A client is recovering from general anesthesia after an emergency cesarean birth. What actions should the nurse take when providing care to this client? Select all that apply
1. Position on the left side.
2. Observe urine for hematuria.
3. Assess level of anesthesia every 15 minutes.
4. Evaluate perineal pad every 15 minutes for 1 hour.
5. Gently palpate the fundus with vital signs assessment.
1, 2, 4, 5
Explanation:
1. If the client has been under general anesthesia, she should be positioned on her side to facilitate drainage of secretions.
2. It is important to observe the urine for a bloody tinge, which could mean surgical trauma to the bladder.
3. Assessment of the level of anesthesia is performed for a client recovering from spinal anesthesia.
4. After a cesarean section, evaluate the dressing and perineal pad every 15 minutes for at least 1 hour.
5. The fundus should be gently palpated to determine whether it is remaining firm.
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