Obstetrics for NursesReed, Charles B. (Charles Bert)
Science
Obstetrics for Nurses
Reed, Charles B. (Charles Bert)
Maternity nursing
This would be a plausible theory when the uterus is high, if it were not
that the vertebræ of the patient and the pelvic brim keeps the uterus
from being pushed out of its place and after the uterus descends into
the pelvis the gentle pressure of the binder evenly distributed over the
abdomen can not affect it appreciably. Furthermore, the uterus in
involution shows a persistent tendency toward anteflexion and
anteversion.
The binder is merely a girdle put on just tight enough to hold in place
the bandage that supports the perineal pads and to allow the patient
more easily to grow accustomed to the sudden change in intraabdominal
pressure which the delivery of the child creates. However, if the doctor
objects to a binder, it may be left off with safety.
=The Lochia.=—When the placenta is delivered, the uterus normally closes
down and all gross hæmorrhages cease; but for the next two weeks or
possibly longer, a vaginal discharge continues. For the first few days
it is hæmorrhagic in character and it is called lochia rubra, and
consists mostly of fluid blood with occasional small clots. By the
fourth day, usually it has become brown and thinner. It is now called
lochia serosa. By the tenth day, it is yellowish-white, and is called
lochia alba.
The lochia is the wastage from the shrinking uterus, and is made up of
red blood corpuscles, epithelial cells, leucocytes, and pieces of
broken-down deciduæ. The entire lining of the uterus is loosened,
discharged and a new one formed during the puerperium. The lochia is
regularly infected by bacteria in the vagina. If involution is slow, the
lochial discharge may be prolonged.
=The After-Pains.=—The puerperium is not infrequently accompanied by
painful contractions of the uterus called after-pains. These are more
common in multiparas and serve a useful purpose in maintaining a
definite contraction of the uterus.
If the pains are at all severe, they are a suggestive symptom of the
retention of blood clots, a fragment of placenta, or of membrane. This,
of course, will occur either in a primipara or multipara. In all cases
the after-pains must be differentiated from gas and from the pains of
pelvic inflammation.
Gas pains can be relieved by hot spiced drinks, asafœtida and the high
rectal tube.
=Subinvolution= is treated by the administration of fluid extract of
ergot, in twenty to twenty-five drop doses, three or four times daily.
This will bring about the discharge of the irritating fragment or clot,
and the nurse can aid the process by gently massaging the uterus several
times daily or by giving a hot vaginal douche. Codeine may be used for
after-pains if absolutely necessary.
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