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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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2.Imbalanced Nutrition
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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2.Imbalanced Nutrition
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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4. Risk For Ineffective Coping
Interventions :
Provide reassurance and a calm, restfulatmosphere.
Encourage the patient to discuss herfeelings about her pregnancy and thedisorder.
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4. Risk For Ineffective Coping
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.
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