Thermometer registers normal 98'4

Thermometer registers normal 98'4°

Thermometer registers 102

Thermometer registers 102°

The temperature may fall below normal in low conditions of vitality, and in fever also it may fall below the normal and then rise again.

The different types of fever which a nurse has to study are:

1. Continuous, when the temperature remains raised, varying only a degree or two for several days, such as in an ordinary uncomplicated case of measles.

2. Irregular, when the temperature is high for a few days, then low, then high again. This type is seen in rheumatic fever. Whenever new joints are attacked the temperature rises.

3. Hectic fever is typically seen in consumption. The temperature is very high in the evenings and very low in the mornings.

4. An intermittent fever is associated with malaria or ague, the temperature rising at fixed intervals, and remaining up for a fixed time, perhaps daily, perhaps for two days, perhaps for three days.

At the end of an acute stage in fevers the temperature falls either suddenly by crisis or gradually by lysis, until the normal is reached. In pneumonia we have an example of the temperature falling by a crisis. In typhoid fever, on the other hand, the temperature goes down by lysis. During a high temperature the skin is hot and dry to the touch, and as the temperature falls it is covered with perspiration.

The Pulse

A rapid pulse is associated with rise of temperature, and both are signs of " fever." One wrist below the first. A doctor always does this so that he can press on the pulse with one finger, and test by means of the other whether the pulse is easily obliterated. Count carefully for half a minute, and double the number of beats, thus giving you the rapidity of the pulse per minute. The normal pulse in a healthy grown-up person is 70 or 80 beats per minute. In children the pulse beats more quickly, perhaps 90 normally; whilst in infancy the normal pulse may beat as fast as 100. The pulse is a very valuable guide in such a condition as appendicitis or peritonitis. In these cases a good pulse is a good sign, and a very rapid, thready pulse an indication that the patient is seriously ill, even if the temperature is not very high.

Fig. 3

Fig. 3. The thermometer should always be re' turned to its case immediately after use

The Breathing

In all chest cases the breathing is a very important matter. The nurse has to note whether the breathing is easy, tranquil, and regular. In pleurisy, the breathing is painful. In heart conditions it is laboured and difficult. When there is much fever it is rapid. It is a good plan to count the respirations when pretending to take the pulse, so that the patient is not aware of what you are doing. Otherwise, the breathing is apt to become quicker at once. The breathing can be counted also by laying the hand on the chest or abdomen. Under normal conditions the breathing is about 15 to 20 times per minute. Children breathe more rapidly. At the end of the first year they will breathe 28 or 30 times per minute, and in a newly-born infant the respirations are 40 or 44. By the end of the fourth year they have slowed down to 25; whilst as the child grows older the respirations become gradually slower until adult life.

In lung cases the nurse must be careful not to count the breathing just after coughing, since then the patient will breathe more rapidly, as also he will in cases in which any wheezing or crowing accompanies the respirations. "Dyspnoea" is the medical name given to difficult breathing, which in heart cases may necessitate the patient sitting up, supported by pillows night and day, to give the chest free play. Any paroxysms or dyspnoea must be reported to the doctor, and in asthmatic conditions and heart attacks the nurse may be ordered to give a capsule, a draught, or an inhalation at the beginning of an attack.

The careful nurse gradually increases her power of observation. She notes every detail, and reports everything abnormal to the doctor at his morning visit. It is only by care and attention that a nurse can learn in detail all that is necessary about the art of sick nursing. Exactness is everything, and that is why each duty will be described carefully and in a detailed fashion in this series, so that no woman who has properly studied these articles will nurse in a slipshod, careless fashion when she may be called upon to take charge of a case.

Rules To Remember

1. Always write down immediately the temperature, pulse, and respirations on the chart given in an earlier nursing article.

2. Ask the doctor at what times he wishes the temperature and pulse to be taken.

3. Excitement will increase the rapidity of the pulse and respiration, so that they should be taken when the patient is as tranquil as possible.

4. Study the pulse in health by counting with a watch, so that you may be able to apply your knowledge to the pulse in disease.

5. Reauing the thermometer accurately requires practice. The ordinary person will find it extremely difficult even to see the thread of mercury until it has been studied for some

6. A feverish patient must be guarded against further chill by keeping the room at an even temperature, regulated by the thermometer.

7. No fevered patient should have solid food. Milk and water, varied in some cases by broth, are all that are necessary during the acute stage of the illness. Anything more is only a tax upon the enfeebled organs.

8. Small quantities of water should be given occasionally, as the patient desires it, but it is not a good thing to give long drinks of cold water.

9. Sponging the patient's hands and face adds considerably to his comfort.

10. A doctor should always be in attendance where there is elevation of temperature and other signs of fever.