Heart disease is not uncommon; and although it often happens that those with some heart affection are not confined to bed, no series of articles would be complete without some particulars of how to deal with affections of the heart.
There are various varieties of heart disease, perhaps the commonest being valvular disease, which may follow upon rheumatic fever. The rheumatic poison in the blood causes inflammation of the delicate valves guarding the openings of the heart, with the result that the efficiency of these valves is impaired, and the heart is handicapped in consequence.
Another form of heart disease is called aortic disease. The large bloodvessel of the heart, the aorta, is affected, and various symptoms of heart disease, such as breathlessness and palpitation, are present.
Whatever the type of heart disease, there are various general rules of treatment and nursing which must be followed.
The most important thing for the patient is rest combined with a type of diet that will not cause flatulence and which, will be easily digested and assimilated. When a patient with heart affection is not ill enough to be confined to bed, the duty of the nurse will be in seeing that her patient is protected from chill, that he has sufficient but not excessive exercise, that he lives a hygienic life, and eats simple, nourishing food.
When a patient is ill enough to go to bed, it is wonderful how improvement follows upon complete rest. The one thing a weak heart needs is as much rest as possible; and everything should be done to keep the patient cheerful, as anyone with heart trouble is apt to be depressed and melancholic. This is due, of course, to interference with the circulation in the brain, and improvement of the circulation and digestion will make a great difference to the mental condition.
The chief symptoms of heart affections which the nurse will have to deal with are breathlessness, palpitation, pain, and dropsy.
Breathlessness is increased by any excitement or muscular strain, and it is most important to keep a patient comfortably in bed. When the symptom is at all marked she should not even be allowed to lift herself or to move about unnecessarily. It is important to support the patient chiefly below the waist in order to allow breathing to be free and unimpeded. In some cases the patient is most comfortable when leaning forward; and one of the best methods of propping the patient up under these circumstances is by means of a plank resting on trestles or upon two perpendicular pieces of wood ten inches higher than the bed. This forms a sort of bridge across the bed, on which a pillow can be placed, and the patient can then rest the arms comfortably upon it. This bridge idea is splendid also for convalescent patients, as it makes a good book-rest or improvised desk.
Splendid support for a patient with difficult breathing is supplied by a plank resting on trestles placed across the bed
Every care must be exercised by the nurse in moving the patient. In the case of a heavy person suffering from dropsy, two people will always be required to do this properly. The nurse must always ask the doctor if the patient is to be allowed to sit up or to get out of bed, and she must faithfully follow out his wishes with regard to this matter.
These symptoms are frequently present even when there is no pain, and the careful nurse has several little devices to make her patient more comfortable. Sometimes by merely fanning the face and sponging the hands the patient will become quiet and ready to sleep. Very often too many bedclothes will keep a person restlessly tossing about. Anyone with enfeebled circulation almost invariably suffers with cold feet, and a hot bottle wrapped in flannel is often all that is necessary to make the patient quiet and comfortable.
Dropsy is due to obstruction of the circulation. The enfeebled heart is unable to pump the blood through the body, and the veins and capillaries become distended with blood. Then the fluid part of the blood escapes into the tissues round about, and causes swelling. This may be confined to the feet and ankles, and in such cases the patient must rest lying down as much as possible, as the swelling diminishes after rest in bed.
In some cases of heart disease the patient suffers from sudden attacks of pain (angina pectoris), which are apt to be brought on by exertion, excitement, or exposure to chill or fatigue. Thus, everything should be done to avoid excitement or over-exertion, and the doctor will probably supply capsules of nitrite of amyl, which can be crushed and the vapour inhaled the result being that the blood-vessels on the surface of the skin are dilated, and this relieves the congested heart.
Poultices and blisters are sometimes ordered for the relief of pain in various heart affections, and sometimes an ice poultice relieves the pain better than a hot one.
This requires to be carefully prepared. The nurse will require gutta-percha tissue, chloroform, ice, salt, and linseed meal, or wood-wool, which is better than meal, because it is more absorbent.
Take a piece of gutta-percha tissue a little larger than the poultice is desired to be when it is doubled over. Break the ice with a strong hatpin or safety-pin point. Place on the lower leaf of the gutta-percha a layer of woodwool or linseed meal, then some crushed ice, covered in turn by common salt, and then another layer of wood-wool or linseed is placed on the top. Now fold down the gutta-percha tissue, and paste the two edges together with the chloroform. This poultice may be put in a thin flannel bag, and applied to the heart. After the poultice is removed the part should be covered up, and if the bag is slit open and washed out it may be used again in the same way. Sudden Fainting, or Syncope Sudden fainting, or syncope, is another and often very troublesome occurrence in certain types of heart disease. The patient should always be laid quietly down; and if the doctor has given permission to use them on such occasions, stimulants should be kept at hand. The clothes should be loosened from the neck and chest, and the patient given plenty of fresh air. The windows should be open and the face fanned, whilst smelling-salts are always useful In most cases the feet and legs will be found chilly, and hot bottles should be applied. Any further remedies must be given by the doctor.
Making an ice poultice. The block of ice on a plate, a basin, a little chloroform, a tin of salt, and a tin of linseed meal should all be placed ready. The nurse is cutting the gutta-percha tissue to the required size
Meals must be light and frequent, and all foods likely to cause indigestion avoided. The patient may be given lightly boiled or poached eggs, oysters, boiled plaice, cod, whiting, flounders, lightly cooked meat once daily, beef, mutton, lamb, sweetbread, chicken, pheasant, tripe. Whilst vegetable and all rich soups are to be avoided, mutton or chicken broth and beef tea and clear meat soup can all be taken. Stale white bread, toast, plain biscuit, should be served with meals, and vegetables should only be taken in very moderate quantities. Uncooked vegetables or salads should not be allowed. Stewed fruits, oranges, grapes, and peaches are suitable.
The nurse should avoid giving large meals, and must never provide pork, goose, duck, or rich fish, like salmon or mackerel. Strong tea and coffee must be forbidden, and all effervescing beverages, as the presence of gas in the stomach presses up the diaphragm, and hinders the heart's action. Cheese, pickles, and pastry, as well as condiments, are unsuitable, because they are difficult of digestion. Milk, or water or barley water, weak tea, and such mineral waters as Carlsbad, Vichy, Ems, or Hunyadi Janos should be allowed fairly freely. Food should be avoided late at night, and the person who sleeps in a well-ventilated room is more likely to get a good night's rest than if the windows are closed. The chief meal should be taken in the middle of the day, and only a very light supper at seven o'clock.
The Nauheim treatment has become very widely known in England in recent years. It consists in medicated baths and special active and passive movements, followed, as the patient improves in health, with graduated exercise such as mountain climbing. The idea is gradually and regularly to stimulate the heart by strengthening its muscles, and it is only suitable for chronic cases, and must be associated with a sufficient amount of rest.
Treatment should be carried on under the care of a doctor, who will describe how to prepare baths by adding table salt and other chemicals and give instructions as to the proper temperature. The movements also must be very carefully done, and the nurse will require special teaching in the manipulations necessary.