Nursing Care Plan (NCP) for Hyperemesis Gravidarum

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Outline

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 
  • Weight loss

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Assess Vital Signs  HR, RR, BP. Get baseline vitals and note any changes (tachycardia, hypotension, tachypnea)
Assess for signs of dehydration  dry membranes, skin tenting, confusion. All signs of dehydration 

Patient can lose many fluids from vomiting/inability to tolerate oral fluids 

Monitor diagnostic lab values  Metabolic panel (see if the patient has an electrolyte imbalance or renal impairment from excessive vomiting (Metabolic Alkalosis)
Administer IV fluids/Medications  IV fluids will be necessary to help manage electrolyte balance and maintain adequate hydration.

Medications may be administered to help relieve nausea.

Monitor I’s & O’s Monitor urine and emesis for blood; also note dark urine and decreased output that indicates renal function impairment 
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

Monitor nutrition status to prevent further weight loss/weight patient 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 patients and fetuses. 

Provide a comfortable environment Loose-fitting garments

Decrease environmental stimulation (light/noise)

Avoid foods or odors that trigger nausea

Promote safety Emesis basin within easy reach

Clear access to toilet

Non-slip socks/shoes

 

Avoid accidents or injuries by providing a safe environment.

Provide assistance and supplies as necessary to promote skin integrity and avoid falls.

Writing a Nursing Care Plan (NCP) for Hyperemesis Gravidarum

A Nursing Care Plan (NCP) for Hyperemesis Gravidarum starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

https://my.clevelandclinic.org/health/diseases/12232-hyperemesis-gravidarum-severe-nausea–vomiting-during-pregnancy

https://www.mayoclinic.org/diseases-conditions/morning-sickness/symptoms-causes/syc-20375254

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Transcript

Hey everyone. We are going to be working on the nursing care plan for hyperemesis gravidarum. So let’s get started. So we’re going to first look at pathophysiology. So hyperemesis gravidarum is a morning sickness that causes long lasting, intense nausea, vomiting, and weight loss. While morning sickness is common, hyperemesis gravidarum develops between the fourth and six weeks of pregnancy, and it may last beyond week 20. Some nursing considerations: you want to assess vital signs, assess for dehydration, monitor lab values, administer IV fluids, medications, monitor I & O, and monitor for constipation. Some desired outcomes: reduce and manage the symptoms of nausea and vomiting, maintain appropriate nutrition and hydration, and avoid any sort of complications and injury to the patient and the fetus. 

So we’re going to go ahead and get started on the care plan. We’re going to be looking at some of the subjective data and the objective data. So what are we going to see with these patients? Some of the biggest things are nausea and vomiting. So for some of them, this can be pretty debilitating to where it’s very difficult to be able to get through some of your daily tasks. So this is one of the main things that they talk about. Another thing is weakness. You’ll also see that they’re going to be very dehydrated and you’ll see hypotension – decreased blood pressure. Other things to consider: dizziness, fatigue, some food or smell aversions, headache, confusion, also fainting, jaundice, tachycardia (increased heart rate), and some weight loss. 

So what interventions are we going to look for in these patients? Well, one of the things that we want to make sure we’re always doing with every patient is we’re going to be checking and assessing their vital signs – their heart rate, respirations, and blood pressure. You’ll want to get a baseline vital and note any other changes. So if you do see that they’re pretty tachycardic, and they have decreased blood pressure, it could be because of the vomiting. Another intervention that we’re going to look for is any sort of signs of dehydration; because, once again, if they’re super nauseous and vomiting a lot, they’re losing a lot of those fluids, which can make them pretty confused. You’re going to look for any sort of dry membranes, any skin tenting, which are all signs of dehydration. Another intervention we’re going to be looking to do is monitor their lab values. 

Okay. Monitor lab values. So metabolic panel is typically what you would want to run for these patients. You want to see if they have any sort of electrolyte imbalance or any sort of renal impairment from the excessive vomiting, which could lead to metabolic alkalosis. Other interventions: we’re going to make sure we’re giving them IV fluids and medications. The IV fluids will be necessary and will help manage their electrolyte balance and maintain adequate hydration. Certain medications can be administered for these patients and are able to help relieve the nausea that they’re feeling. We’re going to monitor their I & O: we want to make sure that they’re taking in enough and monitoring their urine output and the amount of emesis. You also want to note any sort of dark colored urine and any decreased urine output, which could imply that there’s some sort of renal function impairment. 

Another intervention we’re going to do is we’re going to be treating for constipation. A decrease in intestinal mobility from dehydration can cause some uncomfortable constipation. So you really want to encourage oral intake as tolerated and increase intestinal motility to relieve the constipation. And sometimes you may end up needing to give stool softeners. And another intervention that we want to do is we want to make sure that the patient is not losing any more weight. You want to encourage them to have an increased food intake or fluid intake, and you may have to insert an NG tube for feeding if excessive vomiting and food smell aversions make it difficult to maintain proper nutrition. And tube feedings may be necessary to provide adequate nutrition for patients and the fetus. 

So let’s go over some of the key points. So pathophysiology: basically it is extreme morning sickness that can cause long lasting intense nausea, vomiting, and weight loss and is usually caused by a rapid rise in hormone or HCG levels. Some subjective objective data you’ll see in these patients: nausea and vomiting. You’ll also see weight loss, headache, weakness, dehydration, and hypotension. You’re going to see a high heart rate, fainting and confusion. You’re going to want to make sure you’re doing your assessments and giving medications. You’re going to look at their vital signs, check for the signs of dehydration, monitor the lab values and give antiemetics for that nausea and vomiting. Lastly, you’re going to assist with nutrition and help with constipation. Prevent any further weight loss by encouraging fluid and food intake as tolerated and give any stool softeners for constipation as needed. 

Great job guys. We love you go out and be your best self today. And, as always, happy nursing.

 

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