Question

1. Explain the post-natal care following post-natal surgery.

2. While awaiting surgery, explain the post-natal course and post-natal care for the baby following delivery and prior to surgery.

3. What parental education needs to occur before the transition to home and discharge following post -natal surgery?

Answer 1

1. 1. Explain the post-natal care following post-natal surgery.

Postnatal period is the time occurring after birth until the genital tract and uterus have returned to normal.

It starts from the expulsion of the placenta (the third phase of childbirth) until the last 42 days, also known as the period of confinement.

Post natal care following postnatal surgery

1. First 24 hours ( Day 0)

The client is observed meticulously for last 6-8 hours

Periodic check up of pulse, blood pressure, amount of vaginal bleeding and behaviour of the uterus ( in low transverse abdominal incision) is mandatory.

Fluid - Sodium chloride (0.9%) or Ringer lactate drip is continued until atleast 2-2.5 Litters of the sodium are infused.

Blood transfusion is helpful in anemic mothers for a speedy post operative recovery.

Blood transfusion is required if the blood loss is more than average during the operation (average blood loss in Caesarian section is approximately 1/2 to 1 litre)

Injection methergine 0.2 mg intramuscularly may have to be repeated.

Prophylactic antibiotics is usually prescribed parenterally for the first 48 hours

Analgesics in the form of phethedine hydrochloride 75-100mg is administered and may have to be repeated.

Ambulation.

The patient can sit on the bed or even get out of bed to evacuate the bladder , provided the general condition permits. She is encouraged to move her legs and ankles and to breathe deeply to minimise leg vein thrombosis and pulmonary embolism.

2. Day 1

Oral feeding in the form of plain or electrolyte water or raw tea may be given

Active bowel sounds are observed by the end of the day.

3. Day 2

Light solid diet of the patient choice is given

3-4 teaspoons of lactulose may be given at bed time, if the bowel do not move spontaneously.

Day 5 or Day 6

The abdominal skin stitches are to be removed on the day 5 ( in transverse) or day 6 (in longitudinal)

Discharge

The patient is discharged on the day following removal of the stitches, if otherwise fit. Usual advices like those following vaginal delivery are given. Depending up on the postoperative recovery and availability of care at home, the patient may be discharged as early as third to as late as seventh post operative day.

2. While awaiting surgery, explain the post-natal course and post-natal care for the baby following delivery and prior to surgery.

Soon after the delivery

It should be placed on a tray covered with clean dry linen with the head slightly downwards (15 degree). It facilitates drainage of the mucus accumulated in the tracheobronchial tree by gravity. The tray is placed between the legs of the mother and should be at lower level than uterus to facilitate gravitation of the blood from the placenta to the newborn

Air passages should be cleared of mucous and liquor by gentle suction

Apgar rating at 1 minute and 5 minute is to be recorded..

Clamping and ligature of the cord

The cord is clamped by two Kocher's forceps, the near one is placed 5cm away from the umbilicus and is cut in-between.

Baby is wrapped with a dry warm towel

The identification tape is tied both on the wrist of the baby and the mother

Immediately following bath or cleaning the baby should be weighed naked.

Care of the eyes

Eye are kept clean with cotton wool soaked with saline

Clothing

Swaddle the baby appropriately.

Breast feeding

Start breastfeeding as soon as possible

Conduct newborn assessment

Close observation atleast 4-8 hours.

3. What parental education needs to occur before the transition to home and discharge following post -natal surgery?

1. Teach the mother to eat a diet high in roughage and fluid

2. An inisional pain may interfere with the woman’s ability to use her abdominal muscles eeffectively advice the mother to take stool softeners as per order.

3. Advice the mother not to strain to pass stools because this puts pressure on their incision.

4. Advice the woman that it is normal not to have bowel movements for 3 to 4 days postoperatively, especially if there is enema administered before surgery.

5.Mothers, particularly new mothers and significant others have to educate regarding

• Nutritional needs of the baby,
• How to breast feed or bottle feed
• How to provide cord care and circumcision care
• Diapering,
• Bonding, attachment
• Preventing accidents