SURGICAL MANAGEMENT

EPIDURAL ANESTHESIA
 Epidural anesthesia is a technique whereby a local anesthetic drug is injected through a catheter
placed into the epidural space. This technique has some similarity to spinal anesthesia.
PURPOSES:
 epidural anesthesia is frequently given for surgeries involving:
• Pelvis, hips, and legs
• Childbirth
Advantages of this type of anesthesia include:
• The ability to be awake during the operation
POSSIBLE COMPLICATIONS:
 Severe headache or back pain
 Drop in blood pressure
 Nerve damage
 Infection
 Allergic reaction to the anesthetic used
 Longer labor during childbirth with an epidural anesthesia
PRIOR TO PROCEDURE:
Make sure that your doctor is aware of:
• Patient allergies to drugs
• Medications currently using
• Any heart or lung conditions
• Any previous reactions that the ptient or other family members have had to anesthesia
• Any bleeding problems have had in the past

PROCEDURE:
• An area on the back above the spinal cord will be cleaned.
• A local anesthetic will be injected into the skin to numb the area.
• The medication will be sent directly into the sac of fluid that surrounds the spinal cord.
• After the surgery, a bandage will be placed over the injection spot.

NURSING RESPONSIBILITY:
• Monitor vital signs.
• Assess for level of consciousness.
• Check for urine output.
• Ensure safety.
CESAREAN SECTION
 A cesarean section is an operation that delivers a baby through a cut in abdomen and uterus.
 Cesarean birth happens through an incision in the abdominal wall and uterus rather than through
the vagina.
 Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room.

PURPOSE: Surgical treatment for patient with congenital heart disease, previous cesarean section,
patients who are unable to give normal spontaneous delivery and to prevent further blood loss that could
occur with disruption of the placenta during vaginal bleeding.

PROCEDURE:
PREOPERATIVE
You will have an IV for fluids and medicines as ordered.
Before surgery, you will be given an anesthetic (general, spinal, or epidural) if you have not
already been given one earlier in your labor.
A general anesthetic is normally only used for emergency cesareans because it works quickly
and the mother is sedated.
The spinal and epidural anesthesia will numb the area from the abdomen to below the waist
(sometimes the legs can be numb also), so that nothing can be felt during the procedure.
In this procedure you will probably receive a catheter to collect urine while your lower body
is numb.
Your abdomen will be cleaned and prepped.
A nurse will insert a catheter to drain urine from your bladder.
Your heart rate, blood pressure, and breathing also will be monitored.

INTRAOPERATIVE
The health care provider will make an incision in the abdomen wall first.
The doctor will make an incision that is about 6 inches long and goes through the skin, fat,
and muscle.
In an emergency cesarean this will most likely be a vertical incision (from the navel to the
pubic area) which will allow the health care provider to deliver the baby faster.
The most common incision is made horizontally (often called a bikini cut), just above the
pubic bone.
The muscles in your stomach will not be cut. They will be pulled apart so that the health care
provider can gain access to the uterus.
An incision will then be made into the uterus, horizontally or vertically. The same type of
incision does not have to be made in both the abdomen and uterus.
The classical incision made vertically, is usually reserved for complicated situations such as
placenta previa, emergencies, or for babies with abnormalities.
The most common incision is the low transverse incision. This incision has fewer risks and
complications than the others and allows most women to attempt a VBAC in their next
pregnancy with little risk of uterine rupture.
 The health care provider will then suction out the amniotic fluid and then deliver the baby.
The baby’s head will be delivered first so that the mouth and nose can be cleaned out to allow
it to breathe.
Once the whole body is delivered, the health care provider will lift up and show you your
baby.
Most health care providers will then pass the baby on to the nurse for evaluation.
Finally, your placenta will be delivered (you may feel some tugging) after which the surgical
team will begin the close up process.

POST OPERATIVE
After the surgery, you might begin to experience some nausea and trembling. This can be caused
by the anesthesia, by the effects of your uterus contracting or from an adrenaline let down. These
symptoms usually pass quickly and can be followed by drowsiness.
If your baby is healthy, this is normally when the baby can rest on your chest and you can start
breastfeeding and bonding. You and your baby will continually be monitored for any potential
complications.
When you are discharged from the hospital you will be advised on the proper post-operative care
for your incision and yourself.

NURSING MANAGEMENT FOR CS:

PREOPERATIVE
1. Verify the patient’s identity.
2. Obtain an informed consent.
3. Monitor maternal Vital signs and fetal heart tone.
4. Ensure cardio pulmonary clearance.
5. Perform hand hygiene and apply antiseptic or alcohol (70%).
6. Inform the patient of what is happening and provide support.
7. Position the patient for the skin preparation and placement of the indwelling catheter.
8. Insert the indwelling catheter and position the drain tube of the catheter under the patient’s leg. If
a catheter is already in place, confirm its patency and the colour and amount of urine currently in
the drainage bag, and then place the bag near the head of the table.
9. Place the padding around the area of skin to be prepare for the incision to prevent the pooling of
solutions under the patient. This padding should be removed after preparation is complete and
before sterile drapes are applied.
10. Perform surgical counts of sponges, sharps, and instruments per institutional policy and
procedure. A count is conducted before the start of the procedure and before the closure of the
uterus, peritoneum, and skin incision. A count is also performed when a change in surgical staff
takes place.
11. Perform a sterile abdominal skin preparation.
12. Continue monitoring the FHR until abdominal sterile preparation has been started and abdominal
preparation is complete.
13. Alleviate patient anxiety
INTRAOPERATIVE:

1. Verify that all required documentation is completed.

2. Correct informed surgical consent, with patient’s signature.
3. Completed records for health history and physical examination.
4. Verify details, provide explanations, and answer questions to provide a sense of professionalism
and friendliness that can help the patient feel secured.
5. Give attention to physical comfort of the client.
6. Inform the patient who else will be present in the OR, how long the procedure is expected to take
and other details that helps the patient prepare for the experience and gain a sense of control.
7. Position patient according to the surgical procedure to be performed and as well as to the physical
condition of the patient.
8. Precautions for patient safety must observe particularly with thin, elderly, or obese patients and
those with physical deformities.
9. Monitor and manage potential complications that may occur.
10. Add additional sponges, sharps, and instrument to the operating room as requested. Count
additions with the scrub person and add them to the count sheet.
11. Bring any medication, fluids, or surgical supplies as requested to the operating field using sterile
technique.
12. Monitor conditions in the OR. Any break in sterile technique must be reported and corrected.
13. Perform surgical counts of sponges, sharps, and instruments per institutional policy before
closure of the uterus, peritoneum, and skin incision. A count is also conducted when a change in
surgical staff takes place.
14. Notify the practitioner immediately if the surgical count is not correct.

POST-OPERATIVE

1. Monitor airway and level of consciousness.

2. Monitor vital signs every 15 minutes for the first hour, every 30 minutes for the next hour and
every 1 hour for the next 2 hours, if stable, every shift.
3. Administer pain reliever as ordered.
4. Encourage also deep breathing exercise.
5. Check for complications of surgery. (e.g. Bleeding, haemorrhage, infection, wound dehiscence,
evisceration, palpable lymph nodes, increase WBC count, presence of malodorous vaginal
discharge, etc.)
6. Assess for signs and symptoms of respiratory depression and altered level of consciousness due
to effect of anesthesia.
7. Assess patient’s pain scale.
8. Promote relaxation techniques such as listening to music, diversion of activities, splinting, etc.
9. Verify whether the infant is being transferred to the nursery or will remain with the patient to be
cared for in a family-centered environment.
10. Check for skin integrity.
11. Maintain aseptic technique when dressing and caring wound.
12. Emphasize the importance of proper hand washing.
13. Administer antibiotics and analgesics as ordered.
14. Document the procedure in the patient's record.