1229 exam 3: C section Flashcards Preview

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Flashcards in 1229 exam 3: C section Deck (24):
1

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.

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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)

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previa

the placenta is implanted in the lower uterine segment near or over the internal cervical OS.

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Abruptio

occurs because body contours change in reaction to the force of collision

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surgical techniques:

classic and lower

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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.

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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.

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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.

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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

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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.

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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.

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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.

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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.

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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)

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VBAC:

vaginal birth after c-section

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VBAC: nursing care

physician must be available throughout the labor process.
risk of uterine rupture with TOL (Trial of labor)
psychological needs: Anxiety

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risk involeved to the mother and fetus attempting VBAC

ruptured uterus

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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.

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Classifications of Ruptured Uterus

Complete and incomplete

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Complete

Extends through the entire uterine wall and into the peritoneal cavity or broad ligament.

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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

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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

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complete rupture S&S

sudden, sharp or ripping pain
may state "something gave way"
signs of hypovolemic shock
hypotension, tachypnea, pallar, cool, clammy skin

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nursing care of rupture

start IV fluids
transfuse blood products
administer oxygen
prepare for surgery
support family
if rupture occurs