N136-137 OB - Module 6 - Hypertensive & Hemorrhagic
Disorders Questions With Complete Solutions
Therapeutic MgSO4 level
4-7 mEq/L
If above 7, we might ↓ mag maintenance to 1g/hour
Continue infusion for 24 h after birth (some pts will develop
first symptoms pp)
Expected S/S of MgSO4 infusion
warmth/flushing
diaphoresis
fatigue
burning at IV site
S/S of MgSO4 toxicity
absent DTRs
↓ RR
↓ LOC
pt should be peeing if renal impairment, risk of mag tox ↑
hourly assessments performed
Mag Sulfate Nursing Care
Maintain bedrest with side rails up, dark and quiet environment
,FLUID RESTRICTION: Total IV and oral fluids should not
exceed 125 mL/hr to reduce risk of pulmonary edema (strict
I&O - may need cath)
Mag Sulfate Reversal Agent
Calcium gluconate
High risk Rx...can usually be 2-RN sign off; can kill pt - can
cause cardiac arrest
Mag Sulfate during pregnancy and pp: Fetal-Infant Impact
Doesn't go thru breast milk
Can cause ↓ RR in baby in utero (pre-birth), can be floppy and
have ↓ tone too
CHRONIC Hypertensive Disorders
Chronic Hypertension
Chronic Hypertension w/ Superimposed Preeclampsia
Chronic HTN
htn present before pregnancy or htn that persists after the
postpartum period.
Woman with chronic htn may develop superimposed
preeclampsia and should be treated accordingly
↑ risk for adverse maternal and fetal outcomes:
Stroke
, kidney injury
heart failure
placental abruption
IUGR
preterm birth
death
African American women have the highest rates of chronic
HTN in pregnancy
Avoid use of ACEs in pregnancy b/c they can be
teratogenic
instead, Labetalol usually given – should be managed by
neonatologist
Maybe nifedpine
Follow-up care for HTN Disorders during Pregnancy
Contact health care provider or return to hospital if HA, visual
changes, epigastric pain occur after discharge
BP monitoring for 48-72 h PP and BP check within 7-10 days
after discharge or earlier if symptoms develop
Women with BP > 150/100 (on 2 occasions 4 h apart) should
take an antihypertensive postpartum
Typically labetalol (low levels in breastmilk, no impact on
supply)
Disorders Questions With Complete Solutions
Therapeutic MgSO4 level
4-7 mEq/L
If above 7, we might ↓ mag maintenance to 1g/hour
Continue infusion for 24 h after birth (some pts will develop
first symptoms pp)
Expected S/S of MgSO4 infusion
warmth/flushing
diaphoresis
fatigue
burning at IV site
S/S of MgSO4 toxicity
absent DTRs
↓ RR
↓ LOC
pt should be peeing if renal impairment, risk of mag tox ↑
hourly assessments performed
Mag Sulfate Nursing Care
Maintain bedrest with side rails up, dark and quiet environment
,FLUID RESTRICTION: Total IV and oral fluids should not
exceed 125 mL/hr to reduce risk of pulmonary edema (strict
I&O - may need cath)
Mag Sulfate Reversal Agent
Calcium gluconate
High risk Rx...can usually be 2-RN sign off; can kill pt - can
cause cardiac arrest
Mag Sulfate during pregnancy and pp: Fetal-Infant Impact
Doesn't go thru breast milk
Can cause ↓ RR in baby in utero (pre-birth), can be floppy and
have ↓ tone too
CHRONIC Hypertensive Disorders
Chronic Hypertension
Chronic Hypertension w/ Superimposed Preeclampsia
Chronic HTN
htn present before pregnancy or htn that persists after the
postpartum period.
Woman with chronic htn may develop superimposed
preeclampsia and should be treated accordingly
↑ risk for adverse maternal and fetal outcomes:
Stroke
, kidney injury
heart failure
placental abruption
IUGR
preterm birth
death
African American women have the highest rates of chronic
HTN in pregnancy
Avoid use of ACEs in pregnancy b/c they can be
teratogenic
instead, Labetalol usually given – should be managed by
neonatologist
Maybe nifedpine
Follow-up care for HTN Disorders during Pregnancy
Contact health care provider or return to hospital if HA, visual
changes, epigastric pain occur after discharge
BP monitoring for 48-72 h PP and BP check within 7-10 days
after discharge or earlier if symptoms develop
Women with BP > 150/100 (on 2 occasions 4 h apart) should
take an antihypertensive postpartum
Typically labetalol (low levels in breastmilk, no impact on
supply)
