c-section question and nursing dx

[Qtip]

So I know how the lady partsl flora changes postpartum causing increased risk for UTI because of amniotic fluid flowing out the lady parts changing ph and such. BUT, do these changes also ocurr in a women with scheduled c-section and AROM? Does the amniotic fluid still flow out the lady parts or is it manually removed during cesarean? Also from what I understand even though there is more blood loss during cesarean theses patients usually have less bleeding post delivery.

Another question I have is my NDx is going to be risk for infection r/t a urinary problem the pt has causing a superficial collection of urine and the lady partsl flora changes postpartum. My question is should I include c-section incision and low hgb in the same NDx even though they are seperate infection risks?

[Double-Helix, BSN, RN]

Yes, women who have a c-section still lose blood and fluid from the lady parts. It does tend to be a little less than a lady partsl delivery, due to the suctioning that's done during a cesarean. However, a lot of the bleeding comes from the lining of the uterus (which has built up very thickly during pregnancy) shedding. That happens whether it's a lady partsl or cesarean delivery.

When you have a nursing diagnosis, you include all data related to that diagnosis in one section. So you would list low Hgb and the incision in the same section if your diagnosis is risk for infection. However, if your diagnosis is risk for infection, urinary tract, then you would not include the hgb because it's not relevant to your diagnosis.

Finally, are you supposed to come up with the diagnosis of highest priority? A risk for diagnosis is never highest priority. Think about what else is happening to your patient: They just had major abdominal surgery. Are they having pain? They had spinal anesthesia. Has that worn off? How are they moving around due to the epidural and the incision? How does surgery affect skin integrity? Does your patient have staples, sutures or a dressing? What risks are there related to the incision?

I'd also encourage you to more thoroughly examine your risk for infection diagnosis. While your patient may be at an increased risk for a UTI due to her pre-existing urinary condition, postpartum women in general are not at an increased risk for UTI unless they have had a catheter inserted during labor. While the lady partsl flora may change, urine comes from the urethra, a separate opening not affected by the floral changes in the lady parts. So the changes in lady partsl flora may put the woman at a higher risk for vaginosis or a yeast infection, but not a UTI.