Obstetrics for NursesReed, Charles B. (Charles Bert)
Science
Obstetrics for Nurses
Reed, Charles B. (Charles Bert)
Maternity nursing
Rubber gloves should be worn both by nurse and physician as much for
personal protection as for the patient’s safety. In many cases of
incomplete abortion or of puerperal sepsis the endometrium is more
satisfactorily curetted with the gloved fingers.
=Abortion= may be indicated in many of the early complications of
pregnancy, such as hyperemesis, nephritis, uncompensated heart lesions,
tuberculosis, insanity, hydramnios, incarcerated retroversions of the
uterus and the presence of hæmorrhage. These cases require the operation
to be undertaken and finished by the doctor, but other conditions
develop wherein, without volition on the part of the patient or doctor,
the abortion begins. Some may be saved, but at times the attempt is
futile.
If the emptying of the uterus seems inevitable, the function of the
physician is to see that the process is finished as quickly and cleanly
as possible.
This may be done in the early stages by packing the cervix and vagina
with iodoform gauze and administering ergot in twenty-five drop doses
thrice daily.
In case of dangerous hæmorrhage from spontaneous abortion, the vagina
can be tamponed with cotton pledgets or gauze by a clean nurse while
awaiting the arrival of the doctor.
When the uterus has partially emptied itself and the retained fragments
prevent the complete contraction and allow of serious bleeding, or if
the fragments are septic, then their removal is required. This is done
by the finger or curette.
The preparation of rooms, patient and doctor are the same whether the
operation is for therapeutic or incomplete abortion. These have been
described.
The instruments are:
1 pair dressing forceps.
2 vaginal retractors.
artery forceps.
2 curettes of different sizes.
2 vulsellum forceps.
1 long uterine douche point.
1 pair Goodell dilators.
1 douche can.
[Illustration: Fig. 89.—Pean forceps.]
=The induction of labor= at or near term is done for pelvic contraction,
maternal disease, for danger threatening mother or child, or to avoid
the birth of a post-mature child. A variety of methods may be employed,
but the Vorhees bag is best.
_Technic._—Assemble, and sterilize by boiling twenty minutes, a Vorhees
bag No. 3 or 4, Simon speculum or vaginal retractor, 1 pair long Pean
forceps, 2 pairs vulsellum forceps, 1 dressing forceps, 2 pairs
compression forceps, 1 Goodell dilator, 1 tenaculum forceps, Davidson
hand bulb syringe with glass tubes and rubber connections for the bag.
Patient, prepared as for delivery, is placed upon the table in
exaggerated lithotomy position. Stirrups will serve.
The vagina is retracted, a smear made from cervix, and the mucous
membrane wiped clean with pledgets of gauze on forceps.
Anæsthesia is only occasionally necessary even in primiparas.
[Illustration: Fig. 90.—_A_, Hand bulb syringe; _B_ and _C_, Vorhees
bags; _D_, Bag rolled and grasped by Pean forceps ready for
introduction.]
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