postoperative care after cesarean section ppt?

Cesarean Section Postoperative Management

Aka: Cesarean Section Postoperative Management, C-Section Postoperative Management
Obstetrics
Postpartum Disorders Chapter

Examination
Postpartum Inpatient Management
Cesarean Section Postoperative Management
Postpartum Office Visit
Fatigue
Postpartum Fatigue

From Related Chapters

Prevention
Postpartum Education
Mental Health
Postpartum Psychosocial Issues

I. See Also

Postpartum Inpatient Management
Postpartum Education
Postpartum Office Visit

II. Management: Acute

Transfer to postpartum ward when stable
Vital Signs q15 minutes for 1 hour, then q4 hours
Monitor intakes and outputs every 4 hours for 24 hours
Activity:
Bed rest
Supine for 8 hours after spinal anesthetic
Incentive Spirometry every 1 hour while awake
Standard Diet
Nothing by mouth for 8 hours after cesarean section
Sips of water after 8 hour window
Advance to clear liquids as tolerated
Advance to Regular diet when flatus or Bowel Movement
Early Solid Diet Protocol
Solid food within 8 hours of C-Section
Well tolerated
Resulted in faster bowel function return
Shortened hospital stay by 24 hours
Patolia (2001) Obstet Gynecol 98:113-6 [PubMed] (or open in [QxMD Read])
Intravenous fluids
D5LR OR D51/2NS at 125 cc/hour
Foley to gravity
Contact physician for
Temperature > 100.4
Systolic Blood Pressure <90 mmHg or >140 mmHg
Diastolic Blood Pressure >90 mmHg or <50 mmHg
Heart Rate >130 or <60
Respiratory Rate >32 or <8
Urine output
Foley Catheter in place: <60 cc in 2 hours
Intermittent Urine collection: <300 cc per shift

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III. Medications:

Antibiotics if patient labored before cesarean section
Cefoxitin 2 grams IV every 4 hours for 3 doses or
Ancef 1 gram IVPB every 8 hours for 3 doses
Nausea
Inapsine 1.25 mg IM/IV every 4-6 hours prn Nausea
Initial Analgesia
Demerol 50-75 mg IM every 3-4 hours prn
Morphine 10 mg IM every 3-4 hours prn
Vistaril 25-50 mg IM every 3-4 hours prn
Later analgesia
Ibuprofen 800 mg PO tid prn
Tylenol #3 1-2 mg PO every 4-6 hours prn
Other Medications
Iron Sulfate dosing based on Postpartum Anemia
Prenatal Vitamin po qd
Colace 100 mg PO bid OR 200 mg PO at bedtime
Mylicon 80 mg PO qid prn bloating
Milk of Magnesia

IV. Labs

Complete Blood Count in morning
Maternal Blood Type Indications for Cord Blood
Mother Rh Negative

V. Rounds

Assess
Abdominal and perineal Pain
Lochia
Flatus or Bowel Movement
Examine
Cardiopulmonary exam
Abdominal examination
Fundal height
Uterine tenderness
Bowel sounds
Incision clean and dry
Extremity exam
Calf tenderness
Homan's sign
Intravenous Access discontinuation
Patient taking adequate fluids
No signs of Postpartum Hemorrhage
Discontinue Foley Catheter when no longer needed
Administer Rubella shot id mother not immune
RubellaVaccine 0.5 cc SQ at Discharge
Mother Rh Negative
Blood Type and Indirect Coombs
Cord blood sent to lab
RhoGAM indicated for Rh Positive infant

VI. Disposition

Staple Removal
Horizontal incision
Remove staples on Day 3-4 and place steri-strips
Vertical incision
Remove staples on Day 4-5
Follow-up in clinic
Status post Cesarean Section at 2 weeks
Postpartum visit at 6 weeks

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