(6) NURSING CARE OF THE FAMILY DURING CESAREAN BIRTH

Caedore

"Cesarean" is derived from the Latin word, which means to cut

Cesarean Birth

Birth accomplished through an abdominal incision into the uterus.

Elective Cesarean Birth

Planned throughout the antepartal period Expectant mothers attend a Childbirth preparation class

Emergent Cesarean Birth

Are done for reasons that arise suddenly during labor

Stress Response

Responds with measures to preserve the function of major body systems This results in a release of epinephrine and norepinephrine from the adrenal medulla.

Epinephrine

increases the heart rate, causes bronchial dilatation, and elevates the blood glucose level. It also leads to peripheral vasoconstriction, which forces blood to the central circulation and increases blood pressure.

Skin

serves as the primary line of defense against bacterial invasion, so when skin is incised for a surgical procedure there is at risk for infection

500-1000mL

During a vaginal birth, a woman loses 300-500 mL of blood; this loss increases to _____ __ ____ with a cesarean birth

DEHISCENCE

Obese women are prone to __________(rupture of the incision); respiratory and cardiac problems; difficulty in ambulation

Vitamin K

is necessary to ensure blood clotting after surgery

Fluid and electrolyte imbalance

A woman who enters surgery with a lower than usual blood volume will experience the effect of surgical blood loss more

Fear

Women who are extremely worried about surgery need a very detailed explanation of the procedure in order to reduce their anxiety to a tolerable level

Cesarean

For this reason, more infants born by ________ birth develop some degree of respiratory difficulty.

Antibiotics

may predispose insufficiency one or to renal increase neuromuscular blockage; can lead to opportunistic infection like yeast.

Anticoagulants

May cause hemorrhage due to lack of hemostasis during surgery.

Tranexamic acid.

The most commonly used anticoagulant in cesarean deliveries is

Anticonvulsants

May increase liver action and metabolism of anesthetic agent.

Antihypertensives

May result in hypotension after anesthesia.

Corticosteroids

May block body’s response to shock and so lead to lack adrenal function.

Insulin

May lead to hypoglycemia during labor, and underlying diabetes can lead to hyperglycemia if a dextrose solution is administered.

Antianxiety agents

May cause hypotension after anesthesia. Talk to your patient, that is one of the ways to ease their anxiety.

Preoperative Teaching

Aimed at acquainting a woman with the Cesarean Procedure and any special equipment to be used so they are informed as possible.

Deep Breathing, Incentive spirometry, Turning, Ambulation

Teaching to prevent complications:

Periodic deep breathing exercises

fully aerate the lungs and prevent stasis of lung mucus from the prolonged time spent in the supine position during surgery. A typical exercise is to take 5 to 10 deep breaths every hour.

Incentive spirometer

is a common device used three to four times a day postoperatively to encourage deep breathing.

Turning

Important to prevent both respiratory and circulatory stasis.

Ambulation

To stimulate lower extremity circulation after a cesarean birth is by early ambulation. ○ Because the edema from the low pelvic surgery compresses circulation to the lower extremities, thus increasing the risk for lower extremity circulatory stasis.

Informed Consent

Obtaining operative consent is the primary healthcare provider’s responsibility (doctor), but being certain it is obtained prior to surgery is everyone’s responsibility. ○ You may be asked to witness a patient’s signature on such a form.

Overall hygiene

Follow your institution’s procedures with regard to removing nail polish, jewelry, contact lenses, lip or mouth piercings, or hair ornaments before surgery.

Metoclopramide (Reglan)

gastric emptying agent to speed stomach emptying.

Ranitidine (Zantac)

histamine blocker to decrease stomach secretions.

Citric acid and Sodium citrate (Bicitra)

oral antacid to neutralize acid stomach secretions.

Indwelling urinary catheter

may be prescribed before transport for surgery or after arrival in the surgical suite. ○ Be certain that urine drains freely because fetal pressure on the urethra may reduce the flow of urine.

Hydration

IV Fluid line before surgery such as lactated ringer’s solution ○ This ensures a woman will be fully hydrated and will not experience hypotension from epidural anesthesia administration, temporary use of a supine position, or blood loss at birth.

Preoperative Medications

It is ideal to minimize __________ __________before a cesarean birth to prevent compromising the fetal blood supply and to ensure that the newborn is wide awake at birth and can initiate respirations spontaneously.

30

A cesarean birth should be completed within __minutes from the time the procedure was documented.

Supine hypotension syndrome

During transport and while in surgery, encourage the woman to remain on her side, or place a pillow under her right hip to keep her body slightly tilted to the side, to prevent

Spinal anesthetic

is to be administered, the anesthesiologist usually will do this with the woman sitting up.

Duramorph

is a form of morphine commonly used in addition to a local anesthesia in epidurals; its effect lasts up to 24 hours

Regional Block, Epidural or spinal block, Spinal, Patient controlled Anesthesia

Anesthesia of Choice:

Epidural Anesthesia

usually administered with the woman lying on her side.

Spinal Anesthetic

which may be used in an emergency, the anesthesiologist usually will do this with the woman sitting up.

Patient controlled analgesia (PCA)

A method of pain control in which women administer doses of intravenous narcotic analgesia such as morphine to themselves as needed

Skin Preparation

Reducing the number of bacteria on the skin before surgery automatically reduces the possibility of bacteria entering the incision at the time of surgery.

Classic incision and Transverse incision

Two types of cesarean incisions:

Classic incision

The incision is made vertically through both the abdominal skin and the uterus.

Classic incision

The incision is made high on the uterus, so that it avoids cutting a possible placenta previa. ● A disadvantage of this type of incision is that it leaves a wide skin scar and also runs through the active contractile portion of the uterus

Low segment incision

Commonly referred to as a low transverse uterine incision and a Pfannenstiel skin incision

low segment incision

Made horizontally across the abdomen just over the symphysis pubis and also horizontally across the uterus just above the cervix.

Provide adequate pain management, Encourage EARLY AMBULATION. Help the woman bond successfully with her infant (Goal of care)

3 BASIC NURSING RESPONSIBILITIES

1. Redness or drainage at the incision line.

2. Lochia is heavier than a normal menstrual period.

3. Abdominal pain

4. Temperature greater than 38°C

5. Frequency or burning on urination.

Teach her to recognize signs of possible complications directly related to the surgery, such as:

Staples, sutures, steri strips

types sutures

• Do not scrub

• Open to the air as much as possible

• Clean and dry

• Try and inspect your incision daily

• Others lift things

• Rest frequently

Cesarean Incision Care (DOCTOR)

Incision

a cut made in the skin during an operation.

• Stitches

• Staples

• Skin glue

• Skin closure strips

The edges of the incision maybe held together with:

Bandage or Dressing

Covers the incision

Amniotomy

is the artificial rupturing of membranes during labor if they do not rupture spontaneously to allow the fetal head to contact the cervix more directly, which possibly increases the efficiency of contractions and therefore increases the speed of labor.

Episiotomy

Is a surgical incision of the perineum made to prevent tearing of the perineum

Internal electronic monitoring

Is the most precise method for assessing FHR and uterine contractions. Often used to assess whether contractions are strong enough to cause cervical change in the case of a prolonged labor course.