PAINT-Model: Hyperemesis Gravidarum

What is hyperemesis gravidarum?

• Severe, excessive nausea and vomiting during pregnancy

• Leads to weight loss, dehydration, electrolyte imbalance, nutritional deficiencies, and ketonuria

• Caused by elevated estrogen, progesterone, and hCG levels

What differentiates normal morning sickness from hyperemesis gravidarum?

• Morning sickness: mild, limited to early pregnancy

• Hyperemesis: persistent, severe, interferes with nutrition and fluid intake, causes ketonuria and electrolyte imbalance

What are the key assessment findings for a client with hyperemesis gravidarum?

• Weight loss and dehydration

• Dry mucous membranes and poor skin turgor

• Decreased BP, increased pulse

• Irritability, tearfulness, mood changes

What laboratory findings are expected in hyperemesis gravidarum?

• Hypokalemia, hyponatremia, ketonuria, bilirubinemia, and decreased total protein

• Electrolyte imbalances: ↓Na⁺, ↓K⁺, ↑BUN/Cr if dehydrated

• Positive ketones in urine from starvation ketosis

• May have metabolic alkalosis from prolonged vomiting

What are normal reference ranges for key labs to monitor?

• Hgb: 12–16 g/dL

• Hct: 37–47%

• WBC: 5,000–10,000/mm³

• BUN: 10–20 mg/dL

• Creatinine: 0.5–1.1 mg/dL

• Albumin: 3.5–5 g/dL

• Bilirubin: 0.1–1.2 mg/dL

• Blood pH: 7.35–7.45

What are the primary problems of concern in hyperemesis gravidarum?

• Electrolyte imbalance

• Decreased fluid volume

• Undernutrition

• Anxiety

What is the initial nursing intervention for a client with severe hyperemesis?

• Insert IV catheter

• Begin IV therapy for fluid and electrolyte correction

• NPO initially, then small frequent meals as tolerated

What medications are used to manage hyperemesis gravidarum?

• Vitamin B6 (pyridoxine) or pyridoxine + doxylamine (Diclegis)

• Antiemetics:

  • Promethazine (Phenergan)

  • Ondansetron (Zofran)

• Acid reducers:

  • Antacids, H2 blockers, proton pump inhibitors (PPIs)

• IV fluids or TPN if oral intake not tolerated

What nursing interventions support comfort and recovery?

• Provide a quiet, odor-free environment

• Monitor urine ketones daily

• Monitor I&O and weight

• Oral care after vomiting

• Offer small, frequent meals (bland, dry, salty, or sweet)

• Monitor for metabolic acidosis signs

What should a nurse do if a pregnant client calls reporting vomiting for 5 days?

• Instruct her to come in immediately to clinic or ER

• The severity cannot be determined safely by phone

What alternative or complementary remedies may help nausea in pregnancy?

• Ginger (tea, warm ginger ale)

• Peppermint or raspberry leaf tea

• Acupressure wristbands (SeaBands)

What teaching should nurses provide to manage nausea/vomiting at home?

• Eat dry, starchy foods (toast, crackers) before rising in morning

• Eat small, frequent meals every 2–3 hrs

• Avoid skipping meals or getting too hungry

• Eat high-protein snacks at bedtime

• Avoid strong odors and fatty/spicy foods

• Drink fluids between meals, not during

• Avoid brushing teeth immediately after eating

• Try cool foods with low aroma

• Get fresh air or open windows for ventilation

• Suck on lemon slices or try salty/tart foods (chips, lemonade)

• Get up slowly from bed to prevent nausea

What discharge teaching is important for ongoing management?

• Monitor weight and urine output daily

• Report no improvement, signs of dehydration, or persistent vomiting

• Emphasize rest, hydration, and nutrition

• Follow-up visits to reassess labs and fetal growth

What indicates effective treatment of hyperemesis gravidarum?

• Client tolerates oral fluids

• Stable weight or weight gain

• Normal electrolyte values

• No ketones in urine

• Improved mood and energy