Obstetrics for NursesReed, Charles B. (Charles Bert)
Science
Obstetrics for Nurses
Reed, Charles B. (Charles Bert)
Maternity nursing
=Intravenous Injections.=—The vein in the front of the elbow is usually
chosen. (Median basilic or median cephalic.) A rubber bandage or
tourniquet is wound tightly about the middle of the upper arm to make
the veins stand out prominently. The surface of the skin should be
sterilized for operation by scrubbing with green soap and hot water and
rinsing with 50 per cent alcohol, followed by 1:2000 solution of
bichloride, or by the application of tincture of iodine.
The hypodermic needle is then introduced after expulsion of all the
contained air and the piston is drawn up until the blood enters. This
assures the operator that the needle has entered the vein. The bandage
is now loosened and the solution of the drug is introduced very slowly.
Intravenous infusion or transfusion is given in the same way. The fluid
(normal saline?) must be running from the needle as it is introduced.
=Hypodermoclysis= is the introduction of normal saline solution, under
the skin, or under the breasts. The solution may be transfused also into
a vein.
By this operation, the quantity of fluid in the vessels is greatly
increased and a circulatory stimulant is provided. Normal saline also
promotes diuresis and aids in the removal of wastage.
The principal dangers arise from too great rapidity or too large a
quantity of the flow.
The skin should be sterilized at the point of attack by a coating of
tincture of iodine.
The _instruments_ required are, a bath thermometer, a douche can
(fountain syringe) with long tubes and an aspirating needle. A
hypodermic needle will do, but the reservoir must be well elevated since
the caliber is so small. Ordinarily the reservoir need be held only two
or three feet above the point of discharge. The water should be flowing
through the needle when it enters the tissues. If the fluid is to be
introduced under the skin, the best place is in the loose region between
the hips and the ribs in front. If under the mammary gland, the needle
must go _below_ and under the gland from the outside edge, not into the
gland. If into a vein, such additional instruments will be needed as a
rat-toothed tissue forceps, a pair of sharp-pointed scissors, a knife
and some fine catgut. From four to sixteen ounces of fluid may be used
at a temperature varying from 105° to 110° F.
The openings where the needles entered are closed by cotton and
collodion.
=Curettage of uterus= is done for abortion or puerperal sepsis when
foreign fragments are left in the uterus. The room is prepared as for
delivery.
The instruments are:
1 vaginal retractor.
1 vulsellum forceps.
1 long uterine douche point.
2 dull curettes.
2 sharp curettes of different sizes, together with gauze for
packing the uterus.
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