PHYSICIAN'S ORDERS
Mark in for desired orders. If is blank, order is inactive.
OB CESAREAN SECTION POSTOP - Routine
Diagnosis / Procedure Cesarean section Reason for cesarean section: __________________________________
Unit
Post Partum
Med Monitored
Other: ______________________________
Isolation
Standard Contact Strict Contact Droplet Airborne
Admitting Physician ______________________________________________________________
Attending Physician ______________________________________________________________
Consulting Physician _____________________________________________________________
Allergies
NKDA _______________________________________________
Code Status Full Code
Activity
Up as tolerated.
Diet
NPO (except ice chips)
Clear liquids
Advance as tolerated
Nursing Orders
Vital signs every 15 minutes times 4, then ever 30 minutes times 2, every 1 hour times 4; then every 4 hours.
Temperature every 4 hours for 8 hours, then every 8 hours.
I & O every ____________ hour(s)
Notify physician if urine output less than 30 mL per hour.
May discontinue urinary catheter 8 hours postpartum.
Urinary catheter to straight drainage
Incentive spirometer every hour while awake
Respiratory
Incentive spirometer every hour while awake. Initiate and instruct on use.
Continuous pulse oximeter for 24 hours post epidural.
Laboratory
If Rh negative, Rhogam work-up and give if indicated:
Mother's Rh __________
Baby's Rh __________
CBC at__________
Other______________________
DVT Prophylaxis: Not Indicated
Contraindicated _________________________________
Low Risk (surgery lasting less than 30 minutes, patient younger than 40 years, no additional risk factor)
Ambulate patient early
Moderate Risk (surgery lasting less than 30 minutes and additional risk factors, or 40 - 60 years of age, or major surgery in
patients under 40 years).
TED until ambulatory
Heparin SQ 5000 units every 12 hours
SCD's until ambulatory
enoxaparin (LOVENOX) 40 mg SQ daily
High Risk (over 60 years of age, or major surgery in patients over 40 years of age)
SCD's
Heparin SQ 5000 units every 8 hours
enoxaparin (LOVENOX) 40 mg SQ daily
Prescriber's Signature
Scanned to pharmacy / entered into TDS by:
_______________________Date_____________Time______
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT171*
PHYSICIAN ORDERS
OB CESAREAN SECTION POSTOP - Routine
E.F. 171-0931 Rev. 6/11 Pg. 1 of 4
Orders verified by:
_______________________Date_____________Time______
PHYSICIAN'S ORDERS
Mark in for desired orders. If is blank, order is inactive.
OB CESAREAN SECTION POSTOP - Routine
IV Fluids
1000 mL __________ at __________ mL per hour. Add __________ units pitocin (OXYTOCIN) times ______ bags.
Continue maintenance IVF (without pitocin) until order to discontinue IV fluids is received.
May discontinue IV if infiltrates after 8 hours.
Medications - Contingency (PRN)
Gas: (choose only one)
simethicone (MYLICON) 160 mg PO four times a day and every 6 hour as needed for gas
bisacodyl (DULCOLAX) suppository 1 per rectum daily as needed for gas
Constipation: (choose only one)
docusate calcium (SURFAK) 240 mg PO daily as needed for constipation
magnesium hydroxide (MOM) 30 mL PO daily as needed for constipation
Insomnia: (choose only one)
temazepam (RESTORIL) 30 mg PO daily at bedtime as needed for sleep
zolpidem (AMBIEN) 10 mg PO daily at bedtime as needed for sleep
Itching: (choose only one)
diphenhydrAMINE (BENADRYL) 25 mg PO every ____ hours as needed for mild to moderate itching
diphenhydrAMINE (BENADRYL) 50 mg PO every ____ hours as needed for mild to moderate itching
Nausea / Vomiting:
ondansetron (ZOFRAN) 4 mg IV push every 4 hours as needed for nausea and/or vomiting
promethazine (PHENERGAN) _____ mg IM every 4 hours as needed for nausea and/or vomiting if unrelieved by ZOFRAN.
Mild Pain (1 - 3) (choose only one)
ibuprofen (MOTRIN) 800 mg PO every 8 hours as needed for mild pain
acetaminophen (TYLENOL) 650 mg PO every 4 hours as needed for mild pain or fever
Moderate Pain (4 - 6) (choose only one)
acetaminophen-HYDROcodone (NORCO 5) 5/325 mg 1 or 2 tablets PO every 4 hours as needed for moderate pain
Severe Pain (7 - 10) (choose only one)
acetaminophen-oxyCODONE (PERCOCET) 5/325 mg 1 or 2 tablets PO every 4 hours as needed for severe pain
acetaminophen-HYDROcodone (NORCO 10) 10/325 mg 1 or 2 tablets PO every 4 hours as needed for severe pain
butorphanol (STADOL) _____ mg IM every 3 hours as needed for severe pain
See separate PCA orders.
Date:____________
(Required)
Time:_______________
(Required)
Cell/Pager:__________________________
_______________________________________
Prescriber's Signature
_______________________________________
Printed Name
Scanned to pharmacy / entered into TDS by:
_______________________Date_____________Time______
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT171*
PHYSICIAN ORDERS
OB CESAREAN SECTION POSTOP - Routine
E.F. 171-0931 Rev. 6/11 Pg. 2 of 4
Orders verified by:
_______________________Date_____________Time______
PHYSICIAN'S ORDERS
Mark in for desired orders. If is blank, order is inactive.
OB CESAREAN SECTION POSTOP - Routine
Postop Day One:
Date: ___/___/___
Activity
Ambulate __________________________
May shower and remove dressing
Diet
Clear liquids
Full liquids
Regular _________________________
Nursing Orders:
Discontinue urinary catheter ___________________
Discontinue IV ___________________
Discontinue saline lock IV ___________________
Heating pad as needed.
Instruct in management of engorgement.
Vaccines:
Rubella vaccine if non-immune and if patient is not allergic to vaccine components.
MMR, if indicated and if patient is not allergic to vaccine components
Tdap vaccine if patient is not allergic to vaccine components.
Date:____________
(Required)
Time:_______________
(Required)
Cell/Pager:__________________________
_______________________________________
Prescriber's Signature
_______________________________________
Printed Name
Postop Day Two:
Date: ___/___/___
Activity
Ambulate __________________________
Diet
_________________________________________
Date:____________
(Required)
Time:_______________
(Required)
Cell/Pager:__________________________
_______________________________________
Prescriber's Signature
_______________________________________
Printed Name
Scanned to pharmacy / entered into TDS by:
_______________________Date_____________Time______
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT171*
PHYSICIAN ORDERS
OB CESAREAN SECTION POSTOP - Routine
E.F. 171-0931 Rev. 6/11 Pg. 3 of 4
Orders verified by:
_______________________Date_____________Time______
PHYSICIAN'S ORDERS
Mark in for desired orders. If is blank, order is inactive.
OB CESAREAN SECTION POSTOP - Routine
Discharge Orders:
Return to Office: ____________________________
Check all that apply:
Discharge home today.
Special Instructions
Pelvic rest for ______ week(s)
No heavy lifting for ______ week(s)
No driving for ______ week(s)
Remove staples and apply steri strips
Return to ____________________ for staple removal
Other: __________________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Date:____________
(Required)
Time:_______________
(Required)
Cell/Pager:__________________________
_______________________________________
Prescriber's Signature
_______________________________________
Printed Name
Patient expresses understanding of discharge instructions.
______________________________________________
_________________________________________________
Patient / Guardian Signature
Nurse Signature
______________________________________________
_________________________________________________
Patient / Guardian Printed Name
Nurse's Printed Name
Scanned to pharmacy / entered into TDS by:
_______________________Date_____________Time______
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT171*
PHYSICIAN ORDERS
OB CESAREAN SECTION POSTOP - Routine
E.F. 171-0931 Rev. 6/11 Pg. 4 of 4
Orders verified by:
_______________________Date_____________Time______