Peri Operative Care

8/3/2019 Peri Operative Care

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REASONS FOR CESAREAN DELIVERY Labor is not progressing as it should. This may occur if the

contractions are too weak, the baby is too big

, the pelvisis too small

, or the baby is in an abnormal position. If awoman's labor does not progress normally, in many cases,the woman will be given a medication (Pitocin/oxytocin)to be sure that contractions are adequate for severalhours. If labor still does not progress after several hours, acesarean delivery may be recommended.

The baby's heart rate suggests that it is not toleratinglabor well.

The baby is in a transverse (sideways) or breech position(buttocks first) when labor begins.

Heavy vaginal bleeding. This can occur if the placentaseparates from the uterus before the baby is delivered(called a placental abruption).

A medical emergency threatens the life of the mother orinfant.

Charlene Anne I. Puzon, S.N.


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Peri-operative Care



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Peri-operative Care

ALSO CALLED AS PERI-OP

IS THE TIME PERIOD DESCRIBING

THE DURATION OF APATIENT'S SURGICALPROCEDURE

THIS COMMONLY INCLUDESWARD ADMISSION, ANESTHESIA,SURGERY, AND RECOVERY

TAKES PLACES IN HOSPITALS, INSURGICAL CENTERS ATTACHED



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USED TO PREPARE THE PATIENT

BOTH PHYSICALLY ANDPSYCHOLOGICALLY FOR THE

SURGICAL PROCEDURE AND AFTER

SURGERY.



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GOAL OF PERIOPERATIVECARE

TO PROVIDE BETTER

CONDITIONS FOR PATIENTSBEFORE OPERATION,DURING OPERATION, AND

AFTER OPERATION



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THREE PHASES OF SURGERY:

PREOPERATIVE,

INTRAOPERATIVE, AND

POSTOPERATIVE.



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PREOPERATIVE PHASE

RESERVING EQUIPMENT FOR SURGERY

REVIEWING A PATIENT'S CHART PREPARING AND MAINTAINING AN

OPERATING ROOM PUTTING ON PERSONAL PROTECTIVE

CLOTHING AND EQUIPMENT STERILIZING SUPPLIES SCRUBBING HANDS FOR SURGERY

SETTING UP SURGICAL EQUIPMENT DRAPING AND POSITIONING PATIENTS AND

PREPARING THEIR SKIN. REMOVING JEWELRIES, NAIL POLISH (TO

LOOK FOR COLOR OF NAILS-CYANOTIC ORJAUNDICE)Charlene Anne I. Puzon, S.N.


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INTRA-OPERATIVE PHASE

COUNTING AND IDENTIFYINGINSTRUMENTS

ANTICIPATING SURGICAL STEPS

UNDERSTANDING THE METHODSAND APPLICATIONS OFHOMEOSTASIS

PLACING AND SECURING

RETRACTORS; PASSINGINSTRUMENTS DURING SURGERY

IRRIGATION, SUCTION ANDSPONGING

ASSEMBLING, TESTING ANDCharlene Anne I. Puzon, S.N.


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VERIFYING, LABELING, MIXING,COUNTING AND REPORTING THE

AMOUNT OF MEDICATIONS ANDSOLUTIONS USED

PREPARING DRAINS,CATHETERS AND TUBING

OBSERVING PATIENT STATUS PREPARING AND CUTTING

SUTURE MATERIALS

USING SUTURES, NEEDLES AND

STAPLING DEVICES PERFORMING APPROPRIATE

EMERGENCY ACTIONS

VIDEO RECORDING;

CONNECTING AND ACTIVATINGCharlene Anne I. Puzon, S.N.


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POST-OPERATIVE PHASE

EVALUATING PATIENTS AFTER

SURGERY

TRANSFERRING PATIENTS FROMOPERATING TABLE TO STRETCHER

REMOVING PATIENT DRAPING

CLEANING UP THE OPERATINGROOM POST-SURGERY

DISPOSING OF CONTAMINATEDWASTE AND DRAPES



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PROCEDURE

After being admitted to the hospital, awoman may be given an oral dose of anantacid to reduce the acidity of thestomach contents. Another medication

may be given to reduce the secretions inthe mouth and nose. An intravenous linewill be placed into the hand or arm, and anelectrolyte solution will be infused.

Monitors will be placed to keep track ofblood pressure, heart rate, and bloodoxygen levels



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PACU--- POST ANESTHETIC CAREUNIT



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Anesthesia The woman is usually accompanied toan operating room before anesthesia is administered.A spouse or partner can usually stay with the womanin the operating room.

There are two types of anesthesia used duringcesarean delivery: regional and less commonly,general. For a planned cesarean delivery, regionalanesthesia is usually performed. Meeting with theanesthesiologist allows the woman to ask specificquestions about anesthesia, and allows theanesthesiologist to identify any medical problems thatmight affect the type of anesthesia that isrecommended.

With epidural and spinal anesthesia, the anesthetic isinjected near the spine, which numbs the abdomenand legs to allow the surgery to be pain-free whileallowing the mother to be awake.



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General anesthesia induces unconsciousness. This means thatthe mother will not be awake or aware during the procedure.

After the anesthesia is given, the woman will fall asleep within10 to 20 seconds and a tube will be placed in the throat toassist with breathing. General anesthesia carries a greater riskof complications than epidural or regional anesthesia becauseof the need for an endotracheal (breathing) tube and becausedrugs given to the mother affect the infant.

Women who have general anesthesia will not be awake duringthe cesarean delivery. Regional anesthesia is generallypreferred because it allows the mother to remain awakeduring the procedure, enjoy support from staff and a familymember, experience the birth, and have immediate contactwith the infant. It is usually safer than general anesthesia.

After the anesthesia is given, a catheter is placed in thebladder to allow urine to drain out during the surgery andreduce the chance of injury to the bladder. The catheter isusually removed within 24 hours after the procedure.



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SKIN INCISION

There are two basic types of incision:horizontal (transverse or "bikini line") andvertical (midline). Most women have atransverse skin incision, which is made 1 to 2inches above the pubic hair line. Theadvantages of this type of incision includeless postoperative pain, more rapid healing,and a lower chance that the wound willseparate during healing.

Less commonly, the woman will have avertical ("up and down") skin incision in themidline of the abdomen. The advantages ofthis type of incision include rapid access tothe uterus (eg, if the baby is in distress or ifthe woman is bleeding excessively).



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UTERINE INCISION

The uterine incision can also be either transverse orvertical. The type of incision depends upon several factors,including the position and size of the fetus, the location ofthe placenta, and the presence of fibroids. The mainconsideration is that the incision must be large enough toallow delivery of the fetus without causing trauma.

The most common uterine incision is transverse. However,a vertical incision may be required if the baby is breech orsideways, if the placenta is in the lower front of the uterus,or if there are other abnormalities of the uterus.

After opening the uterus, the baby is usually removedwithin seconds. After the baby is delivered, the umbilical

cord is clamped and cut and the placenta is removed. Theuterus is then closed. The abdominal skin is closed witheither metal staples or reabsorbable sutures.

After the mother and baby are stable, she or her partnermay hold the baby.



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POSTOPERATIVE CARE

After surgery is completed, the woman will bemonitored in a recovery area. Pain medication isgiven, initially through the IV line, and later withoral medications.

When the effects of anesthesia have worn off,generally within one to three hours after surgery,the woman is transferred to a postpartum roomand encouraged to move around and begin todrink fluids and eat food.

Breastfeeding can usually begin anytime after thebirth. A pediatrician will examine the baby withinthe first 24 hours of the delivery. Most women areable to go home within three to four days afterdelivery.



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Staples are usually removed within three toseven days of delivery, while reabsorbablesutures are absorbed by the body and do

not need to be removed. The abdominal incision will heal over the

next few weeks. During this time, there maybe mild cramping, light bleeding or vaginaldischarge, incisional pain, and numbness in

the skin around the incision site Mostwomen will feel well by six weekspostpartum, but numbness around theincision and occasional aches and pains canlast for several months.

After going home, the woman should notifyher healthcare provider if she develops afever (temperature greater than 100.4 F[38 C]), if pain or bleeding worsens, orthere are other concerns.



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End of discussion (:


Peri Operative Care

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