Development of graphic assessment tool to aid in care planning for hyperemesis gravidarum

E. Gretsinger, B. Middlemiss
West Lincoln Hospital, Grimsby, Ontario, Canada


To develop a tool that relates environmental, psychosocial, medical, or other events to the presence or absence of nausea and vomiting in hyperemesis gravidarum (HG) and to use the information gathered to modify treatment plans and behaviours to minimize the symptoms of HG.


A collaborative effort between nurses and physicians to create a graphic flow chart, the P-Graph (P = puke), to assess the level of well-being from "feeling well, no nausea or vomiting," to "severe vomiting" at regular intervals daily while admitted to hospital. As well as indicating a subjective and objective assessment of the level of nausea and vomiting on the graph, an attempt is made to relate the level of nausea and vomiting to the events that occur prior to, during, and after the assessment by reviewing a list of variables and indicating those that apply to the particular assessment (i.e., family visit, medication given, diet taken, etc.).


The graph demonstrates possible relationships at a glance. We have used the information to modify treatment regimes, indicate to the patient the activities/events that appear to trigger an episode and thereby attempt to initiate behaviour modifications that may reduce the severity/incidence of acute nausea and vomiting. The P-Graph has gone through modifications to increase the ease of use by care personnel and to increase inter-rater agreement. The P-Graph has been used on a small number of HG patients and requires further refinement and study to demonstrate its usefulness.

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