Fig. 2. For lifting a patient with a broken leg, a third person.
Fig. 3. To remove a patient from one bed to another, twist the undersheet the roll at different parts and lift the patient
Light blankets and, if necessary, a light eiderdown are just as warm, and much more serviceable, than heavy coverings.
The article on page 1462, Part 12, dealt with the making of poultices and fomentations. There are, however, a few other remedies which the amateur nurse must study.
Blisters are used in chronic affections as counter-irritants, when redness of the skin, and perhaps vesication, or the formation of blisters, are desired. The basis of a blister is cantharides, which is really a Hungarian beetle. A blister plaster cut to the desired size may be used, or a blistering fluid painted on. When these are applied to the skin, a sensation of tingling and heat is experienced. Soon the true skin which lies under the epidermis, or outer skin, becomes congested, and drops of fluid, or serum, ooze out, raising the epidermis upwards. Thus blisters are raised, which run together, gradually forming larger blisters. This irritation stimulates the nerve-endings in the true skin, and these carry the impression to the brain. This impression is sent on by the brain through other nerve fibres to the seat of pain or congestion.
To apply blisters, the following points must be attended to: The natural grease of the skin should be washed off with soap and warm water; the can-tharidis plaster must be cut to the required size, or the blister fluid painted carefully on with a camel's-hair pencil. To prevent the fluid running, a circle of oil should be painted round the part to which the blister is to be applied, and a piece of cotton-wool should be used to mop up the blister fluid at once, if, in spite of care, it tends to run over the skin.
The dressing of a blister requires careful attention after it has risen. It should not be opened unless the doctor orders it, but should be covered with a layer of cotton-wool until the fluid is absorbed. If the blisters get torn, and the cold air is allowed to reach the raw surface, the patient suffers a great deal of pain, and the part may ulcerate if the vitality is low.
If a blister has to be opened, a needle should first be boiled in clean water, and then used to prick the blister. The vesicles should not be squeezed, as the serum will gradually ooze out. The fluid must be carefully mopped up with clean cotton-wool, as it may irritate the skin. When most of it has come away, a little boracic ointment should be spread on lint and laid on the part, and secured in place by a gauze bandage or strips of sticking-plaster.
Counter-irritation can also be achieved by mustard-leaves or by iodine. Mustard-leaves can be bought from the chemist, and should be kept in a tin in the household medicine cupboard. They produce a very mild form of blister. Tincture, or liniment, of iodine, makes a useful application when a counter-irritant effect is wanted in any chronic swelling of a joint, such as water in the knee, or to reduce the swelling in glands. In chilblains, also, the counter-irritant effect of painting with iodine influences the congested condition in the underlying tissues, relieving pain and swelling. Pain in the chest or back is sometimes treated in the same way.
Leeches are used in the sick-room for the removal of blood in acute inflammation. The doctor will probably show the amateur nurse exactly how to apply leeches in the first instance. The part has first to be washed with warm water, long broom-handle in the sheet and blanket at each side. A heavy patient can
Fig. 4. An improvised hammock for moving a patient can be made by rolling a be lifted easily thus by two persons and dried. The leeches are placed in a wineglass of water, the top of which is covered with a piece of notepaper. The wineglass is inverted over the part indicated by the doctor, the notepaper slipped out without spilling any of the water, when the leeches will very soon bite the skin.
Fig. 5. A useful emergency bed-rest can be made with an ordinary chair, placed so as to afford a slope, and padded with pillows tied to the chair, which must itself be secured to the bedstead of the bed-clothes off injured limbs can be made from
Fig. 6. Improvised "cradles" for keeping the weight three-legged stools or bandboxes
Then the water is allowed to escape, being soaked up with a towel. The glass is lifted off after each leech has sucked about a teaspoonful and a half of blood, when it usually drops off. If it fails to do so, a little salt can be put on its body; but the leech should never be pulled off, as the teeth are apt to be left in the wound and cause a sore. When it is desired to stop the bleeding, a little bit of cotton-wool will do this with gentle pressure. When the leech has to bite one particular spot, it is generally applied in a leech glass, which is simply a little tube tapering at one end, with a small hole through which it can bite and suck. This glass is very often used when the leech has to be applied behind the ear. It sometimes happens that a leech bite begins to bleed an hour or so afterwards, but firm pressure with the fingers, or with a piece of lint, will generally stop the bleeding.
Preparing for the Doctor
The well-trained nurse has everything in readiness before the doctor's visit. Her daily report is written out in accordance with the instructions given on page 1110, Part 9. The room is clean and tidy, the patient washed and dressed for the day. The room has been flushed with air whilst the patient is warmly covered with bedclothes. The temperature and pulse have, of course, been taken and noted in the report. Hot and cold water, antiseptic soap, and clean towels are arranged neatly, and if the doctor has to attend to any surgical dressings or poultices, the materials for these applications must be got ready. Cottonwool, lint, oilskin, bandages, scissors, needle, thread, and safety-pins should be at hand. Everything possible should be done to save time and unnecessary fuss during the visit, and any questions the nurse desires to ask should be noted beforehand. No change with regard to the patient's treatment or diet should be permitted by the nurse without the doctor's permission, and when visitors are allowed, the nurse must clearly understand how long they are to stay and how many may be admitted each day.
Fig. 7. A bandbox with a " tunnel" cut through it, makes an efficient "cradle' for a patient with an injured leg
Detailed information regarding the patient's diet should be obtained from a doctor at his visit, especially if the patient is fevered and is requiring a low diet. This subject will be considered more fully in later articles, but at this stage it will be sufficient if the nurse learns what the doctor means by the following terms:
When vegetable diet is ordered, meat is dispensed with; but fish, and even a little grated fowl, are occasionally permitted.
Certain illnesses, such as typhoid and diabetes, require very careful dieting. A diabetic diet means that no sugar or starch is taken. Instead of ordinary bread, glutin bread, rusks, and well-browned toast are given. Meat and milk are generally permitted, but all starchy food such as potato, rice, tapioca, etc., are rigidly forbidden.
It is so important for anyone who has the care of an ailing person to know how to prepare sickroom foods, that something will be said on this subject later on. In serious cases, milk, beef tea, and broth should be served in measured quantities. It is essential to observe strict accuracy, and to note on the chart every ounce of food swallowed by the patient, in accordance with the instructions given in the article on p. 1109, Part 9. The doctor should be told at each visit the exact quantity of food taken by the patient during the previous twenty-four hours.
Fig. 8. When leeches are used, they are placed in a wineglass filled with water, the top of which is covered with note-paper. The glass is in-verted over the part affected, and the paper slipped out without spilling the water. After the leeches have bitten, the water is allowed to escape and soaked up with a towel
The following are the principal rules which the nurse should observe in connection with this section:
2. In lifting or moving a patient, shaking must be avoided, and the nurse should obtain any necessary assistance rather than risk overstraining her own muscles.
4. To prevent a patient slipping downwards in a bed when supported by a bed-rest, it is a good thing to place pillows against the feet.
5. In performing any new duty, such as applying blisters or leeches, the amateur nurse must be perfectly sure that she knows how to set about the work. The doctor will be only too pleased to give her a lesson in the first instance, and by carefully-following in detail his instructions, the intelligent woman can soon acquire self-confidence.