Certificate No.

AJA19-0226
Certificate No.
Republic of the Philippines
EASTERN SAMAR STATE UNIVERSITY
College of Nursing Allied Sciences

A Case Study of Hyperemesis

Gravidarum with Mild Dehydration

Submitted by:
Joan Pedrosa
Ma. Fraila Cabato
BSN2

Submitted to:
Ammy Evilynda C. Cesista, RN, MAN
Instructor
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TABLE OF CONTENTS:

A, NURSING ABSTRACT
B, DEMOGRAPHIC PROFILE
C. NURSING HISTORY
D. GORDON’S TYPOLOGY OF 11 FUNCTIONAL HEALTH PATTERNS
E. PHYSICAL ASSESSMENT
F. VITAL SIGNS
G. LABORATORY RESULT
H. PATHOPHYSIOLOGY
I. DRUG STUDY
J. NURSING CARE PLAN
K. TEACHING PLAN
L. LEARNING FEEDBACK
M. REFERENCES
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A. CLINICAL ABSTRACT
Mrs. X, a 24 year old female was admitted in the OB ward last February 26, 2020, at
Eastern Samar Provincial Hospital with a diagnosis of PU 13 weeks AOG G1P0
Hyperemesis Gravidarum with mild Dehydration. She has been experiencing a severe
vomiting since the month of January and not able to focus on her work and decided to
resign due to her illness. She’s also been experiencing chest pain and weight loss.

B. DEMOGRAPHIC PROFILE
Name: Mrs. X
Age: 24
Sex: Female
Birthday: May 19, 1995
Nationality: Filipino
Religion: Roman Catholic
Address: Brgy. Bato Borongan City E. S
Father’s Name: xxx
Mother’s Name: xxx
Spouse Name: xxx
Occupation: None
Educational Attainment: High School level
Chief Complaint: Vomiting
Admitting Diagnosis: PU 13 weeks AOG G1P0 Hyperemesis
Gravidarum with mild Dehydration
Attending Physician: Leah Golda M. Domingo M.D.
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C. NURSING HISTORY
1. History of Present Illness
The patient’s chief complaint is uncontrolled vomiting for almost 2 months
already, either eating or drinking small amount of food and water triggers her to
vomit at any time of the day. She doesn’t know her last menstruation due to her
irregular period and based on ultrasound, November 25, 2019 revealed a positive
result.
During the 1st trimester, she had her 1st prenatal check-up at Bato
Borongan City but doesn’t have a baby book yet.
2. Past Health History
As stated by the patient, she had no history of any hospitalizations. She
has experience cough and colds during her early years.
3. Immunization
As stated by the patient, she doesn’t know if she had a complete
vaccination during her childhood years.
4. Family Health History
4.1 Father Side
According to the patient her father is hypertensive and a cigarette
smoker too.
4.2 Mother Side
According to the patient her mother’s side has a history of
hypertension.
5. Allergies
According to the patient she had neither allergy to food nor beverages and
has not taken food supplements in the past.
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D. GORDON’S TYPOLOGY OF 11 FUNCTIONAL HEALTH PATTERNS

1. Health Management and Health Perception
Prior to the admission the patient stated that she was suffering from
severe vomiting since the month of January and this affects her well-being
because she experiences fatigue and restlessness and not able to
perform ADL’s due to her condition and she noticed some weight loss.
During Hospitalizations the patient stated that after some medication she
now consider herself as all well because in that day she’s not anymore
experiencing vomiting but still under observation.
2. Nutrition and Metabolic Patterns
Prior to the admission the patient stated that her usual meals during
breakfast was rice and a viand or bread and she is not choosy in terms of
eating but she preferred vegetables and sweets but because of severe
vomiting, either drinking or eating small amount of food or beverages
triggers her to vomit in any time of the day. She doesn’t drink plenty of
water and half glass of it is enough for her. patient has no allergy with food
and medicine.

3. Elimination Patterns
Before Hospitalization Mrs. X usually had a bowel elimination once a day
and did not specified how many times a day she urinates but she made
mentioned that she urinates frequently a day due to pregnancy and
according to the urinalysis her urine is yellow and slightly turbid.

4. Activity and Exercise

Before Hospitalization, patient considers her work being a team leader in J
and F as a form of exercise. According to her being a team leader works
all around, managing and assessing other team members though she
finds her work tiring, she doesn’t have any reasons to give up but due to
her severe vomiting she decided to quit on her job first because she is not
able to focus on it but given the chance she will go back to her work as a
team leader as soon as possible.
During Hospitalizations and able to take some medications her functional
level is as follows:
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Functional Level Classification Findings / Assessment

1. Perceived ability for bed mobility 4

2. Perceived ability for general mobility 4

3. Perceived ability for dressing 4

4. Perceived ability for bathing 3

5. Perceived ability for grooming 2

6. Perceived ability for toileting 4

7. Perceived ability for home maintenance 4

8. Perceived ability for shopping 4

9. Perceived ability for cooking 4

10. Perceived ability for feeding 4

11. Perceived ability for use of telephone 4

12. Perceived ability for going to places out 4

of walking distance

Legends:

0 = complete independent
1 = requires use of equipment or device
2 = requires help from another person for assistance, supervision, or
teaching
3 = requires help from another person and equipment or device
4 = complete dependence

5. Sleep-Rest Pattern
Prior to Hospitalization, the patient stated that she’s having a difficulty of
sleeping because of severe vomiting and restlessness and during
hospitalization, the patient stated that she usually sleeps 3 hours a day
she doesn’t have a consistent hour of sleep because she’s staying in the
hospital.
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6. Cognitive Perceptual
Based on observation, Patient’s senses are all functioning, she is able to
read and write. She is aware to the environment, has a good perception,
responses very well and very cooperative.

7. Self-Perception and Self-Concept Pattern

According to the client even before hospitalization, she always feels good
about herself. She’s always fine and able to do the things she wants to do
but due to her present illness, she is not able to do them. She described
her nervousness as 1 in a scale of 1-5, 1 is the lowest and 5 is the
highest.

8. Role-Relationship Patterns
According to the patient she lives in the house of her parents with his
husband and this is her first pregnancy and she has a good relationship to
her family and friends. She is not involved to any organizations in her
community.

9. Sexuality and Reproductive Pattern

The patient stated that she is sexually active she is satisfied with her
relationship to his husband. They don’t use any contraceptives and
engaged in any family planning method. She didn’t able to know her last
menstruation period because she’s having an irregular menstruation and
doesn’t have any pelvic problem.

10. Coping-Stress Tolerance Pattern

According to the patient, whenever they have a problem they talk about it
and provide choices or alternative to solve it. She always talks to her
husband about everything especially when it comes to financial problem
because she believes that everything will be alright when you talk to your
partner at all times.
11. Value-Belief Pattern
The patient stated that family is love, having a complete family gives her
peace and joy in life. She is a Roman Catholic, but seldom goes to church
because of her inconsistent time of working hours but she has a good faith
in God and surely believes and trust in Him.
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E. PHYSICAL ASSESSMENT
Assessment Findings Actual Findings

Integumentary

Skin When skin is pinched it goes Normal

to previous With brown and slightly dry
state immediately (2 skin
seconds).
With fair complexion.
With dry skin

Hair Evenly distributed hair. Evenly distributed hair.

With short, black and shiny With short, black hair.
hair.
With presence of pediculosis
Capitis.

Nails Smooth and has intact Normal with long nails.

epidermis Convex with good capillary
With short and clean reflex.
fingernails and
toenails.
Convex and with good
capillary refill time
of 2 seconds
Rounded, normocephalic and Normal
Skull symmetrical, smooth and has
uniform
consistency.
Absence of nodules or
masses.
Face Symmetrical facial Normal
movement, palpebral
fissures equal in size,
symmetric
nasolabial folds.

Eyes and Vision

Eyebrows Hair evenly distributed with Normal

skin intact.
Eyebrows are symmetrically
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aligned and
have equal movement.
Eyelashes Equally distributed
and curled slightly
outward.

Eyelids Skin intact with no discharges Normal.

and no
discoloration.
Lids close symmetrically and
blinks
involuntary.
Bulbar conjunctiva Transparent with capillaries Normal
slightly.
Lacrimal gland, Lacrimal sac,

Palpebral Conjunctiva Shiny, smooth, pink Normal

Sclera Appears white. Normal

Lacrimal gland, Lacrimal No edema or tenderness over Normal

sac, the
Nasolacrimal duct lacrimal gland and no tearing.

Cornea

Clarity and texture Normal

Transparent, smooth and
shiny upon
inspection by the use of a
penlight which
is held in an oblique angle of
the eye and
moving the light slowly across
the eye.
Has [brown] eyes.

Corneal sensitivity Blinks when the cornea is Normal

touched
through a cotton wisp from
the back of
the client.

Pupils Black, equal in size with Normal

consensual and
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direct reaction, pupils equally
rounded
and reactive to light and
accommodation,
pupils constrict when looking
at near
objects, dilates at far objects,
converge
when object is moved toward
the nose at
four inches’ distance and by
using
penlight.

Visual Fields When looking straight ahead, Normal

the client
can see objects at the
periphery which is
done by having the client sit
directly
facing the nurse at a distance
of 2-3 feet. The right eye is
covered with a card and
asked to look directly at the
student
nurse’s nose. Hold penlight in
the
periphery and ask the client
when the
moving object is spotted.

Visual Acuity Able to identify letter/read in Normal

the
newsprints at a distance of
fourteen
inches.
Patient was able to read the
newsprint at
a distance of 8 inches.

Ear and Hearing

Auricles Color of the auricles is same Normal

as facial skin,
symmetrical, auricle is
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aligned with the
outer canthus of the eye,
mobile, firm,
non-tender, and pinna recoils
after it is
being folded.

External Ear Canal Without impacted cerumen. Normal

Hearing Acuity Test Voice sound audible. Normal

Watch Tick Test Able to hear ticking on right Normal

ear at a
distance of one inch and was
able to hear
the ticking on the left ear at
the same
distance

Nose and sinuses

External Nose Symmetric and straight, no Normal

flaring,
uniform in color, air moves
freely as the
clients breathe through the
nares.

Nasal Cavity Mucosa is pink, no lesions Normal

and nasal
septum intact and in middle
with no
tenderness.
Mouth and Oropharynx Symmetrical, pale lips, brown Lips are pale.
gums and
able to purse lips.

Teeth With dental caries and Has visible and strong

decayed lower teeth with some removed
molars upper and lower molars.

Tongue and floor of the Central position, pink but with Normal
mouth whitish
coating which is normal, with
veins
prominent in the floor of the
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mouth.

Tongue movement Moves when asked to move Normal

without
difficulty and without
tenderness upon
palpation.
Uvula Positioned midline of
soft palate.

Gag Reflex Present which is elicited Normal

through the use
of a tongue depressor.

Neck Positioned at the midline Normal

without
tenderness and flexes easily.
No masses palpated.
Head movement Coordinated, smooth Normal
. movement with no
discomfort, head laterally
flexes, head
laterally rotates and
hyperextends
Muscle strength With equal strength Normal

Lymph Nodes Non-palpable, non-tender Normal

Thyroid Gland Not visible on inspection, Normal

glands ascend
but not visible in female
during
swallowing and visible in
males.

Thorax and lungs

Posterior thorax Chest symmetrical Normal

Spinal alignment Spine vertically aligned, Normal

spinal column is
straight, left and right
shoulders and hips
are at the same height.
Breath Sounds With normal breath sounds Normal
without
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dyspnea.
Anterior Thorax Quiet, rhythmic and effortless Normal
respiration
Abdomen Unblemished skin, uniform in Normal
color,
symmetric contour, not
distended.

Symmetrical movements Normal

Abdominal movements cause by respirations.

Auscultation of bowel With audible sounds of 23 Normal

sounds bowel
sounds/minute.
Upper Extremities Without scars and lesions on With some scars on both
both extremities.
extremities. (-) Lesions
Lower Extremities With minimal scars on lower Normal
extremities

Muscles Equal in size both sides of the Normal

body,
smooth coordinated
movements, 100%
of normal full movement
against gravity
and full resistance.

Bones and Joints No deformities or swelling, Normal

joints move
smoothly.

Mental Status

Language Can express oneself by Normal

speech or sign.
Orientation Oriented to a
person, place, date or time.

Attention span Able to concentrate as Normal

evidence by
answering the questions
appropriately.

Level of Consciousness A total of 15 points indicative Normal

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of complete
orientation and alertness.

Motor Function

Gross Motor and Balance

Walking gait Has upright posture and Normal

steady gait with
opposing arm swing unaided
and
maintaining balance.

Heel toe walking Maintains a heel toe walking Normal

along a
straight line

Toe or heel walking Able to walk several steps in Normal

toes/heels.

Fine motor test for Upper Extremities

Finger to nose test Repeatedly and rhythmically Normal

touches the
nose.
Alternating supination Can alternately supinate and Normal
and pronation of pronate
hands on knees hands at rapid pace.

Finger to nose and to Perform with coordinating and Normal

the nurse’s finger rapidity.

Fingers to fingers Perform with accuracy and Normal

rapidity.

Fingers to thumb Rapidly touches each finger Normal

to thumb
with each hand.

Fine motor test for the Lower Extremities

Pain sensation Able to discriminate between Normal

sharp and
dull sensation when touched
with needle
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and cotton.

F. VITAL SIGNS
Area Assessed Technique Used Normal Findings Actual Findings
Temperature Measured using 36.5 - 37.5 36.6 C
Thermometer
Pulse Rate Palpation 60- 100 bpm 92 bpm

Respiratory Rate Inspection 12-25 cpm 24 cpm

Blood Pressure Measured using 90/60-120-80 102/80 mmHg

sphygmomanometer mmHg
and stethoscope

G. LABORATORY FINDINGS:
A. HEMATOLOGY
TEST NAME RESULT NORMAL ANALYSIS
VALUES
Hgb 150 g/L 135-180g/L
Hct 0.64 0.40-0.54
WBC 6.7x10 3 /mm 3 4.5-11.0x10 3 /mm Normal
3

Diffeential
Count
Neutrophils .66 0.55-.70 Normal
Lymhocytes 0.20-0.40 Normal
Basophils
Monocytes
Eosinophil 0.01-0.04 Normal
Stab
CT
BT
Platelet
Count

B. URINALYSIS
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H. PATHOPHYSIOLOGY
TEST NAME RESULT NORMAL VALUES ANALYSIS

Color Yellow Pale yellow to amber Normal

Transparenc Slightly turbid Clear to slightly hazy Normal
y
pH 6.5 4.5-8.0 Normal
Sp. Gr. 1.020 1.015-1.025 Normal
Glucose
Albumin Trace
Sediments
Puss cell 1.0-1.5
RBC 0-2 0-2/HPF
Am urates Few
Am
phosphates
Epithelial Many
cells

Bacteria Rare
Mucus
threads
Cast
Hyperemesis gravidarum refers to intractable vomiting during pregnancy that leads to
weight loss and volume depletion, resulting ketonuria and/or ketonemia. There is no
consensus on specific diagnostic criteria, but it generally refers to the severe end of the
spectrum regarding nausea and vomiting in pregnancy.
Pathophysiology
The exact cause of hyperemesis gravidarum remains unclear. However, there are
several theories for what may contribute to the development of this disease process.
Hormone Changes
Levels of human chorionic gonadotropin (hCG) have been implicated. hCG levels
peak during the first trimester, corresponding to the typical onset of hyperemesis
symptoms. Some studies show a correlation between higher hCG concentrations and
hyperemesis. However, this data has not been consistent.
Estrogen is also thought to contribute to nausea and vomiting in pregnancy. Estradiol
levels increase early in pregnancy and decrease later, mirroring the typical course of
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nausea and vomiting in pregnancy. Additionally, nausea and vomiting are the known
side effects of estrogen-containing medications. As the level of estrogen increases, so
does the incidence of vomiting.
Changes in the Gastrointestinal System
It is well-known that the lower esophageal sphincter relaxes during pregnancy due to
the elevations in estrogen and progesterone. This leads to an increased incidence of
gastroesophageal reflux disease (GERD) symptoms in pregnancy, and one symptom of
GERD is nausea. Studies examining the relationship between GERD and emesis in
pregnancy report conflicting results.
Genetics
An increased risk of hyperemesis gravidarum has been demonstrated among women
with family members who also experienced hyperemesis gravidarum.
Two genes, GDF15 and IGFBP7, have been potentially linked to the development of
hyperemesis gravidarum.
Evaluation
There is no single accepted definition for hyperemesis gravidarum. However, it
generally refers to the extreme cases of nausea and vomiting during pregnancy. It is a
clinical diagnosis. The criteria for diagnosis include vomiting that causes significant
dehydration (as evidenced by ketonuria or electrolyte abnormalities) and weight loss
(the most commonly cited marker for this is the loss of at least five percent of the
patient’s pre-pregnancy weight) in the setting of pregnancy without any other underlying
pathological cause for vomiting. Significant abdominal tenderness, pelvic tenderness, or
vaginal bleeding should prompt workup for alternative diagnoses.
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 DRUG ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING RESPONSIBILITY
Binds to Treatment of History of Antibiotic-associated Baseline assessment
bacterial cell susceptible hypersensitivity/anaphylacti colitis, other Obtain CBC, renal function tests.
Cephalexin membranes, infections due c reaction to superinfections Question for history of allergies,
500 mg Oral inhibits cell to cephalexin, cephalosporins. (abdominal cramps, particularly
wall staphylococci, Cautions: Renal severe cephalosporins, penicillins.
PHARMACOTHERAPEUTIC: synthesis. group A impairment, history of GI watery diarrhea, Intervention/evaluation
First-generation Therapeutic streptococcus, disease fever) may result Assess oral cavity for white patches on
cephalosporin. Effect: K. pneumoniae, (esp. ulcerative colitis, from altered bacterial mucous membranes, tongue (thrush).
CLINICAL: Antibiotic. Bactericidal. E. coli, P. antibiotic-associated colitis), balance in GI tract. Monitor daily pattern of bowel activity,
mirabilis, H. history of penicillin allergy. Nephrotoxicity may stool consistency. Mild GI effects may
influenzae, M. occur, esp. in pts be tolerable (increasing severity may
catarrhalis, with preexisting renal indicate onset of antibiotic-associated
including disease. Pts with colitis). Monitor I&O, renal function tests
respiratory tract, history of penicillin for nephrotoxicity. Be alert for
genitourinary allergy is at superinfection: fever, vomiting, diarrhea,
tract, skin, soft increased risk for anal/genital pruritus, oral mucosal
tissue, bone developing a severe changes (ulceration, pain, erythema).
infections; otitis hypersensitivity With prolonged therapy, monitor
media; reaction (severe renal/hepatic function tests.
rheumatic fever pruritus, Patient/family teaching
prophylaxis; angioedema, • Doses should be evenly spaced.
follow-up to bronchospasm, • Continue therapy for full length of
parenteral anaphylaxis). treatment.
therapy. • May cause GI upset (may take with
OFFLABEL: food, milk).
Suppression of • Refrigerate oral suspension.
prosthetic joint • Report persistent diarrhea.
infection.
 DRUG ACTION INDICATION CONTRAINDICATI ADVERSE NURSING RESPONSIBILITY
ON EFFECTS
Ampicillin inhibits Treatment of susceptible Hypersensitivity to Antibiotic-associated Baseline assessment
bacterial cell wall infections due to ampicillin, any colitis, other Question for history of allergies,
Ampicillin synthesis. streptococci, S. penicillins, or superinfections esp. penicillins, cephalosporins;
1 g q8h Sulbactam inhibits pneumoniae, sulbactam. (abdominal cramps; renal
bacterial staphylococci (non– Hx of cholestatic severe, impairment.
beta-lactamase. penicillinase-producing), jaundice, hepatic watery diarrhea; Intervention/evaluation
CLASSIFICATION Therapeutic meningococci, Listeria, impairment fever) may result Promptly report rash (although
PHARMACOTHERAPE Effect: Ampicillin is some associated with from altered bacterial common with ampicillin, may
UTIC: Penicillin. bactericidal in Klebsiella, E. coli, H. ampicillin/sulbactam balance in GI tract. indicate
CLINICAL: Antibiotic. susceptible influenzae, Salmonella, . Cautions: History Severe hypersensitivity) or diarrhea (fever,
microorganisms. Shigella, including GI, of allergies, esp. hypersensitivity abdominal pain, mucus and blood
Sulbactam protects GU, cephalosporins; reactions, including in stool
ampicillin from respiratory infections, renal anaphylaxis, acute may indicate antibiotic-associated
enzymatic meningitis, endocarditis impairment; interstitial colitis). Evaluate IV site for
degradation. prophylaxis. OFFLABEL: infectious nephritis, blood phlebitis. Check
Surgical prophylaxis for mononucleosis; dyscrasias may IM injection site for pain, induration.
liver transplantation. asthmatic pts. occur. High dosage Monitor I&O, urinalysis, renal
may produce function
seizures. tests. Be alert for superinfection:
fever, vomiting, diarrhea,
anal/genital pruritus,
oral mucosal changes (ulceration,
pain, erythema).
Patient/family teaching
• Take antibiotic for full length of
treatment.
• Space doses evenly.
• Discomfort may occur with IM
injection.
• Report rash, diarrhea, or other
new symptoms.
DRUG ACTION INDICATION CONTRAINDICATION ADVERSE NURSING
EFFECTS RESPONSIBILITY
 Inhibits histamine Short-term treatment of Hypersensitivity to Reversible Baseline assessment
Apo-RaNITIdine action at active duodenal ulcer. raNITIdine. OTC: Do not hepatitis, Obtain history of
IV histamine H2- Prevention of duodenal use if trouble blood epigastric/abdominal
receptors of ulcer or pain when swallowing dyscrasias pain.
PHARMACOTHERAPEUTIC gastric parietal recurrence. Treatment of food, vomiting with occur rarely. Intervention/evaluation
: Histamine H2-receptor cells. active benign gastric blood, or bloody or black Assess mental status in
antagonist. Therapeutic ulcer, pathologic GI stool is elderly. Question present
CLINICAL: Antiulcer. Effect: Inhibits hypersecretory conditions, present. Do not use 150 abdominal pain, GI
gastric acid acute gastroesophageal mg with kidney disease distress.
secretion. reflux disease (GERD), (unless medically Patient/family teaching
Reduces gastric including erosive advised). • Smoking decreases
volume, esophagitis. Maintenance Cautions: Renal/hepatic effectiveness of
hydrogen ion of healed erosive impairment, elderly pts, medication.
concentration. esophagitis. OTC: history of acute • Do not take medicine
Relief of heartburn, acid porphyria. within 1 hr of
indigestion, sour stomach. magnesium- or
OFF-LABEL: Treatment aluminum-containing
of antacids.
upper GI bleeding. • Transient
Prevention of stress- burning/pruritus may
induced ulcers in ICU. occur with IV
Anaphylaxis administration.
(adjunct therapy). • Report headache.
Premedication to prevent • Avoid alcohol, aspirin.
taxane hypersensitivity.

DRUG ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING RESPONSIBILITY

 Stimulates motility ORAL: Symptomatic Hypersensitivity to Extrapyramidal Baseline assessment
Metoclopramide of upper GI tract. treatment of diabetic metoclopramide. reactions occur Antiemetic: Assess for
q8h 2 doses Blocks gastroparesis, Concurrent use of most frequently in dehydration (poor skin turgor,
dopamine/seroton gastroesophageal medications likely to children, young dry mucous membranes,
PHARMACOTHERAPEUT in receptors in reflux. produce adults (18–30 longitudinal furrows in tongue).
IC: DOPamine receptor chemoreceptor IV/IM: Symptomatic extrapyramidal yrs) receiving large Assess for nausea, vomiting,
antagonist. trigger zone. treatment of diabetic reactions. Situations doses (2 mg/kg) abdominal
CLINICAL: GI emptying Enhances gastroparesis, in which GI during distention, bowel sounds.
adjunct, peristaltic acetylcholine placement of enteral motility may be chemotherapy and Intervention/evaluation
stimulant, antiemetic. response in upper feeding tubes, dangerous (e.g., GI usually are Monitor for anxiety,
■ BLACK BOX ALERT ■ GI tract; prevent/treat hemorrhage, GI limited to akathisia restlessness, extrapyramidal
Prolonged use may cause increases lower nausea/vomiting with perforation/obstruction (involuntary limb symptoms (EPS) during IV
tardive dyskinesia. esophageal chemotherapy or ), movement, facial administration. Monitor daily
sphincter tone. after history of seizure grimacing, motor pattern of bowel activity, stool
Therapeutic surgery. To stimulate disorder, restlessness). consistency. Assess
Effect: gastric emptying and pheochromocytoma. Neuroleptic skin for rash. Evaluate for
Accelerates intestinal transit of Cautions: Renal malignant syndrome therapeutic response from
intestinal transit, barium when impairment, (diaphoresis, fever, gastroparesis (nausea,
promotes gastric delayed emptying HF, cirrhosis, unstable B/P, vomiting, bloating). Monitor
emptying. interferes with the hypertension, muscular rigidity) renal function, B/P, heart rate.
Relieves nausea, radiological depression, has been reported. Patient/family teaching
vomiting. examination of the Parkinson’s disease, • Avoid tasks that require
stomach elderly. alertness, motor skills until
and/or small response to drug is
intestine. To facilitate established.
small bowel • Report involuntary eye,
intubation in adults facial, limb movement
and children. (extrapyramidal reaction).
• Avoid alcohol.
ASSESMENT DIAGNOSIS PLANNING INTERVENTIONS EVALUATION
S: “Medjo okay nak yana Risk for deficient fluid After 30 min of interview,
compared han hani, waray volume as evidence by the patient and nurse will
nak pagsuka yana na adlaw patient reports of vomiting be able to;
tas dri nak nalilinop” as every day and poor  Identify the cause
verbalized by the patient appetite. of the excessive
vomiting and apply
O: appropriate
 The patient is visibly interventions.
weak  Reduce and
 Pale, dry skin manage symptoms
 Temp. 36.6 C of nausea and
 PR 92 bpm vomiting; maintain
 RR 24 cpm appropriate
 BP 102/80 mmHg nutrition and
hydration; avoid
complications and
injury to patient and
fetus through health
teaching.
1. Review laboratory data to evaluate After 30 min of comprehensive
fluid and electrolyte status. nursing intervention, the nurse
and patient was able to:
2. Assess skin and oral mucous  Identified the cause of
membranes for severity of excessive vomiting and
dehydration, such as dry skin and apply appropriate
mucous membranes, poor skin interventions such as:
turgor, delayed capillary refill and flat Reviewed laboratory
neck veins. result and assessed
skin and moral mucous
3. Engage client, family, and all membrane
caregivers in a fluid management  Reduced and managed
plan. This enhances cooperation with symptoms of nausea
the regimen and achievement of and vomiting
goals.
4. Prevent current occurrence of
deficit
 Compare current fluid intake to
fluid goal
 Weight the client and compare
with recent weight history
 Offer a variety of fluids and
water-rich foods, and make it
available throughout the day, if
the client is able to take oral
fluids.
 Assist/remind the client to
drink, as needed
 Administer Medications as
appropriate.
5. Promote wellness
  Discuss individual risk
factors, potential problems
and specific Interventions
6. Initiate and monitor IV
hydration while keeping the
patient NPO (nothing by
mouth) for 48 hr, as prescribed
by the health care provider. R:
This approach aids in resting
GI motility, resolving
dehydration, and improving
electrolyte balance caused by
intractable vomiting

ASSESMENT DIAGNOSIS PLANNING INTERVENTIONS EVALUATION

 S: “Nagsisinuka man ak Risk for Electrolyte After 30 minutes of health
tikang pa han January, bisan Imbalance d/t teaching, the client will be 1. Assess characteristics of the
ano tak kanoon or inumon Vomiting and poor eating able to know and manage patient’s nausea/vomiting: frequency,
iginsusuka ko” as verbalized habits. her vomiting and eat duration, and severity; amount and
by the patient. appropriate foods to color of vomitus; accompanying
sustain nutritional needs symptoms (abdominal pain, diarrhea,
of her body and the baby. dyspepsia [a vague feeling of
O: discomfort or bloating after eating]);
 Temp. 36.6 C and precipitating factors. Reassess
 PR 92 bpm q8h or as indicated. R: This
 RR 24 cpm comprehensive initial assessment
 BP 102/80 mmHg provides a basis for nursing
 Slim body for a 13- interventions/teaching and a
week pregnant woman subsequent comparison for changes.

2. Encourage patient to take

approximately 100 mL (e.g., in 1 oz.
portions qh) of liquid between each
meal and avoid fluids with meals. R:
This measure prevents dehydration
between meals, over distension of the
stomach during meals, allowing more
space for caloric foods, and may
prevent nausea.

ASSESMENT DIAGNOSIS PLANNING INTERVENTIONS EVALUATION

S:
“Dire naman ak nakakakaon kay
kun nakaon ak or nainom, permi
ko la ginsusuka” as verbalized by
the client.
O:
 Pale mucous membrane,
 dry skin and lips
 Food intake less than
recommended daily
allowances
 Weakness of muscles
Imbalanced nutrition: Less Within 24 hours, the 1. Assess for signs of starvation q8h
than body requirements patien will be able to (e.g., jaundice, bleeding from mucous
related to inability to increase her nutritional membranes, and ketonuria). R:
ingest, digest, and absorb intake and will Insufficient nutrition may cause
sufficient nutrients and demonstrate improvement hypothrombinemia, depleted vitamin
calories because of in her acid-base balance, C and B complexes, and ketosis and
prolonged vomiting. electrolytes, and may harm the fetus.
nutritional status.
2. Suggest alternative dietary
patterns (e.g., frequent small and dry
meals, six or more per day, followed
by clear liquids). R: Small, frequent,
dry meals may reduce nausea and
vomiting from a distended stomach.
3. Administer prescribed therapies for
nausea, e.g., ginger or ginger syrup;
antiemetic medications such as
pyridoxine (vitamin B6) (Cochrane
Review), metoclopramide (Reglan),
or promethazine (Phenergan) as
indicated by physician. R: These
therapies are known to decrease
nausea and may enable the patient to
ingest and retain fluid and food
nutrients, vitamins, proteins,
carbohydrates, and fats from oral
intake.
K. WORKSHEET B (HEALTH TEACHING PLAN)
 HEALTH TEACHING
Teaching Strategies Learning Content Time Resources Evaluation
Objectives Duration
The main objective Discussion Teaching Plan
of this teaching 1. Dietary Changes 30 minutes Materials: The patient and the SO showed
plan is to give the Demonstratio  Try eating before soon as you feel hungry for the Laptop interest during the discussion
client the n to avoid empty stomach discussion Leaflets and demonstration
knowledge about  Eat snacks frequently and have small
the importance of Video meals (six small meals a day) high in Human: The patient verbalizes
Nurse
hydration, eating presentation protein or carbohydrates and low in fat. understanding on the discussion.
Significant
Nutritious food,  Bland diet Others
increasing fluid  Drink Cold, clear and sour fluids and drink
intake for safe these in small amounts between meals
pregnancy and  Eat small amount of food every 1 to 2
things to do to hours
lessen nausea and
vomiting. 2. Fluid Intake
 Drink liquid as directed. Drink small
amount of liquid to prevent dehydration
3. Rest when needed
 Avoid things that may make hyperemesis
worse
 Avoid odors, heat and humidity.
 Limit noise and flickering lights
 Smelling fresh lemon, mint or orange or
any scents that are useful
4. Relaxation techniques, massage, alternative
medicine practices, and distraction to alleviate
the discomforts of nausea and vomiting or the
actual symptoms
.
 L. LEARNING FEEDBACK
A. Significant Activities
During our entire duty in the Eastern Samar Provincial Hospital, our
clinical instructor is Ma’am Ammy Evilynda C. Cesista. Before we went to our
assigned patients, Maam Cesista first oriented us on what we should do while on
duty. We took their vital signs and monitor the other patients. We performed
bedside care, assisted patients with their needs like positioning themselves, we
interviewed the patients and gather some data about them. We got the chance to
see the patient’s chart and analyzed the Doctor’s order. In the following days of
duty, some of us had given medications to patients through oral and some were
tasked to give medication through IVTT.

B. Nursing Observations
During our duty, the ward was kept clean. Every now and then, there
would be new patients being admitted. The patients seemed uncomfortable with
oyur presence but they fe
C. Personal Reaction
We feel very happy for those patients because we know that they are also
happy that they already had the operations and others, finally, will be having their
operation. We love how the doctors and nurses from the Bulig Kablas Medical
Mission treated the patients because we know they are trying their best to
understand patients and assist their health needs. Were so amazed on how they
have their rounds because we can see that they really have the heart to help
patients. Whenever these people smiles, patients also smiles which makes the
ward a very busy yet happy place to us, to the client’s SO and to post-operative
patients.

D. Learning Insights
While on our duty, we learned that we should not just sought to help
patients just for personal experience of handling patients but also we should be
able to understand and acknowledge patients’ stories, feelings and have
empathy for them. It is really important that we establish not only to our individual
patients but also to their significant others, who, just like us give care to our
patients. Being with the patients, taking care of them, and understanding them is
really a great responsibility that we, student nurses, should be very patient with.
We should have a good communication skills not only for our own good but also
for the patients, for them to be open with us and render them the appropriate
service that they need while in the facility.

E. Recommendation

We are hoping that the facility will always give their best of care to patients in
order for them to fully recover from their illnesses. It will also be good to the patients
if the facility’s surrounding will be maintained for patient’s comfort and faster
recovery.

M. REFERENCES:
 Barbara Kozier, MN, RN, and et al; Fundamental of Nursing, Concepts, Process,
and Practice, 8th Edition; Pearson Prentice Hall, Upper Saddle River, New Jersey
07458

 Marilyn Doenges, Mary Frances Moorhouse, et al; Nurse’s Pocket Guide. 14 th

edition, F. A Davis Company, Philadelphia, Pennsylvannia