Patients should always be encouraged to empty their bladder naturally:
many are unable to pass water whilst lying on their backs. In these
cases the urine is drawn from the bladder by a carefully sterilized
glass catheter. Before passing the catheter, the nurse carefully wipes
away the mucus from the urethral orifice. Cleanliness and care with the
catheter must be enforced: cystitis causes much misery. During the first
few days the quantity of urine passed by the patient is measured, and
recorded in the notebook.
The temperature should be observed every four hours during the first
week and recorded. The first record after the operation is usually
subnormal, and in twelve hours it rises to normal or beyond. During the
first twenty hours it may rise to 100° without causing alarm; beyond
this, if accompanied by a rapid pulse, an anxious face, and distended
belly, it will cause anxiety to the surgeon. A temperature of 101° or
102° unaccompanied by other unfavourable symptoms is not a cause for
alarm, unless maintained.
The state of the pulse is a valuable guide and more trustworthy than the
temperature. When the pulse remains steady and full there is no cause
for alarm. When it increases in frequency to 120 or 130 beats per
minute, and is thin and thready, then there is danger, even if the
temperature is only slightly raised.
On the seventh or eighth day the sutures will require removal.
Occasionally a hæmatoma forms in the wound; and in patients in whom the
operation has been performed for septic conditions, stitch abscesses
will occur. In septic cases the sutures require to remain a few days
longer, to allow the wound to unite more securely.
When oöphorectomy, ovariotomy, or hysterectomy is followed by a
non-febrile convalescence the patient may be allowed to leave her bed on
the fourteenth day, and at the end of another week she may return to her
home or go to the seaside according to circumstances. When the wound has
healed by primary union, and this is usual where aseptic methods have
been followed and buried sutures employed for the fascial and muscular
layer, an abdominal belt is unnecessary. When suppuration has taken
place in the wound and healing has been retarded, especially in a
patient in whom operations have been performed for septic conditions, it
is a useful precaution to advise her to wear a well-made belt. This is
more necessary for women who have to get their living by hard work.
COMPLICATIONS OF ABDOMINAL GYNÆCOLOGICAL OPERATIONS
=Metrostaxis.= After ovariotomy and oöphorectomy, unilateral or
bilateral, blood sometimes escapes from the uterus in the course of the
first week, and simulates menstruation: it sometimes occurs within
forty-eight hours of the operation, and is usually ushered in with a
rise of temperature (100°-101°).
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