Obstetrical Nursing: A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her BabyVan Blarcom, Carolyn Conant
Science
Obstetrical Nursing: A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her Baby
Van Blarcom, Carolyn Conant
Infants -- Care; Maternity nursing; Pregnancy
Since the retention of even a small piece of placental tissue will
prevent the uterus from contracting firmly, the treatment of hemorrhage
from this cause is immediate removal of the retained fragment. It is to
obviate this occurrence that the placenta is carefully inspected after
its expulsion. If it is not intact, the obstetrician may introduce his
finger and remove the retained portion, thus making it possible for the
uterus to contract properly and close off the open blood vessels.
Atony, or impaired tone of the uterine muscles, may result in hemorrhage
because of failure of the muscle fibres to constrict the vessels. Quite
evidently, the first step toward controlling hemorrhage from this cause
is to stimulate the muscles to contract; this is done by means of
massage and the administration of pituitrin and ergot. Elevation of the
foot of the bed and application of ice-bag to the abdomen are also
employed.
In severe cases, the doctor may give an intra-uterine douche of hot,
sterile salt solution and if this fails he may pack the uterus tightly
with sterile gauze. The douche and pack represent operative maneuvers
and, therefore, are never to be undertaken by the nurse. Her assistance
is important, however, as strictest asepsis is imperative and she will
have to prepare the patient and the necessary articles with the greatest
care.
Should bleeding become profuse during the doctor’s absence _the nurse
must stay with the patient and massage the fundus_ and have some one
else elevate the foot of the bed on the seat of a straight chair or upon
firm blocks and summon the doctor. In anticipation of such an emergency
the nurse must always have an understanding with the doctor about the
administration of pituitrin and ergot. If there has been no
understanding, and the doctor is delayed or the bleeding becomes
alarmingly profuse, the nurse will usually be upheld if she gives 1
cubic centimetre of pituitrin, hypodermically and a dram of ergot by
mouth.
It is, of course, definitely understood that nurses do not give
medicines without orders, but a single dose of pituitrin and ergot upon
the occurrence of a profuse hemorrhage can scarcely do harm and may
actually save the patient’s life. Such a situation is an emergency
fortunately a rare one, and the nurse will have to be quick-witted and
use the best judgment she is capable of.
The patient is usually more or less shocked by the time the bleeding has
been controlled and needs the rest, quiet and stimulation that are
ordinarily employed in such cases. She should be well wrapped in
blankets and surrounded with hot water bottles _placed outside the
blankets, watched constantly and moved frequently_; salt solution or
strong coffee are sometimes given by enema, or saline infusions or
intra-venous injections may be given. The patient must be kept warm and
quiet and pressed to drink large amounts of fluids.
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