PART I HOME NURSING (Part 10)

Jjjiet albumen water should be given, unless the doctor allows more variety. Whenever the doctor thinks best he will order purgatives or an enema, to secure a free passage of the bowels. If an enema is ordered, oil should be given the night before. In cases where the operation has been for repair of laceration of the perineum, which is sometimes In lacera- ruptured during child-birth, the stitches should be of the douched with warm water after each time of voiding penneum urine, as absolute cleanliness is essential if a good result is expected. Liquid diet is required till the bowels have moved, which will probably be the third day. Light diet should follow for another day, and then if the bowels have been thoroughly cleared and the temperature is normal, full diet may be given. 104 HOME NURSING In cases of curettage or scraping of the lining of in curet- the uterus, the patient is usually kept on liquid diet for forty-eight hours, or until the temperature be- comes normal. Douches may be ordered, and a sterilized douche point and boiled water will be necessary unless some antiseptic is to be used. Sometimes in operative cases there is complete in- To over- ability to void urine in the recumbent position. This ability To difficulty is due to a nervous condition, which may void urine not manifest itself in any other way, but unless some device can overcome the trouble, the water must be drawn. This should on no account be attempted by unskilled hands, as unless extreme care is observed there is great danger of setting up a distressing in- flammation of the lining membrane of the bladder. Sometimes, if very hot water is placed in the bed- pan, the steam from it relaxes the muscles and the patient can urinate. A hot compress over the genitals or the sound of dripping water may also effect the same result. All these methods should be faithfully tried before resorting to catheterization. If there has been a rectal operation it is usually easier for the patient to urinate lying on the abdomen rather than in the usual position. In cases of operation for cataract the room should Care after be kept- darkened and the patient should not be al- ?ion°Pfeorr" lowed to turn the head on either side or to lift cataract himself forward in the bed, for fear of jarring the eyeball. At night the hands must be tied loosely to the bed, giving plenty of freedom but preventing them from reaching the head while asleep. The first night the patient should have some one sit with him, as the nervousness is apt to be very great. Liquid or very soft diet must be given for a few days, because the effort of mastication might do injury to the wound. CARE OF OPERATIVE CASES 105 Another operation which is becoming more com- mon each year is the removal of the tonsils. These On re- are small bodies situated in the back of the throat, of°the and their function in health is a very important one. tonsils They stand as sentinels to arrest the progress of any foreign particles which may find their way into the lungs. These particles, whether dust or micro- organisms, are absorbed and disposed of by these glandular bodies. In that case the system is entirely unaffected by such germs-, which might otherwise cause disease. When the tonsils become diseased their absorptive function may be increased, but their power of disposing of the absorbed matter is impaired, and there is besides this the mechanical obstruction to the throat and nasal passages, due to their enlargement. Hence we find a patient with enlarged tonsils very susceptible to colds and often suffering with other disorders of digestion or catarrhal affections, and generally with marked nervous symptoms. With these facts in mind, there need be no hesi- tation in following a doctor's advice as to their re- The care T-i • 1 which moval. I he operation is an unpleasant but not a follows painful one, and the after-care required is slight, be- yond frequent rinsing of the mouth and throat with a weak solution of peroxide of hydrogen or whatever wash is ordered. There will probably be vomiting of blood and mucus, which has been swallowed during the operation, and, though very disagreeable, it need never seem alarming. CONVALESCENCE The period of convalescence, as people in general realize, is apt in some respects to be the most trying. Difficulties Whatever excitement the acute stage of the sickness ^scen™* has furnished has tended to make one forget the 106 HOME NURSING weariness, and now while fatigue is uppermost even more responsibility is given over to the nurse as the doctor lessens the number of his visits. Convales- cence may be rapid or very gradual, but in either case great watchfulness is needed because the patient's own feelings are no trustworthy guide to the amount his strength is equal to, and no patient is able to realize this, particularly if it is the first illness. In surgical cases, unless there has been a heavy When drain upon the system and great depletion of strength recovery previous to the operation, a speedy recovery may be lookecTfor l°°ked f°r- Less caution is usually necessary in the matter of diet than must be observed in medical cases, but rich and heavy food should never be brought to the sick-room. The patient's whims and fancies can often be indulged, but it should not surprise, much less offend, the nurse if after taking great pains to prepare some special delicacy, it is not touched or is even set aside with querulous impatience. Some persons seem to have less control over irascibii- their feelings than others, and it is true that irritability the °corwa- of disposition sometimes accompanies weakness of lescent body in persons naturally sweet-tempered. If patience is exerted for a few days till a little more strength is gained, the patient will generally realize that he is unreasonable and be able to gain better self-control. Any one of us as a patient is liable to feel this irascibility, and it is well to recognize that while much is excused when bodily weakness has impaired the will, the effort to strengthen it must not be over- looked or indulgence in ill-temper allowed. In preparing a tray for an invalid it should never Ways of be forgotten that small portions daintily served will his food quicken the appetite when a carelessly prepared meal may be left untouched, though the patient very likely CARE OF OPERATIVE CASES 107 will not realize why he can not eat. It is far better that too little rather than too much be furnished. A half cup of soup served alone and very hot, a deli- cately browned chop with a few green peas placed on a hot plate with a hot cover, a piece of roasted potato rolled in a napkin beside the plate, a bit of bread and a small serving of some light dessert, furnishes an ample dinner for full diet. A simple salad may be added if the patient enjoys it. A single flower or a A Nightingale. The Corners Turned Back are to be Fastened as Sleeves sweet-scented leaf laid on the tray is always appre- ciated, but one must not make the attempt at orna- mentation elaborate. It is most annoying to a patient to be constantly beset with questions as to what he would like to eat. Avoid tt 1 i iii- i -,i discussing He does not know, and the thing that will give most his food pleasure is that which has not been discussed before him. The nurse should be on the alert to observe and to remember his tastes, and when the right occa- sion comes can often give a pleasant surprise by placing quietly before him some favorite or new dish which has not been spoiled for him by being talked about. When a patient begins to sit up in bed a loose flannel jacket or a nightingale should be slipped on. 108 HOME NURSING The first loose wrap The first sitting up Extreme weakness after illness Dress for man and woman This latter is a wrap that is easily made and very convenient. Two yards of flannel of ordinary width are required. Cut a straight slit six inches deep in the middle of one side, turn back the points so formed for a collar and those of the corners furthest from it for cuffs ; bind or pink the edges, and add buttons and buttonholes for front and cuffs. Half an hour is a sufficiently long time for a pa- tient to sit up for the first day. As improvement in the patient's condition is made the time for sitting up can be increased and he can be lifted to an easy chair or sofa for a change. At first he should not be kept up longer than the time necessary to make the bed, when he will probably be very willing to return. The extreme weakness that is felt after having been kept in bed for some weeks, even though the illness may not have been severe, is always surprising to one who realizes it for the first time. On no account should the patient be allowed to get up and dress himself, and some one must always be near to help him with his first steps or he will be very likely to fall. Not more than one person should be in the room, unless other assistance is necessary, as it is best to make the con- fusion as little as possible. The room should be warmer than when the patient is in bed. To provide against a draught, first place a blanket in the chair, and when he is seated, fold it up over the feet. A footstool is always desirable. The clothing should be sufficiently warm, but not cumber- some. A man will be more comfortable in a warm bathrobe when the time comes for walking about the room and a woman should not be burdened with a tea- gown having a heavy train, but should wear a loose short wrapper. A patient should not feel obliged to see all the vis- CARE OF OPERATIVE CASES 109 itors who call. Even if he wishes it this is unwise and the nurse should protect him against the fatigue which Protect - n , r. , thein- is sure to tollow too much company, borne people valid from understand perfectly the limitations of a sick person's %lsltor strength and a short and cheery call from such is a benefit, but others with equally good intent make no distinctions and wish to stay on for a lengthy visit as if the patient were well. Two visitors coming together always make it harder for the invalid, as there is more strain in talking, and it is better that they come at different times if possible. Place the visitor's chair in a good position near the bed where there will be little effort for the patient Suggest in listening to what is said and be on the watch for carier go the first sign of fatigue, then do not hesitate to sug- s[^5rstof gest that the visit must be ended and the patient left ftigue to rest. If this is done with good nature and in a spirit of friendliness, taking for granted that the good of the patient is the first consideration, the visitor need not feel anv embarrassment. VII ACCIDENTS AND EMERGENCIES Shock— Hemorrhage— Bleeding from Nose — Bleeding from .Lungs— Fainting — Fractures — Dislocations — Contusions — Sprains — Chilblains — Frostbites — Toothache— Warts— Cuts— Burns and Scalds— Foreign Bodies— Sunstroke and Heat Exhaustion — Artificial Respiration -^ Insect Bites — Bites of Snakes and Rabid Animals— Poisons Simple directions every one ought to be ac- quainted with Keep away the curious crowd In the city EVERY household may expect a certain amount of anxiety and trouble over slight bodily accidents, especially if there are children in the family, and at any time one ought to be prepared to meet these with in- telligence and also so far as it is possible to face the graver emergencies which may come in the same way. It has often been noticed that persons thought to be nervous and unstable in time of alarm show a self- control and power of directing others that is very sur- prising. It is most unfortunate when at such times the mind is able to think clearly, yet is ignorant of how to act. Some simple directions every one ought to be acquainted with follow. The flock of well-intentioned but helpless individ- uals who gather about when an accident has occurred, must be kept as far as possible from the patient, so that he may have plenty of breathing space. The assistance of a policeman will probably be necessary in order to keep the crowd away. If the accident has taken place in a house curious neighbors who come ready with sug- gestions must be kept out and not allowed to throng into the room. In the city an ambulance can be summoned in a few moments, and if a policeman is at hand he will attend to that, if not some reliable person may be sent (no) ACCIDENTS AND EMERGENXIES 111 to the nearest police station or to telephone for the conveyance. If the accident occurs on a country road, the first thing to do, if there is no hemorrhage to be arrested, is On a coun- t 11 11 try road to get the patient ready to be moved to the nearest house. If the patient is insensible, he should be turned on one side and the head raised on a level with the rest of the body so that he can breathe more easily. His clothing should also be loosened, especially about the neck and abdomen. If the patient can swallow, water may be given to drink and the face can be bathed or sprinkled with water, but no stimulants should be given unless it is clear that they are needed. SHOCK If there is shock or collapse as a result of the ac- cident, it will be shown by a cold and clammy condi- The con- tiom of the skin and extreme pallor or blueness about siock or the lips and finger-nails. The pulse grows very feeble, collapse if indeed it can be felt at all ; the patient will complain of faintness and the breathing will be irregular and sighing. Such a condition demands prompt action if life is to be saved, and here stimulants are called for without delay. Brandy is more useful than wine and should be given in small quantity, watching its effect. If the Alcoholic pulse grows stronger, the breathing deeper, and the ^oiiaple, body warmer, it may be kept up in teaspoon doses every fifteen minutes till there is complete reaction, when it should be discontinued. If there has been no loss of blood, alcoholic stimulants should be used spar- ingly and entirely withheld if no sign of improvement follows the first dose. Strong coffee may be used and is always safe, though not so practicable, because of the delay necessary in obtaining it. 112 HOME NURSING If there is bleeding or local injury of any sort, it How to must be treated according to the directions to be given the doctor ^ater on ^ written message stating as clearly as pos- sible the nature of the case should be sent to the near- est doctor, as it is never safe to trust to a verbal mes- sage, no matter how reliable the person may be who is to deliver it. If it seems advisable before the doctor arrives, the patient may be removed to the nearest house. If there has been an injury to the head of any serious account do not allow him to walk, even if he seems quite able. He must be made to lie down and transported as easily How to as possible. A stretcher can be made of a blind, a door, patient or any stout board upon which the patient can lie horizontally, and those who carry it should be in- structed not to take it on the shoulder, but with the hands, as there will be less jolting if carried that way. It. is better also if they do not attempt to keep step. HEMORRHAGE Bleeding from an artery may be recognized by the Bleeding wav the blood spurts out in bright red jets. If a vein from an }s injured the blood oozes forth and is duller in color. artery * Bleeding from an artery is always serious, because of the quantity of blood that escapes in a short time* owing to the amount of pressure in the blood-vessels, and it must be arrested at once. The blood coming through the arteries is being Directions carried away from the heart, while that in the veins is fng the*" returning to it. . For this reason it is plain that bleed- hemor- [ng fr0m an artery must be checked by means of pres- sure above the wound, i. e., between it and the heart, whereas that from a vein demands pressure below the wound. If a limb is bleeding it should be elevated above the ACCIDENTS AND EMERGENCIES 113 level of the heart, and if pressure with the finger is not sufficient to check the flow of blood a handkerchief may be knotted or a smooth stone tied in it and the knot or stone placed directly over the wound or upon the artery above the wound if the bleeding is arterial. Another handkerchief is used to tie around the limb if from in order to hold the compress in place, and through the a hmb knot of this, which should be rather loosely made, a