1229 Exam 5: Hyperemesis

Question 1

What is Hyperemesis?

Answer 1

When vomiting during pregnancy becomes excessive enough to cause weight loss of at least 5% of pre-pregnancy weight AND is accompanied by dehydration, electrolyte imbalance, ketosis, and acetonuria.

*usually begins in the first 10 wks of pregnancy.

Question 2

Risk factors of Hyperemesis

Answer 2

Nulliparous
Increased body weight
history of migraines
pregnant with twins
pregnant with hydatidiform mole
psychological component

Question 3

What does Hyperemesis look like?

Answer 3

significant weight loss
symptoms of dehydration
decreased BP
increased pulse rate
poor skin turgor
Inability to keep down even clear liquids
lab test that reveal electrolyte imbalance (Potassium, calcium, and sodium)

Question 4

Potassium Lab values

Answer 4

3.8-5.0 mEq/L

Question 5

Calcium Lab Values

Answer 5

8.5-10.5 mg/100ml

Question 6

Sodium Lab Values

Answer 6

135-145 mEq/L

Question 7

How is Hyperemesis Diagnosed?

Answer 7

Urinalysis, CBC, Electrolytes, Liver enzymes and Bilirubin levels rule out the presence of underlying diseases (pyelonephritis, pancreatitis, cholecytitis, hepatitis)

test TSH and T4 should be assessed because of hyperthyroidism.

Question 8

How is Hyperemesis Treated?

Answer 8

**Esp. if woman cannot keep down liquids:
IV therapy
NPO until dehydration resolved and for at least 48 hours after vomiting stopped
Antiemetics

Question 9

Different types of Antiemetics:

Answer 9

Pyridoxine –Vitamin B6
Doxylamine– Unisom
Promethazine– Phenergan
Metoclopromide– Reglan

Question 10

Interventions of Hyperemesis include:

Answer 10

Initiate and monitor IV therapy
Administer drug and nutritional supplements
Monitor woman’s response to interventions
Psychotherapy and stress reduction
Observe for signs of complications (metabolic acidosis, jaundice, and hemorrhage)
Monitor: assessment of nausea, retching without vomiting, and vomiting
Accurate measurement of I&O
oral hygiene
assist w positioning
quiet,restful environment free from odors

Question 11

What is the tool that allows quantification of the presence and severity of nausea and vomiting and promotes accurate monitoring?

Answer 11

Pregnancy-Unique Quantification of Emesis/Nausea (PUQE) index.

Question 12

How does the PUQE work?

Answer 12

total score is three replies to each of the three questions:

Nausea score: mild NVP less than six; moderate NVP 7-12; Severe NVP is greater than 13.

Question 13

Interventions of Hyperemesis after woman starts responding to therapy:

Answer 13

limited amounts of fluids and bland foods
(Crackers, toast, or baked chicken)
diet is progressed slowly as tolerated.
promote adequate rest
coordinate treatment to allow for rest periods

Question 14

What do I teach my patient about Hyperemesis?

Answer 14

eat small, frequent meals consisting of low fat, high protein foods
avoid greasy and highly seasoned foods
increase intake of potassium and magnesium
herbal teas may decrease nausea
take in fluids between meals rather than with meals helps to decrease nausea
have other family members cook if possible

Question 15

Dietary instructions for hyperemesis:

Answer 15

eat dry bland foods
high protein 
small frequent meals
cold food
snack before bedtime
drink tea or water with lemon
avoid high fat or spicy foods

Question 16

What is Ectopic Pregnancy?

Answer 16

A pregnancy in which the fertilized ovum is implanted outside of the uterine cavity, mainly in the fallopian tubes, but can also occur in the ovaries, abdominal cavity, and cervix.

Question 17

How is an Ectopic Pregnancy classified?

Answer 17

According to the site of implantation.
Ex: tubal, cervical, abdominal, or ovarian

**The uterus is the only organ capable of containing and sustaining a term pregnancy.

Question 18

What does Ectopic Pregnancy look like?

Answer 18

missed menstrual period
adnexal fullness
tenderness that may suggest an unruptured tubal pregnancy
dark red/brown abnormal vaginal bleeding

Question 19

If ectopic pregnancy ruptures….

Answer 19

pain increases.
May be generalized, unilateral, or acute deep lower quadrant pain caused by blood irritating the peritoneum
referred shoulder pain can occur from diaphragmatic irritation caused by blood in the peritoneal cavity.
signs of shock related to the amount of bleeding in the abdominal cavity and not necessarily vag. bleeding
Cullen sign: an ecchymotic blueness around the umbilicus

Question 20

How is Ectopic Pregnancy diagnosed?

Answer 20

Serum progesterone, B-hCG, Transvaginal ultrasound,

Question 21

How is Ectopic Pregnancy treated?

Answer 21

Quick treatment is the best treatment.

Recommended to remove the pregnancy by salpingostomy before rupture.
general preop and post op care
vital signs per protocol 
blood type
rh factor

Question 22

residual tissure is resolved with a dose of what?

Answer 22

Methotrexate

Question 23

What is Methotrexate?

Answer 23

antimetabolite and folic acid antagonist taht destroys rapidly dividing cells.
Single dose IM injection to treat unruptured pregnancies

• *Look up in drug book.
• • women recieving methotrexate should not take any analgesic stronger than acetaminophen– may mask symptoms of tubal rupture.

Question 24

What is a hydatidiform mole?

Answer 24

A gestational trophoblastic disease (GTD)

Question 25

What are the two types of hydatidiform mole?

Answer 25

complete/classic | partial

Question 26

What causes hydatidiform mole?

Answer 26

unknown, but there may be an ovular defect or nutrition deficiency. women in early teens or over age of 40 OR any woman who has undergone ovulation stimulation

Question 27

Complete/classic hydatidiform mole:

Answer 27

results from fertilization of an egg, the nucleus of which has been lost or inactivated The sperm duplicates itself because the ovum has no genetic material. The mole resembles a bunch of white grapes. The hydropic(fluid filled) vesicles grow rapidly, causing the uterus to be larger than expected for the duration of pregnancy. usually contains no fetus, placenta, amniotic membranes, or fluid maternal blood has no placenta to recieve it, leading to hemorrhage into the uterine cavity vaginal bleeding occurs can cause choriocarcinoma.

Question 28

Partial Hydatidiform mole:

Answer 28

chromosome studies often show a karyotype of 69, XXY; 69, XXX; 69, XYY This occurs because two sperm fertilize an apparent normal ovum. often have embryonic or fetal parts and an amniotic sac congenital anomolies are usually present potential for malignant transformation is less than 6%

Question 29

What does Hydatidiform mole look like?

Answer 29

prune colored discharge early stages of complete mole cannot be distinguished from normal pregnancy vaginal bleeding occurs in 95% dark brown vaginal discharge (scant or profuse) significantly larger uterus than expected for pregnancy dates anemia from blood loss excessive n/v abdominal cramps preeclampsia any symptoms of gestational hypertension before 24 weeks is suggestive of mole hyperthyroidism pulmonary embolization of trophoblastic elements partial mole causes few symptoms and may be mistaken for a miscarriage**

Question 30

How do you treat Hydatidiform mole?

Answer 30

``` Most pass spontaneously, but D&C offers safe and rapid evacuation of mole. hysterectomy is possible assessment provide woman and fam about the disease encourage to express feelings ```

Question 31

What do I teach my patient about Hydatidiform Mole?

Answer 31

pregnancy should be avoided for one year to void confusing signs of choriocarinoma with pregnancy any contraceptive is acceptable except intrauterine device.

Question 32

Follow up of Hydatidform Mole:

Answer 32

close observation for one year pelvic exams and measurement of B-hCG rise tite and enlarging uterus are signs of choriocarcinoma.

Question 33

What is a miscarriage?

Answer 33

Spontaneous abortion-- a pregancy that ends without medical or surgical method before 20 weeks gestation or 500 gram birth weight *we use the term miscarriage because abortion to some patients seems harsh and insensitive.

Question 34

What is early miscarriage?

Answer 34

Ends before 12 weeks

Question 35

Possible causes of early miscarriage:

Answer 35

``` endocrine imbalance immunological factors infections systemic disorders genetic factors ```

Question 36

What is a late miscarriage?

Answer 36

occurs between 12-20 weeks | usually results from maternal causes*

Question 37

Causes of late miscarriage:

Answer 37

``` advanced maternal age chronic infections premature dilation of the cervix chronic debilitating diseases inadequate nutrition recreational drug use ```

Question 38

What does a miscarriage look like?

Answer 38

Early in preg. -- uterine bleeding uterine contractions uterine paine

Question 39

If miscarriage occurs before six weeks of pregnancy--

Answer 39

heavy menstrual flow

Question 40

if occurs 6-12 weeks of pregnancy--

Answer 40

moderate discomfort and blood loss

Question 41

If miscarriage occurs after 12 weeks--

Answer 41

severe pain, similar to labor because fetus must be expelled.

Question 42

Types of spontaneous abortions:

Answer 42

``` threatened inevitable incomplete complete missed ```

Question 43

Threatened S&S:

Answer 43

spotting of blood with a closed cervical os | mild uterine cramping

Question 44

Inevitable S&S:

Answer 44

``` moderate to heavy amount of bleeding open cervical os tissue may be present with bleeding mild to severe uterine pain and cramping ROM passage of products of conception cervical dilation ```

Question 45

incomplete S&S

Answer 45

``` moderate to heavy amount of bleeding open cervical os tissue may be present with bleeding mild to severe uterine pain and cramping expulsion of fetus retention of placenta ```

Question 46

Complete S&S

Answer 46

all fetal tissue passed cervix closed slight bleeding mild uterine cramping

Question 47

Missed miscarriage

Answer 47

Fetus has died but the products of conception are retained in utero for up to several weeks. Diagnosed by ultra sound after fetus stops increasing or even decreases in size. may be no bleeding or pain cervical os closed if the products remain in the uterus they may calcify (womb stone)

Question 48

WHat do I teach my patient on miscarriage:

Answer 48

discharge home when vitals are stable emphasize need for rest teach normal findings: bleeding, cramping, resumption of sexual activity, family planning, follow up phone calls are important