The immediate postoperative period covers the first 24 hours after surgery and includes the time in which the patient remains in the post anesthetic care unit. Immediate postoperative management of a caesarean mother include prompt pain control, assessment of the surgical site and drainage tubes, monitoring the rate and patency of IV fluids and IV access as well as assessing the patient’s level of sensation, circulation anil safety.
A Caesarean section (C-section) is a surgical procedure used to deliver a baby through incisions in the mother’s abdomen and uterus. For mothers undergoing this procedure, care spans preoperative preparation, intraoperative support, and comprehensive postoperative recovery.
Monitoring
- After a cesarean section, a patient needs to be monitored for blood pressure, heart rate and amount of vaginal bleeding.
- Check to make sure that her uterus is becoming firmer.
- When the condition is stable, bring her to the hospital room, where she will spend the next few days.
Purposes of Postoperative Monitoring
Care and monitoring following cesarean delivery are to:
- Assess the health of mother and baby.
- Check the hemodynamic status such as vital signs and lochial flow.
- Institute pain management measures.
- Enhance recovery process and healing.
- Initiate breast feeding within 6 hours.
Articles at bedside
A tray containing:
- BP apparatus and stethoscope.
- Measuring tape to check the fundal height.
- Flash light to check the perineum for lochia.
- IV stand and IV fluids.
- Kidney tray and paper bag.
- Gloves.
- Sterile perineal pads.
- Tray with articles for monitoring body temperature.
Procedure
| Nursing action | Rationale | |
| Upon reaching the unit from recovery room: | ||
| 1. | Receive the patient on the bed and make her comfortable. | Patient relaxes after the stress of surgery. |
| 2. | Orient her to time, place, person and procedures. | Feels safe and comfortable. |
| 3. | Establish/re-start the IV infusion. | Prevents hypotension. |
| 4. | Place a perineal pad under the buttocks after inspecting lochial discharge. | To prevent soiling of linen and to monitor lochial discharge. |
| 5. | Check vital signs, i.e., blood pressure, pulse, respiration and temperature every 15 minutes for first hour and every 30 minutes for next hour followed by hourly check. | To access any deviation in vital signs which is an indication of developing problems. |
| 6. | Assess for color of skin and nails. | To assess for cyanosis. |
| 7. | Check Incision site for bleeding or discharge. | To ensure that no sign of bleeding or infection presents. |
| 8. | Place top sheet over patient. | Prevents hypothermia. |
| 9. | Maintain left lateral position, if general anesthesia was given. If spinal or epidural anesthesia was used, maintain in flat position until sensation in lower limbs return | To prevent regurgitation, and aspiration resulting in airway obstruction. Helps to avoid spinal headache and fall injury. |
| 10. | Monitor intake and output such as IV flow, oral fluids, urine output, etc. | Prevents hypo or hypervolemia. |
| 11. | Asses lochial flow for color, amount, odor and keep pad count. | To detect any PPH or signs of infection. |
| 12. | Monitor mother for pain at the incision area as well as uterine contractions and administer prescribed pain medication. | Reduces discomfort and promotes rest and sleep. |
| 13. | Institute breastfeeding if the mother intends to breastfeed, the baby should be put to breast as soon as possible with minimal disturbance to the mother. | Early feeding improves lactation. |
| 14. | Assist new mother with positioning and breastfeeding techniques: If mother’s condition permits baby can be handed over to mother and if not alright, ask the mother to express breast milk for the baby. | Promotes effective breastfeeding. |
| 15. | After care Replace the articles after the period of immediate care. | For cleaning and further use. |
| 16. | Carry out recording and reporting as per protocols. | For further planning of care. |
Special considerations
- Early ambulation should be done to prevent venous complications such as deep vein thrombosis.
- Encourage mother to maintain her personal hygiene to prevent development of any infection to mother and cross infection to baby.
- Encourage regular deep breathing exercises.
- Encourage to take adequate rest and sleep.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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