1229 Exam 3: C section Flashcards
cesaren
the birth of a fetus through a transabdominal incision of the uterus. It’s purpose is to preserve the life or health of the mother and/or her fetus. It is usually the best choice when there is evidence of material or fetal complications.
indications for a cesarean section:
- Performed for the benefit of the fetus
- Abnormal heart rate and pattern
- Malpresentation (Breech or shoulder)
- Placental abnormalities (Previa or Abruptio)
- umbilical cord prolapse
- Dysfunctional labor pattern
- multiple gestation
- medical factors (hypertensive, active genetal herpes, positive HIV, diabetes)
previa
the placenta is implanted in the lower uterine segment near or over the internal cervical OS.
Abruptio
occurs because body contours change in reaction to the force of collision
surgical techniques:
classic and lower
Classic
Incision is made vertically into upper body of the uterus.
rarely performed today
used when rapid birth is necessary and with placenta previa
shoulder presentation and multiple gestation
associated with higher incidence of blood loss, infection and uterine rupture
labor and vaginal birth is contraindicated after classic.
Lower
segment cesarean incision
horizontal or transverse incision into the uterus.
easier to perform
associated with less blood loss
fewer postoperative infections
less likely to rupture with subsequent pregnancies.
Complications and Risks.
Aspiration pulmonary embolism wound infection wound dehiscence thromboplebitis hemorrhage UTI Injuries to bladder, uterus, or bowel anesthesia related complications fetal injury during surgery economic risk because of the higher cost long recovery.
Nursing Care: Preoperative
Discuss need for Cesarean anesthesiologist assesses informed consent Lab (CbC, CMP, T&CM, UA) foley cath lower abd hair removed iv fluids teach post op expectations
Nursing Care: Intraoperative
if possible, partner is gowned
it is important to position so uterus is displaced laterally to prevent compressing the vena cava
keep family informed
care of infant delegated to pediatric team
encourage skin to skin contact for mother and infant
**Make sure you have consent before answering questions from the family members.
Nursing care: Immediate postoperative
Transfer to recovery room
vital signs every 15 minutes for 1-2 hours
assess condition incision dressing, fundus, and amount of lochia
assess iv intake and urinary catheter output
TCDB every two hours
pain management
give mother and her partner alone time with baby.
initiate breastfeeding within 30 to 60 minutes after birth if possible.
Pain control
Medications: Opioids or NSAIDS
position changes
splinting the incision
relaxation and breathing techniques
ambulation and rocking in a rocking chair helps relieve gas
Avoid gas forming foods and carbonated beverages.
Post op Nursing
be alert to psychological needs Couplet care. (Mother and baby care.) perineal care breast care showering after dressing removed discharge is usually third postop day.
Anesthesia
Spinal, epidural, and general are used for cesarean
the medical history plays a role in making the decision of type of anesthesia. (Spinal injury, hemorrhage, or coagulopathy may rule out spinal or epidural)
VBAC:
vaginal birth after c-section
VBAC: nursing care
physician must be available throughout the labor process.
risk of uterine rupture with TOL (Trial of labor)
psychological needs: Anxiety
risk involeved to the mother and fetus attempting VBAC
ruptured uterus
Rupture uterus causes
prior classic uterine incision single layer rather than double layer closure two or more previous cesareans maternal age over 30 postpartum fever uterine trauma congenital uterine anomaly intense spontaneous uterine contrations labor stimulation with oxytocin multiple gestation malpresentation difficult forceps delivery **Occurs more commonly in multigravidas than primigravidas. **Most common cause is separation of previous cesarean scar.
Classifications of Ruptured Uterus
Complete and incomplete
Complete
Extends through the entire uterine wall and into the peritoneal cavity or broad ligament.
incomplete
extends into the peritoneum but not into the cavity or broad ligament.
bleeding is usually internal
can be a partial separation of an old cesarean scar
Signs and symptoms of Ruptured uterus
vary with extent of rupture may be silent or dramatic if incomplete, pain may not be present late and variable DCELLS decreased baseline variability increased or decreased heartrate woman may experience vomiting, faintness, increased abdominal tenderness and lack of labor or fetal station progress. FHT may be lost blood loss
complete rupture S&S
sudden, sharp or ripping pain
may state “something gave way”
signs of hypovolemic shock
hypotension, tachypnea, pallar, cool, clammy skin
nursing care of rupture
start IV fluids transfuse blood products administer oxygen prepare for surgery support family if rupture occurs
