CLARENCE No. 2 CIGARETTES
Made by Carreras Ltd., London.
A Pure Virginia Cigarette with a Soft Delicate Flavor.
1/3 per Oz. 9/- per lb. Box.
May, 1918. THE SPECULUM. 45
BORES' Flat-Iron STETHOSCOPES
Cardiac Murmurs made Audible
e,°•n Applied Easily
under Clothes
Modes of Application of Flat-Iron Stethoscope
Full volume Less volume Intercostal Above of sound of sound Apices, &c. Clavicle
DISTRIBUTERS
46 TI I SPECULUM. May. 1918 Nursing During the Puerperium.
The following essay is being printed by courtesy of Nurse Blacklock, late of the Women's Hospital. The opinions expressed in this paper agree in the main with the current accepted teaching on the subject. Several points may call for discussion—(i.) the time for getting the patient out of bed, (ii.) the use of corrosive sublimate in ophthalmia neonatorum.
The details as given in this paper haVe all been carried out at the Women's Hospital, and excellent results have been obtained.
The object of having this essay printed is to afford the students some idea of the nurse's part in the puerperium. It was felt that this aspect of midwifery is scantily -dealt with in text books, and the publication of this essay might therefore be beneficial to the students about to begin midwifery practice.]
Hygiene.—Fresh air, warmth and cleanliness are most essential to the mother's well being.
Room.—The patient should be placed in a good-sized room which is bright and airy, in the quietest portion of the house, having preferably a southern aspect.
Keep the windows open top and bottom, taking care that the mother is not in a draught. The temperature of the room should be as nearly as possible from 6o to 65° Fahrenheit. In winter a fire will be necessary.
Bed.—The bed is single and the mattress preferably of horsehair.
The bed should be sufficiently away from the walls to permit the doctor or nurse to work unhampered for space.
The bed is made with an under blanket and sheet tucked tightly in all round, over which is placed a mackintosh covered by a slip sheet, which is sufficiently wide to reach from the patient's shoulders to well below the buttocks, and tucked well in at the sides, being perfectly taut, as any creases are most uncomfortable ; the rest of the clothes are light and warm.
Should the patient complain of her feet being cold, a hot- water bottle well covered with a flannel wrapper may be placed in the bed.
Sponging.—The patient is sponged morning and evening, the back and dependent parts well rubbed with methylated spirit or eau-de-cologne.
If a good talc or starch powder is added to the toilet, it will be found a great comfort, especially in hot weather.
While the patient is lying down, her head will be most.com- fortable when her hair is parted at the back and braided on either side.
The patient should be made to look as nice as possible.
All soiled linen and excreta should be removed at once.
When it is necessary to bring a bed pan into the room it should be covered by a cloth wrung out of a deodorant such as car- bolic 1-8 or cyllin. No .eating or drinking utensils should be left in the room, but taken away on the tray as soon as the patient has finished her meal. As few evidences of the sick room should be about as possible.
Flowers are always cheering if fresh and well arranged.
Lochia.—The lochia is the natural discharge of the puer- peral woman.
It should be noted as to odour, colour, and amount. For the first three days it is bright red like blood and moderate in quantity ; from the third to the seventh day it is gradually decreasing in amount and becoming more serous ; and during the seventh to the tenth day it is of the palest yellow, and has almost ceased.
The lochial odour is peculiar to itself, but should not be offensive or heavy.
The greatest cleanliness must be exercised ; the vulva and surrounding parts should be thoroughly cleansed of the lochial discharge. This is best done immediately after the patient has passed urine or bowels acted. Rub up the fundus of the uterus and endeavour to express any blood clot that may be there.
Remove pan, replacing it clean and warmed. Have ready on a tray at the bed-side—jug with a pint to a. pint and a half of antiseptic solution such as Y2 drachm to a pint of lysol, a small bowl of sterile swabs in the same solution, a few dry ones, a sterile perineal pad, a larger outer one, and a T bandage.
Instruct patient to draw up knees, keeping them well apart to thoroughly expose the area to be cleaned, and with hands that have previously been well scrubbed and disinfected in biniodide of mercury 1-2000, part inner labia with first finger and thumb of left hand, and pour the lotion from above down- wards over the genital organs, washing away the discharges, then swab from above downwards, using the wet ones and a fresh one each time until the vulva and surrounding parts are quite clean—dry with sterile swabs, and place perineal pad over vulva, then outer pad, and secure with a T bandage.
The pad should be changed at least four-hourly, and as often as necessary during the day and twice during the night when awake.
Afterpains are often a source of discomfort and distress to the mother. These may be relieved by massaging the fundus
48 THE SPECUL:M. May, 1918.
and expressing any bloodclot and applying a hot antiseptic foment to the vulva and securing firmly with a T bandage.
Breasts.—The breasts should be thoroughly washed with soap and water twice a day when the patient is sponged, and before and after feeding with sterile water and boracic lotion.
After the feeding and washing, the nipples may be painted with tincture of benzoin to keep them from cracking.
It is also advisable in primipara to put the infant to both breasts for each feed during the first three days, about two minutes for each breast for each feed, and gradually increasing the time according to, babies' need ; this will draw the nipple out and be less likely to crack the tender skin than prolonged sucking at one breast at the beginning.
A binder of comfortable tightness applied on the second day and until the flow of milk can be regulated is often a great comfort to the patient and a support in cases of pendulous breasts. The milk should establish itself by the third day.
Should the breasts become engorged restrict fluid, and with surgically clean hands which have been lubricated with warm oil, massage with circular movement and from the base towards the nipple, thus expressing a little milk and releiving tension.
In inverted nipples it may be necessary to use a breast shield for a time.
Temperature and Pulse.—The temperature and pulse should be taken morning and evening just before the patient is sponged and at the same time each day.
If the temperature does not exceed too° F. and the pulse not more than 92 there is no need for alarm. Should the rise in pulse and temperature be greater, nurse must, if possible, ascertain the cause and report to the doctor in charge.
Visitors.—As rest is so important to the puerperal woman, the patient should not be allowed visitors for the first three days, then only those who will.not be likely to tire or irritate.
Not more than two visitors should be allowed in at one time, and they should not stay longer than fifteen to twenty minutes.
Rest.—Rest to both mind and body is very necessary. To procure bodily rest, study patient's comfort, carrying out as much as possible at the one time of the necessary treatment, and observing strict regularity. The room may be slightly darkened and the patient kept quiet.
Mental rest is procured by allowing no visitors or disturb , ing influences to enter the room.
At night the baby will miss alternate feeds twice, thus leaving two intervals of four hours for undisturbed rest.
PHONE 9571. Established 5o Years.
Rimless Fits-U Sps. Pince-Nez. Bi-focal Sps Krytop Lenses. CrooKe's Tinted Lenses.
REPAIRS PROMPTLY EXECUTED.