PART I HOME NURSING (Part 6)

to give some relief. When one lung is congested the patient turns natu- rally toward the affected side in order to give the well lung freedom of motion. When there is great difficulty in breathing, as in asthma or in heart dis- ease, the patient can not lie down, but must be OBSERVATION OF SYMPTOMS 63 bolstered up in bed day and night. As relief is gained the recumbent position is resumed. Patients who are extremely weak often slip toward the foot of the bed. This is considered a sign of failing strength. Great restlessness is also often an unfavorable svmptom. Sometimes in the course of disease the other 1 symptoms arm or hand is kept constantly in one position. This is significant of some brain affection, as is also grinding of the teeth or rolling the head from side to side. Any swelling of the face or other parts of the body should be reported at once, whether or not it is attended by pain. Any unusual facial expression should be regarded as noteworthy. If breathing is difficult the distended nostrils may be the first sign of it. Any contortion of the muscles, however slight, should be regarded as significant. A chill is always considered a serious symptom, whether in the course of disease or otherwise. If Serious- i • iiii- i ness °f a the person is apparently well this may mean the onset chin of some acute trouble. The patient should be given a hot drink, abundant covering, and hot-water bags. The temperature must be taken and the doctor noti- fied. High fever is sure to follow a genuine chill. If a chill occurs in the course of an inflammatory con- dition, it is probably due to the formation of pus, which must be given an outlet. In malaria the chills are prolonged and often severe, but are seldom re- garded as alarming. One should be able to describe the character of a cough, whether it is dry, i. c, without expectora- Charac- tion, or loose ; whether short, frequent, choking, in- coush and cessant, or if it is more troublesome at night or after eating. The sputum or expectorated matter should be examined and often must be saved for the doc- 64 HOME NURSING tor's inspection, as it has a characteristic appearance in various diseases. If there is perspiration the amount and character Perspira- of the moisture should be noted when it first appears, tion 1 , 1 • • ,1 and whether it is warm or cold. When there is persistent vomiting the vomited matter must also be carefully described or saved in a covered vessel for the doctor to see. It should be observed also whether vomiting follows immediately the taking of nourishment or seems to have no con- nection with it. The same care is necessary regard- Abnormaii- ing the observation of stools and the necessity of ties in ° J aSd^tolis sav^n§" anything which appears abnormal. Curds may be seen and are easily recognized if milk is not being digested. Some drugs affect the color of the stools so that they might appear alarming if one were ignorant of this. Iron and bismuth blacken the stools. The presence of blood gives them a dark color and tarry consistency. In cases where the function of the gall-bladder is interfered with the stools are clay- colored. The condition of the tongue and mouth is signifi- The sig- cant. Note the color of the tongue and if it is coated, nificant ■ ° , tongue and dry, swollen, or bitten. In fever cases it is almost mouth •" ' ■ always furred, though this condition is. not absolutely a sign of ill-health. When the tongue begins to clear from the edges it is a sign that the intestinal tract is resuming its normal condition and improvement may be looked for daily. The odor of the breath and the condition of the gums and throat also indicate the state of the stomach. The color and texture of the skin is another thing what that is significant in disease. The skin may be yellow, stones ^ « Sa ste8 as *n Jauncnce, showing that the liver is disordered; waxy, as in Bright's disease of the kidneys; anaemic OBSERVATION OF SYMPTOMS 65 or pallid, showing a lack of red corpuscles in the blood; or mottled, or covered with an eruption. Any eruption in the course of disease or any unusual rash appearing in apparent health should be reported to the physician. The place of its first appearance should be noted, as also the character of the eruption and the patient's general condition. A rash may be due to the development of some contagious or infectious disease, to the effect of some poison in the system, or may result simply from a disordered state of the digestion, but the doctor should always be the one to decide upon the matter. The condition of the kidneys is detected by the examination of the urine, which in health will appear Considera- . . tion as to of a pale amber color, with characteristic odor, the urine and should be voided to the amount of about fifty or sixty ounces in the twenty-four hours. Some variation is expected in health, due to the season and the amount of liquids taken into the system. In winter the urine shows a larger amount and is paler than in summer, when there is more loss of water through perspiration, and there- fore a more concentrated and highly colored fluid. Under diseased conditions the urine should be care- fully measured each time it is voided, in a measuring glass kept for the purpose and used for nothing else. Any sediment, opacity, unnatural color, or odor should be noted. The doctor may wish at any time a specimen of the urine for examination, and unless when the otherwise stated the first urine voided in the morning wishes a should be saved in a perfectly clean and dry bottle. Under some nervous conditions, as when one has a severe headache, the urine is voided very frequently and is paler than normal urine. The increased amount is also a characteristic of hvsteria. Retention of 66 HOME NURSING urine means the complete inability to void it, and we have already spoken of that as a condition which must receive attention from the doctor or skilled nurse. The suppression of urine, however, is a much more Suppres- serious complication, and implies, not as in retention, sion of r urine that the muscles around the neck of the bladder re- fuse to act, but the inability of the kidneys themselves to perform their function, the bladder being found empty upon catheterization. Unless these organs can be forced to act, and will respond to treatment, the issue must be fatal, as the system soon becomes thor- oughly poisoned through absorption of the waste matter which should be thrown off by means of the kidneys. Incontinence of urine or lack of power in the blad- inconti- der to retain its contents is common as old age advances urine and the muscles are inclined to relax. The same con- dition exists sometimes in disease and implies extreme weakness. Incontinence may sometimes accompany retention of urine, the bladder being so full that some of the contents dribble away. None of these conditions should be kept from the knowledge of the physician. Painful and frequent urination may indicate an irri- tated and inflamed state of the bladder, and treatment is always necessary in order to hasten relief. The eye is sometimes the first thing to indicate a indka- general disorder of the system. It may be unduly the eye prominent, as in a disease of the thyroid gland known as goitre, or the pupils may be abnormally or unevenly contracted or dilated. Sometimes the eyelids droop, as in certain nervous disorders, or there may be squint- ing, which accompanies brain trouble. Pufrmess about the eyes and face suggest heart or kidney difficulty. The color of the eyeball may be abnormal or the eye OBSERVATION OF SYMPTOMS 67 take on an unnatural brightness or peculiar lack of ex- pression, all of which is significant in disease. Hearing, too, is sometimes temporarily impaired by disease, as in the deafness accompanying typhoid fever, state of but often this sense becomes more acute than in health. An increased keenness of hearing may precede deli- rium. Any discharge from the ear should always be noted as to its character and amount. The mental state is subject to frequent changes in disease. If there is delirium, notice its character, The ner- ' vous men- whether it be. mild, muttering, or inclined to be violent. tal state A delirious patient should never be left alone for an instant, no matter how mild the nature of the delirium, for at any moment an idea may seize his brain and be instantly acted upon, which might bring fatal con- sequences. Many such accidents have resulted from a delirium thought to be mild and therefore not need- ing special watchfulness. Any manifestation of a ner- vous character, such as incoherency of speech, dulness of intellect, difficulty of swallowing, involuntary twitch- ing or actual convulsions, are grave symptoms. Ob- serve the mental state before, during, and after a con- ^tl°rTl and vulsion, whether the attack is sudden, how long it lasts, convulsion and whether the spasms are general or confined to one part of the body. Sleeplessness may be regarded as a serious condi- tion, according to the length of time it lasts. Watch- sieepiess- fulness is necessary in order to make an accurate re- port as to the amount of sleep a patient actually ob- tains in the twenty-four hours, since it is never safe to trust to a sick person's account of himself and the short naps which he has been able to get if summed up may amount to several hours of sleep. It is never wise to oppose any statement in regard to the lack of sleep, as it can do no good and only irritates a nervous 68 HOME NURSING person. He may be soothed and his mind diverted from the troublesome subject in the various ways that sug- gest themselves to a thoughtful person. The careful observation of symptoms added to ftlfobser" g"°°d reasoning as to their meaning will often throw Symptoms much %nt on the disease in question and make the nursing of a case more than mere drudgery if one has any taste along scientific lines. A little judicious questioning of the doctor, if he is inclined to give explanation, will interest him and add much to the intelligent understanding of the work to be done. Close observation of symptoms, however, is of small account if there is no attempt to report con- ditions to the doctor in an accurate and orderly fashion. The memory ought never to be relied upon, but The value notes of some kind should be kept in the sick-room and written important points recorded from time to time. A neatly statement \ r J written statement simplifies the account for the doc- tor and will be much appreciated by him, whether he takes the trouble to show it or not. A sheet of ruled paper with columns marked off in which to tabulate the time, pulse, temperature, respiration, nourishment, sleep, urine, and stools, with a margin where remarks can be added, will be found a convenient form of keep- ing the record. A small blank book in which the doc- tor's orders can be written is also a valuable acquisition. INFLAMMATION, EXTERNAL APPLICATION, MEDICINES Inflammation— Treatment— Dry Heat— Hot- Water Bags— Moist Heat— How to Make a Poultice— Fomentations— Cold Applications— Ice Coils— Counter- irritants— Massage— The Giving of Medicine— Hypodermic Injections- Care of Medicines A INFLAMMATION LARGE number of diseases, both medical and sur- gical, are of an inflammatory nature at some time during their course ; all diseases the names of which terminate in "itis" are understood to be inflammatory. Inflammation implies changes in the tissues, which are brought about by certain irritants. These irritants, How con- whatever they may be, cause a larger amount of caused " blood than is usual to be sent to some part of the body. This condition is known as congestion. It means that the tissues can not take up the excess of nutritive material fast enough, that the capillaries be- come clogged, and that there is an oozing of some of the constituents of the blood into the surrounding tissues. The congestion may slowlv disappear in a few days, The resuit- i • r i- 1 • r. • i- 11 inS inflam- but if not soon relieved, inflammation must follow, mation This state is characterized by pain, swelling, tenderness, heat and redness. It may subside by gradual return to a healthy condition, or it may go on to suppuration, which is the formation of pus or matter. If for any reason inflammation takes place, the white corpuscles of the blood, which we have called the scavengers, hasten to the spot, make their way through (69) 70 HOME NURSING the walls of the blood-vessels and begin their work of absorbing the irritant. If they are successful, we say- that resolution has taken place and the inflammatory condition disappears ; but if not, the symptoms of red- ness, swelling, pain, etc., increase in severity and pus is formed. If the inflammation attacks mucous sur- yvhen pus faces, there will be a natural outlet for the pus, as these is iormed L surScesUS a^ways *ead to tne external membrane of which they are merely a turning in, and with drainage thus estab- lished the inflammation will probably subside. If, Uvous however, a serous membrane, as those are called membrane which line the cavities of the body or any solid part, is affected, the pus has no means of escape. Such an accumulation of pus is known as an abscess, and unless an opening is made to afford free drainage for the imprisoned matter it remains as a menace to life. Sometimes an abscess is left to burst spontaneously, Abscess and if the body is in good general condition, it will and blood- J ° ° poisoning absorb the poison and throw it out of the system. But there is always great danger of blood poisoning, and even if the person escapes such consequences, and there seems to be a speedy recovery, the possibility remains that the poisonous matter has not been entirely evacu- ated and that what is left will be sufficient to set up further irritation and cause a repetition of the same conditions. For this reason it is plain that an abscess which has Serious- not had free drainage, even when its immediate con- anSab°scess tents have disposed of themselves, needs to be cleared out and thoroughly purified before health can be as- sured. If an abscess in either the pelvic or abdominal cavity is neglected, the consequences are very liable to be fatal. When there is severe pain with a throbbing, full sensation and increase of temperature attending an INFLAMMATION 71 inflammatory condition, we may be quite sure that pus is forming. In severe cases, chills also occur and are always to be regarded as a serious symptom. TREATMENT FOR INFLAMMATION The treatment for inflammation is always to seek if possible to remove the cause and to allay the irrita- Removing r the cause tion that has resulted. Various measures may be adopted in order to accomplish this. Both cold appli- cations and hot are used in the early stages, some doctors preferring the former and some the latter method. DRY HEAT Dry heat is used to increase the temperature of the body, whether general or local, to allay inflammation What dry , . " , . heat is or to encourage suppuration, and to induce free per- used for spiration when it is desired to relieve the work of the kidneys. Dry heat is less enervating to the tissues than moist and there is less danger of taking cold after its use. "When dry heat is to be employed to induce perspi- ration, the patient may be placed on a chair with his Method of feet in hot water, the clothing removed and blankets perspira- fastened from his neck down around the chair reach- ing to the floor. A lighted alcohol lamp is placed in a basin underneath the chair, and the patient is kept well wrapped up. After sitting thus for a half-hour or an hour, free perspiration may be expected to follow, and the patient should then be put to bed between warm blankets and sponged off with alcohol. Any ar- rangement for a hot air bath to be given in bed will scarcely be practicable outside the hospital. 72 HOME NURSING How to make a hot-water bottle ready HOT-WATER BAGS AND BOTTLES Hot-water bags for ordinary use should never be filled more than half full, as they are unwieldy if en- tirely full. If the bag is held by the handle when rilling, rather than by the top, there will not be danger of scalding the hand as the water bubbles up from the bag. As much air as possible should be expelled from the bag before screwing on the top. It is well to form Hot- Water Bag Bottles and bricks man^ the habit of turning a bag upside down after filling, in order to be sure that the top is screwed on firmly and that there are no leaks. Hot-water bottles are useful times where bags are not available. They should always be well protected with flannel and should not be filled more than two-thirds full, for fear of their cracking; for this reason also the corked end should always be turned away from the patient. Bricks INFLAMMATION 73 may be used and retain their heat a long time, but they are clumsy. Flannels for application to any part