Patient Preparation Worksheet

Adm. Date: May 2023 Days since adm.:1

Chief Complain/Primary problem: Past Medica History

• Decreased hemoglobin requiring • Hyperthyroidism
blood transfusion after a post-partum • Mild anxiety
hemorrhage. • Pregnancy was high risk due to age
• G5P4 • O(-) blood type
• Vaginal delivery – 1.5hrs ago • No previous blood transfusion
• Approx 1.5 L blood loss during
hemorrhage after delivery
• Bleeding stopped with fundal message
• Hemoglobin 64g/L

Time Meds/Care priorities Misc.

Daily Synthroid • Indication
(Levothyroxine) 0.25 Underactive thyroid
mcg PO • Monitor for:
Weight loss
Tremors
Chest pain
Insomnia
Daily Clexa (Citalopram) • Indication
10mg PO Depression
• Monitor
Electrolytes
Heart rate
Heart Rhythm
ongoing R/L with 20 Units of • Infusing at 125ml/L
oxytocin • Indication
Replace fluids and electrolytes with low
blood volume
• Monitor
Stomach pain
Difficulty breathing
Confusion
Potassium levels
Numbness/tinging in lips, hands, feet
Irregular heartbeat
Weakness in lower extremities.
Once at 28 Rh immunoglobin IM • Indication
week Risk of forming antibodies – can happen if patient
gestation is Rh- negative and pregnant

STAT post N/S 0.9 % IV bolus

transfusion
Stat post Diphenhydramine 25- • Indication
transfiuion 50mg IV Allergic reaction
 CV Resp Neuro GI GU skin Misc. VS
Prior Hypotensio Resp 20 Anxiety WNL Catheter. pale Small rubra BP 88/60
nursing n Chest Clear Insitu lochia R 20
assessmen Tachycardic Denies Draining Fundus firm P 110
t SOB clear, amber and midline at T 37.1
urine the level of O2 95% on
umbilicus RA
Current Hypotensio Resp 19 Anxiety WNL Catheter. Pale Small rubra BP 90/64
nursing n Chest Clear Insitu Iv site lochia R 19
assessmen Tachycardic Denies Draining Bilateral arm Fundus firm P 104
t SOB clear, amber rash – and midline at T 37.3
urine transfusions the level of O2 96% on
reaction (legs, umbilicus RA
back, chest)

Lab test Current

Hgb. 64g/L

Allergies: dust, glass, peanut butter

Code Status: Presumed Full
IV site: Right arm
IV maintenance: Flush of N/St
IV Drip: R/L 20 units of oxytocin at 125mL/h
Fall Risk/Safety: yes
Bladder/bowl: Urinary Catheter

Situation
• 40-year-old female
• G5P4
• Delivered Vaginally at 1200
• Post partum hemorrhage – EBL 1.5L
• Hgb. 64g/L
• 1 unit of PRBC
Background
• Hypothyroidism
• Mild anxiety
• G5P4
Assessment
• Fundus firm after message – midline at
the umbilical
• Catheter draining clear, amber urine
• Blood transfusion reaction today – rash to
arms bilateral
• Post transfusion vitals
BP 90/64
R 19
P 104
T 37.3
O2 96% on RA
Recommendations:
• Transfusion stopped
• Diphenhydramine 25-50 mg IV ordered
STAT
• Transfusion to restart in 20-30 min post
Diphenhydramine