Stamp Wet Electronic

Subject:

created August 17^th 2022 by Dr. John Robertson, licensed under a GPL.
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MotherRisk PUQE24 Scoring System
In the last 24 hours how long have you felt nauseated or sick to your stomach?		Not at all (1)	1 hour or less (2)	2-3 hours (3)	4-6 hours (4)	More than 6 hours (5)
In the last 24 hours have you vomited or thrown up?		I did not throw up (1)	1 - 2 times (2)	3 - 4 times (3)	5 - 6 times (4)	More than 7 times (5)
In the last 24 hours how many times have you had wretching or dry heaves without bringing anything up?		No time (1)	1 - 2 times (2)	3 - 4 times (3)	5 - 6 times (4)	More than 7 times (5)
Date
	Mild =< 6 Moderate = 7 - 12 Severe = 13 - 15
How many hours have you slept out of 24 hours? Why?
On a scale of 0-10 how would you rate your well-being? (0 = worst possibe; 10 = the best you felt before pregnancy)
Can you tell me what causes you to feel that way?

Algorythm for treatment of Nausea and Vomiting in Pregnancy: if no improvement proceed to the next step
Discontinue oral prenatal vitamins and iron. Give folic acid 1 mg PO once daily
↓
Start doxylamine-pyridoxine long acting 10 mg-10 mg tab (DICLECTIN EQUIV). Typical starting dose: one tablet orally in the morning and afternoon, and two tablets orally before bed. Titrate dose up to 8 tablets a day and adjust schedule according to severity of symptoms. Note: DICLECTIN EQUIV is a delayed release tablet; administer regularly to improve efficacy
↓		↓
No Dehydration		Dehydration
• dimenhyDRINATE 50 mg orally or rectally 1 hour before DICLECTIN EQUIV doses OR 50 mg orally or rectally Q6H (may increase up to Q4H regularly) • famotidine 20 mg PO BID		• IV rehydration • multivitamin IV supplementation once daily • dimenhyDRINATE 50 mg IV Q6H (may increase up to Q4H regularly) • famotidine 20 mg IV Q12H
↓		↓
Add • metoclopramide 10 mg PO Q8H		Add • metoclopramide 10 mg IV Q8H
↓		↓
Add • ondansetron 8 mg PO Q12H PRN OR 4 mg PO Q8H PRN (stop metoclopramide if previously given)		Add • ondansetron 8 mg IV Q12H PRN OR 4 mg IV Q8H PRN (stop metoclopramide if previously given)
		↓
• Bowel Care   ○ If able to tolerate oral fluids give polyethylene glycol (PEG 3350)   ○ glycerin adult suppository • Consider DVT prophylaxis while in hospital • Inpatients: in preparation for discharge from hospital, gradually change each IV medication to oral dose and route		Add • methylprednisolone 15 to 20 mg IV Q8H PRN for up to 24h