Hyperemesis Gravidarum Nursing Care Plan
Severe pregnancy vomiting causing dehydration and weight loss; IV fluids and antiemetics.
Quick answer
A Hyperemesis Gravidarum nursing care plan centers on restore fluid, electrolyte and acid-base balance; stop vomiting with scheduled antiemetics; restore nutrition and reverse weight loss. Priority nursing diagnoses are Deficient fluid volume, Imbalanced nutrition, Risk for electrolyte imbalance. The plan below gives assessment cues, measurable goals, 4 intervention sets with rationales, and patient teaching.
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 numbers to know
Diagnostic markers
Weight loss over 5%, ketonuria, dehydration and electrolyte disturbance — not just frequent nausea.
Typical labs
Hypokalemia, hyponatremia, hypochloremic metabolic alkalosis and elevated urine specific gravity and ketones.
Thiamine first
Give thiamine before or with dextrose-containing fluids to prevent Wernicke encephalopathy.
First-line drug therapy
Vitamin B6 (pyridoxine) with doxylamine; then ondansetron, promethazine or metoclopramide as ordered.
Rule out
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.
Nursing assessment
Subjective data
- 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 data
- 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
Key nursing diagnoses
Goals and expected outcomes
- 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.
Nursing interventions and rationales
Rehydration and electrolytes
- 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.
Symptom control
- 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.
Nutrition rebuilding
- 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.
Psychosocial and fetal care
- 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 and family 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.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Hyperemesis Gravidarum questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
More Maternal & Newborn (OB) care plans
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Care plan writing guides
Common questions
What are the nursing diagnoses for Hyperemesis Gravidarum?
Priority nursing diagnoses for Hyperemesis Gravidarum: Deficient fluid volume; Imbalanced nutrition; Risk for electrolyte imbalance.
What are the nursing interventions for Hyperemesis Gravidarum?
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. 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.
What are the nursing care goals for Hyperemesis Gravidarum?
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.
What should you assess in a patient with Hyperemesis Gravidarum?
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; 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