bath or alcohol sponge would be called for. THE BED-BATH Before beginning a bed-bath everything required must be at hand — a basin, soap, hot and cold water, slop-jar, face-cloths, towels, and clean linen. The patient is now to be placed between blankets, and the bedding removed. A very convenient plan is to substitute for the under blanket a large Turkish towel which can be slipped under the different parts of the body as they are being bathed and thus protect the bed. After a towel has become thoroughly damp it should be replaced by a fresh one. A sponge or flannel wash-cloth will retain the heat better than cotton. Only a small part of the body should be exposed at a time and that thoroughly washed and dried before going on. The water should be kept comfortably warm, and changed once during the bath. All fresh linen must be well aired and warmed before putting on the patient and careful attention given to the hair, mouth, and nails.
THE FOOT-BATH A foot-bath in bed can be easily managed, and is refreshing to the patient, who lies on his back with knees flexed and the top covers turned back over his body. The lower part of the mattress is then covered by a folded blanket, over which is laid a towel. The foot-tub is placed on this, the feet gently lowered into the water, and the top blanket drawn back over the tub. After removing the bath the feet rest on the towel and must be left thoroughly dry and warm.
THE CARE OF THE HAIR The combing of the hair is a detail of the toilet which most patients dread, yet this is quite unnecessary if it is properly done. If arranged in two braids it is both comfortable and easily cared for, even if a person is very ill or can not lie easily on her side, and two braids it should never be allowed to become snarled or matted. If it is braided closely once, or in case of unusual restlessness twice, a day, there will be no difficulty in keeping it free from snarls.
<Callout type="important" title="Importance of Daily Hair Care">No hair need ever be sacrificed if this method is remembered, though it may take many hours of labor at different intervals to remove all the snarls.</Callout>
In combing, begin always at the ends of the hair, holding it firmly, but without exerting any tension on the scalp. If the hair has been wet with blood, as in the case of a scalp wound, the clots can be removed by the use of a solution of soda. A shampoo may be managed easily in the convalescent days by placing the patient across the bed so that the head pillow lies along the side. The pillow should be protected by a rubber sheet and the hair washed in a basin placed on a low table or chair by the bed. A little alcohol rubbed afterward in the scalp will help to dry it quickly and prevent the patient from taking cold.
If a cot bed is used it will not be necessary to change the patient's position, as the same thing can be done at the head of the cot. Sometimes one is confronted with the unfortunate problem of the best way of removing lice from the hair. The routine practice recommended in the large schools of New York, where there is constant inspection of the heads, is to wash the hair and scalp thoroughly with kerosene and leave the head bound up in a towel overnight. The kerosene, though unpleasant to use, has a good effect upon the hair and scalp.
In the morning hot vinegar is applied to destroy the nits. This can be poured upon the hair, but since its effects are not specially beneficial it is better to dip a fine-tooth comb into the vinegar and to thoroughly moisten the hair while it is being combed. The vinegar softens the gelatinous substance which attaches the nits to the hair, so that they come off easily.
Another treatment that is invariably effective is a thorough wetting of the scalp and hair with tincture of larkspur, which is left overnight in the same way. It is not necessary to follow this treatment with the vinegar. A second application may be demanded if it is found that the first has not been successful in destroying the nits.
<Callout type="gear" title="Kerosene and Vinegar">These materials are effective but unpleasant, so consider alternatives like mild shampoos or over-the-counter treatments.</Callout>
If children are in a public school where this trouble is common it is much wiser not to keep the hair very long, and absolute vigilance is necessary in order to make sure that the heads are perfectly free from vermin, as, once started, the nits appear very rapidly. A neglected head means that eventually an eczematous eruption appears, which is due directly to the presence of the vermin.
THE CARE OF THE MOUTH The care of the mouth during sickness must not be overlooked. If the patient is not too ill, the teeth should be brushed night and morning, but if that is impossible small squares of muslin or bits of absorbent cotton wet in a boracic acid or listerine solution may be used to wipe the tongue and gums. A mild solution of boracic acid (half a teaspoon to a glass), or a few drops of tincture of myrrh in a glass of water, makes a good mouth-wash, and if a patient is on milk diet, it is necessary to wipe out the mouth frequently in order to keep it sweet and clean. In cases of pneumonia or typhoid fever, where the mouth and teeth accumulate an offensive and tenacious substance known as sordes, it is necessary to use a mandola and mouth-wash which will help to cut this substance and make it more easy of removal.
Equal parts of lemon-juice, glycerine, peroxide of hydrogen, and water used freely both night and day will keep the mouth in as good condition as is possible. In such cases, as will be seen later on, the fingers should not be introduced into the mouth unless a rubber cot has first been put on, because of the danger of infection, and if a cot is used it should be kept in a solution of boracic acid or other harmless antiseptic.
Swabs made of cotton wound round a toothpick can be used instead, and burned at once. CHANGING SHEETS FOR BED PATIENTS To change the sheets with a patient in bed, it is necessary first to fold the fresh draw-sheet and lay it in large plaits ready to slip under the patient. He is turned on the side most easy for him, the bedding loosened, and all covering but the top sheet and a light blanket removed. The under sheets in succession, including the rubber, are then rolled as near as possible to the patient's back, while the clean under sheet which has been tucked in firmly at top and bottom follows closely the soiled one. The rubber sheet is now unfolded and put back over the fresh under sheet, and the draw-sheet laid over it and tucked securely in at one end, the other folded portion being drawn closely to the patient.
If this has been done carefully the roll of soiled and fresh sheets can be easily flattened, the patient gently rolled over it, and the other side of the bed made. To change the top sheet, first lay the fresh one over the soiled, and while the top one is being held by the patient, if he is able, draw the other from under it so that there may be no exposure of the body.
CHANGING THE NIGHT-DRESS The changing of a night-dress on a helpless patient seems a very wonderful thing to those who are first time watching it done by skilled hands, yet simple it is a very simple matter, and requires only a little practice to accomplish without fatigue to the patient. The fresh night-dress, arranged to slip easily over the head, is first placed on the patient's chest. The soiled one is then gradually drawn up from under the back until it is well past the shoulders, when the sleeves can be easily slipped off, the head gently lifted, and the soiled night-dress exchanged for the fresh one.
The nurse should slip her own hand through the fresh sleeves at the wrist and, gently grasping the patient's arm, draw it through so that no effort on his part is necessary, and finally the rest of the night-dress must be pulled smoothly into place. The use of a short night-dress open in the back is sometimes of great value with very ill patients, especially if frequent night-sponging is required, since it can so readily be slipped off.
Any plain nightgown can be utilized for this purpose with very little trouble. In removing a nightgown or other garment from a person having a disabled arm, it is necessary to take off the sleeve from the well arm first, in order to give plenty of room for the other, and in putting on a garment the process is reversed for the same reason.
THE PREVENTION OF BED-SORES In cases of wasting disease or with aged or paralyzed patients, there is a tendency to the formation of bed-sores, and unless one has had some experience it is hard to realize in how short a time such a sore can make its appearance nor what extreme vigilance is necessary in order to prevent it. A bed-sore is really a part of the tissue of the body which is cut off through pressure from the circulation of the blood and which therefore becomes dead tissue.
It is caused, as stated, by unrelieved pressure accompanied usually by heat and moisture, and those parts of the body where the bones are nearest the surface are naturally the places to be specially guarded. The hip-bones and base of the spine, the elbows, shoulder-blades, heels, and even the tips of the ears should appear be closely watched for the slightest indication of redness or pricking sensation, which gives the first warning of danger.
If possible the position should be changed from time to time, or if there is any reason why that can not be done some measures must be taken to relieve pressure. A rubber ring is useful for the spine or hips if it is not blown up enough to make it hard. A very slight amount of air in the ring will be sufficient to lift the pressure and will prevent its being uncomfortable.
The 'horseshoe' air cushion, though more expensive than the ordinary round rubber ring, is very much more comfortable and more sanitary on account of its construction. Small soft rings made of cotton and wound with a bandage are very useful for lifting an elbow or heel, and can be renewed as they become soiled or out of shape.
Besides the relief from pressure there must be an effort to increase the blood supply in the part in order to build up new tissue. As in the case of the sick body as a whole we aim first at cleanliness, so here gentle friction with the ball of the thumb, working always toward the centre, is used.
The alcohol helps to harden the tender skin and the massage forces the blood through the surrounding tissue. Another measure for establishing better circulation is the use of hot douching of the part, followed by cold. Care must be observed that the water is not hot enough to scald the tissues. This should be kept up for at least ten minutes night and morning.
A little zinc oxide powder may be used to dust the surface and assist in absorbing moisture. Powders as a rule are better omitted, as they are apt to cake and form hard particles which do more harm than good to the tender flesh.
It is necessary that the bed should be kept absolutely dry and smooth. Crumbs must be brushed out and the wrinkles smoothed frequently. It is some- times difficult to accomplish this, especially in the case of a paralytic or aged person when there is incontinence of urine to fight against. However, by the use of a sufficient number of thick pads about fifteen inches square, made of absorbent cotton covered with gauze or cheesecloth, it is possible to keep the bed dry, and the patient need never be left to lie on wet sheets.
There should always be special bathing with warm water after urination. This is essential not only in that the patient may be kept quite clean and free from unpleasant odors, but because when a bed-pan is being used the urine runs back between the buttocks and is sufficiently irritating if left to dry to cause chafing and sometimes even a slight fissure.
If once the skin becomes abraded the alcohol can of course be used only round the edges of the bed-sore, which we must then regard as an open wound and treat accordingly. The advice of a doctor should be sought in such cases. It is always necessary to apply a dressing at once and small thin pads of absorbent cotton covered with gauze or clean linen and fastened in place with strips of adhesive plaster will protect the sore from infection.
LIFTING AND MOVING PATIENTS The expert lifting and moving of patients requires much practice, but a few hints may be useful in preventing the awkwardness one feels who has never taken care of sick people. In moving a patient from one side of the bed to the other it is not necessary either to drag or pull him over. One arm should be placed obliquely under the shoulders with the hand supporting the back, while the other is carried over and under the other shoulder. In this way half of the body can be lifted on to the fresh side.
Then with one hand and arm under the lower part of the back and the other below the hips, the rest of the body can be drawn into place very gently. If the patient is able, he can assist by clasping the hands around the nurse's neck. In raising a patient in order to readjust pillows, support is given in the same way with the head resting in changing pillows on the nurse's shoulder, while her free hand changes the pillows.
To lift toward the head of the bed, the hand and arm are placed under the back as indicated above, and when two join in the other hand under the hips, and the patient lifted gently and steadily. If two people join in lifting, one on each side, in this way even a very heavy person can be easily moved.
To change a mattress with the patient in bed assistance is necessary. One person draws the mattress with the patient on it half way off the bed while the other mattress is slipped into place. The patient is drawn across by means of the sheet on to the fresh mattress, which can then be slipped the rest of the way.
<Callout type="risk" title="Risk of Infection">Always use clean materials and maintain hygiene when changing sheets or moving patients.</Callout>
Key Takeaways
- Proper bed baths are essential for maintaining patient cleanliness.
- Regular hair combing prevents matting and infection.
- Frequent mouth cleaning is necessary to prevent infections and maintain oral health.
Practical Tips
- Use a large Turkish towel under the patient during bathing to protect the mattress from water damage.
- Keep the bed dry by using absorbent cotton pads for incontinence, changing them frequently.
- Regularly check for signs of bed sores on pressure points and take preventive measures.
Warnings & Risks
Risk of Infection
Always use clean materials and maintain hygiene when changing sheets or moving patients.
Be cautious with kerosene as it can be flammable. Use in well-ventilated areas only. - Avoid using powders on the skin, as they can form hard particles and cause irritation.
Modern Application
While many of the techniques described here are still relevant for home care, modern practices have improved hygiene standards and safety measures. The use of disposable materials and advanced cleaning products has reduced the risk of infection. Understanding these historical methods can provide valuable insights into patient care during emergencies or when professional help is unavailable.
Frequently Asked Questions
Q: How often should a bedridden patient's hair be combed?
The text suggests combing the hair once or twice a day, depending on the patient’s condition. This prevents matting and keeps the scalp clean.
Q: What is the best way to remove lice from a patient's hair?
The chapter recommends washing the hair with kerosene followed by vinegar in the morning. Alternatively, using tincture of larkspur overnight can be effective.
Q: How should you change a bedridden patient’s sheets without disturbing them too much?
Fold the fresh draw-sheet and place it under the patient. Turn them gently to one side, remove the old sheets, and replace with the clean ones while keeping their body as undisturbed as possible.