Nursing Care for Gestational Hypertension

1. Monitor for Magnesium Sulfate Toxicity

2. When to Stop the Magnesium Sulfate Infusion: It's not a checklist, stop the mag with any one of these signs. May need to administer Calcium Gluconate as the reversal

2.1. Respirations less than 12 bpm

2.2. Absent Deep Tendon Reflexes

2.3. Urine output less than 30 ml per hour

2.4. Cardiac arrhythmias/dysrhythmias

2.5. Decreased level of consciousness

3. Adverse Signs of Mag Toxicity: These are bothersome signs, but are not reasons to stop the Mag, as the benefits outweigh the risks

3.1. DTR's decreased +1

3.2. Patient feels facial flushing/heat sensations/has red cheeks

3.3. Patient feels drowsy, but is arousable

3.4. GI upset

3.5. Headache

4. Antihypertensive Medications

4.1. Crisis meds: Hydralazine IV, or Labetalol IV

4.1.1. When stable/maintenance meds: Nifedipine, or Methyldopa

4.1.1.1. Educate on orthostatic hypotension

5. Seizure Precautions

5.1. Implement seizure precautions

5.2. Anticonvulsant Medications: Magnesium Sulfate, a CNS depressant to decrease the risk of seizure

6. Monitor Lab Values

6.1. Monitor for elevated liver enzymes: LDH, AST

6.2. Monitor for increased Creatinine

6.3. Monitor for increased plasma uric acid

6.4. Monitor for thrombocytepenia

6.5. Monitor H&H to assess for HELLP syndrome and DIC

6.6. Monitor for Hyperbilirubinemia

6.7. Monitor magnesium levels if on Mag Sulfate

7. Patient Education

7.1. Remain on bedrest/sidelying

7.2. Diversal activites

7.3. Avoid foods high in sodium

7.4. Drink 6-8 glasses of water per day

7.5. Maintain a dark quiet environment/avoid stimuli

7.6. Maintain a patent airway

7.7. Take antihypertensive medications as prescribed