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Uterine Rupture Nursing Management

Note

Uterine separation in the inferior uterine part.

Description
  1. Uterine separation is bursting of the uterus, either consummate (i.e., separation extends through full uterine mole and uterine fluctuation throw-off into the abdominal indentation) or inconsummate (ie, separation extends through the endometrium and myometrium, but the peritoneum excluded the uterus offscourings pure).
  2. Small shatters may be asymptomatic and may cure freely, fostering undetected until the force and purify of a succeedingcited drudge.
Etiology
  1. Traumatic uterine separation may be actiond by waste from obstetric instruments, such as uterine probe or curette used in abortion.
  2. Rupture so may product from obstetric mediation, such as overmuch fundal exigency, forceps introduction, raging submit-toing-down, agitate drudge, and fetal shoulder dystocia.
  3. Spontaneous uterine separation is most slight to arise succeedingcited prior uterine surgery, majestic multiparity totally delay the use of oxytocic agents, cephalopelvic dissimilarity, malpresentation, or hydrocephalus.
Pathophysiology
  1. The most base pathologic rudiment is a pre-existing scar that products in a waveringened or faulty myometrium that does not stretch; this is most frequently authorized in self-originated uterine separation.
  2. Some episodes of separation are due to traumatic hostility of the uterine exterior.
  3. More rigorous separations puzzle the abandon of irreversible tender hypovolemic surprise or succeedingcited peritonitis, accruing fetal anoxia, and fetal or neonatal termination.
Assessment Findings
  • Clinical manifestations dissimilate from tender to rigorous, depending on the residence and size of the separation, amount of extraction of the uterine fluctuation, and intraperitoneal sign or nonproduction of throw-offed amniotic running and rank.
  1. Abdominal trouble
  2. Vaginal bleeding (may be exhibit but is not uniformly)
  3. Nonreassuring fetal core exemplar
  4. Palpation of fetal accommodation underneathneath the skin
  5. Signs of hypovolemic surprise (delay consummate uterine separation)
Nursing Management
1. Monitor for the possibility of uterine separation.
  • In the intercourse of predisposing rudiments, adviser tender drudge exemplar air-tight for hypertonicity or signs of waveringening uterine muscle.
  • Recognize signs of hovering separation, instantly warn the physician, and circumvent for prop.
2. Assist delay accelerated mediation.
  • If the client has signs of enjoyly uterine separation, vaginal introduction is generally not violateed.
  • If symptoms are not rigorous, an strait cesarean introduction may be violateed and the uterine shatter repaired.
  • If symptoms are rigorous, strait laparotomy is done to violate direct introduction of the fetus and hen demonstrate homeostasis.
  • Implement the succeedingcited making-readys for surgery.
    • Monitor tender rank exigency, pulse, and respirations; so adviser fetal core tones.
    • If the client has a accessible venous exigency catheter in establish, adviser exigency to evaluate rank dropping and possessions of running and rank retrieval.
    • Insert a urinary catheter for ceremonious determinations of running redress.
    • Obtain rank to assess enjoyly acidosis.
    • Administer oxygen, and conduct a indisputable airway.
3. Prevent and husband complications. Take these steps in appoint to intercept or stipulation hypovolemic surprise:
  • Oxygenate by providing 8 to 10 L/min using a shut hide.
  • Restore circulating book using one or past IV lines.
  • Evaluate the action, tally to therapy, and fetal requisite.
  • Remedy the submit-toing by preparing the client for surgery and administering antibiotics.
4. Provide substantial and tender prop.
  • Provide prop for the client’s spouse and nobility members once surgery has begun.
  • Inform the spouse and nobility how they get entertain counsel environing the dowager and newborn and wnear to hold.

Exam

Choose the communication of the set-just solution. Good luck!
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Congratulations - you accept consummated Uterine Separation Practice Exam (PM)*. You accountd %%SCORE%% out of %%TOTAL%%. Your execution has been rated as %%RATING%%
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