Post C/S patient care

Fiona59 · Jul 19, 2006

We use usual post op surgical v/s checks.

Monitor colour of urine in catheter

Check perineum (if they laboured for any length of time, hems, swelling, etc.)

Dangle at 12 hours, foley are usually out in 24 hours and we watch like a hawk for the first void.

Walk them at 24 or sooner

No food until passing gas and keeping clear fluids down.

A lot depends on the Mum and if it was GA or Spinal.

Some have PCA's others Demerol

T3s for oral, some take just OTC Tylenol other Motrin.

Once they are up, fundus and flow q shift.

Length of stay max 72 hrs.

Woman_in_love · Jul 19, 2006

Thanks a lot!

That actually looks pretty much like our standards.

I have a problem though to check fundus on fresh section patients.They usually hurt so bad and wont even let you touch their tummy, not mentioning pressing on it to find fundus. What do i do in such case? I mean i do need to assess them, but i also dont want to cause them additional pain.

KellieNurse06 · Jul 19, 2006

Thanks a lot!
That actually looks pretty much like our standards.
I have a problem though to check fundus on fresh section patients.They usually hurt so bad and wont even let you touch their tummy, not mentioning pressing on it to find fundus. What do i do in such case? I mean i do need to assess them, but i also dont want to cause them additional pain.

I was taught by my OB nursing instructor who is awesome to use the hand you are dominant with (righty or left) to hold right above the pubic bone not tightly but just firmly for support and then press in right at the umbilicus , some moms you have to really push in but it should feel like a grapefruit if it is ok (firm) and if it is boggy it feels sort of doughy like. I have assessed many cs patients with my instructor and I never heard anyone complain of pain from the fundus check .....they are usually on a pca pump alot of the times anyway at first so the pain shouldn't really be too much, if they did complain of pain it was mostly gas pains/cramps & not the fundus check. It's ok, don't get too worried! You'll do fine!

Woman_in_love · Jul 19, 2006

Thank you:)

madwife2002, BSN, RN · Jul 19, 2006

Yes I havent ever have one complain of pain post op, when doing a fundus check. Sometimes it is difficult to assess because if it was an emergency there is more abdominal swelling.

Mississippi_RN · Jul 19, 2006

After delivery, their VS are checked Q 15 min for 2 hours, then Q 4h. Alot of the other stuff depends on the doctor. We have one doctor, however, who is predictable to "T". They get Demerol PCA with 10 mg continous, 10 mg PCA (patient) dose, lockout every 10 min and 150 mg four hour max. They have a foley, incentive spirometry Q 2h while awake, CBC in am, TED hose, plexipulse, NPO x ice chips, Kefzol 1 gm Q 8h, Reglan 10 mg Q 6 IVP. We check lochia and fundus Q 2h at first, then about Q 4h (depends on how well the patient is doing). Check drainage for breakthrough drainage, and empty JP drain Q shift and prn. Check foley Q shift (beginning and end), circulation checks in BLE, instruct to TCDB at least Q 2h with position change, they can get Phenergan 50 mg IM Q 4h prn n/v. Usually the next morning, foley is d/c'd (with 3 void checks) (and specimen send to lab for u/a and c/s), clear liquids are given, Lovenox 40 mg daily (or 30 mg BID if a large person), IM Demerol for pain and Tyl #3, Reglan given PO, with Haley's MO and Trinsicon, IV d/c'd and PCA of course. Pretty much taken care of from then on.

RNnL&D · Jul 19, 2006

Hi!
I am curious what are standard procedures/protocols in your postparum(mother baby)unit in regards of taking care of patient who had C/S.
1)How often VS are checked, lochia and fundus.
2)What else you check on your assessment.
3)How soon you ambulate them and discontinue their Foley.
4)How soon they can eat.
5)What pain meds you give them PO and IV.
Thanks for sharing

We are using Duramoprh for most of our CS now, so our protocol has changed a bit.

In RR, we do VS, O2 sat and fundal/lochial checks q 15 minutes. (Generally, about 1 hour).

For PP with Duramoprh: Sedation scale, O2 sat, resp, pulse and pain scale hourly x 24 hours. VS q 30 min x 2, q hour x 4, then q 4 hours. POD 2 VS are q shift. Fundal checks q 4 hours, q shift POD 2.

We dangle at 4 hours, foley out at 8 hours (unless after midnight), IV access out at 24 hours if stable and IV antibiotics complete. They ambulate as soon as they need to void after the foley is out. They are on clear liquids on POD 1 and until + flatus and BS. Then onto a regular diet.

PO pain meds: For Duramorph pts, they get Percocet for breakthrough pain then move onto the normal post op pain meds, Darvocet, Tyl #3, and/or Motrin.

And almost all of my post op pts complain of discomfort with fundal exams while in RR, and many still complain of feeling sore with exams the next day.

nursedude1 · Jul 23, 2006

Our facility protocols were much the same for fresh C/S pts as described in the post above. And for any patient that complains or wants to refuse a fundal check, remind them as to WHY you are checking (prevent PP hemorrhage, ensure adequate involution, etc.) and most will usually come around and let you. If they still won't let you check, document it and watch their lochia like a hawk...

MIA-RN1, RN · Jul 24, 2006

our protocols just changed last week--being still on orientation I had almost mastered them when they were switched. I am pretty sure its like this:

VS q 1/2h X3 Including O2 sat

then VS q1h X2 including O2 sat

then VS q2h X2 including O2 sat

then VS q4h including O2 sat X 48h

Then bid.

Respirs are counted every hour X24h then go to q4 w/ vitals.

Asessments are upon arrival and then Q4 (include fundus and lochia) and prn.

Ambulate about 6-8 hours post-op, scd's in bed til ambulating TID

Advance diet as tolerated with no worries about gas/bm's etc; most have dinner the same day.

Foley out by MD order usually 24h postop or thereabouts.

LRS until adequate intake, then hep-lock (usually w/in first 6-8 hrs if all is stable) Hep lock usually out 2nd pp day.

Meds are generally prn Tyl3 or Percoset q4; prn ibuprofin q6; nubain for itching IVP q3; Some have regular tylenol on their orders as well, also as prn. (not to be given w/ Tyl3 or perc). Csect do NOT have self-meds (just vags)