Nursing Care Plan for Hyperemesis Gravidarum

Pathophysiology

Hyperemesis gravidarum is extreme morning sickness that causes long-lasting intense nausea, vomiting and weight loss. While many pregnant women experience morning sickness, hyperemesis gravidarum develops between the 4th – 6th weeks of pregnancy and may last longer than week 20.  Symptoms may be so severe that they interrupt the patient’s daily activities.

Etiology

While the exact cause is still unknown, many believe hyperemesis gravidarum is caused by a rapid rise in hormone (hCg) levels.  This condition may last several weeks or throughout the majority of the pregnancy. Complications that may arise from excessive vomiting include dehydration, renal impairment, malnutrition and electrolyte imbalance.

Desired Outcome

Reduce and manage symptoms of nausea and vomiting; maintain appropriate nutrition and hydration; avoid complications and injury to patient and fetus

Hyperemesis Gravidarum Nursing Care Plan

Subjective Data:

  • Nausea
  • Dizziness
  • Weakness
  • Fatigue
  • Food/smell aversions
  • Headache
  • Confusion

Objective Data:

  • Vomiting
  • Dehydration
  • Fainting
  • Jaundice
  • Hypotension
  • Tachycardia

Nursing Interventions and Rationales

  • Assess vital signs
    • Heart rate
    • Blood pressure
    • Respirations

 

Note vital signs to get a baseline

 

  • Assess for signs of dehydration
    • Dry mucous membranes
    • Skin tenting
    • Confusion

 

Fluid loss from vomiting and inability to tolerate oral fluids may result in dehydration.

 

  • Monitor diagnostic labs
    • BUN/creatinine
    • Metabolic panel

 

Monitor labs to determine if patient has electrolyte imbalance or renal impairment from excessive vomiting.

 

  • Administer medications and IV fluids

 

  • IV fluids will be necessary to help manage electrolyte balance and maintain adequate hydration.
  • Medications may be administered to help relieve nausea.

 

  • Monitor input and output

 

Monitor urine and emesis for blood; also note dark urine and decreased output that indicate renal function impairment

 

  • Monitor weight

 

Patients often lose approx 5% of their weight. Monitor weight to ensure interventions are effective.

 

  • Assess for and treat constipation as necessary

 

  • Decreased intestinal motility from dehydration  can cause uncomfortable constipation.
  • Encourage oral intake as tolerated to increase intestinal motility and relieve constipation.
  • Administer stool softeners as appropriate.

 

  • Promote bed rest

 

  • Patients are often weak and may become dizzy or lightheaded upon standing.
  • Encourage patient to conserve energy with bed rest and assist with ambulation to prevent injury.

 

  • Monitor nutrition status to prevent further weight loss
    • Encourage oral intake as tolerated
    • Provide frequent snacks
    • Insert and maintain nasogastric feeding as appropriate

 

Excessive vomiting and food/smell aversions make it difficult to maintain proper nutrition and tube feedings may be necessary to provide adequate nutrition for patient and fetus.

 

  • Provide comfortable environment
    • Loose fitting garments
    • Decrease environmental stimulation (light/noise)
    • Avoid foods or odors that trigger nausea

 

Avoid known triggers such as foods or smells. Take note of offending hygiene products and offer alternatives. Toothpaste is often a trigger.

 

  • Promote safety
    • Emesis basin within easy reach
    • Clear access to toilet
    • Non-slip socks/shoes

 

  • Avoid accident or injury by providing a safe environment.
  • Introducing IV fluids and medications may cause bowel or bladder urgency and  result in incontinent episodes.
  • Provide assistance and supplies as necessary to promote skin integrity and avoid falls.

 


References

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