of warmth. Further application of the dressings, should have prepared for her reception, by turning down the covers and removing temporarily the hot soapstone or waterApplication bag. The latter may then be replaced at the patient's feet; a soft towel should have been placed, in lieu of a pillow, under the patient's head and another towel should be placed under her chin. A light basin for the patient to vomit in, in case she is sick, should be placed under the head of the bed; a chair for the doctor should be placed beside the bed. While the doctor and his assistant give their articles attention to the patient, the nurse may quickly operations. remove all the articles used during the operation. attentions. Removal of used during CHAPTER XX. SPECIAL NURSING IN GYNECOLOGICAL OPERATIONS. Points of in manage cases. There will be little points of difference in the difference management of each case, which will depend upon ment of the character of the operation performed. Some of the most frequent gynæcological operations will therefore be referred to separately, in order that the especial points in their nursing may be demonstrated. Immediate attentions operation. After minor operations there is seldom the profound shock which exists after an abdominal or after any other major operation. Should there be, the nurse will need to give her attention to the restoration of the patient, as has already been described in the treatment after abdominal section. Cleansing of room. Should the nurse not be needed by the patient, the doctor or his assistants remaining for a short time with her, the nurse may quietly and quickly busy herself with removing the operating table, soiled sheets, towels, etc., and setting the room in order. When the doctor leaves, her place is by her patient. Careful directions should be received by her as directions. Exact Perineorrhaphy for rupture of to her especial duties in each case. She should inquire of her surgeon whether the patient may be permitted to have her position changed from time to time; what shall be done concerning the use of the catheter; the amount of nourishment given the patient; the use of any medicines, etc. These facts should be carefully put down on paper and kept for her guidance in the care of the case. Rupture of the perineum is so frequent that the perineum. operation for its repair, known as the “perineal operation," is the most common of the gynæcological operations. The extent of the laceration which is usually the result of childbirth varies. When it extends through the sphincter muscle of the bowel it is called a complete rupture. Complete rupture. Prepara It is not only important in the repair of these injuries that the operation should be well done, but that the healing of the wound should in every way operation. be promoted. The patient's general health should, tory treatment for The bowels. therefore, be in a satisfactory condition, and the bowels should have received very careful attention for several days. When we remember that the intestinal canal is about twenty-five feet long, and that fecal masses are often kept stored up in it for months, we can understand how free evacuations on several successive days may be necessary before the patient is in fit condition for operation. Some laxative, as recommended by the physician in charge of the case, will be necessary during this period. The opening of the bowels twice every twenty-four hours is not too frequent. An enema will need to be administered a few hours before operation. Care should be taken not to set up a diarrhoea, as this condition may cause greater inconvenience than constipation during the convalescence. The preparatory treatment will also include attention to hemorrhoids, if they exist, or Hemordischarges from the uterus and vagina. When hemorrhoids exist, it is well to keep them supported by a T-bandage, and a compress over the anus. rhoids. discharges. Discharges from the vagina, which may interfere Vaginal with healing, must be cured before the operation is undertaken. The use of hot-water injections, given by the nurse, and local treatment as required by the physician, will be necessary for this. Position operation. For the operation the patient will need to be during placed in the lithotomy or dorsal position. The preparations for fixing her in this position should, of course, not be undertaken until she is fully etherized and no longer in a condition to be frightened by them. rangements for operation. Her limbs may then be flexed upon the abdomen Special arand held either by an assistant on each side, or by the legholder. The clothing under her back being well pushed up, the hips are brought to the edge of the table and the operating pad adjusted beneath them. The parts are washed thoroughly, first with soap and water and then an antiseptic solution, and the hair on the posterior part of the vulva and the perineum shaved away or cut close. Sterilized sheets or towels are made to envelop the limbs and protect the parts. A large pan or foottub should lie just below the parts on the floor, so as to catch blood or water used in irrigation. The labia are held apart by the assistants on each side. The fingers of one hand of each of the assistants can hold back these greater lips, while the other hand of each remains free to assist with sponges, holding instruments, etc. The assistants should stand so as to keep out of the operator's light. The nurse attends to cleansing and handing the sponges, changing the water in the basins, and responding to the needs of surgeon and assistants. Application After the completion of the operation a T-bandage with antiseptic dressings, as before described, may be applied or not, according to the wish of the After-care. surgeon, and the patient placed in bed. The knees and thighs are flexed, and she is put to bed on the right or left side, as a rule, although many surgeons now put little stress upon position as important in the after-management of their cases. Some surgeons prefer that the patient should continue to lie on her side, her position being made comfort of dressings. |