hyperemesis gravidarum learning objective identify hyperemesis gravidarum differentiate between...
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Hyperemesis Hyperemesis GravidarumGravidarum
Hyperemesis Hyperemesis GravidarumGravidarum
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Learning objective•Identify Hyperemesis Gravidarum
•Differentiate between morning sickness and Hyperemesis Gravidarum
•Describe the complications of Hyperemesis Gravidarum
•Explain management of Hyperemesis Gravidarum
•Discus nursing role of Hyperemesis• Gravidarum
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Outline: * Introduction
Hyperemesis Gravidarum *Introduction
PathophysiologyClinical Manifestations
Complications Diagnostic Evaluation
Management
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Introduction
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Hyperemesis Gravidarum
At lest 80% of women experience nausea &vomiting. The term morning sickness is often used to describe this condition when symptoms usually disappear after the first trimester. this mild form affects he quality of life of women &her family where the sever form hyperemesis gravidarum results in dehydration ,electrolyte imbalance and the need for hospitalization
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IdentificationUnlike morning sickness ,
hyperemesis gravidarum: is a
complication of pregnancy
characterized by persistent
uncontrollable nausea and vomiting that persists beyond the 20th week of pregnancy.
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Pathophysiology
Causes :
numerous theories abound, but few studies have produced scientific evidence to identify the etiology of this condition it is likely that multiple factors contribute to it.
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PathophysiologyElevated Level OF HCG are present in all pregnant women during early pregnancy, usually declining after 12 week .this corresponds to the usual duration of morning sickness .in hyperemesis gravidarum ,the
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Pathophysiology decrease fluid intake&
prolonged vomiting cause dehydration which increase serum concentration of hCG;
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Pathophysiology
Endocrine theory :high levels of hCG & estrogen during pregnancy
Metabolic theory :vitamin B6 deficiency
Psychological theory : Psychological stress increase the symptoms
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ComplicationWeight lossDehydration
Metabolic acidosis from starvation Alkalosis from loss of HCLHypokalemia (electrolyte
imbalance)
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Nursing Role
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Nursing Assessment
•Health history &physical examination:
asking the client about the onset, duration ,and course of her nausea and vomiting
Ask her about any medication or treatments she used and how effective they were in relieving her nausea and vomiting
obtain a diet history from the client including a dietary recall for the past week
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Note the client’s knowledge of nutrition &need for appropriate nutritional intake
Also ask about any complaints of ptyalism.
Ask if she has any noticed any blood or mucus in her stool
Weight the client.
Nursing Assessment
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Inspect the mucous membranes for dryness &check skin turgor for .
Assess blood pressure for changes.
Note any complaints of weakness ,fatigue, activity intolerance ,dizziness, or sleep disturbance
Nursing Assessment
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Laboratory & Diagnostic test Liver enzyme: elevation of (AST) &
(ALT) are usually present.CBC: elevated level of RBC &
hematocrite indicating dehydration.
Urine ketones: positive when the body breaks down fat to provide energy in the absence IIT
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Laboratory & diagnostic test BUN :increase in the presence of salt
&water depletionUrine specific gravity :grater than
1.025indicating concentrated urine linked to inadequate fluid intake
Serum electrolyte decrease levels of k, Na, Cl
Ultrasound :evaluation for molar or multi pregnancy
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DiagnosisFluid & electrolyte
imbalanceImpaired nutrition intake
Knowledge deficit
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Intervention
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Maintain NPO status to allow GI tract to rest
Administer antiemetic drugs like : promethazine,prchlorperazine,odanse-tron.
Administer IV fluid like 5% dextrose in lactated ringer
Administer electrolyte replacement therapy
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Hygiene measures and oral carePay special attention to the
environment making sure to keep the area free of pungent odors
As the Client's nausea and vomiting subside .gradually introduce oral fluid
&foods in small amounts Monitor intake and output
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Offer reassurance that all intervention are directed toward promoting positive pregnancy outcomes for both women fetus
Provide information about the expected plan of care
Listen to here concerns &feeling by answering all here questions
Teach the client about therapeutic life style changes like avoid stressors& fatigue
Avoid noxious stimuli
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Avoid tight waistband Eat small frequent meals (6 meals)
Separate fluid from solid by consuming fluid In between meals
Use high protein supplementAvoid lying down for at least 2
hours after eating Avoid food high in fat drink herbal
tea eat food that settle the stomach
such as toast or soda
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References
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From this book•Susan scote ricci & terri Kyle.
(2009) Maternity and pediatric nursing ,chapter19, pregnancy related complication , page 567-569