Unique Plan Description: OB Vaginal Delivery Postpartum
Plan Selection Display: OB Vaginal Delivery Postpartum
PlanType: Medical                                 
Version: 2          
Begin Effective Date: 2020-04-21 19:26:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-05-08 12:51:48
Available at all facilities: Yes

OB Vaginal Delivery Postpartum
Activity
	Activity-As Tolerated
		T;N
			Comment: MWH/MJE ONLY: Patient may leave patient care unit while remaining on campus as desired when medically appropriate.
Diet
	Regular Diet
		T;N
		T+1;0600
Laboratory
	Glucose POC - RN
		QIDACHS
		ACBKFST
		TIDPC
		TIDAC
	Tissue Request Placenta
		T;N, Placenta
		Diabetes Monitoring(NOTE)*
	Glucose POC - RN
		ACBKFST
		TIDPC, 24, hr
		T;N, No Glycemic Monitoring
	Hemoglobin and Hematocrit
		T+1;0400, Routine, spec type = Blood
IV Solutions
	oxytocin 30 units/500mL Premix IV
		500 mL, IV, Routine, T;N, 24 hr
			Comment: Infuse 15 units over 15 minutes (999mL/hr) immediately post partumFollowed by 15 units over 3 hours (83.3mL/hr) immediately after first bolus dose is completed - The Initial postpartum infusion rate may be decreased prior to 15 minutes based on patient's clinical status and communication between the surgeon and anesthesia provider. - RN will be responsible to adjust IV rate.
		30 units, EVERY BAG, 59.94 units/hr
Medications
		Pain Medications(NOTE)*
	ibuprofen
		800 mg, Tab, BY MOUTH, Q8H, T;N
			Comment: Alternate every 4 hours with acetaminophen
	acetaminophen
		1,000 mg, Tab, By Mouth, Q8H, T;N+240
			Comment: Alternate every 4 hours with ibuprofen
	oxyCODONE
		5 mg, Tab, By Mouth, Q4H, PRN for pain-moderate
			Comment: For pain rating 4-6. If inadequate relief after 1 hour, may repeat dose if pain level moderate (pain rating 4-6) to severe (pain rating 7-10).  If repeat dose given, administer next dose at 4hr minimum unless otherwise prescribed.
		10 mg, Tab, By Mouth, Q4H, PRN for pain-severe
			Comment: For pain rating 7-10.
	ketorolac injectable
		15 mg, Injection, IV Push, Q6H, PRN for pain-mild, duration: 48 hr
			Comment: For pain rating 1-3 and if NPO. Give at least 6 hours after last ibuprofen dose.
	morphine  IV
		2 mg, Syringe, IV Push, Q2H, PRN for pain-moderate
			Comment: For pain rating 4-6; may give if NPO or for breakthrough pain if on oral analgesics.
		4 mg, Syringe, IV Push, Q2H, PRN for pain-severe
			Comment: For pain rating 7-10; may give if NPO or for breakthrough pain if on oral analgesics.
		Opiate Reversal(NOTE)*
	Narcan
		0.2 mg, Injection, IV Push, Q2MIN, PRN for see comment
			Comment: RN may administer naloxone prior to contacting MD, if patient has received opiate agents in the past 24hrs, and if patient becomes somnolent with minimal or no response to stimuli or respiratory rate is less than or equal to 10bpm. May give 0.2mg every 2 minutes up to 1mg total dose.
		Constipation(NOTE)*
	Colace
		100 mg Capsule BY MOUTH DAILY
			Comment: Hold if diarrhea
		100 mg, Capsule, BY MOUTH, BID
			Comment: Hold if diarrhea
	Senokot S 50 mg-8.6 mg oral tablet
		2 TAB, Tab, By Mouth, QHS
	MiraLax oral powder for reconstitution
		17 gm, Packet, By Mouth, Q12H, PRN for constipation
			Comment: Mix in 6 oz juice or water
		17 gm, Packet, By Mouth, DAILY, for constipation
			Comment: Mix in 6 oz juice or water
	Milk of Magnesia
		30 mL, Suspension, By Mouth, DAILY, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min.
		30 mL, Suspension, By Mouth, Q12H, PRN for constipation
			Comment: If Miralax not effective; do not use if creatinine clearance or GFR < 30mL/min.
	Dulcolax
		10 mg, Suppository, RECTALLY, DAILY, PRN for constipation
			Comment: If MOM ineffective or if patient NPO.
		10 mg, Suppository, RECTALLY, Q12H, PRN for constipation
			Comment: If MOM ineffective or if patient NPO.
		Nausea(NOTE)*
	ondansetron
		4 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED and unable to take oral meds.
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
			Comment: Administer for nausea if not previously administered by anesthesia, PACU, or ED
	prochlorperazine
		10 mg, Injection, IV Push, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures.
		25 mg, Suppository, RECTALLY, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures, give if IV access not available.
	Phenergan (MH/WH)
		25 mg, Tab, By Mouth, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures.
		25 mg, Suppository, RECTALLY, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		6.25 mg, Injection, IV Push, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Phenergan (JE)
		25 mg, Tab, By Mouth, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		25 mg, Suppository, RECTALLY, BID, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Phenergan (FH)
		25 mg, Tab, By Mouth, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures.
		25 mg, Suppository, RECTALLY, BID, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
		12.5 mg, INT, IVPB, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures; give if unable to take oral meds.
	Reglan
		10 mg, Injection, IV Push, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective.
		10 mg, Injection, IM-Intramuscular, Q6H, PRN for nausea and/or vomiting
			Comment: Give if ondansetron and phenothiazine ineffective.
	Tums E-X
		750 mg, Tablet-Chew, By Mouth, Q1H, PRN, indigestion
	Tums (JE-FH)
		500 mg, Tablet-Chew, By Mouth, Q1H, PRN, indigestion
	simethicone
		80 mg, Tablet-Chew, BY MOUTH, Q4H, PRN, gas
	Ambien
		5 mg, Tab, BY MOUTH, QHS, PRN, insomnia
	benzocaine-menthol 20%-0.5% topical spray
		1 spray, Spray, TOPICAL, Q1H, PRN for discomfort
	witch hazel pre-moistened pads
		1 appl Pad TOPICAL Q4H, PRN discomfort
			Comment: Use if Dermoplast (benzocaine) Spray ineffective.
	Anusol-HC 2.5% rectal cream
		1 appl, Cream, RECTALLY, Q1H, PRN, hemorrhoids
			Comment: Use if Tucks ineffective.
	hydrocortisone-pramoxine 2.5%-1% topical cream
		1 appl, Cream, TOPICAL, Q1H, PRN, hemorrhoids
			Comment: as needed if Tucks or other rectal medications are ineffective
	mupirocin 2% topical ointment
		1 appl, Ointment, TOPICAL, TID, PRN for see comment
			Comment: for nipple trauma: to nipples as needed for persistent cracks, fissures, yellow crusted lesions, weeping wound.
	dibucaine 1% topical ointment
		1 appl, Ointment, TOPICAL, Q1H, PRN for hemorrhoids
	Benadryl
		25 mg, Tab, BY MOUTH, Q6H, PRN for itching
Immunizations
		IF patient is rubella non immune or equivocal, RN may place MMR vaccine order below.(NOTE)*
	M-M-R II injection
		0.5 mL, Injection, SUBCUTANEOUS, Once, T;N+720
Patient Care

	Intake and Output
		Q12H-Sch
	Resuscitation Status
		Full Code
		No Code
	Cold Therapy
		Ice bag, Perineum, PRN discomfort
	Heat Therapy
		Aqua K, PRN as desired
	Discontinue IV
		T;N, When stable
			Comment: for a minumum of 2 hrs.
	Straight Catheter
		Insert, unable to void
			Comment: If 3rd catheterization required, enter order for Foley catheter insert, ordered by Urologist/GYN once and insert foley catheter.
	VTE Advisor
		Pregnancy or Postpartum
	Notify MD
		Obstetric Call Parameters: SBP >160 mmHg and/or DBP >110 mmHg, P: >120 or <50, O2 Sat: <90%, RR: <10 or >30, Oliguria: <60 mL in 2 hours, Single Temp > 39.0C (102.2F), OR 2 temps between 38.0C (100.4F) and 39C (102.2F), at least 30 min apart
		If blood sugar is > or = 300
	Pulse Oximetry Spot Check by nurse
		T;N
			Comment: If Sat <95%, notify Respiratory Therapy, and enter Oxygen Protocol, titrate/wean to keep sats > or = 90%
Consults/Follow-up
	Consult Lactation Consultant
		
	Pharmacy Consult
		T;N, Consult pharmacy for allergy history and options for pain management

Peripheral Lock - Access
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

DVT VTE Prophylaxis (FH)
Laboratory
	CBC with Diff
		T;N, Routine, spec type = Blood
		T+1;0500, Routine, EVERY OTHER DAY, spec type = Blood
		T+1;0500, Routine, Q24H 3 Day(s), spec type = Blood
		T+1;0500, Routine, Q24H, spec type = Blood
	BMP
		T;N, Routine, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Routine, spec type = Diagnostic Blood
		T+1;0500, Q24H, spec type = Therapeutic Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Routine, spec type = Diagnostic Blood
Medications
		See VTE Risk Assessment for patient risk score(NOTE)*
	Lovenox
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
		30 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		For CrCl < 30 mL/min(NOTE)*
		30 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000. D/C lovenox if INR > 1.8
		For Patients > 150 kg(NOTE)*
		40 mg, Syringe, SUBCUTANEOUS, BID
			Comment: NOTIFY physician if platelets < 130,000
		40 mg, Syringe, SUBCUTANEOUS, DAILY
			Comment: NOTIFY physician if platelets < 130,000
Anticoagulants
		Baseline INR required for Coumadin(NOTE)*
	warfarin
		5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, Once
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		2.5 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		10 mg, Tab, By Mouth, DAILY
			Comment: Notify MD and Hold Coumadin if INR > 2.5
		ORTHO ONLY(NOTE)*
	Xarelto
		10 mg, Tab, By Mouth, DAILY
	dabigatran
		150 mg, Capsule, By Mouth, BID
			Comment: Check renal function
	Eliquis
		2.5 mg, Tab, By Mouth, BID
			Comment: Hip Replacement: Duration of therapy 35 days  Knee Replacement: 12 days
	HEParin 5000 units/mL SUBCUTANEOUS
		5,000 units, Syringe, SUBCUTANEOUS, TID
		5,000 units, Syringe, SUBCUTANEOUS, BID
Patient Care

	Impulse Foot Pumps
		To be worn at all time while patient is not bearing weight
	Sequential Compression Device
		T;N, Wear, Both legs
			Comment: To be worn at all times while patient is not bearing weight
	Anti Embolism Stockings
		TED hose, knee high, Both legs
		TED hose, knee high, Left leg
		TED hose, knee high, Right leg
		TED hose, thigh high, Both legs
		TED hose, thigh high, Left leg
		TED hose, thigh high, Right leg
	Notify MD
		Contact Physician if INR < 1.8 on Day of Dismissal
Therapies
	Consult Physical Therapy, Evaluate and Treat
		
Consults/Follow-up
	Pharmacy Consult
		D/C Lovenox if INR > 1.8
		D/C Lovenox if INR > 2.0
		Contact MD and Hold Coumadin if INR > 2.5
		Contact MD and Hold Coumadin if INR > 3.0
		Contact MD and Hold Coumadin if INR > 3.5

OB Hemorrhage Meds (FH)
Laboratory
	Type and Screen (No Product on hold)
		Routine, spec type = Blood
Medications
	Cytotec
		800 mcg, Tab, RECTALLY, Once, PRN, bleeding
	Methergine
		0.2 mg, Injection, IM-IntraMUSCULAR, Q2H, PRN, uterine relaxation
			Comment: Avoid in hypertensive patients
	Hemabate
		250 mcg, Injection, IM-IntraMUSCULAR, Q15MIN, PRN, uterine relaxation, 8 Dose(s)/Time(s)
			Comment: Avoid in asthmatic patients.  Relative contraindication if hepatic, renal and cardiac disease
	tranexamic acid
		1,000 mg, Solution, IV Push, Once, PRN for see comment
			Comment: Hemorrhage management, push slowly over 10 minutes to avoid hypotension.
	oxytocin 30 units/500mL Premix IV
		500 mL, IV, Routine, T;N
			Comment: infuse 15 units over 15 minutes (999ml/hr), if firm uterine tone present, change rate to 15 units over 3 hours (83.3ml/hr)
		30 units, EVERY BAG

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase