This case presents a 27-year-old laboring patient,

This case presents a 27-year-old laboring patient, Noor Khalil. Noor is Gravida 1 Para 0 and 39 4/7 weeks gestation for this pregnancy. Noor’s blood type is O+. Her labs have been within normal limits for the course of the pregnancy. Her current labor status is: Noor is showing 10cm dilated and 100% effacement/-2 station. She has been pushing for 90 mins. Her membranes ruptured clear fluid 50 minutes ago with bloody show. Her husband is waiting in the waiting room. Prenatal history indicates the following: Blood group O, Rh positive, Rubella immune, RPR NR, Hep B neg, GC/Chlamydia neg, HIV neg, Group B Strep (-). Pregnancy weight gained 25 pounds. Her current vitals and assessments are as follows: BP 116/76, P 82, R 16, T 37 C, O2 98%; urine dipstick negative for blood, protein, and glucose. Labs: See prenatal labs listed above Orders Information in Patient’s Chart/Electronic Health Records information: Lab/Diagnostic Results: urine dipstick negative for blood, protein, and glucose. Provider Orders: Name: Khalil, Noor DOB: 27 years old Gender: female Code Status: Full Medical Record #: 123-45 Allergies: NKDA Admit to Labor and Delivery: IUP 38 5/7 weeks Continuous electronic fetal monitor Activity: As tolerated Admission labs CBC, CMP, UA dipstick blood/protein/glucose Nubain 10 mg IV q3-6h PRN moderate to severe pain during labor Delivery Orders: After placenta delivered Administer 20 units of Pitocin in 500mls of Lactated Ringers at a rate of 250mls for 30 mins, then reduce the rate to 95 mls/hr until bag is complete. Lidocaine 1% injection 10ml, Intradermal, once prn to perineum for vaginal repair. Ibuprofen tablet 600mg, oral, every 6 hours, for mild to moderate pain of 1/10-6/10. Acetaminophen tablet 975mg, oral, every 6 hours, for mild to moderate pain of 1/10 – 6/10. Ondansetron injection 4 mg, Intravenous, every 6 hours, prn, for nausea or vomiting. Sodium Cholride 0.9% flush, 5 ml, Intravenous, as needed. Docusate Sodium Capsule 100mg, oral, 2 times a day for constipation. Prenatal Vitamin tablet, 1 tablet, oral, daily. Apply ice to affected area. Oxygen administration. Bladder scan as needed. Straight Catheterization (urinary catheter) for use after Foley catheter removal: -if no spontaneous void within 4-6 hours -void less than 180mls -new onset of incontinence or reports bladder fullness -bladder scan shows 300mls or greater retained Patient may ambulate as tolerated. Patient may shower. Diet regular. Systems Assessment (Pertinent Information): SYSTEM MOTHER INFANT Neuro HEENT Respiratory Cardiac GI GU Integumentary Peripheral Vascular Repro Psychosocial Medications: Calculate appropriate dose, indication for medication

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