Obstetrics for NursesReed, Charles B. (Charles Bert)
Science
Obstetrics for Nurses
Reed, Charles B. (Charles Bert)
Maternity nursing
In any case, the patient should be put to bed and fed carefully every
two or three hours on milk, peptonized food or barley water. If this is
not retained, albumin water may be given for twenty-four hours at
regular intervals, or rectal alimentation may be tried after stopping
all foods by mouth. Iced champagne, seltzer or Vichy, either alone or
with milk, may be tried. A dry diet is sometimes effective, rusk, toast,
toasted shredded wheat biscuit, crackers, etc., taken early in the
morning, as one eats cheese. No exercise is permitted except such
muscular and nervous excitation as may be derived from massage or the
sedative bath.
Drugs are sometimes of great value—the bromides, in full doses, or 1 m.
doses of tincture of iodine, well diluted, every hour; or bismuth with
hydrocyanic acid; or cocaine or oxalate of cerium. Occasionally good
results are reported from a capsule of pepsin, 2 gr. and ¼ gr. silver
nitrate given just before meals; and adrenalin in 10 drop doses may be
considered. Extract of corpus lutea has been tried by Hirst with
favorable results.
Sinapisms to the epigastrium and ice bags to the spine have been found
useful, and washing out the stomach is efficient at times. In washing
out the stomach, be sure the stomach tube is _iced_ before it is
introduced.
When the case gets worse in spite of treatment and acidosis supervenes,
bicarbonate of soda may be given in sixty grain doses every four hours,
by rectum, if necessary, until the urine gives an alkaline reaction.
Glucose as a readily assimilable carbohydrate may be given in doses up
to 10 oz. of a 6 per cent solution (Eden) or sugar infusions by rectum,
1000 c.c. in twenty-four hours by drop method.
_The obstetric treatment_ is the emptying of the uterus. To be effective
the abortion must be done before the condition of the patient is
desperate. It is most favorable before the febrile stage. If the
vomiting persists in spite of treatment and is accompanied by
emaciation, a pulse of over 100, albumin in the urine, with an increase
of the ammonia output, the pregnancy should be terminated at once. If
the patient can not go to a hospital, the nurse should prepare the room
as described for operations.
After emptying the uterus, the vomiting usually ceases but much labor is
thrown upon the nurse in supplying nourishment and caring for an
exhausted and whimsical patient.
The back must be inspected daily for decubitus (bed sores) and her
position changed frequently. A daily rub with alcohol and water (50 per
cent) followed by an oil inunction will be valuable. The teeth and gums
should be cleaned with gauze, wrapped around the finger and dipped in
solution of boric acid. No brush should be used.
[Illustration: Fig. 29.—Twins. (Lenoir and Tarnier.)]
=Multiple Pregnancy.=—Twins occur about once in ninety labors, triplets,
once in seven thousand.
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