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Patient Label Here UMC MAGNESIUM SULFATE ADMINISTRATION ORDERS FOR FBC/FCU 1. Attending Physician:_________________________________________ Resident/Fellow_______________________________ 2. Diagnosis:_______________________________________________________________________________________________ 3. Co-Morbidities: __________________________________________________________________________________________ 4. Allergies: 5. NURSING: NKDA Allergic to: ___________________________________________________________________ Temperature every 4hrs VS and DTR’s every 15 minutes times 1 hour, then every 30 minutes times 2 hours, then every hour. Notify MD if______________________________________________________________________________________ Intake and output Hourly Other: _____________________________ Insert Foley Catheter and daily Foley Care. Notify MD if urine output less than 30 ml per hour Diet: NPO Other______________________________________________________________________________ Activity: Bedrest Decreased Stimuli Limit visitors Treatments: Initiate seizure precautions Continuous Electronic Fetal Monitoring if undelivered 6. LABORATORY/DIAGNOSTICS: CBC with differential CMP Uric Acid ALT AST PT PTT Fibrinogen Repeat above check labs every 12 hours Magnesium levels: 2-3 hours after the start of the magnesium infusion, then every 6 hours (Notify MD of magnesium level < 4mg/dl or > 8.4 mg/dl or signs and symptoms of toxicity) Notify MD of any abnormal lab results OTHER:________________________________________________________ OTHER:________________________________________________________ 7. IV: Continuous IV fluids: Lactated Ringers to run at ________________________ml/hr Total IV fluids not to exceed 3 liters per 24 hours 8. MEDICATIONS: Refer also to Admission Medication Reconciliation Form Magnesium Sulfate: 50 grams in 400ml of 0.45% Normal Saline (Total Volume 500 ml) Loading Dose: _______grams IVPB over 20-30 minutes via infusion pump Maintenance Dose: _________Grams per hour IVPB via infusion pump (A loading dose of 4-6 grams with a maintenance dose of 2-3 grams per hour is recommended unless renal function is impaired or weight of the patient is less than 45kg) Calcium Gluconate 1 gram IV as needed for magnesium toxicity TO Read back Order taken by Signature: ________________________________________Date/Time: _____________________________ Physician Signature__________________________________________ Date/Time_____________________________ Page 1 of 1- UMC Mag Sulfate for FBC/FCU Orders 11/8/2011 (#963 R-1)