Abstract | Carski rez naziv je za operativni zahvat za operativno porađanje djeteta rezom trbušne i maternične stijenke. Prema Svjetskoj zdravstvenoj organizaciji, sve veći broj „nepotrebnih“ carskih rezova globalni je problem u svim državama svijeta. S obzirom na razvijenost država, posljedice i rizici carskih rezova razlikuju se ovisno o ljudskim i ekonomskim mogućnostima njegova izvođenja. Carski rez povezuje se s kratkotrajnim i dugoročnim rizicima koji utječu na zdravlje žene, djeteta i sljedeće trudnoće. Najčešći rizici operativnog dovršenja poroda carskim rezom su masivna krvarenja s posljedičnom potrebom za transfuzijom krvi, komplikacije anestezije, ozljeda organa, infekcije, tromboembolija i postoperativni ileus zbog adhezija. Osim tih ranih komplikacija, postoje dokazi o dugoročnim posljedicama carskog reza kao što su komplikacije kod sljedećih trudnoća i ponavljanje carskih rezova i svake druge operacije u trbušnoj šupljini zbog postoperativnih priraslica te nastanka kronične postoperativne bolnosti u području laparotomijskog reza. U radu je opisana povijest carskog reza, tehnike koje su se koristile, njihove dobre i loše strane, uspoređene su najznačajnije tehnike današnjeg izvođenja carskog reza te anesteziološka obrada prije zahvata. Medicinska sestra za rodilju važna je od samog prijema na odjel rodilišta. Pri prvom intervjuu medicinska sestra ispunjava sestrinsku listu, objašnjava rodilji plan i program boravka u bolnici, uzima obiteljsku i osobnu anamnezu, uzima podatke vezane uz obrasce M. Gordon za daljnje planiranje zdravstvene skrbi i procesa zdravstvene njege za vrijeme boravka rodilje na odjelu. Medicinska sestra također provodi fizikalni pregled i uzima antropometrijska mjerenja. Nakon smještaja rodilje u sobu i davanja vremena za raspremanje i prilagodbu, ukoliko je elektivan zahvat i situacija to dopušta, medicinska sestra dolazi uzorkovati krv za potrebne transfuzijske i biokemijske pretrage te postavlja venski put. Sestra daje upute i obavještava pacijenticu o potrebnoj pripremi za operativni zahvat dan ranije te neposrednoj pripremi. Tu je važna dokumentacija i suglasnosti koje medicinska sestra daje na potpis: suglasnost za carski rez, suglasnost za medicinske postupke i zahvate, suglasnost za primanje anestezije. Medicinska sestra za vrijeme operativnog zahvata priprema rodilje, priprema i kontrolira operacijsku salu, pomaže liječniku koji izvodi zahvat te sudjeluje u pripremi za prihvat novorođenčeta na svijet. Nakon operativnog zahvata, medicinska sestra skrbi o pacijentici u sobi za oporavak, pomaže oko prelaska na odjel, sudjeluje u upoznavanju majke i djeteta i stvaranju kontakta između majke i djeteta, pomaže rodilji u obavljanju osnovnih ljudskih potreba, podiže je na noge te je zadužena za brigu o prehrani, eliminaciji i nadoknadi tekućina. Medicinska sestra će također educirati rodilje o osobnoj higijeni, dojenju, normalnim poteškoćama i problemima u početnom stadiju babinja te prepoznavanju znakova i simptoma komplikacija i njihovu sprečavanju. Nakon carskog reza, ukoliko zdravstveno stanje majke i djeteta to dopušta, rodilja se otpušta s odjela treći dan postpartalno. Pri otpustu, medicinska sestra daje upute o skrbi rodilje za novorođenče te o brizi za sebe. |
Abstract (english) | Caesarean section (C-section) is the name of the surgical procedure for the delivery of a child through an incision in the abdominal and uterine wall. According to the World Health Organization, an increasing number of "unnecessary" C-sections are a global problem in countries all over the world. Depending on the development of the country, the consequences and risks of C-sections differ depending on the human and economic resources in performing the surgery. The Csection is linked to short-term and long-term risks that affect women's health, the child and later pregnancies. The most common risks of surgical completion of childbirth are massive bleeding resulting in a need for a blood transfusion, complications of anesthesia, injury to organs, infections, thromboembolism and postoperative ileus due to adhesions. In addition to the aforementioned early complications, there is evidence of long-term consequences of the C-section such as complications in later pregnancies and the repetition of the C-section and every other surgery in the abdominal cavity due to postoperative flares and the emergence of chronic postoperative pain in the laparotomic cut area. Furthermore, the paper will describe the history of the C-section, the techniques used through-out history, their good and bad aspects, with a comparison of the most important techniques of today's execution of the C-section and anesthesiological processing before the procedure. The role of the maternal nurse is important right from the admission to the maternity ward. At the first interview, the nurse fills out the nurse's form, explains the maternal plan and the hospital stay program, takes family and personal history, as well as data related to the forms of M. Gordon for further health care planning and health care procedures during the stay on the ward. The nurse also conducts a physical examination and takes anthropometric measurements. After placing the mother in the room and giving her time to unpack and adjust, if it is an electoral procedure and the situation allows, the nurse comes to sample blood for the necessary transfusion and biochemical tests and sets up the intravenous cannulation. Also, the nurse provides instructions and notifies the patient of the necessary preparation for the surgical procedure for the day before and immediate preparation. At this time, documentation and consents, that the nurse gives the patient to sign, are important, and they are: consent for the C-section, consent for medical procedures and operations, and approval for receiving anesthesia. The nurse also has their role during the surgical procedure, and it is prepping the patient, prepping and checking of the operating room, assisting the physician performing the procedure and preparing for the acceptance of the newborn to the world. After the surgical procedure, the nurse takes care of the patient in the "Recovery Room", helps move the patient to the ward, participates in introducing the mother and the child, creating contact between mother and child, helps the mother in carrying out basic human needs, helps her to her feet, they are responsible for taking care of nutrition, elimination and compensation of liquids. They have a major role in educating the mother about personal hygiene, breastfeeding, normal difficulties and problems in the initial stage of puerperium, and recognizing signs and symptoms of complications and preventing them. After the C-section, if the health of the mother and the child allow it, they are released from the maternity ward 3 days postpartum. When releasing, the nurse gives instructions on the care of a newborn and care for the mother herself. |