Tocolytic Monitoring: RPN and LPN Scope of Practice

The RPN/LPN role in tocolytic therapy centers on monitoring, documenting, and escalating — not initiating or independently managing these high-risk medications. Tocolytic agents are ordered and initiated by a prescriber and typically managed collaboratively with an RN. The practical nurse contributes by: 1. Collecting focused baseline and ongoing assessment data 2. Identifying early signs of adverse effects 3. Communicating clearly and promptly using SBAR when findings are abnormal 4. Carrying out delegated medication administration tasks within employer policy Magnesium Sulfate — Key Monitoring Parameters (escalate if): - Respiratory rate <12 breaths/minute → risk of respiratory arrest - Urine output <25–30 mL/hour (<100 mL/4 hours) → magnesium is renally excreted; reduced output → toxic accumulation - Loss of deep tendon reflexes (DTRs) → indicates CNS depression and impending toxicity - Serum magnesium level >7.5 mEq/L → toxic range (therapeutic: 4–7.5 mEq/L) - Flushing, extreme muscle weakness, confusion Calcium gluconate is the antidote. Know its location at the bedside. Report any shortage to the RN. Indomethacin monitoring: - Fetal amniotic fluid via ultrasound — reduced fetal urine output (oligohydramnios risk) - Not...