C-Section Delivery: Sherpath Flashcards
C-section Delivery
Indications for a C-Section
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
Moms Risk (C-section)
Infection Hemorrhage and possibly transfusion Urinary tract trauma or infection Thrombophlebitis, thromboembolism Paralytic ileus Atelectasis Anesthesia complications
Baby’s Risk (C-Section)
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
Validating gestational age for C-Section
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
A nurse receives the shift report when coming onto the antepartum floor. Which patient does the nurse anticipate will require a cesarean delivery?
A patient with complete placenta previa
The charge nurse is planning nursing assignments on a busy antepartum unit. For which patient does the nurse know that cesarean delivery is contraindicated?
A patient with a confirmed absence of fetal heartbeat
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?
“Amniocentesis can be performed prior to cesarean delivery to verify that delivery is safe for your infant.”
Advantages of the “vertical” lesion
Quicker to perform
Better visualization of the uterus
Can quickly extend upward for greater visualization, if needed
Often more appropriate for obese patients
Disadvantages of the “vertical” lesion
Easily visible when healed
Greater chance of dehiscence and hernia formation
Advantages of the “transverse” lesion
Less visibility when healed
Pubic hair grows back
Less chance of dehiscence or hernia formation
Disadvantages of the “transverse” lesion
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
What are the two types of lesions used in C-sections?
Vertical
Transverse
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?
“There likely will be less post-operative pain with a transverse incision.”
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?
“With low transverse incisions, vaginal birth after cesarean is a possibility, because of a decreased risk of incision rupture.”
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?
The patient had minimal blood loss during the surgery.
Pre-op assessment
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
Post-op assessment
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
Preform assessment every 15min for the 1st hr Q30min during 2nd hr.
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
Emotional Support
A calm and confident manner
A quiet, controlled voice
The father or other support person should be encouraged to stay with mom
Preoperative Patient Education
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
Interventions Related to Circulatory and Respiratory Status
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
Interventions Related to Fundal Assessment
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
Assess the patient’s pain relief needs with her vital signs:
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.
Interventions Related to Lochia and Urine Drainage
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.
