Knowledge
What BP is considered severe range, or hypertensive crisis, in a pregnant or postpartum person?
SBP ≥ 160
OR
DBP ≥ 110
Your patient's initial blood pressure is 170/90. When should you re-take it?
Within 15 minutes
What are the re-assessment timeframes for each of the following anti-hypertensive medication:
1. Labetalol
2. Hydralazine
3. Procardia
1. labetalol- 10 minutes
2. hydralazine- 20 minutes
3. procardia
What is the systolic blood pressure threshold for a hypertensive crisis?
greater than or equal to 160mmHg
Name either the typical loading dose or maintenance dose of magnesium sulfate.
Loading dose: 4 or 6 grams over 20 minutes is typical
Maintenance: 2 grams (can be 1 gram) per hour
How many weeks after birth do we worry about preeclampsia?
Up to 12 weeks post birth. We screen for many different pregnancy related disorders up to one year, but preeclampsia is 12 weeks.
Name the C.U.S words we use to escalate a concern we have about a patient.
Concerned, Uncomfortable, Saftey
"I am uncomfortable NOT treating Ms. Susie's BP due to her post partum status, and severe-range blood pressure leaving her at risk for a stroke or an eclamptic seizure".
What is a great option for anti-hypertensive treatment when you need to treat the patient in a timely manner, but haven't yet establised their IV access.
Procardia PO 5-10MG
or you can give Hydralazine IM, though it's not preferred over Procardia.
What is the diastolic BP threshold for HTN crisis?
greater than or equal to 110mmHg
Magnesium Sulfate should be:
a.) Piggy Back
b.) on a separate pump
B.) on a separate pump
Magnesium should not be administered piggy back
How soon after identification of hypertensive crisis (2 confirmed blood pressures) do we want the patient to have anti-hypertensive medications?
You are in triage. Your patient's blood pressure is 172/86 and shes complaining of a headache. You ask her if she has been pregnant in the last year, and she tells you she had a baby three weeks ago. What would your ESI be?
ESI 2
Your patient has an eclamptic seizure. What are 2 medications you can give for this?
Preferred: IV bolus of 4-6 grams of magnesium sulfate
If no IV access: 4mg Lorazepam (Ativan) IM once
What are the diagnostic criteria for preeclampsia?
Blood pressure of >140/90, plus:
Proteinuria
OR
Blood pressure of > 140/90, plus:
Visual Symptoms (headaches, visual disturbances), or
Thrombocytopenia, or
Pulmonary Edema, or
Abnormal laboratory tests (liver function or renal insufficiency)
Why do we give Magnesium to preeclamptic patients?
To prevent ecclamptic seizures. This does not take the place of anti-hypertensive medications. She will need both.
What are the 2 risks of inadequate treatment of hypertension in a pregnant or postpartum woman?
1. Eclampisa/Seizures
2. Stroke
What is the protocol for assessing the patient's blood pressure while she is receiving magnesium sulfate (bolus through maintenance)?
Every 15 minutes for the first hour, then every 30 minutes for the second hour, then hourly
Name the 3 medications that are utilized for pregnant or postpartum women experiencing a hypertensive crisis?
1. Labetalol
2. Hydralazine
3. Nifedepine
Name 1 morbidity risk for a patient who suffers an eclamptic seizure.
Cerebral hemorrhage
Aspiration
Death
How long must the nurse remain at the bedside of a patient being started on magnesium sulfate?
The nurse must remain at the bedside for the first HOUR of administration.
What percentage of women will suffer an eclamptic seizure at > 48 hours postpartum?
25%
Name TWO signs/symptoms of magnesium sulfate toxicity.
Decreased DTR, Decreased respiratory rate, O2 Sat <95%, unresponsiveness.
What is the name of the orderset that we use to treat hypertensive pregnant/postpartum patients?
OB Hypertensive crisis in pregnancy through 12 weeks postpartum
What are the "severe features" we would evaluate a pregnant or postpartum patient for?
Headaches, Blurry Vision/Visual disturbance, Epigastric pain, sudden swelling in hands/feet/face, numbness/tingling
What is the reversal agent (antidote) for Magnesium Sulfate Toxicity?
Calcium Gluconate 1gram IV push over 3-4 minutes
You can use Calcium Chloride if Calcium Gluconate is unavailable.