KNOWLEDGE
Why is magnesium given to preeclamptic patients?
To reduce the risk of seizure activity. This does not take the place of anti-hypertensive medications. She will need both.
After administering IV labetalol for a Hypertensive crisis, when does the blood pressure need to be re-taken?
10 minutes
20 minutes after administering IV hydralazine & PO nifedipine
30 minutes after administering IM hydralazine
Name either the typical loading dose or maintenance dose of magnesium sulfate.
Loading dose: 4-6 grams over 20 minutes
Maintenance dose: 2-3 grams per hour
What is the systolic blood pressure threshold for hypertensive crisis?
160mmHg systolic
How many weeks postpartum do you need to worry about preeclampsia?
Up to 12 weeks postpartum
Name the C.U.S. words to use for escalation of concerns?
Concerned, "I'm concerned about xyz"
Uncomfortable, "I'm uncomfortable not treating her blood pressure of 170/100"
Safety, "It is a safety issue to not treat this hypertensive crisis"
Your patient is a difficult IV stick, has no IV access, and requires medications for a hypertensive crisis. What are your options?
Call the provider & request orders for either PO nifedipine or IM hydralazine.
What is the diastolic blood pressure threshold for hypertensive crisis?
110mmHg diastolic
Magnesium sulfate should be:
A.)piggy-backed
B.) On a separate pump
from the mainline?
B.) Separate pump
Your pregnant or postpartum patient's initial blood pressure is 168/86. When should you retake it?
Within 15 minutes
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 of 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)
What are the 2 risks of inadequate treatment of hypertension in a pregnant or postpartum woman?
2. Seizure
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
Your patient's blood pressure is 172/86. You retake the blood pressure in 15 minutes and it is now 168/90. You call the provider, give an excellent SBAR report, and recommend treatment using the Hypertensive Crisis order set. The provider says to "just watch it". What should you do next?
Utilize your C.U.S. words. If that does not work, activate your chain of command.
Your patient's vital signs are as follows:
T98.8, P 112, R 20, BP 182/100
Why is it important to communicate the heart rate along with the blood pressure during your SBAR to the physician?
The anti-hypertensive medications can affect maternal pulse rate.
The drug of choice for tachycardia is labetalol as it is a beta blocker and will lower the pulse rate. Hydralazine will increase the pulse rate.
How long must the nurse remain at the bedside of a patient being started on magnesium sulfate?
What percentage of women will suffer an eclamptic seizure at > 48 hours postpartum?
25%