pernicious vomiting which is also known as Hyperemesis gravidarum

excessive harmful vomiting in pregnancy , M.Sc. nursing and B.Sc. Nursing topic

1. TOPIC PRESENTATION ON PERNICIOUS VOMITING PRESENTED BY:- RATNA PARMAR

2. HYPEREMESIS GRAVIDARUM Hyperemesis Gravidarum is excessive nausea and vomiting during pregnancy. This pernicious vomiting is differentiated from the more common and more normal morning sickness by the fact that it is of greater intensity and extends beyond the first trimester. Hyperemesis gravidarum may occur in any of the three trimesters. It is a condition affecting one in 1,000 pregnancies. Hyperemesis gravidarum is a complication of pregnancy that is characterized by severe nausea and vomiting such that weight loss occur. The exact cause of hyperemesis gravidarum is not known. Risk factors include the first pregnancy, multiple pregnancy, obesity or family history of hyperemesis gravidarum .

3. DEFINITION Hyperemesis Gravidarum is defined as extreme, excessive, and persistent vomiting in early pregnancy that may lead to dehydration and malnutrition.

4. INCIDENCE- There has been marked fall in the incidence during the last 30years. It is now a rarity in hospital practice ( less than 1 in 1000 pregnancies). (a)Better application of family planning knowledge which reduces the number of unplanned pregnancies,(b) Early visit to the antenatal clinic and (c) Potent antihistaminic, antiemetic drugs.

5. THEORY Endocrine theory :high levels of hCG & estrogen during pregnancy Metabolic theory :vitamin B6 deficiency Psychological theory : Psychological stress increase the symptoms

6. CLINICAL MANIFESTATION- From the management and prognostic point of view the clinical manifestation divided in to two types- EARLY LATE (moderate to severe) 1)Early- Vomiting occurs throughout the day. Normal day to day activities are curtailed. There is no evidence of dehydration or starvation. 2)late- (Evidence of dehydration and starvation are present).

7. Increased vomiting. Urine quantity is diminished. Epigastric pain. Constipation. Dry coated tongue. Sunken eyes.

8. Tachycardia. Hypotension. Rise in temperature. Poor appetite. Poor nutritional intake.  

9. Loss of more than 25% of body weight. Dehydration and electrolyte imbalance. Rapid pulse and low blood pressure. Occasionally, jaundice develops in severe cases.

10. DIAGNOSTIC EVALUATION- Urinalysis : (1) Quantity- small (2) Darkcolour (3) High specific gravity with acid reaction (4)Presence of acetone, occasional presence of protein andrarely bile pigments (5) Diminished or even absence of chloride. Biochemical and circulatory changes : The changes are mentioned previously. Routine and periodic estimation of the serum electrolyte (sodium, potassium and chloride) is helpful in the management of the case.

11. Opthalmoscopic examination : Required if the patient is seriously ill. Retinal hemorrhage and detachment of the retina are the most unfavorable signs. ECG : When there is abnormal serum potassium level.

12. COMPLICATION Weight loss Dehydration Metabolic acidosis from starvation Hypokalemia (electrolyte imbalance)

13. MANAGEMENT- Women with hyperemesis gravidarum are admitted to the hospital. Initially nothing is given by mouth. Hypovolemia and electrolyte imbalance are corrected by intravenous infusion. Vitamin supplements are given parenterally. Fluids and diet are gradually introduced as the woman’s condition improves.

14. principles of management : To control vomiting. To correct the fluids and electrolytes imbalance. To correct metabolic disturbances(acidosis or alkalosis). To prevent the serious complications of severe vomiting.

15. Hospitalization- Whenever a patient is diagnosed as a case of hyperemesis gravidarum , she is admitted, surprisingly, with the same diet and drugs used at home, the patient improves rapidly. Fluids therapy Oral feeding is withheld for at least 24 hours after the cessation of vomiting. During this period, fluid is given through intravenous drip method. The amount of fluid to be infused in 24 hours is calculated as follows: the total amount of fluid approximates 3 litres , of which half is 5% dextrose and half is Ringer’s solution. Extra amount of 5% dextrose equal to the amount of vomitus and urine in 24 hours, is to be added.

16. Drugs- emetic drugs- Promethazine(Phenergan) 25mg or Prochlorperazine ( stemetil ) 5mg or trifluopromazine ( siquil ) 10mg may be administered twice or thrice daily intramuscularly. Trifluoperazine ( Espazine ) 1mg twice daily intramuscularly is a potent anti-emetic therapy. Vitamin B6 and Doxylamine are also safe and effective. Metoclopramide stimulates gastric and intestinal motility without stimulating the secretions. It is found useful. Hydrocortisone- 100 mg I.V. in the drip is given in a case with hypotension or in intractable vomiting. Oral method prednisolone is also used in severe cases. Nutritional support- with vitamin B1, vit B6, vit C and vit . B12 are given.

17. ADVICE Avoid: Before or after meals: Stuffy rooms, odors (e.g., perfume, chemicals, coffee, food, smoke), heat, humidity, noise, visual or physical motion (e.g., flickering lights, driving), being tired. PREFFERABLE DIET Tea and dry biscuit before getting up. Eat small frequent meals. Eat something every 2–3 hours to avoid hunger. Drink fewer liquids with meals. Drinking liquids can cause a full, bloated feeling.

18. Brushing teeth after eating may help prevent symptoms. Avoid lying down immediately after eating . Rest after meals . Sit up in a chair for about an hour after meals. Avoid sudden movements . Rise slowly from the bed. After meals

19. ALTERNATIVE THERAPY FOR NAUSEA AND VOMITTING

20. ACUPRESSURE Acupressure is the stimulation by pressure on specific called acupoints . Relief can be felt in 10-30 seconds, however, it can take up to five minutes.

21. P6 WRIST BAND They are inexpensive and can be positioned over acupressure points on both wrists. Traditional acupuncture should be performed only under the supervision of a trained professional.

22. OTHER THERAPY AROMA THERAPY DIVERTIONAL THERAPY SLEEP AND REST RECREATIONAL THERAPY

23. NURSING DIAGNOSIS TO control the vomiting.

24. 1. Fluid volume deficit related to excessive fluid loss as evidenced by dehydration. 2.Nutrition less than body requirement related to vomiting as evidenced by weight loss.

25. Constipation related to changes in diet(dehydration) and decreased physical activity as evidenced by client not passes the stool even one time in a day. Anxiety related to disease prognosis as evidenced by facial tension.

26. NURSING MANAGEMENT - 1. Need for maintaining fluid volume 2 . Need for reduce pain 3 . Need for prevent from infection 4 . Need for reducing anxiety

27. CONCLUSION- Many women experience morning sickness, or nausea, during pregnancy. This condition is generally harmless. While morning sickness can be quite uncomfortable, it typically goes away within 12 weeks. Hyperemesis gravidarum (HG) is an extreme form of morning sickness that causes severe nausea and vomiting during pregnancy. The symptoms of HG begin within the first six weeks of pregnancy, and nausea often doesn’t go away. HG can be extremely debilitating and cause fatigue that lasts for weeks or months.

28. ASSIGNMENT WRITE IN BRIEF WHAT HEALTH EDUCATION WILL YOU PROVIDE MOTHER SUFFERING FROM HYPEREMESIS GRAVIDERUM .