Fluid and Electrolytes- Hyperemesis Gravidum

Question 1

Maternal age (less than 20), obesity, primagravida, multipara, high stress, and transient hyperthyroidism are all what?

Answer 1

Risk factors for HG

Question 2

What are some physical (objective) assessment findings you would see in a pt. w/ HG?

Answer 2

Decreased BP, increased HR, poor skin turgor, wt. loss, excessive vomiting and diarrhea

Question 3

In a urinalysis to help diagnose HG what are they looking for?

Answer 3

Ketones and acetones

Question 4

What is hyperkalemia?

Answer 4

Elevated K+ levels

Question 5

The regulation of volume and composition of body fluids through several mechanisms is known as what?

Answer 5

Maintaining homeostasis

Question 6

What is another word for HG, but is less severe?

Answer 6

Morning sickness

Question 7

Extreme N/V that is prolonged past 12wks gestation is known as what?

Answer 7

HG

Question 8

What is found w/in the cells of the body and makes up 2/3 of total body fluids?

Answer 8

ICF

Question 9

Blood serum, saline, albumin, urine, bile, hormones and CSF are all what?

Answer 9

Types of fluid and electrolytes

Question 10

What are normal sodium (Na) values?

Answer 10

135-145

Question 11

What are normal potassium (K) values?

Answer 11

3.5-5.3

Question 12

What are normal calcium (Ca) values?

Answer 12

8.5-10.5mg/dL

Question 13

What are normal magnesium (Mg) values?

Answer 13

1.5-2.5

Question 14

What are the major cations of ICF?

Answer 14

K and Mg

Question 15

What are the major anions of ICF?

Answer 15

Phosphate and sulfate

Question 16

Most abundant cation of ECF is?

Answer 16

Na

Question 17

Most abundant anion of ECF is?

Answer 17

Cl

Question 18

What are the principle electrolytes of ECF?

Answer 18

Sodium, chloride, and bicarbonate

Question 19

What is fluid found outside of cells, makes up 1/3 of total body fluids, is divided into intravascular (plasma) and interstitial (pleual, peritoneal, etc.)?

Answer 19

ECF

Question 20

What leads to fluid and electrolyte imbalance, alkalosis, and loss of hydrochloride acid?

Answer 20

Dehydration

Question 21

Flat veins, hypotension, tachycardia, increased Hct and BUN, fatigue/muscle weakness, dry mucosa/skin, weak pulse, decrease urine output are all what?

Answer 21

S/S of FVD/dehydration

Question 22

Hypovolemia/dehydration-insufficient intake, diarrhea/vomit, NG suctioning, Drainage/burns, diuretics are all what?

Answer 22

Causes of FVD

Question 23

What is HG?

Answer 23

Persistent, severe vomiting during pregnancy leading to wt. loss and dehydration

Question 24

Dehydration, wt. loss (>5% of wt), ketosis, and electrolyte abnormalities are all caused by what during pregnancy?

Answer 24

Uncontrolled vomiting

Question 25

When does extreme vomiting usually develop during pregnancy?

Answer 25

5wks gestation

Question 26

When does "morning sickness" usually disappear?

Answer 26

16-20wks

Question 27

True or false. | In a pt. w/ HG vomiting goes away in 16-20wks.

Answer 27

False

Question 28

What hormone is affected (elevated) during HG bc of an increase in vomiting during pregnancy?

Answer 28

Human Chorionic Gonadotropin (HCG)

Question 29

Displacement of the GI track in HG is a pathophysiology caused by what?

Answer 29

Vomiting

Question 30

What psychosocial factor is a a part of the pathophysiology for HG?

Answer 30

Emotional response to stress

Question 31

How much weight loss does a person typically lose if they have HG and is a great sign to admit the pt for treatment?

Answer 31

>5%

Question 32

Excessive vomiting and diarrhea, dehydration w/ possible electrolyte imbalance, wt. loss, increased pulse rate, decreased BP, poor skin turgor and dry mucous membranes are all what?

Answer 32

Physical assessment findings (s/s)

Question 33

True or false. | A pt. w/ HG can keep down water.

Answer 33

False

Question 34

What 2 urine lab tests help diagnose HG?

Answer 34

Urinalysis for ketones and acetones and elevated urine specific gravity

Question 35

What happens to Na, K, and Cl levels in HG?

Answer 35

Decrease bc of low intake

Question 36

What 2 live function tests are done to help diagnose HG?

Answer 36

Elevated AST and ALT

Question 37

Are liver enzymes elevated or decreased in HG?

Answer 37

Elevated

Question 38

What does HCG act as during HG that can send a pregnant female into hyperthyroidism?

Answer 38

Thyroid Stimulating Hormone (TSH)

Question 39

True or false. | Hematocrit concentration is elevated in HG bc of fluid concentration.

Answer 39

True

Question 40

A thyroid test is done in a woman w/ HG to assess for what?

Answer 40

Hyperthyroidism

Question 41

What 2 antiemetic meds are administered for home therapy of uncontrollable N/V?

Answer 41

Ondanseron-Zofran or Metoclopramise-Reglan

Question 42

For nutrition vitamin supplements, specifically which one is administered for HG?

Answer 42

Pyriodoxine (Vit. B6)

Question 43

If a pt. is admitted for HG how long are they NPO?

Answer 43

24-48hrs

Question 44

What type of IV fluids are given to a pt. w/ HG for rehydration?

Answer 44

Lactated ringers or 0.9% NS

Question 45

What important assessments need to be done when assessing a pt. who was admitted for HG?

Answer 45

Intake and output, skin turgor, mucous membranes, VS, and wt.

Question 46

During discharge teaching a pt. should be instructed to be on a clear liquid diet for how long if no vomiting occurs?

Answer 46

24hrs

Question 47

After a clear liquid diet what type of diet can a pt. be on after discharge?

Answer 47

Advanced diet (dry toast, crackers or cereal) then soft diet, then normal diet. All as tolerated

Question 48

If vomiting returns what type of diet does the pt. go on?

Answer 48

Feeding tube or Total Parenteral Nutrition (TPN)