ADAMSON UNIVERSITY

College of Nursing
Date:

Hospital: Justice Jose Abad Santos General Hospital

Area: Labor room

Student’s Name of patient and Activity Nurse on

Name diagnosis Duty/ CI
Signature
 MATERNAL VITAL SIGNS MONITORING SHEET

Name: Admitting Diagnosis Hospital No.

Age: Sex: Date of Admission: Attending Physician: Room/Bed no.

Date BP PR RR TEMP SPO2 FT and Uterine Uterine Name

and Location contractility bleeding and
time signature

Legend:
I: Uterine Contractility II. Uterine Bleeding
 write (+) sign for contracted uterus > write (S) for soaked diaper then
weigh and record
 write (-) sing for not contracted uterus > write (NS) for not soaked diaper