Exam 3 pt 3 Flashcards
c section pot op nursing interventions
-turn, cough, deep breath
-incentive spirometry every 2-4 hrs
-pillow to splint incision
leg exercises every 15 min-2 hrs till ambulate
-SCDs
-monitor/manage pain/ PCA analgesic
-administer analgesic
-comfort measures
-encourage breathing, relaxation
when is incentive spirometry needed
every 2-4 hrs if pt needed general anesthesia
what type of analgesics given after c section
- spinal anesthesia with 24 hr morphine (duramorph) which helps with postop pain
- watch for respiratory distress though
what PCA analgesic is given post op csection
toradol
course of care for c section postop
- indwelling cath 24 hrs
- PCA/Epidural/IM meds
- NPO at first, then liquids, then soft diet
- headaceh
- depression/anger/withdrawal
- slower to bond/breastfeed
- longer costlier stay at hospital
usually occur as the fetal head is being born
perineal lacerations
first degree perineal laceration
laceration that extends through the skin and vaginal mucous membrane but not the underlying fascia and muscle
second degree perineal laceration
laceration that extends through the fascia and muscles of the perineal body but not the anal sphincter
third degree perineal laceration
laceration that include the vaginal tissue, perineal muscle, and anal sphincter
fourth degree perineal laceration
laceration that extends completely through the rectal mucosa, disrupting both the external and internal sphincters
third and fourth degree lacerations must…
be carefully repaired so that the woman retains fecal continence
often occur in conjunction with perineal lacerations
circular and often the result of use of forceps, rapid fetal descent or precipituous birth
vaginal lacerations
injuries to the ____ can have adverse effects on future pregnancies and childbirth
cervix
occurs when the cervix retracts over the advancing fetal head
cervical injuries
what are causes of post partum hemorrhage
lacerations of cervix, vagina, and perineum
when should hemorrhage related lacerations be suspected
if bleeding continues despite firm, contracted uterine fundus
what are the most common of all injuries in the lower portion of the the genital tract
lacerations of the perineum
episiotomy
RARE (,10% of births)
incision into the perineum to enlarge the vaginal outlet
how are pelvic muscles supported
pelvic relaxation and Kegel exercises
when assessing for genital injury always look to…
rule out hematoma esp. if forceps/vacuum used for delivery
describe hematomas
deep, severe, unrelieved pain and feelings of pressure
treatment of genital injuries
-ice for 24 hr, then heat in form of Sitz bath
Tucks, Epifoam, Dermaplast
-Motrin for relief of pain and discomfort
-promote or suppress lactation depending on breastfeeding
how often should you sitz bath if genital injury
2-4 times a day
soothing and helps debride after 24 hrs
describe bowel evacuation
occurs 2-3 days after childbirth
anal sphincter lacerations are associated with postpartum incontinence
nursing interventions for episiotomy
perineal tightening
ice, then sitz bath, motrin
(same as vaginal lacerations)
why does abdominal distension occur post op c section
surgery stops peristalsis for around 24 hrs after surgery
gut may stop working due to block
rigid/boardlike abdomen=BLEEDING
side effects and adverse effects caused by epidural and spinal anesthesia
hypotension, local anesthetic toxicity, dizziness, slurred speech, urinary retention, pruritus, headache, and infection
nursing intervention for perineal laceration
1) place woman in lateral sims, don gloves
2) check for redness, edema, hematoma
3) teach self check with mirror
4) instruct pt to change pad with every void
5) wipe perineum front to back
6) teach pt pain/discomfort relief measures ie ice, sitz, lavage, anesthetic spray
collection of blood in the connective tissue
pelvic hematomas
types of pelvic hematomas
vulvar, vaginal, retroperitoneal
most common and visible hematomas
s/s: persistent pain and feeling of pressure
vulvar
the least common hematoma but life threatening
s/s: minimal pain and shock
retroperitoneal
what is needs to evacuate hematoma
surgery
post op hematoma surgery nursing interventions
pain control (Percocet and ibuprogen)
monitor for bleeding
replace fluids
monitor Hct and Hgb levels
reasons for post delivery headache and interventions
1) caffeine withdrawal (give cup of coffee)
2) preeclampsia induced (do full head to toe)
what is included in head to toe assessment if positive for preeclampsia
clonus, hyper reflexes, abdominal RUQ pain, blurred vision
how to determine if spinal headache
pain in high fowlers but subsides in supine position then positive for spinal headache and call anesthesia
what creates bonding
having the baby close/proximity
the process by which a parent comes to love and accept a child and a child come to love and accept a parent
attachment
attachment occurs through the process of ___
bonding
the infant’s behavior sand characteristics elicit a corresponding set of parental behaviors and characteristics
mutuality
eye contact, touching, talking and exploring the baby
acquantance
signaling behaviors
crying, smiling, and cooing
what is the claiming process
“like me or like you”
identification of the new baby (likeliness, differences, uniqueness)
assessment of attachment behaviors that should be noted prior to discharge
early contact, extended contact, senses, biorhythmicity
baby in tune with mothers natural rhythms (Arcadian and heart rhythms)
biorhythmicity
postpartum infection drugs
ampicillin
clindamycin
postpartum pain meds
Percocet Ibuprofen Extra Strength Tylenol Toradol Narcan
Percocet ingredients and how much in 24 hrs
oxycodone, acetaminophen and do not exceed 30-40 mg in 24 hrs
Percocet indications
relief of moderate to moderately severe pain
common and serious side effects of percocet
lightheadedness, dizziness, drowsiness, N/V
serious: resp depression, apnea, circulatory depression, hypotension, shock
pt teaching of percocet
1) assess BP
2) high concentration first 1-2 hrs (avoid breastfeeding)
3) change position slowly d/t orthostatic hypotension
how often can ibuprofen be given
800 mg PO q8h
ibuprofen indications and contraindications
treatment of mild to moderate pain and fever
contrainidcations: bleeding, GI ulcers, coagulopathy, thyrombocytopenia
common and serious side effects of ibuprofen
headache, dizziness, constipation, dyspepsia, N/V, abdominal discomfort
serious: steven johnsons, anaphylaxis, GI bleed, MI
pt teaching of ibuprofen
1) avoid driving if drowsy
2) avoid concurrent NSAIDS and alcohol
3) consult HCP if bleeding, visual disturbance, headache
4) okay to consume when breastfeeding!!
how much tylenol in 24 hr
2x 500 mg tablets q6h
max daily dose is 4000 mg
tylenol indications and contraindications
mild to moderate pain and reduce fever
contraindicated: severe hepatic impairment and lever disease and concurrent alcohol usage
