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POINTS TO REMEMBER (PHYSIOLOGY)
CARDIOVASCULAR SYSTEM
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Cardiovascular disease is the leading cause of death among
Americans.
Take blood pressures correctly
a. Give client 5 minutes rest.
b. Take blood pressure while client is lying, sitting, and standing.
c. Ask client if he/she has recently smoked, drank a beverage
containing caffeine or was emotionally upset. If so, repeat
blood pressure in 30 minutes.
Rarely, the heart may lie on the right side instead of the left, this is
called Dextrocardia.
Valves control the direction of the blood flow through the heart. Flow
is unidirectional.
When the atria contract, the atrioventricular valves swing open,
allowing the blood to flow down into the ventricles.
When the ventricles contract the valves snap shut preventing blood
from flowing back up into the atria. Semilunar valves open allowing
blood to eject during ventricular contraction.
If the SA node fails to generate an impulse, the AV node takes over,
generating a slower rate. If the AV node fails to generate an impulse,
the Bundle of His takes over, generating an even slower rate. If the
Bundle of His fails to generate an impulse, the Purkinje fibers take
over and generate an even slower rate.
Damaged areas of the heart may also stimulate contractions and
produce arrhythmias.
Rapid, short-term control of blood pressure is achieved by cardiac
and vascular reflexes that are initiated by stretch receptors
(baroreceptors) in the walls of the carotid sinus and the aortic arch.
Many clients with angina or MIs benefit from involvement in a
structured cardiac rehabilitation program to assist clients to increase
their activity level in a monitored environment.
Current research suggests that life style and personal habits are
closely related to cardiac changes once attributed to aging.
The elderly are less able to physically adapt to stressful physical and
emotional conditions, because their hearts do three things less
quickly: the myocardium contracts less easily, the left ventricle
ejects blood less quickly, and the heart is slower to conduct the
impulse for a heartbeat.
Because different enzymes are released into the blood at varying
periods after a myocardial infarction, it is important to evaluate
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enzyme levels in relation to the onset of the physical symptoms such
as chest pain.
Clients who are in postoperative recovery, on bed rest, obese, taking
oral contraceptives or had knee or hip surgery should be monitored
closely for thrombophlebitis.
RESPIRATORY
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Oxygen is essential for life. So, before all else, keep airways open
and ease breathing.
Clients with chronic lung disease use more oxygen and energy to
breathe; this can create a vicious cycle in which the client works
harder, and continually requires more oxygen and more energy.
Nursing interventions for clients with lung disease should include
pacing of activities, because clients have little reserve for exertion.
Quality of life for clients can be significantly improved if you teach
clients diaphragmatic breathing and pursed-lip breathing.
Clients with asthma must understand the different types of inhalers
and when to use each type. Some are rescue inhalers for acute
dyspnea; others are maintenance drugs.
A finger oximeter reading is simply one element of an assessment;
it's not the whole picture.
Cyanosis is determined by oxygenation and hemoglobin content;
anemic clients may be severely hypoxemic and never turn blue;
polycythemic clients may be cyanotic with adequate tissue
oxygenation.
Control of pulmonary TB is a serious public health issue.
If a client is in respiratory distress, start out by administering oxygen
by non-rebreather mask at 10-15 LPM until the client's condition is
clarified or stabilizes.
When caring for a client with a chest tube, you must know whether
the client has a leak from the lung. Only when you know there is no
leak, should you apply an occlusive dressing.
When caring for a client on a ventilator, if an alarm sounds, first,
assess the client. See if the alarm resets or if the cause is obvious. If
the alarm continues to sound and the client develops distress,
disconnect the client from the ventilator, use a manual resuscitation
bag and page or call the respiratory therapist immediately.
To maximize therapeutic effect of inhalers, the key is technique. It is
critical to teach clients the right technique and test how well they use
the inhaler.
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Smoking cessation is critical to reduce the risk and severity of lung
disease. Second-hand smoke hurts children most.
Best treatment of pulmonary embolus is prevention by using
intermittent compression stockings (with anticoagulants in extrahigh risk clients) to prevent clots in deep veins.
TB clients need intensive community follow up to ensure that they
continue with pharmacological treatment once discharged from the
hospital. Clients who stop therapy too soon are the source for the
more deadly multi-drug resistant forms of TB.
NEUROLOGICAL SYSTEM
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In Multiple Sclerosis, early changes tend to be in vision and motor
sensation; late changes tend to be in cognition and bowel control.
Peripheral nerves can regenerate, but nerves in the spinal cord
cannot regenerate.
During a seizure, do not force anything into the client's mouth.
A major problem often associated with a left CVA is an alteration in
communication.
Clients with CVAs are at high risk for aspiration. These clients must
be evaluated to determine if dysphagia is present.
The rate, rhythm and depth of a client's respirations are more
sensitive indicators of intracranial pressure than blood pressure and
pulse.
When caring for a comatose client, remember that the hearing is the
last sense to be lost.
A CVA can result in a loss of memory, emotional lability and a
decreased attention span.
Communication difficulties in a CVA client usually indicate
involvement of the dominant hemisphere, usually left, and is
associated with right sided hemiplegia or hemiparesis.
The client with myasthenia gravis will have more severe muscle
weakness in the morning due to the fact that muscles weaken with
activity and regain strength with rest.
EYE
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Anything that dilates the pupil obstructs the canal of Schlemm,
increases intraocular pressure.
Color blindness is caused by a deficiency in one or more types of
cones and is caused by a sex-linked recessive gene.
Destruction of either the right or left optic nerve tract results in
blindness in the respective side of both eyes
When mydriatics are instilled, caution clients that vision will be
blurred for up to two hours
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Following eye surgery teach client to avoid, for six weeks, activities
that can increase IOP
 Stooping
 Bending from the waist
 Heavy lifting
 Excessive fluid intake
 Emotional upsets
 Constrictive clothing around neck
 Straining with bowel movement (or straining at stool)
Teach client proper administration of eyedrops
Provide sunglasses for photophobia
Assist with activities of daily living as required
When clients wear eye patches, they lose depth perception.
Remember that this loss presents a safety risk.
Systemic disorders that can change ocular status include diabetes
mellitus, atherosclerosis, Graves' disease (hyperthyroidism), AIDS,
leukemia, lupus erythematosus, rheumatoid arthritis sickle cell
disease.
Ear
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Changes in barometric pressure will affect persons with ear
disorders
Hearing loss
 can be partial or total
 can affect one or both ears
 can occur in low, medium or high frequencies
AMA formula for hearing loss: hearing is impaired 1.5% for every
decibel that the pure tone average exceeds 25 decibels (dB)
A hearing loss of 22.5% usually affects social functionality and
requires a hearing aid
Noise exposure is the major cause of hearing loss in the United
States
Ask client how he/she communicates: lip-reading, sign language,
body gestures, or writing
To gain the client's attention, raise your hand or touch the client's
arm
When talking with client, speak slowly and face him/her
Speak toward the client's good ear
If the client wears a hearing aid, allow him/her to show you how it's
inserted
Speaking louder to a hearing impaired client does not increase
his/her chances of hearing
Communicate the client's hearing loss to other staff members
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Ototoxic drugs include:
 Aminoglycosides
 Antimyobacterials
 Thiazides
 Loop diuretics
 Antineoplastics
Tell clients taking ototoxic drugs to report any signs of dizziness,
loss of balance, tinnitus, or hearing loss
GASTRO-INTESTINAL
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Most obstructions occur in the small bowel.
Most large bowel obstructions are caused by cancer.
Onset of cirrhosis is insidious with symptoms such as anorexia,
weight loss, malaise, altered bowel habits, nausea and vomiting.
Management of cirrhosis is directed towards avoiding complications.
This is achieved by maintaining fluid, electrolyte and nutritional
balance.
A client with esophageal varices must be monitored for bleeding
(e.g., melena stools, hematemesis, and tachycardia.
The rupture of esophageal varices is life threatening and associated
with a high mortality rate.
Pancreatitis is often associated with excessive alcohol ingestion.
Pancreatic cancer is an insidious disease that often goes undetected
until its later stages.
Diverticula are most common in the sigmoid colon.
Clients with diverticulosis are often asymptomatic.
A deficiency in dietary fiber is associated with diverticulitis.
Colostomies: an ascending colostomy drains liquid feces, is difficult
to train and requires daily irrigation; a descending colostomy drains
solid feces and can be controlled.
Frequent liquid stools can be indicative of a fecal impaction or
intestinal obstruction.
Bowel sounds tend to be hyperactive in the early phases of an
intestinal obstruction.
GENITO-URINARY
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After a urinary catheter is removed, the client may have some
burning on urination, frequency and dribbling. These symptoms
should subside.
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After a TUR (transurethral resection), tell the client that, because the
three-way foley catheter has a large diameter, he will continuously
feel the urge to void.
After prostatic surgery, it is normal for the client's urine to be blood
tinged and for him to pass blood clots and tissue debris.
Because the prostate gland receives a rich blood supply, it is
important to observe the client undergoing a prostatectomy for
bleeding and shock.
Breast cancer starts with the alteration of a single cell and takes a
minimum of two years to become palpable.
At the time of diagnosis, about 1/2 of clients with breast cancer have
regional or distant metastasis.
ENDOCRINE
About Insulin
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In the Pancreas's islets of Langerhans, beta cells secrete insulin-the
islet-cell hormone of major physiological importance; without
sufficient insulin, the body develops diabetes mellitus.
Currently, researchers are exploring a number of new delivery
systems for insulin.
Oral inhalation of insulin may become a viable alternative to
injections.
Transdermal patches of insulin may someday replace the injections.
Still another prospect is an implanted insulin delivery system,
possibly in combination with a glucose sensor to create an "artificial
pancreas."
Exercise that increases the body's metabolic rate decreases blood
sugar and increases insulin sensitivity. Watch for signs of
hypoglycemia.
Illness can disrupt metabolic control and raise blood sugar, requiring
an increase in insulin.
Insulin-dependent clients should be well controlled for at least one
week prior to any surgery. Special care should be taken to monitor
blood glucose during and after surgery and adjust insulin
accordingly.
About the Thyroid
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Following neck surgery, potentially life-threatening complications
such as laryngeal edema and tracheal obstruction can occur.
Observe for respiratory distress.
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Following thyroid surgery, many clients suffer transient
hypocalcemia. Check for signs of tetany for about three days after
surgery.
Thyroid surgery can cause a thyroid storm.
About the Parathyroid
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Positive Chvostek's sign: contraction of facial muscle occurs when
light tap is given over facial nerve in front of ear.
Positive Trousseau's sign: carpopedal spasm results from inflating
blood pressure cuff above client's systolic pressure.
ORTHO
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After hip replacements, pulmonary embolism may occur even without
thrombosis in foot or leg.
Patients should sit in a straight, high chair; use a raised toilet seat; and
never cross their legs.
In hip or knee replacement, patients will need assistive devices for walking
until muscle tone strengthens and they can walk without pain.
After an amputation, the home must be assessed for any modifications
needed to ensure safety.
The management of soft tissue injury can be remembered by RICE: Rest,
Ice, Compression and Elevation.
Some clients will need transportation to continue rehabilitation.
Amputee support groups can help patients and family.
After Arthroscopy, outpatient rehab may be prescribed depending on
procedure; physician may prescribe knee immobilizer.
External Fixator - If possible, prepare the client preoperatively to reduce
anxiety. Device looks clumsy, but patient should be reassured that
discomfort is minimal.
After a hip pinning or femoral-head prosthesis, caution client not to force
hip into more than 90 degree of flexion, into adduction or internal rotation.
Caution clients with a new prosthesis not to use any substances such as
lotions, powders etc. unless prescribed by the doctor.
Osteoporosis cannot be detected by conventional x-ray until more that
30% of bone calcium is lost.
Foods high in calcium include milk, yogurt, turnip greens, cottage cheese,
sardines, and spinach.
When performing a musculoskeletal assessment on a client with Paget's
Disease, note the size and shape of the skull. The skulls of these clients
will be soft, thick and enlarged.
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Clients at high risk for acute osteomyelitis are: elderly, diabetics, and
clients with peripheral vascular disease.
When clients receive corticosteroids long-term, evaluate them continually
for side effects.
Immunosuppressed clients should avoid contact with persons who have
infections.
Steroids may mask the signs of infections, so client should promptly report
slightest change in temperature or symptoms.
Photosensitive clients should avoid the sun, limit outdoor activities during
peak sun hours and wear sun block.
ONCOLOGY
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Radiation has local effects; chemotherapy is more systemic.
Only certified nurses may administer chemotherapeutic agents.
Ionizing radiation will damage both normal and cancerous cells, and cause
side effects.
Clients who receive external radiation are not radioactive at any time.
Clients receiving internal radiation are not radioactive: the implant or
injection is.
If the source of radiation is metabolized, the client's secretions and
excretions may be radioactive for a time, based on the half-life of the
isotope.
CPR
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Early defibrillation is the key to successful resuscitation for many adults.
Continually reassess during CPR to see if the client regains a pulse or
begins breathing. Reassess to see that the chest moves and pulses are
palpable during CPR.
SHOCK
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In shock, the first hour of treatment is most critical. Early detection is key.
There are different ways to categorize shock. Basically, shock presents
three potential problems:
1. Not enough fluid in the blood vessels OR
2. Fluid has moved outside the vessels, so cannot be pumped to the
organs OR
3. Heart cannot pump fluid that is present
Shock and Temperature
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In septic shock, the skin and body temperature may increase. In other
shock states, body and skin temperature will decrease.
Shock and Heart Signs
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Early stages of shock activate the sympathetic nervous system. So in
early stages, the client will not always be hypotensive.
Bradycardia is a very late sign in shock.
Another late sign is cardiac arrhythmia (other than sinus tachycardia).
Arrhythmias reflect less perfusion of the coronary arteries and myocarditis.
As the myocardium receives less perfusion, heart pumps less.
Because less blood perfuses the brain, level of consciousness drops.
Shock and Urinary Output
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Average adult urinary output is 0.5 to 1.0 ml/kg/hr. Less than 35 ml/hour
reflects decreased renal blood flow. Acute renal failure can result.
Shock and Respiration
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As blood flow to lungs decreases, less gas exchange will occur.
When tissues receive less oxygen, they produce more lactate and
metabolic acidosis sets in. Metabolic acidosis increases risk of cardiac
arrhythmias.
For a client in shock, body cells receive less oxygen and nutrients. Thus
treatment aims at increasing both available oxygen and volume of blood in
vessels (unless the heart has failed).
Medications can improve tone of blood vessels (inotropes) or treat the
cause of shock (corticosteroids, antibiotics).
When treating a trauma client, you must quickly assess ABCs. After you
know the client is breathing and has a pulse, vital signs can wait while you
stop any bleeding and start other interventions (such as starting IVS).
Don't rely only on the vital sign numbers.
Head and Spine Injury
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If client has head injury, the most important assessment is level of
consciousness; next is pupil response to light. Changes in vitals are very
late sign.
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With trauma clients, assume spine is injured until proven otherwise. While
you open the airway, you must keep cervical spine immobile.
Viral Infections
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Viruses are parasites that cannot reproduce or meet own metabolic
needs.
Skin cells react to virus with swelling, "vesiculation," or proliferation,
sometimes warts.
Most viruses are associated with rashes (characteristic of each disorder,
such as chicken pox, rubella, roseola)
Pediatric Neurology
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Abnormal posturing is an ominous sign
A positive Babinski is normal in children until one year of age
Myelinization continues until adolescence
Abnormal CSF findings include: decreased glucose, positive culture, and
cloudy appearance
Due to pharmacokinetics and dynamics, common side effect of the
majority of anti-convulsants include drowsiness, ataxia, lethargy, anorexia,
nausea. Sometimes dyscrasias or liver damage can occur; hence, these
children need periodic tests of blood and of liver enzymes.
Febrile seizures are generally a one-time event, though there may be a
familial predisposition.
Children are more likely than adults to have neuromuscular or
extrapryamidal side effects from psychotherapeutic drugs.
Clinical effectiveness of anticonvulsants varies with the drug's serum level,
mechanism of action, pharmacokinetics and dynamics. The effects also
may vary from child to child.
A newborn's brain is about 2/3 the size of an adult's, and reaches 80%
adult size in one year.
The sudden appearance of a fixed or dilated pupil is an emergency.
The progression from decorticate posture to decerebrate posturing, and
then to flaccid paralysis, indicates deterioration of neurologic function.
Do not do any diagnostic tests that require head movement until cervical
spine injury has been ruled out.
Children with congenital neurological disabilities will often develop
complications in other body systems.
Cerebral palsy is a neuromuscular disorder. It may bring with it certain
problems in perception, language, and/or intellectual function.
Acute bacterial meningitis is a medical emergency, requiring swift action
and treatment.
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The care of the unconscious child focuses on respiratory management,
neurological assessment, monitoring intake and output, providing
appropriate medications and evaluating outcomes.
The primary indicator of neurological status is LOC (level of
consciousness).
Status epilepticus is an emergent situation.
Do not restrain a child experiencing a tonic-clonic seizure, and never place
anything in his mouth.
In head trauma, the primary mechanism of injury is accelerationdeceleration accidents.
Bleeding from the nose or ears calls for evaluation.
Pediatric Cardiovascular
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In a cardiac history, include poor weight gain, chronic respiratory infection,
activity intolerance, and fatigue during eating.
Oxygen is a drug that requires a prescription and frequent monitoring.
Cardiac catheterization serves many purposes: diagnostic, interventional
and electrophysiologic. It also monitors cardiac oxygen saturation,
pressure changes and anatomic defects.
CHF signs usually show either left or right sided heart disorders. These
signs may include increased heart rate, adventitious lung sounds,
cyanosis, edema, hepatosplenomegaly, and distended neck veins.
Acquired cardiac disorders include bacterial endocarditis, acute rheumatic
fever, hyperlipidemia, Kawasaki disease, and cardiomyopathy.
Electrodes for cardiac monitoring are usually color coded: white (upper
right), black (upper left), green (lower right), and red (lower left).
Black
White
Red
Green
In cyanotic heart disorders, major concerns are polycythemia or increased
hemoglobin and hematocrit. These can lead to thrombus.
Pediatric Respiratory
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The principal functions of the respiratory tract are to allow air movement
(ventilation) and exchange (diffusion) of oxygen and carbon dioxide.
Children's airways are smaller, more flexible and shorter than adult's and
are therefore more prone to obstruction than adults.
Stridor usually indicates an upper airway concern, while wheezing
indicates a lower airway disorder.
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Conditions that increase or decrease compliance and/or resistance will
make breathing harder. Signs of increased breathing work are tachypnea,
retractions, abnormal positioning, shortness of breath and fatigue.
Respiratory rate is an important indicator of respiratory status.
Central cyanosis in a newborn usually means severe hypoxia and possible
cardiac etiology.
Acrocyanosis is a common finding in a newborn.
Asthma is not a disease but an inflammatory disorder.
Asthma is not wheezy bronchitis.
The incidence and severity of respiratory tract infections and disorders is
related to the child's age, size, natural defenses, underlying disorder and
agent involved.
After a tonsillectomy child may bleed for up to several weeks.
Epiglottitis, acute tracheitis and status asthmaticus are acute medical
emergencies.
The best way to stop the spread of RSV is meticulous hand washing. RSV
is transmitted by direct contact with the fomite.
Pediatric Endocrine
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The body secretes hormones at various times during the day (influences
of diurnal and circadian rhythm).
Normal hormone levels are related to age and stage of puberty.
The pituitary gland stimulates target organs to produce specific hormones;
when sufficient, these in return signal pituitary to stop stimulation (negative
feedback loop).
Untreated infant hypothyroidism will lead to mental retardation.
Associated terms for hypopituitary function include: short stature,
constitutional delay, dwarfism.
A major concern of precocious puberty is rapid bone growth, which can
result in early fusion and short stature.
Children with SIADH develop an expanded circulatory volume but not
edema.
Because oral potassium tastes very bitter, mix it with a little strongly
flavored fruit juice.
For a child with an endocrine disorder, never discontinue medication
abruptly.
The vast majority of children with new-onset IDDM will experience a
"honeymoon" period when their bodies secrete insulin and their need for
exogenous insulin decreases.
Blood glucose monitoring by finger-stick reflects glucose currently and for
last several hours; glycosylated hemoglobin levels indicate long-term
compliance and true diabetic status.
Never freeze, heat or shake insulin.
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When insulin is absent, the body cannot properly metabolize fats, proteins
and carbohydrates.
The focus of diabetic management is the inter-relationship of diet, activity
and insulin administration.
Pediatric Gastrointestinal
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Infants & children have a much smaller stomach capacity than adults.
Peristaltic waves may reverse occasionally during infancy; gastric
esophageal reflux is very common in infants.
Secretory cells don't reach adult levels until 2-3 years of age.
The GI tract has both intake (fluid, minerals, vitamins, etc.) and output
functions.
Whenever a child coughs, chokes and turns blue with feeding, suspect
tracheoesophageal fistula.
Any newborn failing to pass meconium stool within the first 24 hours of life
and who is prone to constipation or decreased frequency of stooling in the
first month of life, should be evaluated for Hirschsprung's Disease.
The treatment of metabolic acid-base disturbance is oriented toward
correcting the underlying problem.
Dehydration can lead to shock.
Dehydrated infants and children face greater morbidity risk than adults
because children differ in body composition and metabolic rate, and their
fluid-regulation systems have not matured.
Potassium should only be added to IV fluids when the urine output is
sufficient.
1 Gm of diaper weight = 1 cc of urine.
When assessing diarrhea or constipation, remember the acronym ACCT:
amount, color, consistency, and time (duration).
Bilious vomiting indicates source below the ampulla of Vater.
Pediatric Genito-urinary
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The kidney's function is to maintain, in equilibrium, the composition and
volume of body fluids.
Kidney function in an infant is nearly that of an adult by 12 months of age.
Children with urine output less than 1 ml/Kg/hour should be closely
monitored for possible renal failure.
Acute renal failure should be suspected in a child with decreased urine
output, edema and/or lethargy, and who is dehydrated, recovering from
surgery or in shock.
In managing HUS, the goals are to control hematologic manifestations and
any renal complications.
UTI management aims to eliminate the underlying cause, detect and
correct abnormalities, and prevent recurrences.
The effects of hypokalemia or hyperkalemia can be devastating.
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UTI's are extremely common in young children, girls more than boys.
In a child with ambiguous genitalia, the criterion for choice of gender and
rearing is not genetic sex, but the infant's anatomy.
Pediatric Musculoskeletal
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Since many musculoskeletal disorders begin with trauma, it is important to
assess ABC (airway, breathing and circulation) first.
Open fractures increase the risk of infection.
Immobilization has multi-system effects.
For a child with a fracture, it is important to assess the 5 P's of ischemia:
1. Pain and point of tenderness
2. Pulse -distal to the facture
3. Pallor
4. Paresthesia
5. Paralysis
Children with structural defects/disorders require regular follow-up
evaluation until they reach skeletal maturity.
Children in casts or traction need to be monitored for alterations in skin
integrity routinely.
Children under 1 year of age generally do not experience fractures.
Because children's soft tissues are so resilient, dislocation and sprains are
less common.
Pediatric Temperature-Related
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The extent of a burn injury is expressed as percentage of total body
surface area (TBSA)
The larger the percentage of TBSA that is burned, the greater the risk for
burn shock.
In managing alterations in skin integrity, it is necessary to individualize the
type of treatment and medications to the particular causative agent.
If you wouldn't put it into an eye, don't put it into a wound.
Wounds heal by the process of moist wound healing and occlusion.
Dry wounds do not heal.
Wound debridement promotes healing and prevents infection.
Immediate care for a major burn is ABC: airway establishment and
patency, breathing and absence of respiratory distress, and circulation
with fluid initiation.
Potassium should not be administered during the initial oliguric phase of a
burn injury, but should be added when diuresis occurs.
Pediatric Hematology
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For a child with altered platelet function or bleeding disorder, do not
administer acetylsalicylic acid (aspirin, ASA) or take rectal temperatures.
Perform invasive procedures very cautiously.
Children with low WBC may not exhibit common signs of infection such as
purulent drainage. In a febrile client with granulocytopenia, give antibiotics
immediately because this child risks rapid, overwhelming sepsis.
Morphine is the narcotic of choice for pain in children with sickle cell
disease.
Pediatric Oncology
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Signs and symptoms of pediatric malignancies vary according to the
child's age, location and type of tumor, and extent of disease
Cure rate is improving for most types of pediatric malignancies; however
the late effects of treatment are of increasing concern and incidence.
Children typically have longer treatment plans than adults due to their
increased metabolic rate and rate of cell turnover.
Leukemia affects not only the blood, but can metastasize to major organ
systems (extramedullary disease), including the central nervous system.
Nursing care includes monitoring the child for the development of acute
complications of treatment including fever, bleeding, and anemia.
Pediatric oncologic emergencies include: acute tumor lysis syndrome,
superior vena cava syndrome, septic shock.
PREGNANCY
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Normal labor progress in active labor is 1.2cm/hr for primiparas and
1.5cm/hr for multiparas
Prolonged labor at any stage should be evaluated for fetal, pelvic or
uterine dysfunction
Pain and anxiety can impede labor progress
Vaginal birth is the birth method of choice and interventions should be
directed at accomplishing that goal
Cesarean birth is utilized to rescue the infant when fetal, pelvic or uterine
dysfunction cannot be overcome
Maintenance of a calm, soothing environment is necessary
Efficient and effective gathering of supplies and personnel is imperative
Maintain eye contact and verbal contact with woman to provide support
Assist mother to birth as slowly as possible to prevent maternal/newborn
trauma
Be prepared to assist newborn transition to extrauterine environment
Anticipate predisposing factors for prolapsed cord
Gentle displacement of cord with sterile glove to relieve pressure
Inform and support mother in emergency
Prepare for expeditious birth - vaginal or cesarean
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Surgical intervention has associated complications of increased infection,
increased postoperative hemorrhage, increased morbidity and potential of
increased mortality
Surgical delivery of the newborn reduces mechanical compression of the
chest. It may potentiate respiratory difficulties in the newborn such as
Transient Tachypnea of the Newborn.
Surgical delivery is to be avoided except to rescue the fetus or to alleviate
maternal morbidity
Severe postpartum hemorrhage may result in organ failure, DIC, and/or
mortality
Estimation of bleeding is critical
Uterine massage is the first line of defense against excessive hemorrhage
Oxytocins are used to contract the uterus