Post-Partum Failure to Progress- Cesarean Section

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Post-Partum Failure to Progress- Cesarean Section

Interventions with rationale

Intervention: Following after nurse assists patient out of bed and into restroom, The nurse will remove indwelling catheter in a proper, clean antiseptic manor. Nurse will observe if patient has any urinary retention, and or pain with urination. Rationale: The importance of the cleanliness when administering catheter care is imperative due to high hospital acquired infections. Nurse should observe if patient has any problems urinating in regards to possible post partum hemorrhage.

Intervention: Nurse will assist patient out of bed gradually to a stand for precautions of orthostatic hypotension. Nurse will also have gait belt for safety precautions for fall risk. Rationale: The nurse needs to understand to slowly transition a women to sitting then standing watching for signs and symptoms of postural hypotension.

Intervention: Nurse will monitor caesarean incision for signs and symptoms of infection. Rationale: Specifically nurse will be assessing for any elevation in temperature, swelling, redness, purulent drainage. around incision.

Intervention: Nurse will perform post-partum assessments, specifically on the uterus for unexpected changes (firm/boggy, fundal height related to time after delivery, midline fundus, fundal massage if necessary). Rationale: Specifically nurse will be assessing for any unexpected physiological changes following delivery and how to accommodate for the changes accordingly. The nurse should be knowledgeable on where fundus is found, the difference between boggy/firm or midline/deviation, measuring fundal height, and how to perform fundal massage. Also- Intervention: Nurse will perform post-partum assessments, such as lochia (color, odor, consistency, and amount). Rationale: Specifically nurse will be assessing for any unexpected physiological changes following delivery and how to accommodate for the changes accordingly. The nurse should understand and be able to assess for alterations in lochia related to hemorrhage, and or infection.

Outcome/Goals

Patients indwelling urinary catheter will be discontinued by the end of the shift.

By the end of the shift the patient will be out of bed and continue to use antiembolism stockings/SCD's if needed.

Patient's cesarean section incision will heal properly with no signs and symptoms of infection.

Patient will refrain from post partum hemorrhaging for entire post-partum stay.

What is the concept associated?

The nurse should understand the prevalence with the use of indwelling catheters and hospital acquired infections. The removal of indwelling catheter, the decreased incidence of infections.

The nurse should understand the importance on getting patient up and walking as soon as possible to prevent blood clots. If a patient is unable to get up in adequate time. The nurse should be aware of interventions to prevent blood clots. These are compression hose, or the use of SCD's (Sequential Compression Devices)

The nurse should understand that a women with increased adipose tissue whom had a cesarean section, may have improper healing. The nurse should be knowledgeable on the signs and symptoms of infection in relation to various dressings placed on cesarean incisions, and how to treat them.

Post-partum physiological adaptations: The nurse should understand the importance of fundal massages and what to look for regarding signs and symptoms of inadequate uterine contractility. She should also understand the procedure and proper placement of hands to attempt to decrease amount of pain from already sore and tender abdomen from cesarean section.

Post-partum physiological adaptations: The nurse should understand the physiological implications in relation to risk for post-partum hemorrhage. The nurse should perform thorough post partum assessments for signs and symptoms of hemorrhage. Fundal checks, locia, vital signs, urinary status, bowel status, etc. Nurse will perform fundus checks and fundus will remain firm, fundus will descend approximately 1-2 cm every 24 hours, fundus will remain midline. Nurse will educate patient about measures to reduce milk supply with women who do not want to breast feed,

Main topic

What are the problems?

Patient continues with indwelling urinary catheter. Indwelling catheters need to be removed promptly due to risk for infection.

Patient is 12 hours post cesarean section and is still bed ridden. If patient is bed ridden for too long she could have increased susceptibility to blood clots.

Patient has increased adipose tissue (>35 BMI), this could cause improper healing of caesarean section incision.

Cesarean section incision site and abdomen sore, tender to the touch. This could cause challenges with the nurse to do fundal checks.

Post partum hemorrhage level risk is high due to cesarean section, mom is not breast feeding, epidural, long labor period related to failure to progress that lead cesarean section.

Evaluation of outcomes/goals and interventions

This goal was met. The indwelling catheter was discontinued. The patient did not report any pain or discomfort with urination.

The goal was met. Patient was able to get out of bed with mild pain due to abdominal incision and ambulate to restroom.

This goal was not met due to patient continuing to be an inpatient at the time of student dismissal. Patient however did not present with any signs or symptoms of infection during clinical day.

This goal was not met due to patient continuing to be an inpatient at the time of student dismissal. Patient however did refrain from having post-partum hemorrhaging for entire clinical day.

Patient Education and health promotion needs

Education about prompt discontinuation of indwelling urinary catheter in relation to hospital inquired infections.

Education on the importance of ambulation in relation to blood clots.

Education on the importance of fundal checks despite of abdominal pain related to cesarean section.

Education regarding the importance of the frequency of nursing assessments post-partum. Specifically regarding the importance of fundal massage and possible discomfort, assessment of urinary patterns relating to urinary retention and uterine contractility, assessment of perineal pads and the importance of color, odor, consistency, and amount in relation to hemorrhage and or infection.

Saftey needs and how addressed

Safety of mother and baby in regards to mother, father, baby wrists bands promoting safe transport of baby to and from nursery, and potential misplacement or kidnapping of baby.

Frequent assessment from nurse every 15 minutes to watch for unexpected physiological changes.

If the patient has had an epidural, fall risk safety is important. Education on the use of call light for assistance, frequent checks on patients movement and sensation of bilateral lower extremities, torso, and bowel and bladder output.

Pathophysiology

Failure to progress is described as slowed and delayed delivery of the baby. The cervix has not thinned enough as it should. The baby will not be able to move down he birth canal. This results in cesarean section for the health and wellbeing of mother and baby. Cesarean section is a fetal delivery through an open abdominal incision and an incision in the uterus.

Reason for patient admisison

Patient is on post-partum mother baby unit after cesarean delivery of her baby.

Assessment Findings

Patient has chosen not to breast feed and instead bottle feed. She has only pumped once.

Patient is 12 hours post-partum. She continues to be bed ridden with indwelling urinary catheter that has patent output. Lochia is mild.

Patient has abdominal incision from cesarean section. It is dressed with horizontal clean dressing with no signs or symptoms of infection. Patient does present with tenderness to abdominal area. Patient has increased adipose tissue (>35 BMI).

Patient is on post-partum mother baby unit. She had a cesarean section due to failure to progress.