Friday, January 23, 2009

Mag Special

I don't think there is ever gonna be a shift where I don't do something I've never done before. Last night it was actually "starting" someone on mag, with the 4gram bolus and then the 2gram/hr thing. I've heard too many stories about people forgetting to change the pump rate after the 4grams in 15minutes when they hang the "big bag" and send their patients up to ICU because of respiratory failure, so I was a little nervous. The awesome day shift nurse helped me roll the patient out of the OR and get everything straightened out and the mag started and the paperwork organized and stuff before she left.

So I had a fresh section on mag and the patient wasn't one of those who I would call "stoic", actually quite the opposite. This was about her 7th admission in the last 2-3 months of her pregnancy for various things, but when she got hit with the PIH she got hit hard and really was sick, so even though she was only 33wks it was a good thing to get her delivered. Baby looked great for 33 weeks too.

So even though it was just her all night for me, she was a little intense and my hourly mag checks would turn into a full 20-30minute "can I get you anything else" and "I can't give you anything else for pain" and "yes, your epidural is still running, and you've maxed it out for the next hour already" but the next time I'd walk in she'd be asleep. I think she was feeling better towards morning, she wasn't moaning everytime I touched her. I know that mag is awful stuff, heaven help me never have to experience it from the other side!

I know she's gonna feel like a different person after it's been off for a few hours, and hopefully she'll get to feeling better from the C/S soon too. I went to work Wednesday night feeling like I was seriously getting sick and last night wasn't much better. I swear I drank so much water I was in the bathroom like every 2 minutes. I have 2 days off, so if I'm gonna be sick I need to be sick and well again by Sunday night so I can work 3 more in a row, then enjoy a nice long stretch off :) Happy weekend everyone!


  1. Magnesium sulfate is a high risk drug - and should be double checked by 2 RNs for every dosage change (initiation, increases, decreases, boluses). Do you not have a hospital policy of 2 RNs checking the pump settings?

  2. I don't know how I have stumbled across your blog, but I have. I work in a high risk hospital and we use Mag like it's LR. I set my pump at the continuous rate first. So, I will start the pump at 2g/hr (double concentrated, that's 25cc/hr, regular concentrated, that's 50cc/hr), then will set the pump to do a secondary as the bolus so the 4g bolus goes in over 30 minutes (usually the standard), and then it automaticaly switches over to 2g/hr. I hope that makes sense. I'm also not sure what types of pumps you have, but the past two kinds of pumps I've worked with, I've been able to do that. We also have to check mag levels 3 hours after initial bolus is complete.