ED nurse initiated Rx of the patient presenting with hyperemesis

see also:

• EM nursing
• nurse initiated ED treatment
• ED nurse initiated analgesia
• Western Health policies (intranet only):
  • Nurse initiated procedures
  • Nurse Initiated X-rays
  • Nurse Initiated Intravenous Opioid Analgesia Standing Orders

• patients with hypermesis in early pregnancy benefit from early iv fluid replacement and anti-emetics
• their length of stay in ED could be reduced and their symptoms partly relieved by nurse initiated ED Rx, although it is recognised that these presentations can be complex and warrant timely medical assessment to properly exclude important red flags.
• the presence of significant diarrhoea should suggest possible infectious gastroenteritis
• the following is a suggested framework for ED's who have nurses accredited to undertake ED nurse initiated treatment including the ordering of pathology tests.

• see also: basic nursing assessment common to all pathways

• see also: hyperemesis gravidarum

• fever
• third trimester pregnancy
• severe abdominal pain

• transfer patient to EOU after discussion with senior ED doctor
• iv access
• bloods for FBE, U&E. glucose, TSH
• urinalysis - MSU m/c/s if suggestive of UTI
• iv Nsaline over 1-2hrs and repeat as needed
• anti-emetics such as iv metoclopramide