POSTPARTUM CESAREAN SECTION
POST-OP ORDERS
PLACE LABEL HERE
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
OTHER DIAGNOSES: ___________________________________________________________________
Allergies: _______________________________________________________________________________
Maternal/Infant Unit
 High Risk Pregnancy Unit
 May transfer care to Maternal/Infant Unit _____ hrs after magnesium sulfate discontinued
or when ________________________________________________________
2.
Consults: ___________________ Concerning: ______________________  Routine  Urgent
3.
Labs: H&H postpartum day #1
Rho(D) immune globulin workup if Rh negative (Rh ______)
 Glucose monitoring:  FBS q AM  2 hrs postprandial  at Bedtime  at 3 AM  Other: _________
4.
Vital signs on admission to unit, then q 30 min x 2, then q hr x 2, then q 4 hrs x 48 hrs, then q 8 hrs until discharge
 Vital signs, DTRs, breath sounds, I & O per magnesium sulfate orders (form # 20). After magnesium sulfate is
discontinued, obtain vital signs q 4 hrs or q ______hrs
 TPR q ______ hrs; BP q ______ hrs
 I & O q ______ hrs
5.
Foley to bedside bag. Discontinue at 12 hrs post-op. May straight cath once if patient unable to void in 6 hrs after
removal of Foley or becomes uncomfortable. If unable to void a second time, reinsert Foley and notify
Physician/CNM
6.
Notify physician for temperature above 100.4°F twice, four hrs apart, or 101°F once, unstable vital signs, or
excessive vaginal bleeding, systolic BP above _______ or diastolic BP above ________
 FBS above _______ or below _______; 2 hrs postprandial glucose above _______ or below ________
7.
Diet: clear liquids; advance as tolerated to regular diet with snacks
 __________ calorie consistent carbohydrate gestational diabetic diet with no added juice or fruit at breakfast
 Other: __________________________________________________________________________________
8.
Activity: Up on side of bed with assistance first 6-12 hrs post-op. Up with assist first time, first 4 hrs after
magnesium sulfate discontinued, and until stable; then ad lib
 Bedrest with bedside commode  Bathroom privileges only
 Bathroom and shower privileges
9.
VTE Prophylaxis: SCDs  with TEDs OR
 Plexi-pulses  with TEDs
maintain until ambulatory ad lib
OR ______________________________
10. ChloraPrep to incision site 48 hrs after surgery (at discharge if <48 hrs). Repeat in 48 hrs (patient may do at home)
11. Incentive Spirometry q 1-2 hrs while awake for patients on magnesium or that had general anesthesia
 Incentive Spirometry q 1-2 hrs while awake
1.
IV FLUIDS:
12. D5LR at 125 ml/hr IV
OR
 __________________ at _________ml/hr IV
13. Discontinue IV at 12 hrs post-op if afebrile, tolerating po fluids, vital signs are stable, bleeding is not excessive,
and/or when PCA/Epidural pain medications are discontinued. For Rh negative patients, maintain IV access until
cord blood results obtained. Convert to INT if diabetic (> Class A2)
SCHEDULED MEDICATIONS:
14. Prenatal vitamin po daily  patient may self-administer own prenatal vitamin after pharmacist identifies medication
15. Rho(D) immune globulin 300 micrograms x 1 dose if indicated (Rh- mother, Rh+ infant). Rophylac is administered IV
or IM , RhoGAM must be given IM only.
16. MMR II (Mumps/Measles/Rubella) vaccine 0.5 ml SQ x 1 dose if rubella non-immune or equivocal
17. Tdap vaccine (tetanus, diphtheria, acellular pertussis) 0.5 ml IM x 1 dose if patient is candidate (policy 7002-01)
 Cancel Tdap (reason:____________)
18.  Implement “Insulin Subcutaneous for Obstetrics” orders (form # 21502), send to pharmacy
19.  Implement “Magnesium Sulfate for Pre-Eclampsia” orders (form # 20), send to pharmacy
20. VTE Prophylaxis:  Heparin 5,000 units SQ q 12 hrs (do not begin heparin until epidural has been out for two
hrs)
*3-10806*
FORM 3-10806 REV. 03/2011
Send copy to pharmacy _______
(initials)
Page 1 of 3
POSTPARTUM CESAREAN SECTION
POST-OP ORDERS
PLACE LABEL HERE
 Lovenox (enoxaparin) 40 mg SQ q 24 hrs at 1700; if CrCl < 30, give 30 mg SQ q 24 hrs (do
not begin enoxaparin until epidural has been out for 12 hrs)
The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.
21. Stool Softener: Colace (docusate) 100 mg po bid. Hold for loose stools
22. Antibiotics: ___________________________________________________________________________________
23. Antihypertensives: _____________________________________________________________________________
PRN MEDICATIONS:
24. Excessive bleeding: Establish IV access if not present; Pitocin (oxytocin) 40 units in 1,000 ml NS or LR IV and infuse
wide open; decrease rate to 125 ml/hr once bleeding has decreased and fundus is firm. If not hypertensive or preeclamptic, give Methergine (methylergonovine) 0.2 mg IM x 1 dose
25. Breast feeding discomfort: Lanolin breast cream topically prn after breastfeeding
26. Severe pain: PCA/epidural for post-op pain per preprinted order. Discontinue PCA/epidural at 12 hrs post-op
 Toradol (ketorolac) 30 mg IV (or IM if no IV access) q 6 hrs prn (if patient weight <50 kg, give 15 mg)
27. Moderate pain:
Percocet (oxyCODONE/acetaminophen) 5/325 mg 1-2 tabs po or 10/325 mg 1 tab po q 4 hrs prn.
Give first dose 4 hrs prior to DC of PCA/epidural, and give second dose at time of DC of PCA/epidural
OR  Lortab (HYDROcodone/acetaminophen) 5/500 mg 1-2 tabs po or 10/500 mg 1 tab po q 4 hrs prn, DC
Percocet. Give first dose 4 hrs prior to DC of PCA/epidural, and give second dose at time of DC of
PCA/epidural.
OR  Other: ____________________________________________________________. DC Percocet
28. Mild pain: Ibuprofen 600 mg po q 6 hrs prn. Hold if Toradol (ketorolac) is also ordered; may resume 6 hrs after
Toradol (ketorolac) is discontinued. May use while on PCA or 1-2 hrs prior to DC of epidural.
If unable to take ibuprofen: Tylenol (acetaminophen) 1,000 mg po q 6 hrs prn
29. Patient may self-medicate and keep these medications at bedside:
a. Episiotomy pain: Dermoplast (benzocaine) spray topically prn
b. Episiotomy or hemorrhoid discomfort/pain: Witch hazel pads topically with pericare prn
c. Hemorrhoid discomfort/pain: Dibucaine ointment topically with pericare prn
30. Nausea:
Phenergan (promethazine) 12.5 - 25 mg po q 4 hrs prn mild nausea. If unable to tolerate po, may give Phenergan
(promethazine) 12.5 - 25 mg suppository per rectum q 4 hrs prn nausea
OR  Zofran (ondansetron) 4 mg IV q 6 hrs prn. DC Phenergan
OR  Other: ________________________________________________. DC Phenergan
31. Sleep: Ambien (zolpidem) 5-10 mg po at bedtime prn. If 5 mg given, may repeat x 1 dose after 2 hrs
32. Indigestion: Maalox XS (aluminum/magnesium/simethicone) 30 ml po four times daily prn
33. Constipation: Dulcolax (bisacodyl) 10 mg suppository rectally prn, may repeat x 1 in 1 hr if no bowel movement
34. Gas pain: Simethicone 80 mg po four times daily prn
35. Pruritis: Benadryl (diphenhydramine) 25-50 mg po q 4 hrs prn
 Benadryl (diphenhydramine) 12.5-25 mg IV q 4 hrs prn
36. Congestion: Saline nose spray q 2 hrs prn



  Sudafed PE (phenylephrine) 10 mg po q 4 hrs prn
 

 Mucinex (guaifenesin) 600 mg q 12 hrs prn
37. Cough: Robitussin DM (guaifenesin/dextromethorphan) 10-20 ml po q 6 hrs prn. DC if Mucinex (guaifenesin) ordered
ADDITIONAL ORDERS:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
FORM 3-10806 REV. 03/2011
Send copy to pharmacy _______ (initials)
Page 2 of 3
POSTPARTUM CESAREAN SECTION
POST-OP ORDERS
PLACE LABEL HERE
______________
___________________
_________________________________
__________
Date
Time
Physician Signature
PID Number
*3-10806*
FORM 3-10806 REV. 03/2011
Send copy to pharmacy _______
(initials)
Page 3 of 3