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Difficulty: HardPharmacological and Parenteral Therapies

A client at 3434 weeks of gestation is receiving a continuous intravenous (IV) infusion of magnesium sulfate for the management of severe preeclampsia. During an hourly assessment, the nurse notes the client is difficult to arouse, the respiratory rate is 10 breaths/minute10\text{ breaths/minute}, deep tendon reflexes are absent, and urine output was 20 mL20\text{ mL} over the past hour. The nurse immediately stops the magnesium sulfate infusion. Which of the following actions is the highest priority?

  1. Prepare to administer a slow intravenous push of calcium gluconate.Answer
  2. B
    Calculate and initiate a reduced continuous infusion rate of magnesium sulfate at 1 g/hour1\text{ g/hour}.
  3. C
    Place the client in a flat, supine position to promote cerebral blood flow.
  4. D
    Delegate the continuous assessment of the fetal heart rate to the unlicensed assistive personnel.

Answer

The highest priority action is to prepare to administer a slow intravenous push of calcium gluconate.
The client is exhibiting classic, life-threatening signs of severe magnesium toxicity: central nervous system depression (difficult to arouse), respiratory depression (less than 12 breaths/minute12\text{ breaths/minute}), loss of deep tendon reflexes, and oliguria (less than 30 mL/hour30\text{ mL/hour}). Because the nurse has already taken the first critical step of stopping the infusion, the immediate priority is to administer the specific pharmacological antidote, calcium gluconate, via slow intravenous push to reverse the cardiopulmonary depression.

Step-by-Step Solution

1
Analyze the client's assessment data.
The respiratory rate of 10 breaths/minute10\text{ breaths/minute}, absent deep tendon reflexes, and oliguria indicate severe central nervous system depression.
Magnesium sulfate is a potent central nervous system and respiratory depressant.
2
Diagnose the clinical emergency.
The findings confirm life-threatening magnesium sulfate toxicity.
Therapeutic levels of magnesium prevent seizures, but toxic levels cause loss of reflexes, followed by respiratory and cardiac arrest.
3
Determine the priority pharmacological intervention.
Since the infusion has already been stopped, the immediate next step is to reverse the toxicity using its specific antidote.
Calcium gluconate directly antagonizes the cardiopulmonary depressant effects of magnesium.
4
Evaluate safe parenteral administration guidelines.
The antidote must be administered as a slow IV push.
Rapid intravenous administration of calcium gluconate can trigger severe bradycardia or cardiac arrest.

Key Concept

Management of Magnesium Sulfate Toxicity
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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