Fluid and Electrolytes- Hyperemesis Gravidum Flashcards
Maternal age (less than 20), obesity, primagravida, multipara, high stress, and transient hyperthyroidism are all what?
Risk factors for HG
What are some physical (objective) assessment findings you would see in a pt. w/ HG?
Decreased BP, increased HR, poor skin turgor, wt. loss, excessive vomiting and diarrhea
In a urinalysis to help diagnose HG what are they looking for?
Ketones and acetones
What is hyperkalemia?
Elevated K+ levels
The regulation of volume and composition of body fluids through several mechanisms is known as what?
Maintaining homeostasis
What is another word for HG, but is less severe?
Morning sickness
Extreme N/V that is prolonged past 12wks gestation is known as what?
HG
What is found w/in the cells of the body and makes up 2/3 of total body fluids?
ICF
Blood serum, saline, albumin, urine, bile, hormones and CSF are all what?
Types of fluid and electrolytes
What are normal sodium (Na) values?
135-145
What are normal potassium (K) values?
3.5-5.3
What are normal calcium (Ca) values?
8.5-10.5mg/dL
What are normal magnesium (Mg) values?
1.5-2.5
What are the major cations of ICF?
K and Mg
What are the major anions of ICF?
Phosphate and sulfate
Most abundant cation of ECF is?
Na
Most abundant anion of ECF is?
Cl
What are the principle electrolytes of ECF?
Sodium, chloride, and bicarbonate
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.)?
ECF
What leads to fluid and electrolyte imbalance, alkalosis, and loss of hydrochloride acid?
Dehydration
Flat veins, hypotension, tachycardia, increased Hct and BUN, fatigue/muscle weakness, dry mucosa/skin, weak pulse, decrease urine output are all what?
S/S of FVD/dehydration
Hypovolemia/dehydration-insufficient intake, diarrhea/vomit, NG suctioning, Drainage/burns, diuretics are all what?
Causes of FVD
What is HG?
Persistent, severe vomiting during pregnancy leading to wt. loss and dehydration
Dehydration, wt. loss (>5% of wt), ketosis, and electrolyte abnormalities are all caused by what during pregnancy?
Uncontrolled vomiting
When does extreme vomiting usually develop during pregnancy?
5wks gestation
When does “morning sickness” usually disappear?
16-20wks
True or false.
In a pt. w/ HG vomiting goes away in 16-20wks.
False
What hormone is affected (elevated) during HG bc of an increase in vomiting during pregnancy?
Human Chorionic Gonadotropin (HCG)
Displacement of the GI track in HG is a pathophysiology caused by what?
Vomiting
What psychosocial factor is a a part of the pathophysiology for HG?
Emotional response to stress
How much weight loss does a person typically lose if they have HG and is a great sign to admit the pt for treatment?
> 5%
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?
Physical assessment findings (s/s)
True or false.
A pt. w/ HG can keep down water.
False
What 2 urine lab tests help diagnose HG?
Urinalysis for ketones and acetones and elevated urine specific gravity
What happens to Na, K, and Cl levels in HG?
Decrease bc of low intake
What 2 live function tests are done to help diagnose HG?
Elevated AST and ALT
Are liver enzymes elevated or decreased in HG?
Elevated
What does HCG act as during HG that can send a pregnant female into hyperthyroidism?
Thyroid Stimulating Hormone (TSH)
True or false.
Hematocrit concentration is elevated in HG bc of fluid concentration.
True
A thyroid test is done in a woman w/ HG to assess for what?
Hyperthyroidism
What 2 antiemetic meds are administered for home therapy of uncontrollable N/V?
Ondanseron-Zofran or Metoclopramise-Reglan
For nutrition vitamin supplements, specifically which one is administered for HG?
Pyriodoxine (Vit. B6)
If a pt. is admitted for HG how long are they NPO?
24-48hrs
What type of IV fluids are given to a pt. w/ HG for rehydration?
Lactated ringers or 0.9% NS
What important assessments need to be done when assessing a pt. who was admitted for HG?
Intake and output, skin turgor, mucous membranes, VS, and wt.
During discharge teaching a pt. should be instructed to be on a clear liquid diet for how long if no vomiting occurs?
24hrs
After a clear liquid diet what type of diet can a pt. be on after discharge?
Advanced diet (dry toast, crackers or cereal) then soft diet, then normal diet. All as tolerated
If vomiting returns what type of diet does the pt. go on?
Feeding tube or Total Parenteral Nutrition (TPN)
