American Red Cross Text-Book on Home Hygiene and Care of the Sick by Isabel McIsaac (best affordable ebook reader txt) π
FOR FURTHER READING
A History of Nursing--Dock and Nutting, Volume I.
The Life of Florence Nightingale--Cook.
The Life of Pasteur--Vallery-Radot.
The House on Henry Street--Wald.
Public Health Nursing--Gardner, Part I, Chapters I-III.
Origin and Growth of the Healing Art--Berdoe.
Medical History from the Earliest Times--Withington.
Under the Red Cross Flag--Boardman.
Report on National Vitality--Fisher, (Bulletin 30 of the Committee of One Hundred on National Health. Government Printing Office, Washington).
CHAPTER I
CAUSES AND PREVENTION OF SICKNESS
Diseases of two kinds have long been recognized: first, those transmitted directly or indirectly from person to person, like smallpox, measles, and typhoid fever; and second,
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βFor feverish patients doctors often order cool sponge baths. In order to give a cool sponge bath, first protect the bed thoroughly, but leave the patient uncovered except for a towel laid over the hips. Use cool water, or cool water and alcohol, and have the wash cloth as wet as it can be without dripping. Bathe the body without friction, using long, light strokes, and leave each part wet until the bath has been completed. Do not use soap. Sponge in this way the arms, legs, chest, and back, but not the abdomen, for ten to twenty minutes, giving special attention to the neck and inner side of the arms and legs, because in those places large blood vessels lie nearer the surface of the body. After finishing the bath dry the body by patting it gently with towels.
Take the patient's pulse occasionally during the bath, and stop the bath at once if the patient's pulse grows weaker, if she shivers violently, or if her face, fingers, or toes turn a bluish color. Babies react rapidly to cool sponging; for a baby use tepid water, sponge for five minutes only, and watch the child closely during the bath.
EXERCISES What may a bath be expected to accomplish in addition to cleansing? In giving a tub bath, what precautions should be taken to avoid chilling the patient? to avoid tiring the patient? What symptoms would lead you to think that a tub bath was not agreeing with a patient? What should you do in such a case? Name six essentials of a skillfully given bed bath. What preparations should be made and what articles assembled before beginning a bed bath? Describe the method of bathing a patient in bed. What care should the mouth and teeth of every sick person receive? How should such care be given to a patient who is helpless? Describe the daily care of a patient's hair, and tell how a shampoo may be given to a patient in bed. How should you give a mustard foot bath to a patient in bed? When and how should you give a cool sponge bath? FOR FURTHER READING The Human MechanismβHough and Sedgwick, Chapter XI. CHAPTER VIIIAPPLIANCES AND METHODS FOR THE SICK-ROOM
Patients who are confined to bed even for a few days often suffer acutely from muscular tension, from pressure, and from fatigue due to lack of exercise. Indeed, many a sick person is surprised to find that the bed which had seemed so infinitely desirable can change into a place of torment after a few short days of illness. "Bed-weariness" is hard to bear in any case of illness, but it is doubly hard for persons who are really helpless.
Unless the patient is an experienced sufferer he often has no idea what should be done to make him comfortable; while an equally inexperienced helper, though full of good will, is often discouraged to find that the arrangement she had thought perfect soon fails to satisfy her restless patient. But if she is willing to devote thought and ingenuity to removing small annoyances, she can do many things to alleviate his misery.
, or pressure sores, are caused by continued pressure upon the skin. The weight of the body, or of a part of the body, if it comes for a long time upon one place finally interferes with the circulation in the tissues on which the part rests, and consequently interferes with the nutrition of the affected part. Any tissue to which the blood is not bringing all its necessary food supply tends to lose its tone, to become weak, and if the condition persists, to break down altogether.
The direct cause of bed sores then is pressure, and pressure is aggravated by moisture, wrinkles in the bed clothes, crumbs or other hard particles, lack of cleanliness, friction of any kind, or by rough, careless handling. Bed sores occur most often over bony prominences, such as the end of the spine, elbows, heels, shoulders, hips, ankles, and knees, but they may form anywhere, even on the ears or back of the head. They are more likely to appear on thin, aged, or depleted patients. These painful and serious sores can be prevented almost always by faithful care. When they occur, they result in the great majority of cases purely from negligence, and a person who knows the danger and yet through carelessness allows one to develop upon a patient may justly feel herself disgraced.
Prevention of bed sores depends upon keeping the skin dry and clean and upon relieving pressure by special devices and by turning the patient frequently. The parts where pressure comes should be washed at least twice daily with warm water and soap, rubbed frequently with alcohol to improve the circulation and to keep up the tone of the skin, and powdered with a little good toilet powder. Much powder is likely to do harm by collecting in hard, irritating particles. The bed should be kept constantly dry and smooth, and free from crumbs, lumps, wrinkles, or other inequalities. Prolonged pressure should be relieved by turning the patient often,βonce every waking hour is not too often if the body is emaciated,βand by pillows, pads, and rings.
Small pillows or thick pads of cotton should be placed under the patient's back and shoulders, between the knees and ankles when he lies on his side, and in other places where sores are likely to develop. Rubber rings are useful, but few patients like them for a long time. They should not be inflated more than necessary to raise the affected part from the bed; if much inflated, they are uncomfortable and may do harm. The ring may be covered with a muslin pillow case, or it may be wound smoothly with long strips of bandage or old muslin. Ordinary cotton batting wound with strips of muslin may be made into rings and used to remove pressure from heels, elbows, or other parts. These cotton rings are less heating than pads, and give better support.
The first sign of a bed sore is either redness of the skin or a dark discoloration like a bruise. Every point where a bed sore may form should be inspected daily. If the slightest symptom of a sore appears, the patient must not lie on the affected part, and every effort should be made to keep the skin from breaking; vigorous rubbing at this stage is dangerous, and will by no means make up for previous neglect. The condition should be reported to the doctor at once. If in spite of all efforts the skin does break, a peculiarly difficult kind of open wound results which must be treated and dressed according to the doctor's directions.
βThe variety and number of pillows one patient can use is almost unlimited. A weak patient when lying on his side should have his back supported by a pillow. When he lies on his back a pillow should be placed under his knees to lessen muscular tension, and if he may be raised in bed, several pillows are needed to support him comfortably. A back rest is useful for a patient who can sit up in bed. Satisfactory back rests of several types can be purchased, or one may be improvised from a straight chair placed on the bed bottom side up, so that its legs lie against the head of the bed and its back forms an inclined plane. Back rest and chair alike should be covered by several pillows to make them comfortable, and other pillows should be used to support the patient's arms.
A person who is sitting up in bed always tends to slip down toward the foot. This tendency may be corrected by using a foot rest, knee pad, or pillow. A hard pillow may be placed in the bed at the foot for the patient to brace his feet against; or a short board, well padded, may be arranged as follows for the feet to rest against: Fasten ropes to the board, as the ropes of a swing are fastened to the seat; set the padded board on edge at a convenient point below the patient's feet, and hold it in place by tying the ropes of the "swing" to the head of the bed. A pillow may be used in the same way, either at the feet or under the knees, by folding it over a long strip of muslin, the ends of which are then tied to the sides of the bed, brought up to the head, and there tied to prevent slipping. A cylindrical cushion six or eight inches in diameter and as long as an ordinary pillow, stuffed with firm material, may also be used for this purpose. It should be held in place by strips of strong muslin or ticking sewed to the ends of the cushion and tied to the head of the bed. The cushion should have a washable cover.
Supports called bed cradles are used to keep the weight of the bed covers from sensitive parts of the body, generally the feet or abdomen. They are semi-circular pieces of wood or iron fastened together so that they will stand up. A satisfactory cradle may be improvised as follows: Cut a barrel hoop in two, cross the halves at right angles and tie them together firmly; place the cradle over the affected part under the bed clothes. A smaller cradle may be made by taking sections that are less than half of the barrel hoop. If used for one foot only, the cradle should be small enough not to interfere with the motion of the other foot; if used for both feet, it should be large enough to allow some freedom of motion. Since the cradle leaves an air space, the feet should be wrapped in a piece of soft flannel. A cradle used for the protection of the abdomen should extend a little beyond the body on each side.
Adjustable tables are convenient for patients who are able to sit up in bed. These tables are supported on one side only so that they may extend over the bed. Another kind of bedside table has short legs and stands directly on the bed. Such a table can easily be made at home from a wide board with supports six or eight inches high nailed to each end. A lap board supported by heavy books may serve for temporary use. Indeed, home-made substitutes are often as good as expensive apparatus or even better. If sick-room appliances must be bought, it is well to remember that simple standard designs are best. Complicated apparatus is soon out of order, and is generally a trial both to the patient and to those who must adjust it. Persons taking care of chronic patients may often obtain valuable suggestions in regard to appliances by consulting a visiting nurse or the superintendent of the local hospital.
are utensils to receive bowel and bladder discharges of patients lying in bed. Enamel bedpans are better than porcelain, although more expensive. The shape
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