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UNIT 3 - HYPEREMESIS GRAVIDARUM - Coggle Diagram
UNIT 3 - HYPEREMESIS GRAVIDARUM
DEFINITION
excessive vomiting during pregnancy that causes weight loss, electrolyte imbalance, nutritional deficiencies and ketonuria
usually begins at the 1st timester
PATHOPHYSIOLOGY
HORMORNE CHANGES
hCG levels peak during the 1st trimester and there is correlation between higher hCG concentrations and hyperemesis
Estradiol levels increase early in pregnancy and decrease later, mirroring the typical course of nausea and vomiting in pregnancy
CHANGES IN THE GI SYSTEM
lower esophageal sphincter relaxes during pregnancy due to the elevations in estrogen and progestrone
GENETICS
two genes, GDF15 and IGFBP7 have been potentially linked
RISK FACTORS
younger maternal age
-Nulliparity
BMI <18.5 or >25
low socioeconomic status
history of hyperemesis gravidarum
molar or multiple gestations
history of migranes
CLINICAL MANIFESTATIONS
excessive vomiting
significant weight loss
dehydration
Dry mucus membrane
Decreased BP
Increased pulse rate
Poor skin turgor
MANAGEMENT
first-line pharmacologic therapy should include a combination of vitamin B6 and doxylamine
second-line medications include antihistamines and dopamine antagonists such as dimenhydrinate
Dehydration : IV fluid boluses or continuous infusions of normal saline
COMPLICATIONS
MATERNAL
vitamin deficiency, dehydration and malnutrition : may cause death
forceful and frequent vomiting : esophageal rupture and pneumothorax
FETAL
low birth weight
small for gestational age
premature infants
NURSING CARE
Initiating and monitoring IV therapy
administration of drug and nutritional supplements
monitoring the womans response to interventions
observe for signs of metabolic acidosis
monitoring intake and output
oral hygiene if kept NPO
Provide quiet, restful environment
Promoting adequate rest and sleep