1. Other Complication in Pregnancy Hyperemesis gravidarum Diabetes in Pregnancy

2. Hyperemesis gravidarum Definition: Hyperemesis gravidarum is exaggerated nausea and vomiting during pregnancy persisting past the first trimester.complication of pregnancy 3. Hyperemesis Gravidarum Incidence 0.3% to 1% of all pregnancies 4. Pathophysiology/Etiology 1. Cause unknown but may possibly result from high levels of hCG or estrogen. 2. Psychological factors including neurosis or altered selfconcept may be contributory. 3. Seen in molar pregnancies, multiple gestation, and history of hyperemesis in previous pregnancies. 4. Slowed gastric motility occurs. 5. The persistent vomiting may result in fluid and electrolyte imbalances, dehydration, jaundice, and elevation of serum transaminase. complication of pregnancy 5. Clinical Manifestations 1. Persistent vomiting; inability to tolerate anything by mouth 2. Dehydrationfever, dry skin, decreased urine output 3. Weight loss (up to 5-10% of body weight) 4. Severity of symptoms increases as the disease progresses.complication of pregnancy 6. Diagnostic Evaluation 1. Tests may be done to rule out other conditions causing vomiting (cholecystitis, appendicitis). 2. Liver function studieselevated aspartate aminotransferase up to four times normal in severe cases. 3. Prothrombin time, partial thromboplastin time usually normal 4. Blood urea nitrogen (BUN) and creatininemay be slightly elevated 5. Serum electrolytesmay be hypokalemia, hypoor hypernatremia 6. Urine for ketonespositive complication of pregnancy 7. Hyperemesis Gravidarum Goals of Care 1. Maintain hydration 2. Support nutrition3. Treatment of nausea and vomiting 8. Management 1. Try withholding food and fluid for 24 hours, or until vomiting stops and appetite returns; then restart small feedings. 2. Control of vomiting may require antiemetic such as prochlorperazine (Compazine) in injectable or rectal suppository form. 3. Control of dehydration through IV fluidsoften 1 to 3 liters of dextrose solution with electrolytes and vitamins, as needed. Bicarbonate may be given for acidosis. 4. Most women respond quickly to restricting oral intake and giving IV fluids, but repeated episodes may occur. 5. Rarely, total parenteral nutrition is needed. 6. Rarely, complications of hepatic or renal failure or coma could result from disease progression. 7. Rarely, cessation of pregnancy- induced abortion/ delivery complication of pregnancy 9. Nursing Assessment 1. Evaluate weight gain or loss pattern. 2. Evaluate 24- or 48-hour dietary recall. 3. Evaluate environment for factors that may affect the woman's appetite. 4. Monitor vital signs for tachycardia, hypotension, and fever due to dehydration. 5. Assess skin turgor and mucous membranes for signs of dehydration. complication of pregnancy 10. Nursing Diagnoses A. Risk for Fluid Volume Deficit, Electrolyte Imbalance related to prolonged vomiting B. Altered Nutrition (Less than Body Requirements) related to prolonged vomiting C. Ineffective Individual Coping related to stress of pregnancy and illnesscomplication of pregnancy 11. Nursing Interventions A. Maintaining Fluid Volume 1. Establish an IV line and administer IV fluids as prescribed. 2. Monitor serum electrolytes and report abnormalities. 3. Medicate with antiemetics as prescribed. a. Administer intramuscularly or by rectal suppository to avoid loss of dose through vomiting. 4. Maintain NPO status except for ice chips until vomiting has stopped. 5. Assess intake and output, vital signs, skin turgor, and fetal heart tones as indicated by condition.complication of pregnancy 12. B. Encouraging Adequate Nutrition 1. Advise the woman that oral intake can be restarted when emesis has stopped and appetite returns. 2. Begin small feedings. Suggest or provide bland solid foods; serve hot foods hot and cold foods cold; do not serve lukewarm. a. Avoid greasy, gassy, and spicy foods. b. Provide liquids at times other than meal times. 3. Suggest or provide an environment conducive to eating. a. Keep room cool and quiet before and after meals. b. Keep emesis pan handy, yet out of sight.complication of pregnancy 13. C. Strengthening Coping Mechanisms 1. Allow patient to verbalize feelings regarding this pregnancy. 2. Encourage patient to discuss any personal stress that may have a negative effect on this pregnancy. 3. Refer to social service and counseling services as needed.complication of pregnancy 14. Diabetes in Pregnancy 1. Review pathophysiology2. Impact of pregnancy 3. Goals of care 15. Review PancreasInsulinGlucagon 16. Review 1. Insulin Protein hormone that causes decrease blood level of glucose. 2. Glucagon Protein hormone that causes increase blood level of glucose. 17. The body uses glucose as the primary source of energy.Glycogen is stored glucose for times when glucose is not available (i.e. when the person is not eating). 18. Review InsulinHelps glucose leave the blood and enter the cells.Stimulates liver and muscle cells convert glucose into glycogenPromotes transfer of amino acids into cells. 19. Review Diabetes is a disorder of insulin: 1. Altered production of insulin (Type 1)2. Altered response to insulin (Type 2) 20. Review Diabetes is a disorder of insulin: Type 1 = Total deficiency of insulin secretion by pancreatic beta cells. 21. Review Diabetes is a disorder of insulin:Type 2 = Cells resist the action of insulin, and the pancreas does not respond adequately by producing more insulin. 22. The effect of both types of diabetes is too much glucose in the blood (hyperglycemia), and not enough glucose in the cells (hungry cells). 23. Disorder of insulin production or response also causes abnormal metabolism of proteins, fats and electrolytes. 24. Symptoms of Diabetes 1. 2. 3. 4. 5. 6.Extreme thirst and hunger Frequent urination Fatigue Blurred vision Weight loss Recurrent infections 25. Complications of Diabetes 1. Hyperglycemia - thirst - sugar in urine, and excessive urine production - weight loss2. Increased circulation of fatty acids - ketones in body and urine - fat build up in blood vessels - risk of ketoacidosis 26. Complications of Diabetes 3. Microvascular disease - eye damage - kidney damage4. Neuropathy - nerve damage of organs - vascular occlusion - death of tissue in extremities 27. Treatment of Diabetes 1. Type 1 Need insulin shots 2. Type 2 May be controlled with diet, exercise and/or medications 28. Diabetes in PregnancyDefinition: Glucose intolerance (hyperglycemia) that begins or is first recognized in pregnancy is called gestational diabetes. 29. Diabetes in Pregnancy 1. Occurs in about 7% of all pregnancies 2. Higher incidence in African, Hispanic, and Asian populations 3. Uncontrolled diabetes (all types) causes increase risk for maternal and fetal death and complications 30. Diabetes in PregnancyPregnancy Complications: 1. 2. 3. 4.Increased risk of fetal death Increased risk for fetal defects Increased risk for hypertension Increased risk for large baby 31. Diabetes in Pregnancy Pregnancy Complications: Maternal hyperglycemia causes babies to be fatter. Fatter babies are more difficult to deliver and face greater risk of birth trauma. 32. Diabetes in PregnancyRemember! Maternal insulin does NOT cross the placenta.The baby makes its own insulin. 33. Diabetes in Pregnancy This is why when the maternal source of glucose is cut off at delivery, babies who have been over producing insulin (to keep up with lots of sugar coming from mother)may become very hypoglycemic. 34. Diabetes in PregnancyPregnancy complications can be managed with really good care. 35. Diabetes in PregnancyGoals of Care: 1. Maintain normal glucose levels 2. Identify and manage complications 36. Diabetes in Pregnancy Care: 1. Identify women at risk 2. Counsel women on disease, diet, exercise, and medication 3. Monitor maternal glucose levels 4. Monitor fetal growth and well being