A reference hand-book for nurses

by Amanda K. Beck

Elimination.—The bowels must move regularly, and laxatives may be given if necessary. Alkalies should be given before bedtime, and effervescent powders in the morning. Enemata should not be resorted to unless absolutely necessary, as the sudden expulsion of the contents may produce abortion. The kidneys may be regulated by giving simple diuretics; plenty of pure water is the best. The condition of the kidneys is a most important factor in pregnancy. The urine should be clear and of sufficient quantity. Meats should be eaten but sparingly, as they over-produce albumin.

Baths.—Daily bathing in tepid water is very essential to encourage the elimination through the skin and to promote cleanliness. A cold sponge is stimulating and very agreeable to some patients.

Exercise.—Exercise should be moderate. Light work about the home may be encouraged, care being had to avoid over-lifting, over-reaching, etc. Walking should be insisted upon, to maintain correct carriage and posture of the body. Outdoor enjoyments may be had if indulged in with discretion. Tiredness may be overcome by the patient lying down on an incline, the head lower than the body, thereby relieving all tension of the muscles and nerves. Any recumbent position for comfort is beneficial.

Breasts and Nipples.—Plenty of room should be given to permit full growth and to encourage the nipples to prominence. Their inversion or depression may be remedied by massage and manipulation. No alcohol or other strongly astringent washes should be used. The nipples must not be hardened, but should be kept soft and pliable; cocoa-butter or other healing ointments may be applied. Cracks and fissures not only render nursing difficult or impossible, but may lead to mastitis and subsequent abscess formations. There should be perfect cleanliness, to promote pure secretion and prevent sepsis.

Pelvic Organs.—Pelvic organs do not, under normal conditions, require douches. The normal vagina cleanses itself, and a hot douche may induce abortion.

LYING-IN PERIOD.

Confinement Room.—A quiet room should be selected, in which there has been no recent sickness and which is not in proximity to any sewerage. The room should be well ventilated, with no draughts, and at a temperature from 65°-75° F. The furnishings should be plain and few as possible. They should consist of a table or two, a few chairs, and a narrow iron bed of medium height. If the bedspring is soft, a few boards may be placed under it to make it firm. If the patient is to be delivered in bed, it should be made up as follows: (1) Long rubber sheet; (2) long muslin sheet; (3) rubber draw-sheet; (4) muslin draw-sheet; (5) a large pad, 3 ft. square and 3 in. thick. All sheets should be fastened with large safety-pins, and the pad left free to draw the patient to either side, if the bed is of the low-and-wide variety commonly used in many homes. The ideal way is to deliver the patient on a settee, or on two tables, covered with a small mattress; the physicians and nurses have less work to do and they work to a better advantage. Moreover, when the patient is carried from the table to her clean, warm bed she gets immediate comfort and avoids the usual disturbance and uncleanliness attending the clearing away of soiled linen, etc.

Preparatory Treatment for Patient.—The patient should have a warm bath, and the genitals should be scrubbed thoroughly with soap and water. Shaving the parts is much to be desired if the patient has no objection, then an antiseptic pad should be applied. The nurse must be sure the bladder is empty; it is very important that a dribbling from an over-distended bladder should not be mistaken for frequent urinations; this is to prevent the danger of ruptured bladder from the constant pressure of a contracting uterus; also a distended bladder makes labor hard by interfering with the passage of the head.

During the First Stage.—The patient may be out of bed and encouraged to take exercise. She should not walk about too freely before the head is engaged, lest this induce a malpresentation or malposition. The patient’s crying should not be prevented, and she should be told not to press down. She may have a cup of hot water or tea, but no stimulant, as an anesthetic may become necessary.

During the Second Stage.—All clothing should be removed but the night-dress. Pin the gown up under the arm, put on perineal drawers, and a sheet around the body, then place the patient in bed. The pain in the back may be relieved by pressure over the sacrum, and the patient should be encouraged to hold her breath. The nurse should now use tact to quiet the patient, having hitherto managed, if possible, to encourage calmness. For cramps in the limbs, the muscles may be moved and firm pressure applied. A handkerchief bound tightly around the affected part may relieve it. A sheet may be tied to either side of the bed, for the patient to grasp, and a block placed at the foot of the bed for a brace for her feet.