Obstetrics for NursesReed, Charles B. (Charles Bert)
Science
Obstetrics for Nurses
Reed, Charles B. (Charles Bert)
Maternity nursing
During the first stage, light and easily digested food and drinks may be
served, either cold or hot, as the patient prefers.
When the doctor arrives he may want to examine the patient either
externally or internally, or both. So a sheet is thrown across the lower
part of the body and the night-dress pulled up as far as the breasts.
=For the external examination= the doctor washes his hands in warm water
and green soap and scrubs with the nail brush for five minutes. This
period should be prolonged to fifteen minutes, if, by any mischance, the
hands have been in contact with pus or infectious material. It is
extremely difficult to get them even approximately clean after such an
experience.
[Illustration: Fig. 53.—Palpation. What is in the pelvis? (Eden.)]
He now palpates the abdomen, notes the location of the head and back,
finds and counts the heart tones, measures the pelvis and child,
estimates the descent of the head and the character of the pains.
[Illustration: Fig. 54.—Palpation. What is in the fundus? (Eden.)]
If he thinks an internal examination is necessary, he will now return to
the bathroom, pare and clean his nails, scrub hands and arms to elbows
for ten minutes in running water with green soap and a sterile brush,
soak the hands in lysol solution 0.5 per cent for five minutes.
Bichloride of mercury solutions have no place in obstetrics. They ruin
instruments and hands, and are valueless for asepsis since the mercury
unites with the albumin of the mucoid discharges and forms an albuminate
of mercury, which is inert. The bichloride solutions also are
nonlubricating, harsh and astringent, as well as poisonous, as soon as
the mucoid protection has been removed. When the doctor takes his hands
from the lysol solution, they should be wiped on a sterile towel. A
sterile gown is put on, if possible. If it is not available, he should
be careful not to touch anything that may destroy or contaminate his
preparation. The hands are powdered and sterile rubber gloves pulled on
(one will do.).
[Illustration: Fig. 55.—Palpation. Where is the back? Where are the
small parts? (Eden.)]
The nurse, meanwhile, has wrapped the legs of the patient in the ends of
a sterile sheet, the bulk of which covers the abdomen. The knees are
spread apart. The vulva cleansed with pledgets of cotton soaked in lysol
solution. One or two pledgets are used on either side of the vulva and
the same number for cleansing the introitus.
The fingers are now introduced.
The internal examination may be conveniently postponed until the waters
break, or it may be omitted altogether if the heart tones of the child
remain good, the labor progressive, and the head continually advances
into the pelvis, as determined by the external examination. The great
advantage of an internal examination at this time is the diagnosis of
the degree of dilatation and the assurance that the cord has not been
washed down into the vagina by the rush of fluid.
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