Operative

Obstetrics
NURSING INTERVENTIONS
Maternal & Fetal Assessment for IV Induction of Oxytocin:
1. Monitor blood pressure, pulse and respirations every 30 to 60 minutes
and with every increment in dose.
2. Observe contraction pattern and uterine resting tone every 15
minutes and with every increment in dose.
3. Assess intake and output : limit IV intake to 1000 ml / 8 hrs; output
should be 120 ml or more every 4 hours (antidiuretic effect,
decreased urine flow during its administration which may lead to
water intoxication).
4. Perform vaginal examination as indicated.
5. Monitor for nausea, vomiting, headache, hypotension.
6. Assess fetal status using electronic fetal monitoring; evaluate tracing
every 15 minutes and with every increment in dose.
7. Observe for emotional response of women and her partner.
8. If signs of fetal distress occur – stop infusion and seek help.
Nursing Responsibilities for Assisting in Amniotomy:
1. Explain the procedure to the client and family.
2. Assure the client that the procedure is painless to her and her baby.
3. Assess the fluid color, odor and consistency of the amniotic fluid.
4. Note and document the time of rupture.
5. Note and document the fetal heart rate before and after the procedure.
6. Assess the client’s temperature every 1 to 2 hours to check for infection.
7. Frequently assess the client’s level of comfort.
8. Maintain adequate intake and output records.
9. Document maternal and fetal assessments in the medical record.s
Nursing Responsibilities for Episiotomy:

Immediate
 Monitor vital signs of mother
 Observe aseptic technique
 Support the perineum properly

Postpartum
 Do perineal care
 Ice pack within three hours
 Provide hot sitz bath
 Perilite exposure after 24 hours
 Give analgesics as ordered
Nursing Responsibilities For Forceps Delivery:

1. explain the procedure to the mother, tell her what to expect

2. assess and record FHR before and after application
3. assess the mother for vaginal and cervical laceration
4. record the time and amount of first voiding
5. assess the newborn for facial palsy and subdural hematomas
6. explain to the parent that a forceps birth may have a transient
erythematous mark on the newborn’s cheek, face in 1 to 2 days
Nursing Responsibilities for Vacuum Extraction Delivery:

1. provide emotional support to both mother and significant others

2. assess FHR frequently during the procedure
3. position the mother in lithotomy position to allow for sufficient traction
4. newborn should be observed for signs of trauma and infection at the
application site and for cerebral irritation
Immediate pre-operative care measures (Cesarean Section Delivery):

1. Obtain informed consent

2. Overall hygiene – shower, wearing of hospital gown, remove nail
polish
3. Gastrointestinal tract prep (enema)
4. Baseline intake and output determination
5. Hydration (IVF is given)
6. Preoperative meds:
1) IM Cimetadine (tagamet) – decrease stomach secretions
2) Na Citrate (Bicarta) – neutralize stomach secretions
7. Prepare the client’s chart and surgery checklist
8. Transport mother to operating room for surgery