Unique Plan Description: OB Eclampsia
Plan Selection Display: OB Eclampsia
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2021-10-12 11:31:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-12-07 19:25:17
Available at all facilities: No

OB Eclampsia
IV Solutions
	magnesium sulfate 6gm/D5W 100mL (JE)
		6 gm, INT, IVPB, Once, 200 ml/hr, T;N
		Give both 4gm and 2gm to get 6gm (Fremont Hospital and Womens Hospital Only)(NOTE)*
	magnesium sulfate 4gm in 100mL water (WH/FH)
		4 gm, IVPB, Once, 300 ml/hr, T;N
			Comment: Give both a 4 gm and 2gm to get 6gm dose, infuse both bags in 20 minutes
	magnesium sulfate 2gm in 50mL water
		2 gm, IVPB, Once, T;N, 200 ml/hr
			Comment: Give both a 4 gm and 2gm to get 6gm dose, infuse both bags in 20 minutes
	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
	midazolam
		2 mg, Injection, IV Push, Once, PRN seizure activity
			Comment: refractory seizures
	LORazepam
		4 gm, Injection, IV Push, Once, PRN seizure activity
			Comment: refractory seizures, push over at least 2 minutes
	calcium gluconate
		1 gm, Solution, IV Push, Q5MIN, PRN for 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
	Seizure Precautions
		T;N
	Oxygen Therapy, Nurse to Administer
		T;N, Via Non-rebreathing Mask
			Comment: Oxygen 100%. Consider intubation if patient remains unconscious, has refractory seizure, signs of aspiration or persistent hypoxia.
	Continuous Pulse Oximetry by Nurse
		T;N, Q6H-Sch
	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
		T;N, If DTRs absent
	Discontinue IV
		T;N, If serum magnesium greater than 8mg/dL | See Order Comments, Once
			Comment: Discontinue Magnesium Infusion

*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