A 21-year-old female complains of severe nausea and vomiting. She tells you she is six weeks pregnant, and she has been vomiting four times a day. Her conjunctivae are pale and dry. Her vital signs are P 110, R 18, BP 104/86, and SpO2 is 93% on room air. Her blood glucose level is 72 mg/dL. You should administer oxygen and:

• A. Position her to relieve pressure on her inferior vena cava.
• B. Treat for shock.
• C. Give her small sips of water.
• D. Oral glucose.

Answer: (B)

The key idea is recognizing dehydration with potential hypovolemia in early pregnancy and prioritizing shock management to protect both mother and fetus. The patient shows signs of significant fluid loss from vomiting: dry mucous membranes (pale conjunctivae) and a rapid pulse, with a blood pressure that is not severely low but could decline if fluid losses continue. SpO2 of 93% on room air suggests the body would benefit from improved oxygen delivery. In this situation, providing oxygen helps maximize the amount of oxygen reaching tissues while you evaluate and begin circulation support. Treating for shock means more than just giving oxygen; it involves rapid assessment, establishing IV access, and initiating appropriate fluid resuscitation to restore intravascular volume and perfusion, then transporting promptly.

Positioning to relieve pressure on the inferior vena cava is not a priority here because significant vena cava compression from the uterus occurs later in pregnancy; at six weeks the uterus is not large enough to cause this effect. Giving small sips of water won’t correct the dehydration effectively in the face of ongoing vomiting and potential progression to shock. Oral glucose isn’t indicated since her blood glucose is 72 mg/dL and not hypoglycemic. Prioritizing shock management with oxygen supports both maternal stability and fetal well-being.