Obstetrics for NursesReed, Charles B. (Charles Bert)
Science
Obstetrics for Nurses
Reed, Charles B. (Charles Bert)
Maternity nursing
In the course of the first three days, the _temperature_ may rise to
100° F. in a case entirely normal. It has no pathological significance
unless persistent or increasing. The temperature should be taken night
and morning, and in complicated cases every four hours. All temperatures
over 100° F., after the initial rise and descent just described, must be
regarded as septic.
The _pulse_ does not rise with the temperature of the first three days,
but remains firm or even falls a little. When the pulse rises and the
temperature sinks, it means hæmorrhage.
The _urine_ is usually increased for the first few days and then returns
to the normal for that patient. The labor affects the patient like a
surgical operation.
The _digestion_ is disturbed. The appetite is gone, and the stomach must
be treated gently until its tone is restored. The body in repose is less
urgent in its demands for food. Liquids in abundance form the staple
diet for the first two days. For the next three days, semisolids may be
added, and after the milk is well established, a general diet is
desirable; but so long as the mother nurses her child, the liquids must
preponderate in most cases.
[Illustration: Fig. 60.—The progress of involution on the various days
of the puerperium. (von Winchkel, from Knapp.)]
Meanwhile, certain changes are taking place in the pelvis that are
highly important.
=Involution= is the process undergone by the uterus in returning to its
normal nonpregnant state. This shrinkage can be followed abdominally and
is registered by the nurse in the number of finger-breadths or
centimeters above the symphysis pubis.
Edgar gives the rate of shrinkage as follows:
After delivery, 5.92 in. long, or 15.8 cm.
2nd day, 4.63 in. long, or 11.30 cm.
3rd day, 4.37 in. long, or 11.10 cm.
6th day, 3.42 in. long, or 8.48 cm.
8th day, 2.55 in. long, or 6.40 cm.
10th day, 2.22 in. long, or 5.60 cm.
The rate of involution not only varies greatly with different women, but
varies much after the different labors of the same woman.
Ordinarily at the end of the first week the fundus should lie midway
between the navel and the pubes, and should shrink rapidly thereafter.
The necessity for watching the rate of involution is imperative for a
number of reasons. If involution is slow, or stops, it may indicate
fatigue of the muscle from multiparity or over-distention (twins,
hydramnios, etc.) or it may follow a post partum hæmorrhage.
Subinvolution may also indicate infection, the retention of clots, or
pieces of placenta. It happens also when the woman gets up too soon or
does not nurse her child and thereby delays the restoration of her
waistline, as well as diminishes her resistance to disease.
=The binder= is objectionable to some doctors on the ground that it
favors retroversion of the uterus during involution.
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