Unique Plan Description: OB Acute Hypertension and Preeclampsia
Plan Selection Display: OB Acute Hypertension and Preeclampsia
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2017-09-28 11:02:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-05-07 10:51:06
Available at all facilities: Yes

OB Acute Hypertension and Preeclampsia
Vital Signs
	Vital Signs
		Q2H-Sch
			Comment: If patient has been acutely treated for hypertension the BP should be checked q15min until 4 consecutive non severe values are obtained, then q2h x 4, then q4h until discharge. If any severe BP's are obtained, perform BP q15min until 4 consecutive non-severe BP.
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
	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
	Type and Crossmatch (Product Available)
		T;N, Routine, For Possible Transfusion
IV Solutions
	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
		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: If BP remains severe range on 2 consecutive BPs then escalate and administer 20mg dose as ordered.
		Select one of the 20mg doses below - frequency of Q15min OR Q30min(NOTE)*
		20 mg, Capsule, By Mouth, Q15MIN, PRN, hypertension, 2 Dose(s)/Time(s)
			Comment: Notify MD if BP is severe after 3 total doses of nifedipine.
		20 mg, Capsule, By Mouth, Q30MIN, PRN, hypertension, 2 Dose(s)/Time(s)
			Comment: Notify MD if BP is severe 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, bradycardia and severe asthma(NOTE)*
	labetalol  injection
		20 mg, = 4 mL, Injection, IV Push, Once, STAT
		40 mg, = 8 mL, Injection, IV Push, Once, STAT
		20 mg, = 4 mL, Injection, IV Push, Q1H, PRN, hypertension
			Comment: Notify MD if BP is severe after 3 doses of labetalol.
		40 mg, = 8 mL, Injection, IV Push, Q1H, PRN, hypertension
			Comment: Notify MD if BP is severe after 3 doses of labetalol.
		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, hypertension, 4 Dose(s)/Time(s)
			Comment: Notify MD if BP is severe after 3 doses of hydralazine.
		10 mg, Injection, IV Push, Q20MIN, PRN, hypertension, 2 Dose(s)/Time(s)
			Comment: Notify MD if BP is severe after 3 doses of hydralazine.
Patient Care
	Intake and Output
		Q4H-Sch
	Fetal Monitoring
		
	IV-Maintain
		T;N
			Comment: Verify IV access with large bore IV. Consider placement of second IV
	Continuous Pulse Oximetry by Nurse
		T;N, Q6H-Sch
	Notify Health Care Provider
		T;N, Notify provider to confirm when to escalate dosing for Nifedipine, labetalol, and hydralazine.

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

OB Seizure Prophylaxis
	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