what are indications for a c-section?
- hx of previous c/s
- arrest of labor in stage 1 or 2
- placental or uterine abnormalities
- cephalopelvic disproportion
- maternal risk factors
- fetal malpresentation
- Cat 3 FHR patterns (tachysystole)
- maternal exhaustion
- maternal fear
- epidural too early
how can you prevent a c-section?
- induce for medical, not elective reasons
-use Bishop score when considering elective IOL - allow second stage to proceed without precipitous intervention
- consider vacuum- or forceps-assisted birth
- unneeded costs and risks (c/s costs more than vaginal birth; think long-term impacts)
c-sections are classified as
- scheduled: breech position
- non-urgent: should get baby out soon
- urgent: need to get baby out sooner rather than later
- emergent: need to get baby out know
perioperative care for a c-section consists of
- patient teaching
- diagnostic lab tests
- surgical care: catheter, NPO status
- antibiotics and VTE prophylaxis
- anesthesia manangement
- care for an unscheduled c/s
- consider PPH risk and need for type-specific blood on hold
intraoperative care for a c-section includes
- nurse monitoring VS
- surgery complications
- documentation
- emotional support for mother and family
postoperative care for a c-section includes
- recovery in a surgical suite
-2 hours if stable - nursing actions and monitoring
- first 24 hours: medical needs, bonding
- second 24 hours: discharge planing
maternal-newborn bonding includes
- skin-to-skin contact
- positional considerations to avoid SUNC
- emotional support
- patient teaching
what is SUNC?
sudden unexpected newborn collapse
- respiratory and cardiac collapse
full recovery from a c-section takes approximately how long?
6 weeks or more
what are some complications from a c-section?
- DVT
- paralytic ileus
- maternal hemorrhage
- bladder or incisional infections
infection rate is higher for what classification of c-section?
emergent
nursing actions in preparation for discharge after a c-section includes
- monitor incision for dehiscence and swelling
- assess fundus and lochia
- manage pain
- discontinue IVs and foley catheter
- monitor for VTE
- remove staples before discharge (*sutures and glue closer stays in place)
- instruct family that woman will need assistance
- facilitate bonding
clinical pathways of a c-section
- assessments
- activity level (get out of bed, move around, stretching the incision will make them feel better, no heavy lifting)
- education (what is normal, what is not; to mom and family/partner)
- elimination (want gas)
- emotional needs
- medication (as needed)
- nutrition (variety of food, lots of water)
- pain management (meds, non-pharm measures)
arrest of labor is defined as
- dilation of >/= 6 cm with ROM, contracting for > 4 hours
OR - > /= 6 hours of inadequate contractions with no cervical change
arrest of labor during stage 2 is defined as
- with drugs: lack of continuing progress for 3 hours
- without drugs: lack of continuing progress for 2 hours
risks to mom with c/s:
- hemorrhage
- blood clots
- maternal death (r/t PPH)
- increased risk for placenta accreta
a CBC blood test includes:
- hematocrit
- hemoglobin
- WBC count
why NPO status?
risk of aspiration
hemorrhage complications
- bladder, ureter and bowel trauma
- maternal respiratory depression related to anesthesia
- maternal hypotension related to anesthesia, which increases the risk for fetal acidemia
- inadvertent injection of the anesthetic agent into the maternal bloodstream
nursing actions: level of consciousness
- blood pressure and pulse q15 min
- color
- oxygen saturation
- cardiac monitor for rate and rhythm
- pain
nursing actions post c/s: mom
- dressing condition
- I & O
- sensory and motor function
- temperature at least hourly; if hypothermic q15 min
-active warming measures are used to prevent hypothermia - fundal height q15 min, and lochia
- s/e to anesthesia: N/V, pruritus, shivering
-intervene - oxytocin as ordered
- monitor bleeding QBL
- encourage bonding, skin to skin
- initiate breastfeeding if mom and baby are stable
nursing actions post c/s: baby
- vit K injection to thigh
- erythromycin ointment to eyes
- monitor temperature, RR, blood sugar
maternal early warning criteria post c/s
- systolic BP: <90 or >160 mmHg
- diastolic BP: >100 mmHg
- HR: <50 or >120 bpm
- RR: <10 or >30 breaths per min
- O2 sat: <95% in room air
- Oliguria: <30 mL/hour for 2 hours
- maternal agitation, confusion, or unresponsiveness
- women with HTN who have persistent HA or SOB
paralytic ileus
non-mechanical slowing down of the gut
- make patient NPO, let gut rest
- in severe cases, NG tube
