04.10 Hyperemesis Gravidarum

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Overview

  1. Intractable nausea AND vomiting during pregnancy
    1. Usually through 20 weeks gestation
  2. Exact cause unknown
    1. Hormones

Nursing Points

General

  1. Risks
    1. First pregnancies
    2. Pregnant with multiples
    3. Family history
  2. Can cause severe nutritional deficiencies and electrolyte imbalances

Assessment

  1. Symptom check
    1. How often are they vomiting?
    2. Weight loss?
    3. Dehydrated?
    4. Electrolytes
      1. Fluid and electrolyte imbalances can be severe

Therapeutic Management

  1. First try altering diet and eating habits to minimize N/V and maximize oral nutrition
    1. Sit up right after meals
    2. Eat before getting up in am (crackers at bedside)
    3. Eat small portions of easily digestible carbs (rice, cereal, pasta)
    4. Consume liquids between meals, not during
    5. Bland foods
    6. B6 to help with nausea
  2. Then, give meds (Zofran, Phenergan, Diclegis, etc.) to achieve goal
    1. Meds have risks, but at this point, risks outweigh benefits if mother/baby are not getting adequate nutrition
  3. If meds don’t work, then IV fluids and TPN may be initiated to prevent/address electrolyte and fluid imbalances
  4. Monitor vital signs, electrolytes (CMP/BMP, Mag, Phos lab draws) intake and output, urine for ketones, weight, calorie counts

Nursing Concepts

  1. Nutrition
  2. Fluid & Electrolytes
  3. Hormone Balance

Patient Education

  1. Dietary changes
  2. Possible home remedies like B6, peppermint, ginger – ensure no interactions with current medications
  3. Signs of electrolyte abnormalities to report to provider

Reference Links

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Video Transcript

In this lesson I will explain hyperemesis gravidarum, the criteria for diagnosis as well as your role in providing care.

Hyperemesis is not the same as morning sickness. There are some big differences. This is a patient that is very very sick. She vomits 3 or more times a day putting her at risk for electrolyte imbalances and dehydration. The cause is not 100% known, but hormones are thought to be a big cause. There is a rise in hormones when someone is pregnant right? And those hormones make people feel sick! So the factors that put someone more at risk are a first time pregnant person. Her body is like “whoa what is happening!” Then we have those carrying multiples and her body is making extra hormones so her body is feeling sick from all of that. Family history can also be another risk factor. Perhaps similar genetics so similar problems.
So what are the main things to remember? Well hyperemesis gravidarum is severe nausea AND vomiting. This is not your average morning sickness! This is worse! Vomiting occurs usually 3 or more times in order to make this a problem in pregnancy. It occurs with electrolyte imbalance, dehydration, and weight loss because it is so much vomit! Patients require rehydration with IV fluids, PICC lines for longer term or anti nausea medication.

Assessing this patient will involve a symptom check. We need to ask how often are they vomiting? If they are vomiting 3 or more times a day we might be concerned that the patient has hyperemesis. Has she lost any weight? We worry if weight loss is occuring because the fetus isn’t getting the nutrients. Are they dehydrated? We don’t want anyone dehydrated, especially a pregnant patient. Lab work should be taken to assess electrolyte imbalances. Fluid and electrolyte imbalances can be severe and cause harm so this needs to be addressed.
Our therapeutic management for this patient will include things like diet changes. We want to minimize nausea and vomiting. That is the goal. We can help alter their diet to be bland. Have the patient sit up right after meals to aid in digestion. Having crackers by the bed to aat before getting up in morning can help also. The patient should eat small portions of easily digestible carbs (rice, cereal, pasta). Liquids should be consumed between meals so the stomach isn’t getting so full on liquid. Remember an overfull stomach increases nausea.
Nursing concepts for hyperemesis gravidarum are nutrition because we are worried about adequate nutrition getting to the mom and fetus. Fluid and electrolytes are a big concern with the vomiting and hormones because this is thought to be a big cause.

Education should revolve around dietary changes like small frequent meals, sitting upright post meal, and bland foods. Home remedy education should be things like B6, peppermint, ginger as long as there is no going to be no bad interactions with current medications. All of those have been found to help with nausea. Patients should also be aware of signs to report that could mean their electrolytes are low.

Make sure you check out the resources attached to this lesson and review the criteria for hyperemesis. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 7

A pregnant client is admitted to the hospital with hyperemesis gravidarum. She has been vomiting for several days and is dehydrated. What management should the nurse anticipate?

  • Question 2 of 7

Which of the following findings are consistent with the diagnosis of hyperemesis gravidarum?

  • Question 3 of 7

A nurse is making recommendations for a pregnant client with hyperemesis gravidarum. Which of the following should be recommended to alleviate the hyperemesis? Select all that apply.

  • Question 4 of 7

A 25-year-old pregnant woman is being seen for excess nausea and vomiting during her first trimester of pregnancy. Which of the following factors must be present for a diagnosis of hyperemesis gravidarum?

  • Question 5 of 7

A client is experiencing hyperemesis gravidarum and is not getting any relief from ondansetron. Which of the following medications is the next step in nausea control?

  • Question 6 of 7

A nurse is assessing newly pregnant clients for their risk for hyperemesis gravidarum. Which client is at the highest risk?

  • Question 7 of 7

A nurse is assessing pregnant clients for hyperemesis gravidarum. Which of the following clients is likely to be suffering from hyperemesis gravidarum?

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