Hyperemesis Gravidarum Tambahan

8/10/2019 Hyperemesis Gravidarum Tambahan

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Hyperemesis Gravidarum

Anggota Kelompok :

Agustin Lamtiur

Gerry Wina S.B.B

Wahyu Wijayanti

Yesi Paat


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Definition

- hyperfrom the Greek word meansexcessive)

emesis - vomiting

And the latin word gravida;meaningpregnant women.


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Cont

1st

trimester of pregnancy : Nausea andvomiting

Hyperemesis Gravidarum : Nausea and

vomiting that continue throughoutpregnancy yang menyebabkan dehidrasi,

ketidakseimbangan elektrolit atau

defisiensi nutrisi dan kehilangan berat

badan


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1st

trimester nausea and vomiting : 50-90%pregnant women

Throughout pregnancy : 20%

(Philip, 2013)


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Etiology

Not well understood (most literature) Increased Human Chorionic

Gonadotrophin (hCG)

High level estrogen Hypertiroidism

Masalah psikologis


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Faktor predisposisi

Ibu muda usia kurang dari 20 tahun Primigravida

Wanita yang pola reaksi normalnya

terhadap stres mencangkup gangguanpencernaan


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hCG norma level

Men and nonpregnant women:

Less than 5international units per

liter (IU/L)

Pregnant women:

About 24 to 28 days

after the last

menstrual period

(LMP):

5100 IU/L

4 to 5 weeks after the

LMP:

50500 IU/L

5 to 6 weeks after the

LMP:

10010,000 IU/L

Peak, 14 to 16 weeks

after the LMP:

12,000270,000 IU/L
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Signs and Symptoms

HIPEREMESIS GRAVIDARUM TINGKAT 1

Mual muntah terus menerus, yang

menyebabkan penderita tidak mau makan,

berat badan menurun dan nyeri pada

epigastrium, denyut nadi meningkat, tekanan

darah menurun, turgor kulit kurang, mata

cekung, dan lidah kering


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Signs and Symptoms

HIPEREMESIS GRAVIDARUM TINGKAT 2

Mual dan muntah yang hebat yang

menyebabkan keadaan umum penderita lebih

parah, turgor kulit buruk, lidah kering dan

kotor, nadi teraba lemah dan cepat, suhubadan naik (dehidrasi), ikterik ringan, berat

badan turun, mata cekung, tekanan darah

turun hemokonsentrasi oli uri asetnuria.


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Signs and Symptoms

HIPEREMESIS GRAVIDARUM TINGKAT3

Keadaan umum memburuk, kesadaran

menurun (somnolen sampai koma), naditeraba lemah dan cepat, dehidrasi berat,

suhu badan naik, tekanan darah turun,

ikterik, perubahan mental, susunan saraf

pusat terganggu


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Dampak pada janin

Keadaan seperti ini bila terus terjadi akanmenyebabkan janin kekurangan nutrisi.

Namun saat ini hal tersebut jarang terjadi

karena jika sang ibu mengalami mualmuntah yang terus menerus, sang ibu

akan langsung memeriksakan diri ke

rumah sakit.


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Study Case

Carolin Scott (wanita, 20 tahun) dalammasa kehamilan 6 minggu anak pertama.

Masuk ke rumah sakit dengan diagnosa

hiperemesis gravidarum.

Dari hasil pengkajian, didapatkan data

bahwa Carolin muntah-muntah selama 2

hari dan tidak masuk asupan makanan

atau cairan. Ia mengatakan bahwa ia

sangat menderita. Caroline sangat

khawatir dan terus bertanya Apakah bayi

saya akan meninggal?


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Study Case

Selama pemeriksaan fisik dilakukan, perawat

memeperhatikan bahwa kedua mata Carolin

terlihat cekung, turgor kulit buruk, dan membran

mukosa oralnya kering.

Berat badan Carolin menurun sebanyak 2.5 kgsejak kunjungan prenatalnya 2 minggu yang lalu.

Pengkajian TTV menunjukan frekuensi nadi

98x/menit (meningkat dari frekuensi normal

Carolin yakni 70x/menit). Tekanan darahnya

menurun dari 118/70 mmHg menjadi 100/60

mmHg. Hasil uji laboratorium menunjukan

peningkatan kadar hematokrit, BUN, dan beratenis urine.


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Assessment FindingsData Objektif

Kedua mata klien terlihat cekung, turgorkulit buruk, dan membran mukosa oralnya

kering

Berat badan klien menurun sebanyak 2.5kg sejak kunjungan prenatalnya 2 minggu

yang lalu

Frekuensi nadi 98x/menit (meningkat darifrekuensi normal klien yakni 70x/menit).

Tekanan darahnya menurun dari 118/70

mmHg menjadi 100/60 mmHg.


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Assessment Findings

Data Subjektif

Muntah-muntah selama 2 hari dan

tidak masuk asupan makanan ataucairan

Klien mengatakan bahwa ia sangat

menderita Merasa sangat khawatir dan terus

bertanya Apakah bayi saya akan

meninggal?


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Nursing Diagnosis

Hyperemesis

gravidarum

1. Risk for deficient fluid

volume may be r/texcessive gastric losses

and reduced intake

4. Risk for ineffective coping

may be r/t stress

of pregnancy and illness

5. Fear may be r/t

concerns for fetalwell-being

3. Fatigue may be r/t

muscle weakness

2emaciation

2. Imbalanced nutrition: less

than body requirements

may be r/t inability to

ingest/digest/absorbnutrients

(prolonged vomiting)


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1. Risk For Deficient Fluid Volume

Risk for deficient fluid volume may be r/texcessive gastric losses and reduced

intake, possibly evidenced by dry mucous

membranes, dec./concentrated urine, dec

pulse volume and pressure, thirst, and

hemoconcentration.


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1. Risk For Deficient Fluid Volume

Interventions :

Maintain I.V. fluids, as ordered, until the

patient can tolerate oral feedings. Maintain NPO status until vomiting

stopped. Ice chips may be given.

Monitor fluid intake and output, vital signs,weight, serum electrolyte levels, and urine

for ketones.


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2.Imbalanced Nutrition

Imbalanced nutrition: less than body

requirementsmay be r/t inability to

ingest/digest/absorb nutrients (prolongedvomiting), possibly evidenced by reported

inadequate food intake, lack of interest in

food/aversion to eating, and weight loss.


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Interventions :

Advise woman that oral intake can berestarted when emesis has stopped.

Company and diversionary conversation

at mealtime may be beneficial.


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Interventions :

Instruct the patient to remain upright for45 minutes after eating to decreasereflux.

Suggest that the patient eat two or three

dry crackers on awakening in themorning, before getting out of bed, to

alleviate nausea.


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3. Fatigue

Fatiguemay be r/t muscle weakness 2emaciation

Interventions : Teach relaxation techniques; fresh air and

moderate exercise, if tolerated.

Schedule activities to prevent fatigue.


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4. Risk For Ineffective Coping

4.Risk for ineffective copingmay be r/tstress of pregnancy and illness: risk factorsmay include situational/maturational crisis(pregnancy, change in health status,

projected role changes, concern aboutoutcome).


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Interventions :

Provide reassurance and a calm, restfulatmosphere.

Encourage the patient to discuss herfeelings about her pregnancy and thedisorder.


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Interventions :

Help the pt develop effective copingstrategies.

Refer her to the social service departmentfor help in caring for other children athome, if appropriate.

Patient teaching.


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Patient Teaching : Drink plenty of fluids, 6 to 8 glasses of

water daily to maintain hydration.

Avoid fluid that contain caffeine orcarbonation.

Eat a diet that is high in protein and

carbohydrates in small meals daily (5-6meals).


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Patient Teaching :Avoid noxious odors such as tobacco

smoke, and tastes that may nauseating.

Limit stressful events and get plenty ofrest, avoid being in a hurry.

Do not take any medication without

consulting to health care provider.


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5. Fear

5. Fearmay be r/t concerns for fetal well-being.

Interventions : Praise mother for attempts of following

therapeutic regimen.

Explain the effects of all medications andprocedures on maternal as well as fetal

health.

Accentuate the positive signs of fetal well-


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References

Bobak et all. 2005. Buku Ajar KeperawatanMaternitas Edisi 4. Jakarta: EGC

Hidayati, Ratna. 2009. Asuhan Keperawatan

pada Kehamilan Fisiologis dan Patologis.

Jakarta: Salemba Medika. Littleton, L.Y. Engerbretson, C.J. 2005. Maternity

Nursing Care. Canada: Thomson Delmar

Learning.

Philip, B. 2003. Hyperemesis Gravidarum :

Literature Review. Volume 102, No 3. University

of Wisconsin: Wisconsin Medical Journal.

Hyperemesis Gravidarum Tambahan

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