PLACE LABEL HERE

MAGNESIUM SULFATE ORDERS

for FETAL NEUROPROTECTION

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order medications and the bottom of each page when indicated (multipage).

Criteria:

 Gestational age between 24 weeks and 316/7 weeks

and

 Singleton or multiple pregnancy at risk for delivery within the next 30 mins to 24 hrs

and either

 Active preterm labor with cervix 4-8 cm dilated or premature rupture of membranes if rupture occurred after 22 weeks

or

 Indicated preterm birth within the next 24 hrs and not receiving magnesium sulfate for severe preeclampsia/HELLP

  1. 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.
  1. Maternal/fetal assessments per routine, or more often if clinical condition warrants:

Antepartum
Blood pressure & heart rate / Every 5 mins during loading dose,
then q 15 mins for the first hr,
then q 30 mins for the second hr,
then hourly.
Respiratory rate / Every 15 mins for the first hr,
then q 30 mins for the second hr,
then hourly.
FHR & uterine activity / Continuously
Document with each set of maternal vital signs.
DTRs / Every hr
Intake & output / Every hr
Level of consciousness / Every hr
Breath sounds / Every 2 hrs
SaO2 (pulse oximetry) / Every hr
IV site assessment / Every 2 hrs
Fundus/lochia / N/A
  1. Notify physician immediately if patient has:
  • Significant changes in BP from baseline values
  • 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 fours if no Foley)
  • Category III FHR patterns (anticipate minimal variability and loss of accelerations)
  • Vaginal bleeding

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order medications and the bottom of each page when indicated (multipage).

  1. If respirations < 12, discontinue magnesium sulfate, notify Physician, and give supplemental O2 to keep O2 sat > 95%
  2. Foley catheter to bedside bag OR  do not insert Foley; may use bedpan
  3. Activity:Strict bedrest OR  Bedside commode (for BM) with assistance  Bedrest with bathroom privileges with assistance
  4. Hygiene:Bed bath OR  Shower with assistance

IVF/SCHEDULED MEDICATIONS:

  1. LR as primary fluids. Maintain total IV intake at 125 ml/hr, or ______
  2. Loading dose: Magnesium Sulfate4 gram IV loading dose over 20 min x 1 dose
  3. Maintenance: at completion of magnesium sulfate loading dose, run maintenance infusion at 2 grams/hr IV until delivery or for 24 hrs, whichever occurs first

PRN MEDICATIONS:

  1. Respiratory Arrest: Calcium gluconate 10%, 1 gm (10 ml) IV push over 3-5 mins prnand assess VS q

5 min until respiratory rate is ≥ 12, SaO2 is >95%; then q 15 min x one hr, then resume per above

ADDITIONAL ORDERS:

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Date TimePhysician SignaturePID Number

Send copy to pharmacy

FORM 3-33196 INITIATED 03/2013 Page 2 of 2