Cesarean Recovery on the NCLEX
Post-cesarean nursing priorities plus TOLAC and VBAC basics, including uterine rupture warning signs.
A cesarean patient is a postpartum patient and an abdominal surgery patient at the same time. NCLEX tests both lists.
Immediate post-op priorities
Standard post-anesthesia care plus the postpartum set: fundal checks (gentle, splint the incision), lochia (expect less than a vaginal birth), and hemorrhage surveillance. Assess the dressing and incision with REEDA. Monitor urine output via the indwelling catheter, typically removed within 12-24 hours per protocol; confirm voiding after removal.
Lungs, gut, and clots
Incentive spirometer, turn, cough with incision splinting: anesthesia plus abdominal pain sets up atelectasis. Bowel: start with clear liquids and advance as tolerated; listen for flatus. Report a rigid, distended, silent abdomen. VTE prevention: early ambulation and SCDs. Pregnancy is hypercoagulable and surgery adds risk; report unilateral calf pain or swelling.
Pain and teaching
Scheduled multimodal analgesia so she can move, breathe deeply, and feed the baby. Teach: no lifting heavier than the baby per provider guidance, splint to cough or laugh, report fever, foul lochia, incision redness or drainage, heavy bleeding, or calf pain.
TOLAC and VBAC basics
TOLAC = trial of labor after cesarean; VBAC = the successful vaginal result. Candidate: prior low-transverse uterine incision, no other rupture risks, facility able to perform emergency cesarean. Prior classical (vertical) incision contraindicates labor because of rupture risk. Uterine rupture signs: sudden abdominal pain or a tearing sensation, abnormal FHR (often the first sign), loss of fetal station, rising maternal HR with falling BP, contractions that stop. It is an emergency laparotomy, not a wait-and-see.
Frequently asked
Why is the fundal check still needed after a cesarean?
The uterus must still contract to close the placental site. Atony causes hemorrhage regardless of delivery route. Palpate gently and support the incision.
Which prior incision matters, skin or uterine?
Uterine. A patient can have a low transverse skin scar over a classical uterine incision. The operative record, not the skin, decides TOLAC candidacy.
Earliest sign of uterine rupture during TOLAC?
An abnormal fetal heart rate pattern, most often. Pain and loss of station may follow. Continuous monitoring during TOLAC exists for exactly this.
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