PART I HOME NURSING (Part 9)

sterile. China pitchers and bowls will probably have to serve as receptacles for the supply of water CARE OF OPERATIVE CASES 93 94 HOME NURSING sterilizing and since they can not be treated in this way they must be carefully scrubbed and rinsed with some anti- septic solution followed by boiled water. The surgeon will doubtless bring his own supply of sterilized towels and dressings, which he will take charge of himself, but it is always safer to provide unsterilized towels, which can be wrung out in an antiseptic solution and used if necessary. Two dozen of these should be furnished, but it is not essential that they be fine-face towels. Clean sanitary napkins or dish-towels answer the purpose quite as well. Plenty of alcohol, bichloride tablets, carbolic acid, other and brandy should be on hand, and a clean brush for in the the surgeon's nails. Safety-pins and bandages will operation ^e neQded. An abdominal bandage can be made of three yards of white cheesecloth doubled and folded the required width. The room should be kept at a temperature of 70° Tempera- F. unless an abdominal operation is to be performed, ture of ...... . .. the room in which case it will be necessary to have the tem- perature remain at 8o° F. THE PREPARATION OF THE PATIENT The preparation of the patient will be very little Bodily beyond putting on a fresh nightdress and stockings, ituai treat- which are better white than black. The hair, if not "/"lie already so arranged, should be plaited in two braids. patient All food -and water must be withheld. Everything possible should be done to inspire the patient with a quiet and hopeful attitude of mind, and no trace of excitement or nervous tremor should be observed in the sick-room. On no account should the patient be a witness of any of the preparations. The anaesthetic will be given before the patient is moved into the operating-room, and it is not neces- CARE OF OPERATIVE CASES 95 sary that there should ever be any knowledge of the appearance of that room. The patient should void Before urine the last thing before the anaesthetic is admin- anaesthetic istered. If there are false teeth they must be removed, as accidents have been known to occur from their being left in while a patient was unconscious. Be- fore being moved into the operating-room the patient should be covered with a light blanket carefully ar- ranged to avoid exposure. FULL PREPARATION FOR OPERATION All of this preparation can be done in the short time allotted if it is undertaken quietly and system- More atically. If, however, an operation is to take place prepara- at some future date, a more careful preparation of tl0ns the room and patient can be given. In such a case the room should be thoroughly cleaned and aired, the hangings and carpet removed, the walls brushed down, and the floor scrubbed and washed with a bichloride solution. The further preparation would remain about the same as above except that it would ?.? .ster" r llizing be possible to sterilize towels. Packages of these towels should be done up in two covers of muslin and steril- ized according to the directions for sterilization given in Chapter III of Part II. They should not be sterilized earlier than the day before the operation. The preparation of the patient, unless special con- ditions exist, consist of a thorough evacuation of P/epara- the bowels by means of a cathartic if the doctor ap- the patient proves, followed by enemata till the water comes clear, and a cleansing bath the night before the operation. After the enemata nothing should be given in the way of food except beef tea or malted milk, and all nourishment must be withheld for at least three hours before the operation. 96 HOME NURSING' To make an ether cone Guard against inflam- mable character of ether When one of the family- assists THE ANESTHETIC It is customary for the surgeon to provide the anaesthetic. If ether is to be administered and there is no inhaler used, an ether cone can readily be made by folding two or three thicknesses of newspaper to- gether to make a pad about sixteen inches long by nine inches wide and covering this entirely with a piece of loosely woven toweling. This pad can then be twisted into the shape of a cone and pinned with a small opening left at the top. A bit of absorbent cotton can be put inside to receive the ether. If the operation is at night and ether is used, it is well to bear in mind the inflammable character of the fumes. Ether fumes are heavier than air, and the lights should be kept above the region of the can or inhaler. When chloroform is used as an anaesthetic it is usual to apply vaseline over the lips and nose to pre- vent irritation from the vapor. During the time that the patient is getting under the influence of the anaes- thetic it may be necessary that some one of the family be in the room to give some assistance if the patient is inclined to struggle, and considerable anxiety may be removed if one realizes something of the natural effect to be expected from an anaesthetic. The quick- ened breathing and deeply flushed face need not cause any alarm, as it does not indicate distress. ASSISTING THE SURGEON During the operation it will seldom be necessary for one of the family to be present, as in almost all cases the surgeon brings his own assistants. If, how- ever, conditions require it, the duties will doubtless be very simple and will consist of nothing more than CARE OF OPERATIVE CASES 97 the explicit following of the doctor's orders. A cool Explicit , , . t. , . follow- head, close attention to directions, and strict care not jng 0f to touch dressings or instruments are all the re- ^^l s quirements that are necessary for such a trying experience. If, as is altogether probable, there will have to be moments or even hours of intense anxiety outside a closed door, the alternative is a difficult one. It is well to provide one's self with some work which de- Contro1 r . . anxieties mands concentration, because it is always possible to by work keep the mind better controlled if the hands are occu- pied. The first thing, however, to be attended to will be the preparation of the patient's bed. The only Special r i- 'iiii -11 1 needs of variation from an ordinary sick-bed that will be patient's necessary is the placing of a blanket in the bed and precau"1 several hot-water bag's. There should be at least four tion.s against bags provided if the case is an abdominal one, and heat extreme care must be taken not to have them too hot. Frightful burning accidents from contact with hot- water bags have occurred in the case of unconscious patients, and it must never be forgotten that the lowered vitality of an ether patient produces an ab- normally sensitive condition. The method of holding the bag to the cheek a moment in order to test its heat before putting it into the bed is always a safe one. One bag should be filled only half full and may be laid over the heart to stimulate its action. Heat should never be applied directly over or in the region of the operation, as there is danger of its producing hemorrhage from the sudden expansion of the blood- vessels. The pillow should be a low one, preferably of hair, and a towel should be laid over the pillow-case. £J2JJ and Two basins and gauze or towels for wiping the 5 Vol. 3 98 HOME NURSING mouth are to be placed on a table near the bed, for vomiting is almost sure to follow the anaesthetic. AFTER-CARE OF THE PATIENT After the patient is returned to the sick-room he must not be left a moment until consciousness is en- tirely regained. Ether affects persons very differ- The com- ently. With some the unconsciousness and relaxation oTthe are profound and the awakening from it is like that patient from a deep sleep. With others the mind seems more disturbed and there is constant groaning and often excited talking as the effect of the anaesthetic wears off. It will be found, however, that there is no re- membrance later of distress of mind or body, and if this can be borne in mind the strain on the one at- tending will be much less great. If there is continued nausea or vomiting it may Nausea De relieved by giving bits of cracked ice to hold in and food °. , ~ the mouth or a little black coffee may serve to settle the stomach. Sometimes the fumes of acetic acid (vinegar) relieve the feeling of nausea or a cold com- press over the throat may do the same. After an abdominal operation nothing should be given without the doctor's knowledge, and he will wish to leave ex- plicit orders as to the times and quantity of the feed- ings, which must be very cautiously regulated. The patient will probably express alarm lest the effort of vomiting break open the wound, but there is almost no chance of such a possibility, as the surgeon always bears in mind this additional strain and strengthens the wound accordingly. Surgeons differ in regard to the time when ab- Tuming dominal cases may be turned, some regarding it essential that the patient should remain on the back for twenty-four or even thirty-six hours, while others CARE OF OPERATIVE CASES 99 allow their patients after six hours to be turned a little on the side with a pillow at the back. It is impossible to give full instructions in regard to the care of abdominal cases, since so much de- Need of ..' . r 1 i • a special- pends upon the condition of the patient, and it is very ist the necessary that one who thoroughly understands the first week nursing of such cases should have the responsibility for the first week at least. The knee pillow is useful to relieve the strain upon the abdominal wall, and a small pillow that can be ^[j^, easily turned is much more comfortable for the head than a large and thick feather one. The gas pains, which are often very severe, may begin to be felt during- the first twelve hours. The Relieving ° . gas pains soft rubber rectal tube inserted and moved about in the rectum may bring away some of the gas and give immediate relief, though it is hardly to be expected so soon after the operation that the gas will be suffi- ciently low in the bowel to be reached by the tube. Gas pains indicate the activity of the bowels, and are looked for as a sign that all is going well. At the end of twenty-four hours, if the gas is not passing off freely, the doctor will doubtless order a hot saline enema to be administered high, using the soft rubber tube. He may remain himself to give the first enema, but if not some assistance will be needed in giving it, as it is never wise to attempt it alone while the patient is so weak and needs to be lifted on to the bed-pan. As the bowels become warm with the water the gas should begin to pass off. It must be remembered that the bowels have been thoroughlv emptied before the operation, so that it In difficult •11 i r • .i cases will not be necessary for the patient to retain the water as for an ordinary enema. Sometimes the patient is unable on account of weakness to expel 100 HOME NURSING the water, and then it should be returned by inserting the long rectal tube. If after several bags of the saline enema there has been no gas expelled, the patient should rest a while and then the treatment should be resumed until successful, as it is very im- portant that the gas should not be allowed to collect in the bowels. If relief does not come with the use of the saline enema, the doctor will probably advise some medication to be added. With the free escape of gases the patient will find great relief, and the abdomen, if it has been at all distended, will appear normal again. THE PROBLEM OF FOOD If there are no complications attending an ab- , dominal case, and the wound heals without suppura-, tion, the patient will be feeling very comfortable at the end of a week and will begin probably to take solid food. A few days after the operation, if the doctor First food allows it, orangeade can be given occasionally and few days will be most refreshing if served ice-cold with a dash o£ lemon- juice added. If tgg albumen is mixed with it, it can be given as nourishment, but the egg should not be beaten, simply stirred enough not to be stringy. The problem of variety in liquid diet is apt to be troublesome, but there is really quite a list to choose from if one's attention is directed to it. Milk, of Milk course, remains the chief resource if the patient can take it. It may be given cold or warm, as preferred, and if very rich it can be mixed with seltzer water. The old-fashioned gruels made of oatmeal, Indian- Grueis meal, flour, rice, and cracker have different degrees choked ° usefulness if properly prepared. The first two are considered rather too heating for fever cases, and the CARE OF OPERATIVE CASES 101 last are good in cases of diarrhoea. Indian-meal gruel is frequently under-cooked, and served in this way is not easily digested. It should be cooked four hours, and is then delicate and of sweet flavor, quite different from the raw unpalatable stuff that is sometimes carried to the sick-room. The various foods on the market, such as Im- perial Granum, Malted Milk, Cereal Milk, and Eskay's Other Food, are useful. The latter is one of the newer foods and is especially delicate and pleasant. With all of these foods the directions are given on the box, though in almost all cases the time given for cooking is too short and individual taste may suggest some variation, such as pouring the hot malted milk upon a tablespoon of thick cream, which makes it a most delicious drink. Koumiss, is enjoyed by some patients, and is di- gested by very delicate stomachs when other foods are rejected. Fruit egg-nogs, expressed beef -juice, and broths help to make variety, and albumen water, while not especially palatable, can be taken without distaste by most persons. The following receipts for invalid cookery may be helpful : FRUIT EGG-XOG One egg, one orange, half a lemon, two to four teaspoons of sugar. Beat the yolk of the egg and add the orange and lemon juices. Add sugar to the white of the egg, and beat until stiff. Combine and mix well. Pour upon cracked ice and serve at once. Thin slices of banana or a few strawberries may be added if desired. EXPRESSED BEEF-JUICE Take one pound of thick round steak, broil slightly 102 HOME NURSING and place on a hot platter. Cut in small pieces and press out the juice by means of a meat-press, lemon- squeezer, or potato-ricer. Add a very little salt, and serve either ice-cold or warmed by placing the cup in hot water a few moments before serving. If heated over the fire it will curdle. CORN-MEAL GRUEL One pint of boiling water, one scant tablespoon of Indian-corn meal. Mix the meal with a little cold water and stir into the boiling water. Boil for four hours. Strain and season with salt. Sugar and cream may be added if wished. MEAT-BALLS Scrape raw beef and mold into tiny balls three- quarters of an inch in diameter, with a bit of chopped parsley added. Place in a hot pan over the fire, with a little butter and seasoning, and keep the pan moving until the balls are evenly seared. Serve on bits of delicately browned toast. PRUNES WITH WINE Wash quickly in hot water half a pound of dried prunes. Soak overnight. Cover with claret and simmer until soft. Add sugar to taste and cook ten minutes more. Serve cold. CASES OF MINOR SURGERY The cases of minor surgery, by which we mean those that are not naturally attended with serious re- sults, frequently do not require the services of a trained nurse, though the nursing demands intelli- gent watchfulness and attention to detail in the gen- eral care. Rectal cases are often treated at home with en- CARE OF OPERATIVE CASES 103 tirely satisfactory results. It must be expected that there will be great suffering unless the doctor ap- Precaution proves of the use of morphine, which is usually given JJJ0V^ of at first to such cases if treated in the hospital, because |^J£" a very large number of nerve-endings have to be ex- posed by the operation. The removal of hemorrhoids, while not regarded as a difficult operation, is yet one that demands the utmost skill. Very alarming nerv- ous disorders sometimes follow if too large an area of the mucous membrane is interfered with, and too great a number of nerves are exposed. This all goes to show that even minor cases require the work of a skilled operator, and a choice should not be made without careful consideration and advice. If this precaution is observed there need be little fear of the ultimate result not being successful. The diet in such cases will have to be limited to foods which do not tend to increase the accumula- Special tidn in the intestines. Only malted milk, broths, and