OBSTETRICS

Rm:
Name:
Allergies:
Blood type:
gest:
VS:
0800 T:
O2:
0800 T:
O2:
0800 T:
O2:
0800 T:
O2:
0800 T:
O2:
0800 T:
O2:
0800 T:
O2:
Pain: O
L
R
T

Age:
MR#:

Med Hx:
Sx Hx:

L __

wks
Preg Hx:

HR:

RR:

BP:

HR:

RR:

BP:

HR:

RR:

BP:

HR:

RR:

BP:

HR:

RR:

BP:

BABY: B / G

HR:

RR:

BP:

HR:

RR:

BP:

Wt: _______gm _____lb _____oz.

type:______
APGARS:
Bath
[ ]
Labs:
Circ Y / N [ ]

time deliv:____________
blood

Hep B [ ]
Vit K

[ ]

Eyes [ ]
Cardiac: Rhythm: NSR / ST / SB
Apical
pulse:
Cap refill: <3 s / >3 s
S1 / S2 / S3 / murmur / click / lifts / heaves

Anesthesia: epidural / spinal / none /

_______________

Pulm: RA / NC / SM / NRB
@ __________
L/min
RT tx: C / Fcrckles / Ccrckl / H / D / bilat R L

Breasts: soft / filling / firm

hot / red /
discolor
Nipple inverted / flat / everted
comfort:
Intact / bleeding / cracked / redness

GI: Diet:
_____ Tube ___fr _____cm @ nare
Active / hypo / hyper
non -- distended
soft / firm
Last BM _______
hemorrhoids
GU: ____________foley
12H
U/O=_________cc/hr
Difficulty voiding: Y / N
non -distended
Neuro: GCS ___

Feeding: breast / formula / both

Uterus: firm / soft / boggy

Fundal ht ________ FBs @ _________ hrs PP
Location: midline / dev L / R
Fundal ht ________ FBs @ _________ hrs PP
Location: midline / dev L / R

Perineum/episiotomy: laceration _____o

C/S incision: T / C well approx. / dehis / red /

OBSTETRICS
drainage
Pupil R___/___ L___/___ E R B S F
Alert & Oriented x 1 2 3 4

Lochia: EBL _________ mL

Upper Mvmnt: non -- symmetrical L / R / bilat

Lower Mvmt: non -- symmetrical L / R / bilat
Weakness: L / R
U / L / bilat

1 g = 1 mL
_____ S / L / M / H
_____ S / L / M / H
_____ S / L / M / H

Skin: warm / moist / color AFE

Abnormals:

WBC
Gluc

Cl

BUN

CO2

Plt
Hct

wt_______
wt_______
wt_______

Emotion:
NB interaction: eye cont / talks / holds / feeds
Anxiety / crying / exhaustion

Labs:

Na

Homan (Extremities): ped pulse

Color:_____________ Temp:_____________
Blanchable: Y / N
DVT: pain / edema / redness / + HS / skin temp

IV site 1: _________,
IVF:______________@_____mL/hr
IV site 2: _________,
IVF:______________@_____mL/hr
Hgb

R/S/A
R/S/A
R/S/A

Creat