Hypertensive Disorders of Pregnancy & Management

Antihypertensive Medicaiton

100

Severe range blood pressure range

> 160/110

200

Timeframe to recheck BP after severe range BP

15 minutes

300

First line medication cascade for severe hypertension

labetalol cascade

400

Maternal HR is 55. Medication that should NOT be given to treat severe hypertension.

Labetalol. Do not give if HR <65

500

Frequency to cycle BP after treatment, once normal BP has been achieved

q10min x1 hr
q15min x 1 hr
q30min x 1hr
q1hr x 4hrs

Magnesium

100

Magnesium sulfate antidote

calcium gluconate

200

Magnesium loading dose & timeframe 

4gm loading dose over 30 minutes

300

Magnesium sulfate concentration

13gm/130mL NS = 10% solution. 

400

Therapeutic magnesium level

5-9mg/dL
notify is over 8, stop if over 9

500

What is wrong with this statement: An ED RN is initiating a magnesium sulfate on a PP readmitted patient- 4gm loading dose over 30 minutes then a maintenance dose of 2gms/hr.

Only obstetric RNs should be initiating magnesium sulfate, not ED RNs

Magnesium Assessment

100

VS frequency for magnesium bolus 

1x prior to bolus

q15min x2 during bolus

200

VS/assessment during maintenance infusion

q2hrs

300

I&O during magnesium infusion

Hourly

400

VS/assessment frequency once mag has been discontinued for 24 hrs

q4hrs then routine

500

5 Magnesium toxicity s/sxs

changes in level of consciousness, visual changes, decreased or absent deep tendon reflexes, RR<12, ox <95%, SOB, changes in breathing suggestive of pulmonary edema, heart palpitations, new onset or severe edema, low urine output <30mL/hr.

Hypertensive Disorders of Pregnancy

100

Definition of HELLP syndrome

Hemolysis
Elevated Liver enzymes
Low Platelets

200

Diagnostic criteria for Preeclampsia

Elevated BP > 140-90 on two occasions, at least 4 hrs apart after 20 weeks with proteinuria (P/C ratio of >0.3)

300

Diagnostic criteria for eclampsia 

New onset tonic-clonic, focal, or multifocal seizures in the absence of other causative conditions 

400

Definition of chronic hypertension with superimposed preeclampsia

Hypertension diagnosed present before pregnancy or diagnosed before 20-weeks with criteria of preeclampsia

500

Diagnostic criteria for Preeclampsia with severe features

- BP > 160/110
- symptoms: pulm edema, impaired liver fx, RUQ pain, renal abnormalities, thrombocytopenia, CNS dysfunction (think HA)

PP HTN Protocol

100

Criteria to initiate antihypertensive medication 

2 or more SBP >140 or DBP > 90
or
Any SBP >150 or DBP > 100

200

1st line antihypertensive medication

nifedipine 30mg BID (max 60mg BID)

300

Length patients should remain inpatient after initiation/titration of antihypertensive medication

12 hours

400

Discharge criteria when pt is started on hypertensives with PP HTN Protocol

75% of BP <140/90 in last 24 hrs
no BP > 150/100 in last 12 hrs

500

3 location where patient can get home bp machine

Discharge pharmacy

CVS/Amazon

Case management