Labor & Delivery Procedures
25. Report any abnormalities observed to physician
Talk with the client as the examiner begins to insert speculum.
Inform the client that a stretching sensation may be felt speculum is introduced.
Remains at examiner‟s side as cervix is inspected.
Procedure (2): Checklist: Vaginal Irrigation or Vaginal Douche Student„s name: ID#
Group# Date
No. Steps 2 1 0
1. 1-Define the procedure:
Is introduction of a solution into the vagina at a low pressure.
2. 2. Identify the objectives:
To clean the vagina from discharge preoperatively.
To apply an antiseptic solution if infection is present.
To reduce bad odor.
To relive inflamed vaginal mucosa.
To apply heat or medication to the vaginal mucosa and cervix.
To readjust the vaginal P.H.
To wash out the seminal fluid and sperms.
3. - Separate the labia and insert the douche into the vagina down ward and backward.
4. - Open the clamp and rotate gently the douche tip
5. - Clamp off tubing after solution is finished and removes the douche tip and place it in kidney basin.
6. - Ask patient to sit upright on bedpan.
7. - Remove equipment from bed.
8. - Dry the vulva and anal region.
9. - Inspect the returned solution.
10. - Record type of solution used, amount of solution returned, and time of procedure.
11. - Wash hands.
- Total Mark Legend:
2: done correctly and knows rationale Evaluated by: Dr...
1: done correctly but don’t know rationale 0: not done
Procedure (3): chick list: insertion of vaginal suppositories Student„s name: ID#
Group# Date
No. steps 2 1 0
1 Define the procedure:
Insertion of vaginal suppositories is a topical application of anti-infective agents required for female clients with vaginal infections.
2 Review pertinent information.
3 Assess condition of external genitalia and vaginal canal.
4 Review client‟s knowledge of suppository.
5 Identify client and suppository correctly.
6 Explain procedure to client.
7 Wash hands and arrange equipment at bedside.
8 Close room curtain or door.
9 Assist client to dorsal recumbent position.
10 Drape abdomen and lower extremities.
11 Wear disposable gloves.
12 Adjust light over vaginal orifice.
13 Use proper procedure for inserting suppository.
14 Remove gloves properly and discard them.
15 Instruct client to lie on her back for at least 10 minutes.
16 If applicator is used, wash it with soap and water rinse and store.
17 Offer client perineal care.
18 Dispose of soiled supplies and equipment.
19 Inspect condition of vaginal canal and external genitalia.
20 Evaluate client for symptoms of vaginal inflammation.
21 Evaluate client understanding about steps of suppository insertion.
22 Identify unexpected outcomes.
23 Record suppository‟s name, dosage, route and time of insertion.
24 Record condition of vaginal canal and external genitalia.
25 Report any unusual findings to physician.
Total Mark legend:
2: done correctly and knows rationale Evaluated By: Dr. --- --- 1: done correctly but don‟t know rationale
0: not done
Procedure (4):Pre-operative care of the gynecologic patient Student„s name: ID#
Group# Date:
No. steps 2 1 0
1. Define the procedure: It is the nursing care given to the patient before undergoing abdominal or vaginal surgery.
2. Identify the Objectives:
- Keep patient in good physical and mental condition and increase patient‟s satisfaction.
- To prevent infection.
- To avoid complication.
3. I. The day before operation:
1. Interview the patient and take complete history and informed consent.
2. Prepare the patient for physical examination:
Explain the procedure.
A- Assist her to undress and wear examination gown.
B- Ensure that the patient is clean, the room is comfortable, quiet and screen the bed.
C- Collect equipment needed for physical examination and provide adequate light.
D- Medications and treatment should be given as ordered.
E- For examination of the breast and abdomen, the patient lies in dorsal recumbent position, with knees slightly flexed.
F=Drape the patient by placing a towel over the chest and a sheet on the rest of the body.
4.
Prepare the patient for gynecologic examination.
A- Ask her to empty the bladder and save specimen of
B-Give an enema.
C- Place the patient in proper position for vaginal examination.
D- Drape the patient.
E- Reassure the patient.
F-Collect all equipment, focus light and prepare medications.
G- Perform procedure as needed.
K- Label all specimen and slides and send to laboratory.
L- Check vital signs.
Explain procedure and treatment as you work.
5. Give interest to patient.
6. Allow fluids until midnight and a light diet until the evening before operation.
7. Give pre-medications as ordered A sedative may be ordered at evening before operation to ensure a good night‟s sleep.
8. Carry out antiseptic vaginal irrigation once or twice as ordered. Give an enema as ordered at the evening before operation and sometimes the next morning.
9. - Perform skin preparation, which consists of shaving, scrubbing with sterile gauze and water and followed by alcohol scrub.
- Give perineal preparation and apply sterile perineal dressing.
- Give medicated vaginal tampons, suppositories or instillation as ordered.
10.
II. The day of operation :
- Empty the bladder and insert retention catheter as ordered.
11. Remove rings, jewelry and artificial dentures.
12. Assist the patient to wear surgical cap, socks and means of identification as a tap on her wrest, on which her name and
room number is printed.
13. Prepare the patient‟s bed and keep it warm until her return from the operating room. Prepare also equipment for IV fluid and retention catheter in patient‟s room
14. In the operating room :
A-Apply principles of asepsis; sterilize all materials which will come in contact with the wound either directly or indirectly.
B-For vaginal operation, drape the patient in lithotomy position.
C-give the pre- operative medications and reassurance.
D-Place the patient in lithotomy position for vaginal or perineal operation.
E-scrub the area of operation by soap and water then by antiseptic solution.
F-Perform catheterization, insert speculum or retractor and apply antiseptic solution before vaginal operation.
G-Replace wet linen with dry ones and put operator „stool and instrument table into place.
H-Handle various articles as ordered.
I-Keep apparatus for general or local anesthesia ready.
15. -Record all information about operation, name, of doctor and assistants,anesthesia,medications and treatment and patient‟codition.
Total marks:
Legend:
2: done correctly and knows rationale Evaluated by: Dr...
1: done correctly but don’t know rationale 0: not done
Procedure (5): Check list: Post-operative care of the gynecologic patient Student„s name: ID#
Group# Date
No. steps 2 1 0
1. Define the Procedure: It is the nursing care given to the gynecologic patient after undergoing abdominal or vaginal surgery
2. Identify bjective:
To prevent infection.
To avoid post-operative complications.
To facilitate coping with alteration in functions or structure.
To maintain body functions and promote rapid recovery 3. Carry out immediate post-operative orders.
I) Vital signs:
Record BP, pulse, respiratory rate every 15-30 minutes until patient is stable, 2 hourly thereafter for at least 4-6 hours and these measurements include oral temperature and then record them 4 times a day for the rest of post-operative course.
II)Wound care:
1. Watch for excessive bleeding (inspect abdominal dressing or perineal pads)
2. Determine the hematocrit the day after major surgery.
III) Medication:
1. After major surgery the following medications are given and may be helpful such as narcotics, non-steroids, anti-inflammatory and anti- emetics.
4. After minor operation, give mild analgesics as needed.
5. Give medication may be required by patient as it were taken before surgery (insulin, digitalis, cortisone)
6. IV) Position in bed:
1- Put unconscious patient on side, Keep an airway in place and observe
her constantly until she responds.
V) Drainage tubes:
1. Connect the urinary catheter to gravity drainage system.
VI) Intake and out put:
1. Start I.V fluid
2. Record intake and out put of all fluids as well as weight VII) Diet:
1. Following minor operation, offer food as desired when patient is fully awake.
2. Following major surgery, allow for patient only sips of tap water on the day of surgery and don‟t give ice water
3-Give clear liquids on first post-operative day if bowel sound is good.
VIII) Respiratory care:
1. Encourage deep breathing every one-hour for the first 12 hours and every 2-3 hours for the next 12 hours.
2. Provide incentive spirometery with assistance particularly for elderly obese or immobilized patient.
IX) Ambulation:
1. Encourage early ambulation on the day of operation after major surgery and encourage change of position every 3 hours.
7. X) Exercise:
Simple arm, leg and foot exercises are commenced on the first day after operation. Thereafter they are carried out daily and gradually
8. If urinary retention occurs, try the usual methods of inducing voiding. If failed do catheterization. Give care of retention catheter if it is used.
9. Measure and record fluid intake and output for several days pos- operatively.
10. If intestinal distension occurs, insert rectal tube or give carminative enema as ordered.
11. On the second day evening or third day morning, give small oil retention enema followed by tap water or normal saline, after that give laxative as ordered
12. Following vaginal hysterectomy, keep the patient in bed for 10 days. After cervical operations, keep her in bed for 4 days.
13. Following vaginal surgery, give perineal care and apply light treatment to the perineal sutures for one hour, 2-3 times daily, by using dry heat.
14. Use also ice bag or sterile warm moist packs for infected perineal suture.
15. - Elevate the head of the bed
16. XI) Observe for post-operative complications:
1. For post-operative hemorrhage, check pulse and blood pressure as the earliest indication. Keep the patient quiet by giving sedative as ordered, elevate the foot of the bed and provide external heat. Keep stimulants; IV solutions and blood transfusion ready as ordered.
17. If shock accompanies hemorrhage, elevate the foot o keep IV fluids and stimulants ready as ordered.
18. Observe for signs of shock such as rapid pulse, low blood pressure, pallor or sweating, apathy and loss of interest in the surroundings.
19. If vomiting is persistent or acute, gastric dilatation develops, continuous gastric suction may be needed.
20. Infection of incision may occur in the form of reddened and painful skin.
A warm moist antiseptic dressing or removal of some sutures may be helpful. Observe for signs of spread of infection (peritonitis) such as elevation of temperature, rapid pulse, persistent vomiting, and continuous abdominal pain with tenderness and rigidity. IV fluids, continues duodenal suction and antibiotics are given as ordered.
21. Observe signs of toxicity as nausea and vomiting, diarrhea and cyanosis, which may occur due to receiving large amount of sulfonamides. Report at once other complications as skin eruption, high fever, haematuria and jaundice. Daily urine analysis and white blood cells examination are carried out as patient receiving the drug to determine the presence of sulfonamide crystals in urine and development of hemolytic anemia, leuckopnia or agrranulocytosis.
22. Observe for signs of phlebitis as pain in the groin and upper part of thigh,
rise in temperature, swelling of foot and leg and tenderness. Put the patient in bed, elevate the affected leg and keep the patient quiet. Affected leg should not be moved, rubbed or massaged more than necessary. . Sedative is given if the pain is severe.
23. XII) Prepare the patient for discharge and final examination by the surgeon. Remove all drains and dress the wound.
24. XIII) Give specific instructions to the patient regarding care at home such as activity, douches, abdominal dressing, and menstrual period and return visit.
25. XIV) Record the following:
1. Vital signs in schedule as ordered and degree of consciousness.
2. Intake and output including urine and stool.
3. Medications and treatment given.
4. Analysis and procedures carried out and its results.
5. Signs of complications if present and care given.
6. Condition of the wound and its dressing.
7. Reaction of the patient and her psychological condition.
Health teaching and date of next visit.
26. Short and long term plan Total marks:
Legend: Evaluated By Dr.: --- 2: done correctly and knows rationale
1: done correctly but don‟t know rationale 0: not done