Obstetrics for NursesReed, Charles B. (Charles Bert)
Science
Obstetrics for Nurses
Reed, Charles B. (Charles Bert)
Maternity nursing
=Eclampsia= is the sudden appearance of convulsions in the course of
pregnancy. It may precede, follow, or accompany albuminuria. It occurs
rarely in the absence of albuminuria in a woman who was apparently in
good health. The two phenomena are best explained as a consequence of
toxæmia due to poisons at present unidentified.
_Treatment_ of the albuminuria is treatment for impending eclampsia.
Regular examination of the urine is indispensable. The presence of
albumin suggests toxæmia. The daily output of urine and the output of
urea must be compared, for a fall in urea is a premonitory sign of
eclampsia. The bowels and the skin should be stimulated, respectively,
by saline cathartics, hot baths and packs. The digestive organs must be
spared as much work as possible, especially the liver. Water is given in
abundance, and milk is the staple diet. Koumiss, butter milk and ice
cream may be allowed. As the patient improves, vegetables are allowed.
The food should be salt-free; and alcohol, as well as rich, indigestible
things should be forbidden. In the milder cases boiled fish and a little
chicken may be permitted.
The course of the disease and the condition of the patient is determined
by frequent examinations of the urine, while in all serious cases an
examination of the fundus of the eye must be made to detect a possible
albuminuric retinitis.
The treatment of eclampsia will be considered under the complications of
labor, where the attack usually begins.
=Pyelitis of pregnancy= is an acute, and rarely, a chronic infection of
the pelvis of the kidney, due to the Bacillus coli. It usually appears
after the fourth month (fifth to eighth) and attacks by preference the
right side. Extension to the kidney substance, ureters, and bladder is
occasionally observed.
_Symptoms._—Sudden, acute abdominal pain, at first diffuse, but after a
few hours, becoming localized in the right side, and on this account is
often confused with appendicitis, especially as vomiting is not
infrequent. A chill may mark the onset and the temperature rise to 103°
F. or 104° F. The bowels are constipated, the tongue coated, and there
is tenderness over the kidney. The urine is scanty, turbid, slightly
albuminous and contains pus and epithelium in the urinary canal. A
culture reveals the bacillus which has obtained access to the kidney,
either by extension of the ureter from the bladder, by direct invasion
of the tissues from the adjacent colon, or through the circulation.
_Treatment._—The diet should be fluid and mostly milk, the bowels should
be moved freely and frequently. The urine is alkalinized with sodium
citrate, since the Bacillus coli lives only in an acid medium. As the
symptoms subside, urotropin may be administered. If the patient does not
improve within two weeks, abortion must be seriously considered.
Nephrotomy is not to be thought of unless abortion has failed.
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