C-Section Delivery: Sherpath

Question 1

Indications for a C-Section

Answer 1

Dystocia
Cephalopelvic (fetopelvic) disproportion
Maternal hypertension
Maternal diseases, such as diabetes, heart disease, or cervical cancer
Active genital herpes at the time of delivery
Some previous uterine surgical procedures, such as a classic cesarean incision
Persistent non-reassuring fetal heart rhythms (FHR) patterns
A prolapsed umbilical cord
Fetal malpresentations, such as breech or transverse lie
Hemorrhagic conditions, such as abruptio placentae or placenta previa

Question 2

Moms Risk (C-section)

Answer 2

Infection
Hemorrhage and possibly transfusion
Urinary tract trauma or infection
Thrombophlebitis, thromboembolism
Paralytic ileus
Atelectasis
Anesthesia complications

Question 3

Baby’s Risk (C-Section)

Answer 3

Inadvertent preterm birth
Transient tachypnea of the newborn caused by delayed absorption of lung fluid
Persistent pulmonary hypertension of the newborn
Injury, such as laceration, bruising, fractures, or other trauma

Question 4

Validating gestational age for C-Section

Answer 4

Documentation of fetal heart sounds for 20 weeks by nonelectronic means or for 30 weeks by Doppler ultrasound
An interval of 36 weeks since positive results for a serum or urine pregnancy test performed by a reliable laboratory
An ultrasound examination between 6 and 11 weeks of pregnancy
Clinical history and later ultrasound examinations

Question 5

A nurse receives the shift report when coming onto the antepartum floor. Which patient does the nurse anticipate will require a cesarean delivery?

Answer 5

A patient with complete placenta previa

Question 6

The charge nurse is planning nursing assignments on a busy antepartum unit. For which patient does the nurse know that cesarean delivery is contraindicated?

Answer 6

A patient with a confirmed absence of fetal heartbeat

Question 7

The antepartum nurse is caring for a patient who is scheduled for cesarean delivery. The patient reports anxiety about the procedure because she is unsure of her exact due date and whether the fetus is mature enough for cesarean delivery. Which is the best response made by the nurse to this patient?

Answer 7

“Amniocentesis can be performed prior to cesarean delivery to verify that delivery is safe for your infant.”

Question 8

Advantages of the “vertical” lesion

Answer 8

Quicker to perform
Better visualization of the uterus
Can quickly extend upward for greater visualization, if needed
Often more appropriate for obese patients

Question 9

Disadvantages of the “vertical” lesion

Answer 9

Easily visible when healed

Greater chance of dehiscence and hernia formation

Question 10

Advantages of the “transverse” lesion

Answer 10

Less visibility when healed
Pubic hair grows back
Less chance of dehiscence or hernia formation

Question 11

Disadvantages of the “transverse” lesion

Answer 11

Less visualization of the uterus
Cannot be done as quickly, which may be important in an emergency cesarean delivery
Cannot easily be extended to give greater operative exposure
Re-entry at subsequent cesarean delivery may require more time

Question 12

What are the two types of lesions used in C-sections?

Answer 12

Vertical

Transverse

Question 13

A patient having a scheduled cesarean delivery asks the nurse why the provider plans to use a Pfannenstiel incision (transverse skin incision). Which is the most accurate response by the nurse?

Answer 13

“There likely will be less post-operative pain with a transverse incision.”

Question 14

The antepartum nurse is caring for a patient with a history of one cesarean birth via low transverse incision. The patient asks the nurse what her chances are of a successful vaginal birth for the current pregnancy. Which is the appropriate nursing education for this patient?

Answer 14

“With low transverse incisions, vaginal birth after cesarean is a possibility, because of a decreased risk of incision rupture.”

Question 15

A nurse is caring for a patient following cesarean delivery. According to the operative report, the patient had a low transverse uterine incision. Which interpretation of this data by the nurse is accurate?

Answer 15

The patient had minimal blood loss during the surgery.

Question 16

Pre-op assessment

Answer 16

Assess the time of last oral intake and what was eaten
Assess for allergies. Include drug, food, and substance allergies
Determine medications taken and last dose. Include over-the-counter and herbal preparations

Question 17

Post-op assessment

Answer 17

Begin anesthesia-related interventions: pulse oximeter, oxygen administration, and cardiac monitoring
Assess for return of sensation and movement if regional anesthesia was used
Assess level of consciousness if general anesthesia was used

Question 18

Preform assessment every 15min for the 1st hr Q30min during 2nd hr.

Answer 18

Assess vital signs and oxygen saturation
Assess electrocardiogram (ECG) pattern
Assess uterine fundus for firmness, height, and deviation (massage if poorly contracted)
Assess lochia for color, quantity, and presence of large clots
Assess urine output for color, quantity, and patency of the catheter and tubing
Assess abdominal dressing for drainage
Assess return of lower body movement if regional block is used

Question 19

Emotional Support

Answer 19

A calm and confident manner
A quiet, controlled voice
The father or other support person should be encouraged to stay with mom

Question 20

Preoperative Patient Education

Answer 20

Provide teaching in simple language
Include the patient’s partner
Do not assume that a patient who had a previous cesarean delivery already knows what will happen.
Explain preoperative procedures and their purposes, (as labs, the abdominal skin prep, or an in-dwelling catheter)
Explain use of serial compression devices to reduce risks of venous thrombosis
(For patients having general anesthesia) Explain why operative preparations are completed before the patient is anesthetized
Reinforce anesthetic information provided by the anesthesia health provider
Describe the OR and everyone who will be present; explain that a nurse will also be present

Question 21

Interventions Related to Circulatory and Respiratory Status

Answer 21

Observe for return of motion and sensation if the patient had epidural or subarachnoid block anesthesia
Observe for the level of consciousness and respiratory status (skin or mucous membrane color, rate and quality of respirations, oxygen saturation) if the patient had general anesthesia
Assess the patient prior to ambulation
Have naloxone available to reverse opioid-induced respiratory depression
Assess the pulse, respirations, and blood pressure
Have the patient take several deep breaths if oxygen saturation falls below 95%; (if needed) provide supplemental oxygen by nasal cannula, face tent, or mask

Question 22

Interventions Related to Fundal Assessment

Answer 22

Ask the patient to flex her knees and take slow, deep breaths to relax abdominal muscles
Gently “walk” fingers toward the patient’s fundus to determine uterine firmness
Check the dressing for drainage with each fundus check

Question 23

Assess the patient’s pain relief needs with her vital signs:

Answer 23

Patients who received an epidural analgesic may not need other analgesia during the early postpartum period.
A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, provides long-acting analgesia to supplement the epidural drug.
Parenteral analgesic is usually given by a patient-controlled analgesia pump or occasionally intermittent injections.
Oral analgesics usually replace parenteral ones the day after surgery.

Question 24

Interventions Related to Lochia and Urine Drainage

Answer 24

The nurse assesses the lochia and urine output with other assessments. Lochia may pool under the mother’s buttocks and lower back. Urine may be temporarily bloody if the cesarean delivery occurred after a long labor, or an attempted forceps or vacuum delivery. The urine drainage tube should be observed for gradual clearing of the blood. Long-term bloody urine may be a sign of bladder insult from the cesarean procedure and requires immediate attention. Urine should drain freely to prevent bladder distention, which worsens pain and increases the risk for postpartum hemorrhage. The nurse must remember that a falling urine output is an early sign of hypovolemia, occurring well before the fall in blood pressure.

Question 25

The nurse is preparing a patient for cesarean delivery. After the epidural anesthetic is initiated, the patient reports anxiety about being alone and awake in the operating room (OR) during delivery. Which nursing interventions are appropriate for this patient?

Answer 25

Inform the patient that a nurse will be present in the OR during the procedure.
Describe the OR and the people who will be present during the delivery to the patient.
Inform the patient that a family member is allowed in the OR for support, although he or she may have to wait a few minutes to come in.

Question 26

The nurse is assessing a patient in the post-anesthesia care unit (PACU) following a cesarean delivery under general anesthesia. After confirming respiratory status, which is the next assessment the nurse should complete?

Answer 26

Level of consciousness (LOC)

Question 27

The nurse is assessing the fundus of a patient who had a cesarean delivery. The patient reports abdominal discomfort during palpation. Which instructions should the nurse give the patient regarding abdominal pain during fundal assessment?

Answer 27

“Relax and breathe slowly during the fundal assessment.”

Question 28

The postpartum nurse is talking with the patient following a cesarean delivery with a Pfannenstiel skin incision and low transverse uterine incision. The patient asks the nurse to describe the procedure, since the surgical draping prevented her from seeing the operation. Which response from the nurse is appropriate?

Answer 28

“An incision was made on the uterus that looks a lot like the scar on your abdomen.”

Question 29

The antepartum nurse is caring for a new patient who seeks to attempt a vaginal delivery after a cesarean delivery. She indicates her Pfannenstiel incision scar and insists that she should be able to successfully have a vaginal birth. Which nursing education is appropriate for this patient?

Answer 29

Vaginal delivery may be possible, but her previous type of uterine incision would need to be verified before attempting vaginal delivery.

Question 30

The nurse is caring for a patient in the post-anesthesia care unit (PACU) immediately following cesarean delivery. During fundal assessment, the patient reports discomfort and exhaustion and asks the nurse, “Why do you keep poking at me?” Which response from the nurse is appropriate?

Answer 30

“A cesarean delivery puts you at risk for excessive bleeding, so it’s important to assess you frequently.”

Question 31

A patient carrying twins desires an elective cesarean delivery. Which statement indicates a need for further teaching regarding cesarean delivery?

Answer 31

“Since I am not having a vaginal birth, my babies can’t be harmed during delivery.”

Question 32

Which patient laboratory value would the nurse validate as part of routine preparation for cesarean delivery, in order to determine adequate fetal maturity?

Answer 32

Positive serum pregnancy test performed at least 36 weeks prior to surgery.

Question 33

The postpartum nurse is caring for a patient who experienced a cesarean delivery and whose vertical skin incision is closed with sutures and surgical glue. Which step should the nurse take to ensure the patient’s comfort during the assessment?

Answer 33

Administer the patient’s pain medication before fundal assessment.

Question 34

The nurse is assessing a patient who had a cesarean delivery. The patient is silent during the physical assessment, but when asked how she feels responds, “I feel like I can’t do anything right. How am I supposed to raise a child?” Which response from the nurse is most appropriate?

Answer 34

“Tell me why you feel this way.”

Question 35

The antepartum nurse is caring for a patient with a body mass index (BMI) of 30 who is scheduled for a planned cesarean delivery. The patient asks the nurse why the provider has told her that a midline vertical incision will be done for the procedure. Which explanation by the nurse is accurate?

Answer 35

“The midline vertical incision is a better option for larger patients because more of the uterus is exposed.”

Question 36

The patient is discussing with the nurse her preference for a vaginal delivery for her current pregnancy. Which statement by the patient indicates the need for further teaching?

Answer 36

“I had a c-section with my last pregnancy because of placenta previa.”