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