Management of the Inconspicuous Penis In

Home , Linen

AAMJ, Vol. 11, N. 2, April, 2013 ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ IDEAL NURSING CARE RELATIONSHEP BETWEEN ASSUIT UNIVERISTY HOSPITAL AND KING FAHD GIZAN HOSPITAL AMONG POST CESAREAN SECTION CARE Manal Farouk Moustafa , Sahar Nagieb Mohamed and Madiha Mohamed Tosson Obstetric and Gynecological Department - Faculty of Nursing Assuit University ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ABSTRACT Background: The care of the woman after a cesarean birth, is nurses responsibilities it is a combine aspects of surgical and maternity care. For this, the aim of this study was to assess the actual post Cesarean Section Care for women in Assuit University hospital& King Fahd hospital in Gizan and their relation to the ideal nursing care. Patients and Methods:A sample of 267 mothers ( 220 & 47 mothers from Assuit & Gizan respectively ) who inter for delivery unit in both hospital for CS. . Data were collected using observation check list. Results: The result showed that mean age for women was 27.80 ± 5.57, 28.3 ± 6.02 in Assuit & Gizan respectively. While (36.4 % & 34.02 %) from the sample was illiterate in Assuit & Gizan respectively but only( 7.3% & 8.5 ) of sample in Assuit & Gizan respectively had university education .Also found that the majority of the sample (86.4 % & 95.74 %) in Assuit & Gizan respectively as a house wife. For the causes of CS, It was found that ( 30.9 % & 31.9 %) of Assuit & Gizan respectively due to bleeding while ( 15.4% & 8.5 %) of Assuit & Gizan respectively due to pelvic disproportion .as regardes Measuring vital signs every 15,30 & every hour during 4 hours ,observe I& O chart , do exercise ( breathing , leg ) it was found that the care not done in both hospital Assuit & Gizan .As regard check fundal level & learn mother how to carry baby to initiate breast feeding it was found that done (100 %) in Gizan hospital only. As regard observe bleeding from vagina, check hardness of uterus, add some medication as doctor orders & encourage 160

Manal Farouk Moustafa et al ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ women for early ambulation it was found this care done accurate ( 100 % ) in both hospitals with mild statistical significant P = 0.04*. Conclusion: Finally the percentage of post CS. Care in Assuit university hospital was 52.9% and 41.1% in King Fahd hospital in Gizan .

INTRODUCTION

Cesarean section (C.S), is an abdominal operation or cut in the mother’s abdomen to deliver a baby when delivery through the birth canal ( vagina ) is not possible or safe ( Kathyrean , 2005) .Cesarean childbirth ,can be traced back through history to Egypt in 3000 B.C.,which in 715 B.C. mandated surgical removal of an unborn fetus Until recent decades the operation usually had been used as a last resort because of a high rate of maternal complications and death. But with the availability of antibiotics to fight infection and the development of modern surgical techniques, the once high maternal mortality rate has dropped dramatically . In Egypt the incidence of C.S. rate ranges from 12% to 15 % however , maternal mortality from C.S. is much higher in developing countries ( Frigoletto et al 2011).From 1970 to 1980, the number of cesareans in the U.S. more than tripled ,increasing from 5 percent of all births to 16.5 percent. In some localities the rate is much higher.( Flamm ,2008) According to the National Center for Health statistics (2004) , the rate is decreasing ; it was 22.7 percent for the 4.18 million live births in 1990.Cesarean section is now one of the most commonly performed operations in this country . In 1990, the operation was performed 949.000 times . The, rate of C.S in the United States ( USA) has reached a plateau and may be falling. Specifically , the rate of 23.8 percent in 1989 was not significantly different from the rates for the prior 3 years ( Taffel et al , 2003).

The decision to perform a C.S. section delivery can depend on the obstetrician , the delivery location, and the woman’s past deliveries or medical

161 AAMJ, Vol. 11, N. 2, April, 2013 ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ history .Some of the main reasons for C.S. instead of vaginal delivery include the following:

Fetal causes: developmental abnormalities of fetus such as hydrocephalus or spina bifida, abnormal fetal heart rate, abnormal position ,multiple babies., very large baby cephalopelvic disproportion and fetal distress( Rosen et - al 2011), ( Clarke and Taffel ,2006).

Maternal causes : like maternal illness ( heart disease , toxemia , pre- eclampsia or eclampsia ) Infection ( HIV) , genital herpes, previous surgery in the uterus problem with labour or delivery such as prolonged or arrested labor ( Kathryn and Laura , 2005 ), or problems related to the placenta or umbilical cord like cord prolapse, placenta previa or abruptio placenta ( Francome et al , 2008) and ( A.D.A.M 2002).

None -physical indications are less well documented but may include fear of vaginal delivery , fear of pelvic floor damage or previous bad experience of vaginal delivery ( Ryding ,2010) .Some women may feel that caesarean section is the best way to have baby .( Hemminki 2011).

The nurse’s role in the post - operative period ( immediate post operative care) start when the patient return to the nursing unit from the operation , until their condition are stable ( Donna et- al 2004). The postpartum care of patient after CS, requires not only attention to normal puerperal changes but also special attention to general issues of care after any major abdominal procedure ( Brown & Cromblholme 2003 , Dickason et al , 2003 & Donna et al 2004 ) . vital signs are taken frequently every 15 minutes , then every one hour , then every 4 hours until stability( Andolesk 2005 , Pillitteri2000&Ladewg et al 2008).. Atkinson et al 2009) stressed the importance of inspecting the dressing immediately after the

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Manal Farouk Moustafa et al ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ patient returns to the unit ,bed linen should be checked . Burunner et al 2009 stated that the nurse should cover the skin around the drains or tubes with sterile gauze to prevent infection , dressing should not be changed or reinforced unless there are specific orders. Castiglia and Harbin 2009 explained that wet dressing can increase the possibility of contamination ; clean & dry dressing increases the patients comfort . Miovech et al 2008 reported the importance of close observation of any dressing for the signs of drainage or hemorrhage and reinforcement or changing dressing as ordered by the physician .

Adequate fluid intake is important following surgery in order to replace blood loss from surgery & to maintain blood pressure a and renal function. Intravenous fluids must be monitored carefully to prevent giving it all too rapidly or too slowly. Keeping an accurate intake and out put records of all surgical patients for at least the first 48 hours helps to ascertain an adequate fluid balance ( Jones et al, 2007).The nurse is responsible for observing the patient while the infusion is in progress, Inspect I.V. infusion, Observe & record intake and out put accurately . Whaley and Wong ,(2000) reported that the nurse must give oral fluids to the women as soon as active peristalsis is present and can be tolerated , assess serum electrolyte values and report abnormal findings to the surgeon immediately.( Joyce and Esther,2006) .

Schwartz et al, 2000 also mentioned that the nurse should be trained to identify post operative pain & should ensure that the pain related to the surgical procedure. Lorna et al ( 2004) stated that nursing giving analgesic or sedative as ordered by the physician according to the type of surgery site and recording in chart .Medication may be administered orally by routine I.M. or routine I.V. Narcotics are usually given primarily during the first 24 to 72 hours after surgery to relieve pain. Adams 2002 mention that the nurse promote early ambulation for the women within 24 hours after surgery if vital signs are stable and the general condition is satisfactory. 163 AAMJ, Vol. 11, N. 2, April, 2013 ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ The aim of this study was to assess the actual post CS. Care for women’s in Assuit university hospital &King Fahed Gizan hospital and their relation to the ideal nursing care

SUBJECT AND METHODS

SEETTING:

The study was carried out at in delivery unit in Assuit university hospital in Assuit ( Egypt) and King Fahad hospital in Gizan ( Sudia Arabian ) during the period from 2010 to 2011

SAMPLE:

All sample 267,l 220 women’s inter for labour unit in Assuit university hospital for CS. (Egypt) in two months Dec. 2010.Jan.2011 and 47 women inter for labour unit, in King Fahd hospital in Gizan ( Sudia Arabian)in the same two months for CS. delivery

An observational check list it was used to assess the actual nursing care for post CS. women in Assuit university hospital &King Fahad in Gizan hospital . Data were collected statistical analysis was done

RESULT Table (1) illustrated the distribution of the sample according to their sociodemographic characteristics. Regarding age , it was observed that ( 29.09 % ) in Egyptian women’s her aged more than 36 years with mean age 27.80 ± ,while ( 27.65 % ) of Sudien women’s her aged ranged between 31 :35 years with mean age 28.3± 6.02 . As regarding educational level it was observed that the majority of the sample ( 36.4 % & ,34.02 % ) was illiterate in Assuit & Gizan respectively .While 164

Manal Farouk Moustafa et al ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ only ( 7.3% & 8.5% ) was university education in Assuit & Gizan respectively .Also it was found the majority of both sample ( 86.4 % & 95.74 %) was house wife in Assuit & Gizan respectively.

Table (2) showed that the distribution of the samples according to their causes of C.S. it was found that ( 30.9 %and 31.9%) related to bleeding in Assuit & Gizan respectively. Also found that ( 30.4% and 17.2 %) related to hypertensive causes in Assuit & Gizan respectively. While it was found that ( 15.4 % and 8.5 % related to pelvic disproportion ( face & breech presentation) in Assuit & Gizan respectively .And it was found only ( 14.8 %) of Gizan sample related to the cord prolapse causes. ..

Table ( 3) illustrate the comparison between the actual and ideal post operative care for C.S women’s in Assuit university hospital .It was observed that measures vital signs every 15, 30 , minutes and also every hours during first 4 hours not done . As regarding check bleeding from wound dressing & check fundal level, observe I& O chart and evaluate urinary catheter ,make urine analysis before remove catheter , do exercise and learn mother how to carry baby it was observed that care not done in Assuit university hospital. But for observed bleeding from the vagina ,check hardness of uterus, add some medication as doctor order , start oral feeding after 24 :48 hours, encourage women for early ambulation, assessment digestive system , observe first defecation, evaluate dressing every shift it was found that done ( 100 %) with statistically significant difference between ideal and actual care P value ( P = 0.01* ).

Table (4) ) illustrate the comparison between the actual and ideal post operative care for C.S women’s in King Fahd hospital( Gizan ). It was observed that measures vital signs every 15, 30 , minutes and also every hours during first 4 hours not done . As regarding observe I&O chart, evaluate urinary catheter, and 165 AAMJ, Vol. 11, N. 2, April, 2013 ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ urine analysis before remove catheter , start oral feeding after 24 :48 hours , give I.V infusion ,do exercise, observe first defecation & evaluate dressing every shift it was found that the care not done .While check bleeding from wound, observe bleeding from vagina , check fundal level ,check hardness of uterus, add some medication as doctor orders, encourage women’s for early ambulation, assessment digestive system, and learn mother how can carry baby done accurate (100 %) with mild statistical significant difference between ideal and actual care P value ( P= 0.001 **).

Table ( 5) show the comparison among ideal & actual post operative care in Assuit & Gizan hospital ,it was found that measuring vital signs every 15,30 minutes , every one hour , observe I & O chart do exercise ( breathing ,leg) not done in both hospital .As regard check bleeding from wound dressing, check fundal level & learn mother how to carry baby to initiate breast feeding it was found that done accurate (100%) in Gizan hospital & not done in Assuit hospital . With mild statistical significant P (P= 0.04*) between two hospital .As regard observe bleeding from the vagina, check hardness of uterus , add some medication as doctor orders ,and encourage women for early ambulation ,evaluate dressing every shift it was observed that done (100%) in both Assuit & Gizan hospital .

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Table (1): Sociodemographic characteristic between study sample in Assuit & Gizan

Assuit No =220 Gizan No = 47 Sociodemographic

characteristics No % No % 1-Age < 20 25 11.36 7 14.89 21- 25 31 14.09 7 14.89 26 – 30 58 26.36 11 23.40 31- 35 42 19.09 13 27.65 < 36 64 29.09 9 19.14 Mean + SD 27.80 ± 5.57 28.3± 6.02 2- Education level : - illiterate 80 36.4 13 34.02 - read & write 50 22.7 16 27.65 - secondary 74 33.6 14 29.78 - university 16 7.3% 4 8.5 3-occupation - house wife 190 86.4 % 45 95.74 - work 30 13.6 % 2 4.2

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Table ( 2) Causes of Cesareans Section

Assuit No =220 Gizan No = 47 causes No % No %

: Maternal causes

- bleeding 68 30.9 15 31.9

- hypertension 67 30.4 8 17.2

- diabetic 45 20.4 - -

- renal causes 2 0.9 7 14.8

2-pelvic disproportion 34 15.4 4 8.5 (face,breech presentation)

3- fetal causes

Twins - 4 1.8 6 12.7

- cord prolapse - - 7 14.8

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Table (3) The Actual and ideal post operative care for CS .women in Assuit university hospital

Assuit No =220 Items No % p- value 1-Measuring vital signs every 15 minute - -

2-Measuring vital signs every 30 minute - - P= 0. 01* significant 3- Measuring vital signs every hour during 4 hour - - 4- check bleeding from wound dressing - - 5- observe bleeding from the vagina 220 100 6- check fundal level - -

7- check hardness of uterus 220 100 8- add some medication as doctor orders 220 100 9- observe I & O chart for 48 hour ,evaluate - - urinary catheter & make urine analysis before remove catheter 10- start oral feeding after 24 -48 hours 220 100 11- give I. V infusion 220 100 12- do exercise ( breathing , leg ) - - 13-encourage women for early ambulation 220 100 14-Assessment digestive system by ask if she 220 100 flatus or not 15- Observe first defecation 220 100 16- Evaluate perineal pad every shift 220 100 17- learn motherr how can carry baby - -

169 AAMJ, Vol. 11, N. 2, April, 2013 ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Table (4) The Actual and ideal post operative care for CS .women & King Fahd hospital in Gizan

Gizan Items No = 47 p- value No % 1-Measuring vital signs every 15 minute - -

2-Measuring vital signs every 30 minute - - significantP= 0.001** mild 3- Measuring vital signs every hour during 4 - - hour 4- check bleeding from wound dressing 47 100 5- observe bleeding from the vagina 47 100 6- check fundal level 47 100 7- check hardness of uterus 47 100

8- add some medication as doctor orders 47 100 9- observe I & O chart for 48 hour ,evaluate - - urinary catheter & make urine analysis before remove catheter 1 0- start oral feeding after 24 -48 hours - - 11- give I. V infusion - - 12- do exercise ( breathing , leg ) - - 13-encourage women for early ambulation 47 100 14-Assessment digestive system by ask if 47 100 she flatus or not 15- Observe first defecation - - 16-Evaluate perineal pad every shift 47 100 17 - learn motherr how can carry baby 47 100

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Assuit Gizan P value Items No =220 47 No= No % No % 1-Measuring vital signs every 15 minute - - - - 2-Measuring vital signs every 30 minute - - - - 3- Measuring vital signs every hour during 4 - - - - hour 4- check bleeding from wound dressing - - 47 100 5- observe bleeding from the vagina 220 100 47 100 P= 6- check fundal level - - 47 100 0.04* 7- check hardness of uterus 220 100 47 100 8- add some medication as doctor orders 220 100 47 100 9- make I & O chart for 48 hour ,evaluate - - - - urinary catheter & make urine analysis before remove catheter 1 0- start oral feeding after 24 -48 hours 220 100 - - 11- give I V infusion 220 100 - - 12- do exercise ( breathing , leg ) - - - - 13-encourage women for early ambulation 220 100 47 100 14-Assessment digestive system by ask if she 220 100 - - flatus or not 15- Observe first deification 220 100 - - 16-Evaluate perineal pad every shift 220 100 47 100 17- learn motherr how can carry baby - - 47 100

171 AAMJ, Vol. 11, N. 2, April, 2013 ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ DISCUSSION

Women who deliver by Cesarean birth have an additional care concern in the immediate postpartum period ,because they are not postpartum clients but post surgical ones as well .(Adele pillitteri 2005).Nursing responsibilities combine aspects of surgical & maternity care (Tighe & Sweezy 2000).A nursing goal for patient who have undergone C.S, is to promote comfort & relieve pain . Post partum women need to be comfortable alert to parent, to their infants , assume self care & infant care. ( U.S. 2003)

The present study was done with the aim of assessing the actual care for post C.S. women in Assuit university hospital & King Fahed Gizan hospital & compromises with ideal nursing care .The findings of the present study in both hospital ( Assuit & Gizan ) revealed to many deficient in nursing care which provide care for post C.S. women .For the commonest medical indication for C.S. are prior C.S. fetal distress, dystocia & malpresentation ( Lorna et al 2004) .Other factors that may contribute to the high C.S. rate include non medical causes such as differences in physicians practice patterns difference in patient populations , economic incentives,mal practice tissues & hospital setting . In present study it was found the incidence of C.S. done due to antepartum hemorrhage was ( 30.9 % & 31.9 % ) respectively in Assuit & Gizan which is considered very high if compared with that recorded by Dunn (2010) ,which was 8,06 % , and for incidence of CS. due to hypertensive causes it was found that ( 30.4% & 17.2 % ) respectively in Assuit & Gizan which considered a higher than that recorded by Katharyn and Laura ( 2005) who recorded an incidence of 7.5 and 7.0 for cesarean section due to hypertensive causes.

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Manal Farouk Moustafa et al ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Regarding pelvic disproportion in the present study it was found that (15.4% and 8.5%) in Assuit & Gizan respectively which is considered high, in Assuit if compared with that recorded by Dunn ( 2010) which was 8.0% . while this incidence result is lower than that recorded by other studies of Soper (2001) which recorded an incidence of 22% for cephalopelvic disproportion .

Donna et al (2004) , Andolesk (2005) , perry (2ooo) & Ladewiget et al 2008 mention that when the patients return to the nursing unit from operation ,the nurse is responsible for noted their general condition .The vital signs, temperature, pulse, respiration and blood pressure are assessed and recorded until patients are responsive and alert. Vital signs are taken frequently every 15 minute then every one hour, then every hours during 4 hours until stability . This contradict with the result of the present study which observed not measuring vital signs every 15,30 minute & every hours during 4 hours in Assuit & Gizan hospital.

Findings of the present study showed that check bleeding from wound dressing done only in Gizan hospital ( 100%) .This agree with other studies ( Adele Pilliter 2005) which reported that dressing must be checked every 15 minutes for at least an hour . Castiglia & Harbin 2009 explained that wet dressing can increase the possibility of contamination, clean & dry dressing increases the patients comfort . Atkinson et al 2003 stressed on the importance of inspecting the dressings immediately after the patient returns to the unit, bed linen should be checked. Dressing should not be changed or reinforced unless these are specific orders. Miovech et al 2000 reported the importance of close observation of any dressing for the signs of drainage or hemorrhage & reinforcement or changing dressing as ordered by the physician . Walles et al ., 2002 mention that sasses the surgical incision once during each nursing shift to be certain that the wound edges are approximated and that no sign of infection such as erythema are present.

173 AAMJ, Vol. 11, N. 2, April, 2013 ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Regarding observe bleeding from the vagina , the present study revealed that care done (100 %) in both Assiut & Gizan hospital .This similar to (Adele Pillitteri 2005 & Sally 2008 which mentioned that the perineal pad must be observed for lochia every 15 minutes for at least an hour .

Concerning the check of fundal level the finding of the present study showed that done ( 100%) only in Saudia this similar with the study done by ( Katharyn 2005) which reported that it is very important to check & observe the level of the uterus and consistency every 15 minute.

As regarding check hardness of uterus the present study revealed that done accurate ( 100%) in both Gizan & Assuit hospital, this similar with study done by ( Sally 2008- 2010) & ( Adelle Pillitter 2005 ) which reported that the fundus should be gently palpated to determine whether r it is remaining firmness assess the remainder of the abdomen for softies, because a hard ( guarded) abdomen is one of the first signs of peritonitis , complication that may occur with any abdominal surgical procedure .The fundus may be palpated by placing a hand to support the incision.

Findings of the present study showed that add some medication as doctor order done accurately ( 100%) in both hospital Gizan & Assuit .This similar to the study done by( Adele Pillitter,2005), ( Elander et al 2009) which reported that nursing responsibility that help alleviate pain include comfort measures such as changing the patient’s position, straightening bed linen, giving oxytocin as doctor order such as ( pitocin) to be added to the first one or two liters of fluid following surgery to ensure firm uterine contraction & given narcotics through the first 24:72 hour after surgery to relieve pain .Miovech et al 2000 stated that the nurse must be alert to the indications of pain especially in young patients ,careful assessment is necessary for noting change in behavior such as rigidity, thrashing,

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Observe intake & output ( I&O) chart for 48 hour, evaluate urinary catheter, urine analysis before remove catheter, the present study revealed to this care not done in both hospital Assuit university hospital& King Fahd Gizan hospital .This opposite with study done by ( Tidwell 2001,Fox 2010, Adele Pillitteri 2005& Lenox 2000) which mentioned that one of the most important roles of the nurse in maintaining fluid balance is accurate measurement of fluid balance, adequate fluid intake is important after surgery to replace blood loss from surgery & to maintain blood pressure & renal function . Keep an accurate intake and out put record for at least the first 24 hours to ascertain an adequate fluid balance. Ladewig et al 2008 mentioned that the nurse monitors intake and out put and observes the urine for bloody tinge , which could mean surgical trauma to the bladder ( Scott 2009) reported that the catheter should be monitored closely to see that it drains freely. The nurse should note the color, clarity , amount and odor of the urine.Rate of flow and condition of any infusion present, amount and type of medication. All infusion lines, central and peripheral, should be assessed for potency( Ingalls and Salerno, 2009).

Adele Pillitteri 2005 also mentioned that before the catheter is removed, the physician may order a urine culture to ensure that a urinary infection did not occu, such cultures are usually taken from the catheter port by a sterile syringe after the port has been cleaned with an antiseptic solution

But for start oral feeding after 24 :48 hour & give IV infusion .This study revealed this done only (100%) in Assuit university hospital , this similar to (Hamilton et al 2004) stated that nursing observation are very important to check intravenous infusion for correct rate of flow & any post operative infiltrations (Ingalls & Salerno 2004 reported that .Intravenous fluid must be monitored carefully to prevent giving it all too rapidly or too slowly, and for abnormal 175 AAMJ, Vol. 11, N. 2, April, 2013 ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ reaction , change bottle before being completely emptied & check the new bottle to ensure that the correct fluids are given or observe change in color. As regard make exercise( breathing , leg ) it was found that in the present study this care not done in both hospital Assuit university hospital & King Fahd hospital in Gizan , this opposite with the study done by ( Joan & Mik 2010) which stated that postoperative nursing measures that contribute to the prevention of respiratory complications .Frequent deep breathing, coughing & turning are required .( Jamieson et al 2010) & ( Lewis et al 2002) reported that in order to prevent poor air exchange & to maintain adequate ventilation the nurse should begin aggressive pulmonary hygiene early .The benefits of pre operative teaching are realized when the patient is able to participate actively. Diaphragmatic breathing should be exercised at least every 2 hours while awake, maximal inspiration lasting 3: 5 seconds opens up alveoli. ( Mason et al 2008 ) mention that if the patient feels that the incision is painful , a pillow can be used to support the dressing site ..( Whaley & wong 2000- 2003) stated that when the patients cough productively , she expels any mucous secretions blocking the bronchi .Deep breathing after causes the patient to cough , and it assures complete ventilation of the lung, if there is time before the birth, the nurse can teach the women about post operative expectations , pain relief, turning, coughing , and deep breathing ( Bobak & Jensen 2003).

About encourage women for early ambulation it was found that done accurate ( 100 %) in both hospital Assuit university hospital & King fahd hospital in Gizan , this similar with ( Lewis et al 2002 & Beck 2006) which reported that the nurse promotes ambulation & physical activity to stimulate a return of peristalsis & helps in relief of abdominal distention. Ambulation helps the gas to move along the intestine so that it can expelled . Dewit 2009& Adams 2002 indicated that early ambulation is advisable in patient within 12: 48 hours after

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As regard assessment digestive system & observe first deification it was done accurately ( 100%) in Assuit university hospital. This similar with ( Perry & Potter 2000 & Taylor et al 2011) which mention that the nurse routinely auscultate the abdomen to detect the return of normal bowel sounds & monitor tolerance of ordered diet after surgery ,diet progress from clear liquids to full liquids to soft to regular. According to( colmer 2008& Beyer et al 2007) promotion of adequate nutrition & fluid balance , as the length of time before a person can eat postoperatively depends on the type of surgery performed the patient should receive nothing by moth until she is wide awake . Intestine take 24 : 48 hours post operatively to restore normal function. For promotion of adequate nutrition & normal elimination , the nurse should assess for return of peristalsis & the nurse routinely auscultate the abdomen to detect the return of normal bowel sounds.

For evaluate dressing every shift done accurate ( 100%) in both hospital Assuit university hospital & King Fahd hospital in Gizan this result agree with the study done by ( Walls et al 2002) which assess the surgical incision once during each nursing shift to be certain that the wound edges are approximated & that no signs of infection

As regard learn mother how to carry baby to initiate breast feeding it was found that done ( 100%) in King Fahd Gizan hospital only this similar with (Kearney et al 2000) which mentioned that the nurse’s is responsible about learn

177 AAMJ, Vol. 11, N. 2, April, 2013 ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ mother how hold & feed her child. The nurse reviews all postpartum instruction on self care& care of the new born ( Neef & Spray 2006).

For this deficient in nursing care in both hospital . The following recommendations could be drawn :

1- Increasing the number of the nursing staff in the post partum ward to increase the quality of service.

2- In- services education program for nurses working in postoperative ward about ideal nursing care for cesareans section .

3- Providing a sufficient training for the nursing staff in the postoperative ward for care a C. S. women

4-Make check list for ideal nursing care & compromised that by actual nursing care for post cesarean section.

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منال فاروق مصطفى سحر نجيب محمد و مديحة محمد تسن

قسم تمريض النساء والوالدة كلية التمريض جامعة أسيوط العناية بالسيدة بعد الوالدة القيصرية هي إحدى مسئوليات الممرضة وتعتبر كعناية جراحية ونسائية فى نفس الوقت . ولذالك كان الهدف من البحث هو دراسة مقارنه بين العناية المقدمة للسيدات بعد الوالدة القيصرية بمستشفى أسيوط الجامعي بأسيوط ومستشفى الملك فهد بجازان بالمملكة العربية السعودية والعناية المثلى .أجريت الدراسة على عينه شملت 762 سيدة ) 772 سيدة من مستشفى أسيوط الجامعى و 72 سيدة من مستشفى الملك فهد بجازان ( . تم تجميع المعلومات عن طريق استمارة استبيان .وكان متوسط أعمار السيدات بمستشفى أسيوط الجامعي ) 02و72 ± 27 و7 ( و )3و70 ± 27و6 ( بمستشفى الملك فهد بجازان ‘ بينما وجد أن ) 7و 36 % و 27و 37 % ( من عينة الدراسة سيدات أميات بكل من مستشفى أسيوط وجازان على التوالي بينما وجد أن )3و2 % و 7و0 % ( فقط من عينة الدراسة فى أسيوط وجازان على التوالي متعلمات تعليم جامعي. كما وجدت الدراسة أن معظم العينه فى مستشفى أسيوط وجازان ربات بيوت على التوالي ) 7و 06% و 27و 57 % ( . اما الى أسباب القيصرية وجد أن ) 5و 32 % و 5و 33 % ( في مستشفى أسيوط ومستشفى الملك فهد على التوالي يعزى إلى النزيف . بينما ) 7و 37 % و 7و 0 % ( في أسيوط وجازان على التوالي بسبب عدم تناسق أقطار الحوض .

وبالنسبة إلى قياس العالمات الحيوية كل 37 و32 وكل ساعة خالل 7 ساعات األولى بعد أجراء القيصرية وجد أنها ال تقدم وكذالك عمل خريطة سوائل وأيضا تمرينات التنفس واألرجل . أما بالنسبة لفحص مستوى الرحم وكذالك تعليم االم كيفية حمل الطفل الرضاعه وجد أنها تقدم بنسبة ) 322 %( بمستشفى الملك فهد بجازان فقط . أما بالنسبة لمالحظة النزيف من المهبل وتحسس مدى صالبة الرحم وإضافة بعض األدوية بناء على أمر الطبيب وتشجيع السيدة على التحريك مبكرا وجد أن العناية تقدم بنسبة ) 322 %( في كلتا المستشفيتين. وأخيرا وجد ان نسبة تقديم العناية في مستشفى أسيوط الجامعي كانت بنسبة 5و 77 % بينما كانت بنسبة 3و 73 % في مستشفى الملك فهد بجازان مقارنتا بالعناية المثاليه . ولذالك توصى الدراسة بزيادة عدد الممرضات بقسم ما بعد الوالدة لتقديم أفضل عناية كذالك و عمل برامج تدريبيه مستمره للممرضات وعمل استمارة عناية تمريضية مثلى للسيدات بعد الوالدة القيصرية .

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