Hyperemesis Gravidarum

Introduction

Hyperemesis gravidarum is characterized by persistent vomiting that proves to be an extremely severe condition during pregnancy. As a result, patients suffering from this disease experience weight loss, nausea, electrolyte disturbance, hyper olfaction, depression, dysgeusia, irritability, and anxiety. At the mild stage, the condition can be treated with dietary changes, antacids, and rest (Ogunyemi, 2015). It is notable that 80‑90% of pregnant women experience hyperemesis gravidarum, as reported by the research conducted in different states (Ogunyemi, 2015). The essay, therefore, discusses hyperemesis gravidarum (HG) by focusing on such aspects as pathophysiology, statistics, diagnosis, treatment, and education of patients.

Pathophysiology

Pathophysiology refers to the disordered processes of physiology that are associated with an injury or a disease. Hyperemesis gravidarum often appears to be a complex interaction of psychological, biological, and sociocultural factors. Pathophysiology involves such aspects as hormonal changes, gastrointestinal dysfunction, lipid alterations, infections, metabolic derangement, and genetic and psychological issues amongst others. Regarding hormonal changes, it is evident that women with hyperemesis gravidarum are likely to have high levels of human chronic gonadotropin (hCG) that results into transient hyperthyroidism (Ogunyemi, 2015).

In most cases, human chronic gonadotropin (hCG) stimulates the thyroid gland, known as the thyroid-stimulating hormones (TSH) receptor. In the first trimester, hCG levels are at the peak whereby some women with HG at this stage appears to have clinical hyperthyroidism. However, in a greater portion that ranges from 60 to 70 percent, TSH is suppressed, and the free thyroxine can elevate by 45 to 70% with no signs of hyperthyroidism, thyroid enlargement, and thyroid antibodies circulating (Ogunyemi, 2015).

Concerning gastrointestinal dysfunction as the stomach pacemaker causes peristaltic stomach contractions, the myoelectric activity results in a variety of gastric dysrhythmias. The mechanisms that lead to gastric dysrhythmias include thyroid disorders, increased levels of estrogen, and vasopressin secretion due to the intravascular perturbation. All these pathophysiologic factors are believed to be very intense and sensitive to what is termed as hormonal or neural changes in those who have developed hyperemesis gravidarum (HG) (Coleman et al., 2014). According to the other pathophysiology theory involving lipid alterations, women with hyperemesis gravidarum are noted to have high levels of cholesterols, phospholipids, and triglycerides as compared to non-vomiting and non-pregnant controls. Infection is also reported to have an influence on the development of the disease: a bacterium Helicobacter pylori found in the stomach might intensify vomiting and nausea in women (Coleman et al., 2014).

Statistics

Statistics on the condition of hyperemesis gravidarum creates a broader picture of its nature in that it is evident that a bigger percentage of pregnant women are undergoing this persistent and severe condition during their pregnancy period (Coleman et al., 2014). However, the situation of each pregnant woman will differ, and only the woman and her doctor can develop and adapt to a treatment strategy that will help in her current condition. The statistics regarding hyperemesis gravidarum condition and morning sickness reveal that 80% of pregnant women in their first trimester of pregnancy experience morning sickness (Florida Hospital, 2014).

Out of the eighty percent (0.3-2%) of pregnancies are altered by hyperemesis gravidarum condition (Florida Hospital, 2014). It was also revealed that hospitalization in the first half of gestation is commonly caused by hyperemesis gravidarum (HG) and has been ranked to be the second cause of hospitalization during pregnancy period. Besides, it is notable that the annual expenditure on hyperemesis gravidarum condition exceeds $ 200 million in the United States (Florida Hospital, 2014).

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Diagnosis

In most cases, it is hard to properly diagnose hyperemesis gravidarum (HG). However, the results may be of utmost importance, especially if patients show some unusual complaints that might imply to the other disorders, such as abdominal pains and bleeding. The diagnosis includes thyroid evaluation, abdominal assessment, and the general examination that involves the study of the patient’s body weight or nutrition. The other significant aspect during diagnosis is vital signs incorporating lying and standing blood pressure and pulse. Volume status, on the other hand, involves the condition of mucous membrane, neck veins, mental status, and skin turgor. Cardiac and neurologic evaluations also accumulate to the diagnosis process under hyperemesis gravidarum (American Pregnancy Association, 2016).

A few laboratory tests undertaken in the process of diagnozing hyperemesis gravidarum involve serum levels of ketones and electrolytes. Moreover, lipase levels or amylase, urinalysis of specific gravity and ketones, thyroid stimulation hormone, urine culture, and calcium levels play a great role in the test. All the tests incorporated together would lead to reliable results on the conditions regarding hyperemesis gravidarum (American Pregnancy Association, 2016).

In most cases, the condition becomes more severe in that it requires hospitalization for appropriate treatment, which involves the aspect of intravenous fluids (IV). The primary aim of intravenous fluids is to restore electrolytes, hydration, nutrients, and vitamins. The other treatment process is the aspect of tube feeding, which incorporates nasogastric and percutaneous endoscopic gastrostomy. The former method aims at restoring nutrients via inserting a tube through the nose and leading it to the stomach. The latter process of treatment restores nutrients by inserting a tube through the abdomen and leading it to the stomach, and it requires a surgical procedure (American Pregnancy Association, 2016).

Treatment

The medications involved in the treatment of hyperemesis gravidarum incorporate antihistamines, antireflux, and metoclopramide drugs. The other aspects considered in the treatment of hyperemesis are bed rest, which provides comfort, but the patient needs to be cautious of weight loss and muscle effects because of little movement. Acupressure as a process of treatment involves introducing pressure point in the middle of the inner wrist three strides of the finger away from the wrist crease and between the tendons (Coleman et al., 2014).

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Education

Timely patient education regarding the signs and symptoms of pregnancy may be of much help to both the patient and the nurse. Patient education on the aspect of hyperemesis gravidarum (HG) leads to early interventions that include dietary and reassurance counseling. It helps to consult the patient on the proper diet and whether there is a strong need to avoid spicy and high-fat foods. Through education, it is noted that the patient will follow hunger cues and increase the intake of simple carbohydrates and carbonated beverages. By undertaking all these procedures included in the patient education and following them, the cases of hyperemesis gravidarum conditions can be minimized to some extent (American Pregnancy Association, 2016).

In conclusion, the above essay explicitly explains the aspect of hyperemesis gravidarum, a common condition during pregnancy. The symptoms of the disease are severe and include weight loss, hyper olfaction, electrolyte disturbance, depression, dysgeusia, irritability, and anxiety. From the above discussion much is understood on the aspect of pathophysiology, statistics, patient education diagnosis, and the outcomes of patient education. Additionally, it is noted that the aspect of patient education has caused many positive results. Education assists in early interventions, which help to minimize the condition to a great extent. Therefore, it is vital for the expertise to create awareness of hyperemesis gravidarum, so that people can take the necessary precautions.

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