Unique Plan Description: ED OB Hypertension
Plan Selection Display: ED OB Hypertension
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2017-07-18 07:42:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-02-21 09:11:11
Available at all facilities: Yes

ED OB Hypertension
Vital Signs
Treatment (NOTE)
		Severe hypertension defined as a BP greater than or equal to 160 systolic OR greater than or equal to 110 diastolic.(NOTE)*
Laboratory

	CBC with Diff
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	LDH
		T;N, Stat, spec type = Blood
	Uric Acid
		T;N, Stat, spec type = Blood
	Protein Creatinine Ratio Urine
		T;N, Stat, Stat, spec type = Urine
			Comment: Comment: If pt is still pregnant and vaginal discharge or bleeding is present, collect urine sample via straight cath method.
	Protein Urine Timed Set
		T;N, Routine, Routine, spec type = Urine
	Creatinine Urine Timed Set
		T;N, Routine, Routine, spec type = Urine
	Type and Screen (No Product on hold)
		T;N, Routine, spec type = Blood
		T;N, Stat, spec type = Blood
	Crossmatch Red Blood Cells
		T;N, Routine
	Urinalysis
		T;N, Stat, Stat, spec type = Urine
	UA (Culture if Positive)
		Stat, Stat, spec type = Urine
Medications
		First Line Acute Treatment Severe OB Hypertension Nifedipine (Procardia)(NOTE)*
		Do not exceed 120mg in 24 hrs(NOTE)*
	NIFEdipine
		10 mg, Capsule, By Mouth, Once, STAT
			Comment: Take BP If BP is still elevated 15 min after initial dose administer 20mg dose as ordered below.  Severe Hypertension is defined as BP greater than or equal to 160mmHg systolic or BP greater than or equal to 110mmHg diastolic.
		20 mg, Capsule, By Mouth, Q15MIN, PRN, hypertension, 2 Dose(s)/Time(s)
			Comment: Take BP q 15min after each dose until 4 consecutive blood pressures are obtained below the cutoffs for severe HTN, then per protocol.  Severe Hypertension is defined as BP greater than or equal to 160mmHg systolic or BP greater than or equal to 110mmHg diastolic.Notify MD if BP is not below cutoff (160mmHg systolic and/or 110mmHg diastolic) after 3 total doses of nifedipine.
		Second Line Acute Treatment Severe OB Hypertension Labetalol (Normodyne)(NOTE)*
		Do not exceed 300mg in 24 hrs. Avoid in CHF and severe asthma(NOTE)*
	labetalol  injection
		20 mg, = 4 mL, Injection, IV Push, Once, STAT
			Comment: Take BP every 15 min x4 after each dose.
		40 mg, = 8 mL, Injection, IV Push, Once, STAT
			Comment: Take BP every 15 min x4 after each dose.
		20 mg, = 4 mL, Injection, IV Push, Q1H, PRN, hypertension
			Comment: Take BP every 15 min x4 after each dose. Severe Hypertension is defined as BP greater than or equal to 160mmHg systolic or BP greater than or equal to 110mmHg diastolic.Do not exceed 300mg in 24 hours
		40 mg, = 8 mL, Injection, IV Push, Q1H, PRN, hypertension
			Comment: Take BP every 15 min x4 after each dose.  Severe Hypertension is defined as BP greater than or equal to 160mmHg systolic or BP greater than or equal to 110mmHg diastolic. Do not exceed 300mg in 24 hours
		Third Line Acute Treatment Severe OB Hypertension Hydralazine (Apresoline)(NOTE)*
		Do not use if patient has tachycardia, HR >120bpm. Do not exceed 40mg in 24hours.(NOTE)*
	hydrALAZINE
		5 mg, Injection, IV Push, Q20MIN, PRN for hypertension, duration: 4 Dose(s)/Time(s)
			Comment: Severe Hypertension defined as SBP greater than 160 or DBP greater than 110..  Take BP every 15 min x4 after each dose.  Notify MD if desired BP not reached after 4 doses
		10 mg, Injection, IV Push, Q20MIN, PRN for hypertension, duration: 2 Dose(s)/Time(s)
			Comment: Severe Hypertension defined as SBP greater than 160 or DBP greater than 110.  Take BP every 15 min x4 after each dose.  Notify MD if desired BP not reached after second dose.
Patient Care
	Continuous Pulse Oximetry by Nurse
		T;N, Q6H-Sch
Consults/Follow-up
	Consult OB/GYN
		Reason for Referral: Maternal Hypertension

DIC Panel - MH/WH/JE
Laboratory
	.Protime - MH/WH/JE
		T;N, Stat, spec type = Blood
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Fibrinogen Level - MH/WH/JE
		T;N, Stat, spec type = Blood
	D-Dimer - MH/WH/JE
		T;N, Stat, spec type = Blood
	.SchistoDIC
		T;N, Stat, spec type = Blood
	Platelet Count
		T;N, Stat, spec type = Blood

ED Peripheral Lock Insert with Flush
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush, 4 hr
Patient Care
	Peripheral Lock-Insert
		T;N, Once

OB Seizure Prophylaxis
Laboratory
	Magnesium Level
		T;N, Routine, Q6H, spec type = Blood
IV Solutions
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	magnesium sulfate 4gm in 100mL water
		4 gm, IVPB, Once, 200 ml/hr
			Comment: 4 gm in 100 mL water, infuse over 30 minutes
	magnesium sulfate 6gm/D5W 100mL (JE)
		6 gm, INT, IVPB, Once, 200 ml/hr, T;N
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	magnesium sulfate 20 gm in 500 mL water Premix IV
		500 mL, IV
			Comment: 1 gm/hr = 25 mL/hr1.5 gm/hr = 37.5 mL/hr2 gm/hr = 50 mL/hr2.5 gm/hr = 62.5 mL/hr3 gm/hr = 75 mL/hr
		20 gm, EVERY BAG, 2 gm/hr
	Lactated Ringers Injection
		1,000 mL, IV, 75 ml/hr
			Comment: Adjust rate so LR and Magnesium Sulfate TOTAL fluid intake is 125ml/hr.
Medications
	calcium gluconate
		1 gm, Solution, IV Push, Q5MIN, PRN, absence of deep tendon reflexes
			Comment: Flush IV line before administering. May give 1gm IV Push over 5 minutes (max rate: 200mg/min). Administer in large vein to decrease risk of thrombophlebitis and extravasation. May repeat as necessary. Patient must be placed on telemetry if this drug is administered.
Patient Care
	Notify MD
		T;N, If Serum magnesium level greater than 8 and Discontinue Magnesium Maintenance IV stat
		T;N, If O2 sat less than 95%
		T;N, If respiration less than 12, patient still pregnant
		T;N, If DTRs absent
	Discontinue IV
		T;N, If serum magnesium greater than 8mg/dL, Once

DIC Profile - FH
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	Fibrinogen Level - FH
		T;N, Stat, spec type = Blood
	D-Dimer Level - FH
		T;N, Stat, spec type = Blood
	.SchistoDIC
		T;N, Stat, spec type = Blood

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase