Care plan for a 4th degree

  1. I'm curious to see what others use for this. At a lot of hospitals I have worked at, this is missed quite a bit. :imbar
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  2. 12 Comments

  3. by   imenid37
    Sitz bath, tucks, epifoam, no enemas or suppos.. Ice to peri for 1st 24 hours then start warm sitz. No more doughnuts. Mostly just comfort-type measures.
  4. by   SmilingBluEyes
    Quote from imenid37
    Sitz bath, tucks, epifoam, no enemas or suppos.. Ice to peri for 1st 24 hours then start warm sitz. No more doughnuts. Mostly just comfort-type measures.
    yep...with the addition of STRONGLY encouraging fluids and stool softeners BID (no, not PRN, but on schedule). NO more heat lamps or donuts used where we practice, either. i also encourage moms to stay OFF their behinds as much as possible....sitting on them too much makes the pain MUCH worse, not to mention the possibility of decreased circulation exists then.
  5. by   nekhismom
    LOTS of comfort measures. Can you imagine the pain???? I don't even want to think of it. I mean, a small epi was bad enough, I can't imagine a 4th degree.
  6. by   imenid37
    Our docs are bowel fixated and sufak/ mom are routinely rx'd for all of our pt's, no prn's there. They enc an enema 2nd post-op day for our c/s too! If pt. is distended woe to her if she tells one of the docs she refused the enema ( no it's not a fleets ) Sorry I forgot!
  7. by   MommyLauraRN
    I had a 4th degree. (3rd degree epis cut & forceps for long brady, then tore the rest of the way.) I used ice for the first 24 hours, then I took a few sitz baths at the hospital and warm baths at home. I took colace TID until I had a BM at day 4. Ate and drank since right after delivery. I was told if no BM by day 5, then to do M.O.M. I used a donut because I fractured my tailbone (thanks to the rapid delivery!) The broken tailbone bothered me more than anything!!!!
  8. by   dawngloves
    Quote from MommyLauraRN
    I had a 4th degree. (3rd degree epis cut & forceps for long brady, then tore the rest of the way.) I used ice for the first 24 hours, then I took a few sitz baths at the hospital and warm baths at home. I took colace TID until I had a BM at day 4. Ate and drank since right after delivery. I was told if no BM by day 5, then to do M.O.M. I used a donut because I fractured my tailbone (thanks to the rapid delivery!) The broken tailbone bothered me more than anything!!!!
    I did ice for a week at least. :chuckle Sitz PRN (all I wanted to do was sit in there!). Encourage fluids and fiber, ambulate.I did Colace until my a$$ exploded. Where I delivered didn't do donuts anymore Pain relif! Oh yeah! Had one RN that refused to give me any nacs until I tried Tylenol first. I wanted to tear her a new one too! :angryfire
  9. by   webbiedebbie
    Hey...thanks for the interventions! I worked at one hospital years ago (since closed) that would NOT allow us to tell patients about sitz baths! No kidding! When I had my kids back in the 80's, I would be in the sitz bath room as often as I could...the old porcelain ones...THEY WERE GREAT! Since I have never tried the plastic ones over the toilet, I wonder how well they work. My patients don't seem to use them very much even though I encourage them and explain the healing involved.

    Anyway, I found a nsg dx for this: Impaired tissue integrity R/T perineal trauma @ time of delivery AEB tissue laceration on perineum (tear or laceration).
  10. by   dawngloves
    I would have lost my mind without my sitz Debbie! Those women don't know what they're missing. :chuckle
  11. by   webbiedebbie
    How well do the PLASTIC sitz baths work? Since I have never used one myself, I just tell them how to use it. If I knew from you who have experienced them, I probably could be a little more enthusiastic or firm about their use. I had one patient who had water all over the bathroom floor and her gown was soaked, even after I explained the correct use of it. Another patient did not want to be bothered with trying to fill up the bag with warm water and then walking to the bathroom to set it up. (Sinks are not in the bathrooms). Any suggestions?
  12. by   dawngloves
    The ones where I delivered hooked up to the sink,was like a nice bidet. :chuckle When I got home I couldn't use it that way (sink too far from toilet!) so I would fill it up on the toilet and fill up a pitcher of warm water. I'd sit there until the water cooled off and then empty it and fill it up with the pitcher water next to me.
  13. by   BittyBabyGrower
    Oh man...those first few days, I lived on that sitz :chuckle Heck, I even had to nurse the little bugger sitting on that because I thought I was splitting into two pieces! I had 2 epis' and then she got caught up in the cord and the doc had to yank her out...nice lowwww heart rate! As my DH put it...Man was that ugly! 4th degree plus..up and down! Good thing I had that epidural in!

    I am not a wimp by any means, but let me tell you...MSO4 would have been mighty fine :chuckle Home on Percocets...Motrin just didn't cut it!

    No donut...ice x 24hours (nothing like walking around like you have a load in your drawers ), then the nice sitz bath. We also use tucks and dermaplast spray...I loved that spray! And Colace, colace and juice, juice. That first BM is like giving birth to an elephant :uhoh21:
  14. by   Shotzie
    OWW, OWW OWWW!!!!
    I had a big, bad ugly tear too. Forceps deliveries are the pits...at the time I didn't care, just get the kid out fast while he still has a chance at normal!!!...but the next morning I cared...I cared A LOT!!!
    I was one of the last women in that hospital to get a heat lamp. I was in the hospital for several days and I went between the sitz bath and the heat lamp. There was an old nurse on that unit who went down to the basement and dug up a heat lamp for me. She was a great blessing and I loved her to death.
    As far as the plastic sitz bath thingy's go, I just used it like Dawn said. Filled it up with as hot a temp of water as I could stand and sat til it cooled off. Even better, I would get in the bathtub with about 10 inches of water in there and sit with my heels propped up on the sides of the tub. Took a book ands stayed till it was time to feed my precious child again or until I began to be worried about permanent shrivel marks on my fingers.

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