Preterm Labor
Hypertensive Disorder
Side Effects
Labs
Nursing
100
It is okay to administer Magnesium Sulfate to preterm labor patients with vaginal bleeding?
False/No -Magnesium Sulfate is contraindicated with unstable maternal vaginal bleeding and delivery should be expedited. Magnesium Sulfate is a muscle relaxer. If placental abruption is suspected, it should not be administered.
100
What is the main drug used at WMMC on patients exhibiting complications with hypertensive disorders?
Magnesium Sulfate
100
What is the most common side effect patients experience while receiving Magnesium Sulfate therapy?
Warm/Flushed -Magnesium acts peripherally to produce vasodilation. With low doses only flushing and sweating occur, but larger doses cause lowering of blood pressure. The diameter of the blood vessels increase, causing them to be closer to the surface of the skin.
100
How many hours after the Magnesium Sulfate loading does is infused should the first Magnesium Level be drawn?
4 hours after the loading dose is complete
100
How often are the following assessed & documented during Magnesium Sulfate therapy? 1. Intake and output 2. DTR 3. Vital Signs-to include pulse ox 4. Lung sounds, respiratory rate and effort
1. I/O-Hourly 2. DTR-Hourly 3. VS-Q15min during loading dose and an increase in the maintenance infusion. Once stable, then hourly. 4. Lungs/Resp-Hourly --DTR assessment is essential for assessing for Magnesium Toxicity! A loss in DTRs will be your first sign of toxicity.
200
What is the recommended Magnesium Sulfate loading does for Preterm Labor?
6 grams infused over 30 minutes
200
What is the recommended Magnesium Sulfate loading dose for pre-eclampsia?
4gm loading dose infused over 30 minutes
200
Because of some of the side effects of Magnesium Sulfate, what items are important to have in the patient's room to aid in patient comfort?
Fan Cool Wash Cloth Emesis bag
200
What is a therapeutic Magnesium Level range?
4.8-8.4 -CNS depression/muscle relaxation occurs at therapeutic levels. -Protocol says to call with anything less than 4 or greater than 9
200
When should Calcium Gluconate be administered and how do you get it in an emergency situation?
Administer when Magnesium Toxicity occurs and you have a doctors verbal order to give it. Obtain Calcium Gluconate from the L&D Pyxis as an override! Recommended dose of Calcium Gluconate is 1 gram intravenously over 5 to 10 minutes.
300
What is the recommended Magnesium Sulfate maintenance dose for Preterm Labor?
2gm per hour= IV pump rate of 50ml/hr
300
What is the recommended Magnesium Sulfate maintenance dose for pre-elcampsia?
2gm per hour=IV pump rate of 50ml/hr
300
How does Magnesium Sulfate work?
Magnesium works by lowering the calcium levels in muscle cells. Calcium is necessary for muscle cells to contract. It depresses CNS, blocks peripheral neuromuscular transmission, & produces anticonvulsant effects.
300
The first Magnesium Level drawn after the loading was completed and resulted at 7.9. What should you do?
Notify the provider on call as this is an abnormally high initial Magnesium Level.
300
When administering a 6gm loading does of Magnesium Sulfate... 1. How many 4gm/100ml Mag Sulfate bags are required? 2. How many total ml will you infuse? 3. What do you set the IV pump settings at to administer 6gm over 30 minutes?
1. Obtain 2-4gm/100ml bags from Pyxis 2. Administer 1.5 bags-dispose of the remaining 50mls from the second bag 3. First bag- rate of 300ml/hr, volume of 95ml Second bag- rate of 300ml/hr, volume of 55 ml Total of 150ml at a rate of 300ml/hr=30 min infusion time
400
After how many weeks gestation is Magnesium Sulfate contraindicated for Preterm Labor?
34 weeks gestation -After 34 weeks gestation, magnesium sulfate should not be used for tocolysis.
400
Does a patient have to have proteinuria to qualify for Magnesium Sulfate therapy?
NO! ACOG: Hypertensive Emergency defined as:  BP > 160 systolic or 110 diastolic  Seizures  Cardiac Compromise  Abnormal maternal rhythm  Change in Patient Status  Respiratory Arrest  Unresponsive Patient  Staff concerned or worried
400
A significant change in maternal reflexes and LOC is a common side effect?
False/NO -This is a sign of Mag Toxicity! Neuromuscular toxicity is the most consistently observed complication of hypermagnesemia. A loss in deep tendon reflexes is usually first noted when the plasma magnesium concentration reaches 4 to 6 meq/L More severe hypermagnesemia can result in somnolence, loss of deep tendon reflexes, and muscle paralysis, potentially leading to flaccid quadriplegia and, since smooth muscle function is also impaired, decreased respiration and eventual apnea
400
How often are Magnesium Levels drawn while the patient is on a maintenance dose?
Every 6 hours. Nursing is required to enter these Mag Levels!
400
What are some patient signs of Magnesium Sulfate Toxicity?
Absent DTR Vomitting Decrease in urine output Significant drop in pulse and blood pressure Shortness of breath, decrease in pulse ox, slow respirations Chest pain Decrease LOC Weakness
500
What are the 2 main benefits of Magnesium Sulfate therapy for patients with Preterm Labor?
1. Allows for time to administer Betamethasone=up to 34 weeks gestation. 2. Fetal neuro protection= 24-32 weeks gestation. Candidates: a. Advanced dilation (4-8cm) b. PPROM c. Cervical insufficiency with delivery within 12 hours d. Indicated preterm delivery (IUGR) e. Absence of myasthenia gravis & renal failure
500
What is the main purpose of Magnesium Sulfate therapy in patients with hypertensive emergencies?
Prevent seizures.
500
A common side effect of Magnesium Sulfate therapy is a decrease in urine output?
False/No -Magnesium is only excreted from the kidneys. It is important to monitor urine output to assess kidney function. If the kidneys are not excreting the Magnesium, toxicity will occur.
500
What other lab levels should be considered prior to Magnesium Sulfate administration in patients with hx of or current diagnosis of renal complications?
CMP -BUN -Creatinine Why? -Magnesium Sulfate is solely excreted by the kidneys. BUN & Creatinine are renal function tests. Renal insufficiency is defined as a serum creatinine greater than 1.0 mg/dL.
500
What are some ways to avoid Magnesium Sulfate Toxicity and errors.
1. Follow policies/protocols/orders. 2. Double check everything-2 nurses witness administration 3. Continuous nurse monitoring/assessments 4. Continuous nursing education 5. Being prepared for emergenies 6. Correct labeling of IV line tubes from IV bag to patient
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