Nurses HALL Academy

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2ND STAGE OF LABOUR✨✨

Definition ✨
✓This is the time from full cervical dilation to the delivery of the vaby.
✓It usually lasts from 30mins-45 minutes in prime gravida and 15minutes-30 minutes in multigravidas.

SIGNS OF 2ND STAGE OF LABOUR ✨✨
1.EXPULSIVE UTERINE CONTRACTIONS✨✨
✓ Uterine contractions are initiated so that pabour can be induced and be made possible
✓This is because these are needed for expulsion of the foetus.
✓ Without uterine contractions,it is difficult to induce labor and fetal delivery

2.RUPTURE OF THE FORE WATERS✨✨
✓ During the 2nd stage of labour, the fore waters break.
✓This is to give way for passage of the Baby.

3.GAPPING OF THE A**S AND THE VAGINA✨✨
✓ There are some changes and adjustments that occur to the perineum and pelvis so that the foetus can be expelled.
✓This also allows delivery of the baby.

4.TRICKLE OF BLOOD.
✓This is due to some tears made on the va**na by the pressure from the presenting part as it passes through the va**na.

PHYSIOLOGY OF THE 2ND STAGE OF LABOUR✨✨

1.CONTRACTION AND RETRACTION✨✨
✓The contractions becomes more expulsive and strong so that labor is induced.
✓The woman feels the urge to push the baby out due to pressure exerted on the re**um and pelvic floor from the uterine contractions
✓The Secondary powers come to play.
✓The reflexes may be controlled initially but become increasingly strong and involuntarily that they can't be controlled.

2.PELVIC TISSUE SOFT DISPLACEMENT✨✨
✓Anteriorily the Bladder goes upwards into the abdomen stretching and thinning the urethra.
-The advancing presenting part dilates the va**na and may tear it and cause some light bleeding.
-The Perineal area is flattened, stretched and thinnned,This cause the va**nal wall to be legthened posteriorly and va**na or***ce to be taken upwards.
-Posteriorily,The re**um becomes flattened into the sacral curve and f***l matter is expelled.
-The a**s finally Gaps.

3.EXPULSION OF THE FOETUS.
-The head is seen at the V***a which advances at each contraction and receding between contractions untill crowning occurs.
-The head is then born by extension,Shoulders and body follow by the next contractions together with the rest of the amniotic fluid.

MANAGEMENT OF THE SECOND STAGE OF LABOUR✨✨

AIMS✨✨
1.To ensure a live and safe delivery
2. To promote a good foetal and maternal wellbeing.
3.To prevent complications such as post partum haemorrhage

PREPARATION FOR DELIVERY✨✨
✓Maintain normal room temperature which is warm.
✓Let the woman empty the bladder or pass a catheter if she is unable to pass urine to prevent delay of the second stage and third stage as well as preventing rupturing the bladder.
✓Place the woman in the dorsal position or squatting or position of her choiceto promote descent and are good for pushing.
✓Wash your hands, dry them and open the outer part of the delivery pack.
✓Put on a mask, sterile gown and gloves and complete the preparation of the sterile field.
✓The assistant is responsible for fetal monitoringand maternal wellbeing, as well as efficiency of the uterine contractions. She should do the observations every 5 minutes. She should also ensure that the mother maintains a good position and gives clear and helpful instructions.
✓Stand on the right side of the patient
Swab the perineum with antiseptic and place one towel under the woman's buttocks and the other one on the abdomen.

DELIVERY OF THE HEAD✨✨
✓Place a sterile pad over the perineum and a**s using the right hand.
✓Advise the woman to push with each contraction.
✓Watch and control the advance of the fetal head in a downward direction using the lefthand so that the smallest diameter presents.
✓Cover the perineum and a**s with a sterile pad using the right hand
✓Decide whether to perform an episiotomy or not. Avoid performing an episiotomy in an HIV positive woman.
✓The patient should only push when there is a contraction.
✓When the head has crowned, let the woman stop pushing, by instead she should pant so that the head can be delivered slowly to prevent trauma to the head as well as perineal tears.
✓The brow, face and chin are born by a movement of extension.
✓Check to see if the cord is around the neck. If it is loose, it can be slipped over the shoulders. If it is tight, then apply two artery forceps about 3 cm apart. Hold a swab over the cord, cut and unwind. Clean the baby's eyes and clear baby's airway.

DELIVERY OF THE SHOULDERS✨✨
✓Allow restitution (the baby will turn)to take place.
✓Place one hand on each baby's side head and apply gentle downward traction and the anterior shoulder should slip under the symphysis p***s.
✓Once the anterior shoulder is free, carry the baby up towards the mother's abdomen.
✓The posterior shoulder can escape over the perineum and the rest of the body will be born by lateral flexion.

COMPLICATION THAT OCCUR DURING 2ND STAGE OF LABOUR✨✨

1.ANTEPARTUM HAEMORRHAGE(APH)✨
✓This is caused usually by Placental Previa or placental abruption.

2.PERINEALTEARS✨
✓This is caused by pressure exerted on the perineum by the presenting part.

3.FOETAL DISTRESS✨
✓This may be due to baby's malpresentations or malposition.

4.TRAUMA✨
✓Trauma to the presenting part may be that in cephalopelvic disproportion were the head is bigger than the passage.

5.PROLONGED 2ND STAGE OF LABOUR✨
✓This may be due to a full bladder, maternal weight,or the effects of anaesthesia on the woman’s body.

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THIRD STAGE OF LABOUR MANAGEMENT

AIMS
=To deliver the placenta and its membrane.
=To control bleeding and prevent PPH.
=To prevent infections during the 3rd stage.

ENVIRONMENT
=I will ensure the room is clean to prevent nosocomial infection.
=I will ensure there is proper lighting for easy observation of the woman.
=I will ensure that the room is warm enough to prevent hypothermia.
=I will ensure that there is a drip stand for intravenous fluids and drugs.
=I will prepare some intravenous fluids for energy and hydration.
=I will provide privacy in a room to protect our clients from unwarranted interference in their lives.
=I will ensure that all emergency equipment must be readily available.

PSYCHOLOGICAL SUPPORT
=I will give verbal encouragement by telling her how well she is doing to promote cooperation.
=I will guide the woman on what to do during the third stage of labour to prevent complications.

INFECTION PREVENTION
=I will use sterile gloves during the procedure to prevent infections.

=I will discourage the woman from touching the valva to prevent infections.
=I will clean the bed cover after delivery of the baby to prevent infections.
=I will wash my hands to prevent infections.

POSITION
=I will put the woman in the dorsal position for easy applying of cord traction.
= I will allow her to be in this position for comfortability.

DELIVERY OF PLACENTA
=I will give oxytocin 10 iu IM stat to help the uterus contracts fast to control bleeding.
=I will wash my hands and dry them then put on sterile gloves to prevent infections.
=I will clean the valva with savlon to prevent infections.
=I will wait for 2-4 minutes after the delivery of the baby for the contraction and do the traction.
=I will place the right hand on the lower abdomen and fingers stretching the upper uterine segment upwards toward the umbilical to prevent uterine inversion.
=I will hold the forcep clumped to the cord near the valva
=I will pull the placenta using the controlled cord traction method
= As the uterine contractions stop, traction should also be stopped temporarily to prevent breaking the cord.
=If the placenta does not descend after 20-30 seconds of traction, I will stop the traction for 1-2 minutes and wait for them to resume.
=When the placenta is visible on the valva I will stop pulling and start to roll the placenta with my hands to coil the membranes preventing them from remaining inside.
=I will put the placenta on the receiver and do a quick examination of the placenta to check if there is any missing lobe which can cause bleeding.
=I will massage the uterus after the placenta and membranes are evacuated to expel clots
before the examination of the ge***al tract.

OBSERVATION/EXAMINATION OF BIRTH CANAL
=I will observe the woman's physical state after placenta delivery
= I will do vital signs as raised pulse and low blood pressure will signify excessive bleeding.
=I will observe skin for coldness as this may show or present shock.
=I will monitor the breathing pattern to rule out dyspnea.
==I will position her in a lithotomy position to ease the abdominal muscles for easy access through to ge***al tract.
=I will ask the assistant to direct a light on to the perineum.
=I will swab the v***a and perineum gently with an antiseptic solution and dry with a soft dry cloth.
= I will gently separate the l***a and inspect the v***a, the va**na and the cervix for the presence of any tear and laceration.
=I will inspect the perineum for lacerations and tears as well.
=I will give the woman a pad and leave her comfortable.
=I will take note of the findings and if there is any tear I will suture to stop the bleeding.

CONTROL OF BLEEDING
= I will observe for any perineal lacerations to manage bleeding.
=I will measure blood loss if any and treat accordingly.
=I will ensure and observe uterus contractions as this also compresses blood vessels causing blood loss to be less.

REST
=I will ensure the room is free from noise to promote rest.
= I will do all related procedures in blocks to promote rest.
=I will allow the woman to be in her comfortable position to promote comfort and relieve pain thereby promoting rest.

EXAMINATION OF PLACENTA .
=I will examine all the two surfaces of the placenta the maternal and the fetal.
=I will put on clean gloves on both hands to prevent infections.
=I will inspect the cut end of the cord for the presence of two arteries and one vein to rule out conge***al cardiac abnormalities.
=I will drain out all the blood and measure it to rule out postpartum hemorrhage.
=Measure the cord.
=I will hold the placenta in the palms of the hands with the maternal side facing upwards.
=I will hold the cord with one hand inside the membranes with fingers spread out.
=I will Insert the other hand inside the membranes with fingers spread out.
=I will check whether all of the lobules are present and fit together.
=I will inspect the membranes for completeness by stripping the membranes.
=I will note the position of the insertion of the cord.
=I will decontaminate all the equipment used to prevent any cross infections.
=I will note the findings and if any missing part of the placenta and membranes are discovered evacuation or dilatation and curative may be considered.
=I will dispose of the placenta and membranes by incineration or place it in a leak proof.
=I will immerse both gloved hands in 0.5% chlorine solution then remove by turning them
=I will record all findings on the woman’s records.
=I will wash my hands thoroughly with soap and water and dry with a clean dry cloth or air dry.
=I will record all findings on the woman’s records.

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Mrs. Catherine Katuta, aged 45 years, has been admitted to the ward with a diagnosis of cancer of the bladder. Bladder cancer is a malignant growth that develops in the tissues of the urinary bladder and may interfere with normal urinary function.

Signs and Symptoms of Bladder Cancer
Mrs. Katuta may present with the following signs and symptoms:

✅Hematuria (blood in the urine).
✅Dysuria (painful urination).
✅Increased urinary frequency.
✅Urinary urgency.
✅Lower abdominal, pelvic, or back pain.

Differences Between Benign and Malignant Tumours

Benign tumours grow slowly, are usually encapsulated, remain localized, do not spread to other parts of the body, and rarely recur after removal. Malignant tumours grow rapidly, are not encapsulated, invade surrounding tissues, spread to distant organs through metastasis, and may recur even after treatment.

Management of Mrs. Katuta

Chemotherapy

Chemotherapy involves the use of anticancer drugs to destroy cancer cells and prevent their multiplication.
As a nurse, I would explain the procedure and purpose of chemotherapy to the patient, obtain baseline investigations, administer prescribed cytotoxic drugs safely, monitor vital signs, encourage adequate fluid intake, observe for side effects such as nausea, vomiting, alopecia, diarrhea, and fatigue, administer antiemetics as prescribed, monitor blood counts, prevent infection through proper aseptic techniques, and provide emotional and nutritional support.

Radiotherapy

Radiotherapy involves the use of high-energy radiation to destroy cancer cells and reduce tumour size.
As a nurse, I would explain the procedure to the patient, ensure attendance of all treatment sessions, monitor for skin reactions and other side effects, encourage adequate rest and nutrition, maintain hydration, administer prescribed medications, and provide psychological support and reassurance throughout treatment.

Palliative Care for Mrs. Katuta

Palliative care aims at improving the quality of life of the patient by relieving suffering and promoting comfort.
I would assess and manage pain using prescribed analgesics, monitor urinary symptoms and hematuria, maintain catheter care where necessary, prevent infections, ensure adequate nutrition and hydration, assist with personal hygiene, reposition the patient regularly to prevent pressure sores, and promote rest and sleep.

I would also provide emotional support by encouraging the patient to express her fears and concerns, reassuring her, reducing anxiety, and involving her in decisions regarding her care.
Family members would be encouraged to participate in care, and social support services would be arranged where necessary. Spiritual needs would be respected by facilitating prayer and visits from religious leaders according to the patient's wishes.

Throughout care, I would maintain the patient's dignity, privacy, and comfort, manage distressing symptoms promptly, educate the patient and family about the illness and treatment, and provide support to the family before and after death if necessary.

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This image shows a posterolateral view of the lumbar spine. The yellow structure is a spinal nerve root, and the whitish bulging structure projecting backward from the intervertebral disc is consistent with a herniated (pr*****ed) intervertebral disc.

What is happening here?
The intervertebral disc lies between two vertebral bodies.
Normally, the disc's soft center (nucleus pulposus) is contained by the tough outer ring (annulus fibrosus).

In a disc herniation, part of the nucleus pulposus protrudes through a weakened or torn annulus fibrosus.
The protruding disc material compresses or irritates the adjacent spinal nerve root (yellow structure).

Likely diagnosis
Lumbar intervertebral disc herniation with nerve root compression (radiculopathy).

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In my first semester I almost had a repeat course because of this BP machine (sphygmomanometer)💀

After Guessing the readings on a patient, kanshi the thing wasn't even working.🙄
(Osce nayeve sivintu)

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she sent me this picture I have failed to figure out the meaning 😭😔

🐍 SNAKE BITE 🐍

A snake bite occurs when a snake injects venom into the body through its fangs. While not all snakes are venomous, bites from venomous snakes can quickly become life-threatening if not managed promptly.

🔬 What Happens in the Body After a Snake Bite?
Once venom enters the tissues, it begins to spread through the lymphatic and circulatory systems. The effects depend on the type of venom injected:

🧠 Neurotoxic Venom This venom attacks the nervous system by interfering with nerve impulse transmission at the neuromuscular junction. As a result, muscles fail to receive signals from nerves, leading to: • Drooping eyelids • Difficulty speaking and swallowing • Muscle weakness • Respiratory paralysis
🩸 Hemotoxic Venom This venom affects blood cells, blood vessels, and clotting factors. It may destroy red blood cells or prevent blood from clotting properly, resulting in: • Bleeding from gums and nose • Internal bleeding • Shock • Organ damage

🦵 Cytotoxic Venom This venom destroys cells and tissues at the bite site. It causes: • Severe pain • Swelling • Blister formation • Tissue necrosis (tissue death)
💪 Myotoxic Venom This venom damages skeletal muscles, causing: • Muscle pain and weakness • Release of muscle proteins into the blood • Dark urine • Kidney injury

⚠️ Signs and Symptoms
✔ Fang marks ✔ Pain and swelling ✔ Nausea and vomiting ✔ Dizziness ✔ Difficulty breathing ✔ Bleeding tendencies ✔ Paralysis

🚑 First Aid
✅ Keep the victim calm. ✅ Immobilize the affected limb. ✅ Remove rings, watches, and tight clothing. ✅ Seek immediate medical attention.

❌ Do NOT cut the wound. ❌ Do NOT suck out the venom. ❌ Do NOT apply ice. ❌ Do NOT use a tight tourniquet.

💉 Treatment
The definitive treatm
ent for significant venomous snake bites is antivenom, along with supportive care to maintain breathing, circulation, and organ function.

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