A reference hand-book for nurses

by Amanda K. Beck

FETAL CIRCULATION.

From Kimber’s Anatomy.

The peculiarities of the fetal circulation, leaving details aside, are: the direct communication between the two auricles of the heart, through an opening called the foramen ovale; the communication between the pulmonary artery and descending portion of the arch of the aorta, by means of a tube called the ductus arteriosus; and the communication between the placenta and the fetus, by means of the umbilical cord.

The arterial blood for the nutrition of the fetus is carried from the placenta along the umbilical cord by the umbilical vein. Entering the fetus at the umbilicus, the blood passes upward to the liver and is conveyed into the inferior vena cava in two different ways. The larger quantity first enters the liver, and, alone or in conjunction with the blood from the portal vein, ramifies through the liver before entering the inferior vena cava, by means of the hepatic veins. The smaller quantity of blood passes directly from the umbilical vein into the inferior vena cava, by a tube called the ductus venosus.

In the inferior vena cava the blood from the placenta becomes mixed with the blood returning from the lower extremities of the fetus. It enters the right auricle and, guided by a valve—the Eustachian valve, passes through the foramen ovale into the left auricle. In the left auricle it unites with a small quantity of blood returned from the lungs by the pulmonary veins. From the left auricle the blood passes into the left ventricle and is distributed by the aorta almost entirely to the upper extremities by the superior vena cava, the blood enters the right auricle, and, passing over the Eustachian valve, descends into the right ventricle, and from the right ventricle into the pulmonary artery. As the lungs in the fetus are solid, they require very little blood, and the greater part of the blood passes through the ductus arteriosus into the descending aorta, where, mixing with the blood delivered to the aorta by the left ventricle, it descends to supply the lower extremities of the fetus, the chief portions of this blood, however, being carried back to the placenta by the two umbilical arteries.

Diagrammatic view of the fetal circulation
(Dorland).

From this description of the fetal circulation it will be seen:

1. That the placenta serves the double purpose of a respiratory and nutritive organ, receiving the venous blood from the fetus, and returning it again charged with oxygen and additional nutritive material.

2. That the greater part of the blood traverses the liver before entering the inferior vena cava; hence the large size of this organ at birth.

3. That the blood from the placenta passes almost directly into the arch of the aorta and is distributed by its branches to the head and upper extremities; hence the large size and perfect development of those parts at birth.

4. That the blood in the descending aorta is chiefly derived from that which has already circulated in the upper extremities and, mixed with only a small quantity from the left ventricle, is distributed to the lower extremities; hence the small size and imperfect development of these parts at birth.

NURSING IN DISEASES
OF CHILDREN.

Spasmodic Croup.—Spasmodic croup is due to a sudden closure of the glottis.

Causes.—Exposure to a cold, damp atmosphere, indigestion, or irritation of the throat. There may be some hoarseness a few hours preceding the attack and the child awakens suddenly in the paroxysm of the sharp croup cough, experiences difficulty in breathing and has the cyanotic appearance so terrifying to the mother, but which need give no cause for serious alarm.

Treatment.—Apply hot compresses about the throat. If the attack is severe give an emetic—one dram of salt or mustard in one-half cup of warm water, and repeat in twenty minutes if necessary; an enema of warm water should be given and steam inhalation resorted to. Keep the child in an even temperature, restrict diet for a few days, and keep bowels active.

Parotitis (Mumps).—An infectious disease characterized by inflammation of the parotid glands. Incubation is from two to three weeks.

Symptoms.—The disease comes on with a mild chill, pain below the ear and swelling of the glands. There is great discomfort and the tension is very disagreeable.

Treatment.—Keep patient in bed during the height of the disease. Give liquid and soft diet. Bowels should be opened freely. No medicine is required unless fever is high. Apply cold compresses to the affected part, though, if preferred, hot ones may be used. A pad of cotton with oiled silk is the best application. In cases of extreme redness or tenderness of the glands, leeches may be applied. In cases of delirium use the ice-cap. For orchitis, lubricate the parts with camphorated oil and support with a soft cotton pad.

Duration of disease, from seven to ten days.

Whooping-Cough.—An infectious disease, beginning with catarrh of the air-passages, like an ordinary cold. The short expiratory coughs following each other in rapid succession and the period of drawing a long breath give rise to the whoop characterizing pertussis.

Incubation.—A week to ten days.

Treatment.—Isolate patient and if attack is severe put him in bed. Fresh air is the most essential element. If the cough is distressing, ipecacuanha wine and paregoric may be given. During convalescence the child should be watched carefully, as at this period bronchopneumonia and tuberculosis are apt to develop. Change of air is advisable. Tonics and cod-liver oil should be employed. The diet should be easily digestible, nourishing food. After each paroxysm and after the child has recovered from the exhaustion it produces give nourishment. There will be a partial if not complete absorption of the food before another attack. Duration of the disease from six to twelve weeks.

Colic.—Causes.—Constipation, indigestible foods, flatus, overfeeding, improper foods and exposure to cold.

Symptoms.—Child cries out very suddenly and sharply. There is a convulsive movement of the extremities, the hands are tightly closed, abdomen is tense.

Treatment.—Gentle pressure and massage with warm oil over the abdomen and a few doses of hot or peppermint water will expel the gas. Burnt brandy is good. The simple warm enema is a common remedy. Wrap warm flannels around the lower parts of the body and keep the hands warm.

Diarrhea.—Frequent loose evacuations without tenesmus.

Causes.—Impure water or food; irritating secretions poured into the bowels; bottled milk.

Diet should be restricted to cereal and albumin water. Flush the bowels very gently with warm water.

Dysentery.—Symptoms.—Fever, tenesmus and frequent small mucous, bloody stools. Treat as diarrhea. Keep child warm, especially about the abdomen.

Cholera Infantum (Summer Complaint).—Symptoms.—Fever, intense thirst, continuous vomiting, and purging of the bowels. Stools soon become watery and pale-green in color, and the child has all appearances of complete prostration.

Treatment.—Stomach washing and intestinal irrigation carefully given. Restrict diet to barley water containing a few drops of brandy and give hourly for a few days.

Rickets.—A disease of infants, characterized by impaired nutrition of the entire body and alteration of growing bones.

Causes.—Not positively known. Heredity may be a predisposing factor. Another theory given is want of sunlight, impure air, prolonged lactation, and suckling. As it is a constitutional disease it is almost certain to be due to a disturbance of nutrition. It is much less found in the breast-fed than in the artificially fed and more common when the artificial feeding is bad than when it is properly given.

Scurvy is a constitutional disease of metabolism due to a faulty diet. Probably the absence of some constituents in the nature of vitamins. Scurvy and rickets are two distinct diseases, and yet both may be due to impure, improper infant feedings.

Three General Symptoms of Great Importance.—First, a diffuse soreness of the body, so that the child cries when an attempt is made to move it; second, slight fever; third, profuse sweating. Deformities may often be prevented if, in the early stages, constant care is taken that the child is properly held.

Thrush.—Aphthæ.—Small white, furry mouth ulcers developing during the first and second year of infancy.

Cause.—Lack of cleanliness in the care of the mouth, especially after feeding with bottled milk. The patches are tenacious, grow larger, until sometimes they involve the entire gastro-intestinal tract, resulting in acute indigestion and bowel disorders.

The first symptom is usually some evidence of painful distress in the infant’s efforts to nurse; fever, diarrhea and vomiting occur and the trouble may become acute.

Treatment.—Absolute sterile cleanliness in the preparation and administering of the patient’s food. The mouth must be cleansed with warm boric acid solution after every feeding. The patches should be touched gently with the same solution, and the lips anointed with a soothing lotion.

Convulsions.—The principal predisposing causes are infancy conditions affecting the nutrition of the brain and hereditary influences. The brain grows more during the first year than in later life, and this rapidity of growth is in itself an important predisposing cause of functional derangement. After infancy attacks of convulsions are much less frequent, and after seven years they are relatively rare. Death may take place from a single attack in very young infants, especially those who are rachitic.

Convulsions may be thought to indicate the onset of some acute disease when they occur in a child over two years old, and when they come on suddenly or with only slight premonition in a child previously well; but the most important point is that they are accompanied by a high temperature—104°-106° F. Acute meningitis is the only other condition likely to produce these symptoms. Whether the convulsions mark the onset of lobar pneumonia, scarlet fever, malaria, or some other disease can be determined only by carefully watching the patient’s symptoms for 24 or 36 hours.

In convulsions depending upon some disorder of the alimentary tract, we may get a history of chronic constipation or improper feeding, and in nursing infants, sometimes of passion or intoxication in the wet-nurse. Convulsions are so frequently due to digestive derangement that the condition of these organs should be one of the first things to be looked into. Examination of the urine should never be omitted in any case of convulsions of doubtful origin, even where no dropsy is present. This, both in infants and older children, is too often overlooked. In all cases of convulsions of doubtful or obscure origin occurring in infants, rickets should be suspected as the underlying cause, and the child carefully examined for other evidences of that disease.

Treatment.—Cold should be applied to the head, best by means of an ice-cap or cold cloths, and dry heat and counterirritation to the surface of the body and extremities.

The Mustard Pack.—The child is stripped and laid upon a blanket, and the trunk is surrounded by a large towel or sheet saturated with mustard water. This is made as follows: 1 tablespoonful of mustard, 1 quart of water. In this the towel is dipped and, while dripping, wound around the entire body. The patient should then be rolled in the blanket. This pack may be continued for 10 or 15 minutes; at the end of which time there will usually be a very decided redness of the whole body. It may be repeated, according to indications. Where it is desired to produce general counterirritation, the mustard pack is not quite as efficient as the mustard bath, but it has the advantage in causing much less disturbance to the patient. The mustard pack is useful in the conditions of collapse, or of great prostration from any cause whatever, in convulsions, and in cerebral or pulmonary congestion. The degree to which the counterirritant of the skin should be carried will depend upon the condition of the pulse and the cyanosis. The feet may be placed in mustard water while the child lies in its crib (Holt).