Ovarian Hyperstimulation (OHSS): Care of the Patient with

Procedure Page 1 of 3L&D/OB-GYN - Unit Practice ManualJohn Dempsey Hospital – Department of NursingThe University of Connecticut Health CenterPROTOCOL FOR: Ovarian Hyperstimulation Syndrome (OHS): Care of the Patient withSUPPORTIVEDATA: 1. Ovarian hyperstimulation is a condition that can occur when ovulationinduction agents are used to:a. Correct ovulatory dysfunctionb. Achieve simultaneous development of multiple ovarian follicles.2. This protocol addresses the care needs of the patient requiringhospitalization for ovarian hyperstimulation.3. OHS is classified as mild, moderate or severe depending on presentingsigns and symptoms.a. Mild:1) Ovaries 5-8cm.2) Fluid Retention.3) No significant Clinical symptoms.4) < 5lb. weight gain.b. Moderate:c. Severe:1) Ovaries 8-12cm.2) Abdominal distention.3) Nausea, vomiting, diarrhea.4) Abdominal pain.5) 5lb. weight gain.1) Ovaries > 12cm.2) Ascites and/or hydrothorax.3) Hypovolemia, hematocrit > 50%.4) Hypotension.5) Dyspnea.6) Abnormal electrolytes.7) Abdominal pain.8) 10-20 lb. weight gain.DESIRED PATIENTOUTCOMES:1. Patient will verbalize basic understanding of physiologic course ofOHS and the plan of care used to reduce associated symptoms.2. Patient’s pain will be controlled/ reduced to a level acceptable tothe patient.3. Patient will be adequately hydrated.

Procedure Page 2 of 3L&D/OB-GYN - Unit Practice ManualJohn Dempsey Hospital – Department of NursingThe University of Connecticut Health CenterPROTOCOL FOR: Ovarian Hyperstimulation Syndrome (OHS): Care of the Patient withCLINICALASSESSMENT ANDCARE: 1. Assess vital signs at least every 4 hours and prn with orthostaticblood pressure and pulses.2. Assess patient for pain and intervene appropriately following theassessment and care delineated in the above associated standardprotocol for Pain: Care of the Adult Patient with Pain.3. Assess patient for dyspnea - respiratory rate, character, SOB,auscultation of lungs at least every 4 hours and prn.4. Assess appetite, nausea/vomiting.5. Assess for dehydration – strict intake and output, skin integrity,daily weight.6. Assess abdominal distention and measure abdominal girth daily.7. Assess emotional status, level of anxiety.8. Assess level of discomfort.9. Obtain laboratory blood work as ordered.10. Dietary consultation as ordered – high protein, small frequentmeals, restriction of oral/IV fluid intake as ordered.11. IV fluids as ordered.12. Apply PAS device - administer Heparin for DVT/PE prophylaxis asordered.13. Administer analgesia as ordered.14. Administer antiemetics as ordered.15. Provide comfort measures.16. Assist OOB as needed.17. Assist MD with paracentesis as indicated.18. Encourage verbalization of feelings.PATIENTTEACHING: 1. Instruct patient regarding symptoms to report follow-up medical careand self-care objectives as outlined in teaching plan.REPORTABLECONDITIONS: 1. Notify physician if any of the following occur:a. Difficulty breathing.b. Ineffective pain management.c. Patient disoriented or dizzy.d. Menstrual symptoms – cramping, vaginal bleeding.e. Nausea, vomiting, diarrhea.

Procedure Page 3 of 3L&D/OB-GYN - Unit Practice ManualJohn Dempsey Hospital – Department of NursingThe University of Connecticut Health CenterPROTOCOL FOR: Ovarian Hyperstimulation Syndrome (OHS): Care of the Patient withDOCUMENTATION: Document assessment findings and interventions on the unit flowsheets,and Medication Administration Checking (MAK).APPROVAL: Nursing Standards CommitteeEFFECTIVE DATE: 9/96REVISION DATES: 9/97, 8/03, 1/09, 8/12, 12/12