Postoperative Management after Cesarean Section

I. Post Cesarean Section Orders

A. Transfer: to post partum ward when stable.

C. Activity: Bed rest x 6-8 hours, then ambulate; if given spinal, keep patient flat on back x 8h. Incentive spirometer q1h while awake.

D. Diet: NPO x 8h, then sips of water. Advance to clear liquids, then to regular diet as tolerated.

E. IV Fluids: IV D5 LR or D5 / NS at 125 cc/h. Foley to gravity; discontinue after 12 hours. I and O catheterize prn.

F. Medications

1. Cefazolin (Ancef) 1 gm IVPB x one dose at time of cesarean section.

2. Nalbuphine (Nubain) 5 to 10 mg SC or IV q2-3h OR

3. Meperidine (Demerol) 50-75 mg IM q3-4h prn pain.

4. Hydroxyzine (Vistaril) 25-50 mg IM q3-4h prn nausea.

5. Prochlorperazine (Compazine) 10 mg IV q4-6h prn nausea OR

6. Promethazine (Phenergan) 25-50 mg IV q3-4h prn nausea

II. Postoperative Day #1

A. Assess pain, lungs, cardiac status, fundal height, lochia, passing of flatus, bowel movement, distension, tenderness, bowel sounds, incision.

B. Discontinue IV when taking adequate PO fluids.

C. Discontinue Foley, and I and O catheterize prn.

D. Ambulate tid with assistance; incentive spirometer q1h while awake.

E. Check hematocrit, hemoglobin, Rh, and rubella status.

F. Medications

1. Acetaminophen/codeine (Tylenol #3) 1-2 PO q4-6h prn pain OR

2. Oxycodone/acetaminophen (Percocet) 1 tab q6h prn pain.

3. FeSO4 325 mg PO bid-tid.

4. Multivitamin PO qd, Colace 100 mg PO bid. Mylicon 80 mg PO qid prn bloating.

III. Postoperative Day #2

A. If passing gas and/or bowel movement, advance to regular diet.

B. Laxatives: Dulcolax supp prn or Milk of magnesia 30 cc PO tid prn. Mylicon 80 mg PO qid prn bloating.

IV. Postoperative Day #3

A. If transverse incision, remove staples and place steri-strips on day 3. If a vertical incision, remove staples on post op day 5.

B. Discharge home on appropriate medications; follow up in 2 and 6 weeks.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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