NCM 109

Hyperemesis
Gravidarum
aka. Pernicious or persistent vomiting nausea.
It is defined as vomiting of pregnancy
prolonged past week 16 of pregnancy
Cause? Primarily unknown
but studies suggest:
• Increased thyroid function
• associated with
Helicobacter pylori
 S/sx and Laboratory Findings:

• severe dehydration
• ketonuria
• weight loss occurs within the first 12 weeks of pregnancy
• Low hematocrit concentration= DANGER:
Thromboembolism
S/sx and Laboratory
Findings:
• hypokalemic alkalosis
• Ataxia and Confusion
• Preterm birth
 Nursing and Medical
Mgt:
Assessment.

• Always try to determine exactly how much

nausea and vomiting women are having during
pregnancy.
• Ask each to describe the events of the day
before.
• How late into the day did the nausea last?
• How many times did she vomit and how much?
• What was the total amount of food she was able
to eat?
Nursing and Medical Mgt:

• Hospitalization for about 24

• NPO x 24 hrs
• Intravenous fluid therapy.
• Administration of an
antiemetic,
• Strict I and O
 If there no vomiting after the first 24 hrs of NPO

Begin small amounts of clear fluid.

Nursing and small quantities of dry toast, crackers, or cereal can be added

Medical Mgt: q 2 or 3 hours

Soft Diet

Regular Diet
If vomiting returns at any
point, enteral or total
parenteral nutrition may be
prescribed to ensure she
receives adequate
nutrition
 Nursing Diagnoses and
Related Interventions
Imbalanced nutrition, less than body
requirements, related to prolonged
vomiting
 • Encourage a woman to serve
herself small portions
• Limit her exposure to food odors
Nursing • hot foods are served hot, and
Diagnoses cold foods are served cold
and Related • Put it out of sight the emesis
basin
Interventions • Avoid these phrases
“Eat just a little more. You don’t
want to hurt your baby.”
Early identification and
proper management of this
condition will not lead to
pregnancy loss or low birth
weight, but rather, to a
healthy pregnancy
• Sexually transmitted infections (STIs) are diseases
that are spread through sexual contact with an
infected partner. They range in severity from easily
treated infections, such as trichomoniasis, to human
immunodeficiency virus (HIV) infection, which,
despite advances in therapy, is life-threatening.

• If these diseases are discovered in young children,

the possibility of sexual abuse has to be considered
(Reading & Rannan-Eliya, 2007). STIs may be spread
among women having sex with women or men having
sex with men (Evans et al., 2007).

• Male circumcision does not appear to reduce the

spread
• SEXUALLY TRANSMITTED DISEASES AND
PREGNANCY

• [Link] (Thrush)
• >Is a common fungus that harmlessly infect
people and it is normally well
• controlled by our immune system
• >If immune system is weakened because of
infection, excessive alcohol or diseases such as
diabetes, an infection can take hold of the body
• >Can affect people taking antibiotic

• Causative Organism: Candida albicans

• Site:
• >Mucous membrane
• >Internal lining of the genitals and the
mouth

• Signs and Symptoms In Women:

• >Itchiness around the vagina
• >Thick, white discharges
• >Vaginal dryness
• Site:
• >Mucous membrane
• >Internal lining of the genitals and the
mouth

• Signs and Symptoms In Women:

• >Itchiness around the vagina
• >Thick, white discharges
• >Vaginal dryness
•

•
•
•
In immunosuppressed
individuals, it can
become systemic
(Blyth, Palasanthiran, &
O’Brien, 2007).
Therapy for candidal infections includes vaginal suppositories or cream applications of antifungal
preparations such as miconazole (Monistat) or clotrimazole (Lotrimin), once a day for 3 to 7 days. Oral
fluconazole (Diflucan) can be administered as a one-time oral dose.
• Prevention
• >Avoid wearing synthetic
underwear
• >Do not wash with soaps or
bubble baths – use water only
• >Avoid wearing clothing that is tight
around the crotch
• >Taking live, natural yogurts – can
help because it restores the natural
pH balance
[Link]: chlamydia trachomatis
(C. trachomatis)
Chlamydia
• Diagnosis:
• > Culture of the organism
from vaginal secretions
• using a specific
chlamydial kit
• Treatment: In Non pregnant
Women:

• >Doxycycline (Vibramycin), a
tetracycline

• In pregnant Women:

• >Azithromycin (Zithromax)
or amoxicillin (Amoxil) – to
prevent fetal long bone
deformity
C. Syphylis
• A systemic disease caused by
the spirochete Treponema
pallidum
• * Before the 18th week, the
placenta provides some
protection against the
disease
• * After this time, the
spirochete crosses the
placenta freely and may be
responsible for spontaneous
abortion, pre-term labor,
stillbirth or congenital
anomalies of the newborn
Signs and Symptoms:
➢ Painless ulcer (chancre) on the vulva or vagina
Signs and Symptoms:
➢ Painless ulcer (chancre) on the vulva or vagina
Diagnosis:
• All pregnant women should
screened for syphilis 1st the
first natal visit
• In some institution, women
are screened again at the
beginning of labor and
newborns are screened for
congenital syphilis by a cord
blood sample
• Diagnosis:
• All pregnant women should screened for syphilis in
the first natal visit
• In some institution, women are screened again at
the beginning of labor and newborns are screened
for congenital syphilis
by a cord blood sample
•

•
D. Human Pappiloma Virus Infection
• >Fibrous overgrowth on the external
vulva
• >Lesions has no effect on the
fetus during pregnancy, but if it
obstruct the birth canal, C/S is
recommended
• >It is a serious condition for the
mother because it
can

cause cervical cancer later

• in life
• >If with one infection, woman should
have a yearly Pa test for the rest of her
life
• Signs and Symptoms:

• >At first, lesions appear as discrete

pappilary structures, they, spread,
enlarge and coalesce to form large, a
cauliflower like lesions
• >Tend to increase in size during
pregnancy because of
• high vascular flow in the pelvic area
• >Become secondary, ulcerated and
infected lesion
• >With foul, vulvar odor
•

•
Treatment:
• Goal: To dissolve the lesions and end
any secondary infection present

• >Podophyllum (Podofin) – drug of

choice; to be applied directly to
lesions of pregnant women
• >Trichloroacetic acid (TCA) for non
pregnant
• women
• >Large lesions – laser therapy
Example:
• [Link]
• 2. Sitz bath and lidocaine may have some soothing
• >At first, edema may be present at the site, lesions effects
become gangrenous, and sloughing off occurs
• >If it is not a burden on the woman, it can be left
within 7 days
and be removed during the postpartum period
• >Healing is complete within 14 days with slight
• [Link] excision
depigmentation on site
E. HIV Infection
• >Caused by a retrovirus that infects
and disables T lymphocytes, without T
lymphocytes, the body cannot fight
infection through T – cell and B – cell
activity

• >Contacted through sexual intercourse

• >By exposure to infected blood
• >By vertical transmission across the
placenta to the
• fetus at birth
• >By breast mik to the new born
During pregnancy, HIV can pass through
the placenta and infect the fetus.

• During labor and delivery, the baby may be exposed to the virus from a
woman's blood and other fluids.

• When a woman goes into labor, the amniotic sac breaks (her water
breaks). Once this occurs, the risk of transmitting HIV to the baby
increases.
• Risk factors:
• >Multiple sexual partners
• >Bisexual partners
• >IVF used (contaminated materials)
• >Blood transfusion (rare)
• Assessment:

• >CD4 cell count testing -to

determine how many T4 cells are
present and functioning

• >If ↓500 cells/mm3 or the vital load

rises above 5,000 copies/ml it will
lead to difficulty to resist
opportunistic infections

• >Presence of early symptoms of

other diseases
A CD4 count above 500 is
considered “normal”. A • A CD4 count is a test that measures the number of
CD4 cells in your blood. CD4 cells, also known as T
CD4 count below 350 cells, are white blood cells that fight infection and
shows HIV has damaged play an important role in your immune system
your immune system.
• Without Therapy, HIV may progress
• >Initial invasion of the virus with flulike
symptoms
• >Seroconversion, in which the
woman converts
from having no HIV
antibodies positive for HIV (serum positive)
from 6 weeks to 1 year after exposure

• >Asymptomatic period during which the

woman appears to be disease-free except for
symptoms such as weight loss and fatigue
(wasting syndrome)
• 2 to 6 years.
• A symptomatic period during which the
woman develops opportunistic infection
and possible malignancies ( toxoplasmosis,
oral and vaginal candidiasis, carinti
pneumonia (PCP), candida
Esophagitis, Kaposi
sarcoma, and HIV –
associated dementia),
CD4 count is below
200 cells/mm3.
Esophagitis, Kaposi sarcoma,
and HIV – associated
dementia), CD4 count is
below 200 cells/mm3.

• What causes HIV-associated

dementia? When HIV spreads to
the brain, it results in
encephalopathy (a disease
which affects the brain's
function), which causes
dementia. The greater the spread
of infection in the brain, the worse
the dementia symptoms become.
• Therapeutic Management:

• Goal: To maintain the CD4 cell count at greater than

• 500 cells/mm3
• >If HIV positive – advise woman not to get pregnant
• >Administration of protease inhibitor such as Ritonavir
(Norvir), Zidovudine – to help reduce mother to fetal
transmission
• 100 mg p.o. 5x/day during pregnancy

• >During labor – IV
• >For the newborn – drug in syrup – 2 mg q 6H x 6 weeks
• >Amniocentesis should be
avoided to prevent exposure to
maternal blood
• >Episiotomy is also avoided to
limit a possible blood source
• >Breast milk may transmit HIV
and also increased the incidence
of mastitis- also exhausting for
the debilitated woman
• >Patient education – mode of
transmission and safer sex
practices
• >Use standard precaution
• f. Gonorrhea
• Caused by gram-negative coccus Neisseria Gonorrhea
• >Associated with spontaneous miscarriage, preterm birth, endometritis in the
postpartum period
• >Major cause of PID and infertility
DX:
• >Culture of the organism from the
vagina, rectum or urethra
Treatment:
• Cefixime (Suprax) – one time IM
injection – current
recommended therapy, can be safely
administered during pregnancy
• >Sexual partner should be treated to
prevent infection
• >Possibility to have a chlamydial
infection – non pregnant woman
should receive doxycycline
therapy at the same time

• >If pregnant – amoxicillin

• >If present at the time of birth, can
cause severe eye infection that can
lead to blindness in the new born
(Opthalmia Neonatorum)
• Signs and Symptoms:

• >Yellow – green vaginal discharge

• >Woman may be asymptomatic
• >Male partner usually has severe
symptoms of pain on urination and a
purulent
• yellow discharge