Hyperemesis Gravidarum for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Hyperemesis Gravidarum for Certified Emergency Nursing (CEN)
Outline
Hyperemesis Gravidarum
Definition/ Etiology:
Hyperemesis gravidarum is pregnancy-related severe nausea and vomiting that is persistent and results in >5% loss of pre-pregnancy weight.
- Interferes with work performance
- Interferes with daily functioning
- Causes anxiety / depression
- Can lead to termination of pregnancy and avoidance of future pregnancy
Risk factors:
- History of migraines
- History of nausea with estrogen medications
- History of motion sickness
- History of prior hyperemesis gravidarum
- Hydatidiform molar pregnancy
Pathophysiology:
Cause is not clearly understood, but may be related to:
- Hormonal changes (hCG, estrogen, progesterone)
- Abnormal gastric motility
- H. pylori
- Genetic predisposition
Clinical Presentation:
Generally:
- Starts in week 5-6
- Peaks in week 9
- Subsides in week 16-20 for most, but can continue throughout in a few patients
Scoring scales rate:
- Number of hours/day with nausea
- Episodes of vomiting/day
- Episodes of dry heaves/day
Collaborative Management:
Testing:
- Patient weight
- Confirm fetal heart tones
- Fetal ultrasound to rule out molar pregnancy and confirm number of fetuses
- CMP / amylase / lipase / Mag / Phos / TSH
- Urinalysis/ketones
- Orthostatic BP/pulse
Medications:
- Diphenhydramine or Meclazine
- Promethazine
- Ondansetron
- Gabapentin
- Antacids
- Crystalloids / banana bag
Evaluation | Patient Monitoring | Education:
- Cardiac monitoring due to potential for electrolyte disturbances
- PO challenge after treatment
- Use extra caution if patient is diabetic. Frequent glucose checks.
- Although rare, a Mallory-Weiss tear could occur from frequent vomiting. Remain alert for coffee ground emesis or frank blood.
- Wernicke’s encephalopathy can occur from vitamin deficiency from hyperemesis. Ataxia, eye movement disorder, and confusion are signs of this.
Mitigating:
- Encourage small, frequent snacks
- BRAT diet (bananas, rice, applesauce, toast)
- Discourage large meals
- Peppermint or ginger
- Vitamin B6
- Acupressure
Linchpins: (Key Points)
- Watch for electrolyte abnormalities.
- Monitor very carefully if diabetic.
- Small frequent meals, and small volume frequent fluids.
- Mallory-Weiss tear can occur. Prenatal vitamins to avoid complications.
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Smith, J. A. (2022, October 21). Nausea and vomiting of pregnancy: Treatment and outcome. UpToDate. https://www.uptodate.com/contents/nausea-and-vomiting-of-pregnancy-treatment-and-outcome
- Smith, J. A. (2022, April 28). Nausea and vomiting of pregnancy: Clinical findings and evaluation. UpToDate. https://www.uptodate.com/contents/nausea-and-vomiting-of-pregnancy-clinical-findings-and-evaluation
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
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- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
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- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
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- Oncologic Disorders
- Med Term Basic
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- Central Nervous System Disorders – Spinal Cord
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- State of Consciousness
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