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Cabbab, Girly F February 19, 2010

BSN-3 Group 2
NCM 102 RLE

TEACHING LEARNING GUIDE

General Objectives: At the end of my discussion, student nurses will be able to acquire knowledge, develop skills and gain positive
attitude in dealing with nursing care to patients with cesarean section secondary to cephalopelvic disproportion

Specific Objectives: At the end o 15 minutes class-discussion student nurses will be able to:

1. Describe the Causes of the cesarean section


2. Identify its Clinical Manifestation
3. Discuss the Diagnostic Evaluation
4. Discuss Medical Management of the Injury
5. Discuss the nursing Intervention and Patient Education

TOPICS TIME TEACHING- EVALUATION RESOURCES


ALLOTEMENT LEARNING
ACTIVIITIES
1. Causes of 3 mins. 1.http://www.bluegrass.com/html
cesarean / html
section 3 mins.
2. Clinical 2.http://www.brooksidepress.org/Products
Manifestation LECTURE- Post test 10 items /OperationalMedicine/DATA
3. Diagnostic 3mins. DISCUSSION /operationalmed/Manuals
Evaluation /NATOEWS/ch04/04Clinical
4. Medical 3mins. Manifestations.html
management 3. http://generalmedicine.suite101.com
5. Nursing 3mins /article.cfm/whiplash_diagnosis_and_testing
intervention
and Patient
Education
Cesarean section
> Surgical removal of a fetus from the uterus through an abdominal incision at or before full term. It is usually performed when
vaginal delivery would endanger the life or health of the mother or the child. Vaginal delivery is often possible in subsequent
pregnancies. Cesarean section carries the usual risks of major surgery. Once overused, largely for fear of malpractice suits, its
use has been greatly reduced by the natural childbirth movement.

Reasons for cesarean section

The second most common reason that a c-section is performed is difficult childbirth due to non-progressive labor (dystocia).
Difficult labor is commonly caused by one of the three following conditions:

• abnormalities in the mother's birth canal;


• abnormalities in the position of the fetus;
• abnormalities in the labor, including weak or infrequent contractions.
• The mother's pelvic structure may not allow adequate passage for birth. When the baby's head is too large to fit through the
pelvis, the condition is called cephalopelvic disproportion (CPD).
• The mother's health may make delivery by c-section the safer choice, especially in cases of maternal diabetes, hypertension,
genital herpes, malignancies of the genital tract, and preeclampsia (high blood pressure related to pregnancy).
• the mother is carrying more than one baby (twins, triplets, etc.)

• there are problems with the shape of the mothers pelvis

• there are problems with the placenta

• there are problems with the umbilical cord

• there are problems with the position of the baby, such as breech

• the mother has had a previous C-section


Complications Associated With Cesarean Section
• Infections in the mother or baby
• Minor bleeding
• Separation of a scar on the uterus from a previous cesarean delivery
• Hemorrhoids
• Constipation
• Urinary tract infection (UTI)
• Ileus, or a temporary stoppage of bowel activity
• Abnormal or painful scar
• Allergic skin reaction.

Diagnostic Exam
• Ultrasound- testing reveals the positions of the baby and the placenta and may be used to estimate the baby's size and
gestational age.
• Fetal heart monitors, transmit any signals of fetal distress.
• Oxygen deprivation may be determined by checking the amniotic fluid for meconium (feces); a lack of oxygen may
cause an unborn baby to defecate. Oxygen deprivation may also be determined by testing the pH of a blood sample
taken from the baby's scalp; a pH of 7.25 or higher is normal, between 7.2 and 7.25 is suspicious, and below 7.2 is a
sign of trouble.
• Complete blood count (CBC),Blood typing (ABO) and Cross match
• Urinalysis-Determine albumin and Glucose levels
• X-ray pelvinetry – Determine CPD,flexion of head in breech position
• Amniocenteses-Assess fetal lung maturity

Medical Management
Antibiotics after cs
If there were signs of infection or the woman currently has fever, continue antibiotics until
the woman is fever-free for 48 hours.
Analgesia After Cesarean Section

• Adequate postoperative pain control is important. A woman who is in severe pain does not
recover well.
• Avoid over sedation as this will limit mobility, which is important during the postoperative
period.
• Women should be offered diamorphine (0.3–0.4 mg intrathecally) for intra- and
• postoperative analgesia because it reduces the need for supplemental analgesia after
• Adding acetaminophen also potentiates the effects of the other medications with very little
additional adverse risk
• analgesic rectal suppositories for relief of pain in women following caesarean section
• Ambulation enhances circulation, encourages deep breathing and stimulates return of normal
gastrointestinal function. Encourage foot and leg exercises and mobilize as soon as possible,
usually within 24 hours
Nursing Intervention
1.Perform preoperative care

• Insert a retention catheter prior to surgery.


• This keeps the bladder empty, prevents trauma to the bladder, and prevents obstruction of the surgical
field from a full bladder.
• Have oxytocin available for administration after delivery.
• Remove dentures if present.

(2) Perform postoperative care.

• After surgery is completed, the woman will be monitored in a recovery area

• to ensure that the uterus remains contracted, that there is no excessive vaginal bleeding or bleeding at
the incision site,
• that there is adequate urine output,
• monitor routine vital signs (blood pressure, temperature, breathing).
• Pain medication is also given, initially through the IV line, and later with oral medications.
• When the effects of anesthesia have worn off, about four to eight hours after surgery, the woman is
transferred to a postpartum room
• When the woman is passing gas, begin giving her solid food.
• If the woman receives IV fluids for more than 48 hours, monitor electrolytes every 48 hours. Prolonged
infusion of IV fluids can alter electrolyte balance.
• Ensure the woman is eating a regular diet prior to discharge from hospital.
• Women who are recovering well and who do not have complications after CS can eat and drink when
they feel hungry or thirsty