hyperemesis

Symptoms. The patient complains of uncontrollable nausea, persistent retching and vomiting, inability to take any food by mouth, and exhaustion due to restlessness and lack of sleep. As the condition persists the patient becomes severely dehydrated, develops a fever, and may show signs of peripheral nerve involvement and jaundice. The urine may contain blood, bile, albumin, and ketone bodies as starvation develops. Although hyperemesis gravidarum is rarely fatal, these latter symptoms indicate a grave illness that demands prompt treatment.

Treatment. The physical symptoms of the patient are relieved by intravenous administration of fluids and nutrients and mild sedation to promote rest and relaxation. There is some controversy as to the value of psychotherapy; however, it is generally agreed that the patient will need help in overcoming emotional problems and situational tension if they contribute to the occurrence of the disorder. Dietary treatment may include limiting the intake of liquids, eating a snack of crackers or dry toast before arising, and avoiding excessive fat in the diet.

Patient Care. The hospitalized patient should be placed in a quiet, well-ventilated room that is free from odors or sights that may cause nausea. Fluid intake and output are monitored and mouth care is given frequently. Food and liquids are resumed on a prescribed schedule that gradually progresses to a regular diet. The patient should be encouraged to talk about her feelings if she indicates a desire to do so. The caregivers should be alert to signs of depression or fears of pregnancy, labor, or the responsibilities of motherhood. Recovery is much more likely if the patient is able to vocalize her fears and seek aid in solving any situational or emotional conflicts that may contribute to her illness. Those who care for her should be sympathetic, optimistic, and reassuring in discussing her condition with her.