CESAREAN SECTION Your healthcare provider may have other reasons to

recommend a Cesarean delivery.

Cesarean section, C-section, or Cesarean birth
is the surgical delivery of a baby through a cut (incision) What are the risks of a C-section?
made in the mother's abdomen and uterus. Health care
• Some possible complications of a C-section may
providers use it when they believe it is safer for the mother,
include:
the baby, or both.
• Reactions to the medicines used during surgery
The incision made in the skin may be: • Bleeding
• Abnormal separation of the placenta, especially
• Up-and-down (vertical). This incision extends
in women with previous Cesarean delivery
from the belly button to the pubic hairline.
• Injury to the bladder or bowel
• or
• Infection in the uterus
• Across from side-to-side (horizontal). This
incision extends across the pubic hairline. It is • Wound infection
used most often, because it heals well and there • Trouble urinating or urinary tract infection
is less bleeding. • Delayed return of bowel function
• Blood clots
The type of incision used depends on the health of the
mother and the fetus. The incision in the uterus may also After a C-section, a woman may not be able to have a
be either vertical or horizontal. vaginal birth in a future pregnancy. It will depend on the
type of uterine incision used. Vertical scars are not strong
Why might I need a C-section? enough to hold together during labor contractions, so a
If you can't deliver vaginally, C-section allows the fetus to repeat C-section is necessary.
be delivered surgically. You may be able to plan and You may have other risks that are unique to you. Be sure to
schedule your Cesarean. Or, you may have it done discuss any concerns with your healthcare provider
because of problems during labor. before the procedure, if possible.
Several conditions make a Cesarean delivery more SKIN PREP
likely. These include:
Perform perineal care by cleaning the perineum
• Abnormal fetal heart rate. The fetal heart rate with a warmed antiseptic solution and then rinsing the
during labor is a good sign of how well the fetus is area with sterile water. Always clean from vagina outward
doing. Your provider will monitor the fetal heart using a sterile sponge for each stroke.
rate during labor. The normal rate varies between
120 to 160 beats per minute. If the fetal heart rate
shows there may be a problem, your provider will
take immediate action. This may be giving the
mother oxygen, increasing fluids, and changing
the mother's position. If the heart rate doesn’t
improve, he or she may do a Cesarean delivery.
• Abnormal position of the fetus during birth. The
normal position for the fetus during birth is head-
down, facing the mother's back. Sometimes a
fetus is not in the right position. This makes
delivery more difficult through the birth canal.
• Problems with labor. Labor that fails to progress
or does not progress the way it should.
• Size of the fetus. The baby is too large for your
provider to deliver vaginally.
• Placenta problems. This includes placenta previa, CORD CARE
in which the placenta blocks the cervix.
1. Call out time of delivery once the whole body is
(Premature detachment from the fetus is known
as abruption.) born. Call out the gender of the newborn.
2. Place baby onto the dry cloth draped over the
• Certain conditions in the mother, such as
mother’s abdomen in a prone position.
diabetes, high blood pressure, or HIV infection
3. Use the clean, dry cloth to thoroughly dry the
• Active herpes sores in the mother’s vagina or
newborn for full 30 seconds, while assessing the
cervix
baby’s breathing. Quick assessment of APGAR
• Twins or other multiples
must be done.
• Previous C-section
4. Remove the wet cloth and place the infant directly
on the mother’s chest, prone, with the newborn’s
 skin touching the mother’s skin. (Skin-to-skin 12. Deliver placenta when signs of placenta
contact) separation occur by performing controlled cord
5. Cover both the mother and infant with a dry, warm traction (CCT) on the umbilical cord and counter-
cloth or towel and baby’s head with bonnet. traction to the uterus.

6. If the baby is not gasping or no breathing difficulty,

13. Place the palm of the other hand on the LOWER
continue skin-to-skin contact for at least 60
abdomen to check for contraction while gently
minutes.
rolling the cord around the clamp.
7. Inject 10 IU of oxytocin intramuscularly into the
14. Support the placenta with both hands. Gently
mother’s arm or thigh within one minute of the
move membranes up and down until delivered.
baby’s birth after excluding a second baby and
15. Check time of placental expulsion.
informing the mother.
16. Massage the uterus.
8. Remove the 1st set of gloves, if you are the lone
17. Examine the placenta and the membrane. Inspect
birth attendant.
for completeness of cotyledons and for
9. Palpate the cord. After cord pulsations have
abnormalities.
stopped (approximately 3 minutes after delivery),
18. Examine the lower vagina and the perineum of the
clamp and cut the cord following strict hygienic
mother for lacerations.
techniques.
19. Provide immediate care to the mother and baby.
20. Check vital signs of the patient. And monitor vital
signs every 15 minutes for the first hour.
21. Wash the perineum and paint the external
genitalia of the mother with antiseptic solution
then apply perineal pad. Offer a new gown if
necessary. Cover the woman with warm blanket.
10. Clamp cord using a sterile plastic clamp or tie 22. Maintain maternal and newborn bonding. There
around the cord. Drain the cord of blood by should be Non-separation of Newborn from
stripping away from the baby. Apply sterile Mother for Early Breastfeeding.
clamp/forceps (Kelly) at 5 cm from the umbilical 23. Do after care according to institution’s protocol.
base. Cut between the two clamps/ties close to 24. Document the procedure done.
the first clamp/tie using sterile scissors. Weight Taking Weight

• Weigh the newborn using a newborn scale.

• The child should be unclothed.
• The newborn weighs between 2.5 – 3.4 kg

Taking Vital Signs

• Taking temperature by axillary – normal range

36.5–37.5 °C
• Axillary rather than rectal temperatures are
recommended for newborns, to prevent
accidental bowel perforation.
• Counting respiration – normal range 30 to 60
breaths per minute.
• Respiratory rate can be observed most easily by
watching the movement of a newborn’s
11. Observe for the oozing of blood. If blood oozes, abdomen, because breathing primarily involves
place a second tie/clamp between the skin and the use of the diaphragm and abdominal muscles.
first tie. Do not apply any substance or binder to • Assessing the pulse – normal range 120 to 140
the stump. beats per minute This is always determined by
 listening for an apical heartbeat for a full minute, APPENDECTOMY
rather than assessing a pulse in an extremity.
An appendectomy is surgery to remove the
Taking Anthropometric Measurements appendix when it is infected. This condition is called
appendicitis. Appendectomy is a common emergency
• Length - The newborn is 44–55 cm.
surgery.
• Head Circumference - Circumference is 33–
35.5 cm. The appendix is a thin pouch that is attached to the large
• Chest Circumference - Circumference is 30–33 intestine. It sits in the lower right part of your belly. If you
cm (1–2 cm less than head). have appendicitis, your appendix must be removed right
away. If not treated, your appendix can burst. This is a
Injections: Vitamin K and Vaccines medical emergency.
1. Medication / Vaccine: Vitamin K There are 2 types of surgery to remove the appendix.
(phytomenadione) The standard method is an open appendectomy. A newer,
• Dosage/Amount: 1 mg (0.1 ml.) for a term less invasive method is a laparoscopic appendectomy.
newborn. 0.5 mg (0.05 ml.) for preterm or small-
for gestational age • Open appendectomy. A cut or incision about 2 to
• Route: intramuscular (IM) 4 inches long is made in the lower right-hand side
• Purpose: To prevent bleeding of your belly or abdomen. The appendix is taken
out through the incision.
2. Medication / Vaccine: Hepatitis B • Laparoscopic appendectomy. This method is
• Dosage/Amount: 0.5 ml less invasive. That means it’s done without a large
• Route: intramuscular (IM) incision. Instead, from 1 to 3 tiny cuts are made. A
• Purpose: To prevent the baby from catching an long, thin tube called a laparoscope is put into one
infection of the liver that can cause cancer later in of the incisions. It has a tiny video camera and
life. surgical tools. The surgeon looks at a TV monitor
to see inside your abdomen and guide the tools.
3. Medication / Vaccine: BCG The appendix is removed through one of the
incisions.
• Dosage/Amount: 0.05 ml
• Route: intradermal (ID) What are the risks of an appendectomy?
• Purpose: To prevent serious infections due to
Some possible complications of an appendectomy
tuberculosis.
include:
APGAR Scoring
• Bleeding
APGAR scoring is performed at 1 minute and 5 • Wound infection
minutes after birth and may be reassessed at 10 minutes • Infection and redness and swelling
(5 minutes later) after birth, if the score is 6 or less. (inflammation) of the belly that can occur if the
Each category is scored 0-2 and added up for a score 0- appendix bursts during surgery (peritonitis)
10. The higher the score the better the baby is doing. • Blocked bowels
• Injury to nearby organs

OPEN LAPAROTOMY
A laparotomy is a surgical procedure that opens up
your abdomen to expose your organs.

Sometimes, a laparotomy is exploratory — a way for

your surgeon to see what’s going on inside your body and
possibly take tissue samples in order to diagnose your
condition. It can also be therapeutic — a way of treating
some conditions. You may need open surgery to remove
an organ or to manage a critical condition, or your surgeon
may find and fix a problem while they’re exploring.

The term “laparotomy” actually refers to the incision

through your abdominal wall that opens up your peritoneal
cavity — the cavity that includes your abdomen and
pelvis. But you’ll often hear the term used to describe an
open exploratory procedure. Other terms for laparotomy
include “celiotomy” (an incision into your abdomen) and
“peritoneotomy” (an incision into your peritoneal cavity).
What happens during a laparotomy? What are the risks of cholecystectomy?

A laparotomy involves a large incision of three to 12 inches There’s always a small risk of complications occurring
into your abdominal cavity. The specifics of the incision, during surgery. General risks of surgery include:
and what happens after, will depend on the purpose of
• Infection.
your laparotomy. In general, you can expect to be in
surgery for several hours. You may have various tubes • Blood clots.
installed in different parts of your body to deliver and drain • Anesthesia complications.
fluids, and these will stay in place for several days. These • Injury to nearby organs.
may include: Specific risks of cholecystectomy include:
• A catheter connected in your vein to deliver • Pancreatitis (irritation of your pancreas).
anesthesia, antibiotics and IV fluids. • Bile reflux (traces of bile escape into your
• A nasogastric tube inserted through your nose to stomach).
your stomach to drain fluids. • Injury to nearby blood vessels, causing excessive
• A urinary catheter to drain your bladder. bleeding.
• In some cases, you may need a surgical drain, • Bile duct injury, causing bile leakage.
feeding tube or parenteral nutrition (through an
IV). IINTERNAL JUGULAR CATH INSERTION
Internal Jugular Central Lines
LAPAROSCOPIC CHOLECYSTECTOMY
A cholecystectomy is a surgical procedure to remove Internal Jugular Central Lines are excellent
your gallbladder — the small, hollow organ that stores bile alternatives when other central lines such as Peripherally
for your digestive system. Gallbladder removal surgery is a Inserted Central Catheter (PICC) Lines and Small Bore
common treatment for many types of gallbladder disease. Axillary or Femoral Central Venous Catheter Lines are
This is because the downsides of having your gallbladder unavailable or contraindicated. There are many reasons
removed are generally fewer than those of the diseases it why such lines can be contraindicated and an Internal
treats. You can live a healthy life without a gallbladder. Jugular Central Line will provide the access needed to
reach the large vein above the heart, the superior vena
What happens during a cholecystectomy? cava (SVC).
During a laparoscopic cholecystectomy, your surgeon will: Use Cases for Internal Jugular Central Lines include:
• Make a small incision, about 2 or 3 centimeters (a) when an Axillary Central Venous Line is unavailable.
(cm) long, near your belly button.
• Make two to three additional “keyhole” incisions, (b) when a patient has had a bilateral mastectomy with
about 1 centimeter long, in your upper right lymph node removal, usually in the case of breast cancer,
abdomen. and has a higher risk of lymphedema. Lymph node
• Insert a small tube into one of the smaller removal can increase the risk of lymphedema which is
incisions and pump carbon dioxide gas through it swelling on an affected extremity. This swelling can be
to inflate your abdomen. This helps to separate temporary or permanent and is painful and difficult to treat
your abdominal walls from your organs. for the patient.
• Insert the laparoscope into the larger incision. The (c) when a patient is contracted such that their muscles in
laparoscope (a small, lighted camera) projects their body have shortened and their arms will not extend
images to a video monitor above the operating out from the side of their body, thus making access very
table. difficult.
• Using the video monitor as a guide, insert narrow
surgical tools through the one or two remaining (d) when a patient presents with chronic kidney disease
incisions to remove your gallbladder. such that labs results show creatinine is equal to 2 or
• Release the gas from your abdomen and close the greater or GFR is below approximately 45, which indicates
incisions with stitches. stage 3 Chronic Kidney Disease. Vascular Wellness
follows Kidney Disease Outcomes Quality Initiative
During an open cholecystectomy, your surgeon will: (KDOQI) guidelines for line placement. The Internal
Jugular line maintains upper arm vein preservation as
• Make one incision, about 4 to 6 inches (in) long,
preferred dialysis route utilizes upper arm veins.
underneath your right rib.
• Use surgical tools to remove your gallbladder. (e) when a patient presents with upper extremity cellulitis,
• Insert a surgical drain (Jackson Pratt drain) into the regardless of type, a PICC line should not be inserted
wound to drain excess fluids. through areas of infection.
• Close the incision with stitches, leaving the drain
(f) if a patient has deep vein thrombosis (DVT) in an upper
in place.
extremity, that site should not be used for a PICC line.
 EXPLORATORY LAPAROTOMY • Hypoparathyroidism (too little parathyroid
hormone, which can result in abnormally low
Exploratory laparotomy is surgery to open up the
blood calcium levels)
belly area (abdomen). This surgery is done to find the
cause of problems (such as pain or bleeding) that testing OPEN REDUCTION AND INTERNAL FIXATION (ORIF)
could not diagnose. It's also used when an abdominal
Open reduction and internal fixation (ORIF) is a type of
injury needs emergency medical care. This surgery uses
surgery used to stabilize and heal a broken bone. You
one large cut (incision). The provider can then see and
might need this procedure to treat your broken ankle.
check the organs inside the abdomen. If the cause of the
Three bones make up the ankle joint. These are the tibia
problem is found during the procedure, then treatment is
(shinbone), the fibula (the smaller bone in your leg), and
often done at the same time. In some cases, a minimally
the talus (a bone in your foot).
invasive surgery called exploratory laparoscopy may be
used instead. That method uses a tiny camera and several Different kinds of injury can damage the lower tibia, lower
small incisions. But in many cases, an exploratory fibula, or talus. Only one of these bones might break, or
laparotomy is preferred. Read on to learn more about this you might have a fracture in 2 or more of these bones. In
procedure. certain types of fractures, your bone breaks but the pieces
still line up correctly. In other types of fractures, the injury
Reasons for the surgery
can move the bone fragments out of alignment.
Organs that may be examined during exploratory
If you fracture your ankle, you might need ORIF to bring
laparotomy include:
your bones back into place and help them heal. During an
• Liver open reduction, orthopedic surgeons reposition your
• Gallbladder bone pieces during surgery, so they are back in their proper
• Spleen alignment. In a closed reduction, a healthcare provider
• Pancreas physically moves the bones back into place without
• Kidneys surgically exposing the bone.
• Stomach Internal fixation refers to the method of physically
• Small intestine (small bowel) reconnecting the bones. This might involve special
• Large intestine (colon or large bowel) screws, plates, rods, wires, or nails that the surgeon
• Appendix places inside the bones to fix them in the correct place.
• Ovaries, fallopian tubes, and uterus (in women) This prevents the bones from healing abnormally. The
• Lymph nodes entire operation usually takes place while you are asleep
under general anesthesia.
THYROIDECTOMY
Most people do very well with ORIF for their ankle
Thyroidectomy is surgical removal of all or part of the
fracture. However, some rare complications do
thyroid gland, which is located in the front of the neck. The
occasionally happen. Possible complications include:
thyroid gland releases thyroid hormone, which controls
many critical functions of the body. • Infection
• Bleeding
Why might I need a thyroidectomy?
• Nerve damage
A thyroidectomy may be appropriate for people who have • Skin complications
a thyroid tumor, thyroid nodules or hyperthyroidism, which • Blood clotsFat embolism
occurs when the thyroid gland produces too much thyroid • Bone misalignment
hormone. • Irritation of the overlying tissue from the hardware
Hyperthyroidism can be the result of an autoimmune • There is also a risk that the fracture won’t heal
problem, too much iodine in the diet, a benign tumor in the properly, and you’ll need to repeat the surgery.
pituitary gland, too much thyroid medication, a swelling
(goiter) in the thyroid gland or an inflammatory process.
LAYERS OF THE ABDOMEN

What are the risks of thyroidectomy?

• Voice changes, such as hoarseness

• Sore throat
• Bleeding and blood clots
• Adhesions or scar tissue that require another
surgery
• Injury to the esophagus or trachea (windpipe)
 ➢ Assisting in positioning the patient on the
TOTAL ABDOMINAL HYSTERECTOMY WITH A operating table and preparing them for surgery.
BILATERAL SALPINGO-OOPHORECTOMY ➢ Collaborating with the surgical team to maintain a
sterile environment and ensure proper aseptic
Hysterectomy is a surgery to remove the uterus techniques are followed.
and cervix. “Abdominal” is the surgical technique that will ➢ Monitoring the patient's vital signs, anesthesia
be used. This means the surgery will be done through an administration, and surgical progress throughout
incision in your abdomen. A bilateral salpingo- the procedure.
oophorectomy is surgery to remove both of your ovaries ➢ Anticipating and addressing any intraoperative
and fallopian tubes. The hysterectomy and bilateral complications or emergencies that may arise.
salpingo-oophorectomy will both be done during one
procedure. This surgery will remove the uterus, cervix, 3. Postoperative Phase:
ovaries, and fallopian tubes. After a hysterectomy you will
no longer have periods or be able to become pregnant. The postoperative phase begins when the patient
arrives in the PACU and continues until they are
What are the risks? discharged from the recovery area. Perioperative nurses in
This procedure has a small risk of: this phase focus on:

• Bleeding during surgery, which may require a ➢ Monitoring the patient's vital signs, level of
blood transfusion. consciousness, pain, and surgical site for signs of
complications.
• Infection of the bladder or surgical site
➢ Providing postoperative care, including wound
• Damage to surrounding organs (bladder, bowel,
care, pain management, and promoting early
and ureters)
ambulation and respiratory function.
• Possible need for further surgery
➢ Educating patients and their families on
postoperative instructions, potential
BASIC OF PERIOPERATIVE NURSING complications, and self-care measures.
➢ Collaborating with the healthcare team to ensure
Perioperative nursing is a specialized nursing field
a smooth transition to the postoperative unit or
that focuses on providing care to patients before, during,
home care setting.
and after surgical procedures. Perioperative nurses play a
crucial role in ensuring the safety, comfort, and well-being In addition to these phases, perioperative nurses also
of patients throughout the surgical experience. Let's delve play a crucial role in advocating for patient safety,
into the basics of perioperative nursing to help you promoting infection control practices, and maintaining
understand this essential aspect of nursing practice. effective communication among members of the
healthcare team. They must possess strong critical
1. Preoperative Phase:
thinking skills, attention to detail, and the ability to work
The preoperative phase begins when the decision for under pressure in dynamic surgical environments.
surgery is made and continues until the patient is
By understanding the basics of perioperative nursing
transferred to the operating room. During this phase,
and the essential role that perioperative nurses play in
perioperative nurses are responsible for:
each phase of the surgical experience, you can appreciate
➢ Conducting preoperative assessments to gather the comprehensive care provided to patients undergoing
relevant patient information, including medical surgical procedures.
history, allergies, medications, and vital signs.
➢ Educating patients about the surgical procedure,
anesthesia options, postoperative care, and
potential risks and complications.
➢ Collaborating with the healthcare team to ensure
that the patient is physically and emotionally
prepared for surgery.
➢ Administering preoperative medications as
prescribed and ensuring that the patient follows
fasting guidelines.

2. Intraoperative Phase:

The intraoperative phase encompasses the time

when the patient enters the operating room until they are
transferred to the post-anesthesia care unit (PACU).
Perioperative nurses in this phase are responsible for: