Machtportfoliomnt.weebly.com



Rachel Hart KNH 413Hyperemesis GravidarumNPO/ Peripheral Parenteral DietDescription of PatientCasey Schmidt is a 27-year-old female who is 10 weeks pregnant with her first child. She works full time as a secretary at the local high school. Casey is of European American decent and practices Unitarianism. Casey has been in relatively good health all her life. She is a non-smoker, non-alcohol user and non-drug user. She does have seasonal allergies.Anthropometric data:Height: 5 feet 9 inches Current weight: 140 poundsUsual body weight: 150 poundsPercent usual body weight: 93%BMI: 20.7 kg/m2 Family history: Hypertension Diverticulitis No history of hyperemesis gravidarumMedications:Allegra, 60 mg po qdCasey’s appetite usually good, but has not had one in the last few weeks because of severe nausea and vomiting episodes that occur daily. Her 24 –hour recall showed that she had not consumed adequate nutrition and cannot keep anything in her stomach. Usual dietary intake:Breakfast: Usually eggs, whole wheat toast, fruit, and orange juiceLunch: Usually goes out to eat with facility and eats a salad, soup, or a sandwich Dinner: Usually cooks a full dinner for her husband containing meat, a starch, and a vegetableDoes not usually eat snacks or dessertVitamin and mineral intake: Prenatal vitamin, 1 tablet po qdDiagnosisCasey complains of extreme nausea, vomiting, and dehydration. She vomits about six times per day and feels dizzy and lightheaded. Physical exam:General appearance: Tired-looking femaleEyes: Wears contact lenses to correct myopia, PERRLAExtremities: Normal muscle tone, normal ROMAbdomen: Slightly bloatedBlood pressure: LowAbnormal chemistry:Sodium (high)Creatinine (high)Glucose (low)Abnormal hematology:HCT (hematocrit) (high)Abnormal urinalysis:Ketones (positive)Casey’s physician diagnoses her with hyperemesis gravidarum and decides to admit her to the hospital for further evaluation and nutrition support. Etiology Hyperemesis gravidarum may be caused by rapidly rising serum levels of hormones such as HCG (human chorionic gonadotropin) and estrogen. Extreme nausea and vomiting during pregnancy may indicate a multiple pregnancy or hydatidiform mole, an abnormal tissue growth that is not a true pregnancy. The true cause of the condition is still unknown (Her Foundation, 2013). Diagnostic Measures A doctor will ask about symptoms that the patient is experiencing, take a medical history, and perform a physical exam on the patient. In addition, the doctor may order certain lab tests to help in making a diagnosis such as, electrolytes, hematocrit, creatinine, blood glucose, and a urinalysis (Lab Tests Online, 2013). The doctor may need to run tests to rule out liver and gastrointestinal problems. A pregnancy ultrasound will be done to see if the patient is carrying twins or more, and to check for a hydatidiform mole.Treatment Medication to prevent nausea is reserved for cases where vomiting is persistent and severe enough to present potential risks to the patient and the fetusIn the most severe cases, fluids may be administered through an IV(Center For Disease Control and Prevention, 2013)Medical Nutrition TherapySmall, frequent meals and dry, bland foods may help relieve uncomplicated nauseaLower fat foods and ginger and ginger ale can also help with nausea Drinking plenty of fluidsVitamin B6 (no more than 100 mg daily) has been shown to decrease the nausea in early pregnancyIn the most severe cases, parenteral nutrition should be used to provide adequate calories, protein, and vitamins and minerals for the patient and fetus(Nutrition Care Manual, 2013)PrognosisNausea and vomiting usually peak between 2 and 12 weeks of pregnancy and go away by the second half of pregnancy. With proper identification of symptoms and careful follow-up, this condition rarely presents serious complications for the infant or mother (National Institutes of Health, 2012).Possible ComplicationsToo much vomiting is harmful because it leads to dehydration and poor weight gain during pregnancy. Social or psychological problems may be associated with this disorder of pregnancy and need to be identified and addressed appropriately (Cleveland Clinic, 2012).ReferencesAbout HG. (2013). Her Foundation. Retrieved from mothers/about-hyperemesis/index.phpDehydration. (2013). Lab Tests Online. Retrieved from understanding/analytes/dehydration/tab/testHyperemesis gravidarum. (2102). National Institutes of Health [NIH]. Retrieved from gravidarum. (2013). Center For Disease Control and Prevention [CDC]. Retrieved from Hyperemesis gravidarum. (2013). Nutrition Care Manual. Retrieved from gravidarum. (2012). Cleveland Clinic. Retrieved from dietetics & nutrition terminology (IDNT) reference manual: Standardized language for the nutrition care process, Edition 3. (2011). Academy of Nutrition and Dietetics [AND]. Retrieved from =5903#.UEo8MXbDaeYMy fitness log: Foods. (2011). FitDay. Retrieved from , M. N., Long, S., Lacey, K. (2009). Medical nutrition therapy: A case study approach. Belmont, CA: Wadsworth. Nelms, M., Sucher, K. P., Lacey, K., Roth, S. L. (2011). Nutrition therapy & pathophysiology. Belmont, CA: Wadsworth. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download