A pregnant patient reports persistent nausea and vomiting with weight loss. What condition should the nurse suspect?

Supine hypotensive syndromeoccurs in late pregnancy due to compression of the inferior vena cava, decreased venous return, and reduced cardiac outputwhen the woman lies flat on her back. Normally, venous return maintains stroke volume and cardiac output at 4.5–6.5 L/min in pregnancy, but vena caval obstruction can decrease cardiac output by up to 25–30%. Symptoms include dizziness, pallor, hypotension (systolic <100 mmHg), tachycardia, and nausea. The condition is relieved by positional changes that restore venous return.

Rationale for correct answers

3.Turning the client to a side-lying position, preferably left lateral, relieves pressure on the inferior vena cava and restores venous return, cardiac output, and blood pressure. This is the primary and most immediate management strategy.

Rationale for incorrect answers

1.Elevating the legs may slightly improve venous return but does not resolve vena cava compression if the woman remains supine. It is not the primary management.

2.Administering intravenous fluids does not address the mechanical obstruction caused by the gravid uterus. Fluids may support blood volume but cannot restore venous return while the vena cava is compressed.

4.Encouraging the client to lie flat on her back worsens the condition, as the gravid uterus continues to obstruct vena caval flow, further decreasing cardiac output and exacerbating hypotension.

Take home points

• Supine hypotensive syndrome is due to inferior vena cava compression by the gravid uterus.
• Primary management is left lateral positioning to relieve pressure and restore venous return.
• IV fluids and leg elevation are supportive but ineffective without position change.
• Differentiate from hypovolemic shock, where hypotension is due to blood loss, not vena caval compression.

Nausea and vomiting in early pregnancyare mainly due to elevated hCG, increased estrogen, and slowed gastrointestinal motility from progesterone. hCG peaks at 8–12 weeks (up to 100,000 mIU/mL, normal nonpregnant <5 mIU/mL), correlating with symptom severity. Estrogen contributes by delaying gastric emptying, while progesterone relaxes smooth muscle, reducing gastrointestinal peristalsis. Together, these changes cause queasiness, nausea, and occasional vomiting, known as morning sickness, which is physiological unless severe enough to cause dehydration or weight loss (hyperemesis gravidarum).

Rationale for correct answers

2.Elevated hCG, estrogen, and progesterone are the principal contributors to nausea and vomiting in the first trimester. Their hormonal effects explain the timing, severity, and natural improvement of symptoms after hCG levels plateau in the second trimester.

Rationale for incorrect answers

1.Decreased hCG does not cause nausea; rather, high circulating hCG correlates with symptom severity, especially in multiple gestation and molar pregnancy.

3.Gastrointestinal motility is not increased in pregnancy; progesterone actually decreases motility by relaxing smooth muscle, contributing to nausea, constipation, and bloating.

4.High maternal blood glucose is not a physiologic feature of early pregnancy and does not cause nausea. Gestational diabetes usually manifests later and presents differently (polyuria, polydipsia).

Take home points

• Nausea and vomiting in the first trimester are hormonally mediated by high hCG, estrogen, and progesterone.
• hCG peaks at 8–12 weeks, explaining timing of symptoms.
• Progesterone slows gastric emptying, adding to discomfort.
• Severe persistent vomiting suggests hyperemesis gravidarum, not normal morning sickness.