Part 51

OBSTETRIC SUPPLIES.

=Solutions:= Antiseptic solutions. Normal salt solution. Spiritus frumenti. Fluid extract of ergot. Plenty of sterile water (hot and cold).

=Articles:= Rubber sheeting. Plain roll of absorbent cotton. Abdominal binders. Vessel to receive placenta. Large drainage-pan. Large- and medium-sized safety-pins.

=Sterilized Accessories:= One half-dozen sheets. One dozen towels. One night gown. One doctor’s gown. Accouchement pad. Two dozen vulva pads. Receiving pad for baby. Maternity leggings. Gauze sponges. Cotton pledgets. Applicators. Tape for the cord. Rubber and glass catheters. Douche points. Douche bag. Vaselin.

SUPPLIES FOR BABY BASKET.

Blunt-pointed scissors. Needle, thread and thimble. Medium-sized and small safety-pins. Rectal and bath thermometer. Bar of pure mild soap. Jar of pure olive oil. Wide-mouthed bottle of alcohol, 95 per cent. Wide-mouthed bottle of boric solution. Sterile gauze to dress the navel. Sterile applicators. Two slips. Two shirts. Abdominal binders. Diapers and old soft cloths.

BABY SLEEP.

A young baby sleeps eighteen hours out of twenty-four. At six months of age a baby sleeps about sixteen hours. A one-year-old child sleeps about fourteen hours, and at two years of age at least twelve hours. Daytime naps should be continued as long as possible.

FETAL CIRCULATION.

From Kimber’s Anatomy.

The peculiarities of the fetal circulation, leaving details aside, are: the direct communication between the two auricles of the heart, through an opening called the foramen ovale; the communication between the pulmonary artery and descending portion of the arch of the aorta, by means of a tube called the ductus arteriosus; and the communication between the placenta and the fetus, by means of the umbilical cord.

The arterial blood for the nutrition of the fetus is carried from the placenta along the umbilical cord by the umbilical vein. Entering the fetus at the umbilicus, the blood passes upward to the liver and is conveyed into the inferior vena cava in two different ways. The larger quantity first enters the liver, and, alone or in conjunction with the blood from the portal vein, ramifies through the liver before entering the inferior vena cava, by means of the hepatic veins. The smaller quantity of blood passes directly from the umbilical vein into the inferior vena cava, by a tube called the ductus venosus.

In the inferior vena cava the blood from the placenta becomes mixed with the blood returning from the lower extremities of the fetus. It enters the right auricle and, guided by a valve—the Eustachian valve, passes through the foramen ovale into the left auricle. In the left auricle it unites with a small quantity of blood returned from the lungs by the pulmonary veins. From the left auricle the blood passes into the left ventricle and is distributed by the aorta almost entirely to the upper extremities by the superior vena cava, the blood enters the right auricle, and, passing over the Eustachian valve, descends into the right ventricle, and from the right ventricle into the pulmonary artery. As the lungs in the fetus are solid, they require very little blood, and the greater part of the blood passes through the ductus arteriosus into the descending aorta, where, mixing with the blood delivered to the aorta by the left ventricle, it descends to supply the lower extremities of the fetus, the chief portions of this blood, however, being carried back to the placenta by the two umbilical arteries.

From this description of the fetal circulation it will be seen:

1. That the placenta serves the double purpose of a respiratory and nutritive organ, receiving the venous blood from the fetus, and returning it again charged with oxygen and additional nutritive material.

2. That the greater part of the blood traverses the liver before entering the inferior vena cava; hence the large size of this organ at birth.

3. That the blood from the placenta passes almost directly into the arch of the aorta and is distributed by its branches to the head and upper extremities; hence the large size and perfect development of those parts at birth.

4. That the blood in the descending aorta is chiefly derived from that which has already circulated in the upper extremities and, mixed with only a small quantity from the left ventricle, is distributed to the lower extremities; hence the small size and imperfect development of these parts at birth.

NURSING IN DISEASES OF CHILDREN.

=Spasmodic Croup.=—Spasmodic croup is due to a sudden closure of the glottis.

Causes.—Exposure to a cold, damp atmosphere, indigestion, or irritation of the throat. There may be some hoarseness a few hours preceding the attack and the child awakens suddenly in the paroxysm of the sharp croup cough, experiences difficulty in breathing and has the cyanotic appearance so terrifying to the mother, but which need give no cause for serious alarm.

Treatment.—Apply hot compresses about the throat. If the attack is severe give an emetic—one dram of salt or mustard in one-half cup of warm water, and repeat in twenty minutes if necessary; an enema of warm water should be given and steam inhalation resorted to. Keep the child in an even temperature, restrict diet for a few days, and keep bowels active.

=Parotitis (Mumps).=—An infectious disease characterized by inflammation of the parotid glands. Incubation is from two to three weeks.

Symptoms.—The disease comes on with a mild chill, pain below the ear and swelling of the glands. There is great discomfort and the tension is very disagreeable.

Treatment.—Keep patient in bed during the height of the disease. Give liquid and soft diet. Bowels should be opened freely. No medicine is required unless fever is high. Apply cold compresses to the affected part, though, if preferred, hot ones may be used. A pad of cotton with oiled silk is the best application. In cases of extreme redness or tenderness of the glands, leeches may be applied. In cases of delirium use the ice-cap. For orchitis, lubricate the parts with camphorated oil and support with a soft cotton pad.

Duration of disease, from seven to ten days.

=Whooping-Cough.=—An infectious disease, beginning with catarrh of the air-passages, like an ordinary cold. The short expiratory coughs following each other in rapid succession and the period of drawing a long breath give rise to the whoop characterizing pertussis.

Incubation.—A week to ten days.