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Nursing Management for obstetrical procedures

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SREEVIDYA UMMADISETTI
SREEVIDYA UMMADISETTI

The document provides guidelines for nursing management of women undergoing obstetric operations. It outlines: 1) Equipment and monitoring required in recovery, including vital signs monitoring every 5 minutes for 30 minutes; 2) Criteria for safe transfer to the postnatal ward once stable, including pain level below 1; 3) Post-operative observations every 30 minutes for 2 hours then every 2 hours for 24 hours, including vital signs, pain, temperature and wound/loss monitoring.

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N U R S I N G M A N A G E M E N T O F W O M E N U N D E R G O I N G O B S T E T R I C A L O P E R A T I O N S Mrs. U SREEVIDYA Msc. NURSING, Associate Professor, Apollo college of nursing, CHITTOOR
INDEX 1. Purpose 2. Equality and Diversity 3. Equipment 4. Analgesia 5. Recovery Function and Monitoring 6. Responsibilities of the Midwife Caring for the Baby in Theatre Post Operatively and on Transfer to the Recovery Room 7. Transfer to the Postnatal Ward 8. Post operative Care and Observations during the following 24 hours 9. Infection Prevention
As a minimum the following specific requirements will be monitored:  Equipment that should be available, as defined in the GOI guidelines  Criteria for transfer to the recovery area  Minimum requirements for observations whilst in Recovery  Agreed discharge and transfer criteria from Recovery  Documentation of observations whilst in Recovery and agreed discharge and transfer criteria  Guidelines for care for the following 24 hours, including frequency of the observations
Purpose 1. To provide the initial care of the mother when transferring to the Obstetric Recovery area and that of the newborn for entitled ‘Examination. 2. Following any spinal, epidural or general anaesthetic procedure conducted in obstetric theatres, it is the Theatre Recovery nurse’s role to observe the patient for any signs of complications, to ensure that the patient remains pain free and once the patient is in a stable condition to provide a comprehensive handover to the midwife. Equality and Diversity The service that providing is fair, accessible and meets the needs of all individuals.
Equipment It is essential that the following equipment is always in place, working and ready for immediate use (in line with Association of Anaesthetists)  Oxygen supply  Mapelson C-and Hudson mask not connected but available in each cubicle  Suction equipment -with tubing and sucker connected  Pulse oximeter - with finger probe connected  Blood pressure monitoring with a selection of cuff sizes available  A tympanic thermometer  Intravenous stand  ECG monitoring available  Blood sugar machine available
Analgesia 1. The majority of caesarean sections are done under a spinal anaesthetic, thus enabling the mother to be fully conscious. In all but a few cases, the postoperative period is pain free. On the occasions where a general anaesthetic is used largely for reasons of safety, the patient is always extubated whilst still in theatre (either on the theatre bed or after transfer to the bed), in close proximity to the anaesthetic machine. However, facilities are available in the Recovery room for extubation to be carried out there, if necessary. 3. The following meets the criteria for transfer to the Recovery area  Patient maintaining their own airway (Breathing spontaneously)  Physiological parameters are normal (Blood transfusion to be started at the earliest opportunities preferably in theatres)
Recovery Function and Monitoring 1. In practical terms, the Recovery nurse role should commence when the patient is transferred from the operating table to the bed. 2. Monitoring is similar no matter what type of anaesthetic is used. Following a general anaesthetic, however more particular attention must be paid to the level of consciousness, oxygen saturation level and pain level. 3. Following a caesarean section, patients should be observed on a one-to-one basis by a competent trained member of staff until they have regained airway control, cardio- respiratory stability and are able to communicate.
The following should be monitored, at five-minute intervals for 30 minutes or until the transfer criteria are met:  Blood pressure  Respirations  Pulse  Oxygen saturation levels  Amount of oxygen administered if any  Level of consciousness  Pain level  Neurological observations to be checked if any concerns or on request of anaesthetist. (This includes: mobility of the all limbs, the level of the epidural block, this should be no higher than T4).
 The patient’s temperature should be recorded on transfer to the Recovery area and should be 36 degrees centigrade or above. If the patient’s temperature is < 36 degrees centigrade the warm touch system can be commenced to restore an optimum temperature. In addition, it is necessary to check the following:  Wound dressings and drains (reporting to the surgeon any excessive oozing)  Vaginal loss (reporting any excessive loss to the surgeon)  Catheter (noting amount and visual appearance of urine)  IV fluids are prescribed for post operative period  Post operative drugs are properly prescribed  TED stockings are in situ
• The time frame for a post operative patient to remain in the Recovery area is 30 minutes ensuring that the criteria has been met. • It is the Recovery nurse’s responsibility to contact the anaesthetic registrar or consultant on call should there be any concerns in terms of the stability/comfort of the patient.
All aspects of the mother’s recovery should be handed over to the ward, including:  What type of anaesthetic has been used  What drugs and IV fluids have been administered in the Theatre and Recovery  What post-operative drugs and IV fluids have been prescribed  State of wound, dressings, any drains and vaginal loss  General summary of blood pressure, respiratory rate and pulse monitoring  Report on urinary catheter drainage The Recovery room should always be ready for immediate use. Midwife can be handed over the care of the patient in the Recovery- once Recovery criteria are met. If a named midwife available to stay on transfer to postnatal ward during the protected handover- Recovery nurse to assist with safe transfer to the bed space.
Responsibilities of the Midwife Caring for the Baby in Theatre Post Operatively and on Transfer to the Recovery Room 1. The midwife should be competent in resuscitation of the newborn. 2. Carrying out a full baby examination, giving vitamin K (as indicated by the patient), weighing and labelling the baby. 3. Ensure that the baby is kept warm, wrapping the baby in warmed towels and placing a hat on the baby’s head. 4. Introducing the baby to the patient and her partner. 5. Initiating feeding/skin to skin contact in the Recovery room, prior to transfer to the Postnatal Ward. 6. The midwife also has a responsibility to take MRSA swabs in recovery post caesarean. If MRSA swabs are taken between 36/40 gestation and delivery they do not need repeating. 7. Midwife to remain at all times in Recovery if new born present
Transfer to the Postnatal Ward The patient should only be considered for transfer if the following criteria are met:  a stable and acceptable blood pressure and pulse  a pain score of no more than 1  no excessive oozing, loss through drain or vaginal loss  MEOW <2  If vaginal pack in situ  PPH <1.5L  O2 monitoring
Post operative Care and Observations during the following 24 hours 1. The following should be monitored, at 30 minute intervals for a period of 2 hours and then subsequent observations, if the patient remains in a stable condition should continue at 2 hourly intervals for 2 hours and then 4 hourly intervals until 24 hours post anaesthesia; whilst an inpatient; these observations should be recorded in the ‘Operative Delivery and Theatre Care Record’ and on the observation chart to include the Maternity Early Warning System (MEOWS) score  Blood pressure  Respiratory rate  Pulse  Pain  Sedation  02 monitoring
2. The patient’s temperature should be recorded on transfer to the postnatal ward and 4 hourly until 24 hours post anaesthesia; and should be 36 degrees centigrade or above. If the patient’s temperature exceeds 37.5 degrees centigrade, the midwife responsible for the patient’s care should inform the senior house officer (SHO) and repeat the temperature again after one hour and record the findings in the ‘Operative Delivery and Theatre Care Record’ and on the observation chart to include the Maternity Early Warning System (MEOWS) score.
In addition, it is necessary to observe the following:  Wound dressings and drains (reporting to the surgeon any excessive oozing)  Vaginal loss (reporting any excessive loss to the obstetric registrar /consultant on call)  Indwelling urinary catheter, noting amount and visual appearance of urine; this can be removed once the patient is mobile after a regional anaesthetic, unless otherwise indicated by the obstetric registrar/ consultant on call  Intravenous fluids are prescribed for post operative period and running as per chart  Post operative drugs are properly prescribed and administered i.e. for thromboprophylaxis  Patient’s analgesia is issued with full explanation for self administration
• Patients who are recovering well and who do not have complications after LSCS can eat and drink when they feel hungry or thirsty. • Documentation of observations whilst in Recovery and agreed discharge and transfer criteria should be recorded in the ‘Operative Delivery and Theatre Care Record’ Infection Prevention 1. All staff should follow Trust guidelines on infection prevention by ensuring that they effectively ‘decontaminate their hands’ before and after each procedure. 2. All staff should ensure that they follow Trust guidelines on infection prevention. All invasive devices must be inserted and cared for using High Impact Intervention guidelines to reduce the risk of infection and deliver safe care. This care should be recorded in the Saving Lives High Impact Intervention Monitoring Tool Paperwork.
Post Anaesthetic Recovery Score - Salim’s ABC Recovery Score Score for Response Physical Signs 3 2 1 0 Airways Patient can cough or cry Maintains clear airway without holding the jaw Holding of jaw needed Holding the jaw and other measures taken to maintain airway Behaviour Patient can lift the head Can open the eyes and show her tongue Some non-purposeful movement No movement at all Consciousness Fully awake can talk, well orientated Awake but needs some support Responds to stimuli only No response
Management of a Patient Post-Delivery in the Obstetric Theatre Recovery Pain Score Score 0 = No pain at rest No pain on movement Score 1 = No pain at rest Slight pain on movement Score 2 = Intermittent pain at rest Moderate pain on movement Score 3 = Continuous pain at rest Severe pain on movement Movement = Patient attempt to touch opposite side of bed with hand.
Nursing Management for obstetrical procedures
Nursing Management for obstetrical procedures

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Nursing Management for obstetrical procedures

  • 1. N U R S I N G M A N A G E M E N T O F W O M E N U N D E R G O I N G O B S T E T R I C A L O P E R A T I O N S Mrs. U SREEVIDYA Msc. NURSING, Associate Professor, Apollo college of nursing, CHITTOOR
  • 2. INDEX 1. Purpose 2. Equality and Diversity 3. Equipment 4. Analgesia 5. Recovery Function and Monitoring 6. Responsibilities of the Midwife Caring for the Baby in Theatre Post Operatively and on Transfer to the Recovery Room 7. Transfer to the Postnatal Ward 8. Post operative Care and Observations during the following 24 hours 9. Infection Prevention
  • 3. As a minimum the following specific requirements will be monitored:  Equipment that should be available, as defined in the GOI guidelines  Criteria for transfer to the recovery area  Minimum requirements for observations whilst in Recovery  Agreed discharge and transfer criteria from Recovery  Documentation of observations whilst in Recovery and agreed discharge and transfer criteria  Guidelines for care for the following 24 hours, including frequency of the observations
  • 4. Purpose 1. To provide the initial care of the mother when transferring to the Obstetric Recovery area and that of the newborn for entitled ‘Examination. 2. Following any spinal, epidural or general anaesthetic procedure conducted in obstetric theatres, it is the Theatre Recovery nurse’s role to observe the patient for any signs of complications, to ensure that the patient remains pain free and once the patient is in a stable condition to provide a comprehensive handover to the midwife. Equality and Diversity The service that providing is fair, accessible and meets the needs of all individuals.
  • 5. Equipment It is essential that the following equipment is always in place, working and ready for immediate use (in line with Association of Anaesthetists)  Oxygen supply  Mapelson C-and Hudson mask not connected but available in each cubicle  Suction equipment -with tubing and sucker connected  Pulse oximeter - with finger probe connected  Blood pressure monitoring with a selection of cuff sizes available  A tympanic thermometer  Intravenous stand  ECG monitoring available  Blood sugar machine available
  • 6. Analgesia 1. The majority of caesarean sections are done under a spinal anaesthetic, thus enabling the mother to be fully conscious. In all but a few cases, the postoperative period is pain free. On the occasions where a general anaesthetic is used largely for reasons of safety, the patient is always extubated whilst still in theatre (either on the theatre bed or after transfer to the bed), in close proximity to the anaesthetic machine. However, facilities are available in the Recovery room for extubation to be carried out there, if necessary. 3. The following meets the criteria for transfer to the Recovery area  Patient maintaining their own airway (Breathing spontaneously)  Physiological parameters are normal (Blood transfusion to be started at the earliest opportunities preferably in theatres)
  • 7. Recovery Function and Monitoring 1. In practical terms, the Recovery nurse role should commence when the patient is transferred from the operating table to the bed. 2. Monitoring is similar no matter what type of anaesthetic is used. Following a general anaesthetic, however more particular attention must be paid to the level of consciousness, oxygen saturation level and pain level. 3. Following a caesarean section, patients should be observed on a one-to-one basis by a competent trained member of staff until they have regained airway control, cardio- respiratory stability and are able to communicate.
  • 8. The following should be monitored, at five-minute intervals for 30 minutes or until the transfer criteria are met:  Blood pressure  Respirations  Pulse  Oxygen saturation levels  Amount of oxygen administered if any  Level of consciousness  Pain level  Neurological observations to be checked if any concerns or on request of anaesthetist. (This includes: mobility of the all limbs, the level of the epidural block, this should be no higher than T4).
  • 9.  The patient’s temperature should be recorded on transfer to the Recovery area and should be 36 degrees centigrade or above. If the patient’s temperature is < 36 degrees centigrade the warm touch system can be commenced to restore an optimum temperature. In addition, it is necessary to check the following:  Wound dressings and drains (reporting to the surgeon any excessive oozing)  Vaginal loss (reporting any excessive loss to the surgeon)  Catheter (noting amount and visual appearance of urine)  IV fluids are prescribed for post operative period  Post operative drugs are properly prescribed  TED stockings are in situ
  • 10. • The time frame for a post operative patient to remain in the Recovery area is 30 minutes ensuring that the criteria has been met. • It is the Recovery nurse’s responsibility to contact the anaesthetic registrar or consultant on call should there be any concerns in terms of the stability/comfort of the patient.
  • 11. All aspects of the mother’s recovery should be handed over to the ward, including:  What type of anaesthetic has been used  What drugs and IV fluids have been administered in the Theatre and Recovery  What post-operative drugs and IV fluids have been prescribed  State of wound, dressings, any drains and vaginal loss  General summary of blood pressure, respiratory rate and pulse monitoring  Report on urinary catheter drainage The Recovery room should always be ready for immediate use. Midwife can be handed over the care of the patient in the Recovery- once Recovery criteria are met. If a named midwife available to stay on transfer to postnatal ward during the protected handover- Recovery nurse to assist with safe transfer to the bed space.
  • 12. Responsibilities of the Midwife Caring for the Baby in Theatre Post Operatively and on Transfer to the Recovery Room 1. The midwife should be competent in resuscitation of the newborn. 2. Carrying out a full baby examination, giving vitamin K (as indicated by the patient), weighing and labelling the baby. 3. Ensure that the baby is kept warm, wrapping the baby in warmed towels and placing a hat on the baby’s head. 4. Introducing the baby to the patient and her partner. 5. Initiating feeding/skin to skin contact in the Recovery room, prior to transfer to the Postnatal Ward. 6. The midwife also has a responsibility to take MRSA swabs in recovery post caesarean. If MRSA swabs are taken between 36/40 gestation and delivery they do not need repeating. 7. Midwife to remain at all times in Recovery if new born present
  • 13. Transfer to the Postnatal Ward The patient should only be considered for transfer if the following criteria are met:  a stable and acceptable blood pressure and pulse  a pain score of no more than 1  no excessive oozing, loss through drain or vaginal loss  MEOW <2  If vaginal pack in situ  PPH <1.5L  O2 monitoring
  • 14. Post operative Care and Observations during the following 24 hours 1. The following should be monitored, at 30 minute intervals for a period of 2 hours and then subsequent observations, if the patient remains in a stable condition should continue at 2 hourly intervals for 2 hours and then 4 hourly intervals until 24 hours post anaesthesia; whilst an inpatient; these observations should be recorded in the ‘Operative Delivery and Theatre Care Record’ and on the observation chart to include the Maternity Early Warning System (MEOWS) score  Blood pressure  Respiratory rate  Pulse  Pain  Sedation  02 monitoring
  • 15. 2. The patient’s temperature should be recorded on transfer to the postnatal ward and 4 hourly until 24 hours post anaesthesia; and should be 36 degrees centigrade or above. If the patient’s temperature exceeds 37.5 degrees centigrade, the midwife responsible for the patient’s care should inform the senior house officer (SHO) and repeat the temperature again after one hour and record the findings in the ‘Operative Delivery and Theatre Care Record’ and on the observation chart to include the Maternity Early Warning System (MEOWS) score.
  • 16. In addition, it is necessary to observe the following:  Wound dressings and drains (reporting to the surgeon any excessive oozing)  Vaginal loss (reporting any excessive loss to the obstetric registrar /consultant on call)  Indwelling urinary catheter, noting amount and visual appearance of urine; this can be removed once the patient is mobile after a regional anaesthetic, unless otherwise indicated by the obstetric registrar/ consultant on call  Intravenous fluids are prescribed for post operative period and running as per chart  Post operative drugs are properly prescribed and administered i.e. for thromboprophylaxis  Patient’s analgesia is issued with full explanation for self administration
  • 17. • Patients who are recovering well and who do not have complications after LSCS can eat and drink when they feel hungry or thirsty. • Documentation of observations whilst in Recovery and agreed discharge and transfer criteria should be recorded in the ‘Operative Delivery and Theatre Care Record’ Infection Prevention 1. All staff should follow Trust guidelines on infection prevention by ensuring that they effectively ‘decontaminate their hands’ before and after each procedure. 2. All staff should ensure that they follow Trust guidelines on infection prevention. All invasive devices must be inserted and cared for using High Impact Intervention guidelines to reduce the risk of infection and deliver safe care. This care should be recorded in the Saving Lives High Impact Intervention Monitoring Tool Paperwork.
  • 18. Post Anaesthetic Recovery Score - Salim’s ABC Recovery Score Score for Response Physical Signs 3 2 1 0 Airways Patient can cough or cry Maintains clear airway without holding the jaw Holding of jaw needed Holding the jaw and other measures taken to maintain airway Behaviour Patient can lift the head Can open the eyes and show her tongue Some non-purposeful movement No movement at all Consciousness Fully awake can talk, well orientated Awake but needs some support Responds to stimuli only No response
  • 19. Management of a Patient Post-Delivery in the Obstetric Theatre Recovery Pain Score Score 0 = No pain at rest No pain on movement Score 1 = No pain at rest Slight pain on movement Score 2 = Intermittent pain at rest Moderate pain on movement Score 3 = Continuous pain at rest Severe pain on movement Movement = Patient attempt to touch opposite side of bed with hand.