One of the chief duties of the nurse is to administer medicines to the patient, and the right sort of nurse has all her orders written down with regard to this matter."' It is the easiest thing in the world to make a mistake in giving medicines, and this duty should never be delegated to anyone except the chief person in charge of the invalid. The medicine-bottles should be neatly arranged, all poisons kept under lock and key, and the patient should never be allowed to give himself medicine. More than one instance of fatal poisoning has occurred by neglecting these simple rules.
Poisons, of course, must be placed in special, dark - coloured, ribbed glass bottles, with a red label attached, and the nurse must remember that drugs for external use, especially antiseptics, such as carbolic, are poisons when administered internally. All these drugs must be kept apart on one shelf in the medicine cupboard.
Medicines should be made as little disagreeable as possible to take. Conceal any marked taste or smell. Anyone who is ill is very easily upset.
Medicines should be neatly arranged and all poisons kept under lock and key in a cupboard hung on the wall and is unduly sensitive to unpleasant tastes or odours, which would have very little effect on people in ordinary robust health. Castor oil, whenever possible, should be administered in capsules, but the taste is fairly well disguised if it is taken in a little strong coffee, followed by a drink of pure, black coffee. Another way to administer castor oil is in an emulsion with milk. Take half a teacupful of hot milk and gradually stir in a tablespoonful of castor oil until it is well mixed. Flavour with a lump of sugar and a little nutmeg or grated cinnamon, and if the patient drinks this off quickly, he will hardly be able to taste the castor oil at all. Cod-liver oil should be taken with a little salt, which disguises the taste, and it is also very easily swallowed if shaken up with hot milk, in the same way that we have described that castor oil should be taken. Powders can be given in white sugar, or in a little milk or water. As a rule, the doctor will order the medicines to be given either after or before food, or perhaps every two hours. His orders in this respect must be observed implicitly, as the omission of medicine at the usual hour may be followed by serious results when the patient is very ill. Even in convalescence the patient requires his tonic or medicine regularly, if it is to do him any real good, and the nurse who is careless about the administration of medicines is a hopeless person to have in the sick-room at all. Method, regularity, neatness, and exactness are the first qualities she must acquire. Medicine must, of course, always be given in a measured medicine glass, and never in a household spoon, which does not measure exactly. No nurse should ever give a dose of medicine without reading the label, whilst the medicine should always be poured from the bottle on the side away from the label.
Making a castor oil emulsion that is practically tasteless. The hot milk is in the cup; the nurse stirs in the castor oil, dropping it very gradually from the spoon
Alcohol is sometimes ordered to patients by the doctor for its stimulating effect upon the heart. The subject of alcohol has aroused such a great deal of interest and controversy of recent years that the amateur nurse might at this point consider the physiological action of alcohol in some detail. No woman can be considered a properly qualified home nurse who does not understand, first, what alcohol is, and, secondly, how it acts upon the body.
Alcohol is the active agent obtained from the vinous fermentation of sugar. When the juice of grapes is exposed to the air at a certain temperature a chemical change is brought about which results in the decomposition of the sugar in the grape-juice, and its formation into carbonic acid gas and alcohol. The "fermentation process," as it is called, is brought about by a minute fungus in the air. This alcohol is the active agent in all intoxicating beverages. Brandy, whisky, rum, and gin contain about 50 per cent. of alcohol. The lighter wines, such as sherry, port, madeira, contain about 20 per cent., or one-fifth, of alcohol, claret perhaps 8 per cent., and the ales and lager beer, 5 per cent.
The Physiological Action of Alcohol
And now let us consider the effect of alcohol upon the body. When alcohol is swallowed into the stomach it passes into the blood and is carried throughout the body. It exerts a very definite effect upon every tissue and every organ in the body. It first excites and then depresses the nervous system. The stimulating effects are due to the increased blood flow it induces in the brain, but as stimulation is always followed by a reaction, the second effects are exhaustion and gradual depression. If larger quantities are taken confusion of ideas, with loss of control, and narcosis, or unconsciousness, are produced. Alcohol also affects the heart and blood-vessels. It increases the force of the heart beat, and thus makes it work harder. It causes the bloodvessels throughout the body to expand or dilate, so that they become distended with blood, as shown by flushing of the face. In the case of regular drinkers this dilatation of the bloodvessels is apt to become permanent, giving a characteristic redness of the nose and cheeks. It is sometimes said that a little alcohol will induce appetite when anyone is fagged and unable to eat a meal. It does so by dilating the stomach blood-vessels, and causing a sort of temporary flushing of the mucous membrane lining the stomach. The effects of this artificial appetite may induce a person to eat a meal when unfit to digest it, so that the result is not good, but bad. Under such circumstances the proper treatment is complete rest of mind and body for perhaps fifteen minutes, followed by a light meal which is naturally digested. The habitual taking of alcohol, instead of improving the digestion, very soon induces dyspepsia. A chronic inflammation of the lining membrane of the stomach is excited, the food cannot be properly digested, and the body is thus insufficiently nourished. Alcohol is carried from the stomach, in the blood, to the liver, which is very early affected by alcohol. The liver becomes enlarged, its tissue is hardened by the alcoholic poisoning which is taking place, and the condition known as cirrhosis of the liver is brought about. All the digestive organs are affected, and gradual but certain deterioration of health takes place. Even in very moderate quantities alcohol interferes with what is called the metabolism of the tissues - that is, the nutrition of the body.
Stimulants that can be used instead of alcohol are hot tea, coffee, and milk, and heat applied externally by a hot-water bottle
The question of whether alcohol is a food or not is sometimes discussed. The term "food" means that something is taken into the body and oxydised in order to supply us with more energy and increased capacity for muscular and nervous work, and with heat. Now, alcohol is to a certain extent oxydised in the body, but it is not used up for profit, and it cannot replace food. The fact that people feel warmer after taking alcohol has been used as an argument by those who declare that alcohol supplies the body with heat. But the sensation of warmth felt after taking wine or spirit is merely superficial, due to the dilatation of the blood-vessels of the skin, and their engorgement with blood. The body is actually losing heat by evaporation from the hot skin, and alcohol, instead of warming the body, really encourages the loss of body heat.
Alcohol should be given in a measure glass, according to the quantity ordered by the doctor
Although it is scientifically incorrect to say that alcohol is a food, it is a very powerful stimulant. In small doses it stimulates the heart and the brain, and under certain conditions it may be a very useful drug. But these advantages are concerned with the use of alcohol as a medicine in the hands of competent people, preferably medical men and women.
It is the greatest mistake in the world for the amateur nurse or the friends of the patient to administer alcohol without the doctor's order. If the patient seems to require stimulation, hot tea, hot coffee, hot milk, a little soup, and hot bottles for the feet will stimulate sufficiently, and not cause any subsequent depression as alcohol, whether in the form of brandy, whisky, or wine, always does. When the doctor orders alcohol, the nurse should note the exact dose, and the times when the stimulant is to be given. If wine is ordered as a tonic during convalescence the nurse should always inquire how long the stimulant is to be continued, as the habit of taking alcohol is apt to be acquired when it is given for a long time as a tonic. This is especially true of women of highly strung nervous temperaments, to whom alcohol is an especial danger. Always administer alcohol to patients in a measure glass, so that the exact dose ordered by the doctor is given and no more.
The following rules should be committed to memory:
1. Always write down the time of administration of medicine, and dose to be given.
2. Never give medicine without first reading the label on the bottle twice over.
3. Pour the medicine from the side away from the label into a measured medicine glass.
4. Keep all medicine glasses, etc., absolutely clean and ready for use..
6. Alcohol is a medicine, and a poison in large doses or in excess.
7. Alcohol should be given with food unless the doctor orders otherwise.
8. All intoxicating beverages should be given in a dilute form to an invalid.
60 grains make a drachm or teaspoonful.
60 minims make a fluid drachm or teaspoonful.
2 fluid drachms make a dessertspoonful.
4 fluid drachms make half an ounce or a tablespoonful.
8 fluid drachms make one ounce or 2 table-spoonfuls.
16 ounces make a pound.
20 ounces make a pint.
A wineglass equals 2 fluid ounces.
A teacupful equals 5 fluid ounces.
A breakfastcupful equals 8 fluid ounces.
A tumbler equals 10 fluid ounces or half a pint.