Take temperature, pulse, respirations and blood pressure (to take blood pressure adjust sleeve, get radial pulse, pump until obliterated, let out air and read dial at moment pulse returns. See Tycos Manual, sample No. 2, for full detail.) Wash thermometer thoroughly with soap and water, dry and return to case. Scrub hands. Inspect or demonstrate the care of nipples; to be done daily after the fifth month, not before. Use cotton ball (or soft toothbrush previously scalded and kept for this purpose). Thoroughly scrub each nipple with warm water and white soap and dry with a clean towel. Apply albolene, pulling out the nipple. Do not handle breasts. Listen to the fetal heart. If unable to hear make note on record n.h. If fetal movements are felt by nurse put an “x”; if patient says she feels the baby move, put “xx” in space on record for recording fetal heart rate. Look for edema, varicose veins; do not take the patient’s word for these symptoms. Apply bandage for varicose veins (patient to pay 70 cents for bandage, or bandage to be lent to patient as long as needed, to be washed and returned), and teach patient right-angle position. Get specimen of urine, either to take to the station for examination or to examine at once for specific gravity, reaction and albumen, in accordance with instruction given on page [30], Laboratory Technique—Wood, Vogel and Famulener. Have the patient cleanse vulva before voiding, and void in clean vessel. Teach patient proper disposal of urine, emphasizing why kitchen sink is not to be used. If any abnormality in amount, color, specific gravity, or trace of albumen, report to the doctor, midwife or hospital in charge of the patient, if the patient has engaged one; if not, use every effort to get the patient under care of doctor.
Teach patient to measure amount of urine voided in 24 hours. Tell her to void in toilet on getting up in A.M.; then for the rest of that day and night and the following A.M. to void in a suitable vessel and measure in a tomato can (if no suitable vessel, void in a tomato can) and keep count of how many times she fills the can.
On an early visit examine teeth and show how to keep clean. Where possible urge a visit to the dentist or dental clinic for prophylactic treatment. Explain that it is not wise to have extractions done during pregnancy without consulting a doctor, but that cleansing and temporary fillings may be done with much saving of teeth.
On one visit, as early as possible, ask to see the layette, and advise about it, going over the list of baby supplies. Urge the patient to visit the center to see the model layette, and get help in the choice of materials and patterns. Note on the record if layette is not complete by the eighth month. Demonstrate the preparation of bed for the baby, made from clothes basket, soap box, or in a baby carriage similar to the model at the center. If the patient is to be delivered at home, some time after the seventh month ask to see the mother’s supplies, going over the list. The patient should be advised against the use of oilcloth from the kitchen table as a bed protector, and especially urged to prepare newspaper pads like the model at the center. Note on the report if the mother’s supplies are not complete by the eighth month. Advise about the arrangement of the room for delivery, and demonstrate the preparation of the mother’s bed like the model at the center.
No treatment or medicine to be advised except in accordance with standing orders, private physician’s orders, hospital orders and Maternity Centre Association routine (note on record which).
Form letter signed by the head of the medical board sent to doctors who have been engaged by patients for delivery:
My dear Dr. ......:
Mrs. ...... who has engaged you for her care at delivery, has been referred to this association for nursing care.
In order to make the work of the nurses of this association of a uniformly high standard, the Medical Board has adopted the enclosed routine for the nurses to follow.
May we not have your cooperation in our effort to teach the women of the community the need for, and value of, medical supervision throughout their pregnancy?