1229 Exam 5: Hyperemesis Flashcards
What is Hyperemesis?
When vomiting during pregnancy becomes excessive enough to cause weight loss of at least 5% of pre-pregnancy weight AND is accompanied by dehydration, electrolyte imbalance, ketosis, and acetonuria.
*usually begins in the first 10 wks of pregnancy.
Risk factors of Hyperemesis
Nulliparous Increased body weight history of migraines pregnant with twins pregnant with hydatidiform mole psychological component
What does Hyperemesis look like?
significant weight loss
symptoms of dehydration
decreased BP
increased pulse rate
poor skin turgor
Inability to keep down even clear liquids
lab test that reveal electrolyte imbalance (Potassium, calcium, and sodium)
Potassium Lab values
3.8-5.0 mEq/L
Calcium Lab Values
8.5-10.5 mg/100ml
Sodium Lab Values
135-145 mEq/L
How is Hyperemesis Diagnosed?
Urinalysis, CBC, Electrolytes, Liver enzymes and Bilirubin levels rule out the presence of underlying diseases (pyelonephritis, pancreatitis, cholecytitis, hepatitis)
test TSH and T4 should be assessed because of hyperthyroidism.
How is Hyperemesis Treated?
**Esp. if woman cannot keep down liquids:
IV therapy
NPO until dehydration resolved and for at least 48 hours after vomiting stopped
Antiemetics
Different types of Antiemetics:
Pyridoxine –Vitamin B6
Doxylamine– Unisom
Promethazine– Phenergan
Metoclopromide– Reglan
Interventions of Hyperemesis include:
Initiate and monitor IV therapy
Administer drug and nutritional supplements
Monitor woman’s response to interventions
Psychotherapy and stress reduction
Observe for signs of complications (metabolic acidosis, jaundice, and hemorrhage)
Monitor: assessment of nausea, retching without vomiting, and vomiting
Accurate measurement of I&O
oral hygiene
assist w positioning
quiet,restful environment free from odors
What is the tool that allows quantification of the presence and severity of nausea and vomiting and promotes accurate monitoring?
Pregnancy-Unique Quantification of Emesis/Nausea (PUQE) index.
How does the PUQE work?
total score is three replies to each of the three questions:
Nausea score: mild NVP less than six; moderate NVP 7-12; Severe NVP is greater than 13.
Interventions of Hyperemesis after woman starts responding to therapy:
limited amounts of fluids and bland foods
(Crackers, toast, or baked chicken)
diet is progressed slowly as tolerated.
promote adequate rest
coordinate treatment to allow for rest periods
What do I teach my patient about Hyperemesis?
eat small, frequent meals consisting of low fat, high protein foods
avoid greasy and highly seasoned foods
increase intake of potassium and magnesium
herbal teas may decrease nausea
take in fluids between meals rather than with meals helps to decrease nausea
have other family members cook if possible
Dietary instructions for hyperemesis:
eat dry bland foods high protein small frequent meals cold food snack before bedtime drink tea or water with lemon avoid high fat or spicy foods
What is Ectopic Pregnancy?
A pregnancy in which the fertilized ovum is implanted outside of the uterine cavity, mainly in the fallopian tubes, but can also occur in the ovaries, abdominal cavity, and cervix.
How is an Ectopic Pregnancy classified?
According to the site of implantation.
Ex: tubal, cervical, abdominal, or ovarian
**The uterus is the only organ capable of containing and sustaining a term pregnancy.
What does Ectopic Pregnancy look like?
missed menstrual period
adnexal fullness
tenderness that may suggest an unruptured tubal pregnancy
dark red/brown abnormal vaginal bleeding
If ectopic pregnancy ruptures….
pain increases.
May be generalized, unilateral, or acute deep lower quadrant pain caused by blood irritating the peritoneum
referred shoulder pain can occur from diaphragmatic irritation caused by blood in the peritoneal cavity.
signs of shock related to the amount of bleeding in the abdominal cavity and not necessarily vag. bleeding
Cullen sign: an ecchymotic blueness around the umbilicus
