SRI GURU RAM DASS NURSING

INSTITUTE PANDHER, AMRITSAR.

CASE PRESENTATION
ON
HYPEREMESIS
GRAVIDARUM

Submitted To: DR.

Sukhdeep Kaur
(Associate
Professor)
(Head of Deptt.)
OBG. & Gynae

Submitted By: Kartik

Kishore
M. Sc. Nursing
(1st year)
 PATIENT'S IDENTIFICATION DATA:

Name of Patient: Mrs. Simranpreet kaur

Age / sex: 27yrs / female

Education: Graduate

Occupation: House wife

Blood Group: B +ve

Marital status: Married

Religion: Sikh

Name of Husband: Mr. Roop Singh

Education: Graduate

Occupation: Self Business

Total Income: 25,000 per month

Address: Amritsar

Date of admission: 20-02-2020

C.R. No.: 65228

I.P.D. No: 202020118

Obstetrical Score: G-2, P-1, A-0, L1

LMP: 07-12-2020

EDD: 14-09-2020

Doctor Incharge: Dr. Raksha Gupta

Diagnosis: Hyper-emesis Gravidarum

CHIEF COMPLAINTS: The chief complaints of the patient are Nausea, vomiting,
dehydration and weight loss since 1 week with pregnancy.
 HISTORY OF PRESENT ILLNESS:

1) MEDICAL HISTORY: Patient has admitted in hospital with the chief complaints
of Nausea, vomiting, dehydration and weight loss since 1 week with pregnancy. After
investigations doctor diagnosed her as Hyper-emesis Gravidarum. Now she is under
treatment in Bebe Nanki Hospital, Pandher.

2) SURGICAL HISTORY: No any significant of present surgical history.

HISTORY OF PAST ILLNESS:

PAST MEDICAL HISTORY: No any significant of past medical history.

PAST SURGICAL HISTORY: No any significant of past surgical history.

FAMILY HISTORY: Patient lives in joint family with her husband. All the family
members are good & healthy. No any medical or congenital disorder present in
family.

FAMILY MEMBERS:-
S NAME OF AGE/ RELATIONSHIP EDUCATION Occupation HEALTH
No. FAMILY SEX WITH CLIENT STATUS
MEMBERS
1. Mr. Roop 30y/M Husband Graduate Shopkeeper Healthy
Singh
2. Mrs. 27y/F Patient Graduate Housewife Unhealthy
Simranpreet
Kaur
3. Mst. Ambar 3y/M Son - - Healthy
singh

FAMILY TREE

Mr. Roop Singh Mrs. Simrapreet kaur

 30 yrs old 27 yrs old

Mst. Ambar Singh

3 years old

Keys:
Male

Female patient

MENSTRUAL HISTORY:
Age of menarche: 13 years
Duration of cycle: 30 days
Number of days: 5 days
Flow: Normal
Discomfort during menstruation: Mild Dysmenorrhoea

MARITAL HISTORY:
Age of Marriage: 23 years
Nature of marriage: Arranged marriage

OBSTETRICAL HISTORY:

S. Year/ Pregnancy LABOUR Method Puerperium BABY WEIGHT AT

No. Date Event / BIRTH/SEX/DURATION
Delivery OF BREAST FEEDING
1. 2017 About 36 Normal Normal 6 weeks 1) 3 Kg birth weight/
weeks vaginal vaginal (Normal) Male baby/ 1 year
delivery delivery breast feeding
(1st) duration
2. 2020
PRESENT PREGNANCY

 Number of living children : 1 Baby

 Health status of babies : Healthy
 Immunization : Partial
  Last Issue : No any last issue

PRESENT OBSTETRICAL DETAILS:

 Last menstrual period : 10-01-2020
 Expected date of delivery : 17-09-2020

SOCIO-ECONOMIC STATUS:
 Type of house : Cemented house
 Number of Rooms : 3 rooms
 Total income per month : 30,000 from all sources
 Latrine facility : Available
 Drainage facility : Good

PERSONAL HISTORY:
 Sleeping pattern : About 9 hours
 Diet Habit : Disturbed due to vomits
 Bowel and bladder Habit : Good
 Allergic to diet : No any significant
 Personal hygiene : Good
 Amount of water intake :10-12 glasses per day

PHYSICAL EXAMINATION:

GENERAL APPEARANCE:
 Nourishment : Moderate
 Body Build : Moderate
 Health : Unhealthy
 Activity : Dull

VITAL SIGNS:
 Temperature : 99 F
 Pulse : 86/min
 Respiration : 20/min
 B.P : 100/60mm (Hg)

MENTAL STATUS:
 Consciousness : Conscious
 Look : Depressed

POSTURE:
 Body curves : Normal
 Movement : Allowed
HEIGHT & WEIGHT:
 Height : 5’4”
 Weight : 58 kg

SKIN CONDITION:
 Colour : Fair
 Texture : Normal

HEAD:
 Hair Colour : Black
 Texture of hairs : Rough
 Dandruff : Present
 Scalp : Clean

EYES:
 Eye brows : Symmetrical
 Conjunctiva : Normal
 Eye Lids : No infection present
 Pupillary reaction : Reacting to light
 Vision : Normal
 Sclera : White

NOSE:
 Nasal drainage : Absent
 Nostrils : Normal
 Epistaxis : Absent

MOUTH:
 Lip colour : Pink
 Lip Texture : Rough
 Teeth : Pale yellow in colour (Normal)
 Colour of teeth : Pale yellow
 Dental carries : Absent
 Gums : No inflammation

TONGUE:
 Colour : Pink
 Pharynx : Normal

EAR:
  Alignment : Normal (Symmetrical)
 Discharge : Absent
 Hearing : Normal

NECK:
 Range of motion : Normal
 Lymph nodes : Not palpable
 Thyroid glands : Normal, no enlargement

CHEST:
 Chest measurement : Normal
 Respiratory rate : 24 per minute
 Breath sound : Normal, no wheezing sound
 Heart sound : S1 and S2 sound present

BREAST:
 Shape : Round
 Axillary lymph nodes : Not palpable
 Nipples : Symmetrical, not cracked and not inverted
 Discharge : No any abnormal discharge present

NAILS:
 Shape : Round
 Texture : Smooth
 Colour : Pink

ABDOMEN:
Inspection:
 Skin colour : Fair
 Linea nigra : Present
 Umblicus: Round
 Striae gravidarum: Absent

Palpation : Abdominal organs are normal

Auscultation : Normal bowel sound

BACK:
 Back ache : Absent
 Lesions : Absent

EXTREMITIES:
 Deformities : No any deformity present
  Edema : Absent
 Range of motion : Proper

GENITALIA:
 Lesions : Absent
 Inguinal lymph node : Present
 Anal patency : Good

VITAL SIGNS:

S. VITALS PATIENT NORMAL REMARKS

No VALUE VALUE
1 Temperature 99 F 98.6F Pyrexia
2 Pulse 86/Min 72-80/ Min Tachycardia
3 Respiration 20/min 16-24/ Min Normal
4 B.P 100/60 mm(Kg) 120/80 mm (hg) Hypotension

INVESTIGATIONS:
 Ultra sonography (USG): Normal gestational period. Level of AFI is normal.
 Liver function test: Elevated liver enzymes and serum amylase.
 Serum Electrolyte test: hypokalemia ketones in blood and urine.
 Urine analysis: Concentrated urine in small quantities with high specific
gravity with the presence of acetone and with diminished or absent chloride.

LAB INVESATIGATION:

S. NO TEST PATIENT VALUE NORMAL VALUE

1. TLC 10,200/cu mm 4-11000/cu mm

2. DLC :
 Polymorph 59% 50-60%
 Neutrophils 43% 40-70%
 Eosinophil 2% 1-6%
 Basophils 1% 0-1%
3. Blood group B +ve -
4. Hb% 10 gm 12-16gm
5. Blood sugar F-90mg/dl 70-130mg/dl
6. Serum 3.2 g 3.5-4.5g
potassium
7. S. Sodium 130 g 135-145mg
(Na+)
8. HIV Negative -
 9. HbsAg Negative -
10. Bleeding time 1’-6” min 0-5 min
11. Clotting time 4’-16” min 5-10 min
12. Urine Albumin Nil Nil
13. Urine sugar Nil Nil

SUMMARY:
I have taken the patient Mrs. Simranpreet kaur, 27 years old, diagnosed with
Hyperemesis gravidarum. She came in hospital with the chief complaints of nausea,
vomiting, weakness and weight loss since1 week. Advise is given to take proper rest,
nutritious diet and plenty of fluids.
In this case presentation, I have presented:-
 Introduction of patient
 Obstetrical history
 Menstrual history
 Personal history
 Physical examination
 Investigations
 Medications
 Disease condition
 Nursing diagnosis and
 Health education

RECAPITULATION:
After this presentation, group will able to give answers to my questions:
 Define Hyperemesis gravidarum?
 Explain causes of Hyperemesis gravidarum?
 What are the sign and symptoms of Hyperemesis gravidarum?
 Explain diagnostic evaluation of Hyperemesis gravidarum?
 What are the managements of Hyperemesis gravidarum?
 Explain its complications and nursing management?

CONCLUSION
Through this case presentation, Group has learned about Hyperemesis gravidarum, its:
 Definition
 Causes
 Clinical manifestations
 Diagnostic evaluations
 Managements
 Complications and its
 Nursing management
Now, they have sufficient knowledge about placenta previa that will helpful for them
in future.
HEALTH EDUCATION:
Regarding Diet:
 Instruct the client to take meal thrice in a day.
 Instruct the client to avoid more spicy & fatty food.
 Instruct the client to take high caloric and iron rich diet.
 Take plenty off fluids.
 Take small and frequent meals.

Regarding Activity:
 Teach the client to take the proper rest & sleep.
 Instruct client to avoid heavy weight lifting.

Regarding Hygiene:
 Instruct the client & family members to maintain proper personal &
environmental hygiene.
 Teach the client & family members about hand washing methods.

Regarding Treatment:
 Instruct the client to complete her full course of medications.
  Instruct the client about every procedure done on client.
 Instruct client about common side effects of medicines.

Regarding Follow-up:
 Instruct the client for follow up visits.
 Instruct the woman to notify her health care provider if she experiences any
change in health.

BIBLIOGRAPHY:

 Dutta DC “A textbook of obstetrics sixth edition” published by –Hiralal

Konar.
 William & Wilkins, Lippincott “A textbook of Manuals of Nursing Practice 9th
edition” published by- Wolters Kluwer.
 Kumari Neelam, Sharma Shivani, Dr. Gupta Preeti “A text book of Midwifery
and Gynaecological Nursing” Published by Pee Vee.