{
  "name": "Hyperemesis Gravidarum",
  "slug": "hyperemesis-gravidarum",
  "url": "https://nursingplex.com/care-plans/hyperemesis-gravidarum",
  "category": "Maternal & Newborn (OB)",
  "summary": "Severe pregnancy vomiting causing dehydration and weight loss; IV fluids and antiemetics.",
  "nursing_diagnoses": [
    "Deficient fluid volume",
    "Imbalanced nutrition",
    "Risk for electrolyte imbalance"
  ],
  "overview": [
    "Hyperemesis gravidarum is persistent, severe vomiting in pregnancy that goes far beyond normal morning sickness. It produces dehydration, electrolyte imbalance, ketosis and weight loss of more than 5% of pre-pregnancy weight, and it usually begins before nine weeks and can persist into the second trimester.",
    "The cause is multifactorial — high hCG and estrogen, delayed gastric emptying, genetic predisposition and psychosocial stress. It is more common in multiple gestation and molar pregnancy, both of which raise hCG dramatically, so ultrasound is part of the workup.",
    "Untreated, it leads to hypokalemia, metabolic alkalosis from lost gastric acid, thiamine deficiency with risk of Wernicke encephalopathy, and poor fetal growth. Nursing care is built around rehydration, controlled reintroduction of food, antiemetics and validating a condition that patients are frequently told to just tolerate."
  ],
  "key_facts": [
    {
      "label": "Diagnostic markers",
      "text": "Weight loss over 5%, ketonuria, dehydration and electrolyte disturbance — not just frequent nausea."
    },
    {
      "label": "Typical labs",
      "text": "Hypokalemia, hyponatremia, hypochloremic metabolic alkalosis and elevated urine specific gravity and ketones."
    },
    {
      "label": "Thiamine first",
      "text": "Give thiamine before or with dextrose-containing fluids to prevent Wernicke encephalopathy."
    },
    {
      "label": "First-line drug therapy",
      "text": "Vitamin B6 (pyridoxine) with doxylamine; then ondansetron, promethazine or metoclopramide as ordered."
    },
    {
      "label": "Rule out",
      "text": "Molar pregnancy and multiple gestation with ultrasound and hCG levels."
    }
  ],
  "nursing_priorities": [
    "Restore fluid, electrolyte and acid-base balance.",
    "Stop vomiting with scheduled antiemetics.",
    "Restore nutrition and reverse weight loss.",
    "Protect the fetus through adequate maternal intake and perfusion.",
    "Address the psychological toll and isolation of prolonged illness."
  ],
  "assessment": {
    "subjective": [
      "Frequency, timing and triggers of vomiting; ability to keep down fluids",
      "Dizziness, fatigue, weakness and palpitations",
      "Food aversions, odor sensitivity and heartburn",
      "Feelings of guilt, depression or fear of harming the baby"
    ],
    "objective": [
      "Weight compared with pre-pregnancy weight and trend during admission",
      "Dry mucous membranes, poor skin turgor, sunken eyes, tachycardia, orthostatic hypotension",
      "Urine output, specific gravity and ketones",
      "Serum potassium, sodium, chloride, bicarbonate, BUN, creatinine and liver enzymes",
      "Fetal heart tones and fundal height for growth",
      "Emesis amount, color and presence of blood or bile"
    ],
    "related_factors": [
      "Rapidly rising hCG and estrogen levels",
      "Delayed gastric emptying and esophageal reflux",
      "Multiple gestation or molar pregnancy",
      "Psychosocial stress and prior history of hyperemesis"
    ]
  },
  "goals": [
    "The client will maintain urine output above 30 mL/hr with specific gravity below 1.020 and no ketones.",
    "The client will have normal serum potassium, sodium and bicarbonate within 48 hours.",
    "The client will tolerate oral intake without vomiting and stop losing weight, then regain steadily.",
    "The client will report nausea at 3/10 or lower on antiemetic therapy.",
    "The fetus will show growth appropriate for gestational age."
  ],
  "interventions": [
    {
      "title": "Rehydration and electrolytes",
      "points": [
        "Administer IV isotonic fluid with added potassium as ordered; monitor for overcorrection and cardiac rhythm changes.",
        "Give thiamine supplementation with prolonged vomiting, before dextrose infusions.",
        "Keep strict intake and output including emesis volume, and weigh daily on the same scale.",
        "Monitor electrolytes and ketones daily until stable."
      ]
    },
    {
      "title": "Symptom control",
      "points": [
        "Keep NPO initially for gut rest, then reintroduce clear liquids in small sips before advancing.",
        "Administer scheduled rather than as-needed antiemetics so blood levels stay steady.",
        "Reduce environmental triggers: remove strong odors, serve food cold or at room temperature, keep the room ventilated.",
        "Provide oral care after every emesis to protect enamel and reduce nausea from taste."
      ]
    },
    {
      "title": "Nutrition rebuilding",
      "points": [
        "Advance to small, frequent, dry, high-carbohydrate, low-fat meals — six small meals rather than three large ones.",
        "Separate fluids from solids by 30 minutes to reduce gastric volume.",
        "Continue prenatal vitamins when tolerated; take them at night or with food if they trigger nausea.",
        "Consult dietitian and consider enteral nutrition or parenteral support if weight loss continues."
      ]
    },
    {
      "title": "Psychosocial and fetal care",
      "points": [
        "Acknowledge that this is a medical condition, not weakness or an emotional problem.",
        "Provide a quiet, low-stimulation room and cluster care to allow rest.",
        "Monitor fetal heart tones and growth; reassure with ultrasound findings when available.",
        "Screen for depression and connect with support groups and social work for work or childcare strain."
      ]
    }
  ],
  "patient_teaching": [
    "Eat dry crackers or toast before getting out of bed and rise slowly.",
    "Eat small amounts every two hours; an empty stomach worsens nausea.",
    "Avoid greasy, spicy and strongly scented foods; try ginger and vitamin B6 as advised.",
    "Sip fluids between meals and aim for steady hydration throughout the day.",
    "Return for inability to keep fluids down for 24 hours, weight loss, dizziness, dark scant urine or vomiting blood.",
    "Take antiemetics on schedule rather than waiting for vomiting to begin."
  ]
}