CPMS COLLEGE OF NURSING

CASE STUDY
ON
HYPEREMESIS GRAVIDARUM

SUBMITTED TO SUBMITTED BY
MAAM SANGEETA PAUL THOLEH LALRAMDINI JONGTE
ASSISTANT PROFESSOR ROLL NO.-19
OBSTETRICS & GYNAECOLOGY NURSING M. Sc (N) 2nd YEAR
CPMS COLLEGE OF NURSING CPMS COLLEGE OF NURSING
INTRODUCTION:
As a part of my clinical posting in GMCH in “Antenatal Ward”, I met my patient Habibi
Sultana of 22 years old who was diagnosed as Primi at 14 weeks of gestation with hyperemesis
gravidarum. I went and introduced myself to her family members and collected history about the
patient and family history. The patient and her family members were very co-operative and we
maintained a good inter-personal relationship.
IDENTIFICATION DATA:
Name : Mrs. Habibi Sultana
Age : 22 years
Hospital IP No : 887222/22
Date of admission : 22/06/22 at 2:10 pm
Ward : Antenatal Ward
LMP : 16/03/22
EDD : 21/12/22
Obstetrical Score : G1P0A0L0S0
Period of gestation : Primi at 14 weeks of gestation
Occupation : Housewife
Education : HSLC passed
Religion : Islam
Address : Barpeta, Assam
Diagnosis : Primi at 14 weeks of gestation with Hyperemesis Gravidarum

CHIEF COMPLAINTS:
My patient complaints of-
- Cessation of menstruation since 8 months

- Pain and excessive vomiting from last 14 days.

- Weight loss from 2 weeks

- Weakness from last 12 days

- Headache from last 1 week.
OBSTETRICAL HISTORY:

PAST OBSTETRICAL HISTORY-

Patient has no past obstetrical history as she is a primigravida mother.

PRESENT OBSTETRICAL HISTORY-

1st Trimester: The mother came to know about her pregnancy after she had done urine test at
home. She felt morning sickness and for further confirmation she did ultrasound. She is having
excessive nausea and vomiting and has been admitted to the hospital.

MEDICAL HISTORY:

PRESENT MEDICAL HISTORY-

At present the mother does not have any serious illness. She is admitted in GMCH for having
excessive vomiting, headache and weakness.

PAST MEDICAL HISTORY-

There is no past history of any chronic illness like diabetes, hypertension, asthma.

SURGICAL HISTORY:

PAST SURGICAL HISTORY- The patient does not have any past surgical history.

PRESENT SURGICAL HISTORY - The patient has no present surgical history.

FAMILY HISTORY :
Mrs. Habibi Sultana belongs to a nuclear family. No history of diabetes mellitus,
hypertension, epilepsy, blood disorders and any other communicable diseases. No history of
congenital anomaly and twinning in the family.
FAMILY COMPOSITION-

Name Age/Sex Relationship Education Occupation Health Status

with patient

1.Mohammad Ali 26 yrs/M Husband HSLC passed Shopkeeper Healthy

2. Habibi Sultana 22yrs/F Wife HSLC passed Housewife Hospitalized

FAMILY GENOGRAM

INDEX

---- Male

----- Female

---- Patient

PERSONAL HISTORY
Dietary Pattern: She is non vegetarian. She used to eat food 2 times a day. She used to
take light snack with tea in the evening.
Elimination Pattern: Bowel and bladder sound pattern is regular.
Sleep and Rest: Sleep pattern is not normal since 20 days she cannot sleep properly and
 also she cannot lei for long duration.
Exercise: She perform some antenatal exercises like meditation, breathing exercise and
also do a brisk walking for 10 minutes in morning.
Personal Hygiene: She used to maintain her personal hygiene.
Habits: She does not have the habit of taking alcohol, smoking and chewing tobacco.
MENTRUAL HISTORY
Age of menarche : 12 years
Reaction to Menarche : She has not shown any abnormal reaction.
Regularity of cycles : It was regular cycle for 28-30 days
Duration : Bleeding for 5 days
Flow : The flow was average.
Abnormalities if any : Not present.

MARITAL HISTORY
Married Life : They maintain a happy life. Good relationship is present among them.
Relationship with Husband : It is very good and understanding one.
Use of any contraceptive Method : Not used any method.
PHYSICAL EXAMINATION
General appearance:
Anthropometric measurements:
Height: 150 cm
Weight: 56 kg
Appearance : Weak, dull, pale
Nourishment : Well nourished.
VITAL SIGNS
Temperature : 98°F
Pulse : 86b/mins
Respiration : 20b/mins
Blood pressure : 120/80mmHg
HEAD TO TOE EXAMINATION
SKIN
Skin colour – Dark complexion
Skin vascularity- normal
Skin lesions - Not present
Temperature - warm to touch
Texture - soft and smooth
Turgor - normal
Edema – Not present.
HEAD
Hair - eventually distributed, smooth and black in colour
Scalp - No dandruff present, no scar mark present.
FACE - Looks worried, no puffiness present.
Skin : Colour is black and skin lesion is absent. Smooth in touch.
EYES
Eye brows - Eventually distributed and symmetrical.
Eyelids – Normal, no infections
Eyelashes - Equally distributed
Eyeballs - Normal and can move
Conjunctiva – Not present.
Sclera - White in colour, no signs of jaundice present
Pupils - Equal and reacted to light
Vision - Clear vision.
EARS
External ear - symmetrical and no infection
Gross hearing - Hearing ability is normal
 Pinna – symmetrical and no infection
Discharge - Not present.
NOSE
Nasal septum - no septal deviation present.
Nostril – patent, not inflamed
Placement – Properly placed in position.
MOUTH
Lips – pink in colour
Teeth - clean and no dental carries
Tongue - not coated
Odour - No foul odour present.
NECK
Range of motion- Possible
Thyroid gland- not enlarged
Lymph nodes- Not palpable
Distributed neck veins- Not distended
CHEST
Inspection:
Shape- Normal
Symmetry of expansion- symmetrical
Respiratory rate – 20 b/min
Palpation: No lump or mass present
Percussion: No fluid collection in pleural space.
Auscultation: Normal heart sound is heard, S1 and S2
BREAST
Inspection:
Size – normal and symmetrical.
Engorged/ cracked – No engorgement or cracked nipple are present.
Primary and secondary areola – present.
Montgomery tubercle- Present
Nipples – Normal, no inverted or dimpling present.

Palpation:
Colostrum is not yet secreted. Palpation done by circular method, no lump or mass is found.
Tenderness or pain is also not present.
ABDOMEN
Inspection:
Size – Normal.
Shape- spherical in shape
Contour- Convex
Umbilicus - Normal
Flanks- full.
Fetal movement- Not visible in inspection.
Condition of bladder- emptied
Skin changes- linea nigra and stria gravida is present
GENITAL ORGANS
Vulva - clean, no hairs present
Edema – not present
Varicosities – not present
Discharge –White discharge present.
Hemorrhoids – Not present
Signs and Symptoms of Infection – Not present.

EXTREMITIES
Upper limbs:

Capillary refill - 2 secs

Carpel turner syndrome – absent
Numbness – Not present
Range of motion – Possible
Lower limbs:
Range of motion - Possible
Varicosities – not present
Edema – not present.
BACK
Lesion – absent
Scar – absent
Infections – Not present
Scoliosis – Not present
Kyphosis – Not present
Lordosis – absent.

INVESTIGATIONS:
SL INVESTIGATIONS PATIENT PATIENT NORMAL REMARKS
NO VALUE VALUE VALUE
DAY 1 DAY 2

1. Haemoglobin 9.6g/dl 9.6 g/dl 12-15 g/dl Anaemic

2. TLC 11000 11000 4000-11000 Average

3. Platelets 2.98 lakh/ml 2.97 lakh/ml 1.5- 3.5 Normal

lakh/ml

4. ESR 7 7 <20mm/hr Normal

5. Lymphocytes 28% 27.8% 20-40% Normal

6. Monocytes 9% 9.7% 2-8% High

7. Blood sugar 105 100 70-140 mg/dl Normal

8. Serum bilirubin 0.4 0.4 Normal

9. SGOT 28 28 8-45 u/l Normal

10. SGPT 22 22 7-56 u/l Normal

MEDICATIONS:
Sr. Name of the Dose Route Frequency Action Side effects Nursing
Drug responsibilities
no.
1 Inj. 10mg i/v B.D. Antiemetic Diziness,  Assess the
Tiredness vital signs of
Metoclopram Headache patient
ide diarrhoea  Provide
Anxiety hydration
Allergic therapy to
reaction patient
 Maintain I/o
chart of
patient
2. Inj. Metrogyl 500 IV TDS Antibiotics Dizziness  About over
Headache dose of drug
mg  Educate
Diarrhea
Change in taste about the
Dry mouth side effects
4. injRantac 50 mg IV BD H2 Nausea  Continuous
Vomiting monitoring
receptor of client
Constipation
antagonist Dehydration  Provide fiber
ypersensitivity rich diet to
Rash the client
tachycardia
5. Ing 75 mg IM BD analgesics Abdominal
pain
Diclofenac
Bloating
Heart burn
Itching skin
Shortness of
breath
6. Inj 1gm IV BD Antibiotic Headache
Diarrhea
Ceftriaxone
Change in taste
Dry mouth

DISEASE CONDITION
HYPEREMESIS GRAVIDERUM
INTRODUCTION

Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss,

and electrolyte disturbance. Mild cases are treated with dietary changes, rest, and antacids. More
severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition
through an intravenous line (IV). DO NOT take any medications to solve this problem without
first consulting your health care provider.

DEFINITION:It is severe type of vomiting of pregnancy which has got deleterious effect on the
health of the mother and day to day activity.

INCIDENCE: There has been marked fall in the incidence during the last 30 years. It is now a
rarity in hospital practices .The reason are better application of the family planning, reduced the
no of unplanned pregnancy .Early visit to the antenatal visits

CAUSES:

Excessive vomiting is caused by a rise in hormone levels.

 it is more common in first trimester
 younger age
 low body mass
 history of motion
 Family history it is more common in unplanned pregnancy

SIGNS AND SYMPTOMS:

 When vomiting is severe, it may result in the following:

 Loss of 5% or more of pre-pregnancy body weight
 Dehydration, causing ketosis, and constipation
 Nutritional disorders, such as vitamin B1 (thiamine) deficiency, vitamin B6 (pyridoxine)
deficiency or vitamin B12 (cobalamin) deficiency
 Metabolic imbalances such as metabolic ketoacidosis or thyrotoxicosis
 Physical and emotional stress
 Difficulty with activities of daily living
 Symptoms can be aggravated by hunger, fatigue, prenatal vitamins (especially those
containing iron), and diet. Many women with HG are extremely sensitive to odors in their
environment; certain smells may exacerbate symptoms.
 Excessive salivation, also known as sialorrhea gravidarum, is another symptom
experienced by some women.

SYMPTOMS
Book picture Patient picture
 increased frequency of vomiting Present
  diminished quantity of urine Present

 epigastric pain Present

 constipation may occur

Some times constipation occurs
 Featured of dehydration

 Dry coated tongue Dehydrated

Present
 Rise in temperature
Absent
 jaundice
Absent
 excessive salivation
Present
 Emotional stress

DIAGNOSIS

BOOK PICTURE PATIENT PICTURE

 Ultrasound – uses sound waves to Done
produce the picture. The ultrasound probe
can be placed on the abdomen or it can be
placed inside the vagina to make the
picture.
 UPT(urine pregnancy test)- UPT is Done
done to identify the pregnancy.

TREATMENT

Anti-emetic drug promethazine- 25 mg of prochlorperazine 5 mg ,twice a day I/M.

Metoclopramide –it stimulates gastric and intestinal mortality without stimulating

secreation.Metoclopramide is also used and relatively well tolerated. Evidence for the use
of corticosteroids is weak.
there is some evidence that corticosteroid use in pregnant women may slightly increase the risk
of cleft lip and cleft palate in the infant and may suppress fetal activity.
However, hydrocortisone and prednisolone are inactivated

Hydrocortisone- 100 mg i/v in drip is given in case with hypotension or in intractable vomiting
Ondansetron may be beneficial, however, there are some concerns regarding an association
with cleft palate,and there is little high-quality data. in the placenta and may be used in the
treatment of hyperemesis gravidarum after 12 weeks.

Nutritional supplements – vitamin 100mg daily, vitB6 ,Vit C are also given in some cases.

Fluids- the amount of fluid to be infused in 24 hrsis approximately 3litters in which half os
dextrose 5% and half in ringer lactate.
After IV rehydration is completed, patients typically begin to tolerate frequent small liquid or
bland meals.

After rehydration, treatment focuses on managing symptoms to allow normal intake of food.
However, cycles of hydration and dehydration can occur, making continuing care necessary.
Home care is available in the form of a peripherally-inserted central catheter (PICC) line for
hydration and nutrition. 
Home treatment is often less expensive and reduces the risk for a hospital-acquired
infection compared with long-term or repeated hospitalization.

Alternative medicine Acupuncture (both with P6 and traditional method) has been found to be
ineffective.

The use of ginger products may be helpful, but evidence of effectiveness is limited and
inconsistent, though three recent studies support ginger over placebo.

NURSING DIAGNOSIS (Priority Wise):

 Fluid volume deficit related to excessive vomiting as evidenced by physical examination
& Intake output chart
  Imbalance nutrition: less than body requirement related to loss of appetite as evidenced
by less body weight
 Anxiety related to hospitalization as evidence by her facial experience
 Hopelessness related to life threatening disease as evidence by while comunucating with
patient
 Knowledge deficit regarding disease condition as evidenced by conversation.
 Risk for complications related to alteration in normal fluid level

Short term goals:

 To relieve the headache induced by excessive vomiting.
 To maintain normal nutritional status
 To prevent the risk for infection

Long term goals

 To maintain the normal fluid level
 To relieve anxiety related to hospitalization
 To provide knowledge related to condition

Nursing care plan (1)

Assessment Nursing Goal Nursing Implementati Scientific Evaluation
Diagnosis interventions on Rationale

Subjective Fluid Norm Assess the Physical To collect The

al
data volume physical examination the base line patient’s
body
Patient told deficit fluid condition of has been done data fluid level
level
that I am related to the patient. is come to
will
suffering excessive be Check Recorded normal ata
maint intake and
from severe vomiting as theintke some
ained
vomiting and evidenced output chart of output chart. extent.
I have also by physical the patint.
To improve
feeling the examinatio Provide the RL and D5%
the body
abdominal n & Intake fluid to the has been given
pain , output chart patient. to the patient. normal fluid
To prevent
Objective Provide bed Advise rest to
from any
data rest to the the patient
harm.
I observed patient.
Antiemetics To reduce the
the patient by Provide
vomiting antiemetic has been given vomiting
to the patient. episodes.
episodes 5- drugs to the
6 /day, mother. Inj.metoclopra

Facial mide
It will
expression Eliminate the Provide proper
diminished
smell of the ventilation to
the episodes
environment the patient.
of vomiting.

Nursing care plan 2

Assessment Nursing Goal Nursing Implementati Scientific Evaluation
 Diagnosis interventions on Rationale
Subjective Anxiety To Assess the General To provide Anxiety has
general condition has baseline data
data related to reduced been
condition of been assessed for planning
Patient says hospitaliz Anxiety the patient by the of care reduced to
inspection.
that “I am ation as level some
feeling evidence Ask the client Patient has It will extent.
to express her been ventilate reduces her
anxiety” by feelings about with general anxiety now the
Objective mother’s the condition. verbalization patient is
data facial feeling
Observed the expressio Advise Individual It will help to relax.
counselling counselling improve the
patient by n. about the has been knowledge
facial condition provided to the about the
patient . condition .
expression
Crying Provide it will help to
Psychological
questioning psychological support has reduced the
support to the been provided anxirty level.
about her patint to the patint
condition and
treatment.

Nursing care plan 3

Assessment Nursing Goal Nursing Implementati Scientific Evaluation
Diagnosis interventions on Rationale
Subjective Risk of Assess the Assessed the To know the My patient
Risk for compli
data general condition of baseline data. has
complicati cation
Patient says will be condition of patient increased
ons related minimi
that “I am client Dry skin and fluid
to ze
feeling very Reduced urine volume nd
alteration
weak,restless output decreased
in normal
and dry the chances
fluid
tounge.” of
levelas Provide more To hydrate the
Provided more infection.
evidenced fluids to patient
Objective water & juices
by patient to patient.
data
patient’s
Observed the
lab reports Maintain To hydrate the
patient by lab Maintained
intake output patient
reports intake output
chart chart
Unable to
stand To maintain
Provide I/V provided I/V
Dry skin and hydration.
hydrations hydration
tongue
therapy to
patient

PROGRESS NOTES
Day- 1
Monitor the vital sign of the patient. ie.
 temp =99*f
 pulse =74 b/ min.
 BP=100/70 mmhg

ADVICE
  Provide personal hygiene to the patient.
 advice the patient about the for ambulation
 provide fluid to the patient.
Day -2
 patient fluid level is maintaing.
 Advice regarding the personal hygiene.
 help the patient in ambulation
Day -3
 patient is afebrile
 physical movement is in progress
 Now the pain is reduced.
 patient is feeling comfortable.

RECORDING AND REPORTING

• Provide medication to the patient

• Help the patient in early ambulation.
• Clean the suture and dressing over the sutures
• Checked vital signs of the patient
• Give health education to the patient
• Maintain intake output of the patient

HEALTH EDUCATION:

Diet-

 Patient is taught regarding balanced diet.

 Patient is advised to add fruits, juices & salad in diet
 Advise the patient to take platy of water.
 Avoid the food that cause irritation
 Avoid junk food
 Advise to note her intake and output chart
Exercise

 Patient is advised to refused exercise for some time

Hygiene
  Patient is advised to keep her surroundings clear & perform hand hygiene properly.
 Perform lab test after sometimes
 Advised to walk in a fresh environment.
 Advised to talk with others to ventilate her ideas it will reduce the anxiety.
Follow Up

 Follow up dates are given to patient & they should be clearly explained regarding it.
 Explain the family member to engaged her in a little work so that she can divert her mind
from the feelings of vomiting during the pregnancy period
 Help the patient to gain her self-esteem

CONCLUSION

Taking this case is beneficial for me as well as my patient. Psychological support and others life
experience of the other vomiting patients gave motivation to my patient. I learned many things
from patient which I can easily see in patient. The case gives me the new experience that how we
have to take care of patients suffering from hyperemesis gravidarum.