PART I HOME NURSING (Part 2)

now in place of the Marseilles or other heavier materials. At night it should be removed and folded neatly to keep it fresh for day use. In tucking in the clothes at the bottom of the bed, they ought not to be drawn tightly over a patient's toes, a fact which some nurses, overzealous for appearance, are apt to forget. In some cases where there is extreme Comfort nervousness or where the feet are particularly sensi- firstP:atapnt tive to any irritation, it is better not to have the pearance ci0thes tucked in at all at the bottom. The comfort second of the patient should never be sacrificed in order to gain a better appearance of the bed. DAILY CARE OF ROOM The daily care of the sick-room is most im- portant. The room should at all times present a tidy and restful appearance. If the weather is cold a light shawl may be thrown over the -patient's head and extra covering provided so that the apartment EQUIPMENT OF THE NURSE 17 may be thoroughly aired. This should be done both night and morning for a few minutes, and in cases Frequent where the air becomes offensive it should be done several times during the day. If there is a carpet on the floor the surface dust can be removed by going over it lightly with a damp To clean cloth wound round a broom. No thorough sweeping ^ ctrc should be attempted with the patient in the room. A damp dust-cloth is also to be used for the furni- ture, so that as little dust is stirred up as possible. Soiled dishes and remnants of food should never be allowed to stand in the room, but should be removed at once after the patient has eaten. Frequently he will insist that it does not matter, or will even object nesstXatid to tidiness, but there is an unconscious feeling of rest orderliness that is engendered through orderliness of which he is himself quite unaware, and this should not be denied him. A little tact or playful insistence will usually remedy any objection on his part. The same thing is true in regard to the serving of meals to a con- valescent or to some member of the family who is temporarily kept in bed and who thinks to save work by urging that he does not care how things are served. He may be quite honest in his feeling, and yet find that the dainty service tempts his appetite so that he is able to eat a far better meal than otherwise. The necessary medicines, mouth-wash, pitcher of water, and all the paraphernalia of the sick may stand on a small table or shelf, placed if possible out of sight of the patient, as it is pleasanter to have all the reminders of sickness removed. A clean towel on the table looks more suitable than an elaborate table-cover, and a fresh sheet of white wrapping- paper laid over that saves laundry and may be changed every day or two as necessary. 18 HOME NURSING If the patient is able to be moved into another In case room there should be a weekly cleaning of the sick- cieaning y room, with thorough sweeping, cleaning of brasses, beating of mattress and airing of blankets, since fresh air has germ-destroying powers that may be utilized by every one. Large and small squares of cloth are needed for Of the various purposes about the sick-room, and can easily squared be. made and kept on hand for use when required, of cloth There should be several bed-pan covers, made of heavy cloth or doubled thicknesses of old sheeting, furnished with loops to hang by, and separate smaller cloths for wiping the bed-pan and the wash-bowl. It is convenient to have these latter of different size or of figured cotton, so that they can be readily dis- tinguished from each other. Pieces of old sheets or toweling can be cut into convenient sizes and hemmed to slip under the bed-pan when it is used, and a quantity of small pieces of old cotton torn into squares of about six inches will be found useful for the necessary bathing after the bed-pan has been used. Absorbent cotton can of course be used for the same purpose, but is more expensive. GARE OF UTENSILS The care of the utensils in use about the sick- room must not be overlooked. The utmost cleanli- ness is necessary in regard to them. Bed-pans and urinals should be rinsed each time after their use with cold water, and then washed with scalding water and soap and dried with a cloth kept for the purpose. A weekly scouring with sapolio is necessary if the use of the pan continues many weeks. Sputum mugs should be boiled every day for twenty minutes, and a small pan kept expressly for this use. EQUIPMENT OF THE NURSE 19 In preparing a mug for a tuberculosis or pneu- monia case one should be selected which is smoothlv Special 11 T£. Care* °* glazed so that no germs may lodge in any crack. If sputum this is neatly lined with toilet-paper, letting the paper mug entirely cover the edge and fold down over the out- Glass Sputum Mug with Metal Cover side of the cup, the lining can be very easily lifted out and burned and a fresh lining made. It is best to have two mugs, so that one may be in use while the other is being sterilized. A very useful cover can be made by cutting out a piece of cardboard the size Metal Frame Paper Filler of the cup and putting a large safety-pin through the centre for a handle. Excellent appliances for the use of tuberculosis patients are made, consisting of a papier-mache form which is inserted in a covered metal holder. 20 HOME NURSING In nursing cases of cancer, tuberculosis, typhoid Keep the fever or contagious diseases, care must be taken to dishes keep all dishes, knives, forks, and spoons used in the SCD3.r3.tG sick-room separate from those in general use. It is better to keep the sick-room dishes upstairs, and to have a small dishpan in some convenient place for Invalid's Drinking Cup washing them, so that they need not be sent to the kitchen, as errors are apt to occur and the dishes get mixed. They are best disinfected after they are no longer needed by boiling them for half an hour. There are a few things which, if conveniently ar- Littie con- ranged, can save many steps on the part of the nurse. foimsav-es If a patient is on fluid diet, or it is necessary to heat water continually, it is always possible to have a vemences for sav- ing steps Woven Wire Mat saucepan and some device for heating liquids which may be kept in an adjacent room or in the halL Also a dishcloth and towel can be kept at hand so that the glass and saucepan may be washed as soon as used. A very simple arrangement for heating, if gas can be used, is by means of a woven wire mat which can EQUIPMENT OF THE NURSE 21 be bought for a few cents, and is intended to rest on the gas globe. This will hold quite a good-sized pan and heat its contents very quickly. A Nursery Ice-Chest A nursery ice-chest, which is a tin box with two or more compartments, is an ideal thing to hold the^st6 milk and foods that are being used constantly. A Water Cooler very good substitute can be planned for use in cool weather by having fastened outside the window a large uncovered soap-box, with the open side facing 22 HOME NURSING the room. This can be protected by a piece of white enamel cloth tacked on to form a curtain over the front, and the whole thing can be kept sweet with soap and water. Food must never be allowed to stand in the ice- Milk and box till it becomes old, and milk and butter should butter . should nave a separate compartment if possible, as their ciai care flavor is very easily affected by strong-smelling foods. The ice-box should be looked over every day, and the shelves wiped with a damp cloth. Once a week there should be a thorough cleaning with washing soda and warm suds followed by careful drying in the sun if possible. II GENERAL CARE OF BED PATIENTS Structure and Function of Skin— The Cold Bath— Frequency of Bathing in Sickness— The Bed-Bath— The Foot-Bath— Care of the Hair— Care of the Mouth— Changing Sheets for Bed Patients— Changing Night-Dress— Prevention of Bed-Sores— Lifting and Moving Patients— Mechanical Appliances THE comfort of a sick person, whether he realizes it or not, depends upon clean surroundings, a clean body and the ease with which his wants are attended to. This ease is one of the gifts which ex- perience, particularly trained experience, gives. It means that the added burden sickness has brought is The gain •111-1 from absc- not made apparent to the patient, that the little wants lute rest of mind are met before they are realized, and that the re- and body sponsibility of medicines and nourishment is given over by him with a sense of relief; in short, that freedom from care and anxiety is made possible, and with it that absolute rest of body and mind which adds greatly to the chances of a speedy recovery. The subject of bathing and its importance, both in health and in sickness, is so familiar to the students of hygiene and lovers of good health, that we are apt to forget the great number of people who have little sympathy with what they consider the fads of would-be reformers. The ignorance of this great number about the necessary function of the skin and its delicate structure makes their proper care of the body very dull and perfunctory work, if indeed they do not actually neglect it. (23) 24 HOME NURSING a micro scope STRUCTURE AND FUNCTION OF THE SKIN The skin is in two layers. The upper or scarf skin is what is raised as a blister when one is burned, Scarf skin and this is constantly rubbing off in minute scales. We are generally unconscious of this, though we can easily recognize it in the dandruff and in the dried skin that we find on an arm or leg that is left for weeks in a bandage or splint. Although this scarf- skin is constantly being shed, it is as constantly being renewed from the second layer, called the true skin. This upper skin is not sensitive at all, while the under layer is supplied with blood-vessels and nerves. The two Under the microscope we see that these two layers layers or * J skin under 0f skin are composed of a multiplication of tiny bodies which are called cells, the upper ones being very flat and horny, while the lower ones are larger and ir- regular in outline. As the lower cells grow, they push up toward the top and become flattened, so that as scarf-skin they are the tiny scales we can see. This is going on constantly all over the body, whether or not we can detect it, and the principle is just the same as that which makes the swelling buds push ofT the old year's leaves. Another substance that is present on the skin at all times is perspiration, which is constantly being poured out from small glands found in the true skin. At an ordinary temperature, when we are in health, the amount of perspiration is insensible, but as we all know in certain diseases, or when the temperature is raised from any other cause, it is poured out in large quantities. The sweat is not wholly water. In health it con- tains some salt, and in diseases of the kidneys, when they do not perform their proper amount of work, it The per- spiration CARE OF BED PATIENTS 25 also holds some of the waste matter of the bodv, What it contains which would otherwise be carried off in the urine. and accom phshes Sometimes in sickness a person can not be made to perspire sufficiently, and when by means of medi- cine and treatment we find the skin growing moist we regard it as a sign of returning health. By this we see that the elimination of water from the body through the pores of the skin is a very necessary process as a means of regulating the heat of the body, and that anything that interferes with the free action of these glands must be guarded against. The third substance that we find excreted on the skin is a sort of oil which is also contained in little Th? lubr,i- cating oil glands. This serves to keep the skin soft and flexible, particularly to lubricate the hair and to keep it smooth and glossy and also to protect the body from mois- 'ture, exactly as the oil enables the birds' feathers to shed water. The openings from these glands are larger in some parts of the body than in others. For instance, we find them very large and apparent about the nose, and when they become clogged with the secretions they are still more enlarged and form what we know as pimples. There also escapes from the skin some gases like what we exhale from the lungs, and it is capable, too, The skin's of absorbing small quantities of substances that may and ab- be rubbed upon it. It is for this reason that patients, powers particularly babies that are losing flesh, are rubbed with oil or milk, though this is not considered as important a function as it once was. To sum up then, we should say that the skin is protective — that it is a helper to the kidneys in getting what the rid of the waste of the bodv in the perspiration and in Pr°- 1 l tection to the lungs in getting rid of some of the carbonic acid gas ; that it absorbs to a limited extent substances 2 Vol. 3 26 HOME NURSING rubbed over the outside layer and very rapidly absorbs those injected beneath the upper, or scarf, skin; and that, finally, through the sweat glands, it is a power- ful regulator of the heat of the body. It is easy to feel the significance. of the bath as Conse- regards health and comfort in the face of these facts quent values of relating to the structure and function of the skin. All the bath & these glands are essential to our well-being. If they are clogged in any way we feel the results. On ac- count of the oil that is present the warm bath at least once a week is advisable. Plenty of soap, warm water, and a thorough drying afterward, taken at night, clears up the skin, relaxes the muscles, and makes the chances for restful sleep more sure. But it is the value of the daily cold sponge that we need to emphasize. THE COLD BATH OR SPONGE In our changing climate we are very liable to colds. ?onyeCold ^ we ony realized what a safeguard the splashing cold sponge is there would be more willingness to over- come the first unpleasantness of the use of cold water in the winter. The first effect of the cold bath is to drive the blood from the surface, to reduce the temperature of the body and to retard the action of the heart. A its effects natural reaction should take place under normal con- ditions, and the blood be sent to the surface of the body with a general quickening and stimulation of the circulatory and respiratory centres. If this reaction does not occur and if a feeling of pleasant, tingling warmth does not follow, the cold bath is not bene- ficial. If one accustoms the chest to the splash of cold CARE OF BED PATIENTS 27 water followed by a vigorous rub which leaves the surface red and glowing, the resistance to cold is greatly increased. Another advantage in the daily bath is the fact that the body is exposed to the air at least once a dav. Value of J k ■ air on We keep our bodies so securely wrapped from the the skin air that draughts are dangerous and the ordinary change of passing from warm rooms to cool out-of- doors brings on colds. If for any reason the daily bath is impossible, a D bath brisk rub with a coarse towel or brush fulfils to a certain extent the same purpose. These facts which we emphasize as so important in health one can easily see are vastly more potent in sickness, for at such times the excretions of the skin arise from a diseased body. In most cases a daily warm sponge bath is of posi- tive benefit to a patient, though if there is extreme Daily -1 ^ warm weakness the entire surface of the bodv should not be sponge benefits bathed at one time, and it may sometimes be better the patient to substitute for the soap and water bath an alcohol sponge, wiping off the surface of the body and re- freshing the patient without fatiguing him. FREQUENCY OF BATHING IN SICKNESS In ordinary cases of sickness, then, we may say that a daily bath is called for and very rarelv is there Guard 1 r • • i • • • r r against any danger of injury to the patient arising from it if cfiiii and proper care is taken not to chill or to fatigue him. The windows should always be closed, and the room made sufficiently warm before beginning. Baths given in sickness are varied in kind and pur- pose, but it is seldom that anything other than the cleansing