The Importance of the Nurse's Duties In Typhoid or Enteric Fever-how Enteric is Contracted-danger of Haemorrhage or Perforation-symptoms of Diphtheria-after Complicationstracheotomy-special Rules to be Remembered
Many a case of typhoid has ended fatally through the carelessness or ignorance of the nurse in charge. Many lives have been saved simply from the faithful carrying out of the doctor's orders and the good management of the nurse. It is an illness requiring constant vigilance, the patient being subject to relapse, following a small error in diet, a chill, or a forgotten stimulant. The disease is caused by a germ, the typhoid bacillus, which gains entrance to the body with contaminated water or milk. It has been called a drain disease, because contamination of the water supply by sewage is not infrequent. It may be contracted from eating oysters from polluted water, or swallowing icecream made from water or milk which has been infected.
Whenever a case of typhoid occurs, the most rigid inquiries must be made as to the water and milk supply, and careful isolation of the case is necessary, if an epidemic is to be prevented. An epidemic will spread from a dairy, for example, by merely washing the milk-cans in water that has been contaminated, and when there is any risk of infection, the safest preventive is to boil every drop of water and milk consumed in the household.
In nursing a case, the lives of a great many people depend upon the vigilance of the nurse. The discharges of the patient have to be carefully disinfected immediately by the disinfectant ordered by the doctor. The lavatory and receptacles must always be regularly disinfected with carbolic or other chemical. The patient's soiled linen and sheets should be put immediately into a zinc bath, or covered vessel, containing one in twenty carbolic lotion. Then the nurse should have one basin containing disinfectant solution in the sick-room, so that she may carefully wash her hands at once after attending to the patient. The finger-nails must be thoroughly scrubbed with soap, after immersing them in water. The patient's dishes should also be disinfected by' washing in boiling water immediately after use. These precautions prevent the spread of the disease, which is one of the chief duties of the nurse in charge of an enteric case. If she takes care of her own health, has outdoor exercise regularly, and adopts all hygienic precautions in regard to washing her hair, hands, and taking her food, she is not likely to contract the disease herself.
Typhoid fever is a disease which causes inflammation and ulceration of the intestines. Its two commonest and most dangerous complications are haemorrhage, from an ulcer eating into one of the blood-vessels, or perforation through the thinned intestine.
There are various degrees of severity in this disease, but whenever a person is known to have typhoid fever, he must be put to bed and given the greatest care. The disease comes on gradually with fatigue, headache, and lassitude. There is loss of appetite, and, as a rule, diarrhoea, and the temperature gradually rises. At the end of the first week a few rose-coloured spots may appear on the body, and they generally come out in crops, one or two fading as others make their appearance. The patient is very ill during the second week, and the rise of temperature causes him to become thin and even emaciated. It is during the third week that the dangers of perforation and haemorrhage are greatest. The patient at this time generally looks very ill and may be half unconscious, but good nursing will pull round even bad cases.
Food for a Typhoid Patient
The best food for a typhoid fever patient is milk, because it is bland, and digested by the stomach so that it does not irritate the ulcerated intestine. As a rule, the patient is given live ounces of milk every two hours, diluted with barley-water or lime-water. Some doctors will order the milk to be peptonised, which is done by putting one pint of milk, diluted with half-a-pint or a pint of lime-water, as ordered by the doctor, into a clean jug with a peptonizing powder, which is sold ready prepared by the chemist in little glass tubes. Leave this for twenty minutes, when it is ready to be given, but any that is not required at the time must either be boiled, or set on ice to prevent the peptonisation, or digestive process, going on any further. The doctor may also order albumen-water, strained broth, or beef-tea, if there is no diarrhoea. The nurse must remember that all foods should be given lukewarm, and not hot.
It is important for the nurse to get the patient to take his nourishment, although this is sometimes a little difficult, as lack of appetite and distaste for food are generally marked symptoms. So long as the temperature is elevated, low diet is very strictly adhered to, but after perhaps a week of normal temperature, the patient is allowed beaten egg and milk, custard and milk puddings, which gradually bring him on to invalid diet, including fish and soft-boiled eggs. This is the time when a great deal of tact has to be exercised by the nurse. The patient is often ravenously hungry during convalescence, and, although he has been told the danger of eating certain things, he will often take fish skin or anything else on the plate which the nurse has not intended him to eat, so that it is most important only to put on his plate exactly what he is to be allowed to eat.
In nursing a typhoid case, the patient must be kept quiet, and not allowed to sit up in bed or move about until the doctor gives permission. Encourage sleep as much as possible, and watch the temperature carefully for a long time after the fever has disappeared, in case of relapse. Impress upon the patient's friends the danger of giving him anything to eat in the shape of invalid