IDENTIFICATION DATA

NAME OF THE PATIENT: Mrs. Babli Rishi Das

AGE: 24 years

RELIGION: Hindu

MARITAL STATUS: Married

ADDRESS: Housing Complex, Agartala

ADMISSION/ IN-PATIENT NO: MB-I/1986

NAME OF WARD: Antenatal ward.

DATE OF ADMISSION: 11/06/24

LMP: 7/11/23

EDD: 14/8/24

EDUCATIONAL STATUS: H.S+ 2 stage Pass

OCCUPATION: Housewife.

PROVISIONAL DIGNOSIS: Hyperemesis graviderm

CHIEF COMPLAINTS: -
She was having pain and excessive vomiting from last 14 days, Weight loss from 1 week,
Weakness from last 12 days and headache from last 1 weeks.

HISTORY OF PRESENT ILLNESS

Onset of symptoms: - patient was apparently well 15 days back when she had started vomiting
and headache from last 1week and she was feeling very week come to obstetric OPD,IGM
Hospital on dated 11/06/2023, after consulting with doctor, the doctor advise for admission.
PAST HISTORY MEDICAL:

-No H/o Hypertension prior to pregnancy.

- No H/o Diabetes Mellitus.

- No H/o Tuberculosis.

-Childhood immunization: All immunization is done

SURGICAL HISTORY: Patient was not going any surgical procedure in past.

GYNECOLOGICAL: Mothers having no past Significant.

OBSTETRICAL HISTORY: G 1P0 A0 L0

HISTORY OF 1ST TRIMESTER

o No history of fever
o No history of rashes
o No history of burning micturition
o No history of x-ray exposure
o There was a history of vomiting and headache

FAMILY HEALTH HISOTRY:

 Type of family: Nuclear family

 No. of family members:5
 Any Illness: There is no history of Epilepsy, DM, HTN, Twins pregnancy, congenital
malformation.
 FAMILY COMPOSITION: -

NAME OF RELATIONSHIP AGE/ MARITAL HEALTH EDUCATIONAL

THE SEX STATUS OCCUPATIO STATUS BACKGROUND
FAMILY WITH PATIENT N
MEMBER

Balaram Father-in-law 56 years Married Govt Good VIII pass

Hrishi Das Employee

Jyotsna Mother-in-law 48 years Married House wife Good V Pass

Hrishi Das

Gopal Husband 29 years Married Business Good X Pass

Hrishi Das

Babli patient 24 years Married House wife Unhealthy XII pass

Hrishi Das
FAMILY TREE

Lt. Vagabati Hrishi Das Lt. Bimala Hrishi Das

Balaram Hrishi Das Jyotsna Hrishi Das

Gopal Hrishi Das, 29 yrs Babli Hrishi Das, 24 yrs.

KEY

= Male (Death)

= Female (Death)

= Male

= Female
 = Patient

HEALTH FACILITY NEAR HOME.

Health Center- IGM Hospital

Transport Facility-By Road with car

SOCIO-ECONOMIC STATUS –

Middle class

Housing-Pakka

Number of rooms-4

Water supply-Tap Water

Family Income per month- Rs 18,000 month

Sanitation –Adequate

PERSONAL HISTORY

Hobbies: watching TV, Cooking Dietary

Habits: Vegetarian

Addiction- No H/o Drug Addiction

PERSONAL HYGIENE:

Oral hygiene: Maintain oral hygiene

Mode: brush. 2 time a day

Bath : Bath is taken once a day

Diet: Non Vegetarian

No. of meals- 3 meals per day.

Food preferences- Homemade food, more fluids preferences.

Type of food- Bengali Food

Fluid – 3-4 liter per day

Tea &coffee -Tea 2 cups day

Sleep & rest- 7 hours in night, 1 hrs. in a day

Elimination

Bowel per day- Regular

Urine frequency- 3-4 times a day

Mobility & exercise

Exercise /activity Joints- Moderate, No pain in joint.

Menstrual history-

Age of menarche-12 years

Duration of menstruation: 4-5 days

Amount of menstruation: Normal Flow.

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Dysmenorrhea- Present

LMP- 7/11/23

EDD- 14/8/24

POG - 29 weeks
Marital History

Marriage: 22 yrs

Spouse Health – Good

Spouse occupation- Self –Business

Relationship : Satisfactory

PHYSICAL ASSESSMENT

General appearance & behavior: Moderate appearance with normal height good behavior Patient

is comfortable, cooperative,

GENERAL EXAMINATION
 Weight: 48 kg
 Height: 154 cm
 Foul Body Odour: Absent
 Foul Breath: present
 Sensorium: Conscious
 Orientation: oriented to time, place & person
 Nourishment- malnourished
 Body built: Moderate
 Activity: moderate
 Look: Anxious
 Hygiene: not maintained

VITAL SIGNS: -

Temperature-98.4°F.

Pulse -80 beats/min

Respiration= 20 breaths/min
Blood Pressure-120/80 mm Hg

Immunization Status TT1 – at 3rd month of pregnancy/Dose 0.5ml, I/M

TT2 – at 4th month of pregnancy/Dose 0.5ml, I/M

Skin:

Colour-Patient skin colour is pallor.

Moisture-Skin moisture is dry

Texture-Skin texture is dry.

Edema- Edema is absent.

Head:

Hair-Hair colour is black, equally distributed

Scalp-Scalp is clear, dandruff absent.

Face

Anxiousness is present.

Eyes

Eye brows-symmetrical

Eye lids- Eye lids are normal,

Eye lashes - Eye lashes are equally distributed

Eye balls- Eye balls are movable

Sclera-Sclera is normal whitish colour

Conjunctiva -conjunctiva is slightly white

Pupils - Pupils is react with light

Vision-Normal

Nose

Nasal Septum- Not deviated

Nostril- Nostril is normal.

EARS

External Ear - Extermal car is normal absent of any discharge.

Gross hearing- Gross hearing normal

Pinna - Pinna is symmetrical.

Discharge - Discharge absent.

MOUTH

Lips- Lips are dry.

Gums-Gums are normal and gingivitis absent

Teeth-Teeth are whitish and equally distributed

Tongue - Tongue are normal but slight white in colour

Throat - Throat are normal.

Neck:

Range of motion-Ronge of motion normal

Thyroid gland-Thyroid gland is not enlarged

Lymph nodes - Lymph nodes are not enlarged

Chest:

Inspection
Shape-chest shape is normal.

Symmetry of expansion Respiration rate - 20b / min

Breast - Primary and secondary areola present Montgomery tubercles are also present, nipples
are erected.

Palpation-Absence of any abnormal mass

Auscultation-S1andS2 sound are present

Abdomen:

Inspection: -

Size-Normal

Shape-Globuler shape

Linea nigra-Absent

Striae gravidrum -Absent

Umbilicus - Clean

Scar marks-Absent.

Palpation:

Abdominal girth-74 cm

Fundal height-29 cm

Fundal palpation- Not done

Lateral Palpation: Not Done

Pelvic Grip- Not done

Pawlick grip: Not done

Auscultation:

Fetal Heart Sound-130 b/min

Extremities:

Upper:

Capillary refill - Normal.

Numbness- Absent.

Range of motion-Performed, but dull.

Nails: Nails are clean and short.

Lower:

Range of motion-very dull

Edema-present.

varicosity-Absent.

Homan's sign-pain absent.

Back:

Curves- Absent, Lordosis on kyphosis are absent

Genito urinary system:

Discharge- Absent

Bleeding -Absent

Vulva- Normal
INVESTIGATION:
Sr. Investigation Patient value Patient Normal value Remarks
No. value
Day1
Day 2

1. Hemoglobin 9.6 g/dl 9.6g/dl 12- 14g/dl Anemic

2. TLC 11000 11000 4- 11thosands Average

3. Platelets 2.98lakh/ml 2.97lakh/ml 1.30-4lakh /ml Normal

4. ESR 7 7 <10mm/hr Normal

5. Lymphocytes 28% 27.8% 16-46% Normal

6. Monocytes 9% 9.7 % 4-11% Normal

7. Blood urea 18 23 7-23mg/dl Average

8. Blood creatinine 1.2 1.2 0.5- 1mg/dl Increased

9. Serum uric acid 34 32 24-70mg/dl Normal

10. Sodium 141 142 135-145mg/dl Normal

11. K+ 4.4 4.3 3.5-5.3mEq/L Normal

12. Chloride 95 95 98-107mEq/L Decreased

13. Blood sugar 105 100 70-110mg/dl Normal

14. Serum bilirubin 0.4 0.4 <1.5 mg/dl Normal

15. SGOT 28 28 5-40 units Normal

16. SGPT 22 22 7- 56units Normal

 TREATMENT CHART
Sr. Name of the Dose Route Frequency Action Side effects Nursing
no. Drug responsibilities

1 Inj 10mg i/v B.D. Antiemetic Diziness,  Assess

Metaclopram the
Tiredness
ide vital
Headache signs
of
diarrhoea
patient
Anxiety  Provide
hydrati
Allergic reaction
on
2. Inj. Metrogyl 500 IV TDS Antibiotics Dizziness therapy
mg to
Headache
patient
Diarrhea  Maintai
n I/o
Change in taste
chart of
Dry mouth patient
 About
4. inj Rantac 50 mg IV BD H2 Nausea
over
receptor
Vomiting dose of
antagonist
Constipation drug
 Educat
Dehydration e about

ypersensitivity the side

effects
Rash  Contin
 tachycardia uous
monito
6. Inj 1gm IV BD Antibiotic Headache
ring of
Ceftriaxone
Diarrhea client
 Provide
Change in taste
fiber
Dry mouth rich
diet to
the
client
 DISEASE CONDITION

HYPEREMESIS GRAVIDERUM

INTRODUCTION

Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss,

and electrolyte disturbance. Mild cases are treated with dietary changes, rest, and antacids. More
severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition
through an intravenous line (IV). DO NOT take any medications to solve this problem without
first consulting your health care provider.

DEFINITION:It is severe type of vomiting of pregnancy which has got deleterious effect on the
health of the mother and day to day activity.
INCIDENCE: There has been marked fall in the incidence during the last 30 years. It is now a
rarity in hospital practices. Thr reason are better application of the family planning, reduced the
no of unplanned pregnancy. Early visit to the antenatal visits

CAUSES
excessive vomiting is caused by a rise in hormone levels.
 it is more common in first trimester
 younger age
 low body mass
 history of motion
 Fmily history it is more common in unplanned pregnancy

SIGNS AND SYMPTOMS

 When vomiting is severe, it may result in the following:

 Loss of 5% or more of pre-pregnancy body weight
 Dehydration, causing ketosis, and constipation
 Nutritional disorders, such as vitamin B1 (thiamine) deficiency, vitamin B6 (pyridoxine)
deficiency or vitamin B12 (cobalamin) deficiency
 Metabolic imbalances such as metabolic ketoacidosis or thyrotoxicosis
 Physical and emotional stress
 Difficulty with activities of daily living
 Symptoms can be aggravated by hunger, fatigue, prenatal vitamins (especially those
containing iron), and diet. Many women with HG are extremely sensitive to odors in their
environment; certain smells may exacerbate symptoms.
 Excessive salivation, also known as sialorrhea gravidarum, is another symptom
experienced by some women.
SYMPTOMS
Book picture Patient picture

 increased frequency of vomiting Present

 diminished quantity of urine

Present

 epigastric pain

Present
 constipation may occur

 Featured of dehydration

 Dry coated tongue Some times constipation occurs

 Rise in temperature

 jaundice
Dehydrated

 excessive salivation

Present
 Emotional stress

Absent

Absent

Present
DIAGNOSIS

 Ultrasound – uses sound waves to Done

produce the picture. The ultrasound
probe can be placed on the abdomen or it
can be placed inside the vagina to make
the picture.

 UPT(urine pregnancy test)- UPT is

done to identify the pregnancy.

Done

TREATMENT

Anti emetic drug promethazine- 25 mg or prochlorperazine 5 mg, twice a day I/M.

Metoclopramide –it stimulates gastric and intestinal mortality without stimulating secretion.
Metoclopramide is also used and relatively well tolerated.

Ondansetron may be beneficial, however, there are some concerns regarding an association
with palate, and there is little high-quality data. in the placenta and may be used in the treatment
of hyperemesis gravidarum after 12 weeks.

Nutritional supplements – vitamin 100mg daily, vit B6 , Vit C are also given in some cases.

Fluids- the amount of fluid to be infused in 24 hrs is approximately 3litters in which half os
dextrose 5% and half in ringer lactate.
After IV rehydration is completed, patients typically begin to tolerate frequent small liquid or
bland meals.
After rehydration, treatment focuses on managing symptoms to allow normal intake of food.
However, cycles of hydration and dehydration can occur, making continuing care necessary.
Home care is available in the form of a peripherally-inserted central catheter (PICC) line for
hydration and nutrition.
Home treatment is often less expensive and reduces the risk for a hospital-acquired
infection compared with long-term or repeated hospitalization.
Alternative medicine

The use of ginger products may be helpful, but evidence of effectiveness is limited and
inconsistent, though three recent studies support ginger over placebo.

THEORY APPLICATION: - Orem’s theory self-care deficit.

UNIVERSAL SELF – CARE REQUISITE :-

Sr.no. Components Patient componemts

01 Maintenance of sufficient intake of air , Patient were having poor appetite she
water , food. had feeling of nausea less intake of the
water .

02 Balance between activity and rest Patient having tiredness, patient not
between solitude and social interaction able to perform activity of daily living
because of weakness and not able to
maintain interaction with society.

03 Prevention of hazards to human life, Not able to prevent hazards of his life
functioning and well being and also not able to perform the
function of daily living

04 Promotion of human functioning and Patient is not promoting his

development. functioning and development
DEVELOPMENTAL SELF CARE REQUISITIES:-
Sr.no. Components Patient components

01 Maintenance of developmental Not able to feed, difficult to perform.

environment

02 Prevention/ management of the conditions Feel that the problem is due to his
threatening the normal development own behavior.

HEALTH DEVIATION SELF- CARE REQUISITE:

Sr. no Components Patient components

01 Seeking and securing appropriate medical Patient need medical assistance

assistance

02 Being aware of and attending to the effects Patient was aware about her diseases
and results of pathologic conditions. condition

03 Effectively caring out medically prescribed Patient effectively carrying medically

measures. prescribed measures.

04 Modify self concepts is accepting oneself Patient accepting her diseases

as being in a particular state of health and condition and herself
in specific forms of health care.

05 Learning to live with effects of Patient living with his pathological

pathological conditions conditions.
NURSING DIAGNOSIS (Priority Wise):
 Fluid volume deficit related to excessive vomiting as evidenced by physical examination
& Intake output chart
 Imbalance nutrition: less than body requirement related to loss of appetite as evidenced
by less body weight
 Anxiety related to hospitalization as evidence by her facial experience
 Hopelessness related to life threatening disease as evidence by while communicating with
patient
 Knowledge deficit regarding disease condition as evidenced by conversation.
 Risk for complications related to alteration in normal fluid level

Short term goals:

 To relieve the headache induced by excessive vomiting.
 To maintain normal nutritional status
 To prevent the risk for infection

Long term goals

 To maintain the normal fluid level
 To relieve anxiety related to hospitalization
 To provide knowledge related to condition
 Nursing care plan (1)
Assessment Nursing Goal Nursing Implementati Scientific Evaluation
Diagnosis interventions on Rationale

Subjective Fluid Norm Assess the Physical To collect The

data volume al physical examination the base line patient’s
deficit body condition of has been done data fluid level
Patient told
related to fluid the patient. is come to
that I have
excessive level normal ata
suffering Check the
vomiting as will RL and D5% To improve some
from severe intake output
evidenced be has been given the body extent.
vomiting and chart of the
by physical maint to the patient normal fluid
I have also patient.
examinatio ained
feeling the To prevent
n & Intake
abdominal from any
output chart Provide bed
pain , Provide the harm.
rest to the
fluid to the
Objective patient. To reduce the
patient.
data vomiting
Antiemetics
episodes.
I observed the drugs has been
patient by Advise rest to given to the It will
vomiting the patient patient. diminish the
episodes 5- episodes of
Provide Provide
6 /day, vomiting.
antiemetic proper
Facial drugs to the ventilation to
expression mother. the patient.

Eliminate the
smell of the
 environment

Nursing care plan 2

Assessment Nursing Goal Nursing Implementati Scientific Evaluation
Diagnosis interventions on Rationale

Subjective Anxiety Anxiety Assess the General To provide Anxiety has

data related to will be general condition has baseline data been
hospitaliz reduced condition of been assessed for planning reduced to
Patient asked
ation as to some the patient by the of care some extent.
the questions
evidence extend inspection.
about her now the
by
condition Patient has patient is
mother’s It will reduce
treatment and been feeling
facial her anxiety
the I am Ask the client ventilating relax.
expression
feeling to express her with general
.
anxiety feelings about verbalization
the condition.
Objective
data
It will help to
Observed the Advise
Individual improve the
patient by counselling
counselling has knowledge
facial about the
been provided about the
expression condition
to the patient. condition.
Crying

questioning

Psychological it will help to

Provide support has reduce the
psychological been provided anxiety level.
support to the
 patient to the patient

Nursing care plan 3

Assessment Nursing Goal Nursing Implementati Scientific Evaluation
Diagnosis interventions on Rationale

Subjective Risk of Assess the Assessed the To know the My patient

data complic general condition of baseline data. has
Risk for
ation condition of patient increased
Mother told complicati
will be client fluid
me that I am ons related Dry skin and
minimi volume and
feeling very to
zed Reduced urine decreased
weak, restless alteration
output the chances
and dry in normal
of
tongue and fluid level
infection.
mucus as
membrane. evidenced
by Provide more Provided more
patient’s fluids to water & juices To hydrate the
Objective lab reports patient to patient. patient
data

Observed the
Maintained
patient by lab
reports Maintain intake output To hydrate the
intake output chart patient
Unable to
chart
stand

Dry skin and provided I/V

tongue hydration
 Provide I/V therapy to To maintain
hydrations patient hydration.

Health education
Date Topic Health education

11/06/24 Diet management  Diet- patient is taught regarding

balanced diet, Patient is advised to,
fruits, juices & salad in diet
 advise the patient to take plenty of
water.
 Avoid the food that cause irritation.
 Avoid junk food
 advise to note her intake output chart.
12/06/24 Physical and rest  Exercise – patient is advised to refused
management exercise for some time.
 Hygiene –patient is advised to keep her
surroundings clear & perform hand
hygiene properly.
 perform lab test after sometimes repeat
.
 advised to walk in a fresh
environment.
13/06/24 Anxiety management  Advised to talk with others to ventilate
her ideas it will reduce the anxiety.
 Follow Up- follow up dates are given
to patient & they should be clearly
explained regarding it.
 explain the family manber to engaged
her in a little work so that she can
 divert her mind from the feelings of
vomiting during the pregnancy period .
 help the clint to gain her self esteem
PROGRESS NOTES
Day- 1
Monitor the vital sign of the patient. i.e.
 temp =990 F
 pulse =74 b/ min.
 BP=110/80 mmhg
ADVICE
 To maintained personal hygiene.
 advice the patient about the ambulation
 To provide plenty of fluid to the patient.
DAY-2
 patient fluid level is maintained.
 Advice regarding the personal hygiene.
 help the patient in ambulation
Day -3
 patient is afebrile
 physical movement is in progress
 Now the pain is reduced.
 patient is feeling comfortable.

RECORDING AND REPORTING

 Provide medication to the patient
 Help the patient in early ambulation.
 Clean the suture and dressing over the sutures
 Checked vital signs of the patient
 Give health education to the patient
 Maintain intake output of the patient
CONCLUSION
Taking this case is beneficial for me as well as my patient. Because I provided psychological
support and others life experience of the other vomiting patients, that gives motivation to my
patient. I learn many things from patient which I can easily seen in patient. The case gives me the
new experience that how we have to take care of patients suffering from hyperemesis gravidrum.
BIBLIOGRAPHY

1. Bhaskar Nima. “Midwifery and Gynecological Nursing”: A NURSING PROCESS

APPROACH.
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“Textbook of Obstetrics and Gynecology”. New Delhi: Elsevier India Pvt Ltd;
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3. Sharma JB, “Textbook of Obstetrics, Avichal publishing Company”, 2nd edition,

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