Question

Katie has tox labs drawn to assess for worsening pre-eclampsia. The results are as follows: SGOT/AST 44, SGPT/ALT 86, Uric acid 7.7, Creatinine 1.2, Platelets 123K DTR’s are 3+ and brisk with 2 beats of clonus. The order reads to start Magnesium sulfate with a 4 gram bolus over 30 minutes followed by a continuous infusion at 2grams/hr. In addition, her contractions have diminished and a Pitocin augmentation is initiated at 2 milliunits/min and to increase q20 minutes until an adequate contraction pattern is attained. Her blood pressures range from 131/82 – 156/97.

1. What lab work will need to be scheduled and how often?

2. What teaching will you give Katie r/t Magnesium and Pitocin?

3. What is an adequate contraction pattern?

Answer 1

1. What lab work will need to be scheduled and how often?

The patient should be assessed for signs of toxicity (e.g., visual changes, somnolence, flushing, muscle paralysis, loss of patellar reflexes) or pulmonary edema.

If these signs are observed, a physician must be notified. During bolus administration, a staff member should remain at the patient’s bedside to oversee continuous monitoring. Subsequent assessment intervals of 15 minutes are suggested for the first hour, 30 minutes for the second hour, and then hourly.

If there is a concern about toxicity, laboratory testing might be needed.

A clinical assessment is as important as a determination of serum magnesium levels.

Monitor intake and output ratios. Urine output should be maintained at a level of at least 100 mL/4 hr

2. What teaching will you give Katie r/t Magnesium and Pitocin?

Teach the patient that magnesium sulfate is used for treating preterm labor and pre-eclampsia. Here the medicine is admintered for pre-eclampsia.

Patients and their caregivers should be instructed on signs of toxicity to report. The signs of magnesium toxicity includes

The magnesium reduces and prevents the uterine contractions.

Pitocin is given for inducing the uterine contractions. Hence the patient felt pain in accordance with the uterine contractions.

Advice the patient to check the fetal movements

3. What is an adequate contraction pattern?

In latent phase of labour the contrcations are occur every 10 mts one or two contractions lasts for 20 – 30 seconds.

In active labor, the contractions are less than 5 minutes apart, lasting 45-60 seconds and the cervix is dilated three centimeters or more.

Contractions in active labor generally last between 45 to 60 seconds, with three to five minutes of rest in between. In transition, when the cervix dilates from 7 to 10 centimeters, the pattern changes to where contractions last 60 to 90 seconds, with just 30 seconds to 2 minutes of rest between