Name:

______________________________________________ Rm # _________

G______P_____________ Description: ___________________________________

Overnight issues: None /

Pain: Well tolerated with meds/without meds / Not well tolerated

Amb: Without difficulty / With difficulty: (CP, SOB, Dizziness)

Voiding: asymptomatic / dysuria/ catheter in place /

Lochia: scant / small / moderate / heavy / appropriate

Diet: NPO / clear liquids / regular ; well tolerated? Y/N

Baby: Bedside / nursery ; Breastfeeding / Bottle / both ; Difficulty?

Contraception: Declines / Undecided /

Other: + Fever / Chills / Nausea / Vomiting / Chest Pain / Dyspnea

Vitals: Tmax: ______ BP: ________ P:________ RR:_________
Gen: AAO, responding appropriately;
CV: RRR, no m/g/r;
Lungs: CTAB;
Abd: soft, no guarding, rigidity, or rebound tenderness;
Uterus: firm below level of umbilicus;
Incision: c/d/i; bandage w/o leakage of fluids; staples w/ no
warmth, erythema, exudates;
Ext: no calf tenderness or edema;
Labs: Hct _____ Hgb______

A/P: s/p (SVD, PLTCS, RLTC) at wks c/b, doing well, POD#, normal
post-op/partum progression, discharge 48h if SVD and 72h if C/S

Name: ______________________________________________ Rm # _________

G______P_____________ Description: ___________________________________

Overnight issues: None /

Pain: Well tolerated with meds/without meds / Not well tolerated

Amb: Without difficulty / With difficulty: (CP, SOB, Dizziness)

Voiding: asymptomatic / dysuria/ catheter in place /

Lochia: scant / small / moderate / heavy / appropriate

Diet: NPO / clear liquids / regular ; well tolerated? Y/N

Baby: Bedside / nursery ; Breastfeeding / Bottle / both ; Difficulty?

Contraception: Declines / Undecided /

Other: + Fever / Chills / Nausea / Vomiting / Chest Pain / Dyspnea

Vitals: Tmax: ______ BP: ________ P:________ RR:_________
Gen: AAO, responding appropriately;
CV: RRR, no m/g/r;
Lungs: CTAB;
Abd: soft, no guarding, rigidity, or rebound tenderness;
Uterus: firm below level of umbilicus;
Incision: c/d/i; bandage w/o leakage of fluids; staples w/ no
warmth, erythema, exudates;
Ext: no calf tenderness or edema;
Labs: Hct _____ Hgb______

A/P: s/p (SVD, PLTCS, RLTC) at wks c/b, doing well, POD#, normal
post-op/partum progression, discharge 48h if SVD and 72h if C/S

C. Ren

Name: ______________________________________________ Rm # _________

G______P_____________ Description: ___________________________________

Overnight issues: None /

Pain: Well tolerated with meds/without meds / Not well tolerated

Amb: Without difficulty / With difficulty: (CP, SOB, Dizziness)

Voiding: asymptomatic / dysuria/ catheter in place /

Lochia: scant / small / moderate / heavy / appropriate

Diet: NPO / clear liquids / regular ; well tolerated? Y/N

Baby: Bedside / nursery ; Breastfeeding / Bottle / both ; Difficulty?

Contraception: Declines / Undecided /

Other: + Fever / Chills / Nausea / Vomiting / Chest Pain / Dyspnea

Vitals: Tmax: ______ BP: ________ P:________ RR:_________
Gen: AAO, responding appropriately;
CV: RRR, no m/g/r;
Lungs: CTAB;
Abd: soft, no guarding, rigidity, or rebound tenderness;
Uterus: firm below level of umbilicus;
Incision: c/d/i; bandage w/o leakage of fluids; staples w/ no
warmth, erythema, exudates;
Ext: no calf tenderness or edema;
Labs: Hct _____ Hgb______

A/P: s/p (SVD, PLTCS, RLTC) at wks c/b, doing well, POD#, normal
post-op/partum progression, discharge 48h if SVD and 72h if C/S

C. Ren




Name: ______________________________________________ Rm # _________

G______P_____________ Description: ___________________________________

Overnight issues: None /

Pain: Well tolerated with meds/without meds / Not well tolerated

Amb: Without difficulty / With difficulty: (CP, SOB, Dizziness)

Voiding: asymptomatic / dysuria/ catheter in place /

Lochia: scant / small / moderate / heavy / appropriate

Diet: NPO / clear liquids / regular ; well tolerated? Y/N

Baby: Bedside / nursery ; Breastfeeding / Bottle / both ; Difficulty?

Contraception: Declines / Undecided /

Other: + Fever / Chills / Nausea / Vomiting / Chest Pain / Dyspnea

Vitals: Tmax: ______ BP: ________ P:________ RR:_________
Gen: AAO, responding appropriately;
CV: RRR, no m/g/r;
Lungs: CTAB;
Abd: soft, no guarding, rigidity, or rebound tenderness;
Uterus: firm below level of umbilicus;
Incision: c/d/i; bandage w/o leakage of fluids; staples w/ no
warmth, erythema, exudates;
Ext: no calf tenderness or edema;
Labs: Hct _____ Hgb______

A/P: s/p (SVD, PLTCS, RLTC) at wks c/b, doing well, POD#, normal
post-op/partum progression, discharge 48h if SVD and 72h if C/S

C. Ren

C. Ren