2.1 Preoperative preparation
2.1.1 Psychological care preoperative circulating nurse visits the patient, assesses all aspects of the patient's condition, checks preoperative preparation, introduces the operating room environment, surgical position, The anesthesia method allows the patient to undergo surgical treatment in the best physical and mental condition.
2.1.2 Item preparation In addition to the common surgical instruments for ordinary cesarean section, two 20ml syringes, No. 7 sterile sutures, and epinephrine should be prepared.
2.2 Cooperation during the operation
2.2.1 Cooperation by the circulating nurse (1) Establishing intravenous access: Because the patient does not eat or drink before the operation, insufficient blood volume can easily cause blood pressure fluctuations, so during the operation Smooth infusion is a prerequisite for ensuring the safety of anesthesia surgery. A 20G BD indwelling needle should be selected for puncture. The intravenous access should be established in the upper limb venous system and connected to an extension tube to facilitate intraoperative administration. At the same time, the indwelling needle should be properly fixed to prevent falling off. (2) Assist in anesthesia: Assist the anesthetist in setting the required position. After anesthesia is completed, assist in fixing the pipeline. During the anesthesia process, pay attention to observe whether the patient has any adverse reactions. (3) Place the surgical position: Place the patient in a supine position, and use restraints on both arms and lower limbs to fix the limbs with appropriate tightness. (4) Fill the bladder: Inject 250 ml of normal saline through the outlet of the Folley catheter under pressure to fill the bladder so that the reflex of the anterior bladder fascia can be identified during the operation. (5) Connect pipelines: Connect various pipelines correctly and accurately. (6) Moisturize during surgery: The temperature in the operating room should be pre-adjusted to 24°C to 25°C and the humidity to 40% to 50%, and unnecessary body exposure should be reduced. (7) Closely observe vital signs: closely observe the patient's body temperature, pulse, respiration, blood pressure and urine output, accurately record the intake and output, and promptly inform the anesthesiologist and surgeon. (8) Empty the bladder: When the surgeon exposes the lower segment of the uterus, loosen the urinary catheter to drain the urine and empty the bladder.
2.2.2 Cooperation of instruments and nurses (1) Be familiar with the surgical procedures before surgery, and place surgical instruments in order to facilitate rapid and accurate delivery. (2) Lay down sterile drape: After routine disinfection of the skin, pass 4 treatment drape to expose the surgical incision, fix it with towel clamps, and lay out the drape. (3) Incision in the abdominal wall: Make a transverse incision in the skin, subcutaneous fat, and fascia at the natural physiological fold of the two transverse fingers above the pubic symphysis, and separate the rectus abdominis muscle. Cut with a No. 20 knife, wipe the blood with dry gauze, clamp with curved forceps, ligate the bleeding point with a No. 4 silk thread, and bluntly separate the rectus abdominis with a thyroid retractor. (4) Cut the anterior bladder fascia: Pass a 20ml syringe and inject epinephrine saline under the anterior bladder fascia. Pass the Allis clamp to clamp the anterior bladder fascia. Cut it horizontally with scissors. Continue to separate the anterior bladder fascia with curved forceps and pass the scissors. Cut the prevesical fascia along the arc of the bladder roof to see the middle umbilical ligament. Use 2 curved forceps to clamp the middle umbilical ligament, cut it with scissors, tie it with No. 7 silk thread, and cut the thread with scissors. (5) Free bladder: Pass a 20ml syringe and inject epinephrine saline into the tissue space to form a water cushion. Pass the scissors to cut sharply. Pass the curved forceps with wet gauze to separate the space behind the bladder. If you see the preperitoneal reflection of the bladder, pass a 20ml syringe. Inject normal saline and separate posteriorly to the posterior reflexed edge. (6) Incise the anterior uterine fascia: Inject a 20ml syringe into the saline below the uterus, lift the bladder cephalad and move it up, inject a 20ml syringe into the saline, and form a wider water cushion in the tissue space under the anterior fascia. , use scissors to cut open, exposing the lower segment of the uterus. (7) Incise the uterus: pass the bladder retractor to expose the lower segment of the uterus, cut the uterus transversely with a No. 20 knife, rupture the membrane in the middle curve, and remove the retractor. (8) Take out the fetus: After the fetus is delivered, use 2 straight forceps to cut off the umbilicus, disconnect the scissors, and put them under the table. (9) Suture the uterus: 4 Allis clamps are used to clamp the uterine incision to stop bleeding, and oxytocin is injected into the uterine body. After the placenta is delivered, the oval forceps are used to wipe the uterine cavity with gauze, and the No. 1 absorbable suture is used to suture the uterine seromuscular incision with curved forceps, and the suture is cut with suture scissors. (10) Suture and tie the middle umbilical ligament: Pass No. 7 silk thread and curved forceps, suture and tie the two broken ends of the middle umbilical ligament, and cut the thread with scissors. (11) Bladder reduction: pass No. 4 silk thread to a circular needle and curved forceps, suture the bladder fascia intermittently, and trim the thread with scissors. (12) Close all layers of the abdominal wall: After careful hemostasis, count the instruments, gauze, suture needles, spools, and syringes before closing the abdomen. Deliver the No. 1 absorbable suture and curved forceps, suture the rectus abdominis intermittently, and continuously suture the fascia and part of the subcutaneous fat. Deliver the No. 1 absorbable suture and curved forceps, perform intracutaneous sutures, and trim the sutures with thread scissors. (13) Cover the incision: Pass alcohol gauze to disinfect the incision, check the materials again, and cover the incision with gauze.
This article comes from China Nurse Network. Detailed source reference: /2006/7-31/33476.htm
By the way, I will help you find the key points of post-operative care
Anatomy 9 major care points after cesarean section
After cesarean section, how can we care for the mother to suffer less and recover faster?
1. Use less analgesics
After caesarean section, the effect of anesthetics gradually disappears, and the pain in the abdominal wound begins to recover. Generally, the wound begins to suffer severe pain within a few hours after the operation. In order to have a good rest and help your body recover as quickly as possible, you can ask your doctor to give you some painkillers on the day or night of the surgery. After that, be more tolerant of the pain, and it is best not to use drugs to relieve pain, so as not to affect the recovery of intestinal peristalsis function. Generally speaking, the pain of the wound will disappear on its own after 3 days.
2. You should turn over frequently after surgery
Anesthetic drugs can inhibit intestinal peristalsis and cause varying degrees of flatulence, resulting in abdominal distension.
Therefore, it is advisable to do more turning movements after delivery to promote the early recovery of the peristaltic function of paralyzed intestinal muscles and to expel the gas in the intestines as soon as possible. 12 hours after the operation, you can drink some senna leaf water to help reduce abdominal distension.
3. It is advisable to take a semi-recumbent position when lying in bed
The body of a mother after a caesarean section recovers slowly and cannot get up and move about 24 hours after delivery like a natural vaginal delivery. Therefore, it is easy for patients who have had a caesarean section to have lochia that is difficult to discharge. However, if they adopt a semi-recumbent position and turn over frequently, it will promote the discharge of lochia and prevent lochia from accumulating in the uterine cavity, causing infection and affecting uterine reset. It is also beneficial to the uterine incision. heal.
4. Pay attention to urination after delivery
For the convenience of surgery, a urinary catheter is usually placed before caesarean section. 24-48 hours after surgery, the effects of the anesthetic disappear and the bladder muscles resume urinary function. At this time, the urinary catheter can be removed. As soon as you feel the urge to urinate, you must work hard to urinate on your own to reduce the risk of keeping the urinary catheter for too long. and the risk of causing urinary tract bacterial infection.
5. Keep the vagina and abdominal incision clean
Within 2 weeks after the operation, avoid getting the abdominal incision wet. It is advisable to use a sponge bath to clean the whole body. You can shower after this, but lochia You must not take a bath before it is completely drained; rinse your vulva 1-2 times a day, and be careful not to let dirty water enter the vagina; if the wound is red, swollen, hot, or painful, do not squeeze and apply it yourself, and you should seek medical treatment in time to avoid wounding. The infection lingered, causing the entire maternity leave to be "soaked" in wound treatment.