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New Professions Technical Institute |
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ASSOCIATE SCIENCE IN NURSING |
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CLINICAL WORKSHEET: MATERNITY NURSING PROCESS CARE PLAN |
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STUDENT NAME |
DATE |
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Client Initials |
Culture/Ethnicity |
Support System |
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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 |
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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 |
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
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M |
Admissions Vital Signs |
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A |
T |
Frequency |
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B |
P |
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U |
R |
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BB |
B/P |
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L |
Allergies/Side Effects |
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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 |
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Lab Test # 1 |
Lab Test # 2 |
Lab Test # 3 |
Lab Test # 4 |
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Hgb/Hct #1 |
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Hgb/Hct #2 |
Results |
Results |
Results |
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Hgb/Hct #3 |
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. |
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Rationale for abnormal results |
Rationale for abnormal results |
Rationale for abnormal results |
Rationale for abnormal results |
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. |
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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 |
cc/hr |
gtts/min |
2 milliunits/minute via pump |
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Additives |
Additives |
30 U Oxytocin |
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Rationale for solution |
Rationale for solution |
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. |
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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 |
