In addition to the mental nursing, which will be necessary, the patient also needs physical care, for though her trouble may be of emotional origin, she is, nevertheless, physically ill. As a rule, the best results are obtained by putting the patient to bed and separating her from her family as completely as possible. A daily routine should be adopted and rigidly observed, and the patient repeatedly assured that the course being followed will end in recovery.
It is usually considered advisable not to offer food by mouth, in the beginning, but instead to give nourishment, as well as large amounts of saline and sugar solutions by enemata, during the first few days. One routine is to give 500 cubic centimetres very slowly, every six hours at first, gradually decreasing the treatments to one a day as the patient improves. The rectum is irrigated with a simple enema, once daily, immediately preceding one of the injections, consisting of an ounce of dextrose or glucose and one dram of salt to a pint of water.
Small amounts of liquid nourishment are finally given by mouth, and given frequently, the quantity being increased gradually as the patient improves. Very light and easily digestible solid foods, chiefly carbohydrates, are added by degrees, and in the end, five or six small meals, rather than three full ones, are given in the course of the day.
In some cases the patient is induced to drink, daily, two or three quarts of sugar solution (an ounce of lactose to a pint of water), and to nibble at will on olives, walnuts, crisp crackers, or some such articles of food, which are kept within reach on her bedside table. These are usually retained, excepting in very severe cases, to the patient’s great encouragement.
The duration and severity of the attacks vary widely. Some patients are very ill and for a long time, even requiring an abortion before showing signs of improvement, while others recover in a few days if wisely managed. If a patient once suffers from neurotic vomiting, she is very likely to have it in subsequent pregnancies, particularly if the circumstances of her life remain unaltered.
Toxemic vomiting is regarded by some doctors as a very grave and very rare complication of pregnancy, which is usually fatal; by others as simply a severe form of the very common “morning sickness,” which they believe is always toxic, no matter how mild; while still others, as already stated, doubt the occurrence of such a condition as toxemic vomiting of pregnancy. I mention these differences of opinion in order that the nurse may be aware of their existence and be prepared to adjust herself whole-heartedly to the different methods of treatment for which they are responsible. For no matter what else may vary, the earnestness and sincerity of the nurse’s attitude must be a veritable Gibralter of reliability.
The chief symptoms of toxemic vomiting, in addition to persistent vomiting, as described by those who recognize its occurrence, are coffee-ground vomitus; a diminished amount of urine, possibly containing albumen, acetone bodies and casts; coma and sometimes convulsions. The disease may run its course swiftly and the patient die in a week or ten days, or it may persist less acutely for weeks, in which case there is extreme emaciation and prostration. In those cases which come to autopsy there is a definite and characteristic, central necrosis of the liver lobule.
The treatment and nursing care vary widely because so little is definitely known about the cause, and because of the varieties of theories concerning it which are held by different obstetricians. Some believe that prompt emptying of the uterus is about the only course which is effective, while others feel that because of the probable toxicity of the patient it is advisable also to stimulate all of the excretory organs. Accordingly, they give free purges, colonic irrigations, hot packs and copious amounts of sugar and saline solution by mouth, rectum, intravenously and by infusion.
Corpus luteum, too, is sometimes given hypodermically two or three times weekly. Although this treatment is not in universal use or favor, some patients seem to be given absolute relief by its administration.
A fairly typical method of treating toxemic vomiting, and of which the nursing care forms a large part is somewhat as follows: When the vomiting is only moderately severe, the patient is put to bed and isolated from relatives and friends, because of her nervousness resulting from the toxemia. She is given an abundance of very cold, 5 per cent. lactose solution by mouth in water or lemonade; from four to six ounces being given every half hour if she is able to retain it. If she is unable to take, by mouth, a total of about three litres of this solution, in the course of twenty-four hours, she is sometimes given one or two litres (of a 10 per cent. solution) by rectum by means of the drip method. At least three hours are devoted to giving this amount of fluid, the rectum being first washed out with a simple enema.