ED nurse initiated Rx of the patient presenting with hyperemesis


  • 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.

specific history and examination

specific nurse initiated Rx for hyperemesis

red flags to escalate medical referral

  • fever
  • third trimester pregnancy
  • severe abdominal pain

initial Mx

  • 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
nursing/hyperemesis.txt · Last modified: 2012/07/23 14:55 (external edit)