Case Study Antenatal
Case Study Antenatal
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
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:
At present the mother does not have any serious illness. She is admitted in GMCH for having
excessive vomiting, headache and weakness.
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.
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-
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:
INVESTIGATIONS:
SL INVESTIGATIONS PATIENT PATIENT NORMAL REMARKS
NO VALUE VALUE VALUE
DAY 1 DAY 2
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
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:
SYMPTOMS
Book picture Patient picture
increased frequency of vomiting Present
diminished quantity of urine Present
Present
Rise in temperature
Absent
jaundice
Absent
excessive salivation
Present
Emotional stress
DIAGNOSIS
TREATMENT
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.
Facial mide
It will
expression Eliminate the Provide proper
diminished
smell of the ventilation to
the episodes
environment the patient.
of vomiting.
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.
HEALTH EDUCATION:
Diet-
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.