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Care Plan for the Patient Suffering with Hyperemesis Gravidarum

An online survey conducted in 2014 of 345 women who had been admitted to hospital with hyperemesis in the last five years found that 45% had experienced having to empty their own vomit or urine bowl and 40% encountered ward staff who smelled of perfume or cigarettes which exacerbated their symptoms.

Unfortunately, it is often the negative experiences which have a profound impact on the women suffering. However on a positive note it is also relatively easy to make a big positive difference to women you encounter with hyperemesis by ensuring their care is evidence based and effective.

This sample care plan was developed by registered nurse and trustee Caitlin Dean for nurses and midwives to adapt to appropriate in their own professional environments. 

You can download a printable version here.

 

Care Plan for ___________________________________

Date of admission _______________________________

Weeks gestation at admission ___________________________

Pregnancy number ___________
Children at home____________
History of twins: yes / no

Weight at admission: _______________________ KG
Height _______________________ CM
BMI___________

Patient reported weight loss __________________ or % of pre-pregnancy weight loss _____________

Blood Pressure _________/___________

Ketone level on admission _____________________________

TED Stockings provided? YES / NO

Aims of Care Plan:
1. Reduce nausea and vomiting
2. Reduce presence of ketones and increase hydration
3. Prevent further weight loss
4. Provide emotional and psychosocial support to ____________________
5. Provide a comfortable environment for ___________________

Nursing Actions for Care Plan:

1. Reduce Nausea and Vomiting

  • Ensure medication is provided on time to enable stable blood levels of anti-emetics.
  • Reduce sensory stimulation by providing a side room away from ‘smelly areas’, if possible, and ensuring staff are quiet and free from perfume whilst providing care.
  • Provide snacks when required where possible.
  • Review effectiveness of medication and interventions daily or as required, using MUST or PUQE tool.

2. Reduce Presence of Ketones

  • Provide IV fluids as per prescription.
  • Warm IV fluids to 37 degrees before administration, if possible. This is to reduce calorific loss from cold IV fluid administration.
  • Encourage oral fluids when they can be tolerated.
  • Provide information on suitable fluids for pregnancy and tips on getting fluids, for example, via ice lollies.
  • Monitor ketones as per hospital policy or three times per day.

3. Prevent Further Weight Loss

  • Encourage oral food intake where possible.
  • Provide information on fortifying food and fluid. 
  • Ensure medication regime is controlling vomiting and nutrient loss. Adjust timings to maximise ability to eat at mealtimes.
  • Provide snacks as and when _____________ feels able to eat.

4. Provide Emotional and Psychosocial Support to ____________________

  • Where available, discuss referral to peri-natal mental health team for support with psychological impact of HG and refer if appropriate.
  • Provide information about PSS charity and make referral to support network if required.
  • Ensure __________________ has an advocate for ward rounds with doctors if she is struggling with speaking due to nausea and vomiting.
  • Ensure informed consent is obtained for treatments.
  • Provide written information about hyperemesis and any treatments or medication.

5. Provide a Comfortable Environment for ___________________

  • Provide a side room where possible to reduce sensory stimulation such as smell and sound and reduce distress from public vomiting and episodes of incontinence.
  • Ensure staff are free from perfumes or cigarette smoke.
  • Provide pressure relieving mattress to reduce the risk of pressure damage from prolonged bed rest.
  • Ensure vomit bowls and urine samples are removed promptly and adequate empty receptacles provided.

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