SURGICAL INTERVENTION FOR

BIRTH
NURSING PROCESS OVERVIEW

ASSESSMEN NURSING OUTCOME IMPLEMENTATI EVALUATUO

T DIAGNOSI IDENTIFICATIO ON N
S N PLANNING
CPD Fear Woman giving Give support to Patient
Assess related to birth by cs to mother to have understand
physiologic impending have a healthy confidence- the reason
al and surgery mother and the health for CS
psychologi Pain healthy baby personnel who Patient
cal status related to organize will do the states she
Woman’s surgical presurgical procedure felt prepared
preparedn incision steps like GIT, Coordination for CS
ess for the Deficient anesthesia with the health patient
procedure fluid and discharge care team remain free
volume to home care Intervention from
related to focus on infection
continuation

Assess Nursing Outcome implementatio Evaluation

ment diagnosis identification n
planning
Powerlessness Instruction to Patient
related to parent related states birth
medical need to her stay In was a
for episiotomy the facility for fulfilling
or CS 2-4 days. experience
Risk for even of
anxiety related unplanned
to CS
unanticipated Patient
circumstances states her
surrounding incisional
birth pain is
Amniotomy- artificial rupturing of membrane
during labor.
 To allow the fetal head to contact directly to the cervix
more directly , increases the efficiency of contractions
and therefore speeds labor.
 Procedure:
 Woman is in dorsal recumbent position then an
amnionhook ( a thin crochet- like instrument or
hemostat ) is passed vaginally to and membrane is torn
to escape the amniotic fluid.
 Disadvantage – possible for cord prolapse. Monitor FHB
after the procedure
EPISIOTOMY- surgical incision of the perineum
to prevent tearing of the perineum
 Release pressure on the head with birth and
possibly shorten the last portion of the
second stage of labor.
 Incision is made by a blunt-tipped scissor
 Midline episiotomy –incision is midline, less

blood loss and heals easily

 Mediolateral episiotomy- incision in the

midline then directed laterally away from the

rectum , thus creating less danger of rectal
mucosal tear.
Procedures for High –Risk Pregnancies

 Internal Electronic Monitoring – most precise method

of assessing FHR and uterine contractions. A wireless
telemetry is managed by a pressure sensing catheter
passed through the vagina after the membrane has
ruptured and cervix dilated at least 3 cm. It is then
passed into the uterine cavity alongside the fetus. The
end of the catheter is attached to a pressure recorder.
As the uterus contracts puts pressure to the catheters
and thus recorded. ( frequency, duration, baseline
strength, and peak strength contraction , evaluate the
senses of uterine tone to baseline strength between
contraction. ( monitor placental filling )
 Contractions:
 Latent phase –baseline level is less than

5mmHg
 Active phase –about 12 mmHg
 During the 2nd stage of labor as high as 20

mmHg
 Baseline reading that do not return to 20

mmHg or less indicates hypertonia and can

compromise fetal well being.
 FHR is recorded with fetal scalp electrode.
CESAREAN BIRTH
 Indications or alleviate problems of birth.
 1. CPD
 2. breech or multiple fetus birth
 3. failure to progress in labor
 4. transverse presentation
 5. reduces the transfer of herpes type 2 from

mother to newborn
 Scheduled or elective cesarean birth –planned

there is thorough preparation throughout the

antepartal period.
Emergent cesarean birth-done for a
reason that arise suddenly in labor.
 Such as:
 1. placenta previa
 2. premature separation of placenta
 3. fetal distress
 4 failure to progress labor
 Risk for emergent CS
 1. may not be prime candidate for anesthesia or

psychologically unprepared
 2. may have fluid and electrolyte balance
 3. physically & emotionally exhausted from long

labor
Effects of surgery on a woman
 1. stress response- stress increases release of
epinephrine and norepinephrine that results to
increase heart rate, elevates blood glucose,
broncho dilation, high BP due to peripheral
vasoconstriction that forces blood circulation to
ventral part and minimize blood supply to lower
extremities
 2. interference with body defenses-
 3. interference with circulatory system
 4. interference with body organ function
 5. interference with self image or self esteem
Nursing care for woman anticipating a
cesarean birth.
 A. Preoperative interview
 B. Operative risk for a woman
◦ 1. poor nutritional status
◦ 2. age variations
◦ 3. altered general health
◦ 4. fluid and electrolyte imbalance
◦ 5. fear