Hyperemesis Gravidrum and Nursing care Plan

Hyperemesis-Gravidarum
Hyperemesis Gravidrum

About 75% of all women experience a mild form of nausea and vomiting in early pregnancy called” morning sickness” usually disappear by about 12th week, however, vomiting persist causing serious dehydration and starvation such, a condition is called hyperemesis gravidrum .

Hyperemesis Gravidrum Definition
Is a complication of pregnancy characterized by persistent, uncontrollable vomiting that begins in the first weeks of pregnancy and may continue throughout pregnancy.

Incidence:
Varies from 0.5-10 per 1000 births

Etiology:
The cause as unknown, but tend to be younger than 20 years, obese and may related to high level of estrogen or human chorionic gonadotropin and may be associated with transient hyperthyroidism during pregnancy, other possible cause include vitamin B deficiency and increased sensitivity to circulating sex steroid hormone.
Psycho logic factors such as ambivalence toward the pregnancy and family-related stress, and conflicting feeding regarding prospective motherhood, body changes.

Sign and symptoms

Begin with morning sickness and become increasingly sever.
Frequent vomiting when mention, sight or smell food.
Loss of weight
Dehydration
Tachycardia
Thirst
Scanty concentrated urine
Jaundice caused by liver damage
Blindness caused by retinal hemorrhage
Convulsion
Death

If the fetus dies and expelled, nausea usually stop immediately but damage to major organs of the mother may be permanent.

Assessment:
–     Subjective data
–     a 24 hour dietary recall
–     history of nausea and vomiting
–     Objective data
–     presence of continuous vomiting
–     weight loss
–     pale, dry skin with poor turgor
–     vital sign to monitor increase or decrease in temperature and pulse
–     laboratory data for indications of electrolytes imbalance and starvation “BUN, creatinine, serum electrolytes, liver function studies”

Nursing diagnosis:
Fluid volume deficit related to prolonged vomiting.

Nursing intervention:
–     if vomiting is sever, the woman is hospitalized and oral intake is restricted for 24-48 hours, IV fluid are administered.
–     assess intake and output, serum electrolytes and report abnormalities.
–     oral liquid intake is resumed slowly, usually high in carbohydrates.
–     vitamins B complex to combat nausea.
–     administer antiemetics as prescribed.

Nursing diagnosis:
Altered nutrition: less than body requirement related to vomiting.

Nursing intervention:
–     advise the woman that oral intake can restarted when emesis has stopped and appetite return.
–     begin small feeding, suggest or provide bland solid foods.
–     administer parentral calories replacement .
–     educate woman about proper diet.
–     avoid strong food odors
–     avoid greasy foods
–     give vitamin supplement as prescribed.

Nursing diagnosis:
Ineffective individual coping related to stress of pregnancy and illness

Nursing intervention:
–     have the woman discuss her perception of the problems
–     discuss possible resolutions to problems identified.
–     restriction of visitors usually relieves stress.

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Posted in Maternity, Nursing Care Plans, Nursing Intervention

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