PLACE LABEL HERE
MAGNESIUM SULFATE ORDERS
FOR PREECLAMPSIA
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
Allergies: _________________________________________________________________________________________
1.
Diagnosis & Status: Admit as Inpatient for Preeclampsia to:  L&D  HRPU  __________________________
2.
In addition to these orders, follow:
  Labor Admission Orders (form # 9044)
 Cesarean Section Pre-op Orders (form # 15791)
 Postpartum Readmission Orders (form # 19523)
 Cervical Ripening Orders (form # 9045)
ASSESSMENTS:
3. Obtain baseline maternal/fetal assessments prior to initiation of therapy. This includes maternal vital signs, breath
sounds, deep tendon reflexes (DTRs), oxygen saturation, level of consciousness, fetal heart rate (FHR), and uterine
activity.
4. Maternal/fetal assessments per protocol (policy # 7007-10), or more often if clinical condition warrants:
Antepartum
Intrapartum
Postpartum
Blood pressure &
Every 5 minutes during
Every 5 minutes during
Every 5 minutes during loading
heart rate
loading dose,
loading dose,
dose,
then every 15 minutes for then every 15 minutes for the then every 15 minutes for the
the first hour,
first hour,
first hour,
then every 30 minutes for then every 30 minutes
then every 30 minutes for the
the second hour,
second hour,
then hourly.
then hourly.
Respiratory rate
Every 15 minutes for the
Every 15 minutes for the first
Every 15 minutes for the first
first hour,
hour,
hour,
then every 30 minutes for then every 30 minutes for the then every 30 minutes for the
the second hour,
second hour,
second hour,
then hourly.
then hourly.
then hourly.
FHR & uterine activity Continuously
Continuously
N/A
Document with each set
Document per high-risk
of maternal vital signs.
status guidelines
DTRs
Every hour
Every hour
Every hour
Intake & output
Every hour
Every hour
Every hour
Level of
Every hour
Every hour
Every hour
consciousness
Breath sounds
Every 2 hours
Every 2 hours
Every 2 hours
SaO2 (pulse oximetry) Every hour
Every 30 minutes
Every hour
IV site assessment
Every 2 hours
Every 2 hours
Every 2 hours
Fundus/lochia
N/A
N/A
Every 4 hours after recovery
5. Notify physician immediately if patient has:
 Significant changes in BP from baseline values or failure to respond to antihypertensive medications
 Double (or blurring) of vision
 Tachycardia or bradycardia
 Respiratory rate below 14 or above 24
 Oxygen saturation below 95%
 Adventitious lung sounds
 Changes in level of consciousness or neurological status
 Absence of DTRs
 Urine output less than 30 ml/hr for 2 consecutive hrs (or less than 120 ml in 4 hours if no Foley)
 Category III FHR patterns (anticipate minimal variability and loss of accelerations)
Order writer’s initials _________
Copy to pharmacy
*3-20*
2
FORM 3-20 REV. 11/2015
Page 1 of
PLACE LABEL HERE
MAGNESIUM SULFATE ORDERS
FOR PREECLAMPSIA

Vaginal bleeding
Order writer’s initials _________
Copy to pharmacy
*3-20*
2
FORM 3-20 REV. 11/2015
Page 2 of
PLACE LABEL HERE
MAGNESIUM SULFATE ORDERS
FOR PREECLAMPSIA
6.
7.
8.
9.
The following orders will be implemented. Orders with a “” are choices and are NOT ordered unless checked.
Initial all handwritten order modifications and the bottom of each page when indicated (multipage).
If respirations < 12, discontinue magnesium sulfate, notify Physician, and give supplemental O2 to keep O2 sat > 95%.
Foley catheter to bedside bag OR  do not insert Foley; may use bedpan
Activity: Strict bedrest OR  Bedside commode (for BM) with assistance  Bedrest with bathroom privileges with
assistance
Hygiene: Bed bath OR  Shower with assistance
IVF/SCHEDULED MEDICATIONS:
10. LR as primary fluids. Maintain total IV intake at 125 ml/hr, or  _____________________________________
11. Loading dose:
 Magnesium Sulfate 4 gm IV loading dose over 20 min x 1 dose
 Magnesium Sulfate 6 gm IV loading dose over 20 min x 1 dose
12. Maintenance infusion after loading dose: Magnesium Sulfate 0.04 gm/ml (concentration) at _______gms/hr IV
PRN MEDICATIONS:
13. Respiratory Arrest: Calcium gluconate 10%, 1 gm (10 ml) IV push over 3-5 min prn and assess VS q 5 min until
respiratory rate is ≥ 12, SaO2 is >95%; then q 15 min x one hr, then resume per above orders.
14. Hypertensive Emergency Orders, if Systolic BP ≥ 160 OR if Diastolic BP ≥ 110, notify physician and:
 Administer Apresoline (hydralazine) 5 mg IV over 2 minutes.
 Repeat BP in 20 minutes, if still elevated, administer Apresoline (hydralazine) 10 mg IV over 2 minutes
 Repeat BP in 20 minutes, if still elevated, administer Normodyne (labetalol) 20 mg IV over 2 minutes. Place
patient on MECG and SpO2 monitoring. (do not give if patient is asthmatic or is in heart failure)
 Repeat BP in 10 minutes, if still elevated, administer Normodyne (labetalol) 40 mg IV over 2 minutes and
obtain emergency consultation from maternal–fetal medicine and anesthesia. (do not give if patient is
asthmatic or is in heart failure)
 Once Systolic BP <160 AND Diastolic BP <110, repeat BP measurement every 10 minutes for 1 hour, then
every 15 minutes for 1 hour, then every 30 minutes for 1 hour, and then every hour for 4 hours. DC MECG
and SpO2 monitoring upon physician order.
 If Apresoline (hydralazine) is not available, use the following protocol:
o Administer Procardia (nifedipine) 10 mg po x 1 dose
o Repeat BP in 20 minutes, if still elevated, Procardia (nifedipine) 20 mg PO
o Repeat BP in 20 minutes, if still elevated, Procardia (nifedipine) 20 mg PO
o Repeat BP in 20 minutes, if still elevated, Normodyne (labetalol) 40 mg IV over 2 minutes and
place patient on MECG and SpO2 monitoring (do not give if patient is asthmatic or is in heart
failure)
o Obtain emergency consultation from maternal–fetal medicine and anesthesia.
15. Eclamptic Seizure Emergency Management Orders, in the absence of the attending physician:
 Notify attending physician, Anesthesia, and Respiratory Therapy.
 Protect patient from injury. Do not restrict movements. Turn patient to side when possible.
 Establish or maintain airway, suction mouth as necessary, administer oxygen by facemask at 10 L/min after
seizure stops. Do NOT attempt to insert tongue blade or airway during seizure because of increased risk of
trauma to patient.
 Administer magnesium sulfate 2 gm slow IV push. If patient has recurrent seizures after initial IV bolus, give
additional magnesium sulfate 2 gm slow IV push. After initial loading dose, administer maintenance dose of 2
gm/hr IV.
 Monitor pulse, respirations, SpO2, and blood pressure q 5 min after seizure stops.
 If on HRPU, transfer patient to Labor and Delivery as soon as possible.
 Initiate continuous MECG and SpO2 monitoring.
 Order stat laboratory tests: CBC, DIC profile, FSP, pre-eclampsia profile
 Notify NICU, if undelivered.
_____________
Date
_____________
Time
_________________________
Physician Signature
___________
PID Number
Copy to pharmacy
FORM 3-20 REV. 11/2015
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