Hyperemesis
Gravidarum
Learning objective
Identify Hyperemesis Gravidarum •
Differentiate between morning sickness •
and Hyperemesis Gravidarum
Describe the complications of •
Hyperemesis Gravidarum
Explain management of Hyperemesis •
Gravidarum
Discus nursing role of Hyperemesis •
Gravidarum •
Outline :
* Introduction
Hyperemesis Gravidarum
* Introduction
Pathophysiology
Clinical Manifestations 
Complications
Diagnostic Evaluation
Management 
Introduction
Hyperemesis Gravidarum
At lest 80% of women experience nausea
&vomiting. The term morning sickness is
often used to describe this condition
when symptoms usually disappear after
the first trimester. this mild form
affects he quality of life of women
&her family where the sever form
hyperemesis gravidarum results in
dehydration ,electrolyte imbalance and
the need for hospitalization
Identification
Unlike morning sickness,
hyperemesis gravidarum: is a
complication of pregnancy
characterized by persistent
uncontrollable nausea and vomiting that
persists beyond the 20th week of
pregnancy .
Pathophysiology
Causes :
numerous theories abound, but
few studies have produced
scientific evidence to identify
the etiology of this condition it is
likely that multiple factors
contribute to it .
Pathophysiology
Elevated Level OF HCG are
present in all pregnant women
during early pregnancy, usually
declining after 12 week .this
corresponds to the usual
duration of morning sickness .in
hyperemesis gravidarum ,the
Pathophysiology
decrease fluid intake& prolonged
vomiting cause dehydration
which increase serum
concentration of hCG ;
Pathophysiology
Endocrine theory :high levels of 
hCG & estrogen during pregnancy
Metabolic theory :vitamin B6 
deficiency
Psychological theory : 
Psychological stress increase the
symptoms
Complication
Weight loss 
Dehydration 
Metabolic acidosis from starvation 
Alkalosis from loss of HCL 
Hypokalemia (electrolyte imbalance) 
Nursing Role
Nursing Assessment
Health history &physical •
examination:
asking the client about the onset, 
duration ,and course of her nausea and
vomiting
Ask her about any medication or 
treatments she used and how effective
they were in relieving her nausea and
vomiting
obtain a diet history from the client 
including a dietary recall for the past
week
Nursing Assessment
Note the client’s knowledge of 
nutrition &need for appropriate
nutritional intake
Also ask about any complaints of 
ptyalism .
Ask if she has any noticed any blood or 
mucus in her stool
Weight the client.
Nursing Assessment
Inspect the mucous membranes for 
dryness &check skin turgor for.
Assess blood pressure for changes 
.
Note any complaints of weakness 
,fatigue, activity intolerance
,dizziness, or sleep disturbance
Laboratory & Diagnostic
test
Liver enzyme: elevation of 
(AST) & (ALT) are usually
present.
CBC: elevated level of RBC & 
hematocrite indicating
dehydration.
Urine ketones: positive when the 
body breaks down fat to provide
energy in the absence IIT
Laboratory & diagnostic
test
BUN :increase in the presence of salt 
&water depletion
Urine specific gravity :grater than 
1.025indicating concentrated urine linked
to inadequate fluid intake
Serum electrolyte decrease levels of k, 
Na, Cl
Ultrasound :evaluation for molar or multi 
pregnancy
Diagnosis
Fluid & electrolyte 
imbalance
Impaired nutrition intake
Knowledge deficit
Intervention
Maintain NPO status to allow GI 
tract to rest
Administer antiemetic drugs like : 
promethazine,prchlorperazine,odanse
-tron.
Administer IV fluid like 5% dextrose 
in lactated ringer
Administer electrolyte replacement 
therapy
Hygiene measures and oral care
Pay special attention to the 
environment making sure to keep the
area free of pungent odors
As the Client's nausea and vomiting 
subside .gradually introduce oral
fluid
&foods in small amounts 
Monitor intake and output 
Offer reassurance that all intervention 
are directed toward promoting positive
pregnancy outcomes for both women
fetus
Provide information about the expected 
plan of care
Listen to here concerns &feeling by 
answering all here questions
Teach the client about therapeutic life 
style changes like avoid stressors&
fatigue
Avoid noxious stimuli
Avoid tight waistband 
Eat small frequent meals (6 meals)
Separate fluid from solid by consuming 
fluid In between meals
Use high protein supplement
Avoid lying down for at least 2 hours 
after eating
Avoid food high in fat drink herbal tea
eat food that settle the stomach such 
as toast or soda
References
From this book
Susan scote ricci & terri Kyle.(2009) •
Maternity and pediatric nursing
,chapter19, pregnancy related
complication , page 567-569