Cesarean Section2013(1).ppt - Cesarean Section • Concepts...

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Unformatted text preview: Cesarean Section • Concepts: • Cesarean section is birth of fetus through abdominal & uterine incisions. • Cesarean section involves • a skin incision & • a uterine incision. Indications for Cesarean Section Previous Cesarean birth Failure to progress CPD/macrosomia Abnormal presentation Multiple gestation Fetal intolerance to labor Placenta previa/placenta abruption Prolapsed cord Prolapsed Cord Animation • v-k Cesarean Section Lower uterine segment incision – Pfannenstiel most commonly used transverse incision involving thinnest portion of uterus; involves less blood loss; less likely for bladder trauma; less likely to rupture during subsequent pregnancy; limited in size due to presence of major blood vessels on either side of uterus Skin incision for Cesarean BirthVertical & Pfannenstiel Cesarean Section Lower uterine segment vertical incision Preferred for multiple gestation abnormal presentation placenta previa (can’t cut low transverse if placenta blocking the way) fetal distress pre-term & macrosomic fetuses. Possibility of: bladder trauma uterine rupture w/subsequent pregnancies Cesarean Section Classical incision – upper segment of uterus Used for fetal distress pre-term delivery. More blood loss Increased risk of subsequent uterine rupture. Previous classical will likely have repeat C/S. Uterine incisions for Cesarean Birth: Low transverse, low vertical, & classical . Cesarean Section: Nursing Actions Pre-operative: • Informed consent (physician) • Choice of anesthesia (anesthesiologist) • IV infusion /Blood specimens • Foley catheter • Skin preparation • Antacid – Bicitra (30 ml po) • Teaching about immediate post-op period • Support Vacuum-assisted Birth Cesarean Section: Post-operative • Oxygenation needs Turn, cough, deep breathe & Incentive spirometry • Circulation needs Early ambulation & Hemoglobin & Hematocrit • Urinary Elimination needs Intake & output, Foley catheter first 12-24 hrs IV fluids till taking po fluids, temperature stable Cesarean Section: Post-operative • Immune Needs Handwashing & temperature q4h. • GI Elimination needs Early ambulation, Advance DAT, increased fluids & Simethicone. • Neurosensory needs • Pain management – if pt received Duramorph initial inject-able analgesics may be withheld for first 24 hrs postop. Cesarean Section: Post-operative • Rest/exercise needs Active/passive ROM & early ambulation • Skin integrity needs Incisional care/staple removal 3rd post-op day Handwashing • Reproductive needs Fundal/lochia assessment & pericare ...
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