movement of both bladder and bowels. Then, after preparing and having within easy reach sterile basins, cotton, soap, water, a warm bichloride solution in the strength of one in five thousand, and the pitcher douche of plain sterilized water, the nurse cleans her hands. (The nurse should always keep the basins, brushes, soap and water sterile so they will always be ready, sterilize them as soon as finished using- them. The}- will then be always ready in an emergency), The bed pan is now removed and emptied and replaced under the patient. The nurse now washes off her hands with soap and water again, and then emerges them in a bichloride solution in the strength of one in two thousand. Rubber gloves are very nice, they save the hands, and in cases where the discharge is of an infectious character, they are very necessary. The nurse then washes the genitals with sterilized cotton, sterile soap and water. Wash off all soap thoroughly with plain sterile water. Separate the labia and flush the vulva well, removing all blood clots. The bichloride solution pitcher douche is followed by a 127 pitcher douche of plain sterile water. Wipe dry with plain sterilized cotton. Then the usual dressing. The first four or five days a thin bichloride pad is kept over the genitals to prevent infection. After wiping the parts dry, apply a thin piece of sterilized cotton wrung out of a one in five thousand bichloride solution over the genitals. Have it large enough to entirely cover the birth canal and hairy region. Over this a large piece of dry sterilized absorbent cotton. Now remove the bed pan and wash the thighs and buttocks with warm water and soap, remove the abdominal binder and wash the abdomen and back with soap and warm water. Wipe dry with a clean towel, and give a gentle alcohol rub. A clean abdominal binder is now applied, fitted well into the figure at the sides with safety pins. See that the room is the proper temperature, so as not to chill the patient. As soon as a part is washed dry immediately, then rub the part with alcohol, and cover. Expose only the part that is being washed so as to avoid chilling the patient. Watch the uterus carefully, see that it contracts properly and keep it in the median line. If it inclines to either side, keep the patient on the opposite side and nature usually adjusts matters. If too large or abnormally sensitive the physician should be informed at once. All physicians do not give these matters their personal attention. Some leave this condition to the supervision of the nurse, and she should be very careful. After applying the abdominal bandage, the occlusion bandage is applied. It should be pinned tightly in front with two safety pins, one on either side, and the same way in the back. The patient's night gown is now removed and the rest of the body bathed with warm water and soap., followed by an alcohol rub. Then a clean night gown is put on. If the sheet is the least bit soiled it must be removed and replaced by a clean one. If not soiled it should be made smooth and free from all folds and wrinkles. A clean draw sheet or pad is always put on. This should be put on fresh and clean even if it is not soiled. It is usually damp with perspiration, and absorbs the odor. The hair is then combed and braided into two braids. It is best to braid the hair in two braids while the patient remains in bed as it is easier to comb. The patient can turn first on one side and then on the other in combing the hair and the exertion is not so great. The patient may now be placed on the other side of the bed : a glass of milk given her, and she usually takes a nap. This is the daily morning toilet of the patient as long as she remains in bed. In the evening a fresh dry gown should be put on, the back rubbed with alcohol and the patient moved to the other side of the bed. To economize in washing, if the gown removed in the morning is not soiled it should be hung out in the sun to dry and air, and used again at night.<Callout type="important" title="Proper Hygiene">Always keep basins, brushes, soap, and water sterile for hygiene purposes.</Callout><Callout type="gear" title="Sterilized Equipment">Use sterilized cotton, bichloride solution, and other equipment to prevent infection.</Callout>HOW TO CHANGE THE PATIENT'S BED. To Change the Under Sheet.<Callout type="tip" title="Efficient Patient Movement">Move the patient gently but firmly to avoid injury or discomfort.</Callout>— Remove all covers but the sheet. Move the patient to one side of the bed, as close to the edge as possible to be comfortable. If the patient is able she may move herself slowly over, if too weak, and there is a tear in the perineum, which necessitates her being careful not to make much of an effort, allow her to put her arms around your waist. The nurse then places her hands under the patient's back, and an assistant on the opposite side of the bed likewise places her hands under the patient's back, and together the nurse and her assistant, in a swinging movement, are able to move the average patient without much effort. But the nurse should never attempt to lift a patient without assistance. Now roll and fold the under sheet and draw sheet close to the back. Against the soiled sheet, the clean sheet, half rolled, is placed. Spread the unrolled part of the clean sheet smoothly over the exposed part of the mattress and tuck it firmly in. Pin with safety pins if necessary to keep it smooth and firm. Place the pillow with a fresh clean slip on it on the clean side of the bed. Now simply turn your patient on her back, then let her turn on her side over on the clean sheet. If there is any reason why the patient should not move she must be lifted to the other side of the bed, and the nurse must have an assistant, if no other can be had call in a neighbor. Remove the soiled sheet and unroll the remainder of the clean sheet over the rest of the bed. Draw it smoothly and tuck it in under the mattress. Pin if necessary. The draw sheet is then adjusted. It is first placed smoothly over the under sheet on the side of the bed opposite that occupied by the patient. Tuck it well in at that side. The remainder of the sheet is rolled or folded close to the side of the patient. The nurse returns to the side of the bed on which the patient is lying. The patient raises her body a little, in the same manner in which she would for the adjustment of a bed pan, and the nurse quickly pulls the remainder of the sheet through and tucks it well in.<Callout type="warning" title="Patient Safety">Ensure the patient does not overexert herself during movement to avoid complications.</Callout>To Change the Draw Sheet. — When it is only necessary to change the draw sheet, it is placed smoothly across the bed over the lower sheet and should be 130 wide enough to reach from the middle of the patients back to her knees, and should be long enough so as it can be tucked well under the mattress at both sides of the bed to hold it firm so it will not wrinkle. When soiled it can be easily removed according to direction already given. The draw sheet should always be kept clean and dry, and changed each morning whether soiled or not.<Callout type="important" title="Regular Cleaning">Change the draw sheet daily to maintain hygiene.</Callout>To Change the Top Sheet. — Loosen the soiled sheet from the foot of the bed. Spread the clean sheet over the soiled one and tuck it in at the foot. Then, while holding the clean sheet with the left hand, draw the soiled sheet out with the right one. After which spread the remaining bed clothes on the bed.
Key Takeaways
- Maintain strict hygiene by using sterile equipment and solutions.
- Regularly change bedding to prevent infection.
- Monitor the patient's uterus for proper contraction and position.
Practical Tips
- Use sterilized cotton and bichloride solution to minimize the risk of infection during postpartum care.
- Ensure that the room temperature is appropriate to avoid chilling the patient, which can lead to complications.
- Gently move the patient when changing sheets to prevent overexertion and potential injury.
Warnings & Risks
- Do not attempt to lift a patient without assistance as this could cause injury or discomfort.
- Always check for signs of infection such as large or abnormally sensitive uterus, and report them immediately to the physician.
- Ensure that bedding is changed daily, even if it appears clean, to maintain hygiene.
Modern Application
While many of the specific techniques described in this chapter are outdated, the principles of maintaining cleanliness and monitoring for signs of infection remain crucial. Modern practices have improved with more advanced medical equipment and protocols but the core importance of proper postpartum care has not changed.
Frequently Asked Questions
Q: How often should bedding be changed during the puerperal period?
Bedding should be changed daily, even if it appears clean, to maintain hygiene. This is important for preventing infections and ensuring a comfortable environment for the patient.
Q: What equipment should be sterilized before use in postpartum care?
Basins, brushes, soap, water, bichloride solution, and other equipment should always be kept sterile to prevent infection during postpartum care.
Q: How can a nurse ensure the patient does not overexert herself when moving her on the bed?
The nurse should move the patient gently but firmly using assistance if needed. The patient should be encouraged to use pillows for support and avoid sudden movements that could cause discomfort or injury.