2. Complications affecting nutrition/elimination: hyperemesis gravidarum
   • Pathophysiology - pernicious vomiting during first 14-16 weeks (peak incidence around 10 weeks of gestation); excessive vomiting at any time during pregnancy. Potential hazards include the following:
     1. Dehydration with fluid and electrolyte imbalance.
     2. Starvation, with loss of 5% or more of body weight; protein and vitamin deficiencies.
     3. Metabolic acidosis - due to breakdown of fat stores to meet metabolic needs.
     4. Hypovolemia and hemoconcentration; increased blood urea nitrogen (BUN); decreased urinary output.
     5. Embryonic or fetal death may result, and the woman may suffer irreversible metabolic changes or death.
   • Etiology:
     1. Physiological - secretion of HCG, decrease in free gastric HCI, decreased gastrointestinal motility. Increased incidence in hydatidiform mole and multifetal pregnancy (due to high levels of HCG).
     2. Psychological - thought to be related to rejection of pregnancy or sexual relations.
   • Assessment:
     1. Intractable vomiting.
     2. Abdominal pain.
     3. Hiccups.
     4. Marked weight loss.
     5. Dehydration - thirst, tachycardia, skin turgor.
     6. Increased respiratory rate (metabolic acidosis).
     7. Laboratory - elevated BUN.
     8. Medical evaluation: rule out other causes (infection, tumors).
   • Analysis/nursing diagnosis:
     1. Altered nutrition, less than body requirements, related to inability to retain oral feedings.
     2. Fluid volume deficit related to dehydration.
     3. Ineffective individual coping related to symptoms, insecurity in role, psychological stress of unwanted pregnancy.
     4. Personal identity disturbance related to symptoms or perception of self as inadequate in role, sick, socially unpresentable.
   • Nursing care plan/implementation:
     1. Goal: physiological stability
        • Rest GI tract (keep NPO), e.g., maintain IV fluids, parenteral nutrition.
        • Progress diet, as ordered; present small feedings attractively; ↑CHO, ↓fat, ↓acid.
        • Weigh daily, assess hydration; note weight gain.
        • Antiemetics (IV, suppository).
     2. Goal: minimize environmental stimuli.
        • Limit visitors and phone calls.
        • Bed rest with bathroom privileges.
     3. Goal: emotional support.
        • Establish accepting, supportive environment.
        • Encourage verbalization of anxiety, fears, concerns.
        • Support positive self-image.
   • Evaluation/outcome criteria:
     1. Womans signs and symptoms subside; she takes oral nourishment and gains weight.
     2. Woman’s pregnancy continues to term without recurrence of hyperemesis.