WEEK 10 - SURGICAL INTERVENTION FOR DELIVERING THE BABY

1. NCM 109- Care of Mother
and Child at Risk or with
Problems
(Acute and Chronic)-LECTURE
Wesleyan University –Philippines
Cabanatuan City
CONAMS
Jhonee Balmeo
Instructor

2. NURSING CARE OF A FAMILY DURING A SURGICAL INTERVENTION FOR
BIRTH
1. Amniotomy- it is the artificial rupturing of membrane during labor if they do not
rupture spontaneously to allow the fetal head to contact the cervix more directly.

3. Amniotomy also referred to as artificial rupture of membranes [AROM] is the
procedure by which the amniotic sac is deliberately ruptured so as to cause the
release of amniotic fluid.
POSITION:
• DORSAL RECUMBENT

4. • MATERIALS:
• AMNIOHOOK or HEMOSTAT
DISADVANTAGE
AT RISK FOR CORD PROLAPSE
•
NURSING MGT
•
MEASURE FHR

7.  2. CESARIAN BIRTH

8.  2. CESARIAN BIRTH

9.  2. CESARIAN BIRTH

10.  2. CESARIAN BIRTH
 > Birth accomplished through an abdominal incision into the uterus
 > One of the oldest types of surgical procedures known
 > More hazardous than vaginal birth
 > If compared with other surgical procedures, it is one of the safest
type.
 > It came from the latin word, “Caedore” which means to cut

11. Indications:
Maternal Factors:
 >CPD
 >Active genital herpes pappiloma
 >AIDS or HIV positive virus
 >Cervical Cerclage
 >Severe Hypertension
 >Dystocia
 >Previous C/S
 >Elective – no indicated risks

12. Placental factors:
 Placenta Previa
 Abruptio Placenta
Fetal factors
 Fetal macrosomia
 Fetal Distress
 Hydrocephalus

13. Nursing Diagnosis
 >Risk for infection related to a surgical incision
 >Fear related to impending surgery
 >Pain related to a surgical incision
 >Deficient fluid volume related to blood loss from surgery
 >Powerlessness related to medical need for cesarean birth

14. Implementation;
>Woman and her partner should feel
confidence in the health care personnel
 >Establish a helping relationship during labor
process
 >The more a woman understands about what
is happening, the more she can accept and
cooperate with the procedure
 >Sterile technique is essential
 >After procedure, provide “talk time”
 >Coordination with other health care personnel
– anesthesiologist, surgeon, pediatrician or
neonatologist and recovery room or nursery
personnel

15. TWO TYPES OF CESAREAN BIRTH:
1. Scheduled C/S – needs thorough
preparation for the experience
throughout the antepartal period
2. Emergency C/S – preparation is done
rapidly but with the same concern

16. Outcome Evaluation:
> Patient states that she understands the reason for C/S
 >Patient states that she felt well prepared for C/S even in the light of
emergency
 >Couples state that they feel able to cope with newborn care even with
mother recovering from surgery
 >Patient remains free of signs and symptoms of infection after C/S
 >Patient states that incisional pain is controlled and tolerable

17. Outcome Evaluation:
> Patient states that she understands the reason for C/S
 >Patient states that she felt well prepared for C/S even in the light of
emergency
 >Couples state that they feel able to cope with newborn care even with
mother recovering from surgery
 >Patient remains free of signs and symptoms of infection after C/S
 >Patient states that incisional pain is controlled and tolerable

18. Effects of Cesarean Birth
1.Stress Response
 >Body is subject to stress, this results in the release of epinephrine and
norepinephrine from adrenal medulla.

19. Effects of Cesarean Birth
2. Interference with Body Defense
 >Skin serves as the primary line of defense against bacterial invasion
 >When skin is incised for surgical procedure, the important line of defense is lost
 >Sterile technique is important before, during the surgery and in the days following
procedure

20. Effects of Cesarean Birth
3. Interference with Circulatory Function
> Some blood loss always occurs with surgery, even though vessels were immediately
ligated and clamped after cutting

21. Effects of Cesarean Birth
Complications:
 Hypovolemia – lowered BP, - ineffective perfusion of all body tissues

22. 4. Interference with Body Organ Function
 >Pressure from edema or
inflammation as fluid moves into are
further impairs function of the
primary organs as well as that of the
surrounding organs
 >Edema may be the result
 -deprivation of blood flow
 -impaired functions of these organs

23. 4. Interference with Body Organ Function
 >Uterus is handled during the procedure
 – can lead to failure to contract that leads to
postpartum bleeding
 >In order for the surgeon to reach the uterus,
the bladder should be displaced anteriorly –
that leads to loss of sense of filling-urinary
incontinence
 >Lower extremity circulation is also affected
due to edema

24. 5. Interference with self- image or self-
esteem
> Incisional scar can be noticed to some
extent

25. TYPES OF CESAREAN BIRTH
1.Classic cesarean Birth – incision is made through both the abdominal skin and the
uterus, made high on the uterus so that it can be used on a placenta previa
Disadvantage: leaves a wide skin scar also runs through the active contractile portion
of the uterus
2. Low Segment Incision
 >Bikini incision or bikini cut, Plannenstiel incision, made horizontally across the
abdomen just over the cervix,
 Disadvantage – takes longer to perform

26. TYPES OF CESAREAN BIRTH
1.Classic cesarean Birth – incision is made through both the abdominal skin and the
uterus, made high on the uterus so that it can be used on a placenta previa
Disadvantage: leaves a wide skin scar also runs through the active contractile portion
of the uterus
2. Low Segment Incision
 >Bikini incision or bikini cut, Plannenstiel incision, made horizontally across the
abdomen just over the cervix,
 Disadvantage – takes longer to perform

27. NURSING CARE OF A WOMAN ANTICIPATING CESAREAN BIRTH
I. 1.Preoperative Interview
 >woman’s knowledge about the procedure
 >The length of hospitalization
 >Any post surgical equipment to be used, such as indwelling catheter or IVF
 >Any special precautions that will be necessary for the infant

28. OPERATIVE RISK FOR WOMAN
1. 1.Poor nutritional status
a.Woman is obese –interfere with wound healing
-tissue that contain abundant fatty cells is difficult to suture,
-incision may take longer to heal
>Prolonged healing period increases the risk for infection and rupture of the
incision (dehiscense)
>Heart – may increase workload
–physiologic shock of surgery,
-may place greater stress on an already overworked organ
- >Difficulty of turning and ambulating after the procedure
- – high risk for respiratory or circulatory complications
- – pneumonia or thrombophlebitis

29. • * Homan’s sign: pain in calf upon dorsiflexion of foot – possible thrombophlebitis;
pedal edema
b. Woman with protein and Vitamin Deficiency –at risk for poorer wound healing
because these has something to do with cell formation at the incision site
• >Vitamin K Deficiency – this is very necessary for blood clotting after surgery
• >Iron Deficiency – this places the woman at high risk – can lead to fatigue that
affects parent-child bonding
c.Age Variations – can decrease circulatory and renal functions
d. Altered General Health Condition – woman with secondary illness is at greater risk,
may have an accompanying nutritional or elective or electrolyte imbalance related
to her primary illness

30. • * Homan’s sign: pain in calf upon dorsiflexion of foot
• – possible thrombophlebitis; pedal edema

31. e.Fluid and Electrolyte Imbalance – emergency C/S –subject to be placed on NPO
f.Fear - C/S is performed through epidural anesthesia
g.Operative Risk to newborn – when fetus is placed through birth canal, pressure on
the chest helps to rid the lungs of lung fluid – infants may have some degree of
respiratory difficulty for a day or two

32. PREOPERATIVE DIAGNOSTIC PROCEDURE
Include the following:
 Vital Signs
 Urinalysis
 CBC
 Coagulation Profile
 BT and Cross Matching
 UTZ results

33. PREOPERATIVE TEACHING
1.Deep Breathing Exercise – aerate the lungs through periodic breathing exercise and
help prevent stasis of lung mucus, can happen due to prolonged stay in supine
position during surgery.
 >Take 5 – 10 deep breaths every hour helps to increase lung function
 >Inhale as deeply as possible, holding breaths for a second or two. If not deeply
can lead to lightheadedness from hyperventilation
 Incentive Spirometry – common device used postoperatively to encourage deep
breathing
 Advantage – gives woman a sense of accomplishment

34. 2. Turning – remind the client to do it to prevent
both respiratory and circulatory complications
3. Ambulation – to stimulate lower extremity
circulation, surgeons prefer client to ambulate or
walk 4H after surgery ( as soon as the effect of
the anesthesia has worn out), it can be difficult
for the woman due to fatigue and pain, help
client to understand the importance of this.
-Antiembolic Stocking (TEDS) may be
prescribed to support and encourage venous
return

35. IMMEDIATE PREOPERATIVE CARE MEASURES
1. >Informed consent
2. >Overall hygiene- bath, removal of makeup, eye lenses, hair ornaments

36. Have you asked yourself?
Sino ba ang dapat nagpapapirma ng consent form?
Si doc? Or Tayo? Or tayo na <3

37. POSTPARTAL CARE MEASURES;
1. Urge woman to take adequate analgesia
2. Do not use acetylsalicyclic acid (aspirin), interfere with blood clotting and healing
3. Place pillow over her lap while breastfeeding
4. When giving pain control medications, support it with other measures such as:
 >Changing of position
 >Straightening of bed sheets
 >Check for abdominal incision
 – pain
 – suggests intestinal gas than incision pain
 – ambulation is the most effective measures
 >Ask woman what type of pain she is experiencing

38. Risk Related to deficient fluid volume related to blood loss during surgery
 >Monitor signs of bleeding – check BP, PR, RR every 30 mins for the
first 2H, every Hour, for the next 4H or as prescribed or ordered
 >Check for Signs of Shock

39. Nursing Measures;
1. Inspect dressings over the surgical wound for blood staining at the same time check
V/S
2. Observe the perineal pad for lochia flow.
3. Palpate the fundal height each time
4. Help woman turn to see under her body for bleeding
5. Oxytocin may be ordered to the 1st iL IVF

40. Risk for impaired urinary elimination related to surgical procedure
 >Catheter is left for 4H to 24H to ensure good urine flow
 >Before removal – urine culture is ordered to check for UTI
Nursing Measures:
1. >Administer prescribed analgesics to relax the abdominal muscle
2. >Provide privacy for voiding
3. >Offer bedpan, assist woman to go to bathroom every 2H
4. >Pour water over the vulva
 >Drink 5-6 glasses of water daily

41. Risk for ineffective peripheral tissue perfusion related to immobility during and after
surgery
Nursing Measures:
1. Leg exercise
2. Ambulation
3. Prescribing thromboembolic stockings

42. Bago natin ito tapusin, sagutan muna natin ito
Kailan tayo magsasagawa ng caesarean section?
1. Vaginal delivery would put baby or mother at risk
2. When the mother fears natural delivery
3. When the woman is having twins
4. When the doctor is tired

43. Bago natin ito tapusin, sagutan muna natin ito
When caring for a woman who had a cesarean section, the
priority intervention is to:
1. Give pain control medications
2. Monitor vital sign every 30mins for first 2 hours, then every
hour for 4 hourS
3. Measure the height of the fundus
4. Asking the patient for the type of pain

44. Last na ito, sagutan natin.
Which of the following is NOT a con/risk of birth by c-section?
1. not exposed to microorganisms in the birth canal of the mother
2. potential scalpel injury
3. probable respiratory issues
4. All of these disadvantages of a c-section
5. All are life-threatening.

45. Hindi pa yun last, Ito pa bruh…
Which of the following statements is false?
1.Babies born vaginally are healthier than those born
2.Babies born vaginally are exposed to harmful
3.Babies born via c-section often have breathing
4.Babies born vaginally are less likely to develop
5.Recovery from a c-section is longer than recovery

46. Done 