OB Chapter 24
What is not part of the discharge planning for a woman who has had a cesarean birth? "Rest when your baby rests, and don't reject help from family and friends." "Drink plenty of fluids—8 to 10 glasses of water a day." "If you have any vaginal bleeding, you should contact your health care provider." "If you have severe abdominal pain or a high fever, contact your health care provider."
"If you have any vaginal bleeding, you should contact your health care provider." It is important to counsel all postpartum women about the signs of a postpartum hemorrhage after discharge. A woman who has had a cesarean birth should expect a minimal amount of vaginal bleeding and needs to notify her health care provider only if she should have any signs or symptoms of a postpartum hemorrhage.
A 21-year-old has been in labor for 4 hours; her examination 2 hours ago revealed 6 cm/100%/-3. During a contraction, she spontaneously ruptures her membranes. The doctor checks the patient, finds her to be 9 cm/100%/-3, and states that the cord is palpable. What should the nurse do? Call for help and prepare the client for an emergency cesarean birth. Set up for imminent vacuum delivery. Set up for imminent forceps delivery. Call the pediatricians into the room for imminent vaginal delivery.
Call for help and prepare the client for an emergency cesarean birth. When the cord is palpable on examination, this indicates that the cord has prolapsed and emergency cesarean birth is needed. This client is not a candidate for vacuum or forceps delivery because she is not 10 cm dilated.
Which of the following measures is the most effective way for the nurse to assist the woman recovering from cesarean birth to stimulate lower extremity circulation? Place ice packs on the woman's calves. Help the woman to ambulate as soon as possible. Have the client use a pillow to splint the incision when moving about. Apply TED hose.
Help the woman to ambulate as soon as possible. The most effective way to stimulate lower extremity circulation after a cesarean birth is by early ambulation. For this reason, most surgeons prefer a woman to be out of bed and walking by 4 hours after surgery.
The nurse is preparing a client for an emergent cesarean delivery. Which action should the nurse prioritize? Sign informed consent. Ensure that a urinary catheter is in place. Record EFM tracing. Prep her abdomen.
Sign informed consent. Before the client can be transported and the cesarean can begin, the client must sign a consent form. The client should have an EFM from labor, and the urinary catheter is usually placed once the spinal is completed. The abdomen is clipped or shaved once the consent has been signed.
At 0500 hrs, a client was started on oxytocin. The nurse notes on assessment the client is dilated to 4 cm with contractions every 1 minute and increased signs of fetal distress. What action should the nurse prioritize after noting the time is now 1200 hrs? Administer pain medication. Increase IV fluids. Stop the oxytocin infusion. Notify the health care provider.
Stop the oxytocin infusion. The drug oxytocin is used for induction of labor. It is a uterine stimulant. In this client, the uterus is showing signs of overstimulation. The first intervention is to stop the infusion. The nurse should then contact the health care provider for further instructions. It would be inappropriate to administer pain medications or increase the IV fluids.
What is the most effective way to stimulate circulation after cesarean birth? ambulation within 4 hours of birth ambulation within 8 hours of birth TEDS stockings Venodyne boots
ambulation within 4 hours of birth Early ambulation is extremely important to prevent edema and DVT formation. Women should be encouraged to ambulate 4 hours after cesarean birth. Venodyne boots and TEDS stockings are helpful, but ambulation is the best way to stimulate circulation.
A woman is being seen in the clinic for care during her first pregnancy and birth. The nurse will educate this woman and her significant other about their planned cesarean birth and what can be expected. When should the nurse provide this family education? when the client presents for admission for the procedure at a preset time one month prior to the scheduled delivery each time the nurse sees the woman before surgery only when she and her significant other can come to the clinic together
each time the nurse sees the woman before surgery The focus of nursing intervention for a planned cesarean is family education. Each time you encounter the woman before surgery is an opportunity to explore with the woman and her partner what they know about cesarean birth. Part of the education will include the circulatory and musculoskeletal activities which the woman can practice before the surgery to help prevent potential complications after the surgery. The nurse should also assess how much the family knows and ensure they have the correct information.
A new mother calls the clinic on her fourth day after delivery and reports difficulty urinating and defecating because of the perineal pain. What does the nurse suspect is causing these problems? trauma from a cesarean birth trauma from a Foley catheter infection episiotomy
episiotomy An episiotomy is an incision done right before birth. It requires repair with sutures that are absorbable and do not need to be removed. The pain of an episiotomy can cause vaginal pain when urinating and defecating. Having a cesarean or vaginal birth should not cause this type of pain. An infection may cause pain in the vagina, but normally it is not the cause of pain while urinating and defecating.
An obese client gave birth via cesarean with sutures applied at the surgical incision site. The nurse is concerned that the client's obesity will make it difficult to achieve which postpartum outcome? pain management in the postoperative period involution of the uterus blood clotting at the incision site healing at the site of incision
healing at the site of incision A client who is obese is at added risk from surgery because the tissue contains an abundance of fatty cells and is difficult to suture. This causes the surgical incision to take longer to heal. A prolonged healing period increases the risk for infection and rupture of the incision. Obesity is not necessarily associated with lack of blood clotting at the incision site (more likely caused by vitamin K deficiency), difficulty with uterine involution (though the fundus may be more difficult to palpate) or pain management in the postoperative period. Clients typically are prescribed opioid analgesics PRN for the first days following a cesarean birth then transition to nonopioid pain medication.
The LPN/LVN is caring for a client who is scheduled for a cesarean birth. The nurse points out to the client that during which stage of the process a different nurse will be the primary caregiver? late postoperative immediate postoperative intraoperative preoperative
immediate postoperative In the immediate postoperative phase, the PACU RN will be the primary manager of her care. The LPN/LVN may be involved in some of the preoperative care to prepare the woman for surgery, and may also be a part of the intraoperative care by functioning in the role of scrub nurse. The LPN/LVN may assume care of the woman during the postoperative phase, after she has sufficiently recovered from anesthesia.
The nursing instructor is conducting a class presenting the various aspects of a cesarean birth. The instructor determines the class is successful after the students correctly choose which complication as the most common postoperative complication? pneumonia infection thrombosis laceration of the uterine artery
infection Infection is the most common postoperative complication. Laceration of the uterine artery is an intraoperative complication. Pneumonia and thrombosis are also potential postoperative complications but not as common as infection.
Eight hours after a cesarean section, a postpartum woman is having heavy lochia. She informs the nurse, who suspects which of the following causes? postpartum hemorrhage infection another cause other than the birth normal for a cesarean section
postpartum hemorrhage During cesarean birth, the surgeon thoroughly cleans inside the uterus. Therefore, lochia is less than after a vaginal delivery. If lochia flow is moderate or heavy, it could indicate a postpartum hemorrhage.
The nurse is coordinating upcoming procedures and appointments for a client about to undergo a cesarean birth. Which specialist(s) should the nurse anticipate in the client's care? Select all that apply. surgeon nutritionist recovery room personnel pediatrician anesthesiologist
surgeon recovery room personnel pediatrician anesthesiologist Coordinating health care team members such as an anesthesiologist, surgeon, pediatrician, and recovery room personnel is an important intervention for ensuring continuity of care for the client. A referral to a nutritionist should not be anticipated in the absence of other complicating circumstances.
While the nurse is assessing the prenatal client's understanding of the information provided at a recent appointment, the client states, "I want to avoid the pain and long hours of labor, so I'm electing to have a cesarean birth." How should the nurse respond? It is important to inform the health care provider of your decision so that we can plan appropriately for when the birth occurs." "Cesarean birth is a low-risk surgery that is the ideal option in many cases." "A cesarean birth is a method to be used when vaginal birth is not possible—it is not a true option." "Many women elect to have a cesarean birth to avoid the risk of anoxia."
"A cesarean birth is a method to be used when vaginal birth is not possible—it is not a true option." It is important for the nurse to explain that cesarean birth is a method to be used when a vaginal birth is not possible and is not a true option. For this reason, the nurse will not inform the health care provider of the client's decision to plan for cesarean birth, although additional follow-up with the client's health care provider may be required. Cesarean birth is one of the safest types of surgeries, but the nurse should not present a cesarean birth as an ideal option in the absence of other supporting information. It is not the responsibility of the client to make the decision to undergo a cesarean birth to avoid the risk of anoxia.
When counseling a client about maternal risks and benefits of cesarean birth, which of the following would not apply? "A surgical incision may be made at the perineum to enlarge the vagina just before the birth of the baby." "We will be giving you antibiotics preoperatively, but it is still possible to develop an infection at the incision site after the birth." "Although unlikely, if severe hemorrhage does occur, you may require a hysterectomy." "Complications that may occur include hemorrhage, infection, and damage to the bladder and bowel."
"A surgical incision may be made at the perineum to enlarge the vagina just before the birth of the baby." A surgical incision made at the perineum is an episiotomy and is not part of a cesarean birth.
How should the nurse counsel a client who has arrived for a scheduled repeat cesarean birth? "You will undergo general anesthesia, so you will be asleep during the procedure." "An IV catheter will be placed, and we will do some preoperative blood work. Then we will give you some antibiotics." "After surgery, you will be immediately transferred to the postpartum unit." "A Foley catheter will be inserted before surgery and will be removed once you arrive to the postpartum unit."
"An IV catheter will be placed, and we will do some preoperative blood work. Then we will give you some antibiotics." Epidural or spinal anesthesia is most commonly used for a scheduled cesarean, and the woman is awake during the procedure. Immediately after the procedure, the woman is transferred to the postanesthesia care unit or the recovery unit to recover from the surgery for 1 to 2 hours. The Foley usually remains in place for 24 hours.
A client underwent a cesarean birth due to fetal distress. The medical records reflect a low transverse uterine incision was used. When speaking with the nurse, the client questions her ability to give birth vaginally with her next pregnancy. What response by the nurse is most appropriate? "The reason for your cesarean birth may indicate an inability to have a vaginal birth in the future." "The type of incision used on your uterus may hinder your ability to have a vaginal birth with your next birthing experience." "You will be able to have a vaginal birth with your next birthing experience." "Having a cesarean birth does not mean you will have a cesarean birth with future births."
"Having a cesarean birth does not mean you will have a cesarean birth with future births." There are a variety of reasons for an unscheduled cesarean birth. The reason in this case was a prolonged labor. The ability to experience a vaginal birth after a cesarean (VBAC) will be tied closely to the reasons for the cesarean birth. The woman who has a cesarean birth due to a prolonged labor experience may be a candidate for a VBAC. The incision used for this client does not prevent a future VBAC.
A woman has just arrived to the recovery room after an emergency cesarean birth and is anxious to begin breastfeeding her baby. What is the best response from the nurse? "I need to monitor you closely for 30 minutes, first." "Sure, let me help you with that." "Just as soon as you get to the postpartum unit in an hour or 2." "You will not be able to breastfeed until you can get up and walk around."
"Sure, let me help you with that." Once out of the operating room, a woman who has given birth by cesarean can breastfeed just as if she had given birth vaginally.
A nurse is inserting a urinary catheter into a woman about to undergo a cesarean birth. The client asks why this is necessary. How would the nurse accurately respond? "We need to keep a very strict record of your intake and output because of the surgery, and this is the easiest way to do so." "You will need a catheter because you will not be able to get around to urinate regularly for at least 2 days after having the baby." "Doing this will make sure you are comfortable during the procedure." "This measure will help keep your bladder away from the site of surgery."
"This measure will help keep your bladder away from the site of surgery." To reduce bladder size and keep the bladder away from the surgical field, an indwelling urinary catheter may be prescribed before transport for surgery or after arrival in the surgical suite.
The health care provider has ordered a cesarean birth for an exhausted client who has been in labor for many hours with the fetus now showing increasing signs of distress. As the client and partner express disappointment in not having a natural birth (and anxiety in not knowing what will now happen), which response will the nurse prioritize? Briefly describe what will be experienced, explain each procedure, and encourage the partner to participate. Tell them firmly that the client must be prepped for surgery and place an IV and catheter. Calmly and confidently describe the qualifications of the surgical team. Compare the risks of cesarean birth with those of continuing to attempt vaginal birth.
Briefly describe what will be experienced, explain each procedure, and encourage the partner to participate. The client and her partner were not prepared for the possibility of an operative delivery. The nurse should explain as much as possible and provide support to them. This is not the time to compare the risks to the mother and the fetus of continuing to attempt a vaginal birth as compared to a cesarean birth. This is not the time to talk about the qualifications of the surgical team. A client always has the right to refuse a procedure. If the nurse places an IV and/or a catheter without the client's consent, he or she could be arrested for assaulting the client.
A nurse preparing a client for a scheduled cesarean birth. The client is getting on the stretcher to move from the admission room to surgical suite. When placing the client on the stretcher, which nursing intervention will helpful to prevent supine hypotension syndrome in the client? Open the clamp on the intravenous fluids (IV) to quickly infuse. Place the client's newly inserted foley catheter lower on the frame of the stretcher. Ensure that the client is warm by covering with a blanket or sheet. Have the client lie on the left side during transport.
Have the client lie on the left side during transport. A client may be transferred to surgery in the bed, or the client may be helped to move to a stretcher. Supine hypotension syndrome is caused when the uterus compresses the inferior vena cava when the client is in the supine position. The nurse will urge the client to lie on the left side during transport, to prevent supine hypotension syndrome. It is important to maintain the foley catheter below the client's bladder to prevent backflow of the urine. The nurse will cover the client with a blanket or sheet to avoid the client feeling chilled. Depending upon the analgesia prescribed, the intravenous catheter may be opened for a rapid infusion of fluids; however, this is completed by personnel in the surgical suite.
The nurse is monitoring a client at 41 weeks' gestation receiving IV oxytocin. Which action should the nurse prioritize if noticeable contractions are occurring every 2 minutes, lasting 60 to 90 seconds on the fetal monitor? Notify the health care provider. Change the client's position. Stop the IV oxytocin infusion. Administer oxygen 10L via face mask.
Stop the IV oxytocin infusion. The first action is to stop the IV infusion. This contraction pattern is noted to be hyperstimulation of the uterus, and the uterine stimulant should be stopped first. Administering oxygen assists in the prevention of hypoxia to both the mother and the fetus, but it does not take priority over stopping the uterine stimulant. Changing the client's position will have no effect on the hyperstimulation of the uterus as long as the stimulant is still being infused. The nurse would notify the health care provider after stopping the stimulant.
A woman has just entered the recovery room after cesarean birth of a baby weighing 9 lb 14 oz. After connecting the client to the blood pressure monitor, it is noted her heart rate (HR) is 120 and blood pressure (BP) is 80/40. What nursing action should be a priority? administer oxygen administer an IV bolus of fluids call the MD assess for bleeding
assess for bleeding The elevated HR and BP could be an indication of hemorrhaging. The priority will be to assess for bleeding by assessing the uterine fundus and checking the perineum. Although this is a responsibility of the RN, the LPN should also be aware. The other choices may follow if deemed necessary, depending on the cause of the elevated HR and BP.
Which considerations are explained to be an advantage of a low-transverse incision ("bikini cut) on a client experiencing a cesarean birth? less traumatic for the fetus decreased chance of rupture decreased risk of uterine infections decreased blood loss shorter surgical time
decreased chance of rupture decreased risk of uterine infections decreased blood loss Because this type of incision is through the nonactive portion of the uterus (the part that contracts minimally with labor), it is less likely to rupture in subsequent labors, making it possible for a woman to have a VBAC with a future pregnancy. It also results in less blood loss, is easier to suture, decreases the chance of postpartum uterine infections, and is less likely to cause postpartum gastrointestinal complications. The major disadvantage of this incision is that it takes longer to perform, possibly making it impractical for an emergent cesarean birth.
The nurse is caring for a client following a cesarean birth who received a low segment incision. Which outcome is possible for the client? prolonged hospitalization after delivery development of placenta previa during future pregnancies requiring cesarean birth for future deliveries experiencing vaginal delivery during future births
experiencing vaginal delivery during future births Vaginal delivery after a cesarean birth is possible for clients who have received a low segment incision during cesarean birth. A low segment incision does not increase the risk of placenta previa, require future cesarean births, or prolong hospitalization.
A nurse correctly recognizes which of the following as a current trend within the population of birthing women? increased rates of cesarean sections increased public funds for using doulas more natural births with fewer medical interventions decreased use of epidurals
increased rates of cesarean sections Cesarean sections are increasing in frequency across North America. Providers are using more medical interventions during birth, including epidurals. Doula services are not covered by health insurance and are either privately funded or provided by volunteers for at-risk populations.
A young woman comes into the clinic in the eighth month of her pregnancy. She is requesting information regarding cesarean delivery and wants to discuss this method of birth. The nurse knows that the rate of cesarean deliveries has increased because of which reasons? Select all that apply. increased use of induction for nonmedical reasons increased incidence of maternal obesity change in perception of risk by clients and physicians an increase in vaginal birth after cesarean (VBAC) attempts rise in the number of older pregnant women
increased use of induction for nonmedical reasons increased incidence of maternal obesity change in perception of risk by clients and physicians rise in the number of older pregnant women The decrease in VBAC attempts have lead to an increase in cesarean deliveries. All other answers are correct.
The nurse is teaching a prenatal class about a cesarean birth. What benefit of a low transverse uterine incision should the nurse point out in the teaching? least likely to rupture during subsequent labors easier to extend the incision in the uterus if needed best way to deliver a premature breech baby quickest way to deliver a baby
least likely to rupture during subsequent labors A low transverse uterine incision is less likely to rupture, enabling the woman the opportunity of a VBAC with subsequent pregnancies. A classical incision is used when the baby needs to be delivered urgently and quickly. It is also easier to extend the incision in the uterus if the surgeon is having difficulty getting the fetus out. A premature fetus which needs to be delivered will probably be an emergent case and require the horizontal incision to get to the infant quickly.
The nurse is caring for a client who is being prepared for a cesarean birth due to nonprogession of the labor process. The nurse will direct the client to the proper placement on the operating table and abdominal preparation for which type of incision? low transverse incision ("bikini cut") low-abdominal incision classical incision vertical incision
low transverse incision ("bikini cut") The nurse anticipates the most common incision because no complication is noted. A low transverse incision ("bikini cut") is the lowest of the incisions performed. This incision is safe and more cosmetically appealing while allowing for a vaginal birth in a future pregnancy. The classic incision is a vertical, mid-abdominal incision. While safe, it is not the incision of choice. The low-abdominal incision is above the low transverse incision ("bikini cut") site. The best choice is below the abdomen.
To prevent tearing of the perineum of a client during birth, a physician performs a mediolateral episiotomy. The nurse recognizes that an advantage of a mediolateral episiotomy over a midline episiotomy is which of the following? lower rlsk for rectal mucosal tear less blood loss easier healing less postpartal discomfort
lower rlsk for rectal mucosal tear Mediolateral incisions have the advantage over midline cuts in that, if tearing occurs beyond the incision, the tear will not be directed toward the rectum, creating less danger of a rectal mucosal tear, which can result in loss of sphincter function and fecal incontinence later in life. Midline episiotomies, however, heal more easily, cause less blood loss, and result in less postpartal discomfort.
The nursing instructor is leading a group discussion on the various types of birth. The instructor determines the session is successful when the students correctly categorize forceps or vacuum-assisted birth as what type? spontaneous vaginal birth failed vaginal birth operative vaginal birth surgical birth
operative vaginal birth The use of instruments during birth to remove the fetus is invasive and with multiple risks. This type of birth is termed an operative vaginal birth (a baby was born vaginally with assistance). A spontaneous vaginal birth is one in which the baby is born without the assistance of the health care provider. A failed vaginal birth is one in which cesarean birth becomes necessary. A surgical birth is a cesarean birth.
A client in labor has just learned that she will have to undergo a cesarean birth due to failure to progress. The woman looks frightened and stressed. Which of the following is a physiological stress response that the nurse would expect to see in such a client? decreased blood glucose level decreased heart rate peripheral vasoconstriction bronchial constriction
peripheral vasoconstriction Whenever the body is subjected to stress, either physical or psychosocial, it responds with measures to preserve the function of major body systems. This results in the release of epinephrine and norepinephrine from the adrenal medulla. Epinephrine increases the heart rate, causes bronchial dilatation and elevation of the blood glucose level. It also leads to peripheral vasoconstriction, which forces blood to the central circulation and increases blood pressure.
A nurse is caring for a client who requires a cesarean birth because of labor dystocia. The woman's husband signs the consent form. Which of the following individuals is responsible for obtaining the informed consent prior to a cesarean birth? physician the client admitting nurse senior staff nurse
physician A physician (anesthetist/surgeon) is responsible for obtaining the informed consent from the client, guardian, or designate prior to a cesarean birth. Nurses may facilitate the signing of the consent document, but are not legally or ethically responsible for obtaining the informed consent prior to a cesarean birth.
The maternal health nurse assists the health care provider during an artificial rupture of membranes procedure. Which direct outcome does the nurse expect? release of prostaglandins decreased impedance of birth canal increased strength of uterine contractions relief of pressure
release of prostaglandins Artificial rupture of membranes (AROM), also known as amniotomy, can be done to induce labor or augment labor that has already begun. The direct outcome of AROM is the release of prostaglandins. Relief of pressure decreased impedance on the birth canal, and increased strength of uterine contractions do not occur as a direct outcome of AROM.
When an infant is born by cesarean delivery there is always a risk of complications. What is one of the most common complications to the fetus because of a cesarean delivery? broken limb due to being wedged in the pelvis respiratory distress a cut on the face from the scalpel bruising on the trunk
respiratory distress The most common fetal complications are unintended delivery of an immature fetus because of miscalculation of dates and respiratory distress because of retained lung fluid.
The nurse is assessing a neonate after a cesarean birth. Which most common complication should the nurse be prepared for? shoulder dystocia respiratory distress a facial nerve injury hemorrhage
respiratory distress The most common fetal complications involve miscalculation of dates, which leads to the unintended delivery of a premature fetus and respiratory distress due to retained fluid in the lungs. Hemorrhage and infection are the two most common maternal complications. A cone-shaped head and facial nerve injury are seen in fetuses delivered via vaginal birth. Shoulder dystocia occurs during vaginal births and is an obstetric emergency.
The nursing instructor is teaching a group of student nurses about the current use of episiotomies during the labor process. The instructor determines the session is successful when the students correctly choose which situation that may require the health care provider to perform an episiotomy? VBAC delivery persistent occiput anterior position shoulder dystocia multifetal births
shoulder dystocia An episiotomy is appropriate in certain situations. These include shoulder dystocia (baby's shoulders are stuck in the birth canal after the head is born); the head will not rotate from an occiput posterior position (persistent occiput posterior, not anterior); the fetus is in the breech presentation; or instruments (forceps or vacuum) are being used to shorten the second stage of labor. A VBAC delivery would not necessarily require an episiotomy unless one of the above situations was present. A multifetus birth is also not an automatic indication unless one of the above situations is present.
The nursing instructor is teaching a group of student nurses about the current use of episiotomies during the labor process. The instructor determines the session is successful when the students correctly choose which situation that may require the health care provider to perform an episiotomy? persistent occiput anterior position VBAC delivery shoulder dystocia multifetal births
shoulder dystocia An episiotomy is appropriate in certain situations. These include shoulder dystocia (baby's shoulders are stuck in the birth canal after the head is born); the head will not rotate from an occiput posterior position (persistent occiput posterior, not anterior); the fetus is in the breech presentation; or instruments (forceps or vacuum) are being used to shorten the second stage of labor. A VBAC delivery would not necessarily require an episiotomy unless one of the above situations was present. A multifetus birth is also not an automatic indication unless one of the above situations is present.
The client has been progressing well through the labor process and the health care provider prepares to deliver the infant and performs an episiotomy. The nurse predicts which situation is the reason for this procedure? previous perineal laceration with her last child client request so she does not tear prior episiotomy with last child shoulder dystocia
shoulder dystocia There is no reason to perform an episiotomy because of having had a prior one, nor because of a prior laceration with a child. Each delivery is different and the same may not be needed with this birth. The provider should not perform one on client request. The common indication is a "stuck" baby, one with shoulder dystocia or difficulty exiting due to a tight vaginal and perineal area.
A nurse is assisting with preparations for a cesarean birth due to nonprogression during labor. The surgeon has arrived, as has the anesthesiologist, a student assistant to the surgeon, and multiple nurses. To whom will the nurse hand the informed consent paperwork, to be completed prior to the procedure? anesthesiologist student assistant surgeon any of the nurses
surgeon Obtaining operative consent is the surgeon's responsibility, but seeing that it is obtained is the nurse's responsibility. The anesthesiologist focuses on the correct anesthesia for the client and completes a physical assessment and history of past anesthesia use. The student assistant to the surgeon is guided by the surgeon but, as a student, does not have the responsibility to obtain the consent.
A client is being prepared for a scheduled cesarean birth by the medical team. Which intervention will be most critical for the team to monitor in the first 24 hours post-cesarean birth? maintaining IV access urinary output administration of sodium citrate preparing for blood transfusion
urinary output It will be critical to carefully monitor the client's kidney function by monitoring her urinary output. This may include maintaining the Foley catheter for the first 24 hours to ensure accurate measurements of urinary output. Sodium citrate may be administered before surgery to help minimize gastric upset. Maintaining the IV access will depend on the client's situation; however, it is not the priority that monitoring her kidney function is.
There is much discussion in the medical community about vaginal birth after a cesarean delivery (VBAC). When a woman has had a previous emergency cesarean delivery, she is at high risk for a ruptured uterus. When is VBAC contraindicated? when a low cervical uterine incision has been made previously when a transverse abdominal incision ("bikini cut") has been made previously when a classical uterine incision has been made previously when a vertical abdominal incision has been made previously
when a classical uterine incision has been made previously The risk for uterine rupture during VBAC is much higher when a woman has a classical uterine incision from a previous cesarean delivery; therefore, VBAC is contraindicated when this type of scar is present.
