PHYSICIAN'S ORDERS
Mark in for desired orders. If is blank, order is inactive.
OB POSTPARTUM VAGINAL DELIVERY HOSPITAL ORDERS
Unit
Postpartum
Isolation
Standard
Med Monitored
Contact
Diagnosis
Normal delivery
Other: ______________________________
Strict Contact
Droplet
Airborne
Complications: ___________________________________________________________
Admitting Physician ______________________________________________________________
Attending Physician ______________________________________________________________
Consulting Physician _____________________________________________________________
Allergies
NKDA
Other: _______________________________________________
Code Status
Full Code
Condition
Stable
Fair
Guarded
Critical
Activity
As tolerated. May shower
Diet
Regular diet if bottle feeding, lactation diet if breast feeding.
Nursing Orders
Vital signs every 15 minutes times 8, then every 30 minutes times 2, then every 1 hour times 4, then every 4 hours.
Temperature every 4 hours for 8 hours, then every 8 hours.
Routine fundus care and pericare; surgigater three times as needed; ice pack for 8 hours and as needed.
I & O. If unable to void in 4 to 6 hours, straight catheter. Insert urinary catheter if second catheterization is necessary.
Instruct in engorgement management.
Heating pad as needed.
Rhogam work-up if patient Rh negative. Rhogam administration as indicated:
Mother's Rh ______
Infant's Rh ______
Accuchecks, fasting and 2 hours postprandiol.
Urinary catheter to gravity drainage
Laboratory
Draw at 4:00 a.m. on first postpartum day:
CBC
H&H
None
IV Fluids
RL with 20 units pitocin (OXYTOCIN) / L in first 2 liters at rate of 125 mL per hour in recovery, then 125 mL per hour for
at least 4 hours.
D5RL with 20 units pitocin (OXYTOCIN) / L in first 2 liters at rate of 125 mL per hour in recovery, then 125 mL per hour for
at least 4 hours.
Keep IV open for 4 hours post delivery, then may discontinue if patient is stable.
May discontinue IV if infilitrates.
Prescriber's Signature
Scanned to pharmacy / entered into TDS by:
_______________________Date_____________Time______
TRINITY MOTHER FRANCES
HOSPITALS AND CLINICS
*DT171*
PHYSICIAN ORDERS
OB POSTPARTUM VAGINAL DELIVERY
HOSPITAL ORDERS
E.F. 171-0793 Rev. 6/11 Pg. 1 of 3
Orders verified by:
_______________________Date_____________Time______
PHYSICIAN'S ORDERS
Mark in for desired orders. If is blank, order is inactive.
OB POSTPARTUM VAGINAL DELIVERY HOSPITAL ORDERS
Medications - Scheduled
MMR vaccine if rubella non-immune and if patient is not allergic to vaccine components
Tdap vaccine if patient is not allergic to vaccine components and over 2 years since last dT immunization.
Medications - Contingency (PRN) (Confirm patient allergies prior to administration.)
diphenhydrAMINE (BENADRYL) 25 mg PO every 6 hours as needed for mild to moderate itching
acetaminophen (TYLENOL) 650 mg PO every 4 hours as needed for fever greater than 101.5
simethicone (MYLICON) 160 mg PO every 4 hours as needed for gas
glycerin-witch hazel topical (TUCKS) at bedside. Apply topically to perineum as needed for local discomfort.
hydrocortisone-pramoxine topical (PROCTOFOAM HC) every 8 hours as needed for hemorrhoidal discomfort
lanolin topical (LAN-O-SOOTHE) - Apply after breastfeeding and as needed for sore nipples.
Nausea / Vomiting:
promethazine (PHENERGAN) 25 mg PO every 4 hours as needed for nausea and/or vomiting.
May give 25 mg IM if unable to take PO.
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
bisacodyl (DULCOLAX) suppository 1 per rectum daily as needed for constipation
sodium biphosphate-sodium phosphate (FLEET ENEMA) 1 per rectum 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
Mild Pain (1 - 3) If Motrin and Tylenol are selected, start with Motrin and alternate with Tylenol if Motrin is ineffective.
ibuprofen (MOTRIN) 800 mg PO every 8 hours as needed for mild cramps
acetaminophen (TYLENOL) 650 mg PO every 4 hours as needed for mild pain OR alternate with Motrin if Motrin is also
ordered and is ineffective for pain
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
butorphanol (STADOL) _____ mg IM every 3 hours as needed for severe pain
morphine
mg IV every
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 POSTPARTUM VAGINAL DELIVERY
HOSPITAL ORDERS
E.F. 171-0793 Rev. 6/11 Pg. 2 of 3
Orders verified by:
_______________________Date_____________Time______
PHYSICIAN'S ORDERS
Mark in for desired orders. If is blank, order is inactive.
OB POSTPARTUM VAGINAL DELIVERY HOSPITAL ORDERS
Check all that apply:
Discharge to home on ___________________ (date)
Special instructions
Pelvic rest for 6 weeks
No heavy lifting for ______ weeks.
No driving for ______ weeks.
Other:
Send home visit follow-up report to: _____________________________________
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 POSTPARTUM VAGINAL DELIVERY
HOSPITAL ORDERS
E.F. 171-0793 Rev. 6/11 Pg. 3 of 3
Orders verified by:
_______________________Date_____________Time______