Hyperemesis gravidarum (HG) is a severe form of morning sickness that affects approximately 0.3-3% of pregnancies. This comprehensive guide explores the essential nursing diagnoses, interventions, and care plans necessary for managing this challenging condition. Understanding these elements is crucial for healthcare providers to deliver optimal care to patients suffering from HG.
What is Hyperemesis Gravidarum?
Hyperemesis gravidarum is characterized by severe, persistent nausea and vomiting during pregnancy that can lead to dehydration, electrolyte imbalances, and weight loss exceeding 5% of pre-pregnancy body weight. Unlike typical morning sickness, HG can significantly impact a woman’s quality of life and may require hospitalization.
Common Signs and Symptoms
The primary clinical manifestations include:
- Severe, persistent nausea and vomiting
- Significant weight loss (>5% of pre-pregnancy weight)
- Dehydration
- Electrolyte imbalances
- Ketosis
- Nutritional deficiencies
- Fatigue and weakness
- Headaches
- Dizziness or lightheadedness
Risk Factors
Several factors may increase the likelihood of developing hyperemesis gravidarum:
- Previous history of HG
- Multiple pregnancies
- Family history of HG
- First pregnancy
- Young maternal age
- Elevated HCG levels
- History of motion sickness or migraine headaches
Nursing Assessment
A thorough nursing assessment is essential for developing appropriate care plans. Key assessment areas include:
- Hydration status assessment
- Weight monitoring
- Vital signs evaluation
- Nutritional status assessment
- Psychological well-being evaluation
- Laboratory values monitoring
Nursing Care Plans for Hyperemesis Gravidarum
1. Fluid Volume Deficit
Nursing Diagnosis Statement:
Fluid Volume Deficit related to excessive vomiting and decreased oral intake as evidenced by dry mucous membranes, decreased skin turgor, and concentrated urine.
Related Factors/Causes:
- Excessive vomiting
- Inadequate fluid intake
- Increased fluid losses
- Electrolyte imbalances
Nursing Interventions and Rationales:
- Monitor intake and output strictly
Rationale: Helps assess fluid balance and guides replacement needs - Assess vital signs every 4 hours
Rationale: Early detection of dehydration complications - Administer IV fluids as ordered
Rationale: Restores fluid balance and prevents complications - Monitor laboratory values
Rationale: Identifies electrolyte imbalances requiring correction
Desired Outcomes:
- The patient maintains adequate hydration
- Vital signs remain within normal limits
- Laboratory values return to the normal range
- Patient demonstrates improved skin turgor and moist mucous membranes
2. Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than body requirements related to inability to retain oral intake as evidenced by weight loss and inadequate food intake.
Related Factors/Causes:
- Persistent nausea and vomiting
- Food aversions
- Altered taste perception
- Decreased appetite
Nursing Interventions and Rationales:
- Monitor weight daily
Rationale: Tracks nutritional status and effectiveness of interventions - Offer small, frequent meals
Rationale: Reduces gastric distention and nausea - Implement dietary modifications
Rationale: Identifies and provides tolerable foods - Administer prescribed nutritional supplements
Rationale: Ensures adequate nutrient intake
Desired Outcomes:
- Patient maintains or gains appropriate pregnancy weight
- Patient tolerates oral intake
- The patient demonstrates improved nutritional status
- Fetal growth remains within normal parameters
3. Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to weakness and fatigue as evidenced by excessive fatigue with normal activities and verbal reports of exhaustion.
Related Factors/Causes:
- Malnutrition
- Dehydration
- Physical weakness
- Electrolyte imbalances
Nursing Interventions and Rationales:
- Assess activity tolerance
Rationale: Determines appropriate activity levels - Assist with activities of daily living
Rationale: Prevents exhaustion and ensures safety - Encourage rest periods
Rationale: Conserves energy and reduces fatigue - Implement a progressive activity schedule
Rationale: Builds strength and endurance gradually
Desired Outcomes:
- The patient demonstrates improved activity tolerance
- The patient maintains safe mobility
- The patient reports decreased fatigue
- The patient performs ADLs independently
4. Anxiety
Nursing Diagnosis Statement:
Anxiety related to effects of condition on pregnancy outcomes as evidenced by expressed concerns and increased tension.
Related Factors/Causes:
- Uncertainty about pregnancy outcomes
- Physical discomfort
- Social isolation
- Financial concerns
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety and promotes coping - Educate about condition and management
Rationale: Increases understanding and control - Facilitate support system involvement
Rationale: Enhances emotional well-being - Teach relaxation techniques
Rationale: Provides coping mechanisms
Desired Outcomes:
- The patient verbalizes decreased anxiety
- The patient demonstrates effective coping strategies
- The patient utilizes support systems effectively
- Patient expresses optimism about pregnancy outcomes
5. Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to poor nutritional status and dehydration.
Related Factors/Causes:
- Malnutrition
- Dehydration
- Decreased mobility
- Poor tissue perfusion
Nursing Interventions and Rationales:
- Assess skin integrity daily
Rationale: Identifies early signs of breakdown - Implement pressure relief measures
Rationale: Prevents pressure injuries - Maintain adequate hydration
Rationale: Promotes skin turgor and healing - Provide proper skincare
Rationale: Maintains skin integrity
Desired Outcomes:
- The patient maintains intact skin
- Patient demonstrates improved skin turgor
- The patient performs appropriate skincare
- Patient identifies risk factors for skin breakdown
Patient Education
Effective patient education is crucial for managing hyperemesis gravidarum. Key topics include:
- Dietary modifications
- Hydration importance
- Medication compliance
- Warning signs requiring medical attention
- Stress management techniques
- Available support resources
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Elder, T. J., Iacurto, G., & Deys, L. (2024). Enhancing maternal wellbeing: A qualitative exploration of women’s experiences of tailored education and holistic support while experiencing Hyperemesis Gravidarum. Midwifery, 104258. https://doi.org/10.1016/j.midw.2024.104258
- Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am. 2008 Sep;35(3):401-17, viii. doi: 10.1016/j.ogc.2008.04.002. PMID: 18760227.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
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- Jansen LAW, Shaw V, Grooten IJ, Koot MH, Dean CR, Painter RC. Diagnosis and treatment of hyperemesis gravidarum. CMAJ. 2024 Apr 14;196(14):E477-E485. doi: 10.1503/cmaj.221502. Erratum in: CMAJ. 2024 May 12;196(18):E630. doi: 10.1503/cmaj.240608. PMID: 38621783; PMCID: PMC11019608.
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