MgSO4 patients on Postpartum

RNnL&D · Jul 1, 2005

What about the PP patients who develop pre e days after delivery? Or those readmitted after discharge for pre e? Our pts with severe pre e prior to delivery are kept in L&D until they are stable. Those who worsen after being sent to PP aren't sent back to L&D, kwim? And being on Mag doesn't mean they won't be transferred to PP, if their BPs are stable.

I think the only issue for PP nurses would be ensuring there is enough staffing to adequately monitor a pt on Mag.

NurseforPreggers · Jul 1, 2005

None of our Mag patients go to PP. It doesn't matter the reason they are on Mag, they are all either on L&D or Antepartum if on Magnesium therapy. Sorry can't help you more.

Dayray, RN · Jul 1, 2005

PP shoudl be okay to handle Mag as long as you have the staffing for it. AWONN has publised nurse to patient ratios and it includes a guidline for nurse:mag patients. I dont remeber the actual guidline but Id say no more then 2 mag patients to a nurse and mabey 2 regular PP patients on top of that. Also you need to make sure your nurses know how to manage the pateints.

Post partum nurses should be able to handle mag as it is part of post partum managment. I currently work at a hospital where to PP nurses are ... well embarrasing. They can't even do IV puses and they call us constantly to do IV sticks, put in foleys, calculate drug does for them etc....

I used to work PP and handled all that stuff on my own. Heck, they even call us to assess bleeding and if a patient is hemerageing they don't know what to do (other then call us).They have limited themselves to just fundal checks and passing PO meds.

We all learned the same stuff in school and it's a shame to see some nurses lose their skills because they are afraid to use them.

SmilingBluEyes · Jul 1, 2005

I would think it depends on staffing patterns and adequate training of your staff. I believe a good PP nurse SHOULD be able to care for a Mag patient, if numbers are not too high.

Being in an LDRP unit, we all take care of Mag patients, as well as labor/delivery. But the nurse assigned to care for the mag patient is given the definate light load, as mag patients can be a bit labor-intensive (hourly vitals, I/O's, q4 neuro checks, etc).

Editorial Team / Admin · Jul 2, 2005

by all means the patient must remain on mgso4 if pre e. eclampsia can occur 72 hours after delivery. there must p and p for all patients receiving mag in hosp. all pp nurses must be trained and know how to manage patient on mag on the pp floor. it is not possible to keep patient in l and d for 3 days. severe liability if hosp. practice does not include this guideline for high risk patients. should not be delivering if this is the case.

i am the new nurse manager of a mother/baby unit. on our unit we receive the patients from l&d who are on mgso4. in my 21 yrs of working in women's services, at all the other hospitals i have worked at, our mgso4 patients stayed in l&d until they came off mgso4.(because of the complications ) or they went to a high postpartum area. i just want to hear any thoughts and and find out what other hospitals are doing. thank you

USA987, MSN, RN, NP · Jul 5, 2005

We decide on a case by case basis. Staffing, space availability, and stability of the pt. are usually the deciding factors.

camay1221_RN · Jul 5, 2005

Our mag pts stay in labor and delivery for 24 hours after delivery and if BP's are stable they will come to PP, sometimes with mag, sometimes without.

JaneyW · Jul 5, 2005

siri said:

By all means the patient must remain on MgSo4 if pre e. Eclampsia can occur 72 hours after delivery. There must P and P for all patients receiving Mag in hosp. All PP nurses must be trained and know how to manage patient on Mag on the PP floor. It is not possible to keep patient in L and D for 3 days. Severe liability if hosp. practice does not include this guideline for high risk patients. Should not be delivering if this is the case.

I chuckled when reading your reply. It is the right reply to the OPs problem, but way off from what happens in the real world of community hospital OB. I just left that kind of facility for a teaching facility because it all made me too nervous, but there are many many babies born every day in "low risk" places that end up in "high risk" situations and everyone just makes do as they can. I'm sure there are P&P in place, but sometimes you just have to do what is right for the safety of the patient given the staff you are working with. Thank God for good nurses. I can't tell you how many situations I saw over the past two years that could have ended badly and didn't thanks to good nursing--and sometimes maybe a guardian angel?

tamrnmomof4 · Jul 5, 2005

Our patients stay in L&D until they are off of the mag!!! Not fair to a PP nurse to give her even 2 other pp patients along with a mag, because we all know that 2pp patients really equal 4, 2 moms and 2 babies, along with mag patient, not fair.

SmilingBluEyes · Jul 6, 2005

Our patients stay in L&D until they are off of the mag!!! Not fair to a PP nurse to give her even 2 other pp patients along with a mag, because we all know that 2pp patients really equal 4, 2 moms and 2 babies, along with mag patient, not fair.

it is fair, if staff are trained and staffing is appropriate. 2 couplets is a very nice, light load.

SmilingBluEyes · Jul 6, 2005

By all means the patient must remain on MgSo4 if pre e. Eclampsia can occur 72 hours after delivery. There must P and P for all patients receiving Mag in hosp. All PP nurses must be trained and know how to manage patient on Mag on the PP floor. It is not possible to keep patient in L and D for 3 days. Severe liability if hosp. practice does not include this guideline for high risk patients. Should not be delivering if this is the case.
I chuckled when reading your reply. It is the right reply to the OPs problem, but way off from what happens in the real world of community hospital OB. I just left that kind of facility for a teaching facility because it all made me too nervous, but there are many many babies born every day in "low risk" places that end up in "high risk" situations and everyone just makes do as they can. I'm sure there are P&P in place, but sometimes you just have to do what is right for the safety of the patient given the staff you are working with.
Thank God for good nurses. I can't tell you how many situations I saw over the past two years that could have ended badly and didn't thanks to good nursing--and sometimes maybe a guardian angel??
Maybe.....
or maybe like you said.
Just really good nursing.
Because you are right; OB can be a real crapshoot and we have to hope for the best while preparing for the worst. :)