Hyperemesis Gravidarum Nursing Diagnosis & Care Plan

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Written by
Maegan Wagner, BSN, RN, CCM

Hyperemesis gravidarum is a condition affecting pregnant women which causes intractable nausea and vomiting during pregnancy. While the exact cause remains unclear, this condition is thought to be caused by rapidly rising hormone levels like HCG and estrogen during the first trimester. Another potential cause may include an increased incidence of gastroesophageal reflux disease (GERD), causing nausea. Hyperemesis gravidarum risk does increase among women with family members who also experienced this condition.

Clinical manifestations of hyperemesis gravidarum typically occur in the first trimester of pregnancy and include the following:

  • Nausea accompanied by severe vomiting
  • Vomiting that occurs more than 3-4 times per day
  • Weight loss of more than 5% of pre-pregnancy weight
  • Dizziness
  • Lightheadedness
  • Dehydration 
  • Headaches
  • Fainting

A physical examination and medical history can diagnose hyperemesis gravidarum. Laboratory tests like complete blood count, electrolyte levels, and urine ketones are monitored for the effects of severe dehydration.

Nursing Process

The priority of nursing care for patients with hyperemesis gravidarum is to identify the severity of nausea and vomiting, the degree of dehydration, and the extent of the weight loss. Nurses provide medications to prevent nausea and vomiting and administer IV fluids and electrolyte supplementation for severe cases. Patient education helps prevent complications and manage discomfort at home.

Nausea

Pregnant women with hyperemesis gravidarum experience severe and persistent nausea and vomiting, leading to weight loss and dehydration.

Nursing Diagnosis: Nausea

  • Pregnancy
  • Unpleasant sensory stimuli 
  • Rise in hormone levels
  • Multiple gestation pregnancy
  • Genetic predisposition

As evidenced by:

  • Food aversion
  • Increased salivation
  • Gagging sensation
  • Sour taste
  • Increased swallowing
  • Vomiting

Expected outcomes:

  • Patient will verbalize the reduction of incidence and severity of nausea and vomiting. 
  • Patient will demonstrate effective interventions that can help alleviate nausea and vomiting.
  • Patient will be able to eat small meals and/or consume fluids.

Assessment:

1. Assess for possible causes and triggers of nausea aside from pregnancy.
Proper assessment of the triggers and causes of nausea can help plan an appropriate treatment regimen, preventing the condition from becoming severe.

2. Assess for a history of nausea.
Research shows that women who experience nausea and vomiting outside of pregnancy, such as due to motion sickness or migraine headaches, are at a higher risk of experiencing nausea and vomiting during pregnancy.

Interventions:

1. Eliminate objects or food with strong and unpleasant odors.
Pregnancy can cause odor sensitivity, which may trigger nausea and vomiting. Strong and unpleasant odors can exacerbate hyperemesis gravidarum.

2. Encourage nonpharmacologic interventions to manage nausea.
Meditation, diversion, music therapy, and deep breathing exercise can help reduce the incidence of nausea and vomiting in pregnant women.

3. Administer antiemetics as indicated.
Antiemetics may be provided to pregnant women with hyperemesis gravidarum to help alleviate nausea and vomiting.

4. Encourage acupressure.
Placing pressure on the point located in the middle of the inner wrist is thought to reduce nausea. Special acupressure bands can be bought to put pressure on this site.

Deficient Fluid Volume

Hyperemesis gravidarum is characterized by excessive nausea and vomiting, which can result in excess fluid loss, weight loss, and dehydration.

Nursing Diagnosis: Deficient Fluid Volume

  • Nausea and vomiting
  • Inadequate fluid and food intake
  • Increased gastric secretions
  • Disease process

As evidenced by:

Expected outcomes:

  • Patient will remain adequately hydrated, as evidenced by urine output within normal limits.
  • Patient will deny the presence of dizziness, weakness, or faintness.

Assessment:

1. Monitor intake and output.
Patients with hyperemesis gravidarum often are unable to keep any food down. Strict monitoring of intake (oral or IV) and output (vomiting, urine) is required as dehydration can occur quickly.

2. Assess for any signs of dehydration.
Signs of dehydration like dry skin, dry mucous membranes, poor skin turgor, reduced blood pressure, tachycardia, and fever can result from excessive nausea and vomiting.

Interventions:

1. Evaluate and monitor laboratory values.
With excessive and prolonged vomiting, fluid loss and electrolyte imbalances occur. When potassium and magnesium are low, complications such as cardiac dysrhythmias and altered kidney function can occur.

2. Administer intravenous fluid replacement as ordered.
Intravenous fluid replacement can help manage fluid loss, prevent dehydration, and correct electrolyte imbalances in patients with hyperemesis gravidarum.

3. Provide ice chips.
The patient may not be able to tolerate large quantities of food or liquids. Ice chips can feel soothing and support hydration

4. Promote safety.
Dehydration can cause feelings of dizziness and fainting. Ensure the pregnant patient’s safety by always assisting with ambulation, encouraging non-slip socks, and keeping bed rails upright.

Imbalanced Nutrition: Less Than Body Requirements

Pregnant women with hyperemesis gravidarum experience excessive vomiting causing weight loss, dehydration, malnutrition, and electrolyte imbalances. It becomes impossible for these patients to take in adequate food and fluids for several weeks to months, compromising their nutrition and the development of the fetus.

Nursing Diagnosis: Imbalanced Nutrition

  • Nausea and vomiting
  • Disease process
  • Altered taste perception
  • Food aversion

As evidenced by:

  • Muscle weakness
  • Malnutrition
  • Weight loss
  • Dehydration 
  • Fatigue 
  • Food intake less than recommended daily allowance
  • Hypoglycemia
  • Pale mucous membranes
  • Dry skin
  • Poor fetal growth

Expected outcomes:

  • Patient will progressively gain weight with decreased severity of nausea and vomiting. 
  • Patient will be able to increase food and fluid intake, recognize triggers for nausea, and demonstrate interventions that can help alleviate nausea and vomiting.

Assessment:

1. Assess the fetus.
If inpatient management is required, continuous fetal monitoring may be recommended to monitor the fetal heart rate.

2. Assess and monitor maternal weight.
Severe and prolonged nausea and vomiting can cause malnutrition, dehydration, and weight loss. A weight loss of 5% of the pre-pregnancy weight is a common finding to support hyperemesis gravidarum.

Interventions:

1. Administer parenteral nutrition as indicated.
Administration of parenteral nutrition may be required for patients with hyperemesis gravidarum who cannot tolerate foods and fluid intake.

2. Encourage small meals.
Small meals allow food intake without aggravating bouts of nausea and vomiting.

3. Consult with a dietitian.
A dietitian can help plan an appropriate and well-balanced meal for patients with hyperemesis gravidarum giving special attention to the nutritional needs of pregnant women.

4. Offer ginger or change prenatal vitamins as ordered.
Switching the mother’s prenatal vitamins to folic acid alone may help. Ginger chews or drinks can also help relieve nausea.

References

Published on
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Maegan Wagner, BSN, RN, CCM
Maegan Wagner is a registered nurse with over 10 years of healthcare experience. She earned her BSN at Western Governors University. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public.