Danger of Slackness in Nursing During Convalescence - Progress Must be Gradual - Importance of Rest - Prevention of Chill - Diet as Important in Convalescence as in Acute Stage of Illness Value of Fresh Air and Sunshine as Restoratives - Care of the Skin and Hair
It is surprising how many people never get really well after an illness. They have been carefully nursed through all the acute stages of their disease; they have had every attention in the matter of diet, medical care, and hygienic conditions; and yet they fail to take up life afterwards as hale and strong as they ought to be.
The whole secret lies in badly managed convalescence. It is the amateur nurse who is most likely to make mistakes in this respect. As the patient seems well, she relaxes effort, allows things that ought to be forbidden in the way of food and amusements, and does not recognise the danger of hurrying this stage of the illness. It is during this period that the patient is very weak, liable to chill and to contract fresh diseases. How many people recovering from influenza take pneumonia! How many children sink into consumption after measles!
A sheet folded in this way and fastened to the bedposts makes a support for a convalescent patient when first sitting up
The chief points which the nurse in charge of a convalescent patient must pay attention to are:
The prevention of over-exertion or nervous fatigue.
Guarding the patient against chill.
Regulation of the diet.
After a serious illness, at the beginning of convalescence, when the temperature is normal and the pulse strong, the doctor will probably allow the patient to sit up in bed. This may be regarded as the first stage of convalescence, but even this should be gradual. The patient should never be elevated immediately into the upright position, but given one pillow to raise him a little, then another and another, so that the transition from lying down to sitting up is made gradually. Thus you avoid any strain upon the heart from sudden change of posture.
A bed-rest, well padded with pillows, can then be provided, with a heavy book or hassock against the feet outside the counterpane to prevent any chance of slipping down in bed. Another plan is to fold a sheet diagonally to form a broad band which can be fastened to the posts at the head of the bed, and this will prevent the patient slipping down.
When the invalid is allowed to get up, the nurse must be especially careful not to allow her to be in too great a hurry to resume her ordinary life. Let the patient sit up in bed for an hour or two at a time before you dream of getting her on to a couch or chair to have her bed made. Remember that all the organs at this period are suffering from lack of tone, and that any sudden change or abrupt movement may bring on faintness or breathlessness. The doctor must say how long the patient is to sit up or to be out of bed at a time. But the nurse will have to see that the room is warm, and kept at a temperature of about 72 degrees F.
The patient must on no account be allowed out of bed until the temperature has been normal for some days, when she may be helped on to a chair or couch at the side of the bed, and wrapped in blankets. A hot drink, such as beef-tea or milk, just after getting out of bed is an excellent stimulant, and is often required.
When the patient is up, take the opportunity of airing the bed thoroughly by putting the mattress and clothes on end, it possible, where they can be exposed to the sun; and when the patient returns to bed see that she lies down flat and keeps quiet for an hour or two. The second or third time of getting up she may be able to take a step of two, and gradually muscular power increases, and the patient is able to walk round the room quite easily.
The nurse must guard not only against physical over-exertion, - but against mental strain. The convalescing patient is nearly always irritable and cranky, because the mind has not regained its tone or the nervous system its poise. So that visitors should only be allowed occasionally, one person at a time for a visit of perhaps five minutes. If the patient has been seriously ill the visitor should be warned to talk only of cheerful things, and to keep her bright and amused. Friends may be a blessing or the reverse in the sickroom, depending upon the personality and common-sense they possess, and it is for the nurse to guard the invalid from visitors likely to over-fatigue or depress her.
Baths, friction, and massage are useful factors in convalescence, as they increase the tone of the muscular system and the organs of the body, and have been dealt with in previous nursing articles.
Whilst the patient in health should be kept occupied to a certain extent, anything likely to over-fatigue the eyes must be avoided. A little reading and writing are excellent as recreation, and a very comfortable, improvised convalescent table can be arranged with a plank resting on two trestle supports (see page 3890, Vol. 6). These trestles are generally to be found in the laundry or kitchen departments of the house.
Convalescents are extremely sensitive to cold, and should wear some garment of light wool next to the skin both by night and day. They should always be given a wrap when they sit up in bed, and when allowed to get into a chair the legs and feet must be well protected from draughts by rugs. After patients have been seriously ill it is a great mistake to allow them to go out of their own room for some time after D 25 they get up. A draughty passage and sitting-room, whilst it would not have any effect upon anyone in health, may cause a serious chill in convalescence.