Admit to:  L&D/OBS
Service:  FCM or OB
Attending:
Resident:
Dx:  TIUP, GDM, PE, etc.
Condition: 
Allergies:
VS:  call if T> 100.4, BP > 140/90, < 90/60
Diet:  NPO except IC
Activities: 

• BR
• EM'sx2
• NS @ 125 ml/hr (if diabetic)
• D5 1/2 NS @ 125 ml/hr (otherwise)
• Accu-Cheks q 4 hr (if A1GDM)
• Accu-Cheks q 2hr (if >A1GDM)
• Circle CBC, RPR, Hep B, T&S, HIV (these are routine labs)
  (If no prenatal care, then circle rubella, GC, Chlamydia, GBS if suspect pt. to deliver or if pt.  >/=35weeks)
• Pre-eclampsia labs (CBC, SMA 7, LFTs, Uric Acid) if necessary
• Okay for ITN (intra-thecal narcotic- for anesthesia)
• Foley prn

Meds:

• If pre-eclampsia:  Magnesium 4 gm load then 2 gm IV q hr, Magnesium
  level and tox check q 6 hr, D5 ½ NS at 100 ml/hr, Foley to gravity, Strict I&O’s.
• If eclampsia:  Magnesium Sulfate 4gm IM into each buttock if don’t have an IV.
• GBS prophylaxis: Ampicillin 2g IV load then 1g Q4° 
  • If allergic to penicillin, then Clindamycin 900mg IV Q 8h.
    (Goal: to have antibiotic load given at least 4h before delivery)
• If preterm (<34 weeks):  Betamethasone 12 mg IM q 24 hours x 2 OR Dexamethasone 6mg IM q 12 hours x 4. 
• If diabetic:   NS @ 125ml/hr, Accu-Cheks Q4hrs if A1GDM, Q 2hrs if >A1GDM.

PROG NOTES PPD # 1

Rounds start at 9 a.m.

S: Ambulating, voiding, eating without difficulties,lochia decreasing breast/bottle feeding.

O: current vitals

PE: Gen: AAOx3, NAD
CV:S1/S2, no M/R/G
Lungs: CTAB
Abd: Soft, NT/ND, Uterus @ or below umbilicus, BS+, Incision C/D/I without erythema or exudates.
Ext: no edema NT, Homan’s sign negative

Labs: recent labs and also include rubella status, RPR, Hep B & HIV from routine prenatal card. If mom Rh negative then include baby blood type @ Rh

A/P:   20 y/o G3 now P3003 PPD #1 s/p SVD having no complains ,Mother is O+, RPR NR, Rubella I, Hep B (-), HIV (-), GBS (-), Gc/Chl (-).  39 1/7 weeks by dates.  Mother had 10 prenatal visits starting at 23 weeks gestation

1. Continue with routine care.
2. Anticipate discharge home tomorrow.

PPD # 2

As above note if any new changes and D/C home today if no complications.

POST PARTUM ORDERS   

Circle appropriate items on order form. 

• If pre-eclamptic (mild 12h/severe 24h):  Magnesium @ 2 gm/hr, FTG, Magnesium levels and Tox check q 6 hrs, Total ins:  125 if mild, 100 if severe
• If chorio:  treat with Unasyn 3g IV Q 6

ELECTIVE C/S ORDERS

• Abdominal prep
• Anesthesia preop
• Isolyte x 2 @ 125 ml/hr
• Circle CBC, RPR, Hep B, T&S, HIV (Routine labs w/ HIV)
• Sodium Citrate 30 ml po 30 min OCTOR
• Foley to gravity
• Unasyn 3g IV x 1 at cord clamp

S/P C/S ORDERS

• Admit:  comp OB A/B
• Dx:  s/p 1°LTCS, chorio, etc.
• Condition:  stable
• Vitals:  per routine, call HO for T > 100.4, BP > 140/90, < 90/60
• Allergies:
• Activities:  Bed rest, OOB in AM, ambulate TID
• Nursing:  FTG
• Diet:  Low residue diet after 6°
• IV:  D5 1/2 NS @ 125 ml/hr (NS @ 125 ml/hr if DM)
• Meds:  pain meds per anesthesia x 24° (if epidural or spinal)
              Phenergan 25 mg IV q 4-6 hrs prn N/V
  • If general anesthesia - morphine PCA pump (1 mg/ml - 6 mg load, then 1 mg q 6 min with lock out to max of 20 mg in 4 hours)
  • If CHORIO  (then start– Clindamycin and Gentamicin)
    Clindamycin 900 mg IV q 8 hrs AND Gentamicin   2 mg/kg IV load then 1.5 mg/kg IV q 8 hrs with peak/trough after 3rd dose
    OR  Gentamicin for once a day dosing:        
    Wt in lbs/2.2 =KG  X  7 (if overweight) or 5 (if not overweight) = __ mg IV qd with random Gent level 6-11 hours after start of infusion
    ADD Ampicillin 2 g IV q 6 hours if continuous spikes
• IS (Incentive spirometry) 10x/hr while awake
• Labs:  CBC @ 5 AM,  If chorio - blood cx x 2, urine cx, genital cx,  CBC, SMA-7