Question from one who hates OB nsg...

  1. I have a pt whose GF is preg. She was all of 125 lbs soaking wet and at 3 mo preg, has lost 20 lbs!!

    At what point do you consider someone to be hyper-emesis grav?

    She was re-hydrated in the ER four times already. Also, has tachycardia all the time, esp after eating, she tells me she feels palp's (Maybe she's afraid of when she'll puke again??)

    What kind of things do you recommend for someone to eat who is this sick??

    She is also anemic, which I am figuring plays a big role in the tachy, but I am also worried about her K+ level w all that vomitting. I told her to go bac to her doc and get labs, she assured me he does regualr lab work.

    Have you ever seen a healthy baby result from this?? The poor thing is getting only his mom's reserves. She doesn't smoke. But how much weight can this poor woman afford to lose??

    They are a sweet couple, and she works so hard to make ends meet whle he is recoup'ing from a leg crush injury, I just feel bad for her. Reassure me she will be OK, and any safe advice I can give her, since I am not HER nurse?? I am an OB illiterate, and threw my OB books out (gave away really!)

    Oh yeah, forgoot to add, she hasn't been able to take vitamins. I advised her to try Flintstones chewables, just so she will have something. She is a dental assistant, and gets colds a lot, even wearing mask and washing hands, as so many people come in sick, and breath all their bugs into the air all day long.
    Last edit by hoolahan on Dec 21, '02
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    About hoolahan

    Joined: Dec '99; Posts: 3,786; Likes: 129
    Quality Nurse & Home Health Nurse


  3. by   cindyln
    She needs to see her OB asap. Having to be rehydrated that many times and loosing that much weight is not good.Is she taking any phenergan? She needs to eat 6 small bland meals and see that doc! Poor thing
  4. by   hoolahan
    She is seeing OB all the time, and is trying everything, says she can't keep anything down. I don't thinkshe's taking phergan, do they Rx that so early in a preg?? What about birth defects? I know sometimes it is risk vs benefit, so I guess I am asking, is that the usual protocol, phernagan? She isn't taking vitamins or the iron b/c she can't keep it down.

    She is really suffering! Said she will never have another baby if she gets thru this.
  5. by   cindyln
    She would be admitted at my hospital,receiving IV phenergan.
  6. by   hoolahan
    Sounds like she should be to me too! The palpitatins really worry me. Maybe I'll suggest a second opinion doc. That might be the very best advice possible.
  7. by   SmilingBluEyes
    The palpitations worry me...anyone done a 'lyte panel on this poor thing? If not, it sounds as if it is more than appropriate. She would be on IV's and likely potassium at the place I work. This isnot to be taken lightly.
  8. by   indynurse
    I had hyperemesis for the first 16 weeks of my pregnancy with my daughter. I was not in nursing back then and did not think I could take anything for it so I never called my OB about it. When I went for my second prenatal visit and was 12 lbs lighter than I was four weeks earlier, my OB put me on phenergan. It didn't "cure" it, but it helped and I was able to keep some food and fluids down. My daughter, now 10 years old, is just fine and suffered no known ill effects from the phenergan.
    As an OB nurse, I see plenty of hyperemesis patients. Phenergan is not a "cure-all" med for it. For some, even Zofran does not work. The doc just needs to keep trying things to see what will be effective for her. I saw one particularly bad case of hyperemesis respond well to Prevacid.
    In addition to the above stated concerns about potassium levels, I hope she has had her thyroid checked too. Sometimes hypothyroidism makes this worse.
    I have one doc who recommends his pts try sipping lemonade and the other night one of my co-workers was telling me that she read that lemonade and potato chips may help. (I am still trying to find documentation on that one).
    Also, I firmly believe a lot of times the hyperemsis has a psychological side/cause to it, too. By that, I mean that stress or distress probably play a big role in it for many pts. Knowing what I do now, I am convinced that it was a contributing factor for me. It sounds like your friend is under a lot of stress being what sounds like the current sole breadwinner in the family, caring for an injured spouse, and maybe even thinking about how she is going to be able to fit a newborn into the picture both physically and financially care-wise. What kind of support system does she have? Maybe she would benefit from some outside help around the house. If she has any sick time or vacation days left at her work, she should take them. As much as she may need phenergan, she may also need a break from some of the stressors of her daily life.

    I hope you will post future updates on her progress and I hope she feels better soon. I know how miserable she is and I wouldn't wish that on my worst enemy.
    Last edit by indynurse on Dec 21, '02
  9. by   renerian
    I don't think I missed it but how far along is she? Is far enough she probably needs to get some type of med. I hope it goes away. I was like that for one of my dtrs and OMG it was horrible. When I took something and the nausea stopped I gained weight. I gained 22.

    She needs to see her DOC ASAP.

    Poor thing,

  10. by   renerian
    Oh yes my dtr came out fine........

  11. by   semstr
    Did she try the SEA-bands? I swear on them!
  12. by   hoolahan
    Thanks for all the interesting input! I didn't know any of this. I believe what you say about the lemonade, but personally I could not imagine that acidic lemoade would stay down long for me!

    She has no support systems here, her family is in Columbia. I know she is very depressed b/c she couldn't go home for Xmas this year d/t SO's injuries, and now havng a third surgery to remove hardware. She was working 64 hrs a week, in 6 days. Sounds like her boss is greedy, won't even close until 3pm on xmas eve. She has cut her hrs dramatically, and is using sick time too. I just hope he doesn't fire her!

    I'll keep you posted.
  13. by   mother/babyRN
    Is this a true hyperemesis or an eating disorder? We see that a lot but don't always know it right away. Another thing they should probably check is her thyroid, as that has also been found to sometimes be a factor in hyperemesis. We get healthy babies more often than not...Hope things work out...She isn't getting flak from her significant other about gaining weight, is she? We just had someone in that kind of situation, confess that was her main problem....