Name
Item
Name of attending physician
text
Phone
Item
Phone number of attending physician
integer
Admitting Diagnosis
Item
Post-Partum Endometritis Associated Diagnoses
text
Diet
Item
Clear liquid
boolean
Diet
Item
AHA step 2
boolean
Diet
Item
ADA__calories
boolean
Diet
Item
If Diet according to ADA, please specify amount of calories
integer
Diet
Item
If Other, please specify
text
Activity
Item
Bed rest with bedside commode
boolean
Activity
Item
Bathroom privileges
boolean
Activity
Item
Up ad lib
boolean
Nursing
Item
Vital signs ever 4 hrs for 24 hrs then every shift
boolean
Nursing
Item
Notify MD for: T > 101.5, P > 120, BP < 90/60 or > 180/110
boolean
Nursing
Item
Daily weight
boolean
Medications
Item
Unasyn 3 mg IVPB every 6 hrs
boolean
Medications
Item
Clindamycin 900mg IVPB every 8 hrs (if patient PCN sensitive)
boolean
Item
If patient is toxic add to the above:
text
Code List
If patient is toxic add to the above:
CL Item
Gentamycin 80 mg IVPB every 8 hrs obtain trough before 4th dose OR (1)
CL Item
Metronidazole 15 mg/kg load = ____mg x1 dose and Metroidazole 7.5 mg/kg (up to 500mg)=___mg IVPB every 8 hrs (2)
Medications
Item
If Metronidazole please specify 15 mg/kg load =___mg
integer
Medications
Item
If Metronidazole, please specify 7.5 mg/kg(up to 500 mg)=____mg
integer
Medications
Item
Tylenol 500 mg 2 tabs PO every 4 hrs prn fever/pain
boolean
Medications
Item
Prenatal vitamin 1 PO daily if breast-feeding
boolean
IV
Item
IV lock; flush per routine
boolean
IV
Item
IV___at mL/hr
boolean
IV
Item
If IV____at mL/hr, please specify amount
integer
Lab
Item
Admission: CBC, basal metabolic profile
boolean
Lab
Item
If culture: lochia
boolean
Lab
Item
If culture: blood x2
boolean
Lab
Item
If culture: urine
boolean
Lab
Item
If culture: abdominal incision
boolean
Lab
Item
Daily CBC
boolean