A nurse is caring for a client post-seizure. Which of the following actions are the priority? Select all that apply

Hyperemesis gravidarum is a severe complication characterized by intractable vomiting leading to fluid-electrolyte imbalance, ketonuria, and weight loss exceeding 5% of pre-pregnancy mass. The pathophysiology involves high serum hCG levels and potential hyperthyroidism. Patients exhibit signs of intravascular dehydration and metabolic alkalosis.

A. Iron deficiency: While anemia is common in pregnancy, it typically presents with fatigue and pallor rather than acute, persistent emesis and significant weight loss. Iron supplements can actually exacerbate gastric irritation and nausea. It is not the primary cause of the severe hemodynamic instability described here.

B. Hyperemesis gravidarum: The combination of 6-pound weight loss, persistent inability to retain nutrients, and orthostatic dizziness indicates a pathological state beyond normal morning sickness. This condition requires aggressive intravenous rehydration and electrolyte replacement. Dark urine and dizziness are clinical hallmarks of severe volume depletion.

C. Gastroenteritis: An acute infection of the digestive tract usually presents with diarrhea, fever, and abdominal cramping alongside vomiting. While it causes temporary dehydration, the 10-week gestational timing and lack of lower gastrointestinal symptoms point toward a pregnancy-induced etiology. It is typically a self-limiting viral or bacterial event.

D. Normal morning sickness: Physiological nausea of pregnancy usually peaks in the morning and does not result in significant weight loss or clinical dehydration. Clients can typically maintain some oral intake and do not experience dizziness upon standing. It lacks the severe metabolic consequences seen in hyperemesis.

Nonpharmacological pain management focuses on modulating the gate-control mechanism of pain through sensory and cognitive distractions. These methods avoid the systemic side effects and neonatal depression associated with medications. They empower the patient to utilize coping strategies that promote physiological labor progress.

A. Aromatherapy: The use of essential oils like lavender can reduce maternal anxiety and promote a sense of well-being during labor. By calming the limbic system, it can decrease the perception of pain intensity. It is a valid complementary therapy in obstetric care.

B. IV opioids: Opioids are pharmacological agents that cross the placenta and can cause neonatal respiratory depression. While effective for pain, they do not fall under the category of nonpharmacological or "natural" interventions. They require medical prescriptions and close monitoring.

C. Position changes: Alternating between upright, side-lying, or squatting positions utilizes gravity to assist in fetal descent. This reduces pressure on the maternal sacrum and optimizes pelvic diameters. It is a fundamental non-invasive technique for managing labor discomfort.

D. Massage: Effleurage or deep tissue massage stimulates large-diameter nerve fibers to block nociceptive signals from the uterus. This physical touch provides comfort and promotes the release of endogenous endorphins. It is a highly effective manual therapy for laboring clients.

E. Water therapy: Immersion in warm water provides buoyancy and relaxation, which reduces the pressure on the pelvis and improves uterine perfusion. Hydrotherapy is known to decrease the need for epidural anesthesia and facilitates a more comfortable labor experience. It is a widely used non-drug intervention.