She bathes the vulva with pledgets and an antiseptic solution, using forceps, and then separates the labia with two dry pledgets, one each under forefinger and thumb of the left hand, and proceeds as above. It will be observed that the nurse avoids touching the inner surface of the labia or the meatus with anything but sterile pledgets and the sterile catheter. The advantage of this procedure is that it is accomplished quickly and with the minimum of disturbance to the patient.
A distended bladder may so easily occur unless the patient is carefully observed during the puerperium that the nurse should charge herself to watch for this complication. She should give the patient a bedpan every four hours, note the contour of the abdomen and measure the urine during the first week, remembering that the patient should void considerably more than the average amount, both because of the amount of milk and water that she is taking, and the fluid which she is eliminating from her tissues. The importance of measuring the urine lies in the fact that though the patient may void fairly regularly she may not empty her bladder, and thus enough urine may accumulate to distend it.
The temperature, pulse and respirations are usually taken and recorded every four hours for the first five or six days and then two or three times daily, if normal. If the temperature is above normal at any time, the nurse should take it every two hours until it becomes normal and notify the doctor immediately if it goes as high as 100.4° F., or if the pulse reaches 100.
Care of the Perineum. The best way of caring for the perineum, during the first week or ten days after delivery, is a moot question, and the nurse may find herself sorely perplexed by the widely divergent instructions of different doctors who have excellent results, unless she goes back of the details themselves and recognizes their purpose. She will then see that there is entire agreement about the importance of protecting the patient against infection, at this time, when infection may so easily occur. And so far as the nurse is concerned, this means cleanliness as to methods and appliances, when making perineal dressings, and extreme precaution against conveying infection to her patient. The minimum requisites for this are that the bedpan shall be sterilized, by steam or boiling, at least once a day, and well scrubbed and scalded after each time that it is used, and that the nurse shall at least scrub her hands with soap and hot water before making each perineal dressing, and apply only sterile pads.
After the perineum is bathed, immediately following delivery, the usual practice is to apply a sterile pad, after which a fresh one is applied as often as necessary at first, every four hours during the first week and subsequently every eight hours. When the dressing is changed, and after each voiding and defecation, the perineum is bathed with sterile pledgets and some such antiseptic solution as bichlorid 1–2,000 or lysol ½ per cent. or 1 per cent. (Figs. [117] and [118].) The soiled pad must always be removed from above downward and the bathing also directed toward the rectum, each pledget being used for one stroke only. The rectum is bathed last, a fresh sterile pad applied and the patient’s hips and back thoroughly dried.
The nurse may be required to scrub and soak her hands, wear sterile gloves and hold the pledgets in forceps when bathing the perineum, the object of such precautions being, quite clearly, to avoid infecting the patient from without, for the inner surface of the uterus is still regarded as an open wound.
Fig. 117.—Preparation and draping of patient for post-partum dressing. Note rack of equipment on table; bag of dry, sterile pledgets at head of bed; paper bag on floor for used pledgets. The nurse has scrubbed her hands. (From photograph taken at The Manhattan Maternity Hospital.)
Some obstetricians believe that the perineal pad is a menace, since it slips and moves about, and thus may transfer infective material from the anus to the vagina. Accordingly, they forbid the use of all perineal dressings and instead have large, sterile, absorbent pads slipped under the patient’s hips to receive the lochia, the pads being changed as often as necessary. This is the practice at the Brooklyn Hospital, for example, where the nurse bathes the vulva with lysol 1 per cent., placing the patient on a sterile bedpan, using sterile forceps and cotton swabs and wearing sterile gloves while making the dressing.
Another method is to place the patient on a sterile bedpan, remove the pad and with gloved hands pour from a sterile pitcher a warm antiseptic solution over the groin and outside of the vulva; then to separate the labia and pour the solution between them, in some instances pressing a dry, sterile pledgets to the vaginal orifice during the irrigation.