Physician Order Sheet Format

UNCOMPLICATED PREGNANCY
 Please admit patient under the service of Drs.
 Secure consent for admission and management
 NPO temporarily
 Please insert heplock
o Then IVF D5LR 1L x 12hrs
o To start oxytocin side drip: D5LR 1L + 10 ‘u’ oxytocin to run for 10-12 gtts/min then increase
titration until adequate uterine contractions
 Labs: CBC with PC, BTRh
 For trial of labor/vaginal delivery
 For baseline CTG now
 Monitor VS q1 then record, FHT and uterine contraction q1 then record
 Monitor progress of labor
 Refer accordingly

INITIALLY HANDLED BY OTHER INSTITUTION

 Addendum: Therapeutics:
o Ampicillin 2 g IV now ( ) ANST then 1 g IV q6 hrs
o Gentamicin 80 mg IV 20 minutes after cord clamping then q8 hrs
o Metronidazole 500 mg IV now ( ) ANST then q8 hrs

CERVICAL RIPENING
 For cervical ripening using:
o Eveprim 2 capsules per vagina q2
o HNBB 1 amp TIV q4

AUGMENTATION OF LABOR
 Start oxytocin side drip: D5LR 1L + 10 units oxytocin to run 10-12 gtts/min, TITRATE accordingly

PRETERM LABOR
 Please admit patient under the service of Drs.
 Secure consent for admission and management
 DAT
 IVF: D5LR 1L x 12 hours
 Labs: CBC with PC, BTRh, UA
 For control of preterm labor
 For baseline CTGnow
 Therapeutics:
o Isoxuprine drip: D5W 1L + 4 amps isoxuprine to run @ 15-20 drops/min, to be titrated at
increments of 5 gtts/min until no uterine contractionis noted
o Dexamethasone 6 mg/IM now then q6 x 3 more dose
o MgSO4 4 grams SIVP now
 Monitor VS q1 then record
 Monitor FHT and UC q1 then record
 WOF progress of labor
 Refer accordingly

PROM
 Please admit patient under the service of Drs.
 Secure consent for admission and management
  NPO temporarily
 IVF: D5LR 1L x 12 hours
 Labs: CBC with PC, BTRh, UA
 Meds:
o Ampicillin 2 g IV now ( ) ANST then 1 g IV q6 hrs
 For baseline CTG now
 Monitor VS q1 then record
 Monitor FHT q15 minutes then record
 Refer accordingly

PPROM
 Please admit patient under the service of Drs.
 Secure consent for admission and management
 May have light meals
 IVF: D5LR 1L x 8 hrs
 Labs: CBC, PC, BTRh, UA
 Meds:
o Ampicillin 2 g IV now ( ) ANST then 1 g IV q6 hrs
o Gentamicin 80 mg IV 20 minutes after cord clamping then q8 hrs
o Metronidazole 500 mg IV now ( ) ANST then q8 hrs
 For baseline CTG
 Monitor VS q1, FHT q1
 Monitor progress of labor
 Refer

*For repeat WBC with diff.count after 24 hours of IV antibiotics

*Please continue IV meds while awaiting WBC with diff.count results

OLIGOHYDRAMNIOS
 Please admit patient under the service of Drs.
 Secure consent for admission and management
 DAT
 IVF: PNSS 1L x 8 hrs
 Labs: CBC, PC, BTRh, UA
 Meds:
o Nifedipine 30 mg/tab now
o Nifedipine 10 mg/tab TID
o Prenatal multivitamins tablet OD
o CaCO3 tablet OD
o FeSO4 tablet OD
 For baseline CTG
 Monitor VS q1, FHT q1
 For adequate hydration
 For tocolysis
 Refer

PRE-ECLAMPSIA SEVERE
 Please asmit patient under the service of Drs. __
 Secure consent for the admission and management
 May have light meals then NPO once in active labor
 IVF: D5LR 1L x 12 hrs
 Labs: CBC with PC, BTRh, Blood Chem (Na, K, BUN, Crea, AST, ALT, LDH), PT, PTT, CT, BT, CRT, UA
 For assisted vaginal delivery
 For baseline CTG now
 Therapeutics:
 o MgSO4 4g SIVP and 5g deep IM on each buttocks as loading dose, then 5 g deep IM on
alternating buttocks q6 x 4 doses after DTR ++
o Hydralazine 5mg/IV now, then for BP > 160/100
o (If in active labor already) Nicardipine drip: PNSS 90 cc + 1 amp Nicardipine at 10 ugtts/min
and titrate with increments of 5 ugtts/min to maintain BP < 140/90
 Monitor VS and UO q1 then record
 Monitor FHT and UC q15 then record
 Insert IFC and hook to urine bag
 WOF MgSO4 toxicity and signs of Abruptio placenta
 Refer accordingly

*Refer to Ophtha if eclamptic

HYDATIDIFORM MOLE
 Please admit patient under the service of Drs. __
 Secure consent for the admission and management
 NPO temporarily
 IVF: D5LR 1L x 8 hrs
 Labs: CBC with PC, BTRh, Blood Chem (Na, K, BUN, Crea, AST, ALT, LDH), PT, PTT, CT, BT, CRT, UA, FT4,
TSH, Beta HCG pre & post curettage, 12L ECG, CXR
 For suction curettage once cervix is open
 Secure consent for this procedure
 Monitor VS q1 then record
 For referral to Endo for further evaluation and management
 WOF profuse vaginal bleeding
 Refer accordingly

 For cervical ripening: Laminaria inserted

 For removal of laminaria after 24 hours
 Start Cefuroxime 1.5 g/IV now after ( ) ANST then 750 mg/IV q8
 Refer

*To start Propanolol 10 mg/tab BID if biochemically hyperthyroid; for repeat TSH,FT4, FT3 after 3 months; for
repeat B-HCG after 1 week suction curettage

ECTOPIC PREGNANCY
 Please admit patient under the service of Drs. __
 Secure consent for this admission and management
 NPO temporarily
 IVF: D5LR 1L x 12 hrs
 BT Line: PNSS 1L x 12 hrs
 Labs: CBC with PC, BTRh
 For ‘E’ exlap
 Secure consent for this procedure
 Inform AROD regarding this procedure
 Therapeutics: Cefoxitin 2 g/IV now ( )ANST then 1g/IV q6
 Monitor VS q1 then record
 WOF hypotension and tachycardia
 Refer accordingly

CS
 Please admit patient under the service of Drs. __
 Secure consent for this admission and management
 NPO temporarily
 IVF: D5LR 1L x 12 hrs
  Labs: CBC with PC, BTRh
 For baseline CTG now
 For ‘E’ LTCS now for ___ (repeat CS <18 months, macrosomia, footling breech, etc)
 Secure consent for this procedure
 Inform AROD and PROD regarding this procedure
 Therapeutics: Cefuroxime 1.5 g/IV ( ) ANST now then 750 mg/IV q8
 Monitor VS q1 then record
 Monitor FHT q15 then record
 Refer accordingly

EMERGENCY CS
 For ‘E’ LTCS for non-reassuring fetal status (BPS 2/10)
 Please secure consent for the procedure
 May start Cefuroxime 1.5 gm TIV noe ( ) ANST then 750 mg q8
 Refer

POST-PARTUM ORDER OF NSD

 To hallway now
 DAT (1st, 2nd, 3rd degree laceration)
 Increase dietary fiber (if may 4th degree laceration)
 “Please give 10 units oxytocin IM now” (if walang IVF or naka-heplock lang) or “Incorporate 10 units
oxytocin to present IVF” (if meron ng swero) or “Shift oxytocin side drip to mainline to run for 12 hours” (if
may previous order na na oxytocin side drip before manganak). If HPN, usually tuturuan ka naman nila, ang
gusto nila ipasulat is uterotonics series “Incorporate 20 units oxytocin to present IVF. IVF to follow: D5LR 1 L
+ 10 units oxytocin for 8 hours, then D5LR 1 L + 10 units oxytocin for 8 hours, then D5LR 1 L + 10 units
oxytocin for 8 hours”.
 Start oral medications
o Cefalexin 500 mg/cap 1 cap Q6 x 7 days (pero scrap this out pag may antibiotics given prior to
delivery)
o Ferrous sulfate tab OD
o Ascorbic acid 500 mg/tab 1 tab OD
o Mefenamic acid 500 mg/cap 1 cap PRN for pain
For NON-HYPERTENSIVE patients, add:
o Methylergometrine maleate 0.125 mg/tab 1 tab TID for 3 days (separate pad daw ito kasi need ng
S2 prescription)
For 3rd degree laceration, add:
o Metronidazole 500 mg/tab 1 tab TID x 7 days
For 4th degree laceration, add:
o Senna concentrate 1 tab ODHS x 14 days
 Keep uterus well contracted
 Daily perineal hygiene
 Encourage breastfeeding
 Monitor VS Q1 then record
 WOF profuse vaginal bleeding
 For IE prior to discharge
 Refer

POST-PARTUM ORDER AFTER IE (2-4 hours after)

 To Birthing Center Annex
 IE done
 DAT
 Ambulate
 Continue medications
 Follow-up baseline labs
 Monitor VS q4
  For possible discharge once with normal BP baseline

POST-PARTUM ORDER OF HPN AFTER IE (2-4 hours after)

 To ward
 IE done
 Low salt low fat diet
 IVF to follow: D5LR 1L + 10 ‘u’ oxytocin x 8 hours for 2 more cycles
 For repeat UA after 24 hours Cefuroxime IV
 Continue oral medications
 Daily BP control
 Start Amlodipine 10 mg/tab OD (6am)
 Still for completion of MgSO4
 Remove IFC once MgSO4 is completed
 Monitor VS, UO q4 then record
 Refer

POST-PARTUM ORDER AFTER CS (c/o Anesth)

 To RR
 O2 inhalation via nasal cannula at 2 lpm
 Monitor VS q30 minutes then record
 Monitor UO q1
 May have sips of clear liquid
 Regulate present IVF: D5LR 1L + 20 u oxytocin x 30 gtts/min
 IVF to follow: D5LR 1L + 10 u oxytocin x 8 hrs
D5LR 1L + 10 u oxytocin x 8 hrs
D5LR 1L + 10 u oxytocin x 8 hrs
 Meds:
o Tramadol 300 mg IV in 500 mL D5W to run as sidedrip x 24 hrs
o Ketorolac 30 mg IV q6 hrs x 4 doses
o Omeprazole 40 mg IV OD while on Ketorolac
o IV antibiotics c/o main service
 Flat on bed x 6 hrs
 Keep warm and comfortable
 Refer accordingly

POST-PARTUM ORDER OF CS AFTER 2-4 hours

 To ward
 NPO then clear liquids after 6 hours then general liquids after 24 hours then soft boiled egg, crackers
and jello after 36 hours
 Maintain flat on bed then may turn side to side after 6 hours then moderate to high back rest after 12
hours
 Continue IVF fluid
 Continue present medications
 May start once on soft diet
o Ferrous sulfate tab OD
o Mefenamic acid 500 mg/tab q6 for pain
o Ascorbic acid 500 mg/tab OD
 COD prior to discharge
 For repeat Hgb and Hct after 6 hours
 Remove IFC after 48 hours then note spontaneous voiding
 Daily perineal hygiene
 Monitor VS q4 then record
 Refer
For TAHBSO
 Please admit under the service of Drs. _
 Secure consent for admission and management
 For TAHBSO on __
 Secure consent for the procedure
 Labs: CBC, PC
BTRh
BUN, Crea, Na, K
PT, PTT
TPAG, CA125 (if malignant)
Urinalysis
Chest Xray (PA view)
12L ECG
Pleural fluid analysis (if malignant)
 Please attach risk stratification done
 Bowel preparation: 1st day: Soft diet
Bisacodyl tab 1 tab TID
Metronidazole 500 mg/tab 1 tab TID
2nd day: General liquids in AM
Clear liquids in PM
Bisacodyl tab 1 tab TID
Metronidazole 500 mg/tab 1 tab TID
3rd day: NPO post midnight
Fleet enema at 4am
PNSS 1L x KVO and D5LR 1L x 12 hrs once
on NPO
 Cefuroxime 1.5 g/IV ( ) ANST 1 hour prior to OR then 750 mg/IV q8
 Secure 2 units pRBC properly typed and crossmatched for possible OR use
 Monitor VS q4 then record
 Perineal hygiene daily
 For full body bath and oral hygiene prior to OR
 Refer

DEFERRED TAHBSO
 Defer OR, to ward
 Reschedule OR tomorrow
 May have DAT now then general liquids then NPO post mid-night
 Bisacodyl 2 tabs at 6 pm then 2 tabs at 12 midnight
 Shift PNSS 1L to heplock, D5LR 1L to heplock
 D5LR x 12 hrs once on NPO
 Fleet enema at 4am
 Refer

POST-OP ORDERS (c/o Anesth)

 To RR
 O2 inhalation at 2-3 lpm via nasal cannula
 Monitor VS q15 x 1 hr then q1 and record
 Maintain on NPO
 Regulate present IVF: PLRS 1L x 8 hrs
 IVF to follow: D5LR 1L x 8 hrs x 3 cycles
 Meds:
o Tramadol 100 mg IV q8 SIVP and start giving 12 hrs post-op
o Ketorolac 30 mg IV q6 hrs SIVP x 4 doses
o Omeprazole 40 mg IV OD while on NPO
o Tranexamic acid 500 mg IV q8 x 3 doses
 o IV antibiotics c/o main service or Cefuroxime 750 mg IV q8
 Flat on bed x 6 hrs
 For repeat CBC with PC post-op
 Encourage deep breathing exercises
 Keep patient warm and comfortable
 WOF morphine toxicity (hypotension, bradycardia, decreased UO <0.5 cc/kg/hr, severe pruritus,
nausea and vomiting, circumoral numbness and paresthesia)
 Refer accordingly

POST-OP ORDERS AFTER 2-4 HOURS

 To ward
 NPO then clear liquids after 6 hours then general liquids after 24 hours then soft boiled egg, crackers
and jello after 36 hours
 Maintain flat on bed then may turn side to side after 6 hours then moderate to high back rest after 12
hours
 Continue IVF fluid
 Continue present medications
 May start once on soft diet
o Ferrous sulfate tab OD
o Mefenamic acid 500 mg/tab q6 for pain
o Ascorbic acid 500 mg/tab OD
 COD prior to discharge
 For repeat Hgb and Hct after 6 hours
 Remove IFC after 48 hours then note spontaneous voiding
 Daily perineal hygiene
 Monitor VS q4 then record
 Refer

ABORTION INCOMPLETE INDUCED BY MISOPROSTOL

 Please admit patient under the service of Drs. __
 Secure consent for this admission and management
 NPO temporarily
 IVF: D5LR 1L + 10 ‘u’ oxytocin x 12 hrs
 Labs: CBC with PC, BTRh, UA, Blood chem (Na, K, BUN, Crea, AST, ALT, LDH), PT, PTT
 Therapeutics:
o Ampicillin 2 g IV now ( ) ANST then 1 g IV q6 hrs
o Gentamicin 80 mg IV now then q8 hrs
o Metronidazole 500 mg IV now ( ) ANST then q8 hrs
 For completion curettage
 Secure consent for this procedure
 Inform AROD regarding this procedure
 Monitor VS q1 then record
 Perineal preparation please
 Refer accordingly

ABORTION INCOMPLETE NON-SEPTIC, NON-INDUCED

 Please admit patient under the service of Drs. __
 Secure consent for this admission and management
 NPO temporarily
 IVF: D5LR 1L + 10 ‘u’ oxytocin x 12 hrs
 Labs: CBC with PC, BTRh
 Therapeutics:
o Ampicillin 2 g IV now ( ) ANST then 1 g IV q6 hrs
o Gentamicin 80 mg IV now then q8 hrs
 o Metronidazole 500 mg IV now ( ) ANST then q8 hrs
 For completion curettage
 Secure consent for this procedure
 Monitor VS q1 then record
 Perineal preparation please
 Refer accordingly

COMPLETION CURETTAGE
 Please admit patient under the service of Drs. _
 Secure consent for admission and management
 NPO
 IVF: D5LR 1L + 20 ‘u’ oxytocin x 12 hrs
 Labs: CBC, PC, BTRh
 For completion curettage
 Secure consent for the procedure
 Monitor VS q1 then record
 Refer

PRE-CURETTAGE ORDER
 To OR
 IVF: D5LR 1L + 10 ‘u’ oxytocin
 IV Meds:
o Diazepam 10 mg/amp IV now
o Nalbuphine 1 amp IV now
o Methylergometrine 1 amp IV now
 Hook O2 via nasal cannula 2-3 L/min
 Perineal preparation
 Refer

POST-CURETTAGE ORDER
 To RR
 DAT once fully awake
 IVF: D5LR 1L + 10 ‘u’ oxytocin x 12 hrs to consume for 24 hours then consume
 Start oral meds:
o Cefalexin 500 mg/tab Q6 x 7 days
o Methylergometrine maleate 0.125 mg/tab 1 tab TID x 3 days
o Ferrous sulfate tab OD
o Mefenamic acid 500 mg/tab Q6 if in pain
 Daily perineal hygiene
 Keep uterus well contracted
 Monitor VS q1 then record
 WOF acute abdomen, vaginal bleeding
 For IE prior to discharge
 Refer accordingly

IUFD
 Please admit patient under the service of Drs.
 Secure consent for admission and management
 NPO temporarily
 IVF: D5LR 1L x 12 hours
 Labs: CBC with PC, BTRh, Blood chem (Na, K, BUN, Crea, AST, ALT, LDH), PT, PTT, UA, FBS, FT4, TSH
 Therapeutics:
o Ampicillin 2 g IV now ( ) ANST then 1 g IV q6 hrs
o Gentamicin 80 mg IV now then q8 hrs
 o Metronidazole 500 mg IV now ( ) ANST then q8 hrs
 For vaginal delivery
 For placental GS/CS once fetus out
 Monitor VS q1 then record

ANEMIA CORRECTION
 Please secure 3 ‘u; PRBC properly typed and crossmatched then transfuse once available
 BT precautions please
 Insert IFC and hook to urine bag
 Give Furosemide 40 mg IV after each BT
 For Hgb and Hct after 6 hours of BT

ANEMIA CORRECTION (non-BT situations)

 IVF: PNSS 1L x KVO once iron sucrose is available
 For iron sucrose infusion: PNSS 90 cc + 2 amps iron sucrose to run for 1 hour
 For Hgb and Hct after 6 hours of infusion
 Daily perineal hygiene
 Monitor VS q1 then record
 Refer

EPIDURAL ANESTHESIA
 For Epidural anesthesia

*Prescribe Epidural Kit gauge 18 #1, and Bupivacaine 0.5 amp, heavy #1

THYROID STORM
 Please admit under the service of Drs.__
 Secure consent for admission and management
 May have light meals
 IVF: D5W 1L x KVO
 Labs: CBC with PC, BTRh, Blood chem (Na, K, BUN, Crea, AST, ALT, LDH), PT, PTT, FT4, TSH, 12L ECG,
CXR (PA), TVS c/o Room 3001
 Therapeutics:
o Ampicillin 2 g IV now ( ) ANST then 1 g IV q6 hrs
o (?) Gentamicin 80 mg IV now then q8 hrs
o Metronidazole 500 mg IV now ( ) ANST then q8 hrs
o PTU 50 mg/tab 20 tabs as loading dose then 5 tabs q4 hrs
o Propanolol 40 mg/tab 1 ½ tab q4 hrs
o Hydrocortisone 300 mg/IV as loading dose then 100 mg IV q8 hrs
o Paracetamol 500 mg/tab 1 tab q4
 Monitor VS q1 then record
 Refer to IM-Endo for further evaluation and management
 Insert IFC and hook to urine bag
 For abdominal status monitoring q1
 Refer

POST-OP ORDERS ADDITIONAL (UST)

 O2 via face mask at 5-6 lpm until fully awake
 Encourage deep breathing
 Low back rest please
 Due to void 4-6 hours after