Nausea nursing Diagnosis

What are the nursing interventions for a pregnant mother with nausea and vomiting?

Full Text Access for Subscribers:

Individual Subscribers

Institutional Users

Access through Ovid®

Not a Subscriber?

Buy

Request Permissions

You can read the full text of this article if you:

Department - I.V. ROUNDS

Managing hyperemesis gravidarum

LAMONDY, ANNE M. RN, C, MSN

Author Information

Anne M. Lamondy is a women's health nurse practitioner, an assistant professor of nursing at Three Rivers Community College in Norwich, Conn., and a staff nurse in the intravenous therapy department at Day Kimball Hospital in Putnam, Conn.

Nursing: February 2007 - Volume 37 - Issue 2 - p 66-68

At NURSING.com, we believe Black Lives Matter ✊🏿, No Human Is Illegal 🤝, Love Is Love 🏳️‍🌈, Women`s Rights Are Human Rights 👩, Science Is Real 🔬, Water Is Life 🌊, Injustice Anywhere Is A Threat To Justice Everywhere ☮️.

AccessibilitySitemapDrug List

Notes

Description

Hyperemesis gravidarum is severe and excessive nausea and vomiting during pregnancy, which leads to electrolyte, metabolic, and nutritional imbalances in the absence of the medical problems.

Etiology

The etiology of hyperemesis gravidarum is obscure; suggested causative factors include:
1. High levels of hCG in early pregnancy
2. Metabolic or nutritional deficiencies
3. More common in unmarried white women and first pregnancies
4. Ambivalence toward the pregnancy or family-related stress
5. Thyroid dysfunction

Pathophysiology

Continued vomiting results in dehydration and ultimately deceases the amount of blood and nutrients circulated to the developing fetus.
Hospitalization may be required for severe symptoms when the client needs intravenous hydration and correction of metabolic imbalance.

Assessment Findings

Signs and symptoms occur during the first 16 weeks of pregnancy and are intractable.

1. Clinical manifestations include:

Unremitting nausea and vomiting.
Vomitus initially containing undigested food, bile, and mucus; later containing blood and material that resembles coffee grounds
Weight loss

2. Other common signs and symptoms include:

Pale, dry skin
Rapid pulse
Fetid, fruity breath odor from acidosis
Central nervous system effects, such as confusion, delirium, headache, and lethargy, stupor, or coma.

Nursing Management

1. Promote resolution of the complication.

Make sure that the client is NPO until cessation of vomiting.
Administer intravenous fluids as prescribed; they may be given on an ambulatory basis when dehydration is mild.
Measure and record fluid intake and output.
Encourage small frequent meals and snacks once vomiting has subsided.
Administer antiemetics as prescribed.

2. Address emotional and psychosocial needs. Maintain a non judgmental atmosphere in which the client and family can express concerns and resolve some of their fears.

Exam

Choose the letter of the correct answer. Good luck!

Congratulations - you have completed Hyperemesis Gravidarum Practice Exam (PM)*. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

Your answers are highlighted below.

Shaded items are complete.

1	2	3	4	5
End

Nursing Care Plan

Nursing Assessment

1. Main complaint:

Severe vomiting
Nausea, vomiting in the morning and after meals
Epigastric pain
Feeling thirsty
No appetite
Vomiting of food / liquid acid

2. Predisposing factors

Maternal age <20 years
Multiple gestation
Obesity
Trophoblastic Disease

3. Physical Examination

Metabolic acidosis is characterized by headache, disorientation
Tachycardia, hypotension, vertigo
Conjunctival jaundice
Impaired consciousness, delirium

Signs of dehydration:

Dry skin, mucous membranes dry lips
Slow return of skin turgor
Sunken eyelids
Weight loss
Increase in body temperature
Oliguria, ketonuria
Concentrated urine

Laboratory data:

Proteinuria
Ketonuria
Urobilinogen
Decreased levels of potassium, sodium, chloride, and protein
Decreased levels of vitamin
Increased Hb and Ht

Nursing Diagnosis

Fluid and electrolyte imbalances related to excessive vomiting or lack of fluid intake.
Imbalanced Nutrition Less Than Body Requirements related to nausea, vomiting or lack of nutritional intake.
Anxiety related to hyperemesis influence on the health of the fetus.
Knowledge deficit related to lack of information about the treatment of hyperemesis.
Sleep pattern disturbance related to persistent vomiting.
Activity Intolerance related to weakness.

Nursing Interventions	Rationale
Assess for signs of dehydration	improve fluid balance, and maintain a homeostatic mechanism, is the basis for the mother and fetus to maintain balance.
Assess vital signs	temperature, pulse rate increased and decreased BP are signs of dehydration and hypovolemia.
Give parenteral fluids: electrolytes, glucose and vitamins according to program	This fluid will provide or meet the needs of the body’s acid-base balance, electrolytes and hypoavitaminosis.
Provide nutrition in small but frequent portions.	feeding gradually or slowly may help.
Monitor the provision of fluids and food in 24 hours as well as expenditures and recorded fluid intake.	the provision of fluids and electrolytes is a way to deal with persistent vomiting, this recording will be able to assess the balance of electrolytes are given, while the number of how many calories can already be given.
Review of edema in the legs or elsewhere.	the edema may also occur due to lack of albumin or renal failure.
Assess the presence of ketones in the urine.	presence of ketones in the urine indicates maternal fat supplies for energy use due to inadequate caloric intake.
Do collaborations with other teams for the administration of antiemetic drugs.	usually to cope with vomiting.
Give the food a light, when it is allowed in small portions and frequent (liquid and solid)	the provision of solid and liquid foods in small portions and often may reduce vomiting.
Increase feeding of this, if the client is able to accept (tolerance).	an increase in feeding demonstrate efficacy in the treatment.
Monitor FHR and fetal activity.	FHR and fetal movement is an indication that the fetal / fetus in good condition.
Monitor symptoms of morning sickness.	hormonal changes, maternal Hypoglycemia and decreased gastric motility, emotional and cultural factors.
Examine the skin: the texture and turgor.	dry skin and poor turgor is a sign of dehydration.
Encourage clients to multiply the rest.
Create a comfortable environment.

What are nursing interventions for nausea and vomiting?

Introduce cold water, ice chips, ginger products, and room temperature broth or bouillon if tolerated and appropriate to the patient's diet. These aid hydration. Ginger helps relieve nausea whether in ginger ale, ginger tea, or chewed as crystallized ginger. Fluids that are too cold or hot may be difficult to tolerate.

How should the nurse advise a pregnant woman who is experiencing nausea and vomiting?

Eat snacks frequently and have multiple small meals (eg, six small meals a day) that are high in protein or carbohydrates and low in fat. Stick to a bland diet. Drink cold, clear, and carbonated or sour fluids (eg, ginger ale, lemonade) and drink these in small amounts between meals.

What is the management of nausea and vomiting in pregnancy?

Treatments for morning sickness include vitamin B-6 supplements (pyridoxine), ginger and drugs such as doxylamine (Unisom). Continuing symptoms might require prescription anti-nausea medications.

What are the nursing and medical interventions for patient with hyperemesis gravidarum?

Reestablishing normal fluid and electrolyte levels often relieves nausea and vomiting. Encourage the patient to eat, and tell her to avoid going for a long period without eating. Advise her to eat when she feels hungry, starting with small, frequent lowfat meals. She should avoid drinking fluids with meals.