Hagerstown Community College Data Base MATERNAL

Student __________________________ Date__________ Pt. Dx._& room number_____________________________ Age__________

Mother Information: G______

T_______

P______

A_____

L______

VITAL INFORMATION:

MEDICATIONS
PURPOSE
Dosage/Route (complete list of open orders from EMAR)

TREATMENTS / NURSING INTERVENTIONS

(use plan of care in pt chart)

EDC:
Baby DOB and time:
Prenatal History & Care:
(from chart under H&P tab)

IV:
#

Solution :

Rate (for pit give mu/min):

Medical Conditions:
ALLERGIES:
Temp:

Pregnancy Complications:
PATIENT TEACHING/LEARNING NEEDS:
(from plan of care, teaching tab in Centricity, and
discharge instructions)

P:
RR:

Type of Delivery:
BP:
Hospital Room:
LAB TESTS

H & H (on
admission)
H & H (PP)

DIET: (from orders)

RESULTS

NORMAL VALUE

SIGNIFICANCE

SPECIAL DISCHARGE INSTRUCTIONS:

MATERNAL ASSESSMENT
NEUROLOGICAL

ASSESSMENT 1

ASSESSMENT 2

PSYCHOSOCIAL ASSESMENT

Mother/Infant Interaction

Family relationships / issues /

concerns:

Father/ Family support:

Coping skills:

Parenting skills:

Cultural influences:

RESPIRATORY

CARDIOVASCULAR

GASTROINTESTINAL

GENITOURINARY

NEUROVASCULAR

MUSCULO-SKELETAL

INTEGUMENT

MISCELLANEOUS