Obstetrical Nursing / A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her Baby

by Carolyn Conant Van Blarcom

The patient may be entirely normal for six or seven months and then notice that her rings and shoes are a little tight, because of the slight swelling of her hands and feet. Puffiness of the eyelids may appear, and other parts of the body may also be slightly swollen. Headache, dizziness, lassitude, drowsiness, depression, apprehension, nausea and vomiting are all symptoms, as also are high blood pressure and a diminished amount of urine, containing albumen. The patient frequently complains of visual disturbance, which may be only a slight blurring, but in severe cases may amount to total blindness.

Other symptoms, when the condition is grave, are epigastric pain; rapid pulse; extreme nervousness and excitement, which may amount almost to insanity; or drowsiness, which grows deeper and deeper until the patient sinks into a coma. Under such conditions, she may die without recovering consciousness, but more frequently, eclampsia ensues. The child may perish as a result of the toxemia and a dead, premature baby be born.

Prevention is of course, the most important aspect of the treatment and is accomplished by means of the pre-natal care and supervision which were described in the last chapter. In this connection must be mentioned again the danger, during pregnancy, of overeating. It is more and more frequently observed that toxemic seizures follow in the wake of a single, large, heavy meal, such as one is so likely to take at Thanksgiving or Christmas time. This is particularly true of patients who have had nausea or who have even slightly disabled kidneys, which, though able to meet the ordinary demands made by pregnancy, are inadequate to cope with the sudden strain imposed by a large meal. In such a case, toxic materials which should be excreted are retained within the body, and the familiar symptoms of toxemia are the result.

Much the same condition is produced by the patient’s getting wet or chilled. The excretory function of the skin is interfered with, under such circumstances, and the kidneys are unable to do enough extra work to make up for the skin’s failure, and again toxic material is retained, instead of being excreted.

Treatment and Nursing Care. As might be expected, the details of treatment and nursing care of a pre-eclamptic patient vary with different doctors and with the severity of the attack. But the essentials of treatment, the country over, may be summed up as rest and elimination, coupled with close watching for unfavorable symptoms.

The surest way to have the patient really rest is to put her to bed, even in mild cases, and recovery is so hastened, thereby, that she is well paid for the temporary inconvenience.

Since it is widely believed that the metabolic disturbance, in toxemia, is related to the nitrogenous part of the diet, the course usually followed in this particular is a reduction of the nitrogen intake. This is accomplished by putting the patient on a very low protein diet or a milk diet, consisting of two quarts of milk daily. This amount of milk provides adequate nourishment, for the time being, and also supplies a large part of the fluid which is needed to promote elimination. In addition to this, however, the patient is given one, or better still, two quarts of water every day, and free saline purges.

Very frequently this treatment is all that is necessary. The blood pressure falls in a few days, the albumen in the urine gradually disappears, the patient completely recovers and in due time has a normal labor.

But in more severe and less amenable cases it is necessary to increase the eliminative treatment and give copious colonic irrigations; sweat baths, in the form of hot packs or hot air baths, and even venesection and saline infusions, in order to relieve the symptoms. Sometimes, even these are not enough and the high blood pressure and albumen, which are probably the most significant symptoms, will continue. If so, and the patient grows worse, or if she simply fails to respond to the treatment, the usual practice is to induce labor. A daily output of five grams of albumen to a litre of urine, and a blood pressure of 200 millimetres are usually regarded as insistent indications that pregnancy should be terminated. Otherwise, eclampsia, always so dreaded, is practically sure to follow and endanger the life of both mother and child.

It may be mentioned here that the normal blood pressure, during the latter part of pregnancy, is about 120 millimetres. A gradual increase to 130, or even 140 millimetres, may not be serious, but a sudden rise or a pressure of 150 millimetres should be regarded with alarm, even though all other symptoms be absent. The reason for this is that eclampsia may, and sometimes does, occur with little or no warning except the high, or suddenly increasing blood pressure.