Question

A 27 year old pregnant woman is admitted to the hospital at 28 weeks gestation with a diagnosis of pregnancy-induced hypertension (160/100) and is started on an IV magnesium sulfate drip. When assessing the deep tendon reflexes (DTRs) of the woman you notice that the reflexes are 4+ with some clonus. She is becoming agitated. What does this finding indicate to you about the dose of Magnesium Sulfate? Describe the significant parameters you would assess when the patient is on this medication

Answer 1

DTR function is a window to the CNS function. Hyperreflexia occurs as a result of CNS irritability secondary to the vasospasms caused by preeclampsia. The patient DTR elicited 4+ score means she’s is in a state of hyperreflexia. The goal of MgSO4 therapy is to decrease CNS irritability. Here that is not achieved, so the nurse has to consult the obstetrician to increase the dosage of MgSO4.

Assessment of patient on Mg SO4

• Check serum Magnesium level before administration.
• Check BP and pulse every 15 minutes during therapy.
• Assess patellar reflex hourly to monitor for toxicity.
• Monitor hourly urine output.
• Cardiac monitor should be connected to patients receiving the therapy.
• Keep ready injectable form of Calcium gluconate available to reverse paralyzing effects of the drug.
• Don’t administer MgSO4 rapidly, as it may drop BP.
• After administration of the drug, assess for headache, edema , visual disturbances and epigastric pain and report if any to the physician.
• Record the drug administration as per the protocol.