Care of the mother in the postpartum period. Care of a woman in childbirth Care of a woman in the postpartum period

POSTPARTUM PERIOD.

The postpartum period begins with the expulsion of the placenta and lasts 6-8 weeks.

During this time, a woman's body goes through almost all the changes that have arisen in connection with pregnancy and childbirth.

The process of reverse development of these changes is called involution.

Delayed involution is called subinvolution.

The postpartum period is divided into early and late.

Early postpartum period - the first 2-4 hours after childbirth.

Late postpartum period - 6-8 weeks after birth.

EARLY POSTPARTUM PERIOD.

The postpartum woman can be on Rakhmanov's bed (ideally on a functional bed) in the delivery room.

During this period, bleeding from the uterine vessels stops - hemostasis. It goes in 2 ways:

Compression and bending of the vessels due to contraction of the muscles of the uterus = physiological ligature. Closing of blood vessels by thrombi.

In this period, the puerperal is tired, feels weak, dizzy. There is a redistribution of blood from the upper sections to the lower sections of the body.

Due to the large return of heat during childbirth, there may be muscle tremors, chills and a feeling of cold. Also, T can be increased to subfebrile due to increased work in childbirth and absorption of tissue decay products.

After the birth of the placenta, the general condition is assessed. The puerperas measure blood pressure, pulse, t. (there is no need to use ice to prevent uterine bleeding - efficacy has not been proven, skin contact of the child with the mother is carried out).

The external genitalia, the perineal area and the inner surfaces of the thighs are washed with a warm weak disinfectant solution, dried with a sterile napkin. Inspect the birth canal using instruments if indicated.

At the beginning, the external genital organs and the perineum are examined, then the labia are pushed apart with sterile swabs and the entrance to the vagina is examined. Then the cervix is ​​examined using mirrors. Ruptures of the cervix, vagina, perineum are carefully sutured.

After examining the birth canal, the foot end of the bed is pulled out, a clean shirt is put on the puerperal, the sheet is changed under it, and covered with a blanket.

The puerperal lies 2 hours in the birth. hall under supervision: evaluate the general condition, pulse. Every 10-15 min. palpate the uterus and evaluate vaginal discharge.

If the condition of the puerperal is good, there are no complaints, bloody discharge from the uterus is small and the uterus is dense, then after two hours the puerperal is transferred to the postpartum department.

Nurses in obstetric and gynecological institutions carry out doctor's prescriptions, distribute medicines to patients, perform intramuscular and subcutaneous injections, provide careful monitoring of patients in the postpartum and postoperative periods, and prepare patients for various procedures and operations.

Nurses also have to perform simpler work: participate in the reception of patients, women in childbirth and puerperas, monitor and care for the sick, make the morning toilet and clean the patients during the day, monitor the cleanliness of the bed (set it up in time, change bed and underwear) , feed and water the sick, ensure the cleaning of the wards and cleanliness in them, put cleansing enemas, serve vessels to the sick and take them out, monitor the cleanliness of patient care items (vessels, ice packs, lined oilcloths, enema tips, thermometers, heating pads, gas outlet tubes, etc.), deliver patients for dressing, accompany them to procedures and consultations with specialists, to the X-ray room, etc.

When leaving, it is necessary to provide a woman in labor, a puerperal or a gynecological patient with an appropriate sanitary and hygienic regime, a calm environment, avoid noise, take measures to protect the neuropsychic state of patients, be attentive to their complaints and requests, monitor the cleanliness of the bed, the absence of wrinkles in the bed linen, shift patients several times a day, regularly monitor the skin, prevent seriously ill bedsores, wipe the skin with camphor alcohol, and at the first opportunity organize washing the patient in a shower or bath).

It is necessary to monitor the function of the gastrointestinal tract (put cleansing enemas in time, give laxatives as directed by the doctor), ensure the proper toilet of the oral cavity (regular rinsing or wiping it). Careful observation and care of seriously ill patients is especially important.

The hygiene of a woman in labor, a puerperal, a gynecological patient includes a set of measures that contribute to the prevention of diseases and the high efficiency of treatment. Patients entering obstetric and gynecological institutions are subjected to a thorough examination and sanitization (bath, shower or wet rubdown). Skin care begins with the emergency room where patients are admitted. If the nature of the disease allows sanitization, then the patient should be washed first. For some women arriving by ambulance, sanitization is simplified (the most contaminated places are washed - legs and perineum). Pregnant women and women in labor entering the maternity hospital in a satisfactory condition are washed in the shower. If the condition of the woman in labor does not allow to take a shower, they are limited to wet wiping the body, washing the legs and washing (after shaving the hair in the pubic area and external genitalia). Gynecological patients (if there are no contraindications) take a hygienic bath upon admission. In patients and women in childbirth, the nails on the hands and feet are cut short upon admission. In the toilet rooms for gynecological patients, there must be conditions for the implementation of all hygiene procedures. Seriously ill patients in the performance of hygienic procedures are assisted by junior medical personnel. A hygienic shower or bath is recommended in a planned manner once every 7-10 days, followed by a change of underwear and bed linen. If necessary (increased sweating, contamination of the skin and bed with secretions, vomit, etc.), the doctor may prescribe a shower or bath on any day, as well as before the operation.

Hygienic care for women has its own characteristics. Bacteria can accumulate on the skin, which in obese women can cause irritation in the skin folds under the mammary glands, in the groin and in the vulva. Irritation usually produces itching. The accession of a pyogenic infection can lead to the appearance of pustules, boils. In this regard, during care, special attention should be paid to the condition of the skin, in the thickness of which there are sebaceous and sweat glands that secrete fat, sweat and other metabolic products onto the skin surface. Walking patients wash the external genitalia themselves in the shower or in the bathroom or in a special room for personal hygiene. Before this, you should urinate. Cleanly washed hands, watering with a jet of water, wash at least once a day (and on the days of menstruation - 2 times a day) the external genital organs and the skin of the inner surface of the thighs. At the end of the washing of the external genital organs, the anus area is thoroughly washed, and then the skin is dried with a clean napkin or a separate towel. It is necessary to teach a woman to properly perform this toilet.

For bedridden patients, the external genital organs are washed once daily (unless washing is prescribed more often). Before washing, the patient should urinate and empty the intestines. A vessel is placed under the patient and a cotton ball captured by a forceps, pouring from a jug, carefully wash the external genitalia, including the clitoris. For washing, it is recommended to use a weak (1:5000) solution of potassium permanganate or a 1% aqueous solution of lysoform. The nurse must keep her hands clean as well. Washing hands frequently with soap and warm water (using brushes) followed by rinsing with chloramine solution helps keep hands clean. It starts from the birth of the placenta and ends after 6-8 weeks. Symptoms: the uterus contracts well after childbirth, its walls thicken, it is of a dense consistency, very mobile due to stretching of the ligamentous apparatus.

With overflow of neighboring organs (bladder, rectum), the uterus rises. Every day of the postpartum period, the uterus becomes smaller, as can be judged by the height of the uterine fundus - during the first 10–12 days after childbirth, the uterine fundus descends daily by one transverse finger. On the 1st-2nd day, the bottom of the uterus is at the level of the navel (with an empty bladder), and on the 10th-12th day, the bottom of the uterus is usually hidden behind the bosom.

The cervix is ​​formed from the inside out. Immediately after childbirth, the cervix has the appearance of a thin-walled bag, its channel freely passes the brush. First, the internal pharynx is closed, then the external one. The internal os closes on 7-10 days, the external one - on 18-21 days after childbirth. The inner surface of the uterus after childbirth is a continuous wound surface with fragments of the epithelium, the bottoms of the uterine glands and the stroma of the basal layer of the endometrium. Hence the regeneration of the mucous membrane occurs. The mucous membrane on the entire inner surface of the uterus is restored on the 7-10th day, and in the area of ​​the placental site - by the end of the 3rd week.

When the endometrium is restored, postpartum discharge is formed - lochia, which is a wound secret. In the first 3-4 days, the lochia is bloody, in the next 3-4 days they are serous-bloody, by the 7-8th day they no longer contain blood impurities, they become light. From the 3rd week, they become scarce, and by the 5-6th week of the postpartum period, the discharge stops. If the discharge is mixed with blood even after 7-8 days, this indicates a slow regression of the uterus, which happens when it is poorly contracted, there are remnants of placental tissue in the uterus, inflammation, etc. Sometimes there are no discharges, lochia accumulate in the uterus.

In the normal course of the postpartum period, the condition of the puerperal is good, breathing is deep, the pulse is rhythmic, 70-76 per minute, often slowed down, the temperature is normal. An increase in heart rate and an increase in temperature indicate a complication of the postpartum period, most often the development of a postpartum infection.

Urination is usually normal, with only occasional difficulty urinating. After childbirth, stool retention due to intestinal atony may be observed. Atony contributes to the relaxation of the abdominal press and restriction of movements after childbirth.

On the 3-4th day after childbirth, the mammary glands begin to separate milk. They swell, become sensitive, often with severe swelling, bursting pains occur. Sometimes on the 3rd-4th day, the health of the puerperal may worsen due to severe engorgement of the mammary glands, although little milk is produced these days, so pumping during engorgement is useless and harmful. In the postpartum period, the puerperal needs to create a regimen that promotes the correct reverse development of the genital organs, the healing of wound surfaces, and the normal function of the body.

Wound surfaces in the uterus and other parts of the birth canal are the entrance gate for easy infection. Therefore, the basic rule in the organization of care for the puerperal is strict adherence to all the rules of asepsis and antisepsis.

Parent care. The main thing: monitoring the general condition and well-being, monitoring the pulse at least 2 times a day and body temperature. In addition, they monitor the condition of the mammary glands (if there are any cracks in the nipples). Daily measure the height of the fundus of the uterus, its consistency, shape, sensitivity; examine the external genitalia, determine the nature and amount of lochia. Monitor bowel and bladder function. All these data are recorded in the history of childbirth. With painful postpartum contractions, amidopyrine, antipyrine (0.3–0.5 g each) can be prescribed. With delayed involution of the uterus, agents that enhance uterine contraction are used. With difficulty urinating, a number of appropriate measures are taken. If the stool is delayed on the 3rd day, a cleansing enema is made, or a laxative (castor or vaseline oil) is prescribed.

If the postpartum period proceeds without complications and there are no perineal ruptures, the puerperal woman is allowed to sit on the 2nd day, and walk on the 3rd-4th day. Getting up early contributes to better emptying of the bladder, intestines, faster contraction of the uterus. Early rising is not contraindicated for perineal ruptures of I-II degree (you should not sit down). Healthy puerperas from the 2nd day after childbirth begin therapeutic exercises. Classes are held in the first half of the day, preferably 2 hours after breakfast, in summer - with open windows, in winter - after thorough ventilation of the ward. Classes help to increase metabolism, deepen breathing, strengthen the muscles of the abdominal wall and perineum. Exercises are performed at a slow pace. The duration of the lesson is 5-15 minutes. Every postpartum woman who is discharged home should be explained the need to continue therapeutic exercises at home. Before each feeding, the puerperal should wash her hands, change her shirt daily, and toilet the external genitalia at least 2 times a day. The mammary glands should be washed with a 0.5% solution of ammonia or warm water and soap in the morning and evening after feeding. The nipples are washed with a 1% solution of boric acid and dried with sterile cotton wool. With significant engorgement of the mammary glands, drinking is limited, laxatives are prescribed.

If the mammary gland is not completely emptied during suckling, it is necessary to express milk with a breast pump after each feeding. Air baths lasting 15 minutes are carried out in the morning and evening. The mother does not need special nutrition. 0.5 l of kefir, 100–200 g of cottage cheese, fresh fruits, berries, and vegetables should be added to the usual diet. Spicy and fatty foods, canned food should be excluded from the diet. Alcohol is contraindicated. Women in childbirth with fever, catarrh of the upper respiratory tract, postpartum diseases must be isolated from healthy women in childbirth, for which the sick are transferred to another obstetric department or a separate ward. In the normal course of the postpartum period, the puerperal is discharged 7-8 days after childbirth.

7. Control questions to prepare for the lesson:

1) 1. What position should be given to the patient after surgery on the abdominal organs?

2. What are the clinical manifestations of impaired motor function of the gastrointestinal tract?

3. How to provide the first infirmity for hiccups, belching, vomiting?

4. Technique of gastric intubation with a probe.

5. How to help a patient with reflex urinary retention after surgery?

6. Technique for inserting a gas outlet tube.

7. Technique for setting a cleansing enema.

8. Technique for performing a siphon enema.

9. How is the postoperative wound cared for?

10. What is eventration?

11. How are abdominal drains cared for?

12. Care of patients with external fistulas of the digestive system

1) examination of patients in intensive care units;

2) analysis of clinical cases in the training room;

3) solution of situational problems;

4) performance of test tasks.

9) Methodical and visual support for classes:

1) Teaching aid: Zhdanov G.G. Resuscitation Moscow 2005

2) Ambu training manikin.

10. Literature:

A) Main:

1) Nursing in anesthesiology and resuscitation. Modern aspects: textbook. allowance. - 2nd edition, revised. and additional / ed. prof. A. I. Levshankova. - St. Petersburg.

2) Oslopov, Bogoyavlenskaya - General nursing in a therapeutic clinic

B) Additional:

1) Primer on Fundamentals of General Nursing. A.L. Grebenev

C) Educational and methodological materials published by the staff of the department

Sanitary and hygienic standards. Principles of care for women in labor and the sick

FEATURES OF ASEPTS AND ANTISEPTS IN OBSTETRICS AND GYNECOLOGY

After childbirth, the birth canal of a woman is an extensive wound surface. So if microorganisms enter the uterine cavity through abrasions and cracks in the soft birth canal, a postpartum infection may develop. The likelihood of infection in pathological childbirth is greatly increased. Sources of infection can be endogenous and exogenous. Endogenous infection is pustular diseases, carious teeth, tonsillitis, inflammation of the genitourinary organs of the woman herself. From these foci through the blood and lymphatic tract, the infection can enter the birth canal. An exogenous infection penetrates through hands, instruments, dressings (microflora of the throat and nose of personnel), i.e. through everything that comes into contact with the genitals during pregnancy, especially in the last weeks, during and after childbirth. The fight against postpartum infections is carried out with preventive measures. The basis of prevention is the strict observance of asepsis and antisepsis in medical institutions and the rules of personal hygiene.

During pregnancy, it is of great importance to follow the rules of pregnancy hygiene, eliminate foci of infection, keep the body clean, prohibit sexual activity in the last 2 months of pregnancy, and isolate the pregnant woman from an infectious patient.

If, upon admission to the maternity ward, the woman in labor has a temperature above 37.5 ° C, pustular diseases on the skin, tonsillitis, influenza, catarrh of the upper respiratory tract, there is a suspicion of gonorrhea, trichomonas colpitis. Such women should be referred to the second obstetric department. Women in labor who have experienced intrauterine fetal death, or who have given birth at home (street) conditions, are also admitted to the second obstetric department.

Necessarily, upon admission to any obstetric department, they put a cleansing enema, shave off the hair from the skin of the armpits and from the skin of the external genitalia, and wash the external genitalia. After that, the pregnant woman takes a shower, puts on clean underwear and goes to the prenatal ward. In this ward, the woman in labor spends the first stage of childbirth. Under the bed on which she lies, there should be an individual disinfected vessel. Every 5-6 hours, the toilet of the external genitalia is performed by washing with a weak disinfectant solution (1% lysoform solution, potassium permanganate solution 1:6000 or 1:8000). Washing is done with a cotton ball on a forceps, all material in contact with the genitals must be sterile. If a woman in labor undergoes a vaginal examination, then the midwife washes her hands according to one of the methods adopted in surgery.

Childbirth is carried out in a special delivery room, kept in the same cleanliness as operating rooms. All underwear, dressings, instruments must be sterile.

The midwife conducting childbirth treats her hands, as before abdominal operations. The external genital organs and the inner surface of the thighs of the woman in labor are treated with a 3% solution of iodine tincture. A clean shirt and cloth stockings are put on the woman in labor, a sterile sheet is placed under the woman in labor. All staff in the delivery room wear gauze masks, and the midwife puts on a sterile gown before delivering. After childbirth, the puerperal is washed with the external genital organs and, if there are tears, they are sewn up in compliance with all the rules of asepsis and antisepsis.

FEATURES OF THE SANITARY REGIME OF THE OBSTETRIC BED

The sanitary and hygienic maintenance of the maternity bed plays an important role in the prevention of postpartum infections. The couch in the examination room should be covered with oilcloth, which must be treated with a disinfectant solution after examining each woman. Before the examination, each woman is laid a clean lined diaper.

In the delivery room, an oilcloth mattress after each birth is wiped with warm soapy water to remove blood, then with a solution of mercury dichloride (sublimate) or lysoform and covered with a clean lined oilcloth, and a sterile diaper is placed under the woman in labor. The lining oilcloth is washed in the washing room on an installed inclined board with a jet of warm water with soap and a brush, then washed with a solution of mercury dichloride and dried on a special rack.

After discharge of puerperas, the bed and oilcloths are washed with water and a disinfectant solution, mattresses, pillows and blankets are ventilated for at least a day. After discharge of feverish puerperas, bedding is disinfected.

In the second obstetric department, as well as after feverish or dead puerperas, the treatment is carried out especially carefully: the beds are washed and treated with a solution of mercury dichloride, the mattresses are ventilated for 2 days.

An individual vessel with a number corresponding to the number of the bed is boiled once a day, and each time after use it is washed with water and a disinfectant solution. After discharge of the puerperal, the ship is disinfected, for which it is first rinsed with tap water, and then steam sterilized or boiled. The linen removed from the patient should be kept separately; before being sent to the laundry, it is soaked in a Lysol solution in a special tank.

PREGNANT HYGIENE

With a normal pregnancy, moderate labor (physical and mental) has a beneficial effect on a woman's health. At the same time, excessive fatigue and work associated with possible harmful effects on the body are contraindicated for a pregnant woman.

In her free time, a pregnant woman should be in the air, take calm walks without sudden movements and jumps. Her sleep should be at least 8 hours a day. Sexual life during the first 2-3 months of pregnancy should be limited due to the possibility of miscarriage, and in the last 2 months of pregnancy it is completely prohibited, as it contributes to infection in the genital tract. A pregnant woman should not smoke (nicotine adversely affects the body of both the mother and the fetus), should beware of contact with infectious patients. Many infectious diseases, especially viral ones, lead to illness and even intrauterine death of the fetus.

Every day, a pregnant woman should wipe her body with water at room temperature. Twice a day it is necessary to wash the external genital organs with warm water and soap (washing is done with clean hands, the movements of the washing hand from the womb to the anus). Be sure to take a shower once a week. Bathing in the bath during the last months of pregnancy is prohibited, as contaminated bath water can enter the vagina. Douching is contraindicated. Pregnant women need to have a separate bed. It is especially important during pregnancy to monitor the cleanliness of the oral cavity and the condition of the teeth. You need to brush your teeth in the morning and in the evening, and after eating, rinse your mouth with warm boiled water. Be sure to shave the hair in the armpits and wash them daily with warm water. These measures are necessary so that the fungus, which can live in the armpits, does not get into the area of ​​\u200b\u200bthe mammary glands, and then to the newborn.

During pregnancy, the mammary glands should be prepared for the future feeding of the child. The mammary glands are washed daily with boiled water at room temperature, followed by wiping with a towel, the nipple is smeared with petroleum jelly. It is necessary to wear comfortable bras that do not squeeze the mammary glands. On the inside of the bra, according to the projection of the nipples, it is recommended to sew circles of coarse canvas fabric - the friction of the nipples against this matter contributes to the coarsening of the skin, which protects the nipples from cracking. If the nipples are flat or inverted, they should be pulled back. It is done like this. With cleanly washed hands, grab the nipple II and I with fingers and pull it outward 2-3 times a day for 2-3 minutes. Daily air baths for the mammary glands for 10–12 minutes are useful, while a pregnant woman naked to the waist lies on a sofa or bed.

It is important to carefully monitor the proper functioning of the intestines, regulating its function with a diet. Do not prescribe laxatives without special indications. With constipation, you can put an enema of clean boiled warm water. If any signs of the disease and complications are detected, the pregnant woman is immediately sent to the doctor. Particular attention is paid to the rehabilitation of the oral cavity.

Pregnancy clothing requirement: it should be comfortable and loose. Especially harmful is the tightness of the chest and abdomen in the second half of pregnancy. It is necessary to wear loose dresses, skirts with straps. Round garters and tight belts are contraindicated. In the second half of pregnancy, in order to avoid excessive stretching of the anterior abdominal wall, it is necessary to wear a bandage, this especially applies to pregnant women repeatedly. The bandage is put on in the morning in a horizontal position and removed only at night. Shoes should be low-heeled and not squeeze the foot.

Of great importance are special physical exercises performed under strict medical supervision. Exercises improve the well-being of a pregnant woman, strengthen the muscles of the abdominal wall, prevent the formation of stretch marks on the skin, and improve metabolism. Particular attention should be paid to breathing technique. Fast and abrupt movements are contraindicated.

Physical exercises are carried out in the morning, in summer - in the fresh air or in front of an open window, in winter it is necessary to ventilate the room beforehand. After exercise, take a lukewarm shower, or do a rubdown, then dry the body with a terry towel. The total duration of classes should not exceed 10-15 minutes.

NUTRITION FOR A PREGNANT AND NURSING MOTHER

In the first half of pregnancy, nutrition is normal. With nausea, it is better to eat food in a chilled state, lying in bed, and only then get up. In the second half of pregnancy, fine-vegetarian food is prescribed with a restriction of meat and fish dishes (up to 2-3 times a week). Milk, kefir, curdled milk, sour cream, vegetable dishes, cereals are recommended. Useful raw vegetables and fruits. The body should receive proteins in the form of cottage cheese, eggs, potatoes, bread, cereals. Alcoholic drinks, pepper, mustard, vinegar, horseradish and other spicy and spicy substances are prohibited. Liquid intake should be reduced to 4-5 glasses per day (including soups, milk, kefir, etc.).

The need for vitamins during pregnancy increases. Their deficiency reduces resistance to infections, reduces the ability to work, and subsequently the child may develop rickets, diseases of the nervous system and other diseases. The source of vitamin A is the liver and kidneys of animals, milk, eggs, butter, fish oil, carrots, spinach. Vitamin B 1 found in black bread, brewer's yeast, grains and legumes, vitamin B 2 - in the liver, kidneys, meat, eggs, dairy products, vitamin PP - in yeast, meat, liver, wheat grains. For the normal course of pregnancy, vitamin C is especially necessary. There is a lot of vitamin C in vegetables, berries, fruits, especially in currants, wild roses, and unripe nuts. In winter and spring, vitamin C should be additionally administered in the form of dragees, tablets, powders of 0.5–0.6 g per day. There is a lot of vitamin E in the germ part of wheat, corn, eggs, liver, soybean oil. As you know, vitamin D prevents the development of rickets in the fetus. They are rich in fish oil, fatty fish meat, liver, caviar, butter. Pregnant women need an increased amount of potassium, which is found in milk, dried apricots, figs, raisins. Calcium should also be consumed in high amounts. It is found in cottage cheese, cheese, eggs, milk.

Nutrition of a pregnant woman should be four times a day. The first breakfast contains 25-30% of the diet, the second - 10-15%, lunch - 40-50% and dinner 15-20%.

In the first week after childbirth, easily digestible food is recommended. During breastfeeding, nutrition should be complete, as in pregnancy, with a high content of vitamins, without salt and liquid restrictions, but with the prohibition of alcoholic beverages, spicy and spicy foods, at least 4 times a day. Obese women should be limited in the intake of fats, starchy and sweet foods.

During pregnancy, a nurse or midwife visits the pregnant woman at home, teaches her to take care of herself, and provides the necessary assistance. It is very important that the consultation registers pregnant women as early as possible. After discharge from the maternity hospital, the consultation continues to monitor the puerperal. A sister or a midwife visits her at home, monitors how she follows the instructions of the doctor, helps in organizing everyday life, caring for the child, and feeding him properly.

GENERAL PRINCIPLES OF CARE FOR PARENT AND GYNECOLOGICAL PATIENTS

Nurses in obstetric and gynecological institutions carry out doctor's prescriptions, distribute medicines to patients, perform intramuscular and subcutaneous injections, provide careful monitoring of patients in the postpartum and postoperative periods, and prepare patients for various procedures and operations. Nurses also have to perform simpler work: participate in the reception of patients, women in childbirth and puerperas, monitor and care for the sick, make the morning toilet and clean the patients during the day, monitor the cleanliness of the bed (set it up in time, change bed and underwear) , feed and water the sick, ensure the cleaning of the wards and cleanliness in them, put cleansing enemas, serve vessels to the sick and take them out, monitor the cleanliness of patient care items (vessels, ice packs, lined oilcloths, enema tips, thermometers, heating pads, gas outlet tubes, etc.), deliver patients for dressing, accompany them to procedures and consultations with specialists, to the X-ray room, etc.

When leaving, it is necessary to provide a woman in labor, a puerperal or a gynecological patient with an appropriate sanitary and hygienic regime, a calm environment, avoid noise, take measures to protect the neuropsychic state of patients, be attentive to their complaints and requests, monitor the cleanliness of the bed, the absence of wrinkles in the bed linen, shift patients several times a day, regularly monitor the skin, prevent seriously ill bedsores, wipe the skin with camphor alcohol, and at the first opportunity organize washing the patient in a shower or bath). It is necessary to monitor the function of the gastrointestinal tract (put cleansing enemas in time, give laxatives as directed by the doctor), ensure the proper toilet of the oral cavity (regular rinsing or wiping it). Careful observation and care of seriously ill patients is especially important.

The hygiene of a woman in labor, a puerperal, a gynecological patient includes a set of measures that contribute to the prevention of diseases and the high efficiency of treatment. Patients entering obstetric and gynecological institutions are subjected to a thorough examination and sanitization (bath, shower or wet rubdown).

Skin care begins with the emergency room where patients are admitted. If the nature of the disease allows sanitization, then the patient should be washed first. For some women arriving by ambulance, sanitization is simplified (the most contaminated places are washed - legs and perineum). Pregnant women and women in labor entering the maternity hospital in a satisfactory condition are washed in the shower. If the condition of the woman in labor does not allow to take a shower, they are limited to wet wiping the body, washing the legs and washing (after shaving the hair in the pubic area and external genitalia).

Gynecological patients (if there are no contraindications) take a hygienic bath upon admission. In patients and women in childbirth, the nails on the hands and feet are cut short upon admission.

In the toilet rooms for gynecological patients, there must be conditions for the implementation of all hygiene procedures. Seriously ill patients in the performance of hygienic procedures are assisted by junior medical personnel. A hygienic shower or bath is recommended in a planned manner once every 7-10 days, followed by a change of underwear and bed linen.

If necessary (increased sweating, contamination of the skin and bed with secretions, vomit, etc.), the doctor may prescribe a shower or bath on any day, as well as before the operation. Hygienic care for women has its own characteristics. Bacteria can accumulate on the skin, which in obese women can cause irritation in the skin folds under the mammary glands, in the groin and in the vulva. Irritation usually produces itching. The accession of a pyogenic infection can lead to the appearance of pustules, boils. In this regard, during care, special attention should be paid to the condition of the skin, in the thickness of which there are sebaceous and sweat glands that secrete fat, sweat and other metabolic products onto the skin surface.

Walking patients wash the external genitalia themselves in the shower or in the bathroom or in a special room for personal hygiene. Before this, you should urinate. Cleanly washed hands, watering with a jet of water, wash at least once a day (and on the days of menstruation - 2 times a day) the external genital organs and the skin of the inner surface of the thighs. At the end of the washing of the external genital organs, the anus area is thoroughly washed, and then the skin is dried with a clean napkin or a separate towel. It is necessary to teach a woman to properly perform this toilet. For bedridden patients, the external genital organs are washed once daily (unless washing is prescribed more often). Before washing, the patient should urinate and empty the intestines. A vessel is placed under the patient and a cotton ball captured by a forceps, pouring from a jug, carefully wash the external genitalia, including the clitoris. For washing, it is recommended to use a weak (1:5000) solution of potassium permanganate or a 1% aqueous solution of lysoform.

The nurse must keep her hands clean as well. Washing hands frequently with soap and warm water (using brushes) followed by rinsing with chloramine solution helps keep hands clean.

OBSERVATION AND CARE OF THE BIRTH WOMAN

Childbirth rarely occurs unexpectedly. Usually, before their onset, a pregnant woman develops symptoms that are considered as harbingers of childbirth. These include the descent of the bottom of the uterus, the presenting part, the appearance of facilitated breathing, the discharge of thick viscous mucus from the vagina, the protrusion of the navel, the appearance of irregular pulling pains in the lower abdomen and in the lumbosacral region, turning into a feeling of a cramping nature.

The onset of labor is characterized by two signs: the secretion of mucus from the cervical canal and the appearance of pains of a cramping nature, which are called preparatory contractions and occur due to contraction of the muscles of the uterus. The onset of labor is evidenced by the appearance of strong, regular and prolonged contractions.

A pregnant woman is called a woman in labor during the entire time of childbirth.

Contractions are contractions of the uterus. They are involuntary, periodic and often painful. The intervals between them are called pauses.

Attempts are a contraction of the muscles of the uterus and at the same time rhythmic contractions of the abdominal muscles and diaphragm joining them.

Childbirth is divided into periods. The opening period is the time from the onset of regular contractions to the full opening of the uterine os. Contractions at the beginning of labor can last 6-10 seconds, at the end of labor their duration increases to 40-50 seconds or more, and the pauses between them are sharply reduced.

With head presentation of the fetus, normal pelvis size and good functional state of the uterus, part of the lower segment tightly covers the presenting part of the fetus, which leads to the separation of amniotic fluid into anterior and posterior.

Smoothing of the cervix and opening of the uterine os in primiparous and multiparous proceed differently. In primiparas, by the beginning of labor, the external and internal os are closed, and the cervical canal is preserved throughout its entire length. The process of opening the neck starts from the top. First, the internal os opens to the side, and the neck is somewhat shortened. After straightening the cervical canal, the neck is finally smoothed out, and only then does the external pharynx begin to open. Before the external pharynx opens, its edges gradually become thinner. Due to contractions, the uterine os opens completely and can be determined during vaginal examination in the form of a thin border.

In multiparous women, during the entire period of opening, the processes of smoothing and opening of the cervical canal occur simultaneously. At the height of one of the contractions, with full or almost complete opening of the uterine pharynx, the fetal membranes are torn and light (anterior) waters are poured out in an amount of 100-200 ml. If the fetal bladder opens before the full disclosure of the uterine pharynx, then it is customary to talk about the early outflow of amniotic fluid. The fetal bladder can burst even before the onset of labor - in this case, the outflow of water is called premature. Excessively dense membranes of the fetal bladder can lead to its belated opening.

Untimely discharge of amniotic fluid often entails a violation of the physiological course of childbirth and complications from the fetus. The duration of the opening period in primiparous is 12–18 hours (average 15 hours), in multiparous it is almost half as much, and sometimes it is only a few hours.

The period of exile begins with the onset of full disclosure of the uterine os and ends with the birth of the fetus. Contractions after the outflow of water usually weaken, the uterine cavity decreases somewhat in volume, its walls more tightly cover the fetus. Soon, contractions resume, and rhythmic contractions of the abdominal wall, diaphragm, and pelvic floor muscles (pulls) join them. Attempts, following one after another, increase intrauterine pressure, and the fetus, making a series of rotational and translational movements, gradually approaches the pelvic floor. The force of the attempts is aimed at expelling the fetus from the birth canal. Attempts are repeated after 5-4-3 minutes and even more often. There is a change on the part of the perineum, which, during attempts, begins to protrude. At the height of one of the attempts, the lower part of the head is shown from the genital slit. In the pause between attempts, the head hides behind the genital slit, and when the next attempt appears, it is shown again. This phenomenon is called head insertion and usually coincides with the end of the second moment of the labor mechanism - the internal rotation of the head. After some time, the head, moving towards the exit from the small pelvis, is even more shown from the genital gap during attempts. In the intervals between attempts, the head does not go back into the birth canal. This condition is called eruption of the head and coincides with the third moment of the mechanism of childbirth - extension of the head. The birth canal at this time is so dilated that the presenting part (most often the head) is born from the genital slit, and then the shoulders and trunk of the fetus. With the fetus, the back waters are poured out, mixed with a small amount of blood and a cheese-like lubricant.

The duration of the exile period in primiparous is 1-2 hours, in multiparous - from several to 30-45 minutes.

The afterbirth period covers the period of time from the moment of expulsion of the fetus to the birth of the placenta. The duration of the afterbirth period in both primiparous and multiparous is approximately the same (20–40 min). The succession period is characterized by the appearance of successive contractions, which lead to the gradual separation of the placenta from the walls of the uterus. The subsequent period is accompanied by physiological blood loss, which usually does not exceed 250 ml.

In some cases, in the pathological course of pregnancy and childbirth in the afterbirth period, severe bleeding, life-threatening, may occur. The nurse should know that active interventions are performed if the blood loss exceeds 400 ml, or the afterbirth period continues if there is no bleeding for more than 2 hours. It should be remembered that the woman in labor in the afterbirth period is not transportable.

A woman after the birth of the placenta is called a puerperal. The afterbirth period is replaced by the postpartum period.

In the first 2-4 hours after childbirth, dangerous complications can occur: hypotonic bleeding due to insufficient or poor uterine contraction, birth shock, etc. In this regard, the nurse carefully monitors the condition of the puerperal in the early postpartum period, especially in the next 2 hours after childbirth .

In some cases, the placenta may separate from the wall of the uterus, but not be separated from the birth canal. The separated placenta continues to remain in the uterus, thereby preventing its contraction. Therefore, without waiting for the expiration of a two-hour period, the doctor removes the separated placenta using external techniques, and the nurse provides the doctor with appropriate assistance (holds a sterile tray near the external genital organs of the woman in labor, shows the placenta if it is allocated, determines blood loss, etc.). Then they examine the external genital organs, including the vestibule of the vagina, the perineum, the walls of the vagina, and in primiparas, the cervix.

If tears are found, the nurse delivers the puerperal on a gurney to the dressing room for stitching.

OBSERVATION AND CARE OF THE PARTNER

The medical staff working in the postpartum department provides careful care for the puerperal, strictly observing the rules of asepsis and antisepsis. Only healthy women should be in the ward. Women in childbirth with fever, open seams, fetid postpartum discharge are transferred to a special obstetric department, where women in childbirth are under continuous medical supervision.

In the first 4 days, the room is cleaned up to 3-4 times a day, in the following days - in the morning and in the evening. The sister makes sure that the external genitalia of the puerperal are kept clean.

When washing, pay attention to the anus, where hemorrhoids often appear after childbirth. If the nodes are painful, an ice pack wrapped in a sterile diaper is applied to them, a candle with belladonna is injected into the rectum once a day. Large hemorrhoids, if they do not soon decrease and disappear, have to be set inward. They do this in a rubber glove with 1-2 fingers lubricated with petroleum jelly, in the position of the puerperal on her side.

To avoid infection of the newborn, do not allow it to come into contact with the mother's bed. For this, the child is placed on an oilcloth or a sterile diaper. The mother must prepare for feeding the child, her hands must be washed clean.

Particular attention should be paid to the care of the mammary glands. It is recommended to wash them with a solution of ammonia or warm water and soap in the morning and evening after feeding. The nipples are washed with a 1% solution of boric acid and dried with absorbent cotton, preferably sterile.

For small cracks in the nipples, sterile fish oil is used, the nipple and areola are lubricated with it, and the nipple is covered with cotton wool. Fish oil can be replaced with calendula ointment. It is recommended to powder the nipples with streptocide powder.

Parents must strictly observe the rules of personal hygiene. Especially important is the cleanliness of the body, underwear and bed linen, which must be changed every 4-5 days. If the mother sweats a lot, the underwear should be changed more often, especially shirts and sheets. It is also necessary to change bedding frequently, especially in the first days after childbirth. The strictest cleanliness of the ward, bed and all care items must be observed.

The sister makes sure that the sleep of the puerperal is sufficient, and that it is quiet in the ward. Particular attention is paid to the diet of puerperas. Nutrition should be varied, high-calorie, with a sufficient amount of vegetables and fruits. During the day, the puerperal should drink 0.5–1 l of milk.

If a woman complains of chills, headache, pain in the lower abdomen, etc., it is necessary to measure the temperature, count the pulse and inform the doctor about this.

A specially trained nurse or methodologist conducts physiotherapy exercises with puerperas in order to strengthen the abdominal muscles and pelvic floor.

If in the first days after childbirth a woman has impaired urination, then before catheterization of the bladder, one should try to cause independent urination: a warm bedpan is placed under the pelvis of the puerperal and waters the external genital organs with warm water.

With swelling of the external genital organs, they are covered with a sterile gauze pad, and an ice pack is placed on top.

In the first 3 days, bowel function may be difficult. In the absence of contraindications, you can put a cleansing enema.

The nurse is obliged to monitor the air temperature in the wards, which should not be higher than 18–20 °C.

Towels, pillowcases, linen sheets, etc. should be changed regularly. Bed linen is changed before wet cleaning of the room and at least one hour before feeding newborns. Tanks with an oilcloth bag with a tight-fitting lid are brought directly to the place of collection of dirty linen. It is strictly forbidden to throw laundry on the floor or into open laundry bins.

Every day, at least 3 times a day, it is necessary to carry out a wet cleaning of the floor, panels, hard inventory of the mother's wards, corridors and all utility rooms using a 0.15% solution of chloramine. For current disinfection, it is recommended to use not only chloramine, bleach, but also hydrogen peroxide with detergents for processing hard equipment, floors, panels. After wet cleaning, the wards are ventilated for at least 30 minutes, then irradiated with a bactericidal lamp.

The care of the puerperal woman in the presence of stitches on the perineum has its own characteristics. The toilet of the external genital organs of puerperas is carried out in the ward for 4–5 days of the postpartum period. Washing is done very carefully, since the area of ​​\u200b\u200bthe seams cannot be wiped with cotton wool. The inner thighs and external genitalia are washed with a weak solution of potassium permanganate. The seams are treated with 5% tincture of iodine or sprinkled with streptocide, if raids appear on the seams, they should be washed with hydrogen peroxide and lubricated with 5% tincture of iodine once a day.

PREPARATION OF THE PATIENT FOR OPERATION

The preoperative period is the period between the patient's admission to the hospital and the operation. Its duration depends on the nature of the disease, the severity of the upcoming operation, its urgency, the patient's condition, her physical and neuropsychic readiness, the usefulness or functional insufficiency of the most important organs. The more severe the disease and the more difficult the upcoming operation, the more time is required to prepare the patient.

The operation is called emergency (urgent) when the disease does not allow for delay, for example, with an ectopic pregnancy (rupture of the pregnant tube). Delay in the operation can dramatically worsen the patient's condition or lead to death.

Urgent refers to transactions that cannot be postponed for a significant period. In emergency and urgent operations, preoperative preparation is reduced to a minimum and limited to the most necessary studies: urine and blood tests, blood pressure measurements.

Preparation of the patient for surgery is the most important event, the correctness and thoroughness of which often depends on the life of the patient. With the exception of emergency and urgent operations, patients are rarely operated on the day of admission. It usually takes several days to examine the patient and prepare her for surgery.

The negligent attitude of attendants to the patient, the lack of attention during her admission to the hospital, the patient's stay in the ward where women are in serious condition after surgery - all this negatively affects the patient's psyche. An attentive, sensitive attitude to her complaints, elimination of fear of the operation is very important.

In the department of operative gynecology, a clinical examination of the patient is carried out using special examination methods. Often the patient is consulted by specialists, periodically she is examined by a doctor on a gynecological chair in order to clarify the nature of the disease and prescribe special preparation for surgery. Before a gynecological examination, the patient must urinate. If there was no stool, it is necessary to clean the intestines with an enema. In cases where the patient cannot urinate on their own, bladder catheterization is performed. Before the study, the nurse must wash the patient.

During the patient's stay in the hospital, she may have menstruation. The nurse should know that during menstruation, the genitals and the whole body are more susceptible to various infectious diseases, as the overall resistance of the body to infection decreases. During menstruation, you need to monitor the cleanliness of the body, possibly change underwear more often, wash yourself with warm water at least 2 times a day. At the end of menstruation, the patient should take a shower, if this procedure is contraindicated for her, wipe the body with camphor alcohol or a weak solution of ethyl alcohol.

For some diseases of the female genital organs, the doctor may prescribe douching, vaginal tampons or baths before the operation.

douching. This procedure is performed using an Esmarch glass mug and a sterilized glass tip. The mug is held no higher than 1 m above the level of the bed. The patient lies on her back, in this position the walls of the vagina are better and longer irrigated, and at the end of douching, part of the liquid remains in the vagina. The tip must always be inserted along the posterior wall of the vagina, while releasing fluid, and bring it, without delay, to the posterior fornix. Douching is carried out with boiled water at room temperature or some disinfectant solution; after douching, the patient should remain in the supine position for at least half an hour.

Vaginal tampons. A cotton swab is usually used - a lump of cotton wool the size of a large tangerine, tied crosswise with a thread with long ends. The tampons prepared in this way are sterilized. After 1-1/2 hours after douching, a swab soaked in some medicinal substance (fish oil, glycerin, emulsion of streptocide, synthomycin, etc.) is inserted into the posterior fornix of the vagina, exposed with the help of mirrors. The mirror is removed by holding the swab with long tweezers or a finger. The tampon remains in the vagina for 8-10 hours, then it is removed.

Vaginal baths. The vagina is preliminarily douched with a tepid soda solution, then a tubular mirror is inserted into it, the remaining liquid is removed with a tupfer, and a disinfectant solution is poured into the mirror (but as prescribed by a doctor) so that the cervix plunges into it. After 3–4 minutes, with rotational movements very slowly (within 2–3 minutes) the mirror is brought out to the entrance to the vagina. Tilt the mirror downwards and pour the contents into the substituted basin. The rest of the solution before removing the mirror can be dried with cotton swabs. Baths are used every 2-3 days. To avoid stains on linen, you must use a hygienic bandage.

The nurse on the eve of the operation makes the patient a hygienic bath and additionally examines those parts of the body where the operation is to be performed. In the presence of hair, she shaves them off, and, having found boils or a purulent rash, informs the doctor about this, since in such cases the operation is postponed. After the bath, the patient puts on clean underwear. If the bath is contraindicated for health reasons, the patient can be washed in bed with water mixed with alcohol. On the eve of the operation, you need to carefully monitor the temperature: an increase in temperature is also a contraindication to the operation.

Preparation of the gastrointestinal tract occupies an important place in the preoperative preparation of the patient. Before emergency operations, it is advisable to remove the contents of the stomach with a gastric tube. If there is an operation on the perineum (during plastic surgery), especially with a rupture of the perineum of the III degree, bowel cleansing begins two days before the operation, the patient is transferred to light food, a laxative and an enema are prescribed.

Before the surgery, the patient takes a general bath the day before the operation, and on the day of the operation, the hair from the anterior abdominal wall, pubis and labia is shaved again. On the eve and on the day of the operation, no later than 3 hours before it begins, a cleansing enema is given. Immediately before the operation, urine is released with a catheter.

The patient prepared for the operation, dressed in clean linen, is brought to the operating room on a gurney and transferred to the operating table covered with oilcloth and clean sheets.

POSTOPERATIVE PERIOD

By the end of the operation, a bed and a gurney are prepared for the patient. The bed is heated with heating pads. One heating pad warms a sheet laid on a gurney. The patient is carefully removed from the operating table and transferred to a gurney in her arms, carefully covered with a blanket, a heating pad is placed at her feet (on top of the blanket). Accompanied by a doctor or ward nurse, she is transported to a special ward for operated patients.

The postoperative period covers the time from the end of the operation to the recovery of the patient. The first hours and days after the operation, the nurse observes the operated patient, as complications may arise after the operation or completely unexpectedly on any day after it. Therefore, careful monitoring of the operated patient is of paramount importance.

The medical staff carefully monitors the pulse, blood pressure, respiration, the condition of the dressing, the color of the skin and visible mucous membranes of the operated patient. Periodically inspect bed sheets and pads in patients who have undergone vaginal surgery. The nurse should periodically monitor the condition of the dressing in the area of ​​the surgical wound. Any changes in the patient's condition should be reported to the doctor immediately.

The patient, delivered from the operating room, is placed in the supine position. If the operation was performed under anesthesia, a pillow under the head is not placed on the first day. After awakening the patient (if she behaves calmly), you can bend the legs at the knee and hip joints, which brings some relief. For weakened patients, at the direction of the doctor, they put a roller or a folded blanket under their feet.

In order to spare the patient's psyche, medical personnel should in no case discuss the nature of her disease and the result of the operation in the presence of the operated patient. Explanations about the operation of the patient are given only by a doctor. Careful care for the patient, the precise implementation of all appointments create the patient's confidence in the success of treatment and contribute to a favorable postoperative period.

Sometimes vomiting is observed in the postoperative period, most often it happens after the use of anesthesia and lasts several hours, and sometimes 1-2 days. Before starting treatment for vomiting, find out its cause. The cause of vomiting may be some complication in the postoperative period. Sometimes this is due to irritation of the gastric mucosa after anesthesia or with the introduction of a tampon into the abdominal cavity, which leads to irritation of the peritoneum. In other cases, vomiting may indicate incipient peritonitis, acute gastric dilatation, or intestinal obstruction.

After the operation, the patient should not be moved away until she has a pronounced muscle tone. With post-narcotic vomiting, it is necessary to clean the mouth, pharynx and nose from vomit.

In order to prevent diseases of the oral cavity (stomatitis, thrush), parotid gland, intestines, it is necessary to pay great attention to caring for the oral cavity. It is recommended to brush your teeth regularly, rinse your mouth with a solution of hydrogen peroxide or potassium permanganate. If there is plaque on the tongue, it should be cleaned and the mucous membrane of the oral cavity with a cotton swab moistened with glycerin.

Postoperative complications include purulent inflammation of the parotid gland - mumps. Infection from the oral cavity penetrates into the parotid gland. Mumps often develop when hygiene care for the oral cavity is violated. Of great importance in the event of inflammation of the parotid gland is the nutrition of the patient. If he ate poorly for a long time, or received little fluid, then the likelihood of inflammation of the gland increases. The tissue of the gland is very delicate, therefore the development of the inflammatory process in it quickly leads to purulent fusion of the gland - necrosis.

Proper care of operated patients consists in strict adherence to hygienic requirements. After the operation, of course, during the prescribed time (as prescribed by the doctor), bed rest must be observed. Such a patient needs careful care. In the morning, after measuring the temperature, the sister gives the bedpan and washes away the patient. Then, after washing his hands, he brings a jug of warm water and a basin, washes the patient or she washes herself, brushes her teeth, rinses her mouth with boiled water (or a light solution of potassium permanganate). The patient needs to comb, wipe her skin, especially in the back, buttocks and armpits, with camphor alcohol.

If the bedding is dirty, the linen is changed and the bed is remade, the pillows are fluffed, thereby creating a comfortable position for the patient.

When airing the ward, it is necessary to ensure that there is no draft and the patient is well covered with a blanket.

The room is cleaned with a wet method. First, they wipe the dust everywhere with a damp cloth, inspect the nightstand or refrigerator to identify spoiled products that are thrown away. Then the floor is washed with the addition of a disinfectant.

The nurse should take care of the skin of the operated patients, especially the skin in the inguinal folds, anus and perineum, especially in obese and malnourished patients. The skin is wiped with camphor alcohol or cologne, folds and folds are sprinkled with talcum powder. After the operation, the breathing volume is reduced, so wiping the skin with camphor alcohol improves the respiratory function of the skin.

When caring for a patient, a rash on the skin may be detected. The nurse should immediately inform the doctor about this, as the rash may be the result of medication or a symptom of an infectious disease.