DISEASE CONDITION:

HYPEREMSIS GRAVIDARUM:

DEFINITION:-It is a severe type of vomiting in pregnancy which has got

deleterious effect on the health of mother and incapacitate her in day to day
activities.

The simple vomiting or emesis gravidarum is normal in pregnancy.

CAUSES:-
 HORMONAL:- It is related to rising in Human chorionic
Gonadotropins (HCG) level or estrogen level which are elevated in
first trimester of pregnancy.
 PSYCHOGENIC THEORY:- These theories describe hyper-emesis
gravidarum as a conversion or somatization disorder or inability of
women to respond to excessive life stress.
 Appetite disturbance
 Seen in multiple pregnancy & history of hyperemesis in previous
pregnancy.
 Decreased gastric motility accompanies the condition.

CLINICAL MANIFESTATION:-

BOOK PICTURE PATIENT PICTURE

1. Persistent vomiting: - Inability to tolerate  Patient is unable to tolerate anything by
anything by mouth. mouth, she has after eating anything.
 Signs of dehydration are present in client
2. Dehydration: Fever, dry skin, decreased i.e.
urine output, large ketonuria.  Mild fever
 Decreased urine output
 Dry skin.
3. Weight Loss (Up to 5% to 10% of body
 Patient has lost her weight about 2 kg in 1
weight).
week.
4. Severity of symptoms commonly
increases as the condition progressive. -

5. Electrolyte imbalances.
 There is fall in the level of potassium &
plasma sodium in client.
DIAGNOSTIC EVALUATION:

BOOK PICTURE PATIENT PICTURE

1. Past history of Hyperemesis  Past history of client is taken patient has
Gravidarum. no any medical & obstetrical history of
 Medical Hyper-emesis gravidarum.
 Obstetrical history

2. Physical examination  Head to toe examination of client is

done. Height -5’3”, Weight-52 Kg.
3. Tests may be done to rule out other  Tests are done on client.
conditions causing vomiting.
- In ultrasonography there is no any other
- USG Abdomen for rule out
condition present.
cholecystitis, appendicitis,
pancreatitis etc.  Blood test done on client. It is with in
4. Blood tests:-for thyroid disease normal limits.
- Serum electrolyte test- This
is done to rule out - All tests are within normal
hypokalemia, hypernatremia, limits.
or hypernatremia; loss of - Serum bilirubin level is
hydrogen and chloride. mildly elevated.
- Liver function studies:-
serum Bilirubin & serum  ECG is normal.
amylase levels are elevated.
5. ECG: It shows hypokalemia.

NURSING MANAGEMENT:

BOOK PICTURE PATIENT PICTURE

1) Assess vital signs of client & record  Vital signs of client are checked & vital
vital signs to access progress of patient chart of client are maintained.
every 2 hours.
2) Maintains daily intake & output charts  Daily intake & output chart of client is
of client. maintained.
3) Sympathetic but firm handling of client
is necessary.  Client should be handle firmly.
4) Encourage the client to drink plenty of  Patient is encouraged to drink plenty of
fluids. water.
5) Note the amount of vomits.  Amount of vomit is noted.
6) Provide Psychological support to client.  Psychological support is provided to
client.
7) Electrolyte balance should be
maintained in patient.
 I.V. fluids are administered to patient.
8) Frequent monitoring of patient should
 Patient is monitored frequently.
be done.
MANAGEMENT:-

1. Try withholding food and fluid for 24-48 hours or until vomiting stops
and appetite returns; then restarts small feedings.
2. Control of vomiting may require anti-emetics such as :
a. Phenothiazines: Prochloroperazine (Companize, injectable or
rectal suppository) Promethazine (Phenergan); or
chloropromazine(Thorazine).
b. Domperidol (Inapsine).
c. Metoclopramide (Reglan)- Do not give in combination with
phenothiazines.
d. Meclizine (Antivert).
e. Methylprednisolone( Recently found to more helpful than
promethazine; mg per day 3 times for 3 days then tapered over
2 weeks).
3. Treat dehydration with I.V. fluids- typically 1 to 3 liter of dextrose
solution with electrolytes and vitamins as needed.
4. Most women respond quickly to restricting oral intake and giving I.V.
fluids, but repeated episodes may occurs.
5. Rarely total parental nutrition is needed.

COMPLICATIONS:

 Hypovolemia & renal insufficiency.

 Electrolyte imbalance.

NURSING DIAGNOSIS:
1. Risk for fluid volume deficient related to prolonged vomiting.
2. Imbalanced nutrition less than body requirement related to inability to
ingest or digest & prolonged vomiting.
3. In effective copying related to stress of pregnancy and illness.
4. Fatigue related to muscle weakness secondary to imbalanced nutrition.
5. Fear and anxiety related to excessive vomiting.
6. Activity intolerance related to excessive vomiting.
7. Disturbed sleeping pattern related to excessive vomiting.
8. Knowledge deficit related to disease conditions.

NURSING GOALS:

1) Short term Goals:

a) To check the vital signs of client every 2 hours.
b) To maintain good interpersonal relationship with client.
c) To provide comfort to client.
 d) To administer medications to client as per doctor’s order.
e) To maintain fluid volume of client.

2) Long Term Goals:

a) To promote health of client.
b) To prevent disease condition of client.
c) To maintain good nutritional status of client.
d) To teach the client about importance of hygiene.
e) To instruct the client about follow up care.