MS Lecture Notes August 16, 2024 PDF

MS LECTURE Crossmatching = Hemolytic Reaction August 16, 2024 C. Physiologic Alterations (MS) Course Introduction and Orientation in NP18 Non- Communicable (NCDs) Nursing Emergency and Cri...

MS LECTURE Crossmatching = Hemolytic Reaction August 16, 2024 C. Physiologic Alterations (MS) Course Introduction and Orientation in NP18 Non- Communicable (NCDs) Nursing Emergency and Critical A. Heart Disease: Angina / M.I. Sedentary: Hypercholesteremia >200mg/dL A. First / Initial Stressful, Competitive: Quick and easy: Instant Nursing Process: Assessment B. Neoplasm, Cancer 1. Lung Cancer – smoking ABC: Sharp Assessment (Triage, Critical) 2. Breast Cancer A – ask , chief complaint 3. Prostate Cancer 4. Colon Cancer (diet) B – obtain, observe 5. Leukemia (blood) C – check the patient C. Cerebrovascular Accident (CVA) Ischemic and Hemorrhagic (Hypertension) D – determine what happened D. Accident E – examine (physical assessment) MVC – Motor Vehicular Collision 15-25 yrs old, DUI (Driving Under Influence) F – find information E. COPD (Chronic Obstructive Pulmonary Disorder) G – gather everything Bronchitis, Emphysema B. Prioritization (Priority) F. Diabetes Mellitus - ABC (Airway, Breathing, Circulation) 3P’s - Cardiac Arrest (Compression, Airway, Breathing) Polyuria – pee - Trauma C-CAB (Control Bleeding) C, ABC Polydipsia – thirst Polyphagia – hunger Airway Breathing Circulation Glucagon – to increase blood sugar Foreign Body “PNEA” Heart attack Obstruction: Dyspnea Fluids Insulin – to decrease blood sugar Food Apnea Blood G. Acromegaly Saliva Paroxysmal Large Extremities Tongue (Sleep, Nocturnal Pituitary – Tumor Unconscious) Dyspnea H. Perioperative Nursing Denture COPD, Surgery Object Pneumonia A. Technique: Sterile Ascites Why Blood? B. Surgical Team: surgeon, asst. surgeon, scrub, circ. nurse, RN, OR tech Anemia – Packed RBC C. Surgical Environment Unrestricted: outside clothes Bleeding – (>25% blood loss) Hemorrhage Semi-restricted: OR cap, smock gown, scrub Coagulation deficiencies suit Restricted: complete PPE, protected apparel Disseminated Intravascular Coagulation I. Triage (Factor XII 12), IV IG, Cryoprecipitate (Hemophilia) Emergency Severity Index (ESI) – Triage Tool for Assessment Dengue = Destroy semipermeable membrane Decrease platelets Evaluation: BT, inotropes, IV fluids PLR, PNSS ESI 1 (Blue): Seen Immediately ESI 4 Less Urgent (Green): Seen within 60-120 minutes ◼ Cardiac and pulmonary arrest If one resource is required to stabilize the patient ◼ Life and limb situation (major trauma) ◼ Minor trauma ◼ Unconscious / active seizure ◼ Back pain ◼ Shock (anaphylactic), hypoperfusion, sepsis ◼ Headache ◼ Upper airway obstruction ◼ Muscle pain ◼ Respiratory failure ◼ Ankle injury ◼ Burn if airway is compromised ◼ Rashes ESI 2 (Red) Emergent: Seen within 15 minutes ESI 5 Non-Urgent (White): Seen within 120-150 minutes High risk situation: disoriented, distress, and danger vitals If client is stable and does not require any resources to be ◼ Stroke (BE FAST) stabilized o Balance, blurring vision ◼ Sore throat o Facial drooping ◼ Rabies vaccination o Arm weakness ◼ Simple wound cleaning o Speech slurring ◼ Sore eyes o Time ◼ Prescription of medication – refill ◼ Sudden blindness (glaucoma, retinal detachment) ◼ NGT reinsertion, Foley Catheter change ◼ Chest pain ◼ Lower airway obstruction Complication of Burn ◼ Severe pain (10/10) ◼ Profuse bleeding Fluid loss possible cause of complication ◼ Major head trauma Complication = Hyperkalemia ◼ Abnormal vital signs ◼ Suicidality (harming self vs ideation) Hyperkalemia = Ventricular Tachycardia (T-wave peak) ◼ Febrile infant (>38C) ◼ Burn more than 40% body percentage ESI 3 (Yellow) Urgent: Seen within 30-60 minutes (Golden Hour) If multiple resources are required to stabilized the client, but vitals are not in danger ◼ Abdominal pain (appendicitis) o Pag nawala yung sakit, nasa 2 na siya ◼ Active vomiting ◼ Mild asthma attack ◼ Allergic reaction ◼ Diarrhea ◼ Palpitations ◼ Fever adult ◼ Mild Lower Airway Obstruction o Wheezes, pale, tachypnea/dyspnea, tachycardia ◼ Severe Lower Airway Obstruction o Wheezes to stridor, bradypnea to apnea, ABG respiratory acidosis, pH low 45 MS LECTURE HYPOTONIC September 06, 2024 Overload – lamanan ang cell Case Study Session Fluid > cell Objectives: 0.33% NS TO briefly overview each specific diseases that 0.45% NS causes cardiac arrest 0..225% NS TO determine the manifestations reversible cases of cardiac arrest 1. DKA Cardiopulmonary arrest is the cessation of adequate 2. Increase Total Fluid heart function and respiration that results in death 3. Gastro problems – without reversal. UGIB (Upper Gastro Intestinal Bleeding) The causes of CPA in adults varies based by age and population: in overall physiologic status. Bleeding – BT However, a CPA may be prevented by an extent various ISOTONIC – same medical, surgical, and nursing management with proper Replenish the cell expertise and competencies. HYPOVOLEMIA Icocompress para magheal ◼ Blood loss: 4.5L – 6L PNSS and PLR ◼ Fluid: 90-95% PNSS – may develop hyperchloremia Causes: 500 > 500 = 1L Trauma – Hemorrhage PLR / 2024 GI problems – Nausea and vomiting, Disease (DKA) o Colloid o Plasma Lab: CBC-PC, Hgb/Hct, S. Electrolytes PLR – mas effective to replenish fluid resuscitation Chest X-ray, FAST > Focus, Assessment, Sonography in Trauma Causes: Trauma – Bleed – BT Appendicitis, Ap peritonitis, abdomen bleeding, No blood: Crystalloid then colloid thorax–pericardium If available nam blood if hydrated na then switch Treatment: to hypotonic Inotropic pag di gumana Blood – BT Crystalloid then colloid pero Blood ang 1 st option Crystalloids – Isotonic 2nd option is inotropic Colloids – volume expander ◼ Burn, Blood loss, Anaphylaxis (massive vasodilation) HYPERTONIC Kaussmal Breathing – deep rapid breathing Dehydrate the cell Cheyne-Stokes – breath, but period of apnea Cell is swelling (namamaga) Biot Breathing – periodic breathing – apnea Fluid < cell HYPOTHERMIA Hihilahin palabas yung excess fluid Cold/malamig D5W, 3% NS + D5W Sunod ang cardiac arrest if di namanage ◼ Edema (if not able to cure this, use furosemide Mild – 34-36 C which is a diuretic) Moderate – 30-34 C ◼ Hyponatremia ◼ Nurses – O2 – 1-2L Severe – blanket (may foil) spirometer Code blue: ET tube connect to mech vent – warm Treatment: Oxygen, Bronchodilator, Steroids humidifier “DILATE FIRST BEFORE STEROIDS” HYPOKALEMIA (POTASSIUM) “IBUKA MO MUNA BAGO MO IPASOK” ◼ A/C, Manual Cardiac arrhythmia: Inverted T wave 1. SIMV Synchronized Intermittent Mandatory Limp – lethargic Ventilation 2. CPAP Continuous Possible Airway Pressure Treatment: Potassium supplement – oral (tablet) and IV HYDROGEN ION (ACIDOSIS) IV – 2-4 cycles , nakacardiac monitor ◼ Cardio/ respi arrest – as long as may acidosis siya, chance of survival is poor Flat (inverted) T wave, ST elevation, Wide QRS, Prolonged QT - Hyperkalemia, Massive MI Labs: ABG HYPERKALEMIA (POTASSIUM) Metabolic Acidosis – low pH, low HCO3: K either high or low, Renal Failure ◼ >5.0 – recommended by PHC Respiratory Acidosis – low pH, high PACO2: severe Causes: hypoxia, respiratory arrest Overdose in potassium drugs – potassium sparing, ACE, Treatment: NSAIDs Na HCO3 – Sodium Bicarbonate Renal failure Fluid Therapy --- Burn Improved ventilation --- long-term (ICU cases) Trauma – bleed HYPOGLYCEMIA Elderly ◼ Low glucose 70-110 Labs: S. electrolytes Potassium o SVT (narrow R wave) > History of Diabetes Mellitus V-tach (wide R wave) Medications V-tach – asystole, bradyarrhythmia Fasting/Workout Treatment: Manifestations: Fluid therapy Cool, clammy skin Sodium Bicarbonate (NA HCO3) Diaphoresis GICS – Irritability – confusion/dizziness > lethargic > early sign Glucose (D50W) – didikit si K Treatment: Insulin – NPH – way para makapasok si glucose D50W – IV Calcium – panghatak palabas kasama si K If conscious – sweet candy, lemonade Salbutamol – to lower Kor dissolve si K na natira sa loob Glucagon injection – pwede sa pt na confused Hemodialysis/Peritoneal Dialysis TENSION PNEUMOTHORAX THROMBOSIS (CORONARY/PULMO) air – acute Blockage: vessels – heart or lungs mas mabilis, doble, pumapasok air into pleural space = Fats, blood, broken bones, glass (ampule)m visceral pleura tumor 20-50 cc ang pwede mapasok lang sa adults Causes: In infant, wala dapat bubbles Underlying causes: Labs: Angiogram (dye – check for allergy), ECG, CT Trauma scan, X-ray Disease – Pneumonia, TB, COPD Treatment: W/O underlying causes: Anti-platelet, Thrombolytics, Blood thinners Healthy: Embolectomy – femoral, catheter, brain, Angioplasty – cath lab – heart, ECMO Dive – decompression sickness TOXINS Blast injury: shock wave – air pocket - lungs, sinus, thorax, peritoneum, etc ◼ Substance abuse – shabu, cocaine, opioid, alcohol, rugby, nicotine Signs and Symptoms: > Vitamin B12, B complex – IV Shortness of breath + chest pain Meds: NSAIDs, TCA (Antidepressant), Antihistamines Tracheal deviation (mediastinal shift) Loss of appetite – CNS Absence of lung sounds on the affected side Considerations: Before Treat/Resuscitate, know antidote Labs: X-ray CNS Treatment: Substance Antidotes Middle Decompression 18-14G Acetaminophen Acetylcholine Anticholinergics Neostigmine ◼ Nurse: assist, microset, disinfect Aspirin/Tricyclics Na Bicarb (Sodium) ◼ Needle, syringe, 50cc Benzodiazepines Flumazenil ◼ 3rd, 4th, 5th ICS Beta-blockers Glucagon Cyanide Hydroxocobalamin CTT – 3-way system Digoxin Digibind Heparin Protamine Sulfate Position: sit, side-lying – affected side Warfarin Vitamin K CARDIAC TAMPONADE Insulin Glucose Magnesium Sulfate Calcium Gluconate Fluid in the pericardial sac Opiates Naloxone (Intranasal) Cholinergic Toxicity Atropine Sulfate Causes: Pericarditis, aneurysm, MI, Trauma Iron Toxicity Deferoxamine Manifestation: Extrapyramidal Benztropine symptoms Beck’s Triad Ethylene Fomepizole Glycol/Methanol Muffled heart sound Lead Toxicity Succimer/Calcium Hypotension – pulsus parodoxus = low systolic edetate BP + inhale; low HR (10) - trauma Alcohol Fomepizole Jugular vein distension ABG Radial artery – oxygenated Allen’s test – RT (Respiratory Therapist) Normal Values pH – 7.35-7.45 – low Acidosis, high Alkalosis PaCO2 – 35-45 – low Alkalosis, high Acidosis HCO3 – 22-26 – low Acidosis, high Alkalosis ROME – RESPIRATORY OPPOSITE METABOLIC EQUAL PaCO2 and HCO3 pag opposite is Metabolic Partially Compensated – all abnormal Uncompensated – one is normal between paco2 and hco3 Fully Compensated – normal ph kahit abnormal yung 2 ECG – Junctional – no p wave Third degree – puro p Exit block – mahabang space no beat sa gap Pacemaker – no p Sinus Arrest – regular but may gap may beat pa don sa gap MS LECTURE - Every P wave may PQRST wave, count R wave to know the bpm then multiply September 13, 2024 - Friday by 10 = ECG reading 6 seconds’ strip. REVERSIBLE CAUSES OF - Number of heart rate multiple by 10 CARDIOPULMONARY ARREST - Small box 0.04 seconds (40ms) - Big box 0.20 seconds (200ms) Objectives: - Pag tinamaan ng R, di na siya kasama sa To have competencies in a specific chosen topics bilang. Pero start ng bilang is sa unang R. such as: First Degree Heart Block ABG interpretation Electrocardiogram Electrocardiogram (ECG) - Biphasic Defibrillator - Malayo si P wave sa QRST wave - Cardiac Monitor – 6 seconds’ strip - May atrial blockage to the heart - Portable ECG machine – 12 lead conduction pwedeng 6 or 12 seconds - Prolonged T wave - Holter Monitoring Device – continuous - Always look to T wave in heart block ECG monitoring Second Degree Heart Block (Type I or 12 lead site location Mobitz Type) Normal Sinus Rhythm (NSR) - Either overdose to medication, nakalimutan uminom ng medication, - Bilang ng HR is bilang ng R (eg. 3 bpm) maintenance To know if regular of irregular rhythm, count the - May blank in between, prolonged P wave boxes in between the R wave. If 3 3 3 regular but - Sa T wave titingin kay heart block if 3 3 4 3 irregular Wenkeback Sinus Bradycardia Second Degree Heart Block (Type II or Mobitz II) - Normal sa nagjjogging, gym, etc. - Common sa athletic, people having - Prolonged P wave problems with sleep and antihistamine - With problem to electrolytes particularly - 50-60 brady normal – if patient is resting to calcium (ST segment or ST depression) - Eto may irregular rhythm Hay Prepared by: Jamie Mariel Malit Mangahis - If 30 bpm, it is sinus bradyarrhythmia - Nagllead na to Atrial Arrhythmia - Irregular Third Degree Heart Block or Complete - Saw tooth appearance Heart Block - Inverted P waves II, III, aVF Ventricular Tachycardia - Common to patients with heart failure, cardiomyopathy, cardiomegaly - Sharks fin-like - Nagevolve na from SVT - 30-40 bpm na lang siya - May pulseless, may pulse (magkaiba ng - Nacconvert back to regular rhythm gamot to) - Wasak na si P wave, bukas na yung Sinus Tachycardia atrium - Mcdonald’s sign (kayang kuhanin ng gamot/ kuryente) - Regular, broad complex tachycardia, monomorphic if each QRS in the same - 100-120+ bpm 150-200 lead looks identical - Irregular - Polymorphic if QRS variation - Sinus Tachyarrhythmia pag irregular Polymorphic Ventricular Tachycardia Supraventricular Tachycardia (Torsades de Pointes) - No P wave - Panget yung beat niya - Lub is like pitik na lang - Parang Mcdonald’s Sign - If P or T wave is unidentified and - Wide yung QRS tachycardic, considered as SVT - The more panget yung ECG, the more - Tachycardia first, sinus tachycardia, mas Malala sinus tachyarrhythmia (either normal or not), then SVT na Ventricular Fibrillation - 220-250 bpm - Either GCS 14, chest pain or malapit nang mawalan ng malay Atrial Flutter - May problem with electrolytes - GCS 3 - Management: Magnesium Sulfate - Lethal arryhthmia - Maraming P wave Prepared by: Jamie Mariel Malit Mangahis - No clear p waves or qrs complex , chaotic Premature Ventricular Contraction (PVC) uncoordinated electrical activity, amplitude decreases with longer duration then eventually asystole - Cardiac Arrest V TACH AND V FIB IS SHOCKABLE - Wide QRS PEA & ASYSTOLE NON-SHOCKABLE - Pinangunahan yung beat - Nagkaroon ng early beat Aystole - Wide complex – originates from his- purjinke region - Not usually dangerous - Every other beat – bigeminy - Flatline - Chest compression - Wag i-kuryente Atrial Fibrillation - Check patient and leads as well Pulseless Electrical Activity (PEA) - May flutter pero maliit - Either si patient may high blood pressure - No palpable pulse and malapit na mastroke - May rhythm pero walang pulse Premature Ventricular Contraction: - Yung heart may beat pero di sapat yung Bigeminy (PVC every other beat) lakas - Sa sobrang hina di na makakapa yung pulse Peaked T wave: Hyperkalemia - Kada beat, may early beat ulit - T wave napakataas (2 boxes) Ventricular Trigeminy (PVC every 3rd beat) Depressed T wave: Hypokalemia - T wave mababa - Pangatlong beat is premature na Prepared by: Jamie Mariel Malit Mangahis Normal Sinus Rhythm with Pacemaker - Every pacemaker may extra P wave - May maliit before P wave - Pa W naman siya pababa - Battery lifespan is 10-15 years, - No P wave, wide QRS, depressed T wave pinakamura is 1.8 million W and M shape , Deep S in V1 and - Connected sa heart yung pacemaker sa prolonged R in V6 SA node don nagbibigay ng kuryente, WILLIAM automatic siya Junctional Rhythm Myocardial Ischemia to Injury to Infarct - Fixed T wave - Common sa patients with maraming maintenance (polypharmacy) - Walang P wave Right Ventricular Hypertrophy with Bundle Branch Block (RBBB) Normal Acute – ST elevation Hours – ST elevation, low R wave, Q wave begins, may chest pain na Day 1-2 – T wave inversion, Q wave deeper Hallmark ng MI – pathologic T wave - Anything na may notch parang M sa taas - Wide QRS >129ms , RSR in V1, ONAM intervention for chest pain or angina – prolonges S in V6 , M and W shape Oxygen, Nitroglycerin (3 every 5 minutes, max is - MARROW 3), Aspirin, Morphine Left Ventricular Hypertrophy with Analyzing a Rhythm Strip Bundles Branch Block (LBBB) - Determine the heart rate - What is the rhythm o Is it normal sinus rhythm? Prepared by: Jamie Mariel Malit Mangahis  o Is it fast? (tachycardia) or slow? (bradycardia) o Wide QRS or Narrow QRS rhythm o Regular vs Irregular Rhythm - Determine the intervals: PR and QRS - Waves and Segment Morphology: o Is there P waves? and QRS? o Is there ST segment: Elevation or Depression? o Is there T waves: Normal, Inverted, or Peaked? ST elevation - MI, pericarditis, LBBB, Left Ventricular Hypertrophy, Benign early repolarization - Prepared by: Jamie Mariel Malit Mangahis MS LECTURE ◼ A doorway to In-Hospital services – pinunta ng EMS – then pinunta sa triage September 20, 2024 – doon na aandar ang first 60 minutes – Systematic Clinical Approach and Practices yung golden hour. ◼ Provide emergency department systems Objectives: that communicate outside community ◼ To understand different clinical approach Ambulance Deck/Bay related to critical care nursing ◼ To understand each competencies in care ◼ A parking area within a building bundles for providing client care designed for ambulances. Common ◼ To gain knowledge in a specific concepts building are hospital and EMS facilities. in Intraoperative Nursing 1. Emergency Ambulance – counterflow Different Areas Same Responsibilities. 2. Patient Transport Vehicle (PTV) – Emergency Department optimal – do not delay EMS, MD, RN, EMT, Driver, ◼ Golden Hour for less than 60 minutes ESI Client, SO 1 EMS kit, Defib, O2 tank, ◼ Either up or in critical condition stretcher, spine board, foldable ◼ If more than 60 minutes meaning that the chair prognosis of the patient is lowering/ the percentage of survival Triage Critical Care Unit ◼ An initial or primary assessment of care based on client’s urgency of their ◼ 60 mins – treatment. 60 mins – 2 hrs – disposition either in o ESI 1 Resuscitation ICU or ward o ESI 2 Emergent o ESI 3 Urgent ESI 2 – ICU/ OR o ESI 4 Less Urgent ESI 3 - WARD o ESI 5 Non-Urgent ◼ Field Triage – during Disaster – using Surgery Suites color coded assessment ▪ Red – Emergency ◼ Critical condition – stabilization ▪ Yellow – Urgent ◼ Pre-operative then post op goals ▪ Green – Non-Urgent ◼ 60 systolic – you need to stabilize first ▪ Black – Dead o IV fluids/ Inotropics o Ex. 80/50 – pwede na iadmit to Critical Unit OR for surgery ◼ Medical care for client who have life- Emergency Department threatening emergencies or injuries. o Crash cart, Defib, Airway kit, IV, ◼ A complex environment or facility that medications, drape/curtain provides a complete range of emergency and urgent care services. Prepared by: Jamie Mariel Malit Mangahis  ◼ Airway compromised, severe bleeding, o Medication as ordered loss consciousness, intubation (RSI – o Marerelax yung airway Rapid Sequence Intubation) o Go signal to intubate the patient e. Positioning Rapid Sequence Intubation o Head tilt chin lift - Immediate intubation using advanced o If may injury in the cervical airway. spine – Jaw thrust o ET tube o Sellick maneuver – diinan yung - Getting the crash cart/ Supply room throat to visualize the airway o ET tube f. Placement of Proof o Laryngoscope o Intubated na yung patient – o Tongue blade – to hawi the ETCO2 – 35-45 mmHg tongue (it has sizes) o For example, may ambu bag a. Preparation – prepare the patient o 85% O2 sat – bag valve mask ▪ Pwede naman kaso o The more mas mataas yung ethyl merong downtime – 10- carbon dioxide, mas malalim 15 seconds to attempt to yung tubo sa trachea intubate o Nasa taas pag less than 35 ▪ Possible bumaba pa ng g. Post Intubation 10-15 percent - Secure ET ties, ABGs, X-ray - placement ▪ Mas mataas magkaroon for patency, NGT, IFC ng chance mag cardiac Medications: arrest – hypoxia – sa brain Fentanyl (opiods) – lower respiratory drive o 90-94% - pwede na i-RSI ▪ At least may extra Succinylcholine (mucle relaxant) – respiration percentage ka if Ketamine/Propofol (anesthetic) nagdowntime ng 10-15 percent Etomidate (sedative) o Much better if >94% Atropine Sulfate (anticholinergic) o Check din breathing ng patient and yung bibig if there’s any - Intralipids – antidote obstruction Trauma (In-Hospital) b. Pre-oxygenation o BVM – respiratory arrest – 1 ◼ Involving of physiologic functions that pump every 3-5 seconds for 10 causes physical injuries such as cycles accidents, motor vehicular injuries, blast, c. Physiologic optimization burns, animal bite, etc. o Hypoxia – stabilized SP02, ◼ In-Hospital color, hemodynamic stability – ◼ Primary Assessment BP o Initial – First Aid (Triage) d. Paralysis – dapat tapos na si ABC before o Splint ka magparalysis ◼ Secondary Assessment Prepared by: Jamie Mariel Malit Mangahis  o Comprehensive, diagnose, ▪ Active – 4-7 cm – 50- treatment (Trauma unit) 70% o Cast ▪ Transitional – 9-10 cm Bleeding Acute Medical Care Effacement – ◼ Addressing client care in a short-term 100% dapat treatment for any urgent care situations, malambot na illness or injuries. yung cervix ◼ Acute adult medical, acute pedia, acute Cervical Dilation – Stage 1 obstetrics. ◼ If adult, Expulsion of baby – stage 2 o ESI 3-4 – Adult to o ESI 1 and 2 Placental stage – Stage 3 Downgrade na yung patient to ESI 3 Maternal stabilization – stage 4 ESI 3 – acute If okay na siya ESI 4 na either admit or go home Non-Emergent Consult (FastTrack) Ex. ESI 4 – upgrade – pwede mapunta sa ESI 3 - Addressing client with a minimal pero acute pa rin sila treatment of concern If nag upgrade pa ulit to ESI 2 critical na siya - Possible referral for outpatient department consultation ◼ If pedia, o Adjustments of vital signs, Critical Care Unit weight- sa dose ng patient - Handle a severe, potentially life- o Involve others and dapat less threathening cases that need strictly than 18 years old monitoring ◼ If OB, - Intensive care unit, critical care unit, o Usual concern is bleeding intensive therapy unit. o Labor, PROM, possible for CS, - 1:1 – universal to or 1:2 or 1:3 preterm labor, crowning – - Dapat merong admission order or considered as ESI 2 transfer to ICU o If crowning is nag baby out na, - May kasamang MD, NA, significant this is ESI 1 lalo na if cyanotic si others baby - IV lines need to be secured and patent, o The rest is nasa ESI 3 and 4 NGT, IFC, chest tube o Bleeding related to women’s - If may mech vent, magsama ng health. Respiratory Therapist ▪ Less than 38 weeks - If hospital to hospital transfer – need may AOG problems coordination ng doctor ▪ Transitional phase of - Nursing responsibility need may labor coordinate ▪ Latent – 0-3 cm –