NAME: JIMENEZ, KAYCELYN A.

DATE: DECEMBER 9, 2019

GROUP: BSN 2 – 7A NAME OF CI: JOCELYN PULMANO

I. TITLE: Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After
Surgery (ERAS) Society recommendations (part 3)
AUTHOR: Macones GA, Caughey AB, Wood SL, et al.
SOURCE: American Journal of Obstetrics & Gynecology
YEAR OF PUBLICATION: SEPTEMBER 2019

II. SUMMARY

ERAS is a tool for process management, with the creation of a focused care process. The
use of audit and feedback, whereby clinicians are provided with comparative data to educate,
change, and decrease the “harmful” clinical variances that are identified in certain high volume
clinical care processes and procedures that will increase quality of care, patient safety, and
health outcomes. The Enhanced Recovery After Surgery cesarean delivery guideline/pathway
has created a pathway for postoperative care. Specifics include sham feeding, nausea and
vomiting prevention, postoperative analgesia, nutritional care, glucose control,
thromboembolism prophylaxis, early mobilization, urinary drainage, and discharge counselling. A
number of elements of postoperative care of women who undergo caesarean delivery are
recommended, based on the evidence.

III. NURSING IMPLICATIONS

A. TO NURSING PRACTICE

As a Nursing Student who goes to OB ward and who specifically takes care to patient that have
undergone Cesarean Surgeries, It is important for me to know this kind of practice-based
outcomes researches. This is because the ERAS improved surgical quality and safety for obstetric
surgical deliveries. There were informational results and practical recommendations in the study
that can be or might be used in the future practices.

B. TO NURSING EDUCATION

As a Student Nurse I came to realize that there were things that I educate my patient especially
if they are first time mothers. It is my role as a student nurse to pass on the knowledge that I
acquire in this journal. In addition to that, I realized that there are things that should be reiterated
to patients as early as possible for faster and easier recovery.

C. TO NURSING RESEARCH

This journal really helped me to unravel things that can be done to post-cesarean mothers. It
didn’t only educate me about safer caesarean delivery practice but it also added to my
knowledge as a student nurse and as a professional nurse someday. Though in researches, there
are things that can open a room for improvements, it also applies in this journal. As the
Enhanced Recovery After Surgery caesarean delivery pathway (elements/processes) are
studied, implemented, audited, evaluated, and optimized by the maternity care teams, there
will be an opportunity for focused and optimized areas of care and recommendations to be
further enhanced by the future researchers.

IV. LEARNING INSIGHT

I do strongly agree to the authors of this study where they emphasized the positive
correlation of early and fast recovery of mothers from caesarean delivery and the postoperative
pathway recommendations of the authors. I learned that (1) Fluid preloading, the intravenous
administration of ephedrine or phenylephrine, and lower limb compression are effective ways to
reduce hypotension and the incidence of intraoperative and postoperative nausea and
vomiting, (2) Antiemetic agents are effective for the prevention of postoperative nausea and
vomiting during caesarean delivery, (3) Multimodal analgesia that include regular NSAIDS and
paracetamol is recommended for enhanced recovery for caesarean delivery, (4) A regular diet
within the 2 hours after cesarean delivery is recommended, (5) Pneumatic compression
stockings should be used to prevent thromboembolic disease in patients who undergo cesarean
delivery. (6) Heparin should not be used routinely for venous thromboembolism prophylaxis in
patients after cesarean delivery. (7) Early mobilization after cesarean delivery is recommended,
(8) Urinary catheter should be removed immediately after cesarean delivery, if placed during
surgery, and (9) Standardized written discharge instructions should be used to facilitate
discharge counselling.