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Hyperemesis Gravidarum

Anggota Kelompok :
Agustin Lamtiur
Gerry Wina S.B.B
Wahyu Wijayanti
Yesi Paat
Definition
- hyper from the Greek word means
excessive)
emesis - vomiting
And the latin word gravida; meaning
pregnant women.
Cont
1
st
trimester of pregnancy : Nausea and
vomiting
Hyperemesis Gravidarum : Nausea and
vomiting that continue throughout
pregnancy yang menyebabkan dehidrasi,
ketidakseimbangan elektrolit atau
defisiensi nutrisi dan kehilangan berat
badan
1
st
trimester nausea and vomiting : 50-90%
pregnant women
Throughout pregnancy : 20%
(Philip, 2013)
Etiology
Not well understood (most literature)
Increased Human Chorionic
Gonadotrophin (hCG)
High level estrogen
Hypertiroidism
Masalah psikologis


Faktor predisposisi
Ibu muda usia kurang dari 20 tahun
Primigravida
Wanita yang pola reaksi normalnya
terhadap stres mencangkup gangguan
pencernaan

hCG norma level

Men and nonpregnant women:
Less than 5
international 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
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
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, suhu
badan naik (dehidrasi), ikterik ringan, berat
badan turun, mata cekung, tekanan darah
turun, hemokonsentrasi, oliguri, asetnuria.
Signs and Symptoms
HIPEREMESIS GRAVIDARUM TINGKAT
3
Keadaan umum memburuk, kesadaran
menurun (somnolen sampai koma), nadi
teraba lemah dan cepat, dehidrasi berat,
suhu badan naik, tekanan darah turun,
ikterik, perubahan mental, susunan saraf
pusat terganggu
Dampak pada janin
Keadaan seperti ini bila terus terjadi akan
menyebabkan janin kekurangan nutrisi.
Namun saat ini hal tersebut jarang terjadi
karena jika sang ibu mengalami mual
muntah yang terus menerus, sang ibu
akan langsung memeriksakan diri ke
rumah sakit.
Study Case
Carolin Scott (wanita, 20 tahun) dalam
masa 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?
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 kg
sejak 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 berat
jenis urine.
Assessment Findings
Data Objektif
Kedua mata klien terlihat cekung, turgor
kulit buruk, dan membran mukosa oralnya
kering
Berat badan klien menurun sebanyak 2.5
kg sejak kunjungan prenatalnya 2 minggu
yang lalu
Frekuensi nadi 98x/menit (meningkat dari
frekuensi normal klien yakni 70x/menit).
Tekanan darahnya menurun dari 118/70
mmHg menjadi 100/60 mmHg.
Hasil uji laboratorium menunjukan
peningkatan kadar hematokrit, BUN, dan
berat jenis urine
Assessment Findings
Data Subjektif
Muntah-muntah selama 2 hari dan
tidak masuk asupan makanan atau
cairan
Klien mengatakan bahwa ia sangat
menderita
Merasa sangat khawatir dan terus
bertanya Apakah bayi saya akan
meninggal?

Nursing Diagnosis
Hyperemesis
gravidarum
1. Risk for deficient fluid
volume may be r/t
excessive 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 fetal
well-being
3. Fatigue may be r/t
muscle weakness
2 emaciation
2. Imbalanced nutrition: less
than body requirements
may be r/t inability to
ingest/digest/absorb
nutrients
(prolonged vomiting)
1. Risk For Deficient Fluid Volume
Risk for deficient fluid volume may be r/t
excessive gastric losses and reduced
intake, possibly evidenced by dry mucous
membranes, dec./concentrated urine, dec
pulse volume and pressure, thirst, and
hemoconcentration.

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.

2.Imbalanced Nutrition
Imbalanced nutrition: less than body
requirements may be r/t inability to
ingest/digest/absorb nutrients (prolonged
vomiting), possibly evidenced by reported
inadequate food intake, lack of interest in
food/aversion to eating, and weight loss.


2.Imbalanced Nutrition
Interventions :

Advise woman that oral intake can be
restarted when emesis has stopped.

Company and diversionary conversation
at mealtime may be beneficial.
2.Imbalanced Nutrition
Interventions :

Instruct the patient to remain upright for
45 minutes after eating to decrease
reflux.
Suggest that the patient eat two or three
dry crackers on awakening in the
morning, before getting out of bed, to
alleviate nausea.

3. Fatigue
Fatigue may be r/t muscle weakness 2
emaciation

Interventions :
Teach relaxation techniques; fresh air and
moderate exercise, if tolerated.
Schedule activities to prevent fatigue.

4. Risk For Ineffective Coping
4. Risk for ineffective coping may be r/t
stress of pregnancy and illness: risk factors
may include situational/maturational crisis
(pregnancy, change in health status,
projected role changes, concern about
outcome).

4. Risk For Ineffective Coping

Interventions :
Provide reassurance and a calm, restful
atmosphere.
Encourage the patient to discuss her
feelings about her pregnancy and the
disorder.
4. Risk For Ineffective Coping

Interventions :
Help the pt develop effective coping
strategies.
Refer her to the social service department
for help in caring for other children at
home, if appropriate.
Patient teaching.

Patient Teaching :
Drink plenty of fluids, 6 to 8 glasses of
water daily to maintain hydration.
Avoid fluid that contain caffeine or
carbonation.
Eat a diet that is high in protein and
carbohydrates in small meals daily (5-6
meals).
Patient Teaching :
Avoid noxious odors such as tobacco
smoke, and tastes that may nauseating.
Limit stressful events and get plenty of
rest, avoid being in a hurry.
Do not take any medication without
consulting to health care provider.

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

Interventions :
Praise mother for attempts of following
therapeutic regimen.
Explain the effects of all medications and
procedures on maternal as well as fetal
health.
Accentuate the positive signs of fetal well-
being.

References
Bobak et all. 2005. Buku Ajar Keperawatan
Maternitas 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.