Case Study- sis

8/8/2019 Case Study- sis

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Columban CollegeCollege of Nursing

Barretto, Olongapo City

Introduction

Nausea and vomiting are said to be common to all pregnant women, however

there is an incidence that severe nausea and vomiting occurs. Hyperemesis gravidarum

sometimes called as pernicious vomiting, is nausea and vomiting of pregnancy that is

prolonged past week 12 of pregnancy or is so severe that dehydration, ketonuria, and

significant weight loss occur within the first 12 week. The main cause of this illness is

unknown but there are certain theories which explained the possible cause of prolonged

nausea and vomiting in a pregnant woman. Many are postulated that nausea and vomiting

are protective in pregnancy to reduce exposure to potentially teratogenic materials,

however there are factors that makes this symptoms prolonged. And as I mentioned

above, prolonged nausea and vomiting may results in dehydration of the mother, and this

condition can be danger for the fetus life. Because a dehydrated mother has decrease

blood volume, the fetus may not receive essential nutrients and oxygen which may resultsin preterm or IGR (Intrauterine Growth Restriction).

To prevent this to happen, the patient must be hooked into IVF or intravenous

fluid. Proper care was needed for the patient with Hyperemesis gravidarum especially in

monitoring her intake and output. The goal of the nursing management or interventions is

to assured that the client must be free of any signs and symptoms of dehydration.


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Clinical Manifestations:

History

Nausea and vomiting occur in early pregnancy and are nonresponsive tosimple measures, such as reassurance and dietary changes.

Fever and abdominal pain are not characteristic of hyperemesis gravidarum.

If vomiting begins after 9 weeks' gestation, other causes should be

investigated. Other common symptoms include ptyalism (excessive salivation), fatigue,

weakness, and dizziness.

Patients may experience the following:o Sleep disturbance

o Hyperolfaction

o Dysgeusia

o Decreased gustatory discernment

o Depression

o Anxiety

o Irritability

o Mood changes

o Decreased concentration

Physical

Findings at physical examination may include the following:

Weight loss

Dehydrationo Decreased skin turgor


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o Dry mouth or mucous membrane

o Postural changes in blood pressure (BP) and pulse

Abdominal tenderness, fever, and goiter likely indicate another process.

Diagnostic Procedures & Findings:

Laboratory Studies:

Urinalysis

Serum electrolytes and ketones

Elevated liver Enzymes and bilirubin

Elevated Hematocrit, TSH, free thyroxine

Imaging Studies:

Obstetric Ultrasonography

Upper Abdominal Ultrasonography

Abdominal CT Scan / MRI

Therapeutic Management:


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Hospitalization for about 24 hours to monitor intake, output, and blood

chemistries and prevent dehydration.

IVF of 3000 mL Ringers Lactate with added vitamin B

All oral food and fluids are usually with held; if there is no vomiting after

the first 24 hrs of oral restriction, small amounts of clear fluids will be

gone and the woman may be discharged with a referral of home care; if

she continue to take clear fluids, small quantities of dry toast, crackers, orcereal may be added every 2 to 3 hrs, then she can be gradually advanced

to a soft diet, then to a normal diet.

Pharmacological Treatment:


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METOCHLOPROMIDE

Brand name: reglan

Indication:

acute and recurrent diabetic gastro paresis, gastro esophageal reflux

to improve lactation, nausea and vomiting due to various causes, including

vomiting during pregnancy and labor, gastric ulcer, anorexia nervosa.

facilitate small vowel intubation, stimulate gastric emptying, and increase

intestinal transit of barium to aid in radiology examination of stomach and

small intestine.

Dosage:

For adult: 10 to 15 mg per day 30 minutes before meals at bed time. If symptomsoccur only intermittently, single doses up to prior to the provoking situation may

used.

Contra Indication:

Gastro intestinal hemorrhage, contraction or perforation; epilepsy; clientstaking drugs likely to cause extra pyramidal symptoms such a phenothiazines;

Pheochromocytoma.

Side effects:

CNS: Restlessness, fatigue, dizziness, headaches, extra pyramidal symptoms.

GI: Nausea, bowel disturbances (diarrhea).

Nursing Considerations:

Do not confuse metoclopromide with metoprolol ( a beta-adrenergic blocker)or with metolazone ( a thiazine diuretic )

Take tablets as directed. May dilute syrup in water, juice or carbonated

beverage just before taking.

Report lack of response or any persistent side effects so they can be properly

evaluated and counteracted.


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Avoid alcohol and any other CNS depressants.

Extra pyramidal effects should be reported; may be treated with IM

diphenhydramine.

Pathophysiology:

Unknown Cause

Theories: women with elevated Thyroid-stimulating properties of HCG

with infection of Helicobacter pylori (peptic ulcer)

Prolonged NAUSEA and VOMITING

Loss of appetite severe wt. loss inability of the body Hypokalemia

to retained fluids Hyponatremia

Hypochoremia

Vitamin B deficiency

(Thiamine) Hemoconcentration DEHYDRATION


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Insufficient supply

POLYNEURITIS of essential nutrients for

Elevated hct normal fetal growth

Low intake of CHO

Utilizing Fats & CHON PRETERM/IGR

As source of energy

Poor skin turgor,

Dry mouth or mucous

Membrane

KETONURIA


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Case Study: Hyperemesis Gravidarum

Submitted In Partial Fulfillment

Of the Requirement for the Degree of Bachelor of Science in Nursing

Submitted by: Group H

Ana Edralyn Tarusan

Anabelle Candila

Angela Gabrielle Romero

Clara May Wenceslao

Leanne Mendegorin

Mary ann Ventura

Vilma Moreno

Alvin Roca

Jarvis Tacson

Joed Quiambao

Kent Pangan


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Submitted to:

Ms. Charmaine Abdon, RN

Clinical Instructor

ANATOMY AND PHYSIOLOGY OF ENDOCRINE SYSTEM


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The endocrine system affects bodily activities by releasing chemicalmessages, called hormones, into the bloodstream from exocrine andendocrine glands. The function of hormones is to:

Control the internal environment by regulating its chemicalcomposition and volume

Respond to environmental changes to help the body cope withemergencies - infection, stress etc

Help regulate organic metabolism and energy balance Contribute to the management of growth and development

Hormones are chemicals that cause certain changes in particular partsof the body. Their effects are slower and more general than nerveaction. They can control long-term changes such as rate of growth,

rate of activity and sexual maturity.

The endocrine or ductless glands secrete their hormones directly intothe blood stream. The hormones are circulated all over the body andreach their target organ via the blood stream. When hormones passthrough the liver, they are converted by the kidneys. Tests on suchhormonal products in urine can be used to detect pregnancy.


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The endocrine system consists of a series of glands that secretehormones; they are found throughout the body and include thepituitary, thyroid, parathyroid, thymus, supra-renal or adrenal glands,part of the pancreas and parts of the ovaries and testes. Althoughthese glands are separate, it is certain that they are functionallyclosely related because the health of the body is dependent upon thecorrectly balanced output from the various glands that form thissystem.

The Pituitary Gland (Hypophysis)

This gland has been described as the leader of the endocrineorchestra. It consists of two lobes, anterior and posterior. The anteriorlobe secretes many hormones, including the growth-promotingsomatotropic hormone which controls the bones and muscles and inthis way determines the overall size of the individual. Over secretion ofthe hormone in children produces gigantism and under secretionproduces dwarfism. The anterior lobe also produces gonad tropichormones for both male and female gonad activity. Thyrotrophichormones regulate the thyroid and adrenocorticotropic hormones

regulate the adrenal cortex. It also produces metabolic hormones.

The posterior lobe produces two hormones - oxytocin and vasopressin.Oxytocin causes the uterine muscles to contract; it also causes theducts of the mammary glands to contract and, in this way, helps toexpress the milk that the gland has secreted into the ducts.Vasopressin is an anti-diuretic hormone that has a direct effect on thetubules of the kidneys and increases the amount of fluid they absorbso that less urine is excreted. It also contracts blood vessels in theheart and lungs and so raises the blood pressure. It is not certainwhether these two hormones are actually manufactured in the

posterior lobe or whether they are produced in the hypothalamus andpassed down the stalk of the pituitary gland to be stored in theposterior lobe and liberated from there into the circulation.


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The Thyroid

The right and left lobes of this gland lie on either side of the tracheaunited by the isthmus. Average size of each lobe is 4cm long and 2cmacross but these sizes may vary considerably. The secretion of thisgland is thyroxin and tri-iodothyronine. Thyroxin controls the generalmetabolism. Both hormones contain iodine but thyroxin is more active

than thyroxin. Under-secretion of this hormone in children producescretinism; the children show stunted growth (dwarfism) and fail todevelop mentally. Under secretion in adults results in a low metabolicrate. Over secretion in adults gives rise to exophthalmia goiter and themetabolic rate is higher than usual. Such persons may eat well butburn up so much fuel that they remain thin. This is usuallyaccompanied by a rapid pulse rate. This gland, therefore, has aprofound influence on both mental and physical activity.

The Parathyroid Glands

There are four of these glands, two on either side lying behind thethyroid. Their secretion is parathormone - the function of which is toraise the blood calcium as well as maintain the balance of calcium andphosphorus in both the blood and bone structures. Under secretiongives rise to a condition known as testacy in which the muscles go intospasm, and over secretion causes calcium to be lost to the blood fromthe bones giving rise to softened bones, raised blood calcium and amarked depression of the nervous system.

The Thymus Gland

This gland lies in the lower part of the neck and attains a maximumlength of about 6cm. After puberty, the thymus begins to atrophy sothat in the adult only fibrous remnants is found. Its secretion is thoughtto act as a brake on the development of sex organs so that as thethymus atrophies, the sex organs develop. Recent research into theactivity of this gland reveals that it plays an important part in the


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body's immune system by producing T lymphocytes - the T standingfor thymus derived.

The Suprarenal or Adrenal Glands

These are two in number, triangular and yellow in color. They lay oneover each kidney. They are divided like the kidney into two parts -thecortex and the medulla. The cortex is the outer part of the gland andproduces a number of hormones called corticosteroids. Their function

is to control sodium and potassium balance, stimulate the storage ofglucose and affect or supplement the production of sex hormones. Themedulla or inner layer produces adrenaline, a powerful vasoconstrictor.Adrenaline raises vessels and raised the blood sugar by increasing theoutput of sugar from the liver. The amount of adrenaline secreted isincreased considerably by excitement, fear, or anger, which hascaused the adrenals sometimes to be referred to as the glands of frightand fight.

The Gonads or Sex Glands

These glands are naturally different in men and women because theyserve different, though, in many respects, complementary functions. Inthe female the gonads are the ovaries and in the male the testes.Female sex hormones are estrogen and progesterone. The male sexhormone is testosterone, though each sex produces a small quantity ofthe opposite hormone. The female hormones are responsible fordeveloping the rounded, feminine figure, breast growth, pubic andauxiliary hair and all the normal manifestations of femininity andreproduction. Male hormone is responsible for voice changes,increased muscle mass, development of hair on the body and face andthe usual development of manliness.

Pancreas

The endocrine part of the pancreas consists of clumps of cells calledislets of Langerhans that secrete insulin. Insulin regulates the sugarlevel in the blood and the conversion of sugar into heat and energy.Too little insulin results in a disease known as diabetes mellitus. This


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disease is divided into one form, juvenile onset, which occurs beforethe age of 25, and another form that begins in maturity. It is a verycommon disease. It is known that some half million people in theUnited Kingdom suffer from it sufficiently badly to need treatment butis has been estimated that there are many more people in whom thedisease exists at a sub-treatment level.

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