| New Professions Technical Institute | |||||||
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| ASSOCIATE SCIENCE IN NURSING | |||||||
| CLINICAL WORKSHEET: MATERNITY NURSING PROCESS CARE PLAN | |||||||
| STUDENT NAME |
| DATE |
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| Client Initials |
| Culture/Ethnicity |
| Support System | |||
| Unit |
| Room/Bed |
| Religion |
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| Age |
| Sex |
| Language |
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| Pre-preg Wt |
| Pre-preg Ht |
| Marital Status |
| Children & Ages | |
| Current Wt |
| Current Ht |
| Occupation |
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| G | T | P | A | L | Health Insurance |
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| Current Work Status |
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| Current Medical Diagnosis |
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| Name of Significant Other/Primary Caregiver | ||||
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| Highest Grade Completed |
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| Pain Rating, Quality & Location |
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| Infant Feeding |
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| Date/Time of Delivery |
| Delivery Type (Vaginal, Cesarean**, Forceps, Vacuum) |
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| **Reason for Cesarean |
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| Diagnostic procedures |
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| Surgical procedures |
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| Pathophysiology/Psychopathology (List Reference) | |||||||
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Reference |
Today’s Assessment
| M |
| Admissions Vital Signs | ||
| A |
| T |
| Frequency |
| B |
| P |
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| U |
| R |
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| BB |
| B/P |
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| L |
| Allergies/Side Effects | ||
| E |
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| H |
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| Brief Health History | Diet with Rationale | |||
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| Time | Flowsheet Notes | Activity Order | ||
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| Limitations/Prosthetic Device | ||
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| PERTINENT LABORATORY DATA | ||||||||
| Lab Test # 1 |
| Lab Test # 2 |
| Lab Test # 3 |
| Lab Test # 4 | ||
| Hgb/Hct #1 |
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| Hgb/Hct #2 |
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| Results |
| Results |
| Results | |
| Hgb/Hct #3 |
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| Rationale for abnormal results |
| Rationale for abnormal results |
| Rationale for abnormal results |
| Rationale for abnormal results | ||
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| INTRAVENOUS SOLUTION #1 |
| INTRAVENOUS SOLUTION #2 | ||||||
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Type | Lactate Ringers’ (main IV) |
| Type | 500 ml NS (piggyback) | ||||
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cc/hr | 125 | gtts/min |
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| cc/hr |
| gtts/min | 2 milliunits/minute via pump |
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Additives |
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| Additives | 30 U Oxytocin | ||||
| Rationale for solution |
| Rationale for solution | ||||||
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| Medication Name Generic/Trade | Classification | Major Actions (why taking meds) | Dose/ Route Safe Range | Adverse Effects | Nursing Implications |
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Assessment Data Subjective/Objective |
Nursing Diagnosis |
Plan Outcome Criteria (Client Centered) |
Interventions (Nurse Centered) |
Rationale for Interventions (REFERENCED) |
Evaluation |
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Assessment Data Subjective/Objective |
Nursing Diagnosis |
Plan Outcome Criteria (Client Centered) |
Interventions (Nurse Centered) |
Rationale for Interventions (REFERENCED) |
Evaluation |
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