CAESAREAN SECTION POSTOPERATIVEMANAGEMENT WITHREPAIR OF BLADDER

NOORSALINNA BT MOHAMEDR00616

WARD 2B

PATIENT DEMOGRAPHIC DATA• Name : MRS LAU YAN TING

• Date Of Birth : 2 Jan 1974

• Gender : Female

• Marital Status : Married

• Main Language : Malay & English

• Date of Admission :6 November 2014

• Date Discharged :8 November 2014

• Age :40 years

• Race :Chinese

• Religion :Buddhist

• Occupation :Housewife

Past history

Past Obstetric History

1) Baby Boy - 3.04kg2) Baby Girl - 2.79kg3) Baby Girl - 2.64kg

Medical History

NIL

Surgical History

1) LSCS – 20072) LSCS -20103) LSCS -2012

Family History NIL

CURRENT HOSPITALIZATION

Reason For Admission

. Patient G4P3 at 38 week of previous scar has been decided for elective lower segment caesarean section operation due to horoscopic at 6 jan 2014.

ASSESMENT UPON ADMISSION

Admitted from A&E, wheel in to ward 2B via wheel chair accompanied by husband.

Patient’s alert and orientated.

Vital signs checked with BP: 114/60mmhg , pulse : 80bpm, Respiration : 19/ min, Temperature : 36 celcius , weight : 82kg ,Height : 156cm.

No allergy to medication or food

Normal on speech, vision and hearing.

Breathing pattern normal, breath sound is clear

Normal mouth and throat.

Good of appetite.

No disturbance of sleeping pattern.

No contraction, CTG normal.

ON OPERATIVE DAY Fetched patient from ot via bed, post LSCS with repair of bladder due to bladder

laceration, anaesthesia under spinal .

General condition alert and conscious.

On arrival IVD Pitocin 40units in 500mls sterofundin inprogress. IV line patern. No swelling noted.

Operation site at lower abdomen intact with blood stain seen.

CBD 22Fr 3way inplaced with 2nd bag 3000mls irrigation of N/saline running well.

Pad checked,1 and ½ pad soaked,fresh blood seen .pad changed,swabbing done.

Review by midwife, uterus contracted,above umbilical. pv bleeding with fresh blood noted.

Vital sign checked,Temp:36 BP:110/60mmhg Pulse 100/min Resp 21/min. pain score 2/10.

Checked pad after 30min,heavy bleeding with 2 pad soaked of fresh blood. pad changed,swabbing done.

Patient look pale, no complaint of drowsy.No sign and symptom of postpartum haemorrghae (PPH).

Inform doct regarding patient’s condition,phone oder: -IV Pitocin 40 units in 500 mls N/saline run at 4hours stat. -after 30min checked pad,if still active bleeding -IV Durotocin 1mls stat.

After 1 hours pad checked,no active bleeding ,blood stained seen.

Patient CRIB.

IndicationsPossible indications include: Cephalopelvic disproportion (use of pelvimetry is not advised). Malpresentation, eg breech, transverse lie. Multiple pregnancy. Severe hypertensive disease in pregnancy. Fetal conditions: distress, iso-immunisation, very low birthweight. Failed induction of labour. Repeat Caesarean section: two sections nearly always means subsequent births should also be by Caesarean section. Pelvic cyst or fibroid. Maternal infection, eg herpes, HIV.

COMPLICATION Repeat Caesarean section.

Women who have had up to and including four Caesarean sections should be advised that the risk of fever, bladder injuries and surgical injuries does not vary with planned mode of birth. The risk of uterine rupture, although higher for planned vaginal birth, is rare. Therefore the decision about mode of birth after a previous Caesarean section should take .

What are the risks of having a caesarean?Pain You will feel pain for a while after the operation, and will take longer to recover than if you'd had a vaginal birth. You'll probably feel pain in your wound and discomfort in your tummy for a few weeks after the operation, while your body heals (RCOG 2009).

You will be given drugs to reduce the pain, but it will affect your day-to-day activities for some time (NCCWCH 2011, RCOG 2009).

Infection Before you go into surgery, you'll have a single dose of antibiotics, to reduce the risk of infection (NCCWCH 2011). Despite this, it's common for women to have an infection after a caesarean (NCCWCH 2011, Wloch et al 2012).

Tell your midwife if you have heavy bleeding, irregular bleeding, smelly discharge or a fever. These can be symptoms of infection (French and Smaill 2004).

The three main infections are: Infection in your wound. Signs include redness and discharge, worsening pain in the wound and separation of the wound (NCCWCH 2011). This happens to about one in ten women, even after having antibiotics at the time of surgery. It's more likely to happen if you have diabetes or are overweight or obese (Wloch C et al 2012).Infection of the lining of your uterus (endometritis). This is more likely to happen if your waters broke before labour started, or if you had lots of vaginal examinations before your caesarean. Urinary tract infection. The thin tube (catheter) inserted during the operation to empty your bladder can cause infection. You may find that weeing is difficult, painful, and causes a burning sensation.

POST OPERATIVE ORDERS GYNAECOLOGYST UROLOGYST

-NBM for 4 hours then c/fluid.

-N/fluid if no vomiting can soft diet.

-Hourly v/sign for 8hours then 4hourly

-strictly i/o chart.

-pad chart.

-keep CBD for 14days.

-I/V Sulperazon 1Gram BD.

-Tab. Zantac 150 Gram BD.

-Tab pcm 1 Gram TDS.

-cap.ponstan 500 Gram TDS.

-On CBD 22Fr 3way with continuous N/saline irrigation.

-Beware not to distend the bladder.

-keep CBD all the time.

-Irrigation chart/observe urine output.

PRE-OPERATIVE1) Correct patient / ID band in position.

2) Consented for surgery

3) Last meal and drink at 5/11/14 @ 2300

4) Shaving

5) All must be removed (jewellery, cutex etc)

6) Vital sign checked

7) Advice Patient to passed urine

8) Explanation/emotional support.