Expediency of Surgical Procedure - Literature review Example

Running head: SURGICAL PROCEDURE (CAESARIAN SECTION) SURGICAL PROCEDURE (CAESARIAN SECTION) Name Institution Date Introduction Cesarean section, also known as c-section can be defined as a surgical procedure in which one or more surgical incisions are made through a woman’s uterine wall and abdominal wall to deliver her baby, or, uncommonly, to remove a dead fetus. This surgical procedure is normally carried out whenever unusual conditions complicate labour and vaginal delivery, putting at risk the life or health of the mother or her little one. According to Robson et.al, (2009), a survey carried out by the Australian Institute of Health and Welfare National Pre-natal Statistics Unit, indicates that more than 30% of all births in Australia are carried out through caesarean section. This particular paper will therefore evaluate the cesarean section as a surgical procedure. The scope of the analysis will be grounded on highlighting the pathophysiology related to the cesarean section procedure, the pre-opearative preparation relevant to the cesarean section, the pre-operative procedure and finally the post-operative phase related to this surgical process. Relevant pathophysiology related to Cesarean section procedure Pathophysiology simply deals with either the bodily function changes that result in an illness or the bodily function changes that the illness brings about. A common problem for which a caesarean section is suggested is health issues in the mother. One relevant and common pathophysiology related to caesarean section procedure is difficult childbirth caused by non-progressive labour (dystocia).This is normally caused by conditions such as abnormalities in the fetus position, abnormalities in the mother’s birth canal or abnormalities in the labour, including infrequent or weak contractions. The mother’s pelvic structure may therefore not allow enough passage for delivery. Another most common reason for which a caesarean is carried out (in 35% of all cases) is if the woman has had a past caesarean section. The resulting scar after the procedure is normally weak and has a risk of rupturing during subsequent deliveries. Initially the uterine incision was made vertically; however, it is currently made horizontally across the lower end of the uterus resulting in reduced blood loss as well as a decreased chance of rupture (Rivlin, 2011). According to (Rivlin, 2011), another relevant and common pathophysiology related to caesarean section procedure, and which is about 12 percent of c-sections are carried out to deliver a baby in a breech presentation (feet or buttocks first).This is found in approximately 3% of all births. Rivlin, (2011) highlights that in 9% of all relevant pathophysiology related to Cesarean section procedure is normally carried out in reaction to fetal distress. This refers to any situation that can threaten the baby such as the umbilical cord being wrapped around the neck of the baby. This situation may show on the fetal heart monitor as an unusual heart rhythm. Fetal distress is often linked to abnormalities in the fetus position or abnormalities within the birth canal, resulting in reduced blood flow through the placenta. Other remaining and relevant pathophysiology related to Cesarean section procedure is indicated by other grave factors. One of the grave factors is the prolapse of the umbilical cord. The cord is normally pushed into the vagina ahead of the baby and becomes compressed, interrupting blood flow to the unborn child. Another is placenta abruption. In this case, the placenta detaches from the uterine wall before the little one is born, interrupting blood flow to the baby. The risk associated with placenta abruption is normally high in cases of multiple births. Another factor is placenta previa in which the placenta covers up the cervix partly or completely making vaginal birth impossible (Williams & Pastorek, 1995). In terms of pathophysiology that can be brought about by a cesarean section procedure, especially with certain high risk patient populations, endomyometritis, having a prevalence rate of 5 to 85 per cent is the most common. It can be described as the swelling of the endometrial lining of the uterus. The infection is normally brought about by bacteria found in the cervicovaginal tract that are inoculated into the uterus during labour and delivery (Rivlin, 2011). According to Williams & Pastorek (1995), both aerobes and anaerobes are believed to be involved in the infection process. A related problem is bacteremia which has an average prevalence rate of 10% while less common complications include thrombophlebitis, pelvic abscess and Septic Shock. Pre-opearative Preparation relevant to Cesarean Section Procedure According to Shorten et.al, (2009), patients who are carefully prepared for a surgical operation, psychologically and physically go through less anxiety and are likely to achieve an eventful recovery. In the pre-opearative preparation relevant to Cesarean section procedure, the patient’s nothing by mouth status, medical and surgical history, present medication, nutrition state, allergies, symptoms of infection, physical handicaps and elimination behaviours are recorded. The patient’s awareness of the operative, pre-operative and post-operative procedures; the ability of the patient to express anxieties; and the family’s awareness of the planned surgery are thereafter made certain and education provided. The accuracy of the patient’s signed and informed approval is confirmed, requests in the physician’s pre-operative orders are observed, and the identification bands as well as the blood type of the patient checked. Vital symptoms are recorded, and any anomalies of the laboratory tests, chest x-ray or the electrogram are reported to the anesthesiologist and surgeon. If required, the amount of matched blood units required to be seized for a possible blood transfusion is established. If ordered, an enema is provided, a bowel preparation is completed, a nasogastric tube is inserted and parental fluids administered. If pre-operative sedation is given out, the bed’s side rails are raised (Shorten et.al, 2009). Prior to transfer to the operating room with a completed chart, the patient’s voids, contact lenses, jewelry and other valuables are taken away for safekeeping. The nurse then carries out and explains the pre-operative procedures; offers instructions and emotional support; offers response to the patient’s question as honestly as possible, avoiding cliches in responding to any fear; and assures the patient that medication will be made available to alleviate post-operative pain. Depending on the surgical process, the nurse demonstrates to the patient how to cough, turn, breathe deep and support incision during coughing. Instructions on exercises involving legs are also given. The nurse then informs the patient and the patient’s family regarding the post-operative period in the post-anesthesia care unit or the intensive care unit, if specified (Shorten et.al, 2009). Pre-operative procedure in Caesarean Section According to Alison (2006), delivery of a baby through cesarean section can be carried out as a planned (elective) or as an urgent situation procedure. This procedure normally takes less than one hour to carry out. Firstly, a catheter is inserted in the bladder to collect urine before the operation is started. An intravenous line is then inserted in a vein in either the arm or hand. Monitoring of the heart and blood pressure then follows. Once through with monitoring, anesthesia is performed. In majority cases, regional anesthesia is provided, either in the form of epidural anesthesia or spinal block. With anesthesia, the lower part of the patient’s body will have no sensation but the patient will be wide awake throughout the operation. In some cases however, general anesthesia may be given. In this case, the patient will be unconscious throughout the operation. Anesthesia is then followed by the antibacterial washing of the patient’s abdomen as well as partial cutting of hair in the pubic area. After the cleaning of the abdomen with antiseptics and dressing the area, the surgeon gives either of the two types of skin incisions for a c-section (vertical or midline (most common)).Following the incision of the abdomen, the rectus covering is reached and opened, and rectus muscles separated in the midleline through sharp and blunt dissection. After that, the peritoneum is identified (Alison, 2006). The bladder fold of the peritoneum is then picked up and a transverse incision given on it. Using finger dissection, the bladder is detached from the front (anterior aspect) of the uterus and held away in order to stop any injury. A transverse incision, approximately 2 cm long, is made through the front (anterior) uterine wall, and which is then extended in a crescent-shaped manner. The baby is then disengaged and cord clamping and cutting done. In majority cases, the newborn is delivered by means of lifting up using the hand. If the delivery becomes difficult, either one or both blades of forceps are applied to help deliver the baby. After the delivery of the placenta, the uterine incision is repaired in 1 or 2 layers with the chromic catgut or the absorbable synthetic suture. The abdomen is thereafter closed in layers. The oxytocin hormone is then after the baby’s birth to make the uterus contract as well as control bleeding. Antibiotics are then given to prevent any infection. The patient is later on removed to the recovery room and if the baby is able s/he can go with the patient (Alison, 2006). Post-operative Phase until time of Discharge of the Cesarean Section Post-operative care is usually carried out to ease the patient’s recovery from surgery (Weis, 2011).It involves assessment, diagnosis, planning, intervention, and outcome evaluation of the patient. The patient is moved to the Postanesthesia Care Unit after the surgical process. The amount of time spent at the PACU is dependent on the type of surgery, length of surgery, status of regional anesthesia and the patient’s level of consciousness. Some patients are however transferred directly to the Intensive Care Unit. For example, patients who have had coronary artery bypass grafting are taken directly to the Intensive Care Unit (Smykowski & Rodriguez, 2003). In the Postanesthesia Care Unit the nurse anesthetist reports on the condition of the patient, type of surgery carried out, type of anesthesia given, estimated blood loss, and total input and output of urine during surgery. The PACU nurse ought to be made aware of any kind of complications during the process of surgery; including variations in blood circulation (hemodynamic).Other post-operative complications the patient may encounter owing to a wide variety of factors includes atelectasis, hypovolemic shock, dehiscence of the incision, hemorrhage, and thrombophlebitis. The patient’s assessment of airway patency, vital signs, and the level of consciousness is normally the first priorities once a patient is admitted to the PACU (Smykowski & Rodriguez, 2003). Other assessment categories include: proper opening of drainage tubes body temperature (hyperthermia) rate of intravenous fluids circulation/sensation in extremities after orthopedic or vascular surgery pain status nausea/vomiting level of sensation after anesthesia A patient is discharged from the Postanesthesia Care Unit when he/she meets the set discharge criteria as determined by a scale. After the transfer from the PACU, the nurse taking over her care assesses the patient again. According to the American Medical Association & HighWire Press (2011), the expected amount of recovery time varies and is typically about 2 weeks to a 7 months period. Patients acquire a lot of post-operative care information; as a result, they are normally offered pain medication in readiness for any procedure that may cause discomfort. Patients may be given educational materials such as video tapes, handouts, so that they may have a clear understanding of what to anticipate postoperatively. Scottish Intercollegiate Guidelines Network (1999), argue that a post-operative assessment ought to be performed when the patient comes from the theatre and patients at risk be frequently assessed in order to determine projected post-operative complications. Brookside Associates (2007) highlight that; the main goal of the Post-operative phase until discharge is to make sure that patients have good outcomes after surgical procedures. Smykowski and Rodriguez (2003) highlights that it is common for mothers who go through the procedure to develop psychological problems such as depression , less early attachment to the baby, poor early reaction to the baby and psychological trauma. Smykowski & Rodriguez (2003) propose that one of the psychosocial care that can be provided to the mother is group counseling. This involves the mother getting enrolled to a group counseling session with other mothers, who have undergone the same procedure. Such interactive therapy sessions will assist the mother to overcome psychological problems associated to the Cesarean sections. In addition the counseling groups provide materials for educative purposes such as books that may assist the mother overcome the psychological problems and other related complications. Conclusion Cesarean sections have presently become significant in the delivery of babies in cases of abnormal conditions that complicate labour and vaginal delivery. Such surgical interventions, however, may alter the physical appearance as well as the normal physiological functions, as a result, threatening a patient’s psychological security. Awareness of the patient’s needs is therefore vital as this helps in establishing interventions that supports his strengths as well as effective coping skills. References Alison, D. (2006). Cesarean Section Complications, Procedure, Recovery, Time, Retrieved on August 23, 2011 from http://www.healthhype.com/cesarean-section-complications-procedure-video-recovery-time.html American Medical Association & HighWire Press. (2011).JAMA: The Journal of the American Medical Association, Volume 112, American Medical Association. Brookside Associates. (2007).Postoperative Patient Care, Brookside Associates Ltd. Robson, S.J, Tan, W.S, Adeyemi, A & Dear, K.B. (2009).Estimating the Rate of Cesarean Section by Maternal Request: Anonymous Survey of Obstetricians in Australia. The Medical Journal of Australia, 36(3):208-12. Rivlin, M.E. (2011).Endometritis, Retrieved on August 23, 2011 from http://emedicine.medscape.com/article/254169-overview Scottish Intercollegiate Guidelines Network. (1999).Postoperative Management in Adults. Smykowski, L & W. Rodriguez. (2003). "The Post Anesthesia Care Unit Experience: A Family-centered Approach." Journal of Nursing Care Quality 18, no. (1) 5-15. Shorten G, Dierdof, S.F & Iohom, G. (2009) .Case-Based Anesthesia: Clinical Learning Guides, Lippincott Williams & Wilkins. Williams, K.L & Pastorek, J.G. (1995).Postpartum Endomyometritis, Hindawi Publishing Corporation, Retrieved on August 23, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2366154/ Weis, R.E. (2011).C-Section Recovery: How is the C-section Recovery? Read More