Nausea, Vomiting, and Emotional Disturbances (Nursing)

00:01 So the first one, perhaps the one we think of often when it comes to pregnancy, I know, at least I do, every time I watch a movie, anytime someone who's of childbearing age starts to feel nauseated or starts to vomit then I automatically think pregnancy.

00:15 Now, that may be just me, but now it'll be you too.

00:19 But when do we expect this? Typically, during the first trimester, so that's the first 13 weeks of pregnancy and usually it resolves by then.

00:28 Now, unfortunately, that's not everybody, but for most patients by the time they get to 13 weeks it's going to begin to slow down, but it can happen anytime during the day and it can continue well past 13 weeks, so that's nausea and vomiting.

00:44 You may have heard this referred to as morning sickness, but that's kind of a misnomer because it could be afternoon sickness or bedtime sickness or anything else in between.

00:55 Now let's think about the physiology.

00:57 We don't totally know what causes the nausea and vomiting, but what we believe is that the hCG, the human chorionic gonadotropin and the increase in that hormone level is what may be contributing to the nausea and vomiting.

01:12 We also think the increase in estrogen may have something to do with it, so not a 100%, but it's what we know for right now.

01:20 When is it a problem? Hyperemesis gravidarum, now say that about three times fast, or really just one other time to help you remember.

01:29 Hyperemesis gravidarum means that we have vomiting to the point where our electrolytes are going to be off, so think about having vomiting to the point where you can't keep anything down for 24 hours, that's what we mean.

01:43 So if it gets to that point, then chances of having potassium levels that are off balance can be really problematic.

01:50 Also we want to think about the fact that if we have nausea and vomiting in the second or third trimester, and we never had it in the first trimester, there may be something else going on.

02:00 In this case, it might be preeclampsia.

02:04 So, having nausea and vomiting first trimester that continues through pregnancy, understandable, not fun, but understandable.

02:12 Not having nausea and vomiting in the first trimester and then showing up with that as a symptom later on, might be an indication of preeclampsia or some other type of infection.

02:23 Now, we talked about the fact we have to have curative options, so let's think about what they might be.

02:29 The first thing we're going to do is kind of think about how we can avoid triggers so anything that might make your stomach turn, it could be certain kinds of foods, could be certain kinds of smells. I had a client once that couldn't stand the smell of butter.

02:44 I didn't even really know that butter had a smell, but apparently it does, and that was a trigger.

02:50 So we avoided butter and things were much better.

02:53 Any type of smell, odor, maybe a person, I don't know, I'm just a kidding, so just a smell or an odor would be a trigger we'd want to think about.

03:01 Also, we want to think about keeping the stomach with some food in it, so an empty stomach can be a trigger for the nausea and vomiting.

03:09 So what we recommend is in the morning before the client sits up, so kind of in the bed, this is the one time we give permission to eat in the bed.

03:18 You take some sort of food item and put it in your mouth, swallow it before you sit up to keep the stomach full, alright? Not overly full, but just keep something in there, so small frequent meals would be important.

03:31 Now it's not a good idea to eat a large meal because a large meal will over extend the stomach and actually be a trigger for the nausea and vomiting.

03:39 Now you might have heard of salty food like crackers or something like that, even potato chips work.

03:46 There's something in the salt that actually helps with the nausea and vomiting so that would be a wonderful recommendation.

03:52 Also their medications that are approved to help with the nausea and vomiting.

03:57 Some of them will be prescription, some of them might be homeopathic, so you may have a client that has some tricks, peppermint oil or papaya or other kinds of mint or ginger, but you want to make sure you talk to them about it because some of those may not be safe during pregnancy.

04:14 So this is just to give you some idea of some treatments for nausea and vomiting.

04:19 The next symptom we want to talk about is emotional disturbances.

04:23 So, emotional disturbances covers a range of feelings, so being happy, being sad, crying, not knowing why you're crying.

04:31 This might be something you've seen on TV where someone says, "Why are you crying?" and someone says, "I don't know why I'm crying, I'm happy." This is something that happens often during pregnancy as a result of the fluctuation of hormones, so this is called emotional liability or lability, may hear it either way.

04:49 We want to be careful with this particular situation because it might be an indication of depression, so someone who's sad all the time and has lost their joy, that's not a normal pregnancy response, that's depression and it needs to be further investigated because depression during the pregnancy or depression before pregnancy, can be a big sign that someone may develop postpartum depression which takes us into a whole different discussion which we'll have in our postpartum lecture.

05:17 We also want to think about the impact of stress.

05:21 So sometimes, someone is experiencing these emotional changes because their home life is very difficult.

05:26 So remember in a previous lecture we talked about drivers of health or social determinants of health, and stress can be caused by any number of factors, people in the house, work, finances, school, any of those things.

05:39 Did I say school? That when you know, we want to ask about that because it can contribute to emotional disturbances.

05:46 We also want to think about the support.

05:49 So is there someone around that can be with the pregnant patient when they're having a bad day or a good day or going to childbirth classes or coming in for visits? Because support really does help in making you feel better during pregnancy.

06:04 It doesn't matter who it comes from, but having it is very important.

06:08 Now we also want to make sure that we're screening for intimate partner violence.

06:12 There is a great potential for increase in the rate of intimate partner violence during pregnancy, so if you have an experience with a pregnant client who's coming in who seems to be up and down with emotions, you also want to make sure you're asking the question, do they feel safe? What can we do in terms of treatment for this? We can think about a referral, so if it's someone that we have some concerns in terms of depression, then a referral to mental health services might be a good idea.

06:40 Doing some exercise.

06:42 Now we talked about exercise in a previous lecture in terms of antepartum care, so we understand the importance, but we want to make sure that the clients really hear that reminder often, that exercise and doing something everyday actually does help you feel better.

06:57 And encourage the client to get involved in some sort of community support.

07:01 Support doesn't have to come from someone living in your house.

07:04 It could be neighbor, it could be a group, it could be maybe a religious affiliation or just friends and that's a great option.