TOP 4

EMERGENCY CASES
IN THE PHILIPPINES

Submitted by:
BSN 4-2, GROUP 1
BAJARIN, Gayle
CASILAN, Ynalie
CHUA, Jazzmine
DULAY, Joelyn Kay

Submitted to:

DIANA TUAZON.....
 PREGNANCY IN LABOR
Labor is a series of continuous, progressive contractions of the uterus that help the cervix
dilate and efface, allowing the fetus to move through the birth canal. Labor is the body’s
natural process of childbirth. It lasts on average 12 to 24 hours for a first birth. Usually, labor
is shorter for births after that

STAGES OF LABOR
FIRST STAGE OF LABOR
Begins with of onset of true labor contractions and ends with complete
dilatation and thinning of the cervix
Latent (Preparatory) Phase starts from the onset of true labor
contractions to 3 cm cervical dilatation.
Active Phase starts from 4 cm cervical dilatation to 7 cm cervical
dilatation. During this phase, contraction intensity is stronger,
interval shortens, and duration lengthens.
Transition Phase starts from 8 cm cervical dilatation to 10 cm
(full) cervical dilatation and full cervical effacement.

SECOND STAGE OF LABOR

Begins with complete dilatation of cervix and ends with delivery of
fetus
Can last 50-60 minutes in 1st deliveries
Pain felt in the lower back
Mother has the urge to push
BOW usually ruptures in this stage if not already ruptured
Crowning is evident (definitive sign of imminent delivery

THIRD STAGE OF LABOR

Begins immediately after birth of the infant and end with delivery of
placenta
Placenta generally delivers within 5-20 minutes
Sigs of placental separation:
Gush of blood from vagina
Change in size, shape, consistency of uterus
Umbilical cord length increases
Mother has the urge to push
 ASSESSMENT
ADMISSION
Pertinent information about the pregnant woman’s health history is taken during admission. These
include personal data (e.g. blood type, allergies, etc.), previous illness, pregnancy complications,
preferences for labor and delivery, and childbirth preparations. Standard obstetric, medical, and
social history taking is also done.
In addition, the nurse assesses the following: vital signs, physical exam, contraction pattern
(frequency, interval, duration, and intensity), intactness of membranes through a vaginal exam, and
fetal well-being through fetal heart rate, characteristic of amniotic fluid, and contractions. The
nurse performs Leopold’s maneuver to determine the fetal presenting part, point of maximum impulse,
fetal descent, and engagement.
Assess for the signs of true labor.
Assess for the appearance of show, which is blood mixed with mucus and would be present once the
operculum or mucus plug is expelled.
Assess for the rupture of membranes. This is the scanty or sudden gush of clear fluid from the vagina.
Assess for the effacement and dilatation of the cervix. Effacement is the shortening and thinning of
the cervical canal. In cervical dilatation, the enlargement or widening of the cervical canal is
assessed.
Prior ultrasonographic examinations and results, and bleeding during pregnancy or labor (If findings
are positive, be alert for placenta previa.)

INTERVENTIONS AND MANAGEMENT

FIRST STAGE OF LABOR
Measure duration of latent phase.
Allow patient to be continually active to maximize the effect of
uterine contractions.
Conduct interviews and filling in of forms
Conduct health teaching on breastfeeding, newborn care, and effective
bearing down
Educate patient on different relaxation techniques. (e.g. breathing
exercises, distraction method)
Ensure that the total number of internal examinations the woman
receives in the entire course of labor is limited to 5 only.
Ensure that birthing companion of choice is present all throughout the
course of labor.
Inform patient on the progress of her labor
Start monitoring progress of labor with the use of WHO partograph, 2-
hour action line.
INTERVENTIONS AND MANAGEMENT
Assist patient in assuming her position of comfort. For those
who can’t stay upright, left-side lying is recommended to avoid
disruption in fetal oxygenation.
Monitor maternal vital signs and fetal heart rate every 2
hours, or every 30 minutes -1 hour during transition phase or
depending on the doctor’s order.
Anticipate patient needs like providing ice chips or lip balm to
promote comfort.
Determine when patient last voided because a full bladder can
hinder fast labor progress.
When perineal bulging is noticeable, prepare for delivery. Check
room temperature (25-280C and free of air drafts). The nurse
should also notify staff and prepare necessary supplies and
equipment, including resuscitation machine.

SECOND STAGE OF LABOR

Instruct patient on quality pushing. The abdominal
muscles must aid the involuntary uterine
contractions to deliver the baby out.
Take note of the time of delivery and proceed to
initiate essential newborn care. Delayed cord
clamping is recommended.
Assist in restrictive episiotomy for patients who had
vaginal births

THIRD STAGE OF LABOR

Encourage skin-to-skin contact to facilitate bonding
and early breastfeeding.
Administer prophylactic oxytocin as ordered.
Utilize controlled cord traction technique for placental
expulsion.
Utilize absorbable synthetic suture materials (over
chromic catgut) for primary repair of episiotomy or
perineal lacerations.

Here are WHO recommendations for immediate postpartum:

Early (<6 hours) resumption of feeding for patients who have vaginal birth
Prophylactic antibiotics for women who sustained third to fourth degree of perineal tear during delivery
In healthy women who delivered vaginally to term infants, early postpartum discharge is recommended.
 LACERATED WOUNDS
A laceration is a wound that is produced by the tearing of soft body tissue. This
type of wound is often irregular and jagged. A laceration wound is often
contaminated with bacteria and debris from whatever object caused the cut.

TYPES OF WOUNDS

CLEAN WOUNDS CONTAMINATED

CLEAN-CONTAMINATED WOUNDS DIRTY OR INFECTED
WOUNDS WOUNDS

INCISION CONTUSION ABRASION AMPUTATUON

LACERATION PENETRATING PUNCTURE AVULSION

 ASSESSMENT
Assess the location and extent of tissue damage (e.g., partial thickness or full thickness).
Measure the wound length, width, and depth.
Inspect the wound for bleeding.
Inspect the wound for foreign bodies (soil, broken glass,
shreds of cloth, or other foreign substances).
Assess associatied injuries such as fractures,
internal bleeding, spinal cord injuries, or head trauma.
Assess for signs of infection.
Assess for presence of drainage.

INTERVENTIONS AND MANAGEMENT

Control severe bleeding by (a) applying direct Disinfect the sight with atispetic.
pressure over the wound and (b) elevating the Decontaminate the skin injury.
involved extremity Keep the wound moist.
Refer
Prevent infection by (a) cleaning or flushing
abrasions or lacerations with normal saline, and (b)
covering the wound with a clean dressing, if possible.

Control swelling and pain by applying ice over the

wound and surrounding tissue.

PATIENT EDUCATION
Discuss relationship between adequate nutrition (especially fluids, protein, vitamins B and
C, iron, and calories) and healthy skin.
Demonstrate appropriate positions for pressure relief.
Instruct to report persistent reddened areas.
Emphasize principles of asepsis, especially hand hygiene and proper methods of handling
used dressings.
Provide information about signs of wound infection and other
complications to report.
Demonstrate wound care techniques such as wound cleansing
and dressing changing.
 PNEUMONIA

An infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material),
causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria,
viruses and fungi, can cause pneumonia.
 TYPES OF PNEUMONIA
VIRAL PNEUMONIA- VIRUSES ARE THE SECOND MOST COMMON CAUSE OF PNEUMONIA.
MANY KINDS CAUSE THE DISEASE, INCLUDING SOME OF THE SAME VIRUSES THAT BRING ON
COLDS AND FLU AND THE CORONAVIRUS THAT CAUSES COVID-19.

FUNGAL PNEUMONIA- FUNGI ARE A LESS COMMON CAUSE OF PNEUMONIA. YOU'RE NOT
LIKELY TO GET FUNGAL PNEUMONIA IF YOU'RE HEALTHY. BUT YOU HAVE A HIGHER CHANCE
OF CATCHING IT IF YOUR IMMUNE SYSTEM IS WEAKENED FROM:

AN ORGAN TRANSPLANT
CHEMOTHERAPY FOR CANCER
MEDICINES TO TREAT AN AUTOIMMUNE DISEASE LIKE RHEUMATOID ARTHRITIS
HIV
 TYPES OF PNEUMONIA
HOSPITAL-ACQUIRED PNEUMONIA- YOU CATCH THIS TYPE DURING A STAY IN A HOSPITAL.

COMMUNITY-ACQUIRED PNEUMONIA- CAN BE CAUSED BY BACTERIA, VIRUSES, AND FUNGI.

COMMUNITY-ACQUIRED PNEUMONIA ALSO INCLUDES ASPIRATION PNEUMONIA, WHICH
HAPPENS WHEN YOU BREATHE FOOD, FLUID, OR VOMIT INTO YOUR LUNGS.

BACTERIAL PNEUMONIA- BACTERIA CAUSE MOST CASES OF COMMUNITY-ACQUIRED

PNEUMONIA IN ADULTS WHEN SOMEONE WHO IS INFECTED COUGHS OR SNEEZES.
BACTERIA-FILLED DROPLETS GET INTO THE AIR, WHERE YOU CAN BREATHE THEM INTO YOUR
NOSE OR MOUTH.
DIAGNOSTIC TESTS AND
PROCEDURES
Chest X-ray. looks for inflammation in your lungs. A chest X-ray is often
used to diagnose pneumonia.

Blood tests, such as a complete blood count (CBC) see whether your immune
system is fighting an infection.

Pulse oximetry measures how much oxygen is in your blood.

MANAGEMENT & INTERVENTIONS
Medical history and physical assessment- About the symptoms and when they
began.

Exposure to sick people at home, school, or work or in a hospital

Flu or pneumonia vaccinations
Medicines you take
Past and current medical conditions and whether any have gotten worse
recently
Recent travel
Exposure to birds and other animals
Smoking

Check for temperature and listen to lungs with a stethoscope.

MANAGEMENT & INTERVENTIONS
Assess the rate, rhythm, and depth of respiration, chest movement, and use
of accessory muscles.
Assess cough effectiveness and productivity.
Observe the sputum color, viscosity, and odor. Report changes.
Assess the patient’s hydration status.
Elevate the head of the bed and change position frequently.
Observe the color of skin, mucous membranes, and nail beds, noting the
presence of peripheral cyanosis (nail beds)
Teach and assist the patient with proper deep-breathing exercises.
Demonstrate proper splinting of the chest and effective coughing while in
an upright position.
 CHRONIC KIDNEY DISEASE

CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this,
excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and
stroke. High blood pressure and diabetes are two common causes of CKD. also run in families.

STAGES OF CKD
 ASSESSMENT
assess physical symptoms such as dry and itchy
skin, swelling(Na and water retention), and puffy
eyes.
anemia dec. erythropoietin production which
results in fatigue and shortness of breath.
history taking and identifying patients with CKD:
DM, HTN other cardiovascular diseases h family
history.
Urine and blood tests are used to detect and
monitor kidney disease.
urine albumin dx and monitor kidney damage
calculation eGFR assess kidney function. the stage
din.

INTERVENTIONS AND
MANAGEMENT
Fluid status. Assess fluid status and identify
potential sources of imbalance.
Nutritional intake. Implement a dietary program
to ensure proper nutritional intake within the
limits of the treatment regimen.
Independence. Promote positive feelings by
encouraging increased self-care and greater
independence.
Protein. Promote intake of high–biologic–value
protein foods: eggs, dairy products, and meats.
Medications. Alter the schedule of medications so
that they are not given immediately before
meals.
Rest. Encourage alternating activity with rest.
ACE infibitor and angiotensin receptor blocker for lower bp
phosphate binder for eliminating of posphate
diuretic eliminate extra fluids
erythropoietin for anemia
vit d and calcitriol prevent bone loss
end-stage kidney disease (kidney dialysis)
hemodialysis and peritoneal dialysis pt cannot maintain
lifestyle an conservative tx.
kidney transplant- replacement of unhealthy kidneys.
Refer