Obstetrics for Nurses

by Charles B. Reed

Continue efforts so long as heart beats.

Convulsions occur not infrequently during the first few weeks. They may develop as a result of injuries to the head during labor, or as a symptom of toxæmia. They may arise from constipation, from intestinal indigestion with curds, from fever or from hæmophila. Meningitis and other infections are associated with this symptom, and occasionally atelectasis. They may also be the manifestation of a spasmophilic diathesis. The attack may begin with such premonitory phenomena as restlessness, muscular twitching, and staring of the eyes, but more frequently the onset is without warning. The facial muscles are contracted, the neck thrown back, the hands clenched and the extremities spasmodically cramped and tightened. There may be frothing of the mouth and consciousness is lost. Respiration is feeble, shallow and irregular. The face is discolored and strange rattling noises come from the larynx. The bowels and bladder may move involuntarily. The attack lasts from a few minutes to half an hour.

Convulsions are not serious in all cases.

The responsibility for the management of this complication usually falls upon the nurse. She calls the doctor, to be sure, but the attacks in many cases have ceased and the child may either be dead or out of danger of a recurrence before his arrival.

The hot bath is a universal remedy and quite as efficient as anything. The temperature should be taken and the bowels washed out.

If the fontanelles are tense when the doctor arrives, a spinal puncture may relieve the tension. A specimen of the blood is drawn through a needle and sent to the laboratory for examination.

The cause must be found, if possible, and removed. A change of food may be all that is required. Cod-liver oil may be added to the diet in dram doses, three times a day, and milk curds, suspended in arrow-root water. For the acute condition, chloral hydrate is best. It is given by rectum, one or two grains in an ounce of water, and may be repeated in four hours.

Atelectasis is the name given to a failure of the lungs wholly to expand during the efforts at respiration. The child may live for weeks with this affection, but usually it expires within a few days.

In this condition, the child has a constant tendency to get blue, the color deepens, and death may occur in spite of every aid. The treatment may be permanently efficacious in some cases, but in most, the revival is only temporary. Again, the child may live, but in a weakly, declining state for days, until death comes.

Aside from the physical signs of dullness elicited by percussion over the lungs, the most conspicuous symptoms are the cyanosis and the intermittent but persistent whining cry.