There are several tests that may perform to the pregnant women who is suspected for hyperemesis gravidarum. The healthcare provider will perform a physical exam like getting their blood pressure because there is a tendency that their blood pressure may be low while their pulse is oppositely high. Laboratory test is also significant to do because it will help the healthcare provider to check if the pregnant women is positive for dehydration, due to the fluid they loses everytime they vomits, that could lead for them not to be able to provide their fetus an essential nutrients for growth or worse it could lead to intrauterine growth restriction or preterm birth. They might be asked to do a Urine Ketone test in which if they are positive for ketones then it implies that their body is not receiving enough nutrients and is breaking down proteins. Their weight will be measured and test to see if a significant weight loss will be shown because it will only prove that they cannot maintain their usual nutrition. Hematocrit Blood Test will be done to them and see if they have an elevated hematocrit concentration because if they have, they will not be able to retain fluid that may result to hemoconcentration, which is dangerous and could lead to thromboembolism. The healthcare provider will also asked for Electrolyte Testing because there is a possibility that their sodium, potassium, and chloride may be reduced because of their low intake in which hypokalemic alkalosis might develop from loss of hydrochloric acid from the stomach.

RISK FACTORS:
There are several risk factors that increases the possibility of a pregnant women to experience hyperemesis gravidarum and it is because they a have a history of hyperemesis gravidarum in their previous pregnancy, they have a family history of severe nausea or vomiting in pregnancy, younger maternal age, obesity, nulliparity, carrying multiples, a first-time pregnancy, allergies, and a restrictive diet.

PATHOPHYSIOLOGY:
NURSING DIAGNOSES BY PRIORITY:
Imbalanced Nutrition, Less Than Body Requirements related to prolonged vomiting
Deficient Fluid Volume related to excessive gastric losses
Anxiety related to ineffective coping, physiological changes of pregnancy
Activity intolerance related to weakness
Risk for Electrolyte Imbalance related to vomiting

NURSING CARE PLAN:
Imbalanced Nutrition, Less Than Body Requirements related to prolonged vomiting
Fluid Volume Deficit related to excessive gastric losses
Anxiety related to ineffective coping, physiological changes of pregnancy
NURSING MANAGEMENT / INTERVENTION:
A pregnant women who is experiencing hyperemesis gravidarum may need to be hospitalized for 24 hours to monitor and document their intake, output, and blood chemistries and to restore their hydration. Usually, oral food and fluids are being withheld for the first 24 hours. Intravenous fluid may administered to increase hydration and antiemetic drugs to control the vomiting. During this period, proper and careful measuring of intake and output, including the amount of vomitus, must be observe so that the degree of hydration will be evaluated. If after 24 hours of oral restriction there is no vomiting, small amounts of clear fluid is now allowed and they can also go back home for home care. If it continues, they can also take dry toast, crackers, or cereal every 2 or 3 hours then gradually advanced to soft diet to regular diet.

MEDICAL / SURGICAL MANAGEMENT:
If vomiting returns after doing the nursing intervention, enteral or total parenteral nutrition may be prescribed to make sure that they receive adequate nutrition for themselves and for their baby’s. Enteral feedings cost less and carry less risk of exacerbating endocrine dysfunction and total parenteral nutrition or TPN are only required when oral or enteral feedings are not tolerated. It is usually reserved for those whose gut cannot absorb an elemental formula or those with sever refractory diarrhea. Medications may be given also to prevent nausea and vomiting because if this persists or left untreated, it will bring risks to the mother and or to the baby.

REFERENCES:

  • Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2016). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY
  • Potter et. Al (2017). Fundamentals of Nursing (9th ed.). Singapore: Elsevier Inc.

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