ATI Active Learning Template (Medication) - Magnesium Sulfate (MgSO4)

ATI Active Learning Template (Medication) - Magnesium Sulfate (MgSO4) Category/Classification: ● Therapeutic: mineral and electrolyte replacements/supplements ● Pharmacologic: minerals/electrolytes Review Module: Chapter 30 - Mineral/Electrolytes & Their Replacement/Supplement Expected Pharmacological Action: Action: Essential for the activity of many enzymes. Plays an important role in neurotransmission and muscular excitability. Therapeutic Effects: Replacement in deficiency states. Resolution of eclampsia. Therapeutic Use: ● Treatment/prevention of hypomagnesemia. ● Treatment of hypertension. ● Prevention of seizures associated with severe eclampsia, pre-eclampsia, or acute nephritis. Unlabeled Use: ● Preterm labor. ● Treatment of torsade de pointes. ● Adjunctive treatment for bronchodilation in moderate to severe acute asthma. Complications: ● CNS: drowsiness. ● Resp: ↓ respiratory rate. ● CV: arrhythmias, bradycardia, hypotension. ● GI: diarrhea. ● MS: muscle weakness. ● Derm: flushing, sweating. ● Metab: hypothermia. Medication Administration: Eclampsia/Pre-Eclampsia IV, IM (Adults): 4– 5 g by IV infusion, concurrently with up to 5 g IM in each buttock; then 4– 5 g IM q 4 hrs or 4 g by IV infusion followed by 1– 2 g/hr continuous infusion (not to exceed 40 g/day or 20 g/48 hr in the presence of severe renal insufficiency).Contraindications/Precautions: Contraindicated in: Hypermagnesemia; Hypocalcemia; Anuria; Heart block; ● OB: Avoid using for more than 5– 7 days for preterm labor (may ↑ risk of hypocalcemia and bone changes in newborn); avoid continuous use during active labor or within 2 hrs of delivery due to potential for magnesium toxicity in newborn. Use Cautiously in: Any degree of renal insufficiency; ● Geri: May require ↓ dosage due to age-related ↓ in renal function. Nursing Interventions: Assessment: ● Hypomagnesemia/Anticonvulsant: Monitor pulse, BP, respirations, and ECG frequently throughout administration of parenteral magnesium sulfate. Respirations should be at least 16/min before each dose. ● Monitor neurologic status before and throughout therapy. Institute seizure precautions. Patellar reflex (knee jerk) should be tested before each parenteral dose of magnesium sulfate. If response is absent, no additional doses should be administered until positive response is obtained. ● Monitor newborn for hypotension, hyporeflexia, and respiratory depression if mother has received magnesium sulfate. ● Monitor intake and output ratios. Urine output should be maintained at a level of at least 100 mL/4 hr. ● Lab Test Considerations: Monitor serum magnesium levels and renal function periodically throughout administration of parenteral magnesium sulfate. Implementation: ● High Alert: Accidental overdose of IV magnesium has resulted in serious patient harm and death. Have second practitioner independently double check original order, dose calculations, and infusion pump settings. Do not confuse milligram (mg), gram (g), or milliequivalent (mEq) dosages. ● IM: Administer deep IM into gluteal sites. Administer subsequent injections in alternate sides. Dilute to a concentration of 200 mg/mL prior to injection. IV Administration: ● Direct IV: Diluent: 50% solution must be diluted in 0.9% NaCl or D5W to a concentration of 20% prior to administration. Concentration: 20%. Rate: Administer at a rate not to exceed 150 mg/min. ● Continuous Infusion:● Diluent: Dilute in D5W, 0.9% NaCl, or LR. ● Concentration: 0.5 mEq/mL (60 mg/mL) (may use maximum concentration of 1.6 mEq/ mL (200 mg/mL) in fluid-restricted patients). ● Rate: Infuse over 2-4 hr. Do not exceed a rate of 1 mEq/kg/hr (125 mg/kg/hr). When rapid infusions are needed (severe asthma or torsade de pointes) may infuse over 10– 20 min. Interactions: Drug-Drug: May potentiate calcium channel blockers and neuromuscular blocking agents. Client Education: ● Explain purpose of medication to patient and family. Evaluation of Medication Effectiveness: ● Normal serum magnesium concentrations. ● Control of seizures associated with toxemias of pregnancy