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Antihypertensives administered with magnesium sulfate increase the risk of hypotension. A precipitous decrease in maternal blood pressure (BP) may lead to shock and placental abruption, which may be life-threatening to the patient and fetus.undefined#ref4">4
Take steps to eliminate interruptions and distractions during medication preparation.
Hydralazine is a peripheral vasodilator that relaxes the arteriolar smooth muscle. Increases in heart rate, stroke volume, cardiac output, and left ventricular ejection fraction typically occur with hydralazine use.9 Hydralazine is one of three medications available for first-line management of acute-onset severe hypertension in pregnant and postpartum women.1 The drug crosses the placenta in a clinically insignificant degree.
Hydralazine is indicated for IV administration during hospitalization for severely elevated BP and is contraindicated in patients with documented hypersensitivity, coronary artery disease, or mitral valve rheumatic heart disease.2 Caution should be used when administering hydralazine to patients with severe renal impairment.2
The recommended initial dosage of hydralazine is 5 mg IV or IM, followed by 5 to 10 mg IV every 20 to 40 minutes to a maximum total dose of 20 mg; or a constant infusion of 0.5 to 10 mg per hour.1
Common adverse reactions to hydralazine are headache, palpitations, tachycardia, and drug-induced lupus syndrome.2,10 Other adverse reactions include dizziness, diarrhea, nausea, vomiting, edema, and peripheral neuropathy.10
Nurses should closely and frequently monitor maternal vital signs and the fetal heart rate (FHR) pattern after hydralazine administration because of the potential for hypotension. The patient’s response to antihypertensive medication should be monitored closely if preeclampsia or eclampsia are present because eclampsia causes contracted intravascular volume. Antihypertensive therapy should not decrease arterial pressure too significantly or too rapidly because uteroplacental perfusion may be compromised,4 resulting in an interruption of fetal oxygenation with Categorycategory II (indeterminate) or Categorycategory III (abnormal) FHR characteristics.3
Medications should be diluted or compounded in the pharmacy before dispensing and only when recommended by the manufacturer and approved by the organization’s practice.7 Some organizations will allow medication compounding in a specific area of practice.
If dilution or reconstitution of an IV push medication becomes necessary outside of the pharmacy, the nurse should perform these tasks immediately before medication administration in a clean, uncluttered, and functionally separate location.7 The nurse should use organization-approved, readily available drug information resources and sterile equipment and supplies to dilute or reconstitute IV push medications.7
If the mother and support person express concern regarding the accuracy of a medication, the medication should not be given. The concern should be explored, the practitioner notified, and the order verified.
Do not use medication that is cloudy or precipitated unless such is indicated by its manufacturer as being safe.
Remove the ordered dose of medication from the vial using a syringe and needleless attachment immediately before administration. Hydralazine changes color after contact with metal; discard any discolored hydralazine solution.
The drying time for 70% isopropyl alcohol is 5 seconds; for alcohol-based chlorhexidine, it is 20 seconds.5
There is moderate quality evidence to support the recommendation to apply mechanical friction for no less than 5 seconds.5
Rationale: The port protector or cap is never reused.
The effective length of time for exposure depends on the product. Consult the manufacturer’s instructions for use.
Rationale: A 10-ml syringe generates lower injection pressure.
Do not add hydralazine to any IV solution bags. Hydralazine is intended to be used as an IV push medication.
To prevent needlestick injury, do not recap needles.
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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