Enter Title

Medications

100

What medications need to be readily available to treat PIH patients?

Labetalol, Hydralazine and Magnesium Sulfate

200

What medication is used to treat magnesium toxicity?

Bonus: What is the correct dose?

Calcium gluconate 10 %

1 gram 910 ml) IV push over 3-7 minutes

300

What medication should be administered if patient is less than 34 weeks and in a hypertensive emergency in addition to hypertensive medications?

Betamethasone 12 mg IM

400

What is the first line Antihypertensive medication ?

Labetalol

500

List 5 possible side effects of magnesium sulfate

flushed face

generalized warmth

decreased BP

Decreased RR

tiredness

Decreased fetal movement

decreased FHR variability

Hypothermia

Depressed reflexes

Sweating

N/V/D

Burning at IV site

Depressed cardiac functions

Difficulty breathing

Assessment

100

How often does I&O need to be assessed?

every 4 hours

200

Once threshold BP is achieved following IV medication, how often should you reassess BP

every 10 minutes for 1 hour

every 15  minutes for 1 hour

every 30 minutes for 1 hour

then every 4 hours or per labor/provider

300

How often do vitals need to be obtained during Magnesium Sulfate loading dose and maintenance infusion?

every 10 minutes during loading dose and every 30 minutes X2,  hourly until stable, then every 4 hours or per provider 

400

What is included in the PIH assessment?

Headache

Visual disturbances

Epigastric pain

DTR's

Beats of clonus

500

What 5 assessments are included on the mag flowsheet?

Vitals

PIH assessment

Neuro

Respiratory

FHR/CTX in labor

Labs/Diagnostics

100

What is often found in urine with PIH patients?

Protein

200

What are considered severe range BP's ?

160s/110s

300

What labs result would you expect from a patient with HELLP Syndrome?

Hemolysis

Elevated Liver Enzymes

Low Platelets

400

What labs would you expect the provider to order?

CBC, CMP, PCRAT, Uric acid, Type and Screen

500

What is the diagnoses criteria for Pre-eclampsia?

Elevated BP and Proteinuria

• Blood pressure
  • Systolic blood pressure of 140 mm Hg or more or diastolic blood pressure of 90 mm Hg or more on two occasions at least 4 hours apart after 20 weeks gestation in a woman with previous normal blood pressure.
  • Systolic blood pressure of 160 mm Hg or diastolic blood pressure of 110 mm HG or more (severe hypertension can be confirmed within a short interval (minutes) to facilitate timely antihypertensive therapy).                                                                                                                                                                                                                                        AND
• Proteinuria
  • 300mg or more per 24-hour urine collection (or this amount extrapolated from a timed collection) or 
  • Protein/creatinine ratio of 0.3 or more or
  • Dipstick reading of 2+ (used only if other quantitative methods not available).  In the absence of proteinuria, new onset hypertension with new onset of any of the following:
  • Thrombocytopenia: platelet count less than 100x109/L
  • Renal insufficiency: serum creatinine concentrations greater than 1.1 mg/dl or doubling of the serum creatinine concentration in the absence of other renal disease.
  • Impaired liver function: elevated blood concentrations of liver transaminases to twice normal concentration
  • Pulmonary edema
  • New onset headache unresponsive to medication and not accounted for by alterative diagnoses or visual symptoms

Roles/Responsibilities

100

How long is IV labetalol pushed over?

2 minutes

200

How long after a second severe range BP is obtained, do you have to initiate treatment?

1 hour

300

To be diagnosed with Pre-eclampsia, a patient must be at least ____ weeks pregnant or __ weeks postpartum? 

20 weeks

6 weeks

400

How often should you monitor FHR with a pre-eclamptic patient?

Continuously 

500

RN needs to obtain what 3 baseline measurements before starting magnesium sulfate?

Vitals, weight and DTR's

Miscellaneous

100

Where are hypertensive disorder resources available?

Policy Stat

or HTN Binder

200

What precautions do hypertensive patients need to have in place?

seizure 

300

Can Magnesium and Pitocin infuse together?

Yes

400

When treating HTN with Labetalol, you should be cautious with patient who have a history of what medical condition?

Asthma 

Should be avoided with active Asthma

Active Asthma: symptoms at least once a week 

Use of inhalers, corticosteroid for tx during pregnancy and

 Any hx of intubation or hospitalization for asthma

500

What are 4 risk factors for hypertensive disorders in pregnancy?

nullipartity, multifetal gestation, obesity, diabetes mellitus, lupus, antiphospholipid, P antibodies, and age greater than 35

• All high risk patients are reviewed at shift huddles