Curriculum: BSN

Course- Obstetrics

Topic- Care of a patient undergoing a scheduled Cesarean section

Setting- Face to face in the classroom

Lesson Description

This lesson is designed to provide students with the understanding of how to care for a patient
undergoing a scheduled Cesarean section. This lesson will focus on the role of the nurse during
pre-op, intra-op, and post-op. Risk factors and potential complications will be discussed.

Learning Objectives

Objectives will be met by the end of the lesson and again at the end of the course

Students will be able to:

 Identify the responsibilities of the nurse caring for a patient undergoing a scheduled c-
section during pre-op, intra-op and post-op
 Describe potential risk factors for complications of a Cesarean section
 Explain signs and symptoms of possible complications of a Cesarean section
 Assess the need for further patient education or consults
 An overall course objective would be to understand how to care for the laboring
patient- much of which will carry over to the care of the c-section patient; similar
initial care, risk factors, and potential complications
 Students will be expected to assess fetal heart rate monitors during pre-op, however,
this would have initially covered earlier in the course.

Timeline
 The OB course will last 15 weeks
o Conception
o Antenatal
o Fetal Heart Monitoring
o Laboring patient
 Care
 Complications
o Cesarean section
 Care
 Complications
 These concepts will build on what has been taught in the previous
lessons.
 It is necessary to understand how to care for the typical laboring
patient and the associated risks and potential complications first;
much of which relates to these patients as well.
 This lesson should take 1-2 classes to be completed.
o Postpartum
o Breastfeeding
o Newborn Care

Teaching Strategies

 A variety of strategies- incorporating both passive and active learning will be used to
prevent boredom, increase retention, and accommodate different learning styles (Billings
& Halstead, 2016).
o Assign readings prior to class- textbooks/e-books
o Utilize online simulation programs such as ShadowHealth
 Students expected to have some understanding of basic concepts and how
to care for these patients prior to entering the class
o Lecture
 PowerPoint
 Videos
 Provide handouts
 Especially to reiterate fetal heart monitoring
 Pictures of different strips with explanations of interpretation
 Encourage student participation
 Ask verbal questions to students during lessons to encourage them
to think out loud
 Interactive discussions
o Can help evaluate the students understanding of the topic
o Audience response systems – clickers
 Used during lecture
 Multiple choice questions asked
 Students answer anonymously
o Less anxiety for students
o Still allows instructor to gauge the classes’ understanding
of material
 Gives opportunity for students to be interactive and incentive to pay
attention
  Can lead to open in-depth discussion on topics
o Case Studies
 Break class into groups
 Give each group a different scenario
 Groups must identify the patient’s risk factors, steps they will take
to provide care throughout the visit, necessary equipment, etc.
 Groups will present their case study to the class
o Encourage discussion afterwards
 Would someone else have done something
different?
 If times allows- can role play
o Each group member will be a different team member
 Patient, spouse or support person, doctor, nurse,
tech
o Office hours and email should be utilized when students have questions or need
clarifications on the material
o Potential Barriers
 Access to Shadow Health costs money- students must be able to pay for
program and have access to a computer
 The cost of the clickers in the classroom would have to be covered by the
school
 Large classes may be more difficult to use active teaching strategies
 In my experience most nursing classes are on the smaller side so
this should not be a problem
 When the class is broken down into smaller groups it helps
promote teamwork, critical thinking, problem solving, and helps
the students gain a deeper understanding of the topic (Billings &
Halstead, 2016).
 Using a variety of techniques can help reach all types of learners

Evaluation

 Material from this lesson would be included in written exams

o Short quiz given the day after the lesson
 Clear cut right or wrong answers
o Material will appear again on other exams throughout the course- i.e. finals
 Assess work done on Shadow Health
 Class discussions
o Can see student’s thought process and understanding
 Case studies and role playing
 o Assess critical thinking and understanding
 Classroom Assessment Technique (Billings & Halstead, 2016)
o Ask students to write down any questions they still have after the end of the
lesson
 Instructor can see who needs more help and provide individual
attention
 If a common topic is mentioned it can be gone over again for the
whole class
 Some student’s may feel embarrassed to say they do not understand
something. Anonymously writing it down may help ease anxiety.

Lesson Content
Students should already have basic med/surg knowledge (ability to identify abnormal vital signs
and s/s of related abnormalities) and knowledge about the care of the laboring patient

 Risk Factors
o Previous C-section
o Multiple gestation
o Co-morbidities
 HTN, DM
o History of bleeding problems
o Age
 Pre-op
o Obtain medical/surgical history
o Medication Reconciliation
o Review Allergies
o Assess NPO status
o Ensure surgical consent is obtained
o Review lab results
 Report any concerns to MD
o Place peripheral IV
 Draw any needed labs
 Hang IV fluids
 Administer prophylactic antibiotics
 Intra-op
o Scrub Nurse
 Scrub
 Set up room
 Identify necessary instruments
 Assist with surgery
 o Circulating Nurse
 Count instruments
 Assist with anesthesia
 Place Foley catheter
 Apply sequential compression devices
 Time-out
 Provide any necessary equipment, meds, etc. to scrub nurse/tech and MD
 Assess status of patient
 Document
 Assess status of newborn
 Assist in clean-up and transfer of patient to recovery room
 Post-op
o Assess vital signs
 B/P, HR, temp, respirations, pulse ox
o Apply EKG monitor
o Administer postpartum Pitocin
o Fundal checks
o Assess incision
o Assess lochia
o Assess pain and provide medication when needed
o Report any abnormal findings to MD
 Potential Complications
o Hemorrhage
o Blood clots
o Surgical site infection
o Reaction to anesthesia
 Education
o Infection Prevention
o Injury Prevention
o Skin to skin
o Breastfeeding

Reference

Billings, D.M. & Halstead, J.A. (2016). Teaching in nursing: A guide for faculty (5th ed.). St
Louis: MO: Elsevier.