Text-Book of mans Th ae ° » 0) 3 Nursing Tea eh By Irene V. Kelley, B.N. Graduate of St. Vincent's end Hospital, Cleveland; Assistant Director of School of Nursing and Instructor of Principles and Practice of Nursing at St. John’s Hospital, Cleveland, Ohio Illustrated Philadelphia and London W. B. SAUNDERS COMPANY 1926 Vo —r b ne Zl LA 18 ~ { . 2 Le i vd oe v 3 . “EE € ov, i “ . . » se. « . . ee rit 2 et bee A Tf See tS ‘oe * 2 us : 5a cane . | aeue We Cs ReA™ Hoge CIFT PACIFIC 2DOAST JOURNAL] OF NURSING Tu ArGainNg DEPT Copyright, 1926, by W. B. Saunders Company Reprinted November, 1926 MADE IN U. 8. A. PRESS OF W. B. SAUNDERS COMPANY PHILADELPHIA LBC. AFFECTIONATELY DEDICATED TO SISTER M. AMADEUS 743556 “A great deal of the joy of life consists in doing perfectly, or at least to the best of one’s ability, everything which he attempts to do. There is a sense of satisfaction, a pride in surveying such a work—a work which is rounded, full, exact, complete in all its parts—which the superficial man, who leaves his work in a slovenly, slip-shod, half- finished condition, can never know. It is this conscientious com- pleteness which turns work into art. The smallest thing well done becomes artistic.” WiLLiaM MATHEWS. FOREWORD I cannot pretend to give an expert's opinion on the technique of nursing. However, as a teacher and as one deeply interested in schools of nursing I do not hesitate to recommend most warmly the book Miss Kelley is presenting to the hospital world on Nursing Technique. Most every patient and anyone who closely observes the nursing care of pa- tienfs can appreciate the difference between the technically trained nurse and the one who awkwardly and blunderingly goes through vari- ous functions required for the comfort and welfare of the patient. If the spirit of the Introduction is carried out by a well-trained and efficient instructor there can be little doubt in anybody’s mind that the school in which this book is used as a text will become noted for the high type of nurse which it will produce. The text seems admirably systematized and written for the purposes of classroom and demon- stration work. It gives unmistakable evidence of clear thinking, exact expression, and large experience in the training of nurses. It has all the characteristics of a text-book which will be an enlightening and helpful medium for the capable instructor to impart a complete and unified technique to her nurses. Miss Kelley's book is striking in its clearness, plan, and practical purposes. Nursing, besides being a science, is an art. An art is the doing of something with skill and efficiency. The art of nursing is most difficult to learn and to perform with excellence. Miss Kelley's book seems to be perfectly adapted for the training of any capable nurse in this very important art of caring for the sick. As a text-book it must be carefully studied and skilfully applied by one who knows the science of nursing and couples with this science the artistic spirit of nursing. No matter how perfect any technique may be, it will fail to Ze in the classroom and for the student nurse unless handled by a real artist nurse. If Miss Kelley could give some of her years to training real interpreters of her book she would make the hos- pital world her debtor perhaps even more than she has in producing so simple, systematic, and practical a text-book. I should, therefore, like to close these few words of appreciation of Miss Kelley's book by congratulating her, St. John’s Hospital School of Nursing, and the hospital world in having at hand so capable and carefully thought-out a text. C. B. MOULINIER, S. J. President of the Catholic Hospital Association of the United States and Canada. PREFACKH DurING the past five years I have been urgently requested by teachers in Schools of Nursing and graduate and student nurses to put into permanent form the course of nursing procedures as given in the School of Nursing, St. John’s Hospital, Cleveland, Ohio, so that it may be used as a text for the teaching of nursing practice and as a reference book for the general practice of nursing. The aim of this book, therefore, is to meet the needs of these indi- viduals. It is also my intention to present in one volume the nursing procedures in the order in which they should be given as presented in the Standard Curriculum for Schools of Nursing. The material is so divided that all the simpler procedures are given in the Preliminary Period during the first four months. This is fol- lowed by a list of questions from which examination questions (for theory and practice) may be taken after giving the students a general review. The Preliminary Period is followed by the Second Semester, during which time the elementary procedures are given. This course is like- wise followed by a list of questions for general review and examination. The nursing procedures in the junior and senior years are given in correlation with the lectures. The lecture course, usually given by a physician, is followed up with class work and demonstrations. The Instructor in nursing practice presents the new demonstrations as they are given in the lecture course and reviews the elementary procedures if they are included in the treatment. A list of questions follows each course and a lesson plan is given demonstrating the method of class presentation. In writing this book I wish to express particular gratitude to Sister M. Ursula, Director of the Scheol of Nursing, St. John's Hospital, for her hearty co-operation and assistance; to Misses Muriel McKeen and May Cholley, my co-workers, for their valuable suggestions and constructive criticism, and to Misses Eugenie Kelley and Elizabeth Svec for their untiring work in typing the manuscript. LV: CLEVELAND, OHIO. CONTENTS FRESHMEN YEAR. FIRST SEMESTER (PRELIMINARY COURSE) PAGE IN ROBOGTORY. a sa a a an a a es ad a ee, 19 CART AND TIVGIENE OF THE WARD... oe isinies sii iaiee setts 19 DUSTING AND CURANING. iis nds aie is dat ob eS 20 STRIPPING AND AIRING A BED. x... il, Jaen a a a ed Lis 21 INATINGSA CLoSED BED... Lo ba. odes ch sia so sags LG SR 21 MATING 8. CORVALESCENES BED. A bi, vi inn vin a sda oy wind abe a oN 24 WASHING A BED AFTER THE DISCHARGE OF A PATIENT.................. 25 CLEANING A Room AND BATH-ROOM AFTER THE DISCHARGE OF A PATIENT 25 CIEAaNING IA MEDICINE CASES. ois ah ed ahs de ha ny 26 CARE OF LINEN ROOM—BEDS—BILANKETS...........ciiviiiiinnenennnnnn 27 CARE: AND ARRANGEMENT OF FLOWERS... .... 0 unis sus miionibin on nioh 27 GIvivie AND REMOVING THE BED-PAN.......0. ued suis inna dui iii dh 28 DoucHiNg A PATIENT BXImRNALLY. . ... 0 0 aie abn dren thy valninls 29 RE EOING DATIE NTS. vs i hited dian ly vie sin aie A is wi ade a A Oy 29 Macwg'a Beep Wrim A Pavrenr aw To... LL onan li 30 TRING Tae TOMPRRATURE., .... fa od as i dal ins de 33 PAR NG THE PULSE. ob. a i sh SR Ena 35 COUNTING THE BREATHING... ou cin vsins ddan waives deainiss uh siuiisitle § addy 37 ROUTING: PROCEDURES... iiss snide san sons shales shai n a aimin airs J 38 CARE: OF THE -MoUte AND TEETH... oo a dnd dial dia £000 40 CARE oF THE HAIR...... nr dR Re i ee 40 CARE OF THE BACK— PRESSURE SORES nts let ne Lae 42 CIVING A CrzANSING BATH 70 A BED PATIENT... ...cvvh iva bald 43 Esse Near PRINCIPLES IN NURSING. «it. i ate nslun nas vanes womia annotaiatels 44 MOVIRGIA PATIENT UP I BED... cit ints seine vin wie a tus ie arbi J 000 46 SING A PATIENT UP m8 BED....... ani co san 47 SHTING A PATIENT UP IN A CHAIR... oii iii shih ad siarniainte 48 POTTING A PATIENT BACK 10 BED... vt iin diel i Vasant 3 49 CARRYING A PATIENT ON A CHAIR MADE WitH THE HANDS. ............ 49 LIFTING A PATIENT FROM THE BED TO THE OPERATING CART........ 3530 ASSISTING ‘WITH A PHYSICAL EXAMINATION. .&... vives sive srt vsnrss 51 ASSISTING WITH AN EXAMINATION OF EAR, EYE, NOSE, AND THROAT..... 53 TURNING A MATTRESS WITH A PATIENT IN THE BED.................... 54 CHANGING A MATTRESS WITH A PATIENT IN THE BED................... 55 CARE OF A Patient Eaca MorNING WHEN A BaTH 1s NoT GIVEN....... 55 PREPARATION OF A PATIENT POR THE NIGHT.......0 ei ivenvnuninnn J Grvine A ParieNT A Tus Bara. ................. “PREPARING AN ANESTHETIC BED AND TABLE............. "A RIONDIEE BED rrrrrrrrsrrmrsatptuismeert? Ar, WATER, AND FRACTURE BEDS—SAND- ATI CRADLES — SPLINTS. CAND PRAMS... 4 8 tim vyioinis fans Aa Edn alanis a 6 hai sags s kia ws Ji aN AariD 60 PREPARATION OF HoOT- WATER BortLE AND ELEcTRIC PAD FOR USE....... 62 PREPARATION OF ICE-CAP AND ICE-COIL FOR USE...............ccuvuunnn 63 PREPARATION OF HANDS AND ARMS FOR OPERATIONS AND TREATMENTS... 64 CLEANING AND STERILIZATION OF RUBBER Goops AND Grass UTENSILS... 64 1 12 CONTENTS PAGE CLEANING AND STERILIZATION OF INSTRUMENTS............ ei Cy ebaeniD0 ASTISTING "WITH A SURGICAL DRESSING. i void sian, te dal it Ss 67 APPLICATION OF BINDERS =, sian a ve oh i AT a: 68 ADMISSION OF PATIENTS... 00. iii vane vs Pea as ee a 69 CARING FOR A PATENTS PERSONAL BELONGINGS......\''uunih vine, La GIVING. A FOONBATH, 7 50 TL hiss sins nn Sie Waa oN TNE 71 GIVING A STO BATH ri i Or us dled ita ats Phiante 4h wn aaa het td rit 73 PREPARATION OF LABORATORY SPECIMENS FOR ANALYSIS. ................ 75 RE AT ra a Bans a a de a Sr Le 77 GIvING A CLEANSING OR EVACUATING ENEMA 77 LEssoN Prax AND METHOD OF TEACHING A SUBJECT IN WHICH THE ANA- ToMmic AND PrysiorLocic Factors ARE To BE CONSIDERED......... “79 CIVING CARMINARIVE ENEMATA. oi. i so i ts ass te ah etd 83 ENEMATA: EMOLLIENT, SEDATIVE, AND STIMULATING ......ooovinnnnnn... 85 ENEsATA NUTRIENT AND OF. .. co a a 87 ENEMATA: ANTHELMINTIC, ANTISEPTIC, ASTRINGENT, AND. SALINE ,.. wil 88 APPLICATION OF OINTMENTS—INUNCTIONS—LINIMENTS.. ..........0...... 89 ADVIMISTRATION OF SUPPOSITORIES. . io dai bv cia ans os aie ve sivia silts walis in vine 91 DIONHESAT OF PATIENTS. J as va wave i Gr Bo 92 QUESTIONS FOR GENERAL REVIEW AND EXAMINATION.................... 93 DEMONSTRATIONS... ur fr ead es ah sd a re a ie 3 96 SECOND SEMESTER. ELEMENTARY PROCEDURES BD OEORES AR a En EE 101 NV AGIHAL DOUCHE ci hs sh ih sh ines vd ins ae 2 wd sw a rats 101 Lesson PLAN AND METHOD OF TEACHING A SUBJECT IN WHICH THE ANA- ToMIC AND PrysiorLocic FACTORS ARE TO BE CONSIDERED. ........... 103 PUARYNGEAL DOUCHE: J. dS LL nl a he es Lai is Gl 108 PUTTING AN ANESTHETIZED PATIENT 10 BED. Lov. vuviss au vn nat Jit 109 PREPARATION OF PATIENT FOR GYNECOLOGIC EXAMINATION............... 110 PREPARATION OF THE FIELD FOR OPERATIONS AND TREATMENTS. ......... 113 NURSING CARE AFTER PERINEORRHAPHY AND HEMORRHOIDECTOMY........ 115 ADMINISTRATION OF MEDICINES. La ie das ines sha als GIVING HyronuRMIC INJECTIONS. (sis 0 siateis viaitieis 4.0 sabes ams pid bab ivios aed PREPARATION OF A PATIENT FOR OPERATION PROCTOCLYSIS. . .... Bite vd ab wea Ee DE Rath SAE A a A AGEING WITH TY ODE RMOCLYSIO. iv Shut sis sain a vias diss an sls ASSISTING WITH AN INTRAVENOUS INFUSION............ CALz OFTHE BOUY APTER DEATIU. oi. ives san sdtg sn viaione sieliied dais CARE OF THE NEWBORN—BATHING INFANTS AND SMALL CHILDREN... .... 134 TIOT APPLICATIONS, BATHS, AND PACES... 0. aii des vine sis ise ttle A ER DAC. i a i se Te ed a eS a Ry Hor ORE PACE. . on ain Nd LS Ca saa aw een Baa EE OT BATE PACK, was cd ea Es Le id i Hor TOB BATE i. ns vids os svi ve SE a via is Si ArrricarioN or Hor DeEssINGS.............0.. CATHETERIZATION OF THE BLADDER............. Biapper TrriGATION OR VESICAL DOUCET... .....0 0.00 05a va Siaail Corp APPLICATIONS, BATH, AND PACKS... CIviNG ‘A COlD SPONGE BATH... 0a. ih oi foi hits eiufaidi atery Wa SAE CIvING ATCO PACK. 0. fh toe ita tat hate soni wd mid mma ayia et GIVING A BRAND BATT i hr sn bts sdidoaaia nis is haa a 0h is GIVING A SPRAY Or Srogit BATH. 0. oa hea Rely COUNTER RBI TANTS 1 i) hi or BAe rr sa aes ge Sh pi STUPES OR OMENTATIONS | i. ms od a ad 2 Se day APPLYING ABDOMINAL STUPES OR FOMENTATIONS Turpentine Stupes Sterile Stupes. . . CONTENTS 13 PAGE PrupAriNG AND AprryiNG POULTICRS, .. . © nh no ir nin 163 APPLYING SIRAPEME. i. ne Bon a al So a Sh dealin 165 APPEYING PRastuRs, nh. nr ee Te 167 CE PING a i CR BD ee SL 168 PREPARATION AND CARE OF THE ACTUAL CAUTERY—APPLICATION OF HEATED MEDAL. oa RE LB i Sa an Ral iE 171 - ASPIRATIONS AND PUNCTURES... on inal m Ans hr ig 172 ASSISTING WITH A LUMBAR PUNCTURE... a bo ii i 172 ASSISTING WUCH A CHORACENTERIS. . oh a Fri Fi na 173 ASSISTING WITH ABDOMINAL PARACENIESIS. . ...... 00 oii iis ivi 177 ASSISTING WITH AN ASPIRATION OF THE PERICARDIUM. .................. 179 ASSISTING WITH AspipATioN. Ov A Vem. |. i... oo con nin 180 ASSISTING WITH A PHLEBOTOMY, OR VENESECTION.............uuuuenn.n. 181 QUESTIONS FOR GENERAL REVIEW AND EXAMINATION.................... 183 DMONSTRATIONS or co nau ibe dl nal pen Ln a 188 JUNIOR YEAR. FIRST SEMESTER ProceDURES- Usen 1 MunteAr, NURSING ©. i. iv io vi bi i 193 Nursing in Medical Diseases, oo 000 00, crn, drnldl chaaaiaalas yy 193 Assisting with a Transfusion (the Paraffin Tube). .................... 194 Ihalationg PR AE STS 197 Application of Camphorated Oil to the Chest—Pneumonia Jacket. ..... 201 Application of Cold Compresses tothe Chest............. ........... 202 Taking. Blood-pressure. Lo 50 di vl Lai hot siii ah 203 Assisting witha Gastric Uavage. i... ii dad iss diininn sada ind 205 Assisting with Expression of Stomach Contents. .................... 207 Tractional Method of Gastric Analwsls. 0, oi niin Fon rin 208 Preparatian of Patient for Radiography and Fluoroscopy. ............. 209 CYA i eR ae SE ET Ba 211 Nasal Gavage. .. i a rh wt ea 212 Assisting with a Duodenal Feeding... ......uih, ivi an iiin v3 Gastfrogayame Cr rr oo a ae A er 214 Enteroclysis, or Colon lerigation. . 1c. ih. Lo visa 0 Sil ed ey 213 Adwinisteation of Insulin, un, ova sn AE 220 Vader Bathin Bed ooo. 0 ae, an hi dine 221 Hoole Batlvin Bed tL 200 Slaven Dat i era, 223 The Phenolsuiphonephthaleln-Test. oo, is LL Bs i nt 224 Administration of a Test-meal for Renal Function (Mosenthal)........ 226 Rocal. Tot Wet Pack. cord in donc nie bi 228 Yocal:Dlectrie Blah Bath. v.00 ovo dba c nn St ao nal 229 Tocal Botan Bally ol esi i a ie A A Ea 229 Sunlicht Bath or Heliotherapy, 0 fd. oil on is ss eimai 230 Questions for General Review and Examination in Medical Nursing. ... 231 : Demonstrations in Medical Nursing. 00... 0 on. cite ait 233 Proczpunes Uspo 1 Sunoical NURSING. |... 0h viet ba a amt, 234 Nargne in Sovgieal Disenses. Lo. vil a rd had Je cians 234 Care of the Dressing 1001. i. oir oi oe Fr ad es bs its vis a 235 dea Hob-wakter Bath. ou ol i i ni wld sees 236 Conia Hotaie Bath. vc LL, id er sr al Bl a 237 Neutral or Sedative Bath. 0. oon ivi i bia wn dai 238 Alcohol Sponge Baglin, dia Se a ea nas 239 Applicationcof Towmiguell hao sil nin hab re Sa 240 Assisting with Tracheolomiy. T 00, ln, J irda bain so lb is, eis we 8 241 Questions for General Review and Examination in Surgical Nursing... .. 243 Demonstrations in Surgical Nursing... china dali nan ilnag, 244 Nunsive Procupures USED IN GYNECOLOGY. - + ive iva di dit cus sina vinisis 245 Gynecologic NULHING, oc 0 faite hh i ira nd an a 245 Taling a Vadinal Batear. | cou. sits ah vals vis isan cass a Vala santas 20S 14 CONTENTS NURSING PROCEDURES USED IN GYNECOLOGY: PAGE Assisting with the Insertion of Pessaries, Tampons, and Packing........ 246 Assisting with an Intrauterine’ Douche... cL. 00 wh 0 riod oad LAS, 248 Questions for General Review and Examination in Gynecologic Nursing 250 Demonstrations’. 5. hive i a BU ay BS 231 NURSING PROCEDURES USED IN COMMUNICABLE DISEASES................ 252 Sanitation of Sick-room—Hygiene of Patient—Nurse.................. 253 Disinfection of Excreta, Bed Linen, Dishes, Utensils, and Bath Water... 255 Special Care of the Mouthiand Noge. i100 0h. sins bende si tiniinis 258 SDIAYE. he Re re ra LT LL Le 256 Medicated Baths, .. 5... 0i0 0. co dea do ay i LAE 257 Nasal Dofielhie oon LLL Lami, nh ie SL ae at lie 259 Ar Donche, i Joo i, ln ne RL Gea GR fe ie 260 Eye Donche~TInstillation of Drops ...v.cv vies indi nnn. iin 261 Application of Hot Compresses to Eyes.............................. 263 Application of Cold Compresses to Byes. .......... 0. civil 264 Vaccination and Care of Wound... .. Lu. Foon i i ey 265 Talking Whroat and Nose Cultures, . oo... a, cv 0h aids 266 Applications of Cold and Heat fo Throat. ...........00iei oti inh 267 Assisting with Intubation and Extubation........................... 269 Preparation for Artificial Pneumothorax. . .....c.cvevvvninrrenensenesn 271 Questions for General Review and Examination in the Nursing Care of Communicable Diseages.. ova anni fon alas Ts 272 Demonstrations in Communicable Diseases. ......................... 274 NURSING PROCEDURES USED I UROLOGY... 0 ieirisnsr ons sianls sles anunins 275 Preparation of Patient for Radiography and Pyelography.............. 275 Preparation for Cystoscopy and Catheterization of the Ureters......... 276 Bladder Instillation.... BRE aa i 279 Urethial Injection. hi... 0) oo olin int hos SIRs Sal sabiatd like og 281 Preparation for Continuous Catheterization........................ .. 282 Catheterizationiof Male Patient... no 0, adh sheet dd, 282 Questions for General Review and Examination in Urology. ........... 283 Pempnatrations. Lo Ll rr ah a le a A 284 JUNIOR YEAR. SECOND SEMESTER PROCEDURES USED IN OBSTETRIC NURSING. ...o0nnniiiinnnnnnnnnns 287 he Xayette. i. oi. uv vidas e semeic ols d unten JULES TEE 0 a 288 Preparation During the First Stage of Labor......................... 1288 Makingan Ohatetric Bed... o.oo iii ort ci 0 Loi phigh, 289 Preparation of ‘the Baby's Crib... odin iid de Ja laigl 290 Preparation During the Second Stage of Labor. ...................... 290 Preparation of the Delivery ROOMY, vids vies faving sstu hiv altel 290 Preparation During the Third Stage of Labor... .................... 292 Care of the Patient Following Delivery......................'ouih 293 Routine. Cave of the Indanib... 0 i ll vision de bitin ath 204 Careof the Premature Baby... .., 0. ois bias bens sue QE IR dN, 204 General Review and Examination Questions in Obstetric Nursing. ... 297 Demonstrations Ji, Al. 0, a ap LE Ys GL a ee 298 NURSING PROCEDURES USED IN DISEASES OF INFANTS AND CHILDREN..... 299 Making 2:Closed Crib... lv 0 hy be in en a dp dai Le eG 300 Making a: Crib witha Chlldin Te... 000 Lal alo nn de 301 Preparation of Milk Formule. ..ov.vniviiiienns ns pans niid anes 302 Dies Ll a eee ene a ES ea 304 Taking a Child’s Temperature, Pulse, and Respirations................ 305 Crareocfa Child's Mouthand Teeth, . LL chen daw Fadia .... 3006 Care of the Buttocks in Infancy and Childhood....................... 307 Preparation of Urine Specimens for Analysis. ...............ocoiienn. 308 CONTENTS NURSING PROCEDURES USED IN DISEASES OF INFANTS AND CHILDREN: Special Procedures... 0. 2 ha a Hopodermoclysis. a. 20 il iin A LL i Eh Tatravenous Infusion... Lr a Joa niad ig inn hn ie ay Proctoclysis, 0 Lgl NG Ba Sa SE a Mot Wet Pack... in br i, aa a a Di Cold Pack. «oie od he Ll a a a a Tad Cold Sponge Bagh... % i ul oil oly gr A Catheterization... 5 0 oo bi at Sod EE an fT eg Abdominal Stupes or Fomentaiions. ...........0. 0x0 wid, Flaxseed Poultice... |. 0. vvig io oii stall an ini Lumbiar Puncture... 0 JLab ad Le a a bee Abdominal Paracentests. ... 00 no. ol oui diets dl 0 J a Thoracentesi. .. 0 or i rr ca Be Venipahicture | 5000 Ln num Done Da or ao Gastric Lavage oo Lol Dodd Ce al a aE Gavage. Ll a et ER General Review and Examination Ehine in Diseases of Infants and Childven..i/. ol edad ra dd ee Sh pe 313 Bemensteations: Lbs sat in ai il Bei a 315 NURSING PROCEDURES USED IN OCCUPATIONAL, VENEREAL, AND SKIN DISEASES 316 Nursing in Occupational, Skin, and Venereal Diseases. . ............... 316 Assisting with the Administration of Salvarsan. . ...... ............... 316 MerenvialInunction . .... hil ahi SRSA NR A TT 0 320 Assisting with the Administration of Neosalvarsan.................... 321 Preparation for a Swift-Ellls Treatment... ........ 0... ive vusivasde 323 Questions for General Review and Examination in Occupational, Skin, and Venereal Diseases. |... i nu vdlind iad oi 324 Demonstrations. . «oi. ee 324 SENIOR YEAR. FIRST SEMESTER NURSING PROCEDURES USED IN MENTAL AND NERVOUS DISEASES... ..... 327 Nursing in Mental and Nervous Diseases. ...............ccvvuuuen... 327 Restiaintiof Patlents. nc vis rd all la hg Sh rie 328 Givinea Spinal Douche... 0. ee Si a he 329 Questions for General Review and Examination in Nursing Mental and Nervous Diseases. 0. ue doit svi aioli ids ad Bol 330 PeONSETAtIONS. + v0 1h os ie oh a SE a ae A TA 331 NURSING PROCEDURES USED IN DISEASES OF THE EYE... ............... 332 Nursing in Diseasesof the Bye... /.... 0... he. dal oneal iy 332 Application of Ointments and Powders to the Eyes. .................. 332 Gate ob Aviifichl Byen, £00 0, il ona Bs 0, SJ aaise 333 Irrigation of the Conjunctival Sac in Gonorrheal Ophthalmia and Oph- thalmia Neonatorwm.. cx. lod. on ni ail dls ili Jn 334 Questions for General Review and Examination in Diseases of the Eye.. 336 Demonstrations... J.Lo. a Sl dA 0 nl ol I si as iE 337 NURSING PROCEDURES USED IN DISEASES OF THE EAR, NOSE, AND THROAT 338 Nursing in Diseases of the Ear, Nose, and Throat .................... 338 Instillation of Drops, Removal of Cerumen and Foreign Bodies from the a Bara i Da Le nS SL 3 Assistine with a Myringotomy 2.0 bso aiid ns se aE, 339 sealing tL. i dn a en Bh 340 Questions for General Review and Examination in Diseases of the Ear, Nosepand Theat. Loin loon iL La a rr i 341 Demonstrations: . ud ul raw win Sark bE 342 sic LR Ie ON Ri SO AR pe 349 FRESHMEN YEAR FIRST SEMESTER (PRELIMINARY COURSE) Fig. 1.—Demonstration room for the teaching of nursing practice. (One side of room.) Fig. 2.—Demonstration room for the teaching of nursing practice. (The other side of room.) 18 Text-Book of Nursing Techn eg #9 3 te oF Clana dhe I ue } 2 or Dela ” . een vy ig a9 —e 2 toliimisly Joa iat Ne ATER INTRODUCTORY THE recovery of every patient is dependent to a large extent upon the technique employed by the nurses and physicians caring for him. In view of this fact it is essential that thorough instruction in nursing practice be given in schools of nursing in order that the student may develop skill and efficiency in doing the things that are expected of her as a nurse. Nursing technique' has been defined as the skilful handling of the patient with the least discomfort, the skilful handling of sterile apparatus without contamination, and the elimination of unnecessary movements so as to insure the maximum speed compatible with highest efficiency. Nursing practice is to be carried out with the following points in mind: . Comfort of the patient. . Accuracy in detail. . Neatness and finish. . Economy of time, effort, and material. Technique and dexterity. . Therapeutic effect. . Simplicity and safety. Objects of the course: 1. To give a clear understanding of the fundamental principles, which underlie all good nursing, to develop habits of observa- tion, system, economy and manual dexterity, and to establish a uniform and finished technique. " 2. To prepare the student to meet the problems that will confront her in her daily work, limiting her duties as far as possible to those which she can understand and safely practice in the earlier stage of her education. NO Ut Whe CARE AND HYGIENE OF THE WARD Important factors to consider in the daily care: 1. Keep rooms well ventilated and lighted. 2. Keep rooms clean and in perfect order. 3. Prevent noise and unpleasant odors. 4. Properly care for the furniture, utensils, and linen. Ventilation is the continuous introduction of pure air into a room or building, thoroughly mixing it with the contained air, and the simul- taneous extraction of a like quantity of impure air. (Bergey's Principles of Hygiene.) 1 American Journal of Nursing. 2 Standard Curriculum. 19 20 NURSING TECHNIQUE Two importart points to be remembered for proper ventilation: 1. Introduce pure air. 2 Rey the air in motion without allowing the patient to be in a raft. Room temperatures commonly advised are: 1. General ward, 68° F. | 2. Bathroom; 728 ¥.: : : 3. Surgical departriient; «75° to 80° F. Preiuvticies necéssary: to prevesit-odors: "1. Keep che bed utensils clean and cover them as soon as you take them from the patient. 2. Keep all patients and their bedding clean. 3. Flush the toilets and the hoppers when necessary and keep them in perfect working order. 4. Place the soiled dressings in the incinerator and burn them as soon as you take them from the patient. 5. Change the water on flowers daily. References: Sanders’ Modern Methods in Nursing, pp. 823-858. Harmer’s Principles and Practice of Nursing, pp. 3-19. Pope’s Practical Nursing, pp. 3-15 and 28-48. Bergey's Principles of Hygiene, pp. 67-100. DUSTING AND CLEANING Regquisites: 1. Cleaning basin. 2. Two dusters. 3. Cake of soap or Bon Ami on a dish. 4. Floor mop. 5. Carpet sweeper. 6. Newspaper. Procedure: Half fill the basin with hot water and carry it with the other re- quisites to the room or ward. Spread the newspaper on the bedside table and place the requisites so that they will be convenient for use. If there is a large rug on the floor, use the dust mop first around the rug and then use the carpet sweeper. If there are small rugs, use the carpet sweeper first and then roll up the rugs and place them at the side of the room. Use the dust mop on the floor and replace the rugs. Dust the bed, table, chairs and window sills, and wash the glass tops of the dresser and bedside table. Wash the foot-board of the bed, the chairs, and several inches around the door knob, daily if indicated. Place the chairs in position, adjust the shades, and carry the requisites to the utility room. Points to be remembered: 1. Wash the dusters when soiled and change the water when neces- sary. 2. Use long firm strokes and go over each surface but once. 3. Dust high shelves before low ones and do not forget the bars that are out of sight. 4. Avoid knocking the bed and any unnecessary motions. MAKING A CLOSED BED 21 STRIPPING AND AIRING A BED Requisites: 1. Two chairs. 2. A closed bed. Procedure: Place two chairs back to back at the foot of the bed or at the side, as convenient. Remove the pillows and place them on the seats of the chairs. Loosen the clothes all around the bed by starting at the center of the bed at the head, and raising the mattress with one hand and draw- ing out the clothes with the other. Continue along one side and then proceed on the other side by going around the bed. Then remove the spread, folding it in its creases, and place it where it will not get crushed. Remove the clothes, one at a time, and place them over the backs of the chairs. Remove the rubber sheets and hang them over the foot of the bed. Turn the mattress from the top to the bottom, and arch it on its upper and lower ends and allow it to air for thirty minutes. Points to be remembered: 1. Save time and energy. 2. Arrange the clothing so that it will be exposed to the air. MAKING A CLOSED BED METHOD 1 Requisites: 1. Linen piled in order on bedside table. (Spread, three sheets, and two pillow-cases.) Double wool blanket. Two rubber sheets (one large enough to cover the entire mattress, the other to be used under the draw sheet). Quilted pad (large enough to cover the large rubber sheet). . Bed (equipped with springs). . Mattress (covered with a muslin case). 7. Two head pillows (covered with muslin cases). Procedure: ‘Place the mattress in position and cover it with the large rubber sheet. Place the bed-pad over this and cover same with a sheet so that 12 to 18 inches will extend beyond the mattress at the head of the bed. Be sure that the sheet is straight and that there is the same amount on each side. Tuck it under the mattress at the top of the bed (beginning in the center) and make a square corner at the side, tuck it under the mattress along the side at which you are standing. Put on the rubber draw sheet! and tuck it tightly under the side of the mattress. Cover this with the muslin draw sheet folded double and tuck it under the mattress. Place the top sheet with the hem wrong side up, and turn it under the width of the hem. Place it so that the upper edge of the sheet is on a line with the top edge of the mattress and the center fold in the center of the bed. Tuck this sheet under the mattress at the foot of the bed and make a square corner at the side. Tuck it under the mattress along the side. Place the double blanket so that its upper edges will be 6 inches from 1 This may be omitted if the patient’s condition indicates it. Sus wi 22 NURSING TECHNIQUE Fig. 3.—Removing clothes from a bed without a patient. (Step one.) Fig. 4—Removing clothes from a bed without a patient. (Step two.) MAKING A CLOSED BED 23 the top of the mattress. Tuck it under the mattress at the foot of the bed and make a square corner at the side. Tuck it under the mattress along the side. Place the spread so that its upper edge is even with the rim of the mattress at the top. Tuck it under the mattress at the foot of the bed and make an oblique corner and allow the side to hang. Go to the opposite side of the bed and fold the spread and other covers back. Proceed in the same manner as on the first side. Slip the pillows into the cases so that the corners fit well. Press and smooth them so that they lie perfectly flat. Then place them on the bed so that the seams are toward the head and the open ends away from the door. Arrange them so that the second pillow is lying flat on the first one. MetHOD [I Requisites: The same as for Method I, except that two single blankets are used instead of a double one. Fig. 5.—A closed bed. Procedure: Proceed as in Method I, with the under clothes and upper sheet. Place the first blanket so that its upper edge will be 6 inches from the top of the mattress. Then turn this blanket under itself at the foot of the bed so that the lower edge of this fold is on a line with the rim of the mattress at the foot of the bed. Tuck it along the side as in Method I, Place the second blanket so that it will be the same distance from the top of the mattress. Then turn this blanket under itself at the side so that the outer edge of this fold is on a line with the rim of the mattress at the side of the bed. Tuck it under the mattress at the foot of the bed. 24 NURSING TECHNIQUE Proceed with the spread as in Method I. Then proceed with the oppo- site side of the bed. Points to be remembered: - Have all the requisites at hand before beginning work. . Be sure that the mattress is well protected. . Be sure that the under clothes are tight and free from wrinkles. . Arrange the upper clothes so that they can be turned down with- out disturbing the under clothes. Save time and energy. Keep the surroundings neat during the work and do not consider the task completed until the chairs and table are in position and the shades adjusted. 7. Besure that the finished bed is neat and, if making more than one, have them uniform. To open the bed: Open the bed at the sides to within 15 inches of the foot. Turn the spread back over the blanket and the upper edge of the sheet over this fold. Face the foot of the bed and grasp the upper edge of the clothes on either side between the thumb and fingers, with the thumbs on top. Fold the covers down to the center of the bed and then back toward the head so that a double fold is made. } MAKING A CONVALESCENT’S BED Requisites: 1. Linen for bed. 2. Double wool blanket. 3. Bed equipped with mattress, pillows, rubber sheets, and pad. Fig. 6.—An open bed or a convalescent’s bed. CLEANING ROOM AND BATH-ROOM AFTER DISCHARGE OF PATIENT 25 Procedure: Proceed with the under clothing as in a closed bed with the following exceptions. Omit the rubber and muslin draw sheet, unless the pa- tient’s condition contraindicates. Proceed with the upper clothes as in a closed bed with the following exceptions. Tuck the blanket and sheet under the mattress at the sides for only 12 or 15 inches. Turn the covers back to the center of the bed (as in opening a closed bed) and place the pillows on the bed so that one is slightly lower than the other one. WASHING A BED AFTER THE DISCHARGE OF A PATIENT Requisites: 1. Cleaning basin. 2. Bon Ami and soap on a dish. 3. Two dusters. 4. Newspaper. } 5. Mattress cover, if necessary. Procedure: Half fill the basin with hot water and carry the requisites to the bedside. Loosen the bedclothes as in Demonstration No. 5. Re- move the linen and place it directly in the hamper or roll it together and place it on a chair. Hang the blanket over the back of a chair to air, or place it in the hamper with the soiled linen if necessary. Place the rubber sheets on the bed and wash them thoroughly with soap and water and dry them. Proceed in like manner with the knee pillow. Place the rubber sheets on the back of the chair. Dust the springs and change the mattress cover and head pillow covers, if necessary. Arch the mattress on its upper and lower ends. Wash the bed with warm water and Bon Ami, beginning at the head in the center and pro- ceeding along the side and foot and then the opposite side. Do not for- get the bars that are out of sight. Open the windows if the bed is in a private room and close the door and leave the bed to air for thirty minutes. If in a ward, place the rubber sheets over the foot of the bed and the pillows on the springs and draw the screens around the bed and leave it to air for the same length of time. If the patient was suffering from an infectious disease, expose the bed, mattress, rubber sheet, and pillows to the sun, and air them for three consecutive days before using them for another patient. CLEANING A ROOM AND BATH-ROOM AFTER THE DISCHARGE OF A PATIENT Requaisttes: Bed-pan. Urinal. Sputum bowl. Enameled cup for mouth-wash. Soap dish. Enameled wash-basin. Enameled pitcher (large). Enameled pitcher (small, for external douche.) Found in each patient’s cabinet. RN 26 NURSING TECHNIQUE 9. Two dusters. 10. Bon Ami and soap on a dish. 11. Cleaning basin. 12. Newspaper. 13. Floor mop. 14. Carpet sweeper. Procedure: The care of the patient's room and bath-room is an important part of nursing, for the recovery of the patient is dependent in no small way upon the condition of these rooms. Half fill the cleaning basin with hot water and carry it with the other requisites to the bedside. Wash the mirror with plain water and dry it. Wipe out the dresser drawers and the compartments in the cabinet and | place white paper neatly folded so that the double edge is to the front. Dust the closet shelves, hooks and hook supports, and the rollers of window shades. Dust the chairs and bedside table. Wash the window sills and the door knobs. Wash the bed as previously demonstrated and make a closed bed. Wash the glass tops on the dresser, cabinet, and bedside table. Steril- ize the bed-pan and urinal in the bed-pan sterilizer, and the sputum bowl, soap dish, and enameled cup in the instrument sterilizer. Scrub them well upon the removal from the sterilizer and dry them and place them in the cabinet. Sterilize the pitchers and wash basin in the auto- clave and place them in the cabinet. Equip the cabinet with bath and face towels, wash-cloths, bed-pan cover, toilet paper, and soap. Clean the porcelain tub, toilet, and wash-stand with Bon Ami and soap. Never use oxalic acid or strong alkalies for cleansing porcelain ware. Use the dust mop and carpet sweeper as previously demonstrated. If the rugs are small, exchange them for clean ones. If a maid does this work the nurse is responsible for it and inspection of same should al- ways be made before admitting a patient. Always dust a room which has been closed for a number of days, before admitting a patient to same. CLEANING A MEDICINE CASE Requisites: 1. Medicine case. 2. Two dusters. 3. Soap and Bon Ami on a dish. 4. Household ammonia. 5. Cleaning basin. 6. Newspaper. Procedure. Prepare the requisites as for dusting and cleaning. Remove the bottles from the top shelf. Wipe off the shelf and dry it. Wipe off the bottles with a cloth wrung from warm soapy water and be careful not to deface the labels. Be careful to replace the bottles where found. Proceed in this manner until all the bottles and shelves have been wiped off. If the medicine case has glass doors, wash them with plain warm water or weak ammonia water. Points to be remembered: 1. Always keep the solutions and ointments for external use sepa- rate from medicines for internal use. CARE AND ARRANGEMENT OF FLOWERS y 27 2. Observe all the bottles to make sure that they are properly corked and labelled. 3. Keep the surroundings neat during work. CARE OF LINEN ROOM—BEDS—BLANKETS Requisites: 1. Linen closet of demonstration room. 2. General linen from laundry. 3. Bed—mattress and cover. 4. Pillows and covers. 5. Blankets. Linen room: If the paper on the shelves is soiled, remove it and wipe the shelves with a cloth wrung from warm, soapy water. Place white paper neatly folded so that the double fold will be to the front of the shelves. Have a definite place for each piece of linen and place all pieces uniformly on the shelves so that the fold of linen will be to the front. Beds: ~ Dust beds daily and on the discharge or death of a patient, wash them as previously demonstrated. Mattresses: Protect mattresses with muslin covers and then cover them with good rubber sheeting and pads. Change the covers as neces- sary and when doing so, make a careful inspection for bed-bugs. If they are found, report it to the Supervisor of the ward. Pillows: Protect head pillows from perspiration by covering them with muslin covers. Change these when necessary. Protect knee pillows from blood, pus, and body discharges by covering them with rubber cases. Wash these when necessary. Blankets: Give blankets special care by protecting them at the head of the bed with the sheet and spread, and using bath blankets next to the pa- tient for treatments and baths. References: Sanders’ Modern Methods in Nursing, pp. 59-64. Harmer’s Principles and Practice of Nursing, pp. 30-33. CARE AND ARRANGEMENT OF FLOWERS Flowers are a “Thrill of Encouragement and a Will to Live” to the weary hearts of the sick and as such should be accorded the same re- spectful attention as medicines and treatments. These beautiful messages of hopefulness and love are often made short lived and unsightly by improper treatment, and their proper mission thereby entirely defeated. Nothing but a few minutes of in- terested attention and some simple rules are necessary for the care of hospital flowers. Points to be remembered: 1. Keep all flowers out of direct drafts. 2. The freshest flowers will soon languish in vases too small for their length of stem, and only half filled with water. 3. Flowers crowded too tightly not only droop quickly, but lose half their beauty by this loss of natural grace and charming pose. 28 NURSING TECHNIQUE 4. Always use deep, roomy bowls or vases, with water enough to cover the stems a little more than half their length. 5. In case a bowl sufficiently deep is not procurable, dampen a news- paper heavily and wrap around the stems. Insert the flowers, paper, and all, into the small bowl filled with water. The paper will keep the stems moist and the flowers fresh. 6. In the case of arranged baskets of cut flowers be sure that the receptacle contains sufficient water. 7. Water potted plants daily and change the water on cut flowers daily. 8. It will prolong the life of cut flowers to clip a little from the stems every day. GIVING AND REMOVING THE BED-PAN Requisites: 1. A Chase doll in bed. 2. Basin. 3. Pitcher. 4. Wash-cloth and towel. 5. Bed-pan, cover, and toilet paper. 6. Graduated measure. Procedure: If the bed-pan is not in the bed-pan warmer let the hot water run over it and dry it. Carry it to the patient, covered. If the patient is in a ward draw the screens around the bed. Flex the knees and raise the gown well under the buttocks. Raise the patient and slip the pan into position. Be sure that it is properly placed. Place the toilet paper and signal light within reach of the patient. Do not leave her on the bed-pan any longer than necessary. Return to the bedside with a basin or pitcher of warm water as indicated. Fold back the upper covers but do not expose the patient unnecessarily. Use the toilet paper if the patient is not able to do so. Wash the ex- ternal genitals with warm soapy water following a defecation. Douche the external genitals with warm water (poured from the pitcher) fol- lowing micturition. Dry the parts well and raise the patient and re- move the bed-pan. Cover it at once. If the patient prefers to complete her own toilet, allow her to wash her hands afterward. Carry the bed-pan to the utility room and never empty it without noting its contents. If unusual, call it to the attention of the Supervisor. Measure the urine of all bed patients. Use a certain amount of warm ~ water (about 6 ounces) for external douching. If the bed-pan contained 10 ounces, the amount of urine voided would then be 4 ounces, or 120 c. c. Record: 1. Hour, 2. Amount (large, small, medium). 3. Character (constipated, liquid, soft). 4. Color (brown, clay colored). 5. Any abnormality (worms, blood, pus, mucus). References: Sanders’ Modern Methods in Nursing, pp. 82-85. Harmer’s Principles and Practice of Nursing, pp. 104-108. FEEDING PATIENTS 29 DOUCHING A PATIENT EXTERNALLY Requisites: 1. A Chase doll in bed. 2. Bed-pan, cover, and toilet paper. 3. Pitcher. Procedure: Place the patient on the bed. pan as previously demonstrated. After the patient has used the bed-pan, carry the pitcher of warm water to the bedside. Fold back the upper covers, but do not expose the patient unnecessarily. Separate the labia with the thumb and fore-finger and pour the warm water over the genitals slowly but with some force, holding the pitcher in the right hand. Dry the genitals well and remove the bed-pan. Point to be remembered: Avoid burning the patient by testing the water on the back of the hand before taking it to the bedside. Record: 1. How. 2. Amount in cubic centimeters of urine voided. Note: For care of perineorrhaphy and hemorrhoidectomy, see Freshmen Year Procedures (Second Semester), p. 115. FEEDING PATIENTS Prepare the patient for meals by washing her hands if necessary and making her comfortable. Remove any disturbing sights that might in- terfere with the patient enjoying the meal. Screen the beds of patients who are very ill or recovering from anesthesia, if the patient is in a ward. Be sure that the table is properly placed. Open and place the napkin and prepare such food as soft-boiled egg, etc., for it is difficult for the patient to do so when lying in bed. In feeding a helpless patient, always give the food in proper se- quence. Give soup by spoonfuls and do not uncover the hot food until ready to serve it. Cut food in small pieces and feed the patient slowly. Points to be remembered: 1. See that the tray is complete before serving. 2. Always remember a patient's likes and dislikes concerning food. 3. Never give the patient a sense of haste, but make the procedure one to anticipate with pleasure. 4. Always serve food at another time if a patient does not eat a sufficient amount at meal time. 5. Always encourage the appetite. Serving liquids: When serving liquids either at night or in the day time always serve them on a tray with salt, cream, or sugar as the drink demands.! In preparing liquids season them before serving, but always wash the spoon after tasting. Place the arm nearest the head of the bed under the pillow and raise the patient’s head slightly. Hold the glass or cup with the free hand and allow the patient to guide it. If the patient's head can- 1Tf these are omitted a patient frequently does without, rather than ask a nurse to get them. 30 ! NURSING TECHNIQUE not be raised, give the liquid from a drinking-tube. Withdraw the tube occasionally if necessary. Points to be remembered: 1. Always give the liquid slowly. 2. Be sure that it is not too hot. 3. Do not spill the liquid in the saucer when carrying it to the sick- room. References: ; Stoney’s Practical Points in Nursing, pp. 58-60. Harmer’s Principles and Practice of Nursing, pp. 86-93. MAKING A BED WITH A PATIENT IN IT METHOD I Reguisites: 1. A Chase doll in bed. 2. Complete change of linen. 3. Bath blanket. Procedure: Have the temperature of the room from 70° to 72° F. Carry the linen to the bedside and place it on the bedside table. If the patient is in a ward, screen the bed. Place one or two chairs so Fig. 7.—Removing clothes from bed with a patient in it. (Step one.) Tig. 8.—Removing clothes from bed with a patient in it. (Step two.) Fig. 9.—Removing clothes from bed with a patient in it. (Step three.) 32 NURSING TECHNIQUE that they will be convenient for the bed-clothes. Loosen the bed- clothes on all sides and remove the spread. If there are two blankets on the bed, remove the upper one, then turn up the sides of the other blanket and the upper sheet. Fold the draw sheet and place it on the chair. If there is a double blanket on the bed, remove it, cover patient with a bath blanket and at the same time remove the top sheet. (Do not leave a patient without a blanket except in warm weather.) Re- move the pillows (unless this causes the patient discomfort) and dis- tribute the feathers well in the cases. Change the cases and place the pillows on the chair. Turn the patient on the opposite side and gather the draw sheet in folds close to the back. Turn the rubber draw sheet over the patient's side unless the weight is objectionable. Gather the lower sheet in flat folds as close as possible to the patient's back. Smooth the pad and the rubber sheet and place the clean sheet in position and proceed as in a closed bed. Bring over the rubber sheet and tuck it under the mattress at the side. Place the draw sheet as for a closed bed and tuck it under the mattress at the side. Go to the opposite side of the bed and turn the patient carefully. Draw out the lower clothes and place the soiled ones directly in the hamper or on a chair. Be sure that the under clothes are tight and free from wrinkles. Tuck them securely as for a closed bed. Turn the patient back and place the pillows in position. Spread the clean top sheet over the bath blanket and then the double wool blanket. Remove the bath blanket and tuck the sheet under the mattress at the foot of the bed and make square corners on the sides. Tuck it in at the sides about 15 inches from the foot of the bed. Proceed in like manner with the blanket. If the patient is covered with the top sheet and a single wool blanket, then spread the clean top sheet and the second single blanket over these and remove the soiled sheet and blanket. Replace the second single blanket and proceed as above. ; Place the spread over the blanket and turn the upper border over the blanket at the top as for a closed bed. Turn back the upper border of the sheet from 6 to 10 inches. Tuck the spread under the mattress at the foot of ‘the bed and make oblique corners. Roll up the soiled linen (if a clothes-hamper is not at the bed side), and carry it to the clothes chute. MEetHOD II Requisites: 1. A Chase doll in bed. 2. One sheet. 3. One pillow case. Procedure: : Arrange the chairs, loosen the clothes and remove the spread and pillows as in method one. Cover the patient with the clean sheet and remove the blanket and the top sheet. Replace the blanket immediately. Fold the removed top sheet for a draw sheet and place it on a chair. Proceed as in Method I, except that the lower sheet is not changed, but smoothed free of wrinkles. Points to be remembered: - 1. Be sure that the upper clothing is not too tight over the patient's feet. TAKING THE TEMPERATURE 33 2. Be sure that the under clothing is tight and free from wrinkles. 3. Keep the surroundings neat during work, and do not consider the task completed until everything has been returned to its proper place. : 4. Avoid knocking the bed during work. 5. Do not throw soiled linen on the floor, under any circumstances. References: Sanders’ Modern Methods in Nursing, pp. 63-70. Harmer’s Principles and Practice of Nursing, pp. 77-79. TAKING THE TEMPERATURE Temperature is the degree of heat of the body measured according to some chosen scale. It is the balance maintained between the heat pro- duced and the heat lost. (Pope’s Practical Nursing.) Body temperature is measured by means of a clinical thermometer placed in the mouth, axilla, rectum, or vagina. A clinical thermometer is one in which the mercury remains at the degree which it registers until shaken down. Fever is an abnormal condition characterized by temperature ele- vated above 98.6° F. There are various other symptoms present such as increased heart action, respiration, and tissue waste. It is due to a disturbance of the heat regulating centers. Heat production is increased out of proportion to heat elimination. The course of fever is divided into three periods or stages: 1. Invasion or onset. 2. Stationary—called also fastigium or stadium. 3. Decline or defervescence. Invasion or onset is that period during which the temperature rises until it reaches its maximum. This may be gradual as in typhoid or sudden as in scarlet fever. Stationary, fastigium, or stadium is that period during which the temperature remains more or less the same. There may be marked variations, but the temperature repeatedly touches its maximum. Decline or defervescence is that period during which the temperature drops until it reaches normal. If this occurs suddenly, it is called crises, if gradually, it is called /Zysis. There are certain definite types of fever and these are classified as: 1. Continuous. 2. Remittent. 3. Intermittent. Continuous fever is that type in which the temperature remains con- stantly high, with slight variations. Pneumonia and typhus fever are of this type. Remittent fever is that type in which there is considerable range be- tween the fluctuations, but the temperature is always above normal until convalescence begins. Intermittent fever is that type in which there is a very wide range be- tween the fluctuations, the temperature rising to a very high point and then falling to normal or below. Malaria fever is of this type. Regquisites on a mouth thermometer tray: 1. Thermometer jar (containing bichlorid solution 1 : 1000) with a small pad of cotton in the bottom of the jar. : 3 34 NURSING TECHNIQUE 2. Several mouth thermometers. 3. Thermometer jar (containing plain water). 4. Two covered containers (one supplied with clean cotton and the other for waste) marked “cotton” and “waste.” 5. Pad and pencil. 6. Square of gauze (on which the used thermometers are placed). Procedure when taking a mouth temperature: Take the thermometer from the bichlorid solution, wipe it with a cotton pledget, rinse it in plain water and wipe it again, shake it down if necessary and place it in a slanting position under the patient's tongue. Tell the patient to keep her lips closed and to breathe through her nose. Leave it in place for three minutes. Remove, wipe, and read it and place it on the gauze sponge. Record the temperature at once. Take the tray to the dressing room after 6 or 7 thermometers have been used and wash them with soap and water and rinse them. Replace them in the bichlorid solution and continue until all the temperatures have been taken. Wash the tray and jars, and prepare fresh solution once daily. Points to be remembered: Do not take a mouth temperature: . When the temperature is above 100° or below 97° F. . For three days, following an operation. . If the patient is coughing, is delirious, insane, or suffering from dyspnea. . When the patient is under ten years of age. . For ten minutes after the patient has had something hot or cold to drink or eat. Requisites on a rectal thermometer tray: 1. Thermometer jar (containing bichlorid solution 1 : 1000) with a a pad of cotton in the bottom of the jar. 2. Several rectal thermometers. 3. Two covered containers (as on the mouth thermometer tray) for cotton and waste. 4. Pad and pencil. 5. Square of gauze (for used thermometers). 6. Tube of vaselin. Procedure when taking a rectal temperature: Place the patient on the side if possible. If not, flex her knees. Take the thermometer from the solution, wipe it, shake it down if necessary, lubricate the bulb and insert it gently in the rectum about 13 inches. Allow it to remain for three minutes. Remove it and wipe the anus and the thermometer free of lubricant. Place the thermometer on the gauze sponge and record the temperature at once. Care for the thermometers in the same manner as when taking a mouth tempera- ture. . Points to be remembered: 1. Do not take a rectal temperature postoperatively if the rectum has been operated upon or it is diseased. 2. Do not allow a patient to insert the thermometer herself. 3. Always keep children’s thermometers separate because children are susceptible to infection, and infectious diseases are so preva- lent among children. ! [a WN = TAKING THE PULSE 35 4. When taking the temperature of a child proceed in the same man- ner, or place the child across your knees with the face downward. Procedure when taking an axillary temperature: . Wipe the axilla with a cotton pledget so that it will be free from moisture. Remove the thermometer from the solution, wipe it and shake it down if necessary. Place the bulb in the hollow of the axilla so that the stem is pointing toward the patient’s chest. Bring the arm across the chest so that the bulb is in contact with the skin surfaces and there is no circulation of air over the thermometer. Support the arm during the procedure, which requires ten minutes. The Fahrenheit and Centigrade scales compared: In comparing these scales it must be remembered that in the Fahren- heit scale freezing is placed at 32 degrees and the boiling-point of water at 212 degrees. In the Centigrade scale freezing is placed at 0 degree and the boiling-point of water at 100 degrees. Hence 1 degree Centigrade is equivalent to 1.8 (§) degrees Fahrenheit. > To convert Fahrenheit to Centigrade: Subtract 32, then multiply by $. To convert Centigrade to Fahrenheit: Multiply by ¢ and then add 32. References: Sanders’ Modern Methods in Nursing, pp. 194-203. Kimber and Gray's Anatomy and Physiology, pp. 511-519. Williams’ Anatomy and Physiology, pp. 418-420. Harmer's Principles and Practice of Nursing, pp. 134-152. Pope’s Practical Nursing, pp. 168-179. Howell's Text-book of Physiology, pp. 957-979. TAKING THE PULSE The pulse is the alternate contraction and expansion of the artery, corresponding to the heart beat. (Kimber and Gray's Anatomy and Physiology.) The contraction of the heart is known as its systole; its period of relaxation is termed its diastole. Systolic pressure is the greatest pressure which the contraction of the heart Stes in the artery. (Kimber and Gray's Anatomy and Physi- ology. Diastolic pressure is the lowest point to which the blood-pressure drops between beats. (Kimber and Gray's Anatomy and Physiology.) The average normal degree of blood-pressure (systolic) is usually the age of the individual plus 100. The normal diastolic pressure is usually two-thirds of the systolic pressure. Nurses should note and record in taking pulse: 1. Hour. 2. Frequency. 3. Force. 4. Regularity. 5. Pressure. By frequency of the pulse 1s meant the number of pulsations in a given time, usually a minute. This varies even in health. Normal rate in male 60 to 70. Normal rate in female 70 to 80. 36 NURSING TECHNIQUE Normal rate in a child ten to twelve years of age 75 to 85. Normal rate in infants 110 to 130. Normal rate at birth 140 and over. By the force of the pulse is meant its strength. (Pope's Practical Nursing.) A pulse is regular when the pulsations are of equal strength and the intervals between pulsations are of equal length. (Pope's Practical Nursing.) By pressure is meant the force exerted by the blood against the walls of the vessels. A pulse is intermittent when there is an intermission of pulsations, at regular or irregular intervals. Water hammer or Corrigan’s pulse is an abnormal condition charac- terized by a quick powerful beat which suddenly collapses. (Pope's Practical Nursing.) A pulse is dicrotic when the pulsations are as if it were divided, the second part of the beat being weaker than the first. (Pope’s Practical Nursing.) A thready pulse is one that is very fine and scarcely perceptible. (Dorland’s Medical Dictionary.) A pulse is termed running when there are more than 120 pulsations per minute. An infrequent pulse is one which is abnormally slow. (Dorland’s Medical Dictionary.) The usual ratio of pulse lo temperature is as follows: A temperature of 98° F. corresponds to a pulse of 70. A temperature of 99° F. corresponds to a pulse of 80. A temperature of 100° F. corresponds to a pulse of 90. A temperature of 101° F. corresponds to a pulse of 100. The pulse may be counted and observed on any superficial artery that has a bone for a background; for instance: ¢ . The radial. . The facial. . The carotid. . The temporal. . The femoral. . The dorsalis pedis. Requisites for taking pulse: A watch with a second hand. Procedure: Place two or three fingers over the artery, making slight pressure. Observe the general character of the pulse, then count the number of beats occurring in one minute by counting for the first half and then the second half of the minute. Points to be remembered: 1. Do not make too great pressure. 2. Do not use the thumb to feel the pulse. 3. Allow the arm to be at rest when taking the pulse in the radial artery. 4. Always take the pulse in the right and left radial arteries when admitting a patient. Record if there is any appreciable dif- ference or if the pulse cannot be felt in one wrist. QUT WN = COUNTING THE BREATHING : 37 References: Williams’ Anatomy and Physiology, pp. 328-335. Pope's Practical Nursing, pp. 179-192. Harmer’s Principles and Practice of Nursing, pp. 152-171. Kimber and Gray's Anatomy and Physiology: pp. 290-296. Sanders’ Modern Methods in Nursing, pp. 202-209. Howell's Text-book of Physiology, pp. 523-644. COUNTING THE BREATHING Respiration consists of the two processes by means of which the body obtains oxygen and gets rid of the carbon dioxid produced in its tissues. The two distinct processes necessary to accomplish this are called ex- ternal and internal respiration. External respiration takes place in the lungs and consists of the alter- nate expansion and contraction of the chest walls and the lungs by means of which the body takes in oxygen and liberates carbon dioxid. The first action is known as inspiration and the second as expiration. Internal respiration consists of the interchange of the two gases, oxygen and carbon dioxid, which takes place between the blood and the tissues, as the blood flows through the capillaries in the tissues. The average normal frequency of breathing is as follows: Men 16 to 18 per minute. Women 18 to 20 per minute. - Children 20 to 25 per minute. Infants 30 to 35 per minute. (Pope's Practical Nursing.) The usual ratio of breathing to the pulse is 1 to 4. Sy is easy or normal respiration. (Dorland’s Medical Diction- ary. Dyspnea is labored or difficult breathing. (The patient is usually cyanosed.) (Dorland’s Medical Dictionary.) Orthopnea is severe dyspnea and the patient is unable to breathe in a recumbent position. Polypnea: When the respirations are rapid or panting. Apnea: A temporary cessation of breathing. Edematous respiration is characterized by loud, moist, rattling rales. It is accompanied by dyspnea and cyanosis. (Pope's Practical Nursing.) Stertorous respiration is characterized by a deep snoring sound with each inspiration and a puffing out of the cheeks with each expiration. Accelerated respiration: The respirations are accelerated when they exceed 25 per minute. (Dorland’s Medical Dictionary.) Cheyne-Stokes respiration: This type of respiration was first described by Dr. John Cheyne, a Scottish physician, and Dr. William Stokes, an Irish physician. It ap- pears in two forms: In the first the respirations increase in force and frequency up to a certain point, and then gradually decrease until they cease altogether. There is a short period of apnea, then the respira- tions recommence and the cycle is repeated. In the second the respira- tions increase in force and frequency up to a certain point, then cease and the period of apnea intervenes without the gradual cessation of the respirations. (Kimber and Gray’s Anatomy and Physiology.) 38 NURSING TECHNIQUE Requisites for counting the respirations: A watch with a second hand. Procedure: ; Place the fingers on the wrist as though counting the pulse, but do not make enough pressure to feel the pulsation of the artery. Watch the rise and fall of the chest or upper abdomen. Count each inspira- tion and expiration as one breath, and count for one minute. Record: 1. Hour. 2. Frequency. 3. Pain, if associated with the breathing. 4. Any abnormal condition. References: Williams’ Anatomy and Physiology, pp. 342-365. Kimber and Gray's Anatomy and Physiology, pp. 340-375. Pope’s Practical Nursing, pp. 192-201. Howell's Text-book of Physiology, pp. 644-719. Harmer’s Principles and Practice of Nursing, pp. 170-183. Sanders’ Modern Methods of Nursing, pp. 209-216. ROUTINE PROCEDURES To replace the upper bedclothes with a bath blanket: Fold the bath blanket from the top to the bottom and repeat this fold. Place it across the patient's chest so that the open ends will be toward the head of the bed. Have the patient hold the lower free end or tuck it securely around her shoulders. Then face the foot of the bed and grasp the other free end of the blanket between your fourth and fifth fingers. Grasp the upper clothes with the other two fingers and your thumbs. Hold them on either side of the patient so that the thumbs are on top. Then fold the covers down to the foot of the bed. To remove the pillows: MEeTHOD I Stand on the right side of the bed, pass your left hand and arm under the patient’s shoulder so that your hand will be in the patient's opposite axilla and the patient's head will be resting in the bend of your arm at the elbow. Raise the patient slightly and remove the pillows with your free hand by pulling them outward. ~ If the patient is very ill it is some- times easier to remove one at a time. MEeTHOD II When the patient is convalescing and not in need of support: Stand on the right side of the bed and grasp the patient by the arm nearest you so that your right hand is in the region of the patient's right axilla. Have the patient grasp the arm that is lifting her with both of her hands. Then support her head with your free hand and raise her from the pillows. Remove your support temporarily from the head and remove the pillows. Mernop III When the patient is in need of support: Have an assistant stand on the opposite side of the bed. Have her grasp the patient's left arm with her left hand so that it will be in the ROUTINE PROCEDURES 39 region of the patient's axilla. Then have her support the patient's head with her free hand. Stand on the right side of the bed and grasp the patient's right arm by your right hand so that it will be in the region of the patient's right axilla. Then raise the patient from the pillows and remove them with your free hand. To replace the pillows: : MetHOD I Distribute the feathers well in the cases and place the pillows on a chair near the head of the bed. They may also be placed obliquely on the bed at the head on either side of the patient. Grasp and lift the patient as in Method I, for removing the pillows. Then support the patient by means of your right hand over her left shoulder. Have the patient lean forward against your shoulder and ad- just the pillows with your left hand. MerHOD II When the patient is convalescing and not in need of support: Proceed to grasp and raise the patient as in Method II. Then adjust the pillows with the left hand. Mersop II1 When the patient is in need of support: Have an assistant stand on the opposite side of the bed. Then grasp and raise the patient as when removing pillows, in Method III. Ad- just the pillows with your left hand as the assistant supports the pa- tient’s head with her right hand. To remove the nightgown: ; Flex the patient’s knees and draw the gown up under the buttocks. Raise the buttocks and gather the gown up to the shoulders. Flex the patient’s arm and withdraw the sleeve nearest you. Then slip the gown over the head and off the other arm. To put on the nightgown: Much of the technique in putting on the gown depends upon the make of the gown. If the opening is large at the top, gather it up loosely and draw on the sleeve nearest you, by passing your arm through the sleeve and grasping the patient's hand. Then slip it over the head and draw on the other sleeve. Pull down the gown and raise the patient as you do so. To rub the back: Turn back the upper bedclothes so that they are out of the way, but not enough to expose the patient. Flex the patient's knees and raise the gown under the buttocks and over the pubes. Open and remove the swathe, if the patient has an abdominal incision. Turn the patient on the side and place a small pillow under the abdomen if indicated. Pro- tect the bedclothes with a bath towel. Pour some alcohol on your hand and rub it on the patient’s back, beginning at the neck and shoul- ders. Place your hand firmly on the skin and move the flesh on the bone. Continue the treatment until the entire back and hips have been rubbed. Give particular attention to any part that looks red. Sprinkle a small amount of powder on your hand and rub it over the back. 40 NURSING TECHNIQUE CARE OF THE MOUTH AND TEETH The care of the mouth for convalescent patients and those not seriously ill is the same as in health. It should be kept clean and moist by the use of an antiseptic wash two or three times a day. Routine care: Regquisites: 1. Emesis basin. 2. Bottle of mouth-wash. 3. Enameled cup. 4. Tooth-brush. 5. Glass of water. . Towel. Procedure: Wash your hands and prepare the mouth-wash. Place the towel under the patient's chin. Hold the tooth-brush over the emesis basin and pour some of the diluted mouth-wash over it. Then allow the pa- tient to brush her teeth and rinse her mouth with the mouth-wash solu- tion. Assist her by adjusting and holding the basin so that she may expectorate and eject the solution. Wipe the patient's mouth and remove and care for the requisites. Mouth-washes in common use are: 1. Peroxid of hydrogen. Glycerin. Cinnamon water. Alcohol. 2. Listerine. Water. 3. Glycerin. Cinnamon water. Equal parts of each. Boric acid. When salivation is present use an astringent mouth-wash. When the mouth is dry apply a lubricant at night and fifteen minutes before you cleanse the patient's mouth. Do not use an astringent mouth- wash for such a condition. Lubricants in common use are: 1. Boric acid ointment. 2. Cold cream. 3. Albolene with a few drops of lemon juice. Sordes: Sordes is a Latin word meaning filth. It consists of micro-organisms, epithelium, food, and mucus which collects on the teeth and mouth in fever. For special care of the mouth see Procedures in Communicable Diseases (Junior Year). References: Sanders’ Modern Methods in Nursing, pp. 74-77. Harmer’s Principles and Practice of Nursing, pp. 81-83. CARE OF THE HAIR Regquisites for brushing and combing the hair: . Comb. 2. Brush. =) Equal parts of each. | Equal parts of each. CARE OF THE HAIR 41 3. Towel. 4. A Chase doll or a student nurse in bed. Procedure when the patient is a female: If the bed is wide, bring the patient to the side of the bed if possible, Remove one pillow and place the towel over the pillow under the pa- tient’s head. Loosen the hair and part it from the brow to the middle of the neck in the back. Brush one side carefully, holding the hair up in one hand while brushing and combing it with the other. Prevent pulling it by holding the hand between the tangle and the patient's head and by beginning to comb at the free end. After brushing and combing one side, braid it behind the ear so that it will feel comfortable and look well. Proceed in the same manner on the opposite side. Procedure when the patient is a male: Brush the hair carefully and pay special attention to the back of the patient's head. If his condition permits, hold the mirror so that he may part and arrange his hair. If not, do this for him. If pediculi are present: Cover the pillow with a rubber sheet covered with a bath towel. Loosen the hair and wet the scalp and hair near to it thoroughly with a parasiticide (larkspur, or equal parts of olive oil and kerosene). Bind a towel around the head and leave it from eight to twelve hours. If there are nits on the hair, apply hot vinegar. This treatment may be re- peated if there are signs of pediculi or nits when the towel is removed. Disinfect all requisites that have been in contact with the hair, by plac- ing them in bichlorid solution 1 : 5000 or carbolic 3 per cent. for one or two hours. To wash the hair in bed: Regquausites: 1. Student nurse in bed. 2. Kelly pad. 3. Foot-tub. 4. Stool. 5. Tray with the following: . Bottle of soap solution. Two-quart pitcher. Smaller pitcher. Hot-water bottle. Towels (two bath and for face). Small rubber sheet. Newspaper. Wash-cloth. Safety-pin. RE Procedure: Do not wash a patient's hair without special orders. If the order has been given proceed as follows: Fill the 2-quart pitcher with warm water and the small pitcher with cold water. Carry the tray and other requisites to the bedside. Remove the pillows and draw the patient to the side of the bed if possible. Place the rubber sheet covered with a bath towel under the patient's head. Pin a bath towel around the pa- tient’s neck and give her a wash-cloth to protect her eyes. Place the Kelly pad under the patient's head with the drain in the foot-tub at the side of the bed. Elevate the back rest one notch. Wet the hair with 42 NURSING TECHNIQUE a small amount of warm water, and then pour on soap solution and rub it well into the scalp. Wash the head thoroughly. Rinse well and repeat the procedure, using cold water for the last rinse. Wrap the head in a face towel and remove the Kelly pad. Rub the hair as dry as possible with a face towel and if the hair is long, place the hot-water bottle under the bath towel and spread the hair over it. When the hair is thoroughly dried, comb and braid it as previously demonstrated. . References: Sanders’ Modern Methods in Nursing, pp. 84-87. Harmer’s Principles and Practice of Nursing, pp. 83-85. CARE OF THE BACK—PRESSURE SORES The prevention of pressure sores is one of the most important duties of a nurse. With the right kind of nursing care a patient will rarely develop them. Except in unusual cases a nurse should feel that she is responsible for the condition and that she has not put forth the effort necessary to prevent them. Report at once the first symptom of a pressure sore to the Super- visor of the ward so that active measures may be used to prevent it. A pressure or bed sore (decubitus) consists of an ulceration and slough- ing of a localized area of tissue due to death of its cells as the result of pressure. (Pope.) Causes: 1. Wrinkles in the bed-clothing or patient’s clothing. 2. Crumbs in the bed. 3. Chafing. 4. Pressure from splints and casts. This may be aggravated by: 1. Moisture. 2. Breaking the skin. Pressure sores are likely to develop: 1. On bony prominences. 2. The back of the head and ears in infants. 3. Between the folds of the abdomen under the breasts and on the buttocks in obese patients. Patients in danger of developing pressure sores: 1. Emaciatea and obese patients. 2. Those whose vitality is low, due to old age or protracted illness. 3. Those who have involuntary micturition and defecation. 4. Those whose condition is such that the circulation is impaired, due to certain kinds of heart disease and paralysis. 5. Those suffering from faulty metabolism. Preventive measures: . Keep the bed-clothing free from wrinkles and crumbs. . Change the patient's position frequently. . Relieve pressure by the use of rubber and cotton rings and in an extreme case use an air-mattress. . Exercise care when giving and removing the bed-pan to prevent breaking the skin. . Keep the patient clean and dry and prevent chafing. . Bathe reddened areas frequently and massage with alcohol. Keep the skin dry by the use of powder. A He WN = GIVING A CLEANSING BATH TO A BED PATIENT 43 7. Watch splints and casts so that the padding is adequate; also that bandages are not applied tighter than necessary. As soon as the skin breaks a pressure sore is formed and the treat- ment is always prescribed by the physician. Keep the wound surgically clean and observe aseptic precautions. : Treatment commonly prescribed: Stearate of zinc powder. Castor oil and bismuth. Boracic acid powder. Balsam of Peru. Scarlet red ointment. Ichthyol ointment. . Zinc ointment. When sloughing is present: Cleanse the part thoroughly twice a day with equal parts of peroxid of hydrogen and sterile water. Apply it with a sterile medicine-dropper so that all parts of the cavity are reached. Then cleanse the part in the same manner with boracic acid solution 2 per cent. (105° F.) and apply a hot dressing of same. A dressing of Balsam of Peru may be substituted (for the hot boracic) after first thoroughly cleansing the wound. References: Sanders’ Modern Methods in Nursing, pp. 77-83. Harmer’s Principles and Practice of Nursing, pp. 64-69. Pope's Practical Nursing, pp. 109-115. Nes Soke GIVING A CLEANSING BATH TO A BED PATIENT Requisites: . A Chase doll in bed. . Foot-tub. . Bath blanket. . Toilet equipment. . Bottle alcohol. . Two towels (bath and face). . Wash-cloth. . Newspaper. . Bed linen. Temperature of water: From 110° to 115° F. Temperature of room: From 75° to 80° F. Procedure: Close the windows and see that the room is warm. Protect the glass or enameled top of the bedside table. Place the bed linen on the chair and the towels and wash-cloth on the bedside table. Collect the toilet equipment and place it so that it will be convenient for use. Place a chair at the foot or side of the bed for the bedclothes and pillows. Screen the bed, if in a ward. Return to the utility room and half fill the foot-tub with water 115° F. and carry it to the bedside. Ioosen the upper bedclothes and remove them. At the same time cover the patient with a bath blanket. Re- O00 TON UTS WN = 44 NURSING TECHNIQUE move all but one pillow from under the patient’s head unless this po- sition is uncomfortable. Remove the gown and place the face towel on the upper border of the bath blanket and turn it well over the edge to prevent the blanket from coming in contact with the patient’s chin. Wash in the following order: the face, ears, neck, hands, arms, chest, and abdomen; then the feet, legs, and thighs, the back and pubic region. Drape each part with the bath towel as it is bathed to keep the bath blanket dry. Place the foot-tub on the bed and put the patient's feet in it. Allow them to remain there for a few minutes while you bathe the legs. Bathe the genitals last when giving a bath to a female patient. If the patient is a male, place all the requisites so that he can reach them and leave the room until he summons you. If the patient’s condition does not permit him to finish his bath, it is done by the orderly. After the bath, put on the gown, comb the hair and care for the finger- and toe-nails if necessary. Make the bed as previously demonstrated and remove all the requisites. Leave the room in perfect order. Points to be remembered: . Work quickly and make firm gentle pressure. Dry each part well, especially the ears, axillee, pubic region, and between the fingers and toes. . Make no unnecessary exposure. Change the water once during the bath. . Give special attention to parts that are red (especially the back, hips, and shoulders) by rubbing them well with alcohol and powdering them. 6. Always allow the feet to remain in the water for a few minutes during the bath. ; 7. Remember that the care of the mouth, hair, finger- and toe-nails is part of the bath routine. A daily bath is recommended for all patients, but if impossible to follow this rule give the patient a bath every other day. The ideal time for a patient's bath is: 1. About an hour after breakfast. 2. Just before bedtime. Bath temperatures generally followed: 1. Cold bath 40° to 70° F. 2. Cool bath 70° to 80° F. 3. Tepid bath 80° to 90° F. 4. Warm bath 90° to 100° F. 5. Hot bath 100° F. and over. References: Sanders’ Modern Methods in Nursing, pp. 92-95. Harmer’s Principles and Practice of Nursing, pp. 78-81. Pope’s Practical Nursing, pp. 125-131. ESSENTIAL PRINCIPLES IN NURSING Essential principles in nursing: 1. The ability to make and keep a patient comfortable. 2. The prompt and accurate recognition of changes in a patient's condition. 1 Sanders’ Modern Methods in Nursing. 3. 4. ESSENTIAL PRINCIPLES IN NURSING 45 Carrying out orders. The ability to meet an emergency. Requisites for patient's comfort: i NON WN A Chase doll or student nurse in a bed (which is equipped with an adjustable back-rest). . Portable back-rest. . Pillows (large and small). . Cradles. . Sand-bags. . Rubber rings. . Cotton pads. Means of securing physical and mental comfort: 1. Change a patient's pillows, also her position when she is tired. oo NON Ul wi il. 12. 13: 14. 13. 16. 17. 18. 19. 20. . Support her well by means of small pillows and sand-bags. . Rub the entire body, especially the back with alcohol (unless contraindicated). . Relieve pressure by means of rubber rings and cotton pads. . Relieve the strain on abdominal muscles by flexing the knees and supporting them with a pillow. . Pull the draw sheet back and forth occasionally, so that the pa- tient will have a cool place to lie on. . Support the clothing by means of a cradle, when the weight causes discomfort. . Give a cheery “Good morning” (when going on duty) to all pa- tients and a kindly greeting to new patients admitted to your ward. . Always screen a patient when giving treatments and never ex- 10. pose her more than necessary. Form the habit of having all requisites at hand before starting to work and if required to leave the room, do not remain away longer than necessary. Always anticipate a patient’s wants, and assist her to move or turn before she requests you to do so. Remember a patient's likes and dislikes. Never discuss other patients and their peculiarities with a pa- tient. Avoid all unnecessary noise in the rooms and corridors. Never bring unfavorable information to a patient concerning any one in the hospital. Do not lean against or knock a patient's bed. Assist a patient when eating her meals and provide a drinking tube when necessary. Answer all questions that are put to you with tact and under- standing. Avoid telling a patient anything about her condition, the treat- ment or medication prescribed. Always make a patient feel that you are doing things for her because you want to do them, and not because you have to. - Changes in a patient's condition are manifested by symptoms: A symptom is any evidence of disease or of a patient’s condition; a change in a patient's condition indicative of some bodily or mental state. (Dorland’s Medical Dictionary.) 46 NURSING TECHNIQUE The classification of symptoms is as follows: 1. Objective—those observed by the onlooker, such as dyspnea, epistaxis, or cyanosis. 2. Subjective—those complained of by the patient, such as vertigo, headache, or chilliness. References: Sanders’ Modern Methods in Nursing, pp. 219-229. Harmer’s Principles and Practice of Nursing, pp. 45-64 and 599-611. MOVING A PATIENT UP IN BED Reguisites: A Chase doll or student nurse in bed. MEeTHOD I If the patient is helpless and in need of support: Have an assistant stand on the left side of the bed. Stand on the right side of the bed; remove the pillows from under the patient's knees and head. Flex her knees. Pass your left hand and arm under the patient’s shoulders so that your hand will be in the patient's opposite axilla and the patient's head will be resting in the bend of your arm at the elbow. Pass your other arm under the patient's back. Have the assistant pass her right arm under the patient’s back below yours and her left arm under the patient's thighs. Then raise the patient together and move her upward. Replace the pillows as previously demonstrated. i Mersop II If the patient is heavy: Have an assistant as in Method I. Remove the pillows and flex the patient's knees. Loosen the muslin and rubber draw sheets on both sides. Then have your assistant grasp the corners on her side and you do likewise on your side. Move the patient up in bed by raising her on the improvised stretcher. MEeTtHoD III When the patient is convalescing and it is not necessary to support the head: Have an assistant. Remove the pillows and flex the patient’s knees. Then grasp your patient under the arm nearest you so that your hand is near the axilla. Pass your free hand under the patient’s shoulder. Have your assistant grasp her in a similar manner on the opposite side. Then tell the patient to press her feet firmly on the bed when being lifted and grasp the arms of the lifters near the shoulders. Then lift together and move her up in bed. MEeTHOD IV When the patient is small: Remove the pillows and flex the patient's knees. Stand on the right - side of the bed and pass your left hand and arm under the patient's shoulders so that your hand will be in the patient’s opposite axilla and the patient’s head will be resting in the bend of your arm at the elbow. Pass your free arm under the patient’s thighs and move her up in bed. SITTING A PATIENT UP IN BED 47 SITTING A PATIENT UP IN BED Requisites: : 1. A Chase doll or student nurse in a bed which is equipped with an adjustable back-rest. . Portable back-rest. Chair. . Several pillows (large and small). . Bed jacket and bath blanket. . Knee pillow. . Sand-bag. . Twine. Procedure: OAUTH WIN MeTHOD I When the bed is equipped with an adjustable back-rest: Place the bed jacket and pillows where they can be conveniently reached. If the patient is weak, have an assistant support her through- out the adjustment of the back-rest and pillows. Protect her shoulders with the bed jacket or a bath blanket. Elevate the back-rest two or three notches and place a pillow obliquely on either side of the patient and another on top of these so that they af- ford support to the back, arms, neck, and head. Flex the patient's knees and thighs and support them with a knee pillow tied to the head of the bed to prevent her slipping down. Place a small pillow around a sand- bag at the patient’s feet and tie it to the sides of the bed to act as a brace for the feet. To improvise a brace for the knees: Fold a knee pillow over heavy twine and tie the pillow with a piece of bandage. Place it under the knees and tie the twine to the head of the bed. To improvise a brace for the feet: Fold a small pillow over heavy twine and a small sand-bag and tie the pillow with a piece of bandage. Place it at the patient's feet and tie the twine at the sides of the bed, to hold it in position. MEeTHOD II When the bed is not equipped with a back-rest: Substitute a back-rest of wood or canvas or metal. A chair may also be used. Proceed as above and place the back-rest in position, then ar- range the pillows crosswise, one overlapping the other so that there will be no hollow in the small of the back. Place small pillows at the sides to support the arms. Support the knees and feet as in Method I. Points to be remembered: 1. Take the pulse before sitting the patient up, and shortly after elevating her. . Move the patient up in bed if necessary before sitting her up. . Avoid all effort and strain for the patient. . If the patient is weak, support her throughout the procedure. . Except in hot weather, protect her shoulders by means of a bed jacket or bath blanket. . Support her head, neck, arms, and back well to prevent strain. . Watch the patient's condition constantly and do not allow her to become exhausted. SQ UW 48 NURSING TECHNIQUE 8. Do not leave the patient alone for any length of time, if she is sitting up for the first time. 9. Always provide a brace for the feet and knees to prevent her from slipping down. SITTING A PATIENT UP IN A CHAIR Requisites: 1. A Chase doll or student nurse in bed. 2. Pillows (one small and two large). 3. Bathrobe. 4. Stockings and slippers. 5. Colored wool blanket. 6. Foot-stool. Procedure: MEeTtHOD I If the patient is heavy and in need of support: Arrange the chair so that it will be convenient for the patient and nurse. Place it parallel with the bed and facing the head. Have it 2 or 3 feet away from the bed, so that there will be room enough for the assistant. Arrange the blanket so that it is cornerwise in the chair. Place the pillow on the seat and against the back so that they will be comfortable. Prepare the patient by putting on her bathrobe, stockings, and slippers. Have an assistant if possible. Raise the patient to a sitting posture and turn her so that her legs will be over the side of the bed. Have your assistant put one arm around the patient’s waist and one under her knees. Put one arm across the patient’s shoulders and the other under the thighs. Tell the patient to put her arms across each lifter’s back, and to firmly grasp the far shoulders. Raise her from the bed and place her in the chair, standing on opposite sides during the procedure. Protect the patient well with the blanket and place the small pillow under her head and the foot-stool under her feet. MEeTHOD II If the patient is small and in need of support: Arrange the chair and prepare the patient as in Method I. Draw her to the edge of the bed and flex her knees. Place your arms under her shoulders and knees as in moving her up in bed. Tell the patient to put her arms across your chest and back and clasp them on your shoulder. Lift her from the bed and place her in the chair. MEeTHOD III If the patient is not in need of support, but needs help on account of the height of the bed: Arrange the chair and prepare the patient as in Method I. Raise her to a sitting posture and turn her so that her legs will be over the side of the bed. Put your arm around her waist and tell her to put her arm around your waist or across your shoulders. Assist her then to the chair. CARRYING A PATIENT ON A CHAIR MADE WITH THE HANDS 49 Points to be remembered: 1. Count the pulse before and after the patient is in the chair, if she is up for the first time. Do not allow a patient to put her arms around your neck when lifting her. . Be sure the patient is comfortable before leaving her. Do not omit leaving the signal light within reach. . If the patient is sitting up for the first time, do not allow her to remain up longer than five to twenty minutes. Do not allow the patient to become exhausted before putting her back to bed. Turn the mattress and remake the bed if the patient is up for the first time. No GRe oN 5 PUTTING A PATIENT BACK TO BED Regquisites: 1. A Chase doll or student nurse sitting in chair. 2. An open bed. Procedure: MgzTrHOD I If the patient is heavy and in need of support: Prepare the bed by turning the covers down to the foot. Have an assistant and stand on opposite sides of the chair. Grasp the patient securely, as when lifting her out of bed in Method I (Sitting a Patient Up in a Chair). Be sure that there is no obstruction between you and the bed. Raise her from the chair, and turn and place her on the edge of the bed. Place one of your arms under the patient's knees and the other around her waist. Tell her to place her hands upon the bed and raise herself as you turn her into position. Draw up the covers and remove the bathrobe and stockings. Note the patient's condition and count the pulse, if she was up for the first time. Record any unusual symptoms. MetHOD II If the patient is small and in need of support: Turn the covers down to the foot of the bed. Then grasp the pa- tient as when lifting her from the bed in Method IT (Sitting a Patient Up in a Chair), but be sure to grasp her securely. Lift her from the chair and turn and place her on the edge of the bed. Then turn her into position. MersoD III If the patient is not in need of support, but needs help on account of the height of the bed: Turn the covers down to the foot of the bed. Assist the patient from the chair to the bed, supporting her as in Method III (Sitting a Patient Up in a Chair). Then turnher into posi- tion. CARRYING A PATIENT ON A CHAIR MADE WITH THE HANDS Requisites: 1. A Chase doll or a student nurse in bed. 2. Bathrobe. 3. Stockings and slippers. 4 50 NURSING TECHNIQUE Procedure: Prepare the patient as when sitting her up in the chair. Raise her to a sitting posture and turn her so that her legs will be over the side of the bed. Have an assistant and tell her to grasp her left wrist with her right hand. You do likewise. Then pass your clasped hands under the patient’s thighs and clasp each other’s right wrists with the free hands. Tell the patient to put her arms across your backs and grasp each far shoulder securely. Lift her from the bed, tilting her slightly forward and carry her to the destination. LIFTING A PATIENT FROM THE BED TO THE OPERATING CART Regquisites: 1. A Chase doll or a student nurse in bed. 2. Operating cart. 3. Two bath blankets. 4. Wool operating blankets. Procedure: MeTHOD I This method may be used when the patient can help herself or is small: Cover the operating cart with a bath blanket. Replace the upper covers with the second bath blanket. Draw the patient to the side of the bed and flex the knees. Place the operating cart close to the same side of the bed. Stand on the free side of the cart and if same is not too wide, reach across it and assist the patient on to it, at the same time steady the cart to prevent it moving from the side of the bed. Assist the patient onto the cart, by passing your arms under her shoulders and thighs and drawing her over onto the cart. Wrap her in the under bath blanket and remove the upper one. Cover the patient with the wool blanket and tuck it in well along the sides and around the shoulders. MEernoD II This method may be used when the patient is helpless or heavy: Have two assistants for this method. Prepare the patient as in Method I. Cover the cart with the second bath blanket and place it according to the position of the bed and arrangement of the room or ward. The cart may be placed: 1. At right angles with the bed (either at the head or the foot). 2. Parallel with the bed. Have the assistants stand on the same side of the bed as you do. Draw the patient to the edge of the bed. Pass your arms under the patient's head and shoulders and tell your assistants to do likewise under the buttocks and legs. Then tilt the patient slightly toward you and raise her from the bed and walk toward the cart and place her carefully on it. Cover the patient as in Method I. Points to be remembered: 1. Draw the patient to the edge of the bed before lifting her. 2. Bend your knees and throw back your shoulders, but do not bend your back. ASSISTING WITH A PHYSICAL EXAMINATION 51 3. Be sure that the patient's movements will not be interfered with. 4. Tell a patient who is not seriously ill to hold herself rigid when being lifted. 5. Be sure your pathway is unobstructed. 6. Do not lift until all are ready and know what to do. ASSISTING WITH A PHYSICAL EXAMINATION Requisites: 1. Bath blanket. 2. Diagnostic tray with the following: . Laryngeal mirror. . Nasal speculum. . Aural speculum. Metal tongue depressor. Percussion hammer. Wooden tongue depressors (wrapped). Cotton toothpicks (sterile). Sterile test-tubes (2). . Sterile applicator tubes (2). . Microscopic glass slides (sterile). . Finger cots (sterile). . Flash light. . Electric drop light. . Head mirror. . Sphygmomanometer. . Stethoscope. . Camel's hair brush. . Red and blue skin pencils. . Tape measure. . Kidney basin. . Safety-pins. . Auscultation towels (2). Hand towels (2). 24. Paper bag. Procedure: DH Carry the tray to the bedside. Give the patient some information of what is to be done so that she will not be alarmed when the tray is brought into the room. Close the windows and put up the shades. Replace the upper covers with the bath blanket. = Remove the gown unless it can be arranged so that the anterior and posterior chest will be well exposed without removing it. The methods employed in a physical examination are: 1. Inspection. 2. Palpation. 3. Auscultation. 4. Percussion. The procedure is as follows: Head: Hand the nasal and aural speculz, the laryngeal mirror, and tongue depressor to the examiner on a towel and receive them (at the conclusion of the examination) in the kidney basin. (Wooden tongue blades may Wrapped. — ROC RENO URLS mp O00 ~XIO\ UH Wb bo > No Noo © bo = 52 NURSING TECHNIQUE be placed in the paper bag and destroyed.) Direct the light into the cavity being examined or, if reflected lighting is used, attach the drop light to the electric plug and hold it so that the light will be directed onto the examiner's head mirror and be reflected into the cavity. Chest: Cover the chest with an auscultation towel, and while the physician is using the stethoscope move the towel to expose the chest as neces- sary. If he wishes to listen to chest sounds without the stethoscope, cover the chest with the auscultation towel. Hold a folded towel in front of but away from the patient's mouth. If the posterior chest is examined, cover the anterior chest with the bath blanket and either turn the patient as nearly prone as possible or raise her to a sitting po- sition, according to her condition and the physician's wishes. If the patient is sitting up, arrange the bath blanket so that it will cover the front of the chest and as soon as you have raised her draw a pillow down against the lower part of the back. Cover the upper portion of the back with an auscultation towel and put the side which was against the patient previously next to her again for the physician will not want to put his face against the side which has been next to the patient. If the stethoscope is used move the auscultation towel as required. Abdomen: Have the patient lie perfectly straight with the arms passively by her side. Leave the auscultation towel covering her chest and if in- dicated another bath blanket may be used. Place a towel over the pubes and turn the covers down below the abdomen. It will be necessary to have the patient extend her legs during the examination. When doing this, hold the bath blanket to prevent any unnecessary exposure. Legs: Fold back the bath blanket to the upper part of the thighs. If the physician wishes to compare the legs, gather the bath blanket between them. If he does not wish to compare them, expose only the one he wishes to inspect. Points to be remembered: . Have all the requisites at hand. . Anticipate the physician's wants and act quickly. . Make no unnecessary exposure. . Place the patient in the position ordered, for this is most impor- tant. . Provide a good light, especially for examination of the cavities. 6. Have the surroundings quiet when the physician is auscultating. Preparation of a child: If the child is large, proceed in the same manner as for an adult. If the child is small, wrap a bath blanket around her so that the opening is to one side. At the same time remove the gown. Leave the upper portion loose, but wrap the feet and legs securely if necessary for re- straint. Expose the chest as necessary when the physician arrives and hold the child’s hands at her sides. The child may be held on your lap for the examination of the anterior chest with the head falling slightly backward. Restrain the legs if necessary. Stand and hold the child for the posterior chest examination so that her head is over your shoul- der and held with one of your hands. Place your free hand across the child’s thighs for restraint if necessary. G1 BWN = ASSISTING WITH EXAMINATION OF EAR, EYE, NOSE, AND THROAT 53 References: Sanders’ Modern Methods in Nursing, pp. 219-229. Pope’s Practical Nursing, pp. 201-254. ASSISTING WITH AN EXAMINATION OF EAR, EYE, NOSE, AND THROAT Regquisites: 1. Diagnostic tray. 2. Lens. 3. Ophthalmoscope. 4. Tonometer. 5. Sterile cotton. 6. Sterile gauze. Position of patient for examination of the ear (otoscopy): 1. Sitting on a chair with the affected ear toward the physician. 2. Dorsal recumbent with the head turned so that the affected ear is toward the physician. Procedure: Place a towel around the patient's shoulders and another around the head. Arrange the instruments so that they will be convenient for the physician. Anticipate the examiner's wants and provide artificial light by means of a drop light. Hold it behind the patient's head on a level with the ear so that the light will strike the mirror and be reflected into the auditory canal. Preparation of a child: If restraint is necessary, wrap the child in a bath blanket as follows: Place the blanket cornerwise on one side of the bed. Turn the top cor- ner over so that there will be a straight fold. Then lift or draw the child onto the bath blanket so that this straight fold is about 4 inches above the child's neck. Turn the lower corner of the blanket up over the child’s feet and wrap each side of the blanket obliquely around the child. Do this as tightly as possible. Hold the child restrained so that its head is against your chest with the affected ear toward the physician. Position of patient for examination of the eye: 1. For examination in the daylight, seated facing a window. 2. For examination in a dark room, with artificial light—seated ~ facing the physician. Procedure: Place the patient in position and arrange the instruments and arti- ficial light, if used so that they will be convenient for the physician. Preparation of a child: 1. If restraint is necessary, wrap the child as for an ear examination and place it on its back on your knees with its head on the physician’s lap. 2. Place the child on its back on your knees so that its legs will be around your waist. Hold its hands with your hands and re- strain its legs by means of pressure from your arms and elbows. Position of patient for examination of the nose and throat (rhinoscopy and laryngoscopy): 1. Sitting on a chair facing the physician with the head tilted slightly backward. 54 NURSING TECHNIQUE 2. Dorsal recumbent position (if the patient is not able to sit up) with the head tilted slightly backward. Procedure: Place a towel around the patient’s shoulders. Arrange the instru- ments so that they will be convenient for the physician. Connect an electric drop light and hold it on the right side of the patient on a level with the ear and a trifle behind it. The physician wears the head mirror on the left side. ; Preparation of a child: If restraint is necessary, sit the child on your lap with its legs held securely between yours. Pass your right hand and arm around the child’s right arm and behind her back and grasp the child's other arm with your right hand. Then tilt the child’s head backward against your chest by means of your left hand. TURNING A MATTRESS WITH A PATIENT IN THE BED Regquisttes: 1. A Chase doll or student nurse in bed. 2. Three large pillows. 3. One small pillow. 4. Two chairs. 5. Roller bandage. METHOD I Procedure: Have one assistant for this method. Place a chair at the foot of the bed. Loosen the bedclothes on all sides. Remove the spread and place it on the chair. Fold the sides of the upper sheet and blanket back over the patient and turn the bottom part of this fold under the patient's feet. Remove the pillows and sub- stitute a small one under the patient’s head. Fold the lower sheet over the small pillow at the top and fold over the edges along the sides. Roll the under clothes, including the rubber sheets, along the sides and se- cure them with a bandage. Then move the patient to one side of the mattress and with the assistant’s help draw the mattress and patient over until half of the springs are exposed. Support the mattress with a chair. Then go to the opposite side of the bed and cover the exposed springs with three large pillows. With the assistant’s help draw the patient onto the pillows. Then turn the mattress from the top to the bottom and move the patient and bedding over onto the mattress. Remove the pillows and draw the mattress into position. Remake the bed and make the patient comfortable. : Merson II Procedure: Have four assistants for this method. Proceed as in Method I, as far as and including the rolling and tying of the under bedclothes. Have three assistants stand on one side of the bed and move the patient over to the edge. Then as they lift the pa- tient from the bed, turn the mattress from the top to the bottom with the fourth assistant’s help. The operating cart placed in position as previously demonstrated CARE OF PATIENT EACH MORNING WHEN BATH IS NOT GIVEN 55 makes the procedure less difficult if the patient is heavy. Proceed in the same manner and lift the patient from the bed and place her on the operating cart. Turn the mattress, remake the bed, and lift the patient from the operating cart to the bed. CHANGING A MATTRESS WITH A PATIENT IN THE BED Requisites: . A Chase doll or student nurse in bed. . Extra mattress on two chairs. . One small pillow. . Three large pillows. . Roller bandage. . Three extra chairs. NNR NN = MerHOD I Procedure: Proceed as in Method I (Turning a Mattress With a Patient in the Bed) as far as and including the placing of the pillows on the exposed springs and drawing the patient on to them. Then remove the mat- tress from the bed and place it on the two chairs. Replace it with the extra one. After placing the patient oa it, remove the pillows and draw the mattress into position. Meruop 11 Procedure: Proceed as in Turning a Mattress With a Patient in the Bed, Method II, except that the mattress is changed instead of turned. CARE OF A PATIENT EACH MORNING WHEN A BATH IS NOT GIVEN Requisites: 1. Toilet articles. 2. Clean linen. Procedure: Screen the patient. Arrange the requisites so that they will be con- venient and place a chair at the foot or side of the bed for the bedclothes. Loosen the upper clothes on all sides. Take off the spread, fold it, and place it on the chair. Fold the top sheet and blanket back over the patient at the sides so that they will cover the patient when she is turned. Or cover the patient with a bath blanket, and remove the upper covers, if the weight of the clothes interferes with your work. Brush and comb! the hair as previously demonstrated. Remove the pillows, distribute the feathers well and change the cases if necessary. Rub the knees, heels, and ankles with alcohol and powder them. Turn the pa- tient on the side if possible and loosen the swathe. Rub and powder the back well and replace the swathe if it is soiled or damp. Loosen the under bedclothes and change the draw sheet and under sheet if neces- sary. Smooth out the rubber sheets and pad and tuck them in on the side as previously demonstrated. Turn the patient and proceed in the same manner on the opposite side of the bed. Replace the pillows and make the patient comfortable. Arrange the upper clothes as when mak- LIf the patient wishes her face and hands washed, do so at this time, 56 NURSING TECHNIQUE ing a bed with a patient in it. Remove the soiled linen and requisites and return everything to its proper place. Be sure that the patient is comfortable and that the surroundings are in order before leaving the room. PREPARATION OF A PATIENT FOR THE NIGHT Requisites: . Toilet articles. . Wash-basin. . Emesis basin. . Enameled cup for mouth-wash. . Alcohol. . Wash-cloth. . Two towels (bath and face). . Clean linen, if necessary. Procedure: Screen the patient. Prepare the requisites for use and arrange them so that they will be convenient. Allow the patient to use the bed-pan and douche her externally. Cleanse the patient's teeth and mouth. Wash her face and hands and comb her hair. Remove all the pillows unless this causes the patient discomfort. Turn her on her side and wash her back. Rub and powder the back and hips and other parts necessary for the prevention of pressure sores. Always open the swathe when rubbing the patient’s back and change it or the gown whenever it is soiled or damp. Loosen the under bedclothes. Remove the crumbs and smooth the rubber sheets, pad, and muslin sheets. Replace the pillows and arrange the upper bedclothes. Be sure that the patient is com- fortable. Give some liquid nourishment unless contraindicated. Place a pitcher of water and a glass on the bedside table and arrange and shield the light. Remove all equipment and leave everything in perfect order. Open the window and provide an extra blanket, if the weather is cold. Be sure that the patient is not in a draft. Place the signal light within reach. ; ONT WN = GIVING A PATIENT A TUB-BATH Regquisites: . Bath-room. . Bath blanket. . Chair. Bath mat. . Three towels (2 bath and 1 face). Soap and nail brush. . Wash-cloth. . Bath thermometer. . . Safety-pin. Temperature of water: From 95° to 100° F. Temperature of bath-room: 27 F. Duration of bath: Ten minutes. PREPARING AN ANESTHETIC BED AND TABLE 57 Procedure: Have the temperature of the bath-room correct. Half fill the tub with water the proper temperature, letting the cold and hot water run in at the same time. Arrange the chair so that it will be convenient for the patient to sit on. Place the bath blanket and towels on the chair. Place the bath mat at the side of the tub, and the soap, nail brush, and wash-cloth in the rack provided for that purpose. If the patient is not able to walk to the bath-room, take her there in a wheel chair. If the patient is a female, proceed as follows: Remove her slippers, stockings, and bathrobe. Pin the bath blanket around her so that the opening will be in the back. Remove her gown and give her a large towel to drape over the chest and pubic region during her bath. Assist her into the tub and bathe her in the same order as when giving a cleansing bath to a patient in bed. Place a towel over the edge of the tub to prevent her from slipping when leaving the tub. Drape her with the bath blanket upon getting out of the tub and dry her body thoroughly. Put on her gown under cover of the bath blanket and then allow her to sit down. Put on her stockings and slippers and bathrobe and assist her to her room and make her comfortable in bed. If the patient is a male, proceed as follows: Proceed in the same manner as when giving a bath to a female pa- tient as far as and including the pinning of the bath blanket around the patient's neck. Remove his gown and assist him into the tub, but al- low the bath blanket to remain on the patient during his bath. Ex- pose and bathe each part as necessary. Leave the bath-room to allow him to finish his bath. Upon your return assist him to stand and pin a second bath blanket around his neck. Drop the wet blanket in the tub as you do this. Assist the patient from the tub and dry his body thoroughly. Proceed then as above. Wash the tub and tidy the bath- room as soon as you leave the patient. Points to be remembered: . Do not give a tub-bath without permission from the Supervisor. Never permit a patient to lock the bath-room door. Do not leave a patient long without speaking to her, if she takes her own bath. Even though a patient takes her own bath, the nurse is responsible for her cleanliness. Do not permit a patient to remain in the tub longer than ten minutes. Record: 1. Hour. 2. Cleansing tub-bath. 3. Any unusual symptoms which may occur. om Ce PREPARING AN ANESTHETIC BED AND TABLE Requisites: 1. Hospital bed with regular equipment. 2. Two ether sheets (2 yards long and 1 yard wide). 3. One ether rubber sheet (1 yard wide and 27 inches long). 58 NURSING TECHNIQUE : . Two bath blankets. Three hot-water bottles and covers. Linen for bed. . Double wool blanket. . Safety-pins. . Anesthetic table with: 1. Two emesis basins. 2. Mouth gag. 3. Tongue forceps. 4. Six ether towels. 5. Pad and pencil. | Wrapped. Fig. 10.—An anesthetic bed and table. Procedure: Turn the mattress and if possible have clean linen for the under clothes. Proceed as for a closed bed with the under clothes, including the placing of the rubber and muslin draw sheets. Place a bath blanket over these so that the lower edge is about 1 inch from the rim of the mattress at the foot of the bed. Tuck it in at the head of the bed, making a square corner at the side. Then tuck it along the side at which you are standing. Place the ether rubber sheet across the head of the mattress so that it will be on a line with the rim of the mattress. Cover this with an ether sheet and tuck it in at the top and make a square corner at the side. Place the second bath blanket so that the lower edge is about 1 inch from the rim of the mattress at the foot of the bed. Do MAKING A KLONDIKE BED 59 not tuck it in at the side. Place the upper sheet, the double wool blanket and the spread as when making a closed bed, but do not tuck them at the side. Proceed in the same manner on the opposite side. When the bed is completed, fold the spread back over the wool blanket at the top of the bed and turn the top edge of the sheet over these. Fold all the covers back (including the bath blanket) as previously demonstrated. Place the hot-water bottles between the bath blankets.” Cover a rubber pillow with the ether sheet and place it upright against the head of the bed. Make it secure by drawing the ether sheet around the frame of the bed and pinning it. Place the other requisites on the bedside table and leave nothing that will be in the way of the operating cart. Make oblique corners on the spread as soon as the patient's condition permits, after placing her in bed. Points to be remembered: 1. Be sure that the mattress and pillows are well protected. 2. Warm the bed thoroughly and provide extra blankets as indicated. 3. Arrange the upper clothes so that there will be no delay in placing the patient in bed. 4. Have all requisites required for emergency near at hand. References: Sanders’ Modern Methods in Nursing, pp. 580-583. Harmer’s Principles and Practice of Nursing, pp. 226-229. Pope’s Practical Nursing, pp. 56-63. MAKING A KLONDIKE BED Indicated: 1. In tuberculosis. 2. In any condition requiring the patient to sleep out-of-doors. Requisites: 1. One very large woolen blanket or two smaller ones sewed to- gether. . One or two double wool blankets (as indicated). . One bath blanket. . Two rubber sheets the size of the mattress. Three pillows and cases. Three muslin sheets. . Cotton bed-pad. Towel. . Hot-water bottle and cover. 10. Safety-pins. Procedure: Arch the mattress on its upper and lower ends and stand it on the springs near the foot of the bed. Cover the springs with a rubber sheet (heavy paper may be substituted) and over this place the large woolen blanket, so that about 2 feet of it may hang over the edges and foot of the bed. Place the mattress in position and draw the blanket out over ~ the foot of the bed. Cover the mattress with the second rubber sheet and over this place the pad and bottom sheet as in a closed bed. Omit ! One of the purposes of an ether bed is to lessen the danger of shock by pro- viding warm surroundings for the patient on her return to her room. It is the opinion of the author that many ether beds have failed in this respect, due to the fact that they are opened too wide previous to the return of the patient. 60 NURSING TECHNIQUE the rubber draw sheet if possible, but place the cotton draw sheet and tuck it in as in a closed bed. Proceed with the upper covering as in a convalescent’s bed except that a bath blanket is used instead of a muslin sheet. Open the bed half-way and place the three pillows at the head of the bed, two of them obliquely on either side of the patient and the third laid across the upper corners of these. Prepare the hot-water bottle for use and place it at the foot of the bed under the covers. Place a sheet (doubled lengthwise) around the head of the bed and pin it to secure it. Arrange it at the sides so that the patient will be protected from drafts. In cold weather, clothe the patient in a Canton flannel nightgown, bed socks, and a bed jacket or cape with a hood. Canton flannel sheets and pillow cases may be used instead of muslin sheets and cases in extremely cold weather. Place the patient in the bed in a comfortable position and tuck the upper clothing well about the shoulders and along both sides. Draw the large blanket up over the feet at the foot of the bed and fold it over on both sides. Place a towel over the upper clothes at the top to protect the patient’s face from the blankets. Move the bed out-of-doors if possible or open the windows so that the patient may get the full bene- fit of the incoming air. Points to be remembered: 1. Protect the patient from drafts. 2. Keep him well covered and warm. 3. Move the bed under cover or close the windows when giving treatments or loosening the covers for any purpose. AIR, WATER, AND FRACTURE BEDS—SAND-BAGS—CRADLES— Regquisites: SPLINTS AND FRAMES Air and water mattresses. . Fracture board. . Cradles. . Sand-bags. . Bradford frame. . Splints. 7. Fracture cart (properly equipped). An air mattress is one inflated with air. A water mattress is one filled with water. Air and water mattresses are used: 1. To equalize pressure and lessen the danger of pressure sores. 2. To afford comfort to the patient. 3. Inhydrotherapy departments, when giving salt rubs and massage, and on operating tables. A fracture board is a perforated board, the size of the wire springs, placed over the latter to prevent motion or sagging in conditions in which a rigid position is necessary. Cradles are frames made of wire, iron, wood, or wicker in the shape of three or more half hoops resting on flat runners and held in position by cross-bars. They are used to prevent the bedclothes from resting on tender parts. Sand-bags are heavy ticking bags of different lengths filled with sand. They are covered with rubber sheeting, and washable covers are placed on them when in use. They are used: QUT LN = eo AIR, WATER, AND FRACTURE BEDS—SAND-BAGS—CRADLES 61 1. To support an injured or diseased part. 2. To limit motion. The Bradford frame is an appliance made of gas piping and canvas. It is made in different sizes according to the size of the patient. It is used: 1. To relieve pressure in the treatment of bed-sores and wounds of the back. 2. To protect dressings on the back or thighs from moisture by in- voluntary micturition and defecation. 3. To restrain children in the treatment of fractures and diseases of the spine and hip. A splint is an appliance made of such material as wood, plaster, or tin used to immobilize or support injured or diseased parts of the body. Points to be remembered when applying splints: 1. Have the splint long enough to extend slightly beyond the joint above and below the seat of injury and a trifle wider than the part to which it is applied. 2. Pad the splint well to prevent chafing. 3. Secure the splint tightly enough, but be sure circulation is not interfered with. 4. Wash the skin with soap, water, and alcohol if the splint is tem- porarily removed. If there is a wound, use alcohol only. Traction is “the extension of the member in what may be called the physiologic direction and position.” It is accomplished by the use of weights and splints. An extension is an ‘“‘appliance used to bring the members of a limb into or toward a straight condition.” A fracture cart equipped with two trays, an upper and a lower one, and properly supplied gives splendid service if same is kept in the splint room and brought to the bedside as needed. The upper tray consisting of many compartments of different sizes contains the following supplies: 1. Hammer. 2. Nails. 3. Pliers. 4. Wrenches. 5. Steel hacksaw. 6." Adhesive plaster. 7. Mole skin. 8. Pulleys. 9. Bandages (assorted). 10. Screw hooks. 11. Bolts with wing nuts. 12. Rope. 13. Screws. 14. Matches. 15. Alcohol lamp. 16. Non-absorbent cotton. 17. Webbing. The lower tray which has no compartments but a raised edge contains the following supplies: 1. Shock blocks and pins for Fowler's position, 62 NURSING TECHNIQUE 2. Weights. 3. Splints. 4. Sand-bags. References: : Sanders’ Modern Methods in Nursing, pp. 310-325. ky Principles and Practice of Nursing, pp. 299-301 and 630— Pope’s Practical Nursing, pp. 598-606. PREPARATION OF HOT-WATER BOTTLE AND ELECTRIC PAD FOR USE Regquisites: 1. Hot-water bottle and cover. 2. Electric pad and cover. 3. Pitcher. 4. Bath thermometer. Temperature of water: For an adult, from 120° to 150° F. For a child, from 110° to 120° F. Procedure: To prepare a hot-water bottle for use: Be sure that the bottle is in good condition and does not leak. Take the temperature of the water and pour enough from the pitcher into the bottle to half fill it. Expel the air, screw on the top securely and turn the bag upside down to see that there is no leak from the stopper. Put the bottle in the Canton flannel protector (stopper first) so that the metal top will not come in contact with the patient. After use: : Drain the bottle free of water and hang it open end downward with the stopper attached. Inflate the bottle when putting it away, to pre- vent its sides from adhering by coming in contact. Points to be remembered: 1. Be sure that the bottle is in good condition. 2. Do not rely on a patient’s judgment for the degree of tempera- ture. 3. Expel the air and be sure that the bottle is not too heavy. Always take the temperature of the water when the bottle is to be placed in bed with a patient. To prepare an electric pad for use: Prepare the pad for use by slipping it in the Canton flannel protector. Attach the plug to an electric light socket or standard receptacle. If used on an electric light socket, be sure the current is turned on. The pad may be folded to any shape or wrapped around any portion of the body, but always remember it must not be pinned. For low heat push in the button marked on switch “For low heat.” Permit the other button to remain out. For medium heat push in the button marked on switch ‘For medium heat.” Permit the other button to remain out. For high heat push both buttons. To shut off the several heats, push the black button opposite the heat marked on the switch. To shut off the currents entirely, push both black buttons. When through using the pad be sure and shut off the current. PREPARATION OF ICE-CAP AND ICE-COIL FOR USE 63 Points to be remembered: / 1. It is necessary to examine an old pad to see if the insulating ma- terial is intact. 2. As a matter of safety, it is well not to leave the pad “on high” for a great length of time. 3. Do not allow the pad to get wet. PREPARATION OF ICE-CAP AND ICE-COIL FOR USE Requisites: . Ice-caps (assorted). . Ice-coil. . Protectors. . Towels. . Two pails (one for ice and the other for the drain). . Funnel. Small pitcher. Sheet. Screw compressor clamp. 10. Newspaper. Procedure: To prepare an ice-cap for use: Break the ice into parts about the size of a walnut. Put enough into the cap so that it will be from one-half to two-thirds full. Expel the air and screw on the cover. Dry the cap and put on the protector. If the weight causes discomfort, the cap may be tied to a support or cradle. After use: Drain the cap free of water and dry the exterior. Inflate the cap with air and put it away. Be sure that the washer is not lost. Points to be remembered: 1. Be sure that the cap is in good condition. 2. Expel the air and be sure the cap is not too heavy. 3. Do not puncture the cap with sharp pieces of ice. 4. Always replace the cover to prevent the washer being lost. An ice-coil (a substitute for an ice-cap) is made of rubber tubing, coiled so that ice-water may pass through it. It is lighter than an ice- cap and the temperature may be kept constant. To prepare an ice-cotl for use: Fill the pitcher and one pail with cold water. Place a large piece of ice in the pail. Put the screw compressor clamp on the end of the tub- ing coming from the center of the coil and attach the funnel to the open end. Carry the requisites to the bedside. Place the pail on the bedside table, so that it is elevated about 1 foot above the patient. Place the empty pail on the floor by the bedside, and put the end of the tubing extending from the outside of the coil into it. Start siphonage by pouring water from the pitcher into the funnel until the tubing and funnel are filled. Then lower the funnel into the water, and when the flow is well started, envelope the circular portion of the coil in a protector and apply it to the affected part. Regulate the flow by the screw compressor, allowing the water to run slowly through the coil. O00 TON UTA I 64 NURSING TECHNIQUE PREPARATION OF HANDS AND ARMS FOR OPERATIONS AND TREATMENTS Regquisites: . Running sterile water or basins of sterile water. . Liquid or soft soap. . Nail brushes. . Orange wood sticks. . Aleohol, 75 per cent. . Bichlorid solution 1 : 1000. 7. Sterile towels. Procedure: AUTH WN = METHOD I For treatments: Turn the sleeves up above the elbows. Before beginning the proc- ess of scrubbing, remove any dirt that is lodged under the finger-nails and clean the cuticle by means of an orange wood stick. Then wet the hands and arms and rub in a generous amount of soap. Work it into a lather and then rinse the hands and arms. Apply the soap again and take a sterilized nail brush and scrub thoroughly every part of the hands and arms well above the elbows from three to five minutes. Rinse the hands and arms well under running hot water until all the soap is re- ‘moved, then use the cold water. Immerse the hands and arms in bi- chlorid solution 1 : 1000 for one minute and dry with a sterile towel. METHOD II For operations: Proceed in the same manner expect that ten minutes is required for this method. After drying the skin with a sterile towel, apply alcohol 75 per cent. with a gauze sponge and rub it in well. Points to be remembered: 1. Keep the nails trimmed round and close. 2. Always time yourself by the clock when scrubbing your hands. 3. Always rinse the hands and arms free of soap. 4. Use cold water for the last rinsing to check excretions. Care of hands and nails: Always keep them in good condition by: 1. Keeping a constant watch for hang nails and abrasions. 2. Using a hand lotion as indicated. 3. Using forceps for soiled dressings. 4. Washing and drying them well before meals and before retiring. Sterilization of nail brushes and orange wood sticks: After use wash them in green soap and warm water and rinse them well. Wrap them and boil them for ten minutes. References: Sanders’ Modern Methods in Nursing, pp. 478-481. Pope’s Practical Nursing, pp. 342-347. CLEANING AND STERILIZATION OF RUBBER GOODS AND GLASS UTENSILS Requisites: 1. Rubber gloves. 2. Rubber and silk catheters. STERILIZATION OF RUBBER GOODS AND GLASS UTENSILS 65 . Silk ureter catheters. . Gastric lavage tube. . High rectal tube. Ewald evacuating bulb. . Bougies. . Dressing sheets. . Hard Fiber goods (enema and douche tips—syringe and pes- saries). 10. Glass utensils (douche tip—syringes—connections and catheters). 11. French chalk. . 12. Towels. Procedure: Rubber gloves: COTA UIBW MEegTHOD I Wash the gloves in cold water. Then wrap them in a towel and boil them from three to five minutes. Wash them on both sides with warm water and soap. Rinse and dry them thoroughly. Inflate them to dis- cover holes and put aside all imperfect gloves. Powder both sides with French chalk. Fold the wrist of each glove outward to form a cuff. Prepare a small square of tissue paper and fill it with French chalk. Wrap the gloves in a towel and place the package of chalk so that it can be taken from the gloves without contaminating them. Encase them in a second towel and sterilize them in the autoclave for thirty minutes at 15 pounds pressure. MEernOD II Wash them well and turn back the cuffs. Wrap them in a towel and boil them for five minutes. Be sure that they are immersed and pro- tected from the sides of the basin. To patch gloves: Place the glove on a form. Cut a small piece of material from an old glove and apply it over the hole after covering the area with rubber cement. Allow the gloves to dry and proceed as above. To put on dry gloves: Open the outer wrapper so that the hands will not be contaminated later. Wash and dry hands as previously demonstrated. Then remove the package of chalk and powder the hands well. (Do not allow the powder to fall on the sterile gloves.) Take hold of the cuff of the left glove and pull the glove on without touching the outside. Then place the gloved hand under the cuff of the right glove, and at the same time slip the right hand into it. Turn back the cuffs, but do not allow the gloved hands to come in contact with the bare arms or the wrong side of the cuffs. To put on wet gloves: Remove the gloves from the sterilizer with sterile forceps and place them in a basin of sterile water. Scrub the hands, but do not dry them. Put them on, holding your hands over the basin, observing the same pre- cautions as when they are dry. Allow the excess water to drain by hold- ing the hands up. Rubber catheters: 5 66 NURSING TECHNIQUE After use: Hold the catheters under the cold-water faucet of the hopper and allow the water to run through and over them until all body discharge is removed. Then place them in a basin of warm water and soap and wash them well. Rinse them and boil them for five minutes. Dry them. thoroughly and put them in the glass catheter tube and sterilize them in the autoclave for thirty minutes at 15 pounds pressure. Silk ureter catheters: These catheters require much care in sterilization, for if they are sterilized by the ordinary method they will be destroyed. Scrub them first with soap and water. Run water through them, using the urethral bulb syringe. Siphon bichlorid solution 1 :1000 through them for twenty-four hours. Start siphonage with ureter syringe. Place them in cold water in the sterilizer and boil for three minutes. Gastric lavage tube: Proceed as for rubber catheters as far as and including boiling for five minutes. Remove it from the sterilizer (allowing it to drain) and wrap it in a sterile towel. If used for the same patient a second time, it is not necessary to boil it, but cleanse it thoroughly and be sure the lu- men of the tube is unobstructed. Forcing water through with a glass syringe removes all particles from the tube. Ewald evacuating bulb, bougies, silk catheters, and hard-rubber goods: As these will not stand boiling they are disinfected in the following way: Wash them first in cold water, then warm water and soap, and rinse them. Place them in bichlorid solution 1 : 1000 for two hours, then rinse them in sterile water (using sterile forceps). Wrap them in a sterile towel. Rubber dressing sheets: Wash them well and place them in formalin 2 per cent. or carbolic 5 per cent. for two hours. Then rinse and dry them, and put them away. Glass utensils: Wash glass utensils first in cold water, then in hot soapy water, and rinse well. Test the syringes to see that they are in working order. Wrap all glass utensils before sterilizing. Place them in cold water and boil them for ten minutes. High rectal tube: Cleanse it thoroughly in the same manner as a rubber catheter, boil it for five minutes. Allow it to drain and then dry it and put it away for use. ' References: Sanders’ Modern Methods in Nursing, pp. 490-496. Harmer’s Principles and Practice of Nursing, pp. 250-255. Pope's Practical Nursing, pp. 42-49 and 351-357. CLEANING AND STERILIZATION OF INSTRUMENTS Regquisites: 1. Samples of instruments. 2. Syringes and needles. 3. Sterile gloves. 4. Sterile towels. Procedure (For instruments used daily in wards): Look over the supply of instruments to see that none are missing. ASSISTING WITH A SURGICAL DRESSING 67 Rinse them in cold water until they are free of blood and pus. Then allow the hot water to run on them. Use Bon Ami, if necessary, to clean them, and in doing so be careful of the sharp edges. Rinse them free of detergent and place them in the instrument sterilizer and boil for ten minutes. Remove them from the sterilizer with a sterile forceps and dry with a sterile towel. (Wear sterile rubber gloves for this pro- cedure.) Be sure that the supply of instruments is complete. Wrap them in a sterile towel and place them on the dressing tray. Cleanse infusion and aspirating needles and test them. Insert the wires and boil them from ten to twenty minutes, or place them in a test- tube and sterilize them in the autoclave for thirty minutes at 15 pounds pressure. Points to be remembered: 1. Have the water boiling before putting the instruments in, as too long exposure to moist heat is injurious to sharp instruments. . Prevent the edges and points of sharp instruments’ and needles from coming in contact with hard surfaces. . Be sure that infusion and aspirating needles are thoroughly cleansed, tested, wired, and dried before putting them away. . Scalpels, bistouries, and scissors are sometimes disinfected by placing them in 60 per cent. alcohol for thirty minutes. . When putting away instruments that will not be used for some- time, rub them with vaselin to prevent rusting. References: Sanders’ Modern Methods of Nursing, pp. 485-491. ’ Harmer’s Principles and Practice of Nursing, pp. 250-255. Pope’s Practical Nursing, pp. 39-43. Cu a0 ND . ASSISTING WITH A SURGICAL DRESSING Requisites: 1. A Chase doll'in bed. (Surgical dressing on abdomen and leg of doll.) 2. Surgical dressing tray with: 1. Bandage scissors. 2. Clip remover. 3. Probe. 4. Hemostat. Sterile. 5. Tissue forceps. 6. Scissors. 7. Sterile gloves. 8. Sterile dressing sheets. 9. Sterile solution basins (2). 10. Sterile medicine glass. 11. Sterile kidney basin. 12. Sterile gauze sponges. 13. Sterile cotton. 14. Sterile iodoform gauze. 15. Sterile abdominal dressing. 16. Sterile glass syringes (large and small). 17. Sterile boric ointment. 18. Sterile zinc ointment. 19. Safety-pins (sterile and non-sterile). 68 NURSING TECHNIQUE 20. Flask iodin. 21. Flask alcohol (60 per cent). 22. Caustic pencil. 23. Bandages (assorted). 24. Adhesive tape. 25. Rubber dressing sheet. 26. Dressing towel (non-sterile). Procedure for abdominal dressing: Prepare the solution if the physician desires it. Cover it and place it on the tray. Carry the tray to the bedside and screen the patient. Close the window and raise the shade. If the room is cold, cover the patient's chest with a bath blanket. Fold back the upper clothes (mak- ing one fold) so that the area to be dressed will be exposed (but not the pubes). Open the abdominal binder, cut the adhesive tapes and place the bag for waste so that it will be convenient. Remove the outer layer of dressing (unless there is but one layer) and open the package of sterile dressing sheets or towels. The physician places them around the area to be dressed. Open the package of sterile instruments and place them so that they will be convenient for the physician. He then removes the inner layer of gauze from the wound with the sterile forceps. Open the packages of gauze and cotton as indicated, but avoid opening unneces- sary packages. If the wound is to be irrigated, place the rubber dressing sheet, covered with the dressing towel under the patient and hold a sterile kidney basin under the wound for the return flow. When the dressing is completed, make the patient comfortable and remove the dressing tray. Cleanse and sterilize the instruments and dispose of the soiled dressings. Equip the tray for the next dressing. Procedure for dressing arm or leg: Proceed in the same manner as for an abdominal dressing. Remove the bandage and support the leg or arm so that the physician may place the sterile sheets. Anticipate the physician's wants during the dressing and support the part when the physician is bandaging it. Points to be remembered: 1. Have all the requisites at hand. 2. Anticipate the surgeon’s wants and act quickly. Record: 1. Hour. : 2. Dressings changed and by whom. 3. Character of drainage. 4. If sutures or drainage are removed. 5. Any abnormal condition of the wound. References: Sanders’ Modern Methods in Nursing, pp. 518-524. Harmer’s Principles and Practice of Nursing, pp. 243-257. Pope's Practical Nursing, pp. 605-641. APPLICATION OF BINDERS Binders are used: 1. To retain dressings and applications. 2. To make compression. 3. To limit motion. 4. To give support and comfort. ADMISSION OF PATIENTS 69 Requisites: 1. Scultetus binder. 2. Straight binder. 3. Breast binder. 4. T-binders (single and double). The scultetus, or many tailed, binder is used on the abdomen to retain dressings and applications and to supply pressure. To apply: Roll it from one side to the center and place it below the patient’s back. Ifitis used for pressure, apply it from the pubes upward by bring- ing the strips, alternately from each side, obliquely over the abdomen so that they cross in the midline. Secure it by means of one or two safety- pins in front. Straight binders are used on the abdomen to retain dressings and ap- plications and sometimes on obstetric patients after delivery. To apply: Roll it from one side to the center and place it below the patient’s back. Fold over the front edges to fit the form of the patient. If used for pressure, apply it from the pubes upward. If used on an obstetric patient after delivery, apply it from above toward the pubes. Fasten it in front with safety-pins placed close together. If necessary, darts may be made at the waist line and below the hips so that the binder will fit the figure. Breast binders are used on the breasts to retain dressings or applica- tions and to make compression. To apply: Roll'it from either side to the center and place it below the patient's shoulders. If used for compression, place cotton around the nipples to prevent pressure being made on them. Bring the breasts away from the axillee, and pin the binder securely, beginning in the center. Then pin from the lower edge up to the center and continue to the upper edge. Be sure that the pressure is even. T-binders are made of two thicknesses of cheese cloth in the shape of a letter T. They are applied over the rectum and external genitals to retain dressings and applications. A double T-binder is made like the single T-binder, except that two strips are used instead of one. They are applied over the rectum and external genitals to retain dressings and applications on male patients. To apply: Pass the horizontal strip around the patient's waist and bring the single or double ends between the thighs and secure them in front by means of one or two safety-pins. References: Sanders’ Modern Methods in Nursing, pp. 299-306. Harmer’s Principles and Practice of Nursing, pp. 257-301. Pope's Practical Nursing, pp. 586-592. ADMISSION OF PATIENTS Regquisites: 1. A closed bed. 2. A Chase doll on a stretcher. 3. Two bath blankets. 70 NURSING TECHNIQUE Procedure: : Open the bed as previously demonstrated and turn the covers down to the foot of the bed. If the patient is fully clothed, cover the bedding with a bath blanket. It may be omitted if the nightgown and a kimona are worn and the patient is not dirty. Cover the patient with a bath blanket as soon as she is placed on the bed and remove her clothing. If her condition is serious, it may be necessary to cut some of the cloth- ing off. Do so with as little injury as possible by cutting the seams. Remove the clothing from the affected side last. “Undress and put to bed an ambulatory patient and in all instances examine the body care- fully for: . Rashes. . Bed-sores. . Scratches and hemorrhagic spots (petechia). . Swelling. . Burns. . Loss or impairment of motion. Observe the following routine: 1. Give an admission bath. (This may be omitted by permission from the Supervisor.) - Write the patient's name (in full), the address, telephone number, and religious denomination on the chart. . Take the temperature, pulse, and respiration of all patients and record it. . Take the blood-pressure! (systolic and diastolic) and record it. - Send a specimen of urine to the laboratory and label it “ad- mission specimen.” . Start a twenty-four-hour specimen of urine on all urologic, diabetic, and nephritic patients. - Notify the intern on service,? so that the physical examination can be made and the history taken. - Notify the laboratory,? if the patient is an emergency. . Place a pitcher of fresh drinking-water within reach of the pa- tient and urge her to drink freely unless contraindicated. . Demonstrate the use of the signal light before leaving the pa- tient. Patients admitted to hospitals are frequently dirty and a thorough cleansing bath is then necessary. If the dirt is hard to remove, benzine or ether may be'used on the hands and a soap poultice on the feet. For very dirty feet: Place a rubber sheet covered with a bath towel under the feet. Then immerse two dressing towels in warm green soap, apply them to the feet, and cover them with dry bath towels. Allow them to remain an hour and follow with a foot-bath. : Scratches on the body may indicate the presence of pediculi. Look for body lice on the hairy portions of the body and, if found, report it to the Supervisor so that the physician may prescribe the treatment. The classification of pediculi found on patients is: 1. Pediculus corporis: Infests the body and clothing. 1 This is done by the senior nurse. 2 This is done by the Supervisor in charge of the ward. 3 Ibid. ON UT QO ND =a AO 00 ios ON Oni OD — oO GIVING A FOOT-BATH 7 2. Pediculus pubis: Infests the parts of the body covered with hair, especially the pubic region. z 3. Pediculus capitis: Infests the head and scalp. The usual procedure for the destruction of body pediculi: 1. Shave infested parts (if other than the head). 2. Give a bath of bichlorid of mercury solution 1 : 5000. 3. Apply blue ointment to the infested parts. 4. Sterilize or destroy the clothing. References: Harmer’s Principles and Practice of Nursing, pp. 37-43. Pope's Practical Nursing, pp. 120-123 and 131-133. CARING FOR A PATIENT’S PERSONAL BELONGINGS Requistites: 1. Various articles of wearing apparel. 2. A clothes record (a book kept on the ward for that purpose). 3. Hangers. 4. Large envelopes (for valuables). 5. Twine. Procedure: If the patient’s condition permits, ask her if she has any valuables with her that should be taken to the office for safe keeping. If so, make an itemized list of them, check it over with the patient, or if her condition makes this impossible, have another nurse do this with you. Then put all the articles in the envelope and write the patient’s name and room or ward, the date and your own name on it, and give it to the Supervisor. Make a thorough examination of the clothing for pediculi. Make an itemized list of the clothing, check it over with the patient and sign your name in the book. If free from pediculi, hang such clothing as dresses, coats, skirts, and trousers on the hangers provided in each locker. Fold clothing, such as underwear, neatly, and tie it together and place it in the locker. Points to be remembered: 1. When admitting a dirty patient, always examine his body and clothing for pediculi. 2. Never indicate by word or action that you think the patient's clothing is inferior or dirty. 3. Always remember that you are responsible for all valuables taken from a patient until you have given them to the Supervisor. 4. Never destroy scraps of paper found in a patient's pockets. They may be valuable to the individual. References: Harmer’s Principles and Practice of Nursing, pp. 43-495. Pope’s Practical Nursing, pp. 122-125. GIVING A FOOT-BATH A foot-bath consists in immersing the feet and ankles in a tub of water the proper temperature and allowing them to remain the prescribed time. 72 NURSING TECHNIQUE Prescribed: 1. To relieve congestion in the pelvic organs, the throat, the brain, and lungs. 2. To relieve local congestion. 3. To stimulate the involuntary muscles of the intestines and bladder. 4. For cleansing purposes. Temperature of water: From 100° to 120° F. Duration of bath: From ten to thirty minutes. Solutions used: 1. Plain water. 2. Mustard—1 tablespoon to 1 gallon of water for an adult. Requzisites: Foot tub. . Bath blankets. . Two towels (bath and face). . Pitcher. . Hot-water bottle and cover. . Bath thermometer. . Newspaper. $ . Wash-cloth (if bath is given for cleansing purposes). Procedure (in bed): Half fill the foot tub with water about 105° F. and the pitcher with water 200° F. Carry the requisites to the bedside. Fold the bath blanket lengthwise in two and then from top to bottom in four, resembling a W. Loosen the upper covers at the foot of the bed and fold them neatly back. Place the bath blanket at the foot of the bed under the upper covers. Fold back the covers to above the knees and at the same time cover the legs with the bath blanket. Flex the knees and turn the bath blanket back under the feet. Place the bath towel so that it will cover the portion of the blanket under the patient’s feet. Place the tub on the bed on the lower portion of the blanket. Sup- port the patient’s feet and legs with one hand and with the free one move the tub into position. Lower the feet slowly into the water and place a folded face towel over the rim of the tub. Draw down the covers and allow the feet to remain in the bath the prescribed time. Gradually increase the temperature of the bath by adding hot water from the pitcher. Do this under cover of the bath blanket and hold your hand between the stream and the patient's feet. When the bath is completed, carry a hot-water bottle to the bedside. Turn the covers back above the knees and remove the towel from the rim of the tub. Support the feet and legs and raise them from the water. Allow them to drain for a few seconds and then lower them on the bath towel, as you move the tub out of the way. Remove the tub from the bed and dry the feet. Remove the bath blanket from under the feet and place the hot-water bottle near by. Draw the upper covers down and at the same time re- move the bath blanket. Tuck the upper covers under the mattress as previously demonstrated and make the patient comfortable. Procedure (out of bed): Spread a dark wool blanket over a comfortable chair and the floor. When the patient is sitting on the chair, cover her with a bath blanket. PNA UTR LN = Page Missing Page Missing PREPARATION OF LABORATORY SPECIMENS FOR ANALYSIS 75 patient can sit on it after being assisted from the tub. Cover the seat with a bath towel. If the patient is not strong, take her to the bath-room in the wheel chair (unless the sitz-tub is portable). Put on her stockings and slippers and kimona. Remove the kimona in the bath-room and pin the bath blanket around the patient’s neck so that the opening will be in the back. Pin the gown up well out of the way. Assist the patient into the tub and drape the bath blanket well around her and the tub. If the treat- ment is long and it is necessary to raise the temperature of the water, keep your hand between the stream of water and the patient. When the bath is completed, assist the patient from the tub and dry the external genitals and thighs. . Have her sit on the chair and put on her kimona as you remove the bath blanket. Take the patient back to her room and put her to bed. Clean the sitz-tub and leave the room in perfect order. Record: 1. Hour and treatment. 2. Duration of treatment. 3. Any unusual symptoms which may occur. References: Sanders’ Modern Methods in Nursing, pp. 97-101. Harmer’s Principles and Practice of Nursing, pp. 328-330. Pope's Practical Nursing, pp. 305-307. PREPARATION OF LABORATORY SPECIMENS FOR ANALYSIS Requisites: 1. Utensils for sending feces, sputum, gastric contents, and urine. 2. Labels : ! 3. Wooden tongue blades. Procedure: Feces: : Place the specimen in a clean covered receptacle. Label it properly and send it to the laboratory when quite fresh. If the feces is to be examined for ameba, it should be kept warm, as the cold checks the movements of these parasites. Warm the bed- pan before use. Transfer the feces to the warmed container, by means of a tongue blade. If itis not possible to take the specimen to the labora- tory at once, keep it in a water-bath at 110° F. Sterilize the receptacle if the specimen is to be examined for bacteria (tubercle, typhoid, or cholera bacillus). Do not contaminate the out- side of the receptacle or the cover with feces. Sputum: If possible obtain the specimen in the morning before nourishment has been taken. Give the patient a specimen bottle (open mouthed) and instruct her to cough up the discharge from the bronchi or lungs. Label it properly and send it to the laboratory. Gastric contents: Place the specimen in a clean, covered receptacle and label it properly. If the specimen is a test-meal and it is not possible to send it to the laboratory immediately, place it on ice to prevent any alteration.of the specimen. 76 NURSING TECHNIQUE Urine: Be sure that the patient and bed-pan are clean. For an admission, preoperative, or postoperative specimen, send about 4 ounces to the laboratory in a clean bottle, properly corked and labeled. Catheterize the patient and have a sterile specimen receptacle, if a sterile specimen is ordered. If the patient is menstruating, wash the external genitals and place a small pledget of cotton in the vagina. Proceed then as for an admission specimen. A twenty-four-hour specimen of urine: Tag a 1-gallon specimen bottle with the patient's name, room num- ber, and date. Be sure that the bottle is scrupulously clean and properly corked. Have the patient empty the bladder at 6 A. M. Reject this urine. Save all of every specimen voided thereafter and place it in the specimen bottle, which should be kept in a cool place. Complete the total specimen by having the patient void at 6 A. M. and adding this ‘specimen to the total amount. Send a 4-ounce specimen of the mixed twenty-four-hour amount to the laboratory. Precautions: 1. Caution the patient to empty the bladder before each bowel movement. 2. In case the urine is lost with stool or discarded by mistake, place an explanatory note on the chart and estimate the amount lost. Record: 1. When started and when completed. 2. Total amount collected in twenty-four hours. 3. Any irregularities encountered in the collection of the specimen, e. &., approximately 100 c.c. lost by involuntary micturition. A twenty-four-hour specimen of urine for tubercle bacillus: Proceed in the same manner except that the total amount voided in twenty-four hours is sent instead of 4 ounces from the total amount. Points to be remembered in collecting all specimens: 1. Be sure that the receptacle for the specimen is scrupulously clean. 2. Sterilize the receptacle when the specimen is to be examined for bacteria. 3. Cover the specimen immediately after placing it in the recep- tacle. 4. Properly tag all specimens. This includes the patient’s name, room, or ward number, the physician's name, the date, the kind of specimen and any special information known by the nurse. Record: 1. Hour. 2. Kind of specimen sent to laboratory. 3. Any special information. References: Sanders’ Modern Methods in Nursing, pp. 404-414. Harmer’s Principles and Practice of Nursing, pp. 104-108, 124-134, 414-419, and 508-509. Pope's Practical Nursing, pp. 357-364. GIVING A CLEANSING OR EVACUATING ENEMA 77 ENEMATA An enema is a rectal injection given to cleanse the colon or provide a patient with medication or nourishment. Enemata are classified as follows: 1. Cleansing or evacuating: Given to hasten evacuation and to wash out the colon. . Carminative: Given for the relief of distention caused by flatus. . Emollient: Given to soothe irritated mucosa. . Sedative: Given to allay nervousness. . Stimulating: Given for general stimulation in shock or collapse. . Nutrient: Given to provide nourishment. Anthelmintic: Given to destroy worms. . Antiseptic: Given to destroy micro-organisms. . Saline: Given to provide the body with fluid. 10. Astringent: Given to contract the tissues and blood-vessels. Temperature of solution: 1. For hemorrhage: 120° F. 2. For stimulation, inflammation, and a carminative effect: 115° F. 3. For other classification: 105° F. Quantity of liquid for enemata to be retained: From 3 to 8 ounces. Quantity of liguid for cleansing enemata: 1. For adults: Two to, 4 pints. 2. For a child: From 3 to 13 pints. 3. For an infant: From } to 2 ounces. Position of patient: 1. Lying on the left side with the knees flexed. 2. The dorsal recumbent position. 3. The knee-chest or genupectoral position (used sometimes in cases of high intestinal obstruction). CON UTR WIN GIVING A CLEANSING OR EVACUATING ENEMA A cleansing or evacuating enema is a rectal injection of a solution which softens the feces, distends the colon and rectum, and thereby causes a free evacuation. Prescribed: 1. When the peristaltic action of the intestine is defective, causing an accumulation of feces in the rectum and lower colon. 2. When the character of the stools indicate that the waste products are not being eliminated properly. Solutions used: 1. Soap solution. 2. Normal saline. Temperature of solution: From 100° to 105° F. Requisites: 1. Bath blanket. 2. Irrigator stand. 3. Bed-pan, cover, and toilet paper. 4. Tray with: 78 NURSING TECHNIQUE 1. Reservoir supplied with tubing and stop-cock. 2. Sterile enema tip (wrapped). 3. Lubricant. 4. Protector. Procedure: Prepare the solution in a pitcher by dissolving Ivory or Castile soap in hot water with a soap shaker. Close the stop-cock and pour the so- lution in the reservoir. Connect the tip to the tubing and cover the tip with the gauze sponge. Cover the tray with a dressing towel and carry the requisites to the bedside. Screen the patient’s bed and re- place the upper covers with a bath blanket. Flex the patient's knees, raise the gown, and place the protector under the patient's buttocks. Turn the patient on the left side if possible. Fig. 13.—Tray equipped for an evacuating enema. Hang the reservoir about 2 feet above the patient. Expel the air, shut off the flow, and lubricate the tip. Insert it about 2 inches into the rectum, and open the stop-cock. Give the required amount of solution, close the stop-cock, and withdraw the tip. Place the patient on the bed- pan and give her the signal light. Leave the patient alone unless her condition contraindicates it. . When the solution has been expelled, care for the patient as previously demonstrated. Carry the tray to the utility room and rinse and dry the reservoir and tubing. Thoroughly cleanse and sterilize the enema tip and leave the tray equipped for the next treatment. GIVING A CLEANSING OR EVACUATING ENEMA 79 Points to be remembered: 1. Do not expose the patient unnecessarily. 2. Protect the bed from soil and odor. 3. Lubricate the tip and do not use force when inserting it. 4. Do not allow air to enter the intestine. Record: 1. Hour and treatment. 2. Amount and kind of solution injected. 3. Character of return flow. To give an enema to a small child: Regquisites: The same as for an adult, except that a soft-rubber catheter is used instead of a hard-rubber tip. Procedure: Proceed as for an adult, except that the child is placed on the bed- pan. Hang the reservoir about 1 foot above the patient and after ex- pelling the air, insert the catheter, about 3 inches into the rectum, and hold it in position. To give an enema to an infant: Place the infant on a padded table. Place a rubber sheet covered with a diaper under the buttocks. Flex the legs on the abdomen. Pro- ceed as for a child, except that to 2 ounces is injected at a time ac- cording to the age of the infant. Do not use force when injecting the solution. SUBJECT: NURSING TECHNIQUE! Topic: Cleansing or evacuating enema. Class: Probationers. Aim of lesson: To impress upon the students the purpose of the treatment and to develop skill and judgment in carrying out the pro- cedure. OUTLINE Anatomic and physiologic factors to be considered. Definition of enema and classification. Definition of evacuating enema and when prescribed. Dangers involved and precautions to be observed. . Summary. . Assignment. References: Williams’ Anatomy and Physiology, pp. 396-401. Harmer’s Principles and Practice of Nursing, pp. 102-110 and 112- 116. Sanders’ Modern Methods in Nursing, pp. 155-162. OU 1 The above lesson plan is recommended for all subjects in which the anatomic and physiologic factors are to be considered. For the above topic, Evacuating Enema, the students are given a list of questions with references. They have access to the illustrative material and the written up procedure is found in their text- book of Nursing Technique. x If the class has completed the anatomy and physiology of the subject, a brief review only is necessary; otherwise a longer period of study is required. A demonstration is then given by the instructor and repeated by the students until the instructor is satisfied with results. 80 NURSING TECHNIQUE Kimber and Gray's Anatomy and Physiology, pp. 394-397. Written-up procedure. Illustrative material: 1 2 3. Evacuating enema tray. Anatomic chart. Anatomic model. For students: 1. What are the most important excretory organs of the body? 2. What occurs if these organs fail to do their work? 3. Define constipation. What are the most common causes of constipation? 4. Define enema. Give classification. 5. Define an evacuating or cleansing enema. When prescribed? 6. Give the structure of the large intestine. Classify its divisions. 7. What are the functions of the large intestine? 8. Define the sigmoid flexure. 9. Describe: (a) the rectum, (4) the anus. 10. Give the solution and temperature of an evacuating enema. 11. Why should the patient be on her left side with the knees flexed? 12. In what condition would it be necessary to give the enema on a bed-pan? 13. How much solution is usually given and what dangers attend giving more? 14. What would you record after a cleansing enema? Method of Presentation: Subject Matter: What are the most important The kidneys and the bowels are excretory organs of the body? the most important excretory or- gans of the body. (Harmer’s Principles and Prac- tice of Nursing.) What occurs if these organs fail In any disease, if the kidneys to do their work? can be kept actively working and the bowels ‘kept open” so that the waste and poisons are elimi- nated as fast as formed, the cells can put up a good fight so that the patient has a good chance of re- covery. If either one fails to do its work, the whole body will suffer and be clogged up so that the little cells choked and poisoned by their own excretions will fail to carry on their work. (Harmer'’s Principles and Prac- tice of Nursing.) Define constipation. Constipation or infrequent or difficult evacuation of the feces is a common condition, largely re- sponsible for many ills, from which the body suffers. GIVING A CLEANSING OR EVACUATING ENEMA 81 Method of Presentation: What are the common causes of constipation? Define enema. Give classification. Define an evacuating or cleans- ing enema. When is it prescribed? Give the structure of the large intestine. Subject Matter: 1. Lack of regularity in going to stool at a definite time each day. 2. Sedentary habits. 3. Faulty diet. 4. Anatomic defects. An enema is a rectal injection given to cleanse the colon, or pro- vide a patient with medication or nourishment. . Cleansing or evacuating. . Carminative. . Emollient. Sedative. . Stimulating. Nutrient. . Anthelmintic. . Antiseptic. . Astringent. 10. Saline. OOTY WN An evacuating or cleansing enema is a rectal injection of a solution which softens the feces, distends the colon and rectum, and thereby causes a free evacuation. An evacuating or cleansing enema is prescribed: 1. When the peristaltic action of the intestine is defective, causing an accumulation of feces in the rectum and lower colon. 2. When the character of the stools indicate that the waste products are not being eliminated properly. Except in some parts, where the serous coat only partially covers it, and the rectum, where the serous coat is lacking, the large intestine has the usual four coats. Beginning at the inner lining these coats are: 1. Mucous. 2. Areolar, or submucous. 3. Muscular. : 4. Serous. 82 NURSING TECHNIQUE Method of Presentation: Classify the divisions of the large intestine. What are the functions of the large intestine? Define the sigmoid flexure. Describe the rectum. Describe the anus. Give the solution and tempera- ture of a cleansing enema. Subject Matter: The large intestine is divided into three parts: 1. The cecum, with its attach- ment—the vermiform ap- pendix. 2. The colon: (a) Ascending. (6) Transverse. (¢) Descending, with sig- moid flex- ure. 3. The rectum. (Williams’ Anatomy and Phys- iology.) The functions of the large in- testine are three: 1. The process of digestion is continued. 2. The process of absorption is continued. 3. The waste products are re- moved from the body. (Kimber and Gray's Anatomy and Physiology.) The sigmoid flexure is that part of the colon between the descend- ing colon and the rectum. It makes a curve resembling a letter S. The rectum is from 6 to 8 inches long and passes downward in the curve of the sacrum and coccyx to terminate in the lower opening of the tract—the anus. (Williams’ Anatomy and Phys- iology.) The anus is the aperture lead- ing from the rectum to the ex- terior of the body. It is formed by both voluntary and involun- tary muscle fibers, comprising two sphincters, internal and external. (Williams’ Anatomy and Phys- iology.) The solution commonly used for a cleansing enema is a mild soap-suds, although normal saline is sometimes prescribed. The temperature is 105° F. GIVING CARMINATIVE ENEMATA 83 Method of Presentation: Why should the patient be on her left side with the knees flexed? In what condition would it be necessary to give the enema on a bed-pan? How much solution is usually given and what danger attends giving more? What would you record after a cleansing enema? Subject Matter: The patient should be on her left side, if possible, so that the fluid by gravity will flow into the sigmoid and descending colon. The knees should be flexed, the right slightly more than the left to relax the abdominal muscles. It would be necessary to first place the bed-pan under the pa- tient when the sphincters are re-' laxed or torn so that it is impos- sible for the patient to retain the solution even for a few minutes. From 2 to 4 pints are usually used for an adult and from 3 to 15 pints for a child. More than this should not be used without a doctor’s order on account of the danger of overdistention of the intestine and injury to its walls. Record: 1. Hour and treatment. 2. Amount of solution injected. 3. Character of return flow. GIVING CARMINATIVE ENEMATA A carminative enema is a rectal injection of a solution containing a drug that has a carminative action. Substances are used that have an irritant effect on the nerve endings of the mucous membrane of the in- testine. As a consequence the intestinal muscle contracts, peristalsis is stimulated, and the flatus is expelled. Temperature of solution: From 110° to 118° F. Requaisites: 1. Bath blanket. 2. Bed-pan, cover, and toilet paper. 3. Tray with: 1. Reservoir supplied with high rectal tube and stop-cock. 2. Small basin. 3. Tube of vaselin. 4. Gauze squares. 5. Protector. Procedure: Connect the rectal tube to the reservoir and close the stop-cock. Place the free end of the rectal tube in the small basin. Prepare the prescribed solution and pour it into the reservoir. Cover the tray with a dressing towel and carry the requisites to the bedside. Proceed as with a cleansing enema except that the rectal tube is inserted into the rectum about 5 inches. Give the enema slowly and if the prescribed enema is a small one, encourage the patient to retain it 84 NURSING TECHNIQUE from fifteen to thirty minutes. Carry the tray to the utility room and thoroughly cleanse and sterilize the rectal tube and basin. Leave the tray equipped for the next treatment. Carminative enemata commonly prescribed: 1. Tr. asafetida, 2 drams. Hot strong soap solution, 1 pint. Retain fifteen to thirty minutes. If not effectual, follow it with a cleansing enema. 2. Turpentine, 4 drams. Glycerin, 4 ounces. Hot strong soap solution, 1 pint. Retain fifteen to thirty minutes. If not effectual, follow it with a cleansing enema. Fig. 14.—Tray equipped for a carminative enema. 3. Fel bovis, 2 drams. Glycerin, 4 drams. Hot strong soap solution, 1 pint. Retain fifteen to thirty minutes. If not effectual, follow it with a cleansing enema. 4. Alum, 2 ounces. Hot water, 2 pints. To be expelled immediately or siphoned off. 5. 1-2-3 enema. Magnesium sulphate, 1 ounce. Glycerin, 2 ounces. Hot water, 3 ounces. Retain fifteen to thirty minutes. If not effectual, follow it with a cleansing enema. 6. Spirits of peppermint, 2 drams. Hot strong soap solution, 1 pint. Retain fifteen to thirty minutes. If not effectual, follow it with a cleansing enema. ENEMATA: EMOLEIENT, SEDATIVE, AND STIMULATING 85 7. Milk, 8 ounces. Molasses, 8 ounces. Retain fifteen to thirty minutes. If not effectual, follow it with a cleansing enema. 8. Cold water enema: Tap water, 1 to 2 pints. . Give it quickly and have the patient expel it as soon as possible. If not able to do so, siphon it off. Record: 1. Hour and treatment. 2. Formula and amount. 3. Length of time retained. 4. Character of the return. 5. Amount of flatus expelled. References: Sanders’ Modern Methods in Nursing, pp. 164-168. Harmer’s Principles and Practice of Nursing, p. 111. Pope's Practical Nursing, pp. 378-380. Blumgarten’s Materia Medica, pp. 137-141. Pope’s Materia Medica and Pharmacology, pp. 53-54. Stoney’s Materia Medica for Nurses, pp. 26 and 27. ENEMATA: EMOLLIENT, SEDATIVE, AND STIMULATING An emollient enema is a rectal injection of some bland solution given for the purpose of soothing irritated mucous membrane and for checking diarrhea. Common prescriptions are: 1. Cornstarch, 2 drams. Cold water, 1 ounce. Mix it to a smooth paste and add 5 ounces of boiling water. Boil the mixture one or two minutes and cool it to 105° F. If laudanum (tincture of opium) is prescribed, add it to the enema just before giving. 2. Pearl barley, 1 ounce. Boiling water, 1 quart. Wash the barley in cold water. Pour the boiling water over the barley and allow it to simmer until reduced to 1 pint. Strain it and give undiluted at 103° F. The prescribed amount is from 3 to 6 ounces. A sedative enema is a rectal injection of a solution containing a drug that will allay nervousness. Common prescriptions are: 1. Chloral hydrate, 20 grains. Dissolve the prescribed amount in 3 ounces of olive oil or the same amount of milk. Or a starch enema may be used as the base. Give it at a temperature of 105° F. 2. Sodium bromid, 40 grains. Dissolve the prescribed amount in 3 ounces of milk and give it at a temperature of 105° F. . 3. Paraldehyd, 2 drams. Mix the prescribed amount with about 3 ounces of boiled starch and give it at a temperature of 105° F. 86 NURSING TECHNIQUE A stimulating enema is a rectal injection of a solution containing a drug that will act as a general stimulant in shock or collapse. Common prescriptions are: 1. Strong black coffee, 5 to 6 ounces. Give it at a temperature of 115° F. 2. Normal saline, 4 ounces. Brandy or whisky, 2 ounces. Dilute the brandy or whisky with the hot normal saline and give it at a temperature of 115° F. Reguisites: 1. Bath blanket. 2. Tray with: 1. Small reservoir supplied with 3 or 4 inches of tubing and a stop-cock. 2. Glass connection. 3. Catheter (in small basin). 4. Tube of vaselin. 5. Gauze squares. 6. Protector. Fig. 15.—Tray equipped for a sedative, stimulating, nutrient, or emollient enema. Procedure: Connect the free end of the tubing (attached to the reservoir) to the catheter by means of the glass connection. Close the stop-cock and pour the prescribed solution into the reservoir. Cover the tray with a dressing towel and carry the requisites to the bedside. Proceed as with a purgative enema, except that the upper covers are turned back half- way instead of to the foot of the bed. Expel the air, lubricate the cath- eter and insert it into the rectum from 4 to 8 inches. Wait an instant be- fore allowing the solution to enter the rectum. Then open the stop-cock and elevate the reservoir so that the solution will flow in slowly. When all the solution has been given close the stop-cock, remove the catheter, and make pressure against the anus with the protector until the desire ENEMATA: NUTRIENT AND OIL 87 to expel the solution has ceased. Make the patient comfortable. Care for the tray and equip it for the next treatment. Points to be remembered: When giving an enema to be retained it is necessary: 1. To keep the patient quiet after giving the enema. 2. To avoid all stimuli either mental or physical which might excite peristalsis. 3. To have the rectum and colon free from feces. 4. To aid the patient to retain the enema by elevating the foot of the bed in some conditions. Record: 1. Hour and treatment. 2. Formula and amount. 3. Whether retained or expelled. 4. Length of time retained. 5. Patient's reaction to the treatment. References: Sanders’ Modern Methods in Nursing, pp. 155-167. Blumgarten's Materia Medica, pp. 292-297 and 366-382. Pope's Practical Nursing, p 380. Harmer’s Principles and Practice of Nursing, p. 112. Stoney’s Materia Medica for Nurses, pp. 28, 29, 32, 33. ENEMATA: NUTRIENT AND OIL A nutrient enema is a rectal injection of a concentrated, partially di- gested liquid food. Temperature of solution: 105° F Common prescriptions are: 1. Liquid peptonoids, 3 ounces. Normal saline, 3 ounces. 2. One egg. Peptonized milk, 4 ounces. Salt, 10 grains. To peptonize milk: Fairchild’s peptonizing powders contain extract of pancreas, 5 grains, and soda bicarbonate, 15 grains. Dissolve one powder in 4 ounces of fresh cold water and add 12 ounces of fresh milk. Place the mixture in a water-bath of 105° F. for fifteen minutes, then place it on ice for use. To prepare enema: Cut the egg white with a scissors and add it to the salt and egg yolk. Mix it with 4 ounces of peptonized milk and give the enema at a tem- perature of 105° F 3. Dextrose, 2 ounces. Hot water, 3 ounces. Requisites: The same as for an emollient enema. Procedure: Proceed in the same manner as when giving an emollient enema. When nutrient enemata are prescribed four times daily the following routine is observed: 88 NURSING TECHNIQUE 6 A. M.—A cleansing enema of normal saline. 10 A. m.—A nutrient enema. 2 Pp. M.—A nutrient enema. 6 pr. M.—A nutrient enema. 10 rp. m.—A nutrient enema. An oil enema is a rectal injection of olive oil given to soften feces or to act as an emollient for irritated mucosa. : Temperature: 105° F. Common prescriptions are: 1. Olive oil, 5 ounces. 2. Castor oil Olive oil l= 2 ounces. Glycerin * i il, i 3 oe on), } 78 3 ounces. Requisites: The same as for an emollient enema, except that a large catheter or a small rectal tube is used. Procedure: Proceed in the same manner as when giving an emollient enema. The oil enema is frequently retained six to eight hours and followed by a cleansing enema. Record: 1. Hour and treatment. 2. Formula and amount. 3. Whether retained or expelled. 4. Length of time retained. References: Sanders’ Modern Methods in Nursing, pp. 162-164. Harmer’s Principles and Practice of Nursing, pp. 109 and 528-531. Pope’s Practical Nursing, pp. 379-382. ENEMATA: ANTHELMINTIC, ANTISEPTIC, ASTRINGENT, AND SALINE An anthelmintic enema is a rectal injection of a solution containing a drug that will destroy thread worms, which often inhabit the large in- testine. Temperature of solution: 105° F. Common prescriptions are: 1. Infusion of quassia, 6 ounces. To make infusion of quassia: Pour 1 pint of boiling water over 1 ounce of quassia chips. When cold, strain the water off. Give a cleansing enema and follow it in two hours with the quassia enema. If not expelled in thirty minutes, siphon it off. 2. Tannic acid, 30 grains. Hot water, 1 pint. Give a cleansing enema and follow it in two hours with the tannic- acid enema. If not expelled in thirty minutes, siphon it off, APPLICATION OF OINTMENTS—INUNCTIONS—LINIMENTS 89 3. Alum, 30 grains. Hot water, 1 pint. Give a cleansing enema and follow it in two hours with the alum enema. If not expelled in thirty minutes, siphon it off. Requisites: The same as for an emollient enema. Procedure: Proceed in the same manner as when giving an emollient enema. An antiseptic enema is a rectal injection of a solution containing a drug that will destroy micro-organisms. These enemata are usually given in the form of enteroclysis, in the treatment of dysentery and cholera. Requisites and procedure found in Medical Nursing Procedures (Junior Year). Common prescriptions are: 1. Silver nitrate, 10 grains. Water, 1 pint. 2. Alum, 30 grains. Hot water, 1 pint. 3. Tannic acid, 30 grains. Hot water, 1 pint. An astringent enema is a rectal injection of a solution containing a drug that will contract the tissues and blood-vessels and thereby check bleeding. Prescribed frequently in the form of enteroclysis for the re- lief of inflammation. Temperature of solution: 120° F. A saline enema is a rectal injection of a salt solution, given for the purpose of providing the body with fluid. Temperature of solution: 108° F. Regquisites and procedure: When prescribed in small quantities, proceed in the same manner as when giving a emollient enema. The treatment is frequently prescribed in the form of enteroclysis and proctoclysis. Procedure for proctoclysis found in Freshmen Year Course (Second Semester). References: Sanders’ Modern Methods in Nursing, pp. 167-171. Blumgarten’s Materia Medica, pp. 176-187 and 554-623. Harmer’s Principles and Practice of Nursing, pp. 106-108 and 112. Pope's Practical Nursing, p. 378. Stoney’s Materia Medica for Nurses, pp. 23-25. APPLICATION OF OINTMENTS—INUNCTIONS—LINIMENTS An ointment is a fatty medicated preparation for external use of such consistence that it melts when applied to the skin. (Dorland’s Medical Dictionary.) Inunction is the act of annointing or of applying an ointment with friction. (Dorland’s Medical Dictionary.) 90 NURSING TECHNIQUE Prescribed: 1. To alleviate skin affections. 2. That they may be absorbed and produce local or systemic effects. Requisites: . Various kinds of ointments. . Spatula. . Sterile gauze. . Bandages. . Adhesive tape. . Liniment. Method of application: 1. By inunction. 2. Directly to the part. Procedure: By inunction: Wash the skin with soap and warm water (and ether if possible) to remove sebaceous material that prevents absorption. Then rub the ointment (taking a small amount at a time) over the prescribed area until it has all disappeared. (This usually takes from fifteen to twenty minutes.) Darectly to the part: Take a clean spatula and remove some ointment from the jar. Spread it on gauze the required size and secure it to the effected part by means of a bandage, binder, or adhesive tape. Record: . 1. Hour. 2. Kind of ointment. 3. Method of application. 4. Site of application. A liniment is an oily liquid preparation of drug or drugs for external application. Its action is chiefly counterirritant. To apply a liniment: Place the patient in a comfortable position and expose the area to be treated. Pour some liniment on the area and rub it in with the open palm of the hand for ten minutes. Liniments are sometimes applied on a piece of flannel or gauze which prevents evaporation and keeps the part warm. However, some liniments will produce a blister if they are rubbed in or covered, so it is well to receive definite orders when apply- ing a liniment one is not familiar with. Record: 1. Hour. 2. Kind of liniment. 3. Site of application. References: Sanders’ Modern Methods in Nursing, pp. 152-154 and 373-375. Blumgarten’s Materia Medica, pp. 83 and 84. Pope’s Practical Nursing, pp. 501-504. Harmer’s Principles and Practice of Nursing, pp. 329, 331, 332, 333, and 438. Stoney’s Materia Medica for Nurses, pp. 15-17. ON UT WN = ADMINISTRATION OF SUPPOSITORIES 01 ADMINISTRATION OF SUPPOSITORIES A suppository is an easily fusible medicated mass to be introduced into the rectum, vagina, or urethra. Drugs are administered in this way so that they may produce sys- temic or local effects. : Classification of rectal suppositories: 1. Anodyne: Given for local and general effects. 2. Evacuant: Given to produce a defecation. 3. Ice: Given to check local bleeding and for the relief of local in- flammation. 4. Astringent: Given to contract the tissues and blood-vessels. 5. Specific: Specifics are administered by suppository when they cannot be taken by mouth. Regquisites: 1. Various kinds of rectal suppositories. 2. Gauze squares. 3. Tube of vaselin. 4. Hard-rubber enema tip. Soap suppository: Cut a splinter of soap, 1 to 3 inches long. Wash it in hot water to smooth the rough edges. Ice suppository: Select a piece of ice of suitable size and shape. Wash it in warm water to smooth the sharp edges. To administer a rectal suppository: Procedure: Place the suppository on a piece of gauze and lubricateit. (Glycerin, soap, and ice suppositories excepted.) Carry it and a hard-rubber tip to the bedside. Place the patient on her side if possible, otherwise she may be in the dorsal recumbent position. Insert the suppository into the rectum and follow it up with the enema tip so that the suppository is inserted about 3 inches. Apply pressure over the anus for a few moments until the patient has no desire to expel the suppository. Vaginal suppository: Vaginal suppositories are larger in size. They are used for intro- duction into the vagina in treatment of inflammatory conditions of the cervix and walls of the vagina. Requisites: Tray with: 1. Vaginal suppository. 2. Sterile towel. 3. Sterile glove. 4, Vaginal pad. 5. T-binder. Procedure: Cleanse the external genitals, if necessary. Wash your hands. Carry the tray to the bedside. Place the patient in the dorsal recumbent po- sition and drape her. Place the sterile towel surrounding the vagina. Put on the sterile glove and insert the suppository into the vagina as far as the fingers can be introduced. Apply a vaginal pad and a T-binder. 92 NURSING TECHNIQUE Urethral suppository: Urethral suppositories are a great deal smaller and longer. They are seldom used. Regquasites: Tray with: . Two sterile solution basins. . Flask green soap. . Sterile cotton. . Suppository on a sterile towel. . Sterile glove. . Sterile lubricant. . Paper bag for waste. Procedure: Wash your hands. Prepare warm sterile water and a 2 per cent. so- lution of boracic acid for cleansing the external genitals. Carry the tray to the bedside. Place the patient in the dorsal recumbent position and drape her. Cleanse the external genitals thoroughly (especially the meatus) with green soap, sterile water, and boracic solution. Put on the sterile glove and lubricate the suppository. Place the sterile towel surrounding the urethra. Insert the suppository as far as it can be in- troduced. Record: 1. Hour. 2. Kind of suppository. 3. Length of time retained, if the patient expels it. 4. Patient's reaction. References: Sanders’ Modern Methods in Nursing, pp. 171 and 172. Harmer’s Principles and Practice of Nursing, pp. 436-439. NONULR WN = DISMISSAL OF PATIENTS Discourteous treatment on the day of dismissal makes a patient for- get to a large extent the many kind acts of those in attendance and the good nursing care received during her stay in the hospital. It is, there- fore, the duty of the nurse to see that the patient leaving the hospital receives the same consideration the patient does on admittance. Procedure: . When the attending physician or the intern on service has written the order of dismissal the following routine is observed: 1. Take the complete record to the admitting office. 2. Serve liquid nourishment if two or more hours have elapsed since food has been taken. 3. Check over with the patient the itemized list of clothing and valu- ables and give her any assistance required in dressing. 4. Inform the Supervisor of the ward when the patient is ready to depart. 5. Provide a wheel chair if the patient's condition indicates the use of it. 6. Accompany the patient to the waiting machine and bid her good- bye as you would a guest in your own home. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION 93 QUESTIONS FOR GENERAL REVIEW AND EXAMINATION Why is it essential for schools of nursing to give a thorough course in the prin- ciples and practice of nursing? Define nursing technique. What points would you bear in mind in carrying out all nursing procedures? (a) Define hospital. (b) What are the functions of the hospital? (a) Give the classification of hospitals. (b) What does the organization of the hospital include? What important factors should be considered in the daily care of the ward? (a) Define ventilation. (b) What important points would you remember when ventilating a room? What temperature would you advise for the following rooms: (a) General ward? (b) Bath-room? (c) Surgery? How would you prevent odors in a hospital? What points would you remember in dusting and cleaning? Give some general rules for the removal of stains from linen. (a) How may stains be classified? (5) How would you remove the following stains: Blood, ink, iodin, coffee, vaselin, rust, and mildew? (a) Name some hospital parasites and animals which may be termed pests. (b) Does the nurse play an important part in ridding the hospital of such nuisances? What points would you remember in stripping and airing a bed? What points would you remember when making a closed bed? How would you care for the bed, mattress, pillows, and rubber sheets after the discharge of a patient with an infectious disease? How would you care for the enameled ware after the discharge of every patient? Do you think patients should have the exclusive use of bed utensils? What points would you bear in mind in cleaning a medicine case? How can perfect order be maintained in a linen room? Give the routine care of: (a) Beds. (b) Mattresses. (c) Pillows. (d) Blankets. (a) Why is the mission of flowers sometimes defeated? (5) What rules are nec- essary for the care of hospital flowers? Do you think a bed-pan should be warmed before giving it to a patient? Do you think a patient should be douched externally after using a bed-pan? Should a patient be allowed to wash her hands after using the bed-pan? How would you douche a patient externally and measure the urine? What precaution would you observe when douching a patient externally? What would you note and record when removing the bed-pan? What points would you remember when serving a patient house diet? When serving liquid diet? How many times do you go around a bed when making a closed one? (a) Would you consider the number of times you go around the bed when making it with a patient in it? (5) What points would you bear in mind? (a) Define body temperature. (5) How is it measured? How does a clinical thermometer differ from a bath thermometer? (a) Define fever. (b) Describe the course of fever. (c) Name the definite types of fever. giving an example. (a) List the requisites on a mouth thermometer tray. (b) On a rectal ther- mometer tray. What points would you remember: (a) When taking a mouth temperature? (b) A rectal temperature? (a) What are the freezing- and boiling-points of water on a Fahrenheit ther- mometer? (b) On a Centigrade thermometer? % (a) How do you convert Fahrenheit to Centigrade? (b) Centigrade to Fahren- eit? 94 NURSING TECHNIQUE (a) Convert 104° F. to C. (0) Convert 300°C.to F. (c) Convert 284° F. to C. (d) Convert 300° C. to F. Define: (a) Pulse. (b) Systole. (c) Diastole. What would you note and record when taking the pulse? Define: (a) Frequency. (b) Force. (c) Pressure. Describe the following: (a) A regular pulse. (b) An intermittent pulse. (c) A water-hammer pulse. (d) A dicrotic pulse. (e) A thready pulse. (f) A running pulse. (g) An infrequent pulse. (a) What is the usual ratio of pulse to temperature? (b) What is the average normal degree of blood-pressure, systolic and diastolic? (c) What is the normal pulse rate in the adult male, female, child ten to twelve years, infant two to three months, and infant at birth? (a) Where may pulse be counted and its character observed? (b) Give six examples. What points would you remember when taking the pulse? Define: (a) Respiration. (b) Internal respiration. (c) External respiration. (a) What is the usual ratio of breathing to the pulse? (b) What is the average normal frequency in the adult male, female, child ten to twelve years, and infant? Define the following: (a) Eupnea. (b) Dyspnea. (c) Orthopnea. (d) Polyp- nea. (¢) Apnea. Describe the following: (a) Edematous respiration. (b) Stertorous respiration. (¢) Accelerated respiration. (d) Cheyne-Stokes respiration. What would you record when taking the respirations? (@) What care would you give the mouth of a convalescent patient? (0) When would you use a lubricant? (c) When would you use an astringent mouth-wash? (a) ‘What lubricants would you use? (0) Give the formula for a mouth-wash. (¢c) Define sordes. Why would you inspect the head closely when combing the hair of a patient just admitted to the hospital? What is the usual procedure when pediculi are found? Would you wash a patient’s hair without special orders? What would be your feelings if your patient developed a pressure sore? What would you do? . . (a) Define a pressure sore. (b) What are the causes? (c) Where are they likely to form and what patients are in danger of developing them? What preventive measures would you use? What treatment is usually prescribed? (a) Give the temperature of a cleansing bath. (b) List the requisites for same. (¢) What temperature would you recommend for the room? (a) What points would you bear in mind in giving a cleansing bath to a patient in bed. (b) When is the ideal time for a patient’s bath? Do you think that carrying out orders and giving treatments is all that con- stitutes good nursing? What means would you use to secure physical and mental comfort for patients? (¢) How are changes in a patients condition manifested? (b) Define and give the classification of symptoms, giving three examples of each group. What points would you remember: (a) In sitting a patient up in bed. (0) In sitting a patient up in a chair. (c) In lifting a patient from the bed to the operating cart. (¢) What tray would you use when assisting with a physical examination? (b) List the requisites on same. What methods does a physician employ in a physical examination? What are a nurse’s duties in assisting with a physical examination? When would you turn a mattress with a patient in the bed? Give the temperature of the bath-room and water when giving a cleansing tub-bath. How long would you permit a patient to remain in the tub? What points would you remember when giving a tub-bath? (a) When is a Klondike bed indicated? (b) What points would you remember in making a Klondike bed; an ether bed? QUESTIONS FOR GENERAL REVIEW AND EXAMINATION 95 (a) Why are air and water mattresses used? (b) What is a fracture board and why is it used? (c) What is a cradle and why is it used? (a) What are sand-bags and why are they used? (6) What is a Bradford frame and why is it used? What points would you remember in using: (a) Ice-caps; (b) hot-water bottles; (c) electric pads? (a) What care should a nurse give her hands? (5) What points would you remember in scrubbing your hands in preparation for operations and treatments? (a) How would you sterilize nail brushes; (b) catheters; (c) gastric lavage tubes; (d) rectal tubes? (a) How would you disinfect rubber goods that will not stand boiling? (b) How would you sterilize glass utensils? (c) What agent may be used in the water when boiling rubber goods to prevent the rubber from becoming soft? What points would you remember in sterilizing instruments? (a) List the requisites on a surgical dressing tray. (b) What are a nurse's duties when assisting with a surgical dressing? (c) What would you record after a surgical dressing? (a) Why are binders used? (b) What binders are in common use? (a) What would you look for when undressing a patient on admission? (b) What routine would you observe in caring for the patient? How would you treat very dirty hands and feet? (a) Give the classification of pediculi found on the body. (b) What is the usual procedure when pediculi are found? What points would you remember when caring for a patient’s personal be- longings? (a) Define a foot-bath. (b) When is it prescribed? Give the duration of the treatment, the solutions generally used, and the tem- erature. Pp (a) List the requisites for a foot-bath. (b) What would you record after the treatment? (a) Define a sitz-bath. (5) When is it prescribed? Give the duration of the treatment, the solutions generally used, and the tem- perature. (a) List the requisites for a sitz-bath. (b) What would you record after the treatment? Give the technique for collecting the following specimens: (a) Feces. (b) Sputum. (¢) Gastric contents. (d) An admission specimen of urine. (e) A typhoid specimen of urine. Give the technique for collecting: A twenty-four-hour specimen of urine. (a) What points would you remember in collecting all laboratory specimens? (0) What would you record? (a) Define an enema. (b) Give the classification. (a) Give the temperature of enemata. (5) Describe the position of the patient for the treatment. (a) How much solution is given an adult for an evacuating or cleansing enema? (b) A child? (¢) An infant? How much solution is given when the enema is to be retained as a stimulating, emollient or a nutrient enema? (a) Define constipation. (b) What are the common causes? (a) Define an evacuating or cleansing enema. (b) When is it prescribed? (a) Give the structure and classify the divisions of the large intestine. (b) What are the functions of the large infestine? (a) Define the sigmoid flexure. (b) Describe the rectum. (¢) Describe the anus. Why would you place a patient on her left side with the knees flexed when giving an enema? In what condition would it be necessary to give the enema on a bed-pan? (a) What danger attends giving more than four pints for a cleansing or evacuat- ing enema? (b) What points would you remember when giving an evacuating or cleansing enema? 96 NURSING TECHNIQUE ‘What would you record after a cleansing enema? (a) Define a carminative enema. (b) If the formula were not prescribed, would you Fase up your own. (¢) What would you record after giving a carminative enema (a) Define an emollient enema. (b) Define a sedative enema. (a) Define a stimulating enema. (b) If the ingredients were not prescribed, would you make up your own formula? (a) What points would you remember when giving an enema to be retained? ~(b) What would you record after such an enema? Define a nutrient enema. Why must food be predigested when given per rectum? (a) What can a nurse do to aid a patient in retaining a nutrient enema. (b) Why should glycerin not be used in lubricating the catheter? {a) Why are oil enemata given? (b) Define an anthelmintic enema. (a) Define an antiseptic enema. (b) How are these enemata frequently given? Classify the following enemata: (a) Alum, 30 grains. Hot water, 1 pint. (b) Liquid peptonoids, 3 ounces. Normal saline, 3 ounces. (c) Starch enema. (d) Chloral hydrate, 20 grains. Olive oil, 3 ounces. (e) Black coffee, 5 ounces. (f) Milk, 8 ounces. Molasses, 8 ounces. (g) Infusion of quassia, 8 ounces. (h) Fel bovis, 2 drams. Soap solution, 1 pint. (7) 1-2-3 enema. (j) Silver nitrate, 10 grains. Hot water, 1 pint. (k) Tincture asafetida, 2 drams. Soap solution, 1 pint. Define: (a) An ointment. (b) An inunction. (¢) Why are they prescribed? (a) Define a liniment. (b) Give the technique for the application of liniments. Define a suppository. Give the classification of rectal suppositories. ‘What would you record after administering a suppository? ‘What routine would you observe when dismissing a patient? DEMONSTRATIONS Strip and air a bed. Make a closed bed. Demonstrate dusting and cleaning a room (the daily care). Make a bed for a convalescent patient. Demonstrate washing a bed after the discharge of a patient. Demonstrate cleaning a room and bath-room after the discharge of a patient. Demonstrate putting away linen. Demonstrate giving and removing the bed-pan. Make a bed with a patient in it. (a) Demonstrate taking a mouth temperature. (b) A rectal temperature. (c) An axillary temperature. (a) Demonstrate taking a child’s temperature. (b) An infant’s temperature. Demonstrate taking the pulse and respirations. Replace the upper covers with a bath blanket. Remove and replace the pillows, demonstrating three methods. Demonstrate removing and putting on a nightgown. Demonstrate rubbing a patient’s back with alcohol. DEMONSTRATIONS 97 Prepare the requisites for cleaning the mouth and teeth of a convalescent patient. Comb and brush a patient’s hair. Prepare the requisites and demonstrate the care of the head when pediculi are present. Demonstrate washing a patient’s hair in bed. Improvise means to relieve pressure from the heels and elbows. Demonstrate giving a cleansing bath to a bed patient. Demonstrate various methods for making a patient comfortable. Move a patient up in bed, demonstrating four methods. Sit a patient up in bed and improvise a back-rest. Sit a patient up in bed, demonstrating the use of a portable back-rest. Demonstrate sitting a patient up in a bed equipped with a back-rest. Demonstrate: (a) Sitting a small helpless patient up in the chair and putting her back to bed. (b) Sitting a large helpless patient up in the chair and putting her back to bed. (c) Sitting a patient up in the chair and putting her back in bed when she needs support only on account of the height of the bed. 7% Improvise means for carrying a patient from one room to another when the patient may sit up but cannot walk. Demonstrate placing the stretcher and lifting a patient from the bed to the operating cart. Demonstrate assisting a physician with a physical examination. Prepare a child: (a) For an examination of the chest; (b) for examination of the eye, ear, nose, and throat. Prepare a patient for examination of the eye, ear, nose, and throat. Demonstrate two methods for turning a mattress (with a patient in the bed). Demonstrate two methods for changing a mattress (with a patient in the bed). Demonstrate how you would care for a patient in the morning if you were not giving a bath. a mmstrte how you would care for a patient when preparing him for the night. Prepare a bath-room for a patient and demonstrate giving a tub-bath. Prepare an anesthetic bed and table. Make a Klondike bed. Demonstrate how you would arrange the upper covers on a bed when the patient’s leg is covered with a cradle. Demonstrate: (a) Preparing an ice-cap for use. (b) The care after use. Demonstrate: (a) Preparing a hot-water bottle for use. (b) The care after use. Prepare an ice-coil for use. Prepare an electric pad for use. Scrub the hands, demonstrating two methods. Demonstrate sterilizing nail brushes and orange wood sticks after use. Prepare rubber gloves for the autoclave. : Demonstrate: (a) Putting on dry sterile gloves. (b) Putting on wet sterile gloves. Sterilize the following: (a) Rubber catherer. (b) Gastric lavage tube. (c) Rectal tube. (d) Enema tip. (e) Glass douche tip. Sterilize the following: (a) Ewald evacuating bulb. (b) Silk bougie. (c) Pessary. (d) Glass syringe. (¢) Hard-rubber syringe. Demonstrate the care of a rubber dressing sheet that had been used for an infectious disease. Demonstrate how you would care for and sterilize instruments that had been used for a surgical dressing. Demonstrate how you would disinfect a scalpel if a physician would not permit you to boil it. Demonstrate assisting with an abdominal dressing (clean). Demonstrate assisting with an abdominal dressing with drainage. Demonstrate assisting with a dressing on the leg. 7 98 NURSING TECHNIQUE Apply: (a) A scultetus binder, postoperative. (b) A breast binder for com- pression. Apply: (a) A T-binder. (b) A straight binder, postpartum. Demonstrate admitting and putting to bed a stretcher patient. Apply a soap poultice to the feet for cleansing purposes. Demonstrate how you would care for a patient’s personal belongings, on his admittance to the hospital. Give a foot-bath to a patient in bed. Give a mustard foot-bath to a patient sitting up in the chair. Demonstrate giving a sitz-bath. Prepare the following specimens for the laboratory: (a) Feces. (0) Sputum. (¢) Gastric contents. (d) Urine. Prepare the following specimens for the laboratory: (a) A twenty-four-hour specimen, for tubercle bacillus. (b) A twenty-four-hour specimen, for a urologic patient. Prepare and give an evacuating anema: (a) To an adult. (b) To a child. (c) To an infant. Prepare and give: (a) A 1-2-3 enema. (b) A milk and molasses enema. Prepare and give: (a) A starch enema. (b) Chloral hydrate, 20 grains per rectum. Prone and give: (a) A stimulating enema. (b) A nutritive enema of milk and egg. Prepare and give an oil enema and follow it in six hours with an evacuating enema. Prepare and give a quassia enema. Demonstrate applying zinc ointment to the forearm. Apply a liniment to the knee-joint. Administer the following suppositories: (a) Glycerin. (b) Codein. (c) Vaginal. (d) Urethral. FRESHMEN YEAR SECOND SEMESTER ELEMENTARY PROCEDURES DOUCHES By a douche is meant a stream of water directed against a part or into a cavity. Douiches are prescribed for cavities: 1. To cleanse. Dials ; 2. To relieve inflammation. LAL tr, es 3. To check hemorrhage. STH uw east, tes evs 4. To disinfect. wee BR paella Douches are prescribed for external parts: ; 1. To invigorate the nervous system. 2. To produce a sedative effect. VAGINAL DOUCHE A vaginal douche consists of a stream of plain or medicated water directed into the vaginal cavity under low pressure. Solutions prescribed: . Bichlorid of mercury, 1 : 3000 to 1 : 10,000. . Sterile water. . Normal saline. . Boracic acid, 2 per cent. . Lysol, to § per cent. . Carbolic acid, § to 1 per cent. . Green soap, 1 per cent. . Soda bicarbonate, 2 per cent. . Silver nitrate, 1/10 per cent. 10. Potassium permanganate, 1/10 to 1 per cent. 11. Alum, 3 to 1 per cent. Temperature of solution: 1. For cleansing, 105° F. 2. For inflammation, 115° F. 3. For hemorrhage, 120° F. Quantity generally used: Two or 3 quarts. Position of patient: Dorsal recumbent. Regquisites: . Irrigator stand. Sheet for draping. . Bath blanket (for chest if indicated). . Douche pan and cover. Tray with: (a) Reservoir supplied with tubing and stop-cock (sterile). (6) Douche nozzle (sterile). : (¢) Solution basin (sterile). (d) Sterile cotton. (¢) Paper bag. (f) Protector. O00 ~TON UT WN = Gi LN 101 102 NURSING TECHNIQUE Procedure: Scrub your hands and prepare the solution. Prepare the same kind of solution in the basin for washing the external genitals as that pre- scribed for the douche. Connect the douche nozzle with the tubing, being careful that the nozzle is not contaminated. Cover the nozzle with a sterile towel. Close the stop-cock and pour in the solution. Cover the tray and carry all the requisites to the bedside. If the pa- tient is in a ward, screen the bed. Replace the upper covers with a sheet and cover the chest with a bath blanket.! Remove all but one pillow from under the patient’s.head.: Flex her knees and arrange the night- gown so that 1t is out of the way. Place a protector under the patient’s buttocks: : Put-the patient on thie douche pan and drape her. Waght ihe 2xterndl genitals with cotton sponges wet with solution. Do not allow the fingers to come in contact with the mucous membrane and always wash down from the vulva. Separate the labia and remove any visible discharge with a cotton sponge. Hang the reservoir about 2 feet above the level of the patient. Expel the air from the tubing and insert the nozzle carefully into the vaginal cavity. Move the nozzle very gently two or three times during the pro- cedure so that all parts of the cavity and the external surface of the cervix will be reached by the solution. Give the douche slowly and with very little force. Continue the treatment until the prescribed amount has been given. Dry the external genitals with cotton sponges, remove the douche pan and allow the fluid to drain from the vagina. Return to the bedside and dry the patient and make her comfort- able. Remove the tray and thoroughly cleanse the requisites and ster- ilize them.2 Be sure that the stop-cock is open to prevent injury to the rubber tubing. If the douche is given following delivery or operation on the genitals: Proceed in the same manner as far as and including the placing of the patient on the douche pan. Then remove the vaginal pad and cover the genitals with a sterile towel. Drape the sheet around her legs. Hang the reservoir and place the paper bag for waste. Open the pack- age of cotton sponges. Then return to the dressing room and scrub your hands. If the patient's condition does not permit this, immerse them at the bedside in bichlorid solution 1 : 2000 for one minute. Then remove the sterile towel from the vulva and proceed as above. Points to be remembered: Examine the douche nozzle (beforeinsertingit) tosee thatitisintact. Be sure that the solution is the proper temperature. 3. Give the douche slowly and do not use force. 4. Use aseptic technique following delivery or operations on the 5 6 NO = genitalia. . In infectious conditions observe every precaution to avoid con- tracting the infection or carrying it to other patients. . If the patient has a purulent discharge, wear gloves and place the nozzle in the bag for waste. 1 This may be omitted in warm weather. 2 Tf the reservoir and tubing is to be used for the same patient and kept ex- clusively for her use, it will be necessary to sterilize only the douche nozzle before the next treatment. SUBJECT—NURSING TECHNIQUE 103 Record: 1. Hour and treatment. 2. Kind and strength of solution. 3. Character of return flow. Problems: 1. Prepare 2 quarts of a 1/8 per cent. lysol solution. On hand a 5 per cent. solution. 2. Prepare a gallon of silver nitrate solution 1: 6000. On hand a 4 per cent. solution. 3. Prepare 2 quarts of boracic acid solution 3 per cent. On hand a saturated solution. 4. Prepare 2 quarts of potassium permanganate 1 : 1000. On hand potassium permanganate crystals. SUBJECT—NURSING TECHNIQUE Topic: Vaginal douche.! Class: Freshman. Aim of lesson: To impress upon the students the importance of aseptic technique and to develop skill and judgment in carrying out this procedure. OUTLINE 1. Anatomic and physiologic factors to be considered. 2. Definition of vaginal douche and when prescribed. 3. Dangers involved. How infection could travel. 4. Summary. : 5. Assignment. References: Williams’ Anatomy and Physiology, pp. 435-447. Harmer’s Principles and Practice of Nursing, pp. 238-243. Sanders’ Modern Methods in Nursing, pp. 172-175. Kimber’s Anatomy and Physiology, pp. 575-586. Written-up procedure. Illustrative material: Vaginal douche tray. Anatomic chart. Anatomic model. For students: 1. Define vagina: Give the structure and direction of the vagina. 2. How is it connected with the internal genitals? 3. Define: (a) Vulva; (4) uterus; (¢) Fallopian tubes; () external os; (e) internal os; (f) ovaries. . What do you understand by the culdesac of Douglas? . Define a vaginal douche: When prescribed? . Give the solutions used and the temperatures. . When are vaginal douches contraindicated? . What consideration should a nurse show a patient when giving a vaginal douche? : OTN UH ! Another outline of class presentation of a topic in which the anatomic and physiologic factors must be considered. All succeeding topics are to be pre- sented in a similar manner. 104 NURSING TECHNIQUE 9. What precautions would you observe in infectious conditions? 10. What dangers are involved in giving a vaginal douche? 11. What would you record after the treatment? Method of Presentation: Define vagina. Give structure and direction of vagina. How is it connected with the in- ternal genitals? Define vulva. Define uterus. Subject Matter: The vagina is a musculomem- branous canal extending from the cervix to the vulva. Itis a hollow organ with the anterior and pos- terior walls in contact. The anterior wall is from 2 to 3 inches long, and the posterior wall is from 3 to 4 inches long. The walls of the vagina are made up of three layers: 1. Outer, or fibrous. 2. Middle, or muscular. 3. Mucous, or internal. When the patient is in the lith- otomy position, it points down- ward and backward at an angle of 30 degrees with the body. The mucous lining of the vagina is continuous with that of the uterus and through the fallopian tubes with the peritoneum. (Harmer’s Principles and Prac- tice of Nursing.) The vulva is the external part of the organs of generation of the female. The uterus is a hollow, pear- shaped organ about 3 inches long, 2 inches wide, and 1 inch thick. In the virgin state it is situated in the pelvic cavity between the bladder and the rectum. The uterus is divided into three parts: the body, fundus, and neck. The upper part of the uterus above the entrance of the tubes is called the fundus: the narrow constricted portion below, the cervix, part of which extends into the vagina. Between the cervix and the fundus is the body of the uterus. (Williams’ Anatomy and Phys- iology.) SUBJECT—NURSING TECHNIQUE 105 Method of Presentation: Define Fallopian tubes. Define external os. Define internal os. Define ovaries. Subject Matter: The Fallopian tubes or oviducts are two in number, one on each side, and pass from the upper angles of the uterus in a somewhat tortuous course between the folds and along the upper margin of the broad ligaments, toward the sides of the pelvis. They are about 4 inches long and at the point of at- tachment to the uterus are very narrow, but gradually increase in size so that the distal end is larger. The margin of the distal end is surrounded by a number of fringe-like processes called fimbriz. One of these fimbrie is attached to the ovary. The uterine opening of the tube is minute, and will only admit a fine bristle; the abdominal opening is comparatively much larger. (Kimber and Gray's Anatomy and Physiology.) The external os is the lower or distal extremity of the canal of the cervix uteri. The internal os is the internal or upper orifice of the canal of the cervix uteri. The ovaries are the genital glands in the female within which are developed and given off the maternal sex cells. The ovaries are ovoid in shape and measure about 13 inches in length, % inch in width, and % inch in thickness. They are attached at their anterior margin by a short thick band of tissue, the mesovarium, to the pos- terior layer of the broad ligament, near the tubal extremity. They are held in place by three peritoneal folds that act as ligaments. 1. The suspensory ligament. 2. The ovarian ligament. 3. The mesovarium. (Williams’ Anatomy and Phys- jology.) 106 Method of Presentation: What do you understand by the culdesac of Douglas? Define a vaginal douche. In what conditions are vaginal douches used? Give solutions, strength, and temperature commonly prescribed. When are vaginal douches con- traindicated? NURSING TECHNIQUE Subject Matter: The culdesac is a pouch or pocket between the anterior wall of the rectum and the uterus. A vaginal douche consists of a stream of plain or medicated water directed into the vaginal cavity, under low pressure. Vaginal douches are used in the following conditions: 1. Inflammation and congestion of the vaginal or pelvic viscera. 2. Leukorrhea. 3. Hemorrhage from vagina or uterus. 4. As preoperative preparation for operation on the re- productive organs or ex- ternal genitals. (Harmer’s Principles and Prac- tice of Nursing.) Bichlorid, 1 : 3000 to 1 : 10,000. Sterile water. Normal saline. Boracic acid, 2 per cent. Lysol, § to 3 per cent. Soda bicarbonate, 2 per cent. Potassium permanganate, 1/10 to 1 per cent. Silver nitrate, 1/10 per cent. Green soap, 1 per cent. Temperature of solutions: 1. For hemorrhage, 120° F. 2. For inflammation, 115° F. 3. For cleansing, 105° F. Vaginal douches are contrain- dicated: 1. Before or during menstrua- tion. 2. During pregnancy. SUBJECT—NURSING TECHNIQUE Method of Presentation: What consideration should a nurse show a patient when giving a vaginal douche? What precautions would you observe in infectious conditions? What dangers are involved in giving a vaginal douche? What would you record after the treatment? 107 Subject Matter: Consideration for the feelings of the patient must never be for- gotten. The patient may be re- ceiving this treatment for the first time, or even if accustomed to it will not be comfortable in the presence of another. In all treat- ments, even though the patient may lack the ordinary feeling of delicacy and modesty, the nurse owes it to the patient and to herself to maintain this attitude. The patient should be suitably screened, adequately draped, and with no unnecessary exposure. (Harmer’s Principles and Prac- tice of Nursing.) When inflammation is due to infection by the gonococcus, care must be taken to avoid contrac- tion of the infection, or of carrying it to other patients. The nurse should wear gloves, and should be particularly careful to prevent any discharge being carried to the eyes. The patient should have the exclusive use of all utensils used. The sponges should be handled with care and placed in a paper bag and burned in the in- cinerator. (Harmer’s Principles and Prac- tice of Nursing.) Perfect asepsis is of special im- portance, because the peritoneal cavity is highly susceptible to septic influence. The whole gen- ital tract communicates directly with the peritoneum and, there- fore, infection at any point may cause peritoneal sepsis. Record: 1. Hour and treatment. 2. Kind and strength of solu- tion. 3. Character of return flow. 108 NURSING TECHNIQUE PHARYNGEAL DOUCHE A pharyngeal douche consists of a stream of plain or medicated water directed against the mucous lining of the throat. Prescribed: 1. In inflammatory conditions of the throat. 2. In suppurative conditions of the throat. 3. As postoperative treatment for tonsillectomy. Solutions commonly prescribed: 1. Boracic acid, 2 per cent. 2. Normal saline (half-strength). 3. Sodium bicarbonate, 2 per cent. 4. Peroxid of hydrogen, 25 per cent. 5. Dobell’s solution, 25 per cent. 6. Potassium permanganate, 1/10 per cent. Quantity of solution: One quart. Temperature: From 105° to 120° F. Position of patient: 1 Sons recumbent, near the edge of bed, with the head turned to one side. 2. Prone. Requisites: 1. Irrigator standard. 2. Tray with: ; 1. Reservoir supplied with tubing and stop-cock. 2. Pharyngeal douche tip. 3. Basin for return flow. 4. Rubber dressing sheet. 5. Towel and safety-pin. 6. Gauze handkerchief. Procedure: Wash your hands and prepare the solution. Connect the pharyngeal douche tip to the tubing and cover it with a sterile towel. Close the stop-cock and pour in the solution. Cover the tray and carry the re- quisites to the bedside. Place the patient in position and give her a gauze handkerchief. Arrange the rubber dressing sheet and towel so that the patient and bedding will be protected. Place the basin where it will catch the return flow. Instruct the patient! to let the tongue rest within the mouth. Expel the air from the tubing and insert the tip in the upper corner of the mouth. Press down the back part of the tongue with the tip, but avoid touching the back part of the throat. Move the tip from time to time so that the solution will reach all parts of the throat. Continue the treatment until satisfied with the result. Thoroughly cleanse all the requisites and sterilize them. Equip the tray for future use. Points to be remembered: 1. Stop the flow from time to time to prevent the patient from swal- lowing the discharge. 1 A patient frequently prefers to give this treatment herself and no objection is offered if the condition of the patient allows it and the nurse sees that it is satis- factorily given. PUTTING AN ANESTHETIZED PATIENT TO BED 109 2. Avoid using too great pressure. 3. Avoid touching the back part of the throat. Record: 1. Hour and treatment. 2. Kind and strength of solution. 3. Character of return flow. References: Williams’ Anatomy and Physiology, pp. 384-387. Harmer’s Principles and Practice of Nursing, pp. 666-669. Blumgarten’s Materia Medica, pp. 606-609 and 613-615. Paul's Materia Medica for Nurses, pp. 107-109, 122-124 and 291. PUTTING AN ANESTHETIZED PATIENT TO BED Requistites: 1. A Chase doll on the operating cart wrapped as a postoperative patient. 2. Ether bed and table. Procedure: Remove all the articles that might obstruct the passage of the op- erating cart. Open the bed as previously demonstrated and remove the hot-water bottles. Place the cart (according to the arrangement of the room) so that it will be convenient to lift the patient from it and place . her in the bed. Have three lifters (an orderly and two nurses) stand on the same side of the cart. Instruct them to put their armsufider patient as far as possible. Then lift her from the cart when all are ready and informed as to the turns they are to make. When the pa- tient is placed in bed, draw up the upper covers and remove the double wool blanket. Leave the cotton bath blanket covering her unless it is damp from perspiration. Place the-patient in the-position as ordered from-the surgery. Put a pillow under her knees to relax the abdominal muscles and thus lessen the strain on the incision, if an abdominal operation has been performed. If a perineorrhaphy has been done, tie a bandage or towel around the knees to prevent strain on the perineal stitches. Tuck a towel around the neck so that the blankets and other clothing will be protected if the patient vomits. . TT — 43 ~~ Take the reTatare, Se and respiration at once and record E Take and record the pulse every fifteen minutes for the first hour, then hourly to the fourth hour. Then every four hours until discontinued. Take and record the temperature and respiration every four hours until discontinued. Note and record any changes in color of the patient’s skin and character of the respirations. When the patient is conscious, rinse the mouth with cold water (unless contraindicated). When nausea ceases give water in small quantities, gradually increasing the quantity (unless otherwise ordered). Postoperative positions commonly used: 1. Dorsal recumbent: Place the patient flat on the back with the knees flexed. 2. Horizontal recumbent: Place the patient flat on the back with the legs extended or slightly flexed. 110 NURSING TECHNIQUE 3. Prone: 1 Place the patient face downward, with the head turned to either side. 4. Lateral: Place the patient on either side inclining forward. 5. Fowler's: Elevate the head of the bed so that the trunk of the body will be at an angle of 45 degrees in relation to the normal level of the bed. The Fowler position, so called after the American surgeon, George Ryerson Fowler (1848-1906), who first advocated this position in septic abdominal cases, is used so that the pus or fluid will gravitate to the pelvis and be thus retarded from entering the circulation. 6. Exaggerated Fowler's: Elevate the head of the bed so that the trunk of the body will be at an angle of 90 degrees in relation to the normal level of the bed. 7. Reversed Fowler's: Elevate the foot of the bed so that it will be at an angle of 45 degrees in relation to the normal level of the bed. Points to be remembered in lifting and caring for an anesthetized patient: 1. Lift the patient carefully and keep her quiet. 2. Constantly watch the patient’s color, respiration, and pulse. 3. Never leave an anesthetized patient alone until she has entirely recovered consciousness. References: Sanders’ Modern Methods in Nursing, pp. 580-597. Pope’s Practical Nursing, pp. 91-98 and 648-661. Harmer’s Principles and Practice of Nursing, pp. 543-551. PREPARATION OF PATIENT FOR GYNECOLOGIC EXAMINATION Regquisiies: 1. Bath blanket (if indicated). 2. Gynecologic tray with: 1. Bi-valve speculum. 2. Rectal speculum. 3. Sims’ Ipsum, 4. Uterine sound. : 5. Uterine applicator. Startle, 6. Uterine dressing forceps. 7. Scissors. 8. Tenaculum. 9. Sterile gloves (2 pairs). 10. Sterile towels (2 packages). 11. Sterile medicine glass. 12. Sterile gauze sponges. 13. Sterile cotton. 14. Sterile vaginal packing. 15. Sterile solution basins (2). 16. Sterile applicator tubes (2). 17. Sterile microscopic glass slides. 18. Sterile kidney basin (large). 19. Sterile lubricant. 20. Flask iodin. PREPARATION OF PATIENT FOR GYNECOLOGIC EXAMINATION 111 21. Large sheet. 22. Paper bag. 23. Towels (3) (non-sterile). Perfect asepsis is of special importance in gynecologic examinations because the mucous lining of the vagina is continuous with that of the uterus and through the Fallopian tubes with that of the peritoneum. Infection at any point may cause peritonitis. Procedure: If the external genitals are not scrupulously clean, wash them with warm water and soap. Allow the patient to use the bed-pan so that the bladder will be empty. If the bowels have not moved for twenty-four hours an enema may be necessary. Place the table with the gynecologic tray so that it will be convenient for the examiner. Place the patient in the required position and drape her. Anticipate the physician’s wants and act quickly. % Positions commonly used are: 1. Dorsal recumbent: Place the patient flat on her back with one pillow under the head and the knees flexed and separated. Used: For digital and bimanual examinations. 2. Lithotomy: Place the patient on her back across the bed with the buttocks slightly beyond the edge of the mattress. Flex her thighs on the abdomen and separate the knees. Support them by means of a sheet folded diagonally and passed under the knees and around the neck and tied over one shoulder, or have two as- sistants support the legs. Used: (a) For examinations and treatments of the perinuem, vagina, cer- vix, and uterine cavity. (6) For operations on the perineum, vagina, cervix, uterine cavity, and rectum. (¢) For digital examinations of the pelvic organs through the vagina. (@) For cystoscopy. (e) For delivery in obstetrics. 3. Sims’ or left lateral: Place the patient on her left side somewhat obliquely across the bed with the buttocks to the edge of the mattress. Incline the body forward, draw the left arm back under her, and place the right arm free in front. Used: For examinations and treatments of the cervix and vagina, especially its anterior wall. 4. Knee-chest or genupectoral: Place the patient in the prone position. Then assist her to kneel so that her weight rests on her chest and knees. Turn her head to one side and flex her arms at the elbows, extending them on the bed infront of her. Be sure that the thighs are perpendicular to prevent the abdomen from resting on the bed. Watch the pulse! and general condition of the patient. ! Do not place the patient in this position until the physician is ready. 112 NURSING TECHNIQUE Used: (a) To overcome and prevent uterine displacement. (4) For the insertion of pessaries. (¢) For examination of the rectum. (d) For colon irrigations. 5. Standing or erect: Have the patient standing with the knees separated about 10 inches, with one foot on a low stool or the round of a chair. Instruct her to place one hand on the back of the chair for sup- port and the other hand on her hip. Used: To determine the presence of uterine displacement. 6. Trendelenburg: This position is used in the surgery for abdominal operations on the pelvic organs. Place the patient on the operating table so that she is lying on an inclined plane with the head lower than the abdomen and her shoulders held by supports attached to the table. Adjust the lower portion of the table so that the knees will be flexed and tie the patient's legs to prevent her from slipping. ' Method of draping: 1. Dorsal recumbent: Replace the upper covers with a sheet in the same manner as when replacing them with a bath blanket. (The sheet should be folded lengthwise in two and then again in two. It should then be folded from top to bottom twice.) Cover the chest with a bath blanket. Gather the center of the sheet so that the vulva is exposed. Place a towel under the buttocks and bring up the end of it so that the vulva is covered until the ex- aminer is ready. If the sheet is long enough, wrap a lower corner around each foot; otherwise twist the corner around each ankle and cover the feet with the fold of the upper bed- clothes. : 2. Lithotomy: Put on laparotomy stockings or long white stockings. Replace the upper covers with a bath blanket and (when the patient is placed in position) fold the lower portion back over the chest. Place a towel under the buttocks and screen the vulva as in the dorsal recumbent position. 3. Sims’ or left lateral: Replace the upper covers with a sheet and cover the chest with a bath blanket. Turn the patient on her left side as demonstrated above. Gather the lower right corner of the sheet and bring it behind the patient and tuck it just below the axilla. Tuck the lower left corner under the feet and arrange the sheet in loose folds so that the vulva is exposed. Place a towel under the buttocks and bring up the end so that the vulva is screened until the examiner is ready. 4. Knee-chest or genupectoral: Replace the upper covers with a sheet and place the patient in position. Cover the shoulders with a bath blanket. Gather the center of the sheet up so that the vulva is exposed. Pin PREPARATION OF FIELD FOR OPERATIONS AND TREATMENTS 113 the gathered sheet to the patient’s gown so that it will not fall down. Tuck the right and left corner under the feet and place the towel so that it will act as a screen over the vulva until the examiner is ready. S. Standing or erect position: Place the doubled sheet around the patient so that it acts as a skirt. Arrange it so that the opening is at the side. Pin it to hold it in position. Points to be remembered: 1. Avoid unnecessary exposure. 2. Arrange the clothing loosely so as to disguise the patient's figure. 3. Keep the patient warm. References: Sanders’ Modern Methods in Nursing, pp. 229-240. Kimber’s Anatomy and Physiology, pp. 567-600. Morrow's Diagnostic and Therapeutic Technic, pp. 796-873. Macfarlane’s Gynecology for Nurses, pp. 24-34. PREPARATION OF THE FIELD FOR OPERATIONS AND TREAT- MENTS Regquisites: 1. Bath blanket. 2. Preparation tray with: 1. Flask iodin. 2. Flask alcohol. 3. Flask ether. 4. Flask green soap. 5. Sterile towels (1 package). 6. Sterile gauze sponges. 7. Sterile cotton. 8. Sterile pitcher. 9. Sterile basin. 10. Sterile scrub-up forceps. 11. Rubber dressing sheet. 12. Non-sterile towels (3). 13. Razors (safety and plain). 14. Toilet paper. 15. Paper bag. 16. Bandage or swathe. Procedure: For abdominal operations (the afternoon previous): Shave the area and give the patient a cleansing bath and clean linen. Wash your hands and fill the pitcher with warm sterile water. Carry the tray and the other requisites to the bedside. Replace the upper covers with a bath blanket. Open the packages containing the sterile towels and gauze sponges. Expose the field of operation. Protect the bed and patient's clothing by means of the non-sterile towels and rubber sheet. Place the paper bag so that it will be convenient for use. Pick up a sponge with the right hand and place it on the umbilicus. Pour some green soap on the sponge, holding the flask with the left hand. Pour some sterile water on the sponge and scrub the umbilicus well. Discard the sponge and repeat the procedure. Then scrub the 8 114 NURSING TECHNIQUE entire field, beginning in the center and continuing to the bed line. Rinse the area with sterile water until all trace of the soap has been removed. Then dry the field with a sterile towel. Scrub the area then with ether and alcohol (using gauze sponges), beginning in the center and continuing to the bed line. The morning of operation: Scrub the entire field (beginning in the center and continuing to the bed line) with ether (using gauze sponges and the scrub-up forceps). Then paint the area with iodin and apply a sterile towel and a swathe. In preparing the field of operation, include a generous area surround- ing the proposed incision. In determining the area for various operations prepare as outlined below. Laparotomy: Shave the pubes, the skin surrounding the vulva and anus, and the abdomen. Prepare the area from the bed line on either side and from the breast line to the lower border of the pubes. Continue the prepara- tion to the inner surface of the thighs and buttocks and the external genitals. Appendectomy: Shave the pubes and the abdomen. Prepare the area from the ig line to the lower border of the pubes and the bed line on either side. Kidney: Shave the area over the region of the affected kidney. Prepare the area from the vertebra to the bed line and from the axilla to the hip on the affected side. Coccygectomy: Shave the area over the coccyx and in the vicinity of the anus. Prepare the buttocks and thighs and 6 inches of the area above the coccyx and from the crest of the ilium on either side. Stomach: Shave the pubes, the abdomen, and the area over the region of the stomach. Prepare the area from the clavicle to the lower border of the pubes. A sterile lavage is usually prescribed. Breast: Shave the axilla on the affected side. Prepare the area from the breast of the opposite side around the affected side to the vertebrae, and from the hair line to the waist line, including the axilla and arm (on the affected side) to the elbow. Thyroidectomy: Shave only as ordered if the patient is a female. Shave the line of incision if the patient is a male. Prepare the area from the jaw line to the nipple line, including the ears, both shoulders, and the neck to the bed line on either side. Vagina and cervix: Shave the pubes, the skin surrounding the vulva, and the anus. Pre- pare the external genitals and continue the preparation to the inner sur- face of the thighs and buttocks. (Do not use iodin.) Cover the genitals with a sterile pad applied with a T-binder. Rectum: Shave the skin surrounding the anus. With the patient in the lith- otomy position prepare the buttocks and inner surface of the thighs CARE AFTER PERINEORRHAPHY AND HEMORRHOIDECTOMY 115 about 10 inches on either side and to the bed line. (Do not use iodin.) Cover the anus with a sterile pad applied with a T-binder. Arm and leg: Shave the line of incision. Prepare at least 6 inches above and below the site of operation. Include the hand or foot if near the site of operation. Mouth, tongue, palate: An astringent mouth-wash is usually prescribed three or four times the day previous to the operation. Nose: Shave only as ordered. Give nasal douche only as ordered. Wash the face, paying particular attention to the nostrils. Ear: Cleanse the external ear and the auditory meatus. For a mastoid operation: Shave only as ordered. Prepare the neck, ear, and upper half of the shoulder and half of the face on the affected side. (Do not use iodin on the face.) ; . Eyes: : One hour before the operation wash the face from the hair line to the lips with soap and water and rinse and dry with a sterile towel. Sponge the surface with alcohol. (Keep the eyelids closed.) Douche the con- junctival sac with warm boric acid solution, 2 per cent. Cover the af- fected eye with a sterile dressing. For skin grafting: Shave the area from which the grafts are to be taken. Cleanse the part gently with green soap and sterile water, flush it with normal saline, dry it, and apply a sterile towel. Cleanse the wound to be grafted with - normal saline and apply a wet dressing of the same. (To be prepared the morning of the operation.) For emergency operations: Shave dry. Scrub the area well with ether and apply iodin. (To be done in the surgery unless there is sufficient time for the procedure to be carried out in the ward.) For aspirations and punctures: Scrub the area well with ether and apply iodin. For intravenous infusions, tranfusions, and injections of salvarsan and neosalvarsan: Scrub the area well with ether and alcohol and apply an alcohol sponge. For hypodermic injections: Scrub the area with alcohol. References: : Sanders’ Modern Methods in Nursing, pp. 577-581. Harmer’s Principles and Practice of Nursing, pp. 514-519. Pope’s Practical Nursing, pp. 339-343 and 645-649. NURSING CARE AFTER PERINEORRHAPHY AND HEMORRHOID- ECTOMY Regquisites: Tray equipped with the following: 1. Sterile pitcher. 2. Sterile forceps. 116 NURSING TECHNIQUE 3. Sterile gauze. 4. Sterile cotton. 5. Sterile vaginal pads. 6. Bag for waste. Procedure after perineorrhaphy: Wash your hands and prepare from 6 to 8 ounces of boracic acid solution, 2 per cent. Carry the tray with the requisites to the bedside. After the patient has used the bed-pan, fold back the upper covers, but do not expose her more than necessary. Separate the labia with the thumb and forefinger, and pour the solution slowly and with very little force over the parts. If the patient had a defecation, sponge the parts very gently with cotton pledgets moistened with the boracic acid solution. Place the patient in the lateral position and dry the parts well with sterile cotton (using the forceps), but do not pull on the stitches. At each dressing take special notice of any swelling or irritation around the stitches, and record it. Place sterile gauze so that the sutures will be between the layers. Apply a vaginal pad and retain the dressings by means of a T-binder. Procedure after hemorrhoidectomy: Proceed in the same manner, unless special orders have been given. Points to be remembered: 1. That the success of the operation depends to a large extent upon the postoperative nursing care. 2. Aseptic technique is as essential as when dressing an abdominal wound. 3. Restraint of the legs is usually indicated after a perineorrhaphy. 4. The patient must be closely watched for hemorrhage after a. hemorrhoidectomy. Reference: Harmer’s Principles and Practice of Nursing, pp. 592-595. ADMINISTRATION OF MEDICINES Drugs may be administered: . By mouth. . By rectum. . By inhalation. . Externally. . By hypodermic injection: (@) Subcutaneously. (6) Intracutaneously. (¢) Intramuscularly. (@) Intravenously. (e) Intraspinally. Giving medicines by mouth: Regquasites: Tray with the following: 1. Bottle of medicine. 2. Medicine glass. 3. Graduated glass spoon. 4. Teaspoon. Gs WN = ADMINISTRATION OF MEDICINES 117 5. Glass tube. 6. Medicine-dropper. 7. Gauze squares. 8. Minim graduate. 9. Glass tumbler. 10. Powders. 11. Konseals (empty and filled). 12. Capsules (empty and filled). 13. Pills. 14. Tablets. Procedure: Read the label. Take the bottle in the right hand, shake it and read the label a second time. Then remove the cork with the thumb and first and second fingers. Hold it between the first and second fingers and pour out the drug. Hold the medicine glass (with the left hand) so that the mark of the prescribed amount is on a level with the eye. Pour in enough drug to reach the line, designating the prescribed amount. Put the cork back in the bottle and read the label a third time. Wipe the rim of the bottle and return it to its proper place. Pour some ice- water into the medicine glass and give it to the patient. Wash the medicine glass and drinking tube (if used) and return them to their proper places. Record: 1. Hour. 2. Medicine or prescription number. 3. Amount. Points to be remembered: . Always give medicines on time. . Read the label three times before giving the drug. . Do not record it until the drug has actually been taken. . Never converse with any one and think only of the task on hand when giving medicines. . Always shake the bottle if there is a sediment, and avoid defacing the label, when pouring out the medicine. . Always measure accurately and give minims (not drops)' when they are ordered. . Use graduated glasses and not spoons unless they, too, are graduated.? 8. Never give medicines which when mixed form a precipitate or change color. 9. Do not dilute cough medicines. 10. Dilute all medicines that are irritating to the alimentary tract. 11. Give acids and medicines containing iron through a glass tube. 12. Do not give certain foods near the hour that certain drugs are to be given. 13. Give saline cathartics (prescribed for edema) in a concentrated solution and saline cathartics (prescribed for cathartic pur- poses) well diluted. 1 Have the students measure 60 minims and 60 drops to determine the dif- ference. 2 Have the students prove that 1 dram is not 1 teaspoonful unless the teaspoon is graduated. ~ aN wn HNO = N 118 NURSING TECHNIQUE 14. Make medicines as palatable as possible. 15. Keep oils in a cool place and serums and vaccines in the ice-box. 16. Always recork the bottle. 17. Never give a dose of medicine that you are not certain of. 18. Give medicine very slowly and drop it far back on the tongue (using a spoon) when a patient is unconscious. Abbreviations and symbols used: Abbreviation: © Derivation: Meaning: aa ana of each A.c, ante cibum before meals P.c post cibum after meals Ad. lib ad libitum as much as desired or according to pleasure B.i.d bis in die twice a day T.1i.d. ter in die three times a day Q.1i. d. quater in die four times a day Gtt. drop, drops Alt. die. alternis diebus alternate days 0. d. omne die daily O. m. omne mane each morning O. n. omne nocte each night H. "hora hour Q. h. quaqua hora every hour H. s. hora somni at sleeping time Ss. semi one-half 3 drachma dram 3 uncia ounce . S.o.s. si opus sit if necessary (one dose only) P.r.n. pro re nata when required (often as necessary) Stat. statim at once Q.s. quantum sufficit as much as is sufficient Bo recipe take S. or Sig. signa given with the following directions 0. octarius a pint C. congius gallon C. Centigrade Ss sine without C cum with + N.b note bene note well M. ‘ minim Add adde add to M misce mix References: Sanders’ Modern Methods in Nursing, pp. 332-357. Harmer’s Principles and Practice of Nursing, pp. 419-428. Pope’s Practical Nursing, pp. 444-455. Blumgarten’s Materia Medica, pp. 78-103 and 646-656. GIVING HYPODERMIC INJECTIONS Method of administration: 1. Subcutaneously: Beneath the skin. 2. Intracutaneously: Into the skin. GIVING HYPODERMIC INJECTIONS ! 119 3. Intramuscularly: Into a muscle. 4. Intravenously: Into a vein. 5. Intraspinally: Into the spinal canal. Prescribed: 1. To obtain prompt action of the drug. 2. When the patient cannot take the drug by mouth. 3. When the drug is changed by the secretions of the stomach or intestines. 4. When the drug is not absorbed readily in the stomach and in- testines. 5. To anesthetize the area at the site of injection. Intramuscular injections are used in preference to subcutaneous injections: 1. When a large quantity of liquid is preseribed. 2. When the drug is irritating or not easily absorbed. Intravenous injections are usually given by the physician. Intracutaneous injections are usually given by the physician. The sites for subcutaneous injections: 1. The front of the thighs. 2. The outer surfaces of the arm and forearm. The sites for intramuscular injections: 1. The gluteal region. 2. The lumbar region. The sites for intravenous injections: 1. The median cephalic vein. 2. The median basilic vein. Kind of needle: For subcutaneous injection: Use the smallest needle obtainable. For intramuscular injection: Use a needle about 13 inches long of large enough bore to permit the fluid to be forced through easily. For local anesthetic: Use a long needle of very small bore. Dangers to be avoided: 1. Causing an abscess. 2. Injecting the drug into a vein. 3. Breaking the needle in the tissues. Regquisites: Hypodermic tray equipped with: 1. Six glass stoppered bottles containing the drugs. 2. Metal syringe. 3. Glass syringe. 4. Assorted needles. 5. Alcohol lamp. 6. Matches. 7. Two small glasses. 8. Forceps. 9. Bottle sterile water. 10. Bottle alcohol. 11. Container with sterile sponges. 12. Container for waste. 13. Sterile needles in covered container (for emergency). Procedure: Wash your hands. Choose a suitable syringe and needle. The size will depend upon the 120 NURSING TECHNIQUE amount and nature of the drug that is to be given and the way in which it is to be administered. Pour some alcohol into one small glass and place the syringe in it after drawing alcohol into the syringe.! Place the forceps in the alcohol and let them stand for a minute or two. Pour some sterile water into the spoon and light the lamp. Pass the forceps through the flame, then remove three cotton sponges from the container (using the forceps), and place the forceps on one piece. Draw alcohol into the syringe and expel it about five times. The fifth time expel the alcohol on the two cotton sponges. Rinse the syringe with sterile water and place it beside the forceps on the first sponge.? When the water is boiling remove the wire from the needle and put it in the boiling water and boil it for one minute. Be sure that there is enough water in the spoon to cover the needle and that the point is not dulled in putting it in the spoon. If the drug isin tablet form, take it from the bottle with the forceps and dissolve it in 7 to 10 minims of sterile water and draw it into the syringe. Take hold of the screw end of the needle with the forceps and connect it to the syringe. Do not allow the needle to come in contact with anything while you are doing this. Carry the syringe to the bed- side with the alcohol sponges covering the needle. Just before injecting the solution hold the syringe with the needle pointing upward and press the piston until all the air is expelled. To give a subcutaneous injection: Prepare the site of injection by rubbing the alcohol sponge over it several times, making considerable pressure. Take up a cushion of the flesh between the thumb and fingers of the left hand, keeping the skin as taut as possible. Then place the point of the needle upon the skin and insert it quickly but gently into the flesh from 3 to inch, at an angle of 50 degrees. Withdraw the needle slightly and press the piston slowly so as to expel the fluid. Remove the needle quickly, making pressure with the alcohol sponge on the point of puncture while doing so. Massage the part for a few seconds to spread the fluid through the tissues and thus hasten absorption. To give an intramuscular injection: Prepare the site of injection as for a subcutaneous injection. Hold the skin of the part tense by pressing in the opposite directions with the thumb and fingers of the left hand and force the needle perpendicu- larly, steadily, and quickly through the skin directly into the muscle. Massage the part thoroughly (after the injection) to hasten absorption by covering the area with a sterile sponge and massaging over the sponge. To inject a local anesthetic (usually given by a physician): Prepare the site of injection as for a subcutaneous injection. The needle is introduced almost horizontally into the skin (intradermally) along the line of incision. The solution is then injected slowly as the needle is withdrawn so that the superficial nerves are deadened. 1 For an emergency always have in readiness a sterile syringe and needle. 2 It is customary on wards to sterilize (by boiling) all syringes once daily, and disinfect them with alcohol for injections given during the day, PREPARATION OF A PATIENT FOR OPERATION 121 To give serum, antitoxin, and vaccine (usually given by a physician): These injections may be given subcutaneously, intramuscularly, or intravenously. For a subcutaneous injection choose a location where there is an abundance of loose tissue poorly supplied with nerves such as: 1. The infrascapular region. 2. The infraclavicular region. 3. The posterior portion of the axilla. Prepare the site of injection as previously demonstrated. (Iodin is sometimes used.) After the injection, the site may be protected with a sterile gauze dressing retained with adhesive tapes or it may be coated with collodion or painted with iodin. After use: It is every important that the syringe and needle be cleansed im- mediately to prevent the needle becoming clogged. Remove the needle from the syringe and draw enough alcohol into the syringe to fill the barrel.! Attach the needle to the syringe and expel the alcohol. Remove the needle, wire it, and dry it. Leave the tray in perfect condition. Record: 1. Hour and treatment. 2. Drug and amount given. 3. Patient’s reaction to treatment. Problems: 1. How would you give atrophin sulphate, gr. 1/250, from tablets of gr. 1/150? 2. How would you give strychnin sulphate, gr. 1/100, from tablets of gr. 1/30? 3. How would you give strychnin sulphate, gr. 1/25, from a 1 per cent. solution? 4. How would you give strychnin sulphate, gr. 1/60, from a 1/2 per cent. solution? 5. On hand a solution of morphin sulphate in which 10 minims equal gr. 1/4. How would you give gr. 1/5? 6. If the adult dose of morphin sulphate is gr. 1/4, how much would you give a child twelve years old? 7. On hand morphin sulphate tablets, gr. 1/4, and atropin sulphate tablets, gr. 1/150. How would you give morphin sulphate, gr. 1/6, and atropin sulphate, gr. 1/ 200? 8. On by codein sulphate tablets, gr. 1/2. How would you give gr. 3/4? 9. On hand strychnin, gr. 1/40. How would you give gr. 1/30? 10. On hand atropin, gr. 1/200. How would you give gr. cE 150? References: Sanders’ Modern Methods in Nursing, pp. 356-361. Harmer’s Principles and Practice of Nursing, pp. 431-434. Pope’s Practical Nursing, pp. 454-467. Blumgarten’s Materia Medica, pp. 61-75. Purpose: PREPARATION OF A PATIENT FOR OPERATION 1. To make the patient, especially at the site of operation, surgically clean so as to prevent infection. 1 The syringe and needle may be sterilized by boiling and left (in a sterile con- tainer) ready for use. 122 NURSING TECHNIQUE 2. To empty the stomach, intestines, and bladder to prevent nausea. vomiting, gas, pains, and injury to the organs from distention, 3. To save the patient so that her strength will not be impaired. Routine preparation: : . Put the patient to bed as soon as she is admitted. Take the temperature, pulse, and respirations. Take the blood-pressure (systolic and diastolic).! Send a specimen of urine to the laboratory. Notify the intern on service.? Encourage the patient to drink water freely (unless contrain- dicated) until three hours before operation. Give a cathartic or enema as prescribed. Shave the field of operation. Give a cleansing bath. Prepare the field of operation. Give soft diet the evening previous to the operation (unless contraindicated). Give liquid diet every two hours (unless contraindicated) until midnight previous to the operation. PLOT a Sy ui oy ois —— i In a. Mm. 1. Send a specimen of urine to the laboratory. 2. Give a cleansing enema, four hours before the operation.? 3. Take the temperature, pulse, and respirations. 4. Give a partial bath, put on a clean gown, and comb the patient’s hair in two braids. 5. Thoroughly cleanse the field with ether and apply iodin and a sterile towel or dressings and retain it by means of a swathe or bandage. Put on a chest protector and cover the head with a towel. Remove false teeth? (if the patient has them) and jewelry. Put on laparotomy stockings and operating blankets before lift- ing the patient to the operating cart. References: Sanders’ Modern Methods in Nursing, pp. 577-581. Harmer’s Principles and Practice of Nursing, pp. 221-226 and 507- 519. Pope’s Practical Nursing, pp. 641-648. PROCTOCLYSIS Proctocylsis is the slow injection of fluid into the rectum in amounts that can be absorbed. Prescribed: 1. When fluid cannot be taken by mouth. 2. When there has been a loss of body fluid. 3. When the patient is suffering from toxemia or septicemia. Methods: 1. The drop method (15 to 30 drops per minute, unless otherwise prescribed). 1 This is done by a senior nurse. 2 This is done by the supervisor. 3 In some instances this is omitted by special order. 4 Many anesthetists prefer to have the teeth in when giving an anesthetic. pe PROCTOCLYSIS 123 2. The gravity or Murphy method. 3. The Kelly method. Solutions used: 1. Plain water. 2. A hypotonic solution—normal saline (half-strength). 3. Glucose solution, 5 to 15 per cent. 4. Soda bicarbonate, 5 per cent. Temperature of solution: 100° to 105° F. Duration of treatment: (For methods I anp II.) For two or three hours, discontinuing it for the same length of time and repeating the treatment until discontinued by the physician. (For method III.) Four ounces every four hours. Position of the patient: 1. The dorsal recumbent position. 2. The semi-recumbent position. 3. Fowler's position. 4. Lying on the left side. MEgTHOD | Tue Drop METHOD ‘Requisites: 1. Trrigator stand. 2. Bath blanket. 3. Proctoclysis tray with: . Graduated reservoir. One piece of tubing 12 inches long supplied with a stop- cock and a screw compressor. . One piece of tubing 36 inches long.! . One piece of tubing 23 inches long. . One piece of tubing 5 inches long. . Drop attachment. Three glass connections (Y, Plain, and U). . Soft-rubber catheter. . Tube of vaselin. 10. Small gauze squares. 11. Kidney basin. 12. Heater or hot-water bottle and cover. 13. Protector. Procedure: Wash your hands and prepare the solution. Connect the piece of tubing 12 inches long to the reservoir and in- sert the drop attachment? in the free end of this tubing. Connect the piece of tubing 5 inches long to the drop attachment and insert one of the projections on the Y connection in the free end of this tubing. CONOUNA LN Ne 1 This piece may be shorter if the irrigator standard is attached near the center of the bed. 2 Be sure it is properly placed and not upside down. 124 NURSING TECHNIQUE Attach the piece of tubing 23 inches long to the free projection on the Y connection so that it will be carried back to the reservoir and be re- tained there by means of the U connection. Connect the piece of tubing 36 inches long to the stem of the Y con- nection and attach the free end of this tubing to the catheter by means of the plain connection. Half fill the hot-water bottle with water 120° F. Be sure that the temperature of the solution does not exceed that de- gree. Close the stop-cock and pour in the solution. Regulate the flow Fig. 16.—Proctoclysis. Equipment for drop method. so that there will be 20 drops per minute, unless otherwise prescribed. Cover the reservoir with a towel, and carry the tray and requisites to the bedside. Attach the irrigator standard to the side of the bed. Turn down the bed-covers to the level of the rectum and at the same time cover the patient’s shoulders with the folded bath blanket. Place the patient in position with the protector under the buttocks.! Hang the reservoir about 18 inches above the level of the mattress. Expel 1 A small rubber dressing sheet may be placed under the protector. PROCTOCYLSIS 125 the air from the tubing, lubricate the catheter, and insert it into the rectum about 4 inches. Place the hot-water bottle (or heater) close to the rectum, for unless the solution is heated just before entering the rectum it will be too cool. Do not leave the patient until everything is all right. If there is any amount of feces expelled back into the reservoir, notify the Supervisor. A cleansing enema is usually prescribed in which instance the proctoclysis is discontinued for two or three hours. MEegTHOD II THE GRAVITY, OR MURPHY METHOD Requisites: 1. Irrigator stand. 2. Bath blanket. 3. Tray with: 1. Graduate reservoir supplied with about 3 or 4 feet of tub- ing and a stop-cock. . Glass connection. . Soft-rubber catheter. Tube of vaselin. . Small gauze squares. . Kidney basin. Heater or hot-water bottle and cover. Protector. ONY WN Procedure: . Wash your hands and prepare the solution and hot-water bottle as for Method I. Connect the piece of tubing to the reservoir and the free end to the catheter by means of the glass connection. Close the stop- cock and pour in the solution. Prepare the patient as for Method I. Hang the reservoir about 2 inches above the level of the rectum. Expel the air from the tubing, lubricate the catheter, and insert it into the rectum about 4 inches. Open the stop cock-wide so that the caliber of the tubing is not con- stricted. Do not leave the patient until everything is all right. MEegtHOD III Tre KeLLy METHOD Regquisites: 1. Bath blanket. 2. Tray with: 1. Small reservoir supplied with about 4 inches of tubing and a stop-cock. . Glass connection. . Soft-rubber catheter. . Tube of vaselin. . Small gauze squares. . Kidney basin. . Protector. Procedure: Prepare the requisites and patient as for Method II. Expel the air from the tubing, lubricate the catheter, and insert it NOUR WN 126 NURSING TECHNIQUE into the rectum about 4 inches. Give 4 ounces slowly and repeat that amount in four hours unless otherwise ordered. Points to be remembered: x 1. Failure of the patient to retain the solution usually indicates faulty technique. 2. Always provide means for the escape of flatus and unabsorbed water for Methods I and II. 3. Have the solution about body temperature when it enters the rectum. 4. Watch the patient throughout the treatment. After use: Cleanse the requisites well by scrubbing them with soap and warm water. Sterilize them as previously demonstrated. Wrap all the re- quisites and equip the tray for further use. : Record: 1. Hour and treatment. 2. The amount approximately absorbed in twelve hours. (For Methods I and II.) 3. If flatus and feces is expelled during the treatment. 4. Any unusual symptoms which may occur. References: j : Harmer’s Principles and Practice of Nursing, pp. 525-529. Pope's Practical Nursing, pp. 517-525. ASSISTING WITH HYPODERMOCLYSIS Hypodermoclysis is the introduction of fluid, usually normal saline, into the subcutaneous tissues. Prescribed: 1. As a substitute for proctoclysis' when it is not possible to inject fluid into the rectum. 2. When a more immediate result is desired. Solutions used: 1. Normal saline. 2. Ringer's solution. 3. Locke's solution. Quantity injected: From 500 to 1000 c.c. Temperature of solution: 13°F, Sites of injection: 1. Beneath the skin of the abdomen. 2. The loose tissue at the base of the breasts. 3. In the thighs or buttocks. 4. In the axillary line. Height of reservoir: From 18 to 24 inches. Requisites: 1. Irrigator stand. 2. Bath blanket. 3. One tray (for non-sterile requisites). 4. Hypodermoclysis tray with: ASSISTING WITH HYPODERMOCLYSIS 127 1. Sterile glass graduated reservoir. 2. One piece of tubing from 3 to 4 feet long, supplied with stop-cock and a metal screw compressor (sterile). 3. Two pieces of tubing of smaller bore, about 15 inches long (sterile). 4. Two clysis needles in test-tube (sterile). 5. Sterile plain and Y glass connections. 6. Sterile funnel. 7. Sterile gauze. 8. Sterile cotton. 9. Sterile towels (2 packages). 10. Sterile tray cover. 11. Sterile gloves. 12. Sterile forceps. 13. Sterile thermometer. 14. Flask iodin. 15. Flask ether. 16. Flask alcohol. 17. Two flasks normal saline (large and small). 18. Adhesive plaster or collodion. 19. Paper bag. 20. Two dressing towels (non-sterile). 21. Basin and compresses (for hot applications). 22. Tourniquet. MEeTtHOD I Procedure: Count and record the patient's pulse. Heat the large flask of saline (115° F.). Attach the irrigator stand to the side of the bed. Wash your hands. Cleanse one tray with ether and alcohol by means of cotton sponges. Open the packages containing the sterile apparatus and cover this tray with the sterile tray cover (using the sterile forceps). Place the reservoir, tubing, needles, funnel, glass connections, one package each of gauze and cotton and one sterile towel on this tray. Then put on sterile gloves and connect the long piece of tubing to the reservoir. Close the stop-cock. Insert the stem of the Y connection in the free end of this tubing, and the two projections of the Y connection in the two pieces of tubing of smaller bore. (If the injection is to be made in one site only, use the plain glass connection.) Connect the needles (after removing the wires) to the free ends of these pieces of tubing and place them between the folds of sterile gauze. Cover the tray with the sterile towel. Remove your gloves. Place the non-sterile requisites, the sterile thermometer, the scrub- up forceps and one package of sterile towels on the second tray. Extra gauze and cotton sponges may be needed, so prepare for this by having them on hand. Carry all the requisites to the bedside. If the physician is ready, prepare the patient for the treatment. If the fluid is to be injected in both breasts, flex the patient’s knees and draw up the gown so that both breasts are exposed. (In women the loose tissue at the base of the breasts, and in men the loose tissue just below the axilla is usually chosen). Protect the clothing and bedding 128 NURSING TECHNIQUE with non-sterile towels and cover the chest with a bath blanket, if in- dicated. Place the paper bag so that it will be convenient. Prepare the field by scrubbing it with ether and applying iodin (using sterile forceps). Place the table so that the tubing and needles will rest on it when the reservoir is hung 18 to 24 inches above the patient. Then place the sterile towels (without contaminating them) around the site of injection. Take the temperature of the solution and pour 300 c.c. of solution into the reservoir. The physician! then injects the solution. He holds the skin stretched with his left hand and, after expelling the air, he in- serts the needles horizontally about two-thirds of their length and with- draws them slightly. If the treatment is to be continued, the physician usually leaves the patient, and the nurse’s duties are to watch the pa- tient fo see that the fluid is absorbed, to watch the reservoir so that it does not empty, and to maintain the temperature of the solution. Hot compresses are frequently prescribed to hasten absorption. When the required amount has been given withdraw the needles (in the absence of the physician) and cover the punctures with sterile gauze and retain it with strips of adhesive plaster, or punctures may be sealed with collodion. Metuop II (The requisites have been connected before being sterilized in the autoclave.) Procedure: Proceed in the same manner as far as and including the covering of the tray with the sterile tray cover. Then place the reservoir (to which the tubing has been previously attached) on the tray. Place the needles, the glass funnel, and one package each of gauze and cotton beside the reservoir. Close the stop-cock (using sterile forceps) and cover the tray with a sterile towel. Proceed then as in Method I except that the physician connects the needles to the tubing just previous to the injection. Points to be remembered: 1. Maintain the temperature of the solution, if the treatment is continued. 2. Be sure that the needles are sharp and in good condition. 3. Be sure that absorption of the fluid keeps pace with the amount of fluid injected. "4. Watch the patient's condition closely and take care to avoid ex- posure and chilling. Record: 1. Hour and treatment. 2. Quantity of fluid injected. 3. Pulse rate before and after treatment. 4. Any unusual symptoms which may occur. 5. By whom performed. References: Sanders’ Modern Methods in Nursing, pp. 523-529. Harmer's Principles and Practice of Nursing, pp. 560-562. 1 Some physicians wear gloves for this treatment, but this is optional. ASSISTING WITH AN INTRAVENOUS INFUSION 129 Pope's Practical Nursing, pp. 525-529. Blumgarten’s Materia Medica, pp. 188-192. ASSISTING WITH AN INTRAVENOUS INFUSION An intravenous infusion consists of the introduction of an isotonic solution into a vein. Prescribed: 1. When an immediate result is desired as in hemorrhage. 2. When the patient is in shock and collapse to stimulate the cir- culation. 3. In toxemia to dilute the poisons. Solutions used: . Normal saline. . Locke’s solution. . Dawson’s solution. . Fischer's solution. . Ringer's solution. Ringer-Locke solution. Temperature of solution: 115° F. Quantity injected: From 500 to 1000 c.c. Site of injection: 1. The median cephalic vein. 2. The median basilic vein. Regquisites: Irrigator stand. Bath blanket. One tray (for non-sterile requisites). Small rubber pillow and a case. Hypodermoclysis tray. Sterile cannula and infusion needle. Sterile aspirating sheet. Gauze bandage. If the arm is fat or the veins collapsed, it is sometimes necessary to incise the skin and expose the vein. The following requisites will be needed: 1. Local anesthetic: (a) Sterile glass syringe. (6) Sterile needle. (¢) Sterile medicine glass. (d) Novocain, 3 to 1 per cent. . Sterile scalpel. . Sterile hemostats (2). Sterile aneurysm needle. Sterile needle-holder. . Sterile scissors. . Sterile forceps. . Sterile suture material: (a) Catgut. (6) Suture silk. 9. Sterile needles. 9 PNO URN SUE mm 00 =I UT WN 130 NURSING TECHNIQUE Procedure: 4 Count and record the patient's pulse, if time permits. Heat the solution (115° F.). Attach the irrigator stand to the side of the bed. Wash your hands. Prepare the two trays (the sterile and non-sterile) as for hypodermoclysis, except that a plain glass connection is used instead of the Y. Carry the requisites to the bedside. Fig. 17.—Intravenous infusion. (Step one.) Scrubbing field with an ether sponge. Prepare the site of injection as follows: If necessary, remove the gown from the side being treated. Cover the chest with a bath blanket to prevent exposure and chilling. Place the small rubber pillow under the arm and apply the tourniquet loosely. ASSISTING WITH AN INTRAVENOUS INFUSION 131 Place the paper bag so that it will be convenient. Scrub the sides and anterior portion of the arm with ether and alcohol (using the forceps). If the physician is not ready, leave an alcohol compress covering the site of injection. Fig. 18.—Intravenous infusion. (Step two.) Scrubbing field with an alcohol sponge held with a sterile forceps. The physician (after putting on sterile gloves) places the aspirating sheet. Hang the reservoir about 18 inches above the patient. Take the temperature of the solution and pour it into the reservoir. When the physician is ready to inject the solution, tighten the tourniquet so that the vein is distended. After expelling the air from the tubing the phys- 132 NURSING TECHNIQUE ician injects the needle into the vein. Loosen the tourniquet after the needle is inserted. The injection is then given slowly by the physician. The nurse's duties are to watch the patient’s color, pulse, and breath- ing, and to watch the reservoir so that it does not empty. When the required amount has been given, the needle is withdrawn and the site of injection covered with a sterile dressing and retained with adhesive strips or sealed with collodion. When an incision is made the wound is sutured and a sterile dressing is applied. Fig. 19.—Intravenous infusion. (Step three.) Arm covered with the aspirating sheet in readiness for the physician. Points to be remembered: 1. Maintain perfect technique. 2. Be sure that the needle is sharp and in good condition. 3. Do not allow the reservoir to empty. Record: 1. Hour and treatment. 2. Kind and quantity of solution injected. 3. Pulse rate before and after treatment. 4. Any unusual symptoms which may occur. 5. By whom performed, CARE OF THE BODY AFTER DEATH 133 References: Sanders’ Modern Methods in Nursing, pp. 528-531. Harmer's Principles and Practice of Nursing, pp. 555-561. Pope's Practical Nursing, pp. 529-539. CARE OF THE BODY AFTER DEATH Regquisites: Sheet. Gown. . Cotton waste. . Dressing forceps. . Four-inch bandage. Safety-pins. Vaselin, if indicated. Bath and toilet requisites. Two pillows. 10. Dressings for a wound, if indicated. 11. Bag for waste. Procedure: Note the exact time of death and record it later. Do not start the preparation of the body until the physician has pronounced the patient dead, and the members of the family have left the room. Lower the back-rest, remove the shock blocks, etc., straighten the body, and elevate the head and shoulders on two pillows. Close the eyes immediately after death. Remove the upper bedclothes except the top sheet. Prepare the requisites on the bedside table as when giv- ing a bath. Remove all valuables from the body, place them in an en- velop and give them to the Supervisor. : Pack the rectum and vagina, if indicated, with a small piece of ab- sorbent cotton. Remove the swathe, soiled dressings, and any drains and packing. Remove the adhesive marks with ether and apply fresh dressings. Bathe the face and put in the false teeth, if they are worn. Comb the hair. Take a double strip of 4-inch bandage, put it under the chin, bring it behind the ears and pin it on top of the head to hold the jaw firmly in place. : Bathe the dead body as though the patient were living. Tie a piece of bandage around the legs at the ankles and knees. Put on the gown. Lubricate the eyes and lips, if necessary. Cross the arms on the chest and keep them in position by means of a gauze bandage. Cover the body with a clean sheet and pin an identification slip to the sheet. When the cart or stretcher arrives, lift the body gently and reverently on it, with the help of two assistants. Conduct the removal of the body from the ward to the mortuary with dignity and respect. Points to be remembered: 1. Keep the bed and surroundings neat during the preparation. Arrange the body in a suitable position, before rigor mortis sets in. Elevate the head and shoulders to prevent discoloration of the parts that show. Spare other patients the details of the death and the removal of the body. Notify promptly those whom are to be told of the death. PENA URL 2 3 4 3 134 NURSING TECHNIQUE 6. Treat the body with reverence and always remember that ‘‘the body is the temple of the soul.” References: Harmer’s Principles and Practice of Nursing, pp. 302-305. Pope’s Practical Nursing, pp. 164-168. CARE OF THE NEWBORN—BATHING INFANTS AND SMALL CHILDREN Temperature of water: 1. From birth to three months, 95° to 100° F. 2. From three months to one year, 90° to 95° F. 3. One year, 85° to 90° F. 4. Two years, 75° t0'85° F. Frequency of bath: Daily. Time bath: Just before breakfast or the wodia bottle in the A. m. Temperature of the bath-room: Between 75° and 80° F. Classification of baths: 1. Oil bath. 2. Sponge bath. 3. Tub bath. 4. Shower bath. First O1L Bath (To be given as soon as possible following the birth.) Regquisttes: 1. Infant or a Chase doll. 2. Heated table covered with a pad. 3. Flask of sterile oil.! 4. Diapers.? 5. Binder. 6. Individual rectal thermometer. Procedure: Warm the oil. Wash your hands. Apply an alcohol dressing to the cord (observing aseptic technique) and retain it by means of a band, 8 or 10 inches wide. Examine the infant for congenital abnormalities or injuries. Anoint the infant with the warm oil. Take the temperature by rectum and apply the diaper. Work quickly? and make no exposure. Wrap the blanket around the infant and place him in his bed. Keep him warm and dry and watch him closely for six hours. 1 Oil is difficult to keep sterile and if it gets rancid can be extremely irritating. In hospitals where impetigo and other skin infections of the newborn are fre- quent, it would be well to watch the oil. These skin infections are occasionally fatal, and until we have solved the infant mortality of the first two weeks of life we cannot afford to run the slightest of risks. The use of oil has, to my mind, a very definite risk (Lucas). 2 All clothing, including diapers, used in hospitals should be sterilized. 3 Bathing the baby should never be a long, drawn-out process, nor should it be anything but thoroughly done (Lucas). CARE OF NEWBORN—BATHING INFANTS AND SMALL CHILDREN 135 SeEconDp O1L BATH (To be given six hours after the first oil bath.) After six hours take the infant's temperature and give a cleansin: oil bath. 3 Requisites: 1. Infant or a Chase doll. 2. Heated table covered with a pad. 3. Infant's clothing. 1. Binder, shirt, diapers. 2. Hospital gown of Canton flannel opened in front. . Individual rectal thermometer. . Bath blanket. . Bath tray with: Jar of sterile cord dressings (gauze sponges, 3 inches square). . Jar of sterile cotton pledgets (for eyes). . Jar of sterile cotton toothpicks. Jar of sterile cotton (for bathing). Flask of boric acid solution, 2 per cent. Flask of sterile albolene. . Flask of alcohol (for cord). . Flask of sterile oil. . Bottle of zinc stearate powder. 10. Shaker of powdered Castile soap. 11. Tray of safety-pins (assorted). 12. Sterile pick-up forceps. 13. Paper bag. Procedure: Warm the oil and boracic acid (100° F.). Wash your hands. Cleanse the infant's eyes from the inner canthus, outward by means of sterile cotton pledgets, wet with boracic solution. Cleanse the nose by pass- ing an applicator (moistened with sterile albolene) into the external nares. Cleanse the external ear by means of an applicator, wet with boracic acid solution. Do not touch the mouth. Cleanse the face by means of a large cotton pledget moistened with oil. Sponge the face and head and follow with dry cotton pledgets. Go over the entire body in the same way, exposing only the part being cleansed. Observe the following routine: right and left arm, neck, chest, and abdomen. (Cleanse around the cord, but do not touch it.) Then proceed to the back, right leg, left leg, buttocks, and genitals. Do not change the cord dressing unless it is soiled. Apply a clean binder. Then put on the shirt, diaper, and hospital gown. Wrap the infant in a blanket and if his temperature is below 98° F., Dies a covered hot-water bottle (100° F.), on either side of him in his crib. ON UH CONTOUR LO SPONGE Batu (To be given daily until the cord is off.) Requisites: 1. Infant or a Chase doll. 2. Heated table covered with a pad. 3. Infant’s clothing. 136 NURSING TECHNIQUE Bath tray. Bath towel, face towel, and wash-cloth. Clothes hamper or laundry bag. Individual basin. Individual rectal and bath thermometers. . Individual hair-brush. Procedure: Wash your hands. Place a clean towel over the pad on the heated table. Half fill the basin with water about 110° F. Place all articles within convenient reach and arrange the clothing in the order needed. Proceed with the eyes, ears, and nose as when giving an oil bath. Sponge the face gently with plain water and dry it by patting. Lather the hair and hold the infant over the basin so that the head may be rinsed well. After drying it thoroughly, proceed with the rest of the body as when giving an oil bath. Rinse all parts well and dry them thoroughly by patting with the towel. Use stearate of zinc powder or bismuth in the axilla and folds on the groin and neck, when indicated to prevent chafing and irritation. Cleanse the genitals by separating the labia and washing down from the vulva (if infant is a girl). Remove all smegma with cotton pledgets, moistened with sterile oil. If the infant is a boy, ascertain from the physician his wishes regarding the care of the genitals. As a rule, the foreskin should be retracted daily. Dress the infant as after an oil bath. CY Er Tus BATH (To be given daily after the cord is off.) Requisites: Same as for sponge bath except that a foot-tub is used instead of a basin. Procedure: Wash your hands. Proceed in the same manner as for a sponge bath as far as and including the drying of the infant’s hair. Then soap the entire body and grasp the infant under the shoulders with your left hand and support his neck and head. Hold the legs with your right hand and carefully place him in the tub of water. Hold the infant with your left hand so that he floats rather than rests on his buttocks. Then bathe him with your right hand and rinse off all trace of soap.. Do not keep the infant in the tub longer than two or three minutes. Lift him from the tub in the same manner as when putting him in, allowing the water to drip before placing him on the table. Proceed then as after a sponge bath. SHOWER BATH (May be given after the cord is off, if proper equipment is available.) Wash your hands. Place a clean pad on the slab. Care for the eyes, ears, and nose as when giving a tub bath. Wrap the child in a bath blanket and carry 1 Infections in the newborn have to be fought constantly, and the only solution seems to me to be in giving every baby individual and aseptic care (Lucas). HOT APPLICATIONS, BATHS, AND PACKS 137 him to the slab. Test the hot water on the back of your hand before beginning the bath. (It should be 100° F.). Soap the hair and rinse it, being careful not to get soap and water in the infant's eyes. Then pro- ceed with the body directing the spray so that it comes in contact with your hand (to avoid burning) during the bath. Use very little force for the spray. After two or three minutes wrap the child in a bath towel and bath blanket and carry him back to the dressing table and thor- oughly dry him. Dress him as after a sponge bath. Points to be remembered when giving baths to infants in hospitals: 1. Always wash your hands after touching one child before touching the next one, and give every baby individual and aseptic care. 2. If a common dressing table is used, protect it with a pad covered with a rubber sheet and clean towel. Scrub the rubber sheet . with soap and water between each bath because more or less mositure soaks through to it during a bath. 3. Spread a clean towel on the common dressing table and place the baby on the towel when he is bathed or changed. After putting the child in bed, fold the towel with the clean side inside and hang it on the foot of the crib. 4. The bath of the hospital infant (unless individual tubs are pro- vided) should be a gentle sponging off with warm water and dried not by rubbing but by wrapping up in a soft towel that has been previously warmed (Lucas). 5. Use aseptic technique when dressing the cord and do not give a tub bath until the cord is off, as most cases of infection of the new- born can be traced to the cord as the route of entrance (Lucas). References: McCombs’ Diseases of Children for Nurses, pp. 36-45. Lucas’ Children’s Diseases for Nurses, pp. 33-97. Cutler’s Pediatric Nursing, pp. 9-32 and 98-115. HOT APPLICATIONS, BATHS, AND PACKS Heat may be applied to the body in the form of: 1. Moist applications. 2. Dry applications. The applications may be: 1. General. 2. Local. Moist heat may be applied in the form of: 1. Hot wet pack. 2. Hot bath pack. 3. Vapor bath. 4. Fomentations. 5. Poultices. 6. Hot foot-bath. Dry heat may be applied in the form of: 1. Hot-water bottle. Electric pad or blanket. Hot dry pack. . Electric light bath. 5. Hot-air bath, Boot 138 : NURSING TECHNIQUE Emergencies which may arise during treatments: 1. Burning the patient. 2. Fainting. 3. Headache. 4. Chill. 5. Collapse. Symptoms which show the treatment is haiong an undesirable effect: 1. Dizziness. 2. Increasing weakness. 3. Feelings of faintness. 4. Increased pulse rate. Precautions to be observed: 1. Always take the temperature of the water. . Wring wet blankets as dry as possible. . Always hold the hand between a stream of hot water and the patient when adding hot water to a bath. . Always take the temperature of water for hot-water bottles which are to be placed in bed with a patient and do not place them next to wet blankets. 1 . Keep the patient quiet during and after the treatment. . Give liquids liberally unless contraindicated. . Apply cold to the head during and after the treatment. . Dry the skin well and do not expose the body to a low tempera- ture after the treatment. References: Sanders’ Modern Methods in Nursing, pp. 128-141. Harmer’s Principles and Practice of Nursing, pp. 185-201 and 361- 364. Pope’s Practical Nursing, pp. 282-287. > Wi COON HOT WET PACK A hot wet pack consists in wrapping a patient in a blanket (wrung as dry as possible from very hot water) so that the wet blanket is in con- tact with all body surfaces. The patient is then wrapped securely in several dry blankets. Prescribed: 1. To induce perspiration and aid in elimination. 2. To relieve edema. 3. To lower blood-pressure. Duration of pack: From twenty to forty minutes. Temperature of water: 180° F. Requisites: Three bath blankets. One double wool blanket. One large worn woolen blanket (to be wet). Two rubber sheets (one large and one small). Wringer and sticks or clean heavy sheet. . Foot-tub. . Five hot-water bottles and one cover. NOUR ei — HOT WET PACK 139 8. One ice-cap and cover. 9. Two towels (bath and face). 10. Thermometer. 11. Safety-pin. 12. Bottle of alcohol (unless contraindicated). 13. Hot or cold drink (unless contraindicated) and a drinking tube. 14. Basin for ice and compress. 15. Tea kettle or pail for hot water. Procedure: Put the water on to heat if the water in the tap is not hot enough. Prepare the ice-cap and hot-water bottles for use. Place the hot-water bottles in the foot-tub and cover them with the large rubber sheet. Place the wringer and blankets on top of these. Carry the requisites to the bedside. Take and record the pulse. Replace the upper covers with a bath blanket, folding down the for- mer to the foot of the bed. Turn the patient on her side and place a bath blanket, the large rubber sheet, the double wool blanket (unless the condition of the patient does not permit)! and another bath blanket in position so that the center of each is in the center of the bed and the rubber sheet is on a line with the patient’s neck and the blankets 3 or 4 inches higher. Go to the opposite side of the bed and smooth out the blankets and rubber sheet. Remove the gown, and place the covered hot-water bottle to the feet. Draw up the upper covers, if the patient is cold. Prepare the basin of ice and a hot or cold drink. Either may be given as the patient prefers. If the bath-room is near, prepare the pack in the bath-room, otherwise prepare it at the bedside. Place the small rubber sheet on the floor and the tub and wringer in the center of the rubber sheet. Fold the large worn woolen blanket and place it in the center of the wringer. Pour the water (180° F.) over the blanket so that all parts of it are reached by the hot water. With the help of an assistant, wring the blanket as dry as possible. If the covers have been drawn up, turn them down to the foot of the bed. Turn the patient on her side and spread the folded wet blanket on the side at which you are standing so that the center of the blanket is in the center of the bed. Turn the patient on to half of it and draw the other half out on the op- posite side. Then wrap the patient in the wet blanket so that all parts of the body are in contact with it. Fold the blankets that are under the patient across her shoulders and body, being careful to draw them snugly around the neck and feet. Do this work as quickly as possible to prevent the blanket from cooling. Bring the upper edge of the blankets obliquely across the patient’s chest and make a fold in the sides, so that they will fit snugly around the neck. Secure them by means of a safety-pin. Stretch them tightly and tuck them under the patient all along the sides. Place the hot-water bottles along the sides and at the feet after wrapping the patient in the double wool blanket. Place the ice-cap in position. Then bring up the sides of the rubber sheet and fold the bath blanket around the patient. Arrange the towel between the patient's neck and the blankets. ! When it is difficult for the patient to turn, or in eclampsia, this blanket may be placed over the patient instead of under her. 140 NURSING TECHNIQUE Draw up the upper covers. Feel the patient’s pulse at the temporal or carotid artery frequently during the pack. Give 2 ounces of hot or ice water, every ten minutes, unless contra- indicated. Continue the pack the prescribed time (which is usually thirty minutes) if the patient's condition is satisfactory. To remove pack: When the time is over, turn down the upper covers, remove the hot- water bottles, and then loosen the blankets till the wet one is felt. Cover the patient with a bath blanket and, under cover, remove all the blankets and dry her. Turn her on her side, rolling the blankets, etc., under her, and dry her back and other parts thoroughly. Remove the blankets from the opposite side. Wrap the patient loosely in the under bath blanket and draw up the covers. Replace the ice-cap to her head and leave her thus for half an hour. Then dry her thoroughly and rub her with alcohol un- less contraindicated. Put on her gown and make her comfortable. Precautions: 1. Do not leave the patient alone during the pack. 2. Always take the temperature of the water used for a pack and water bottles. 3. Count the pulse every fifteen minutes during the pack. Record: 1. Hour and treatment. 2. Duration of pack. 3. Effects produced. 4. Any unusual symptoms which may occur. References: Sanders’ Modern Methods in Nursing, pp. 108 and 109. Harmer's Principles and Practice of Nursing, pp. 369-372. Pope's Practical Nursing, pp. 291-296. HOT DRY PACK A Jot dry pack consists in wrapping a patient in a dry blanket (that has been thoroughly warmed) so that all body surfaces are in contact with the blanket. The patient is then wrapped securely in several more blankets. Prescribed: The results desired are the same as for a hot wet pack. Duration of pack: From twenty to forty minutes. Requisites: : Same as for a hot wet pack, minus: 1. Tea kettle, for hot water. 2. Thermometer. 3. Wringer and sticks. 4. Small rubber sheet. Procedure: Proceed in the same manner as for a hot wet pack, except that the blanket is thoroughly warmed in the blanket warmer, and brought to the bedside just as it is needed. The blanket may be wrapped in a clean sheet and placed in the oven or on a radiator or an electric pad, if the blanket warmer is not available. HOT BATH PACK 141 HOT BATH PACK A hot bath pack consists in immersing a patient in a tub of hot water the prescribed time. The patient is then removed from the tub and wrapped in several dry blankets. Prescribed: The results desired are the same as for a hot wet pack. Duration of bath: Usually fifteen minutes. Temperature of water: 100° F., increasing to 115° F., if the patient is not depressed. Duration of pack: From twenty to forty minutes. We Fig. 20.—Hot bath pack. Preparation of bed for hot bath pack. Requisites for bath-room: Rubber ring. Towel and piece of bandage. Ice-cap and cover. One large worn woolen blanket. Double wool blanket. One bath blanket. Saftey-pin. Bath mat. Chair. Bath thermometer. Three towels (2 bath and 1 face). — HOON 142 NURSING TECHNIQUE Regquisites for bed: 1. Large rubber sheet. 2. Five hot-water bottles and one cover. 3. One bath blanket. 4. Towel. Reguisites for patient: . Bathrobe. Slippers. . Cotton for ears. . Hair-pins, if patient is a female. . Wheel chair, if indicated. . Hot or cold drink and a drinking tube. . Large bath towel and safety-pins (for loin binder). Procedure: Prepare the ice-cap for use and place it in the bath-room so that it will be at hand when the patient is in the tub. Have the bath-room warm. Tie the rubber ring to the head of the tub and cover it with a towel. Half fill the tub with water 100° F. Place the chair so that it will be convenient for the patient to sit on and cover the seat with a bath towel. Place a second bath towel over the edge of the tub to prevent the patient from slipping. Place the bath mat in front of the tub and the bath blanket and the woolen blankets on the back of a chair. Return to the bedside and count the patient’s pulse and record it. Apply a loin binder, by using a large bath towel as a square diaper. Clothe the patient in a bathrobe and slippers. If the bath-room is not far from the sick-room, the patient may walk to La tub. If the patient’s condition indicates, take her there in a wheel chair. Remove the bathrobe and slippers. Pin a bath blanket around the patient with the opening at the back. Remove the nightgown. Put cotton in the patient's ears and, if a female, pin up her hair. Assist her in the tub, and remove the bath blanket. Place the ice-cap on her head. Have the patient recline in the tub so that her head is resting on the rubber ring and the body is entirely covered by the water. The time prescribed for the bath is usually fifteen minutes. When the patient has been in the tub five minutes run in hot water at intervals until the maximum temperature ordered by the physician is attained. Unless otherwise prescribed, this should be reached in ten minutes. While the patient is in the tub, have an assistant prepare the bed as quickly as possible for it may be necessary to remove the patient from the tub before the prescribed time has elapsed. Place the bath blanket and then the rubber sheet on the bed as for a hot wet pack. Prepare the hot-water bottles for use and place them on the side of the bed. When the bath time has expired, have the pa- tient stand for an instant and pin the dry bath blanket around her. Assist her from the tub. Remove the cotton from her ears. If she is weak, she can sit on the chair for a moment, but do not expose her. Dry her by rubbing over the bath blanket, then wrap the patient in the worn woolen blanket so that the opening is in front. At the same time remove the bath blanket and wrap the double wool blanket around her (so that the opening is in the back) to prevent chilling in going back to the room. Put on her slippers and assist her to her room. Remove the NOW = HOT TUB BATH 143 outer wool blanket at the bedside and place it on the bed so that the center of the blanket is in the center of the bed. Then remove the slip- pers and assist the patient into bed. Wrap her in the blankets as for a hot wet pack. Draw up the covers and replace the ice-cap to the head. Place a towel around the neck over the edge of the blankets, and count the pulse, Give 2 ounces of hot or cold water every ten minutes, unless contrain- dicated. The patient is usually left in the pack for thirty minutes. Count the pulse every ten or fifteen minutes during the pack. If the patient is not able to go to the bath-room, proceed in the same manner except that a portable tub is brought to the bedside. After the pack proceed as after a hot wet pack. HOT TUB BATH A hot tub bath consists in immersing a patient in a tub of hot water, the prescribed time. Prescribed: . To induce perspiration and aid in elimination. . To relieve edema. . To lower high blood-pressure. . To relieve pain in cystitis, gall-stones, and renal and intestinal colic. To hasten the outbreak of the rash in the beginning of measles or scarlet fever. . To relax excessive muscular contraction in convulsions. . To relieve amenorrhea. To stimulate the respirations in asphyxia of the newborn. Duration of bath: From five to thirty minutes. Temperature of water: From 100° to 115° F Requisites for bath- room: . Rubber ring. . Towel and piece of bandage. . Ice-cap and cover. . One bath blanket. . Double wool blanket. . Safety-pin. . Bath mat. . Bath thermometer. . Chair. 10. Three towels (2 bath and face). Requisites for bed: Three hot-water bottles and covers. Regquasites for patient: . Bathrobe. . Slippers. . Cotton for ears. . Hair-pins, if patient is a female. . Wheel chair, if indicated. . Large bath towel and safety-pins (for loin binder). WN UT wR ORT UTHR WN Sk w= 144 NURSING TECHNIQUE Procedure: Prepare the bath-room and patient as for a hot bath pack. Prepare the bed by placing the three hot-water bottles in it. Watch the patient constantly when she is in the tub, and increase the temperature according to the effects desired, and the condition of the patient. Do not permit the patient to remain in the tub longer than fifteen minutes, if the temperature is increased to 115° F. When the bath time has expired assist the patient from the tub and dry her. Clothe her in her gown and bathrobe and wrap her well in the bath blanket and then the double wool blanket to prevent chilling. Assist her to her room and keep her quiet in bed, according to her condition. APPLICATION OF HOT DRESSINGS lot dressings consist of the application of gauze dressings which have been wrung as dry as possible from very hot water. Prescribed: 1. To relieve pain. 2. To produce hyperemia. 3. To promote absorption of serum. 4. To promote suppuration. 5. To soften necrotic tissue. Regquisites: MetzOD I Tray with the following: . Sterile dressings. Sterile basin. Forceps (2 sterile and 1 non-sterile). Hot-water bottle. Oil muslin or waxed paper. Stupe wringer and sticks. . Paper bag. Procedure: Wash your hands. Place the sterile dressings in the stupe wringer and boil them in the ward sterilizer for twenty minutes. Half fill the hot-water bottle with water 130° F., and place it and the other re- quisites on the tray. Remove the wringer and the contents from the sterilizer with the sterile forceps and place them in the sterile basin. Carry the tray to the bedside. Place the paper bag for waste. Remove the soiled dressings with the non-sterile forceps and put them in the paper bag. Wring the dressings as dry as possible, shake them and apply them to the affected area. Cover them with waxed paper or oiled muslin and apply the hot-water bottle. Change the dressings every two hours and the hot-water bottle every thirty minutes. Nerd Le hom Requisites: MerrOD II 1. Electric grill or sterno and matches. 2. Tray with the following: . Sterile basin. . Sterile dressings. . Sterile stupe wringer and sticks. . Forceps (2 sterile and 1 non-sterile). . Paper bag. UU DN = CATHETERIZATION OF THE BLADDER 145 Procedure: Wash your hands. Place the sterile stupe wringer in the sterile basin (using the sterile forceps), and after placing the sterile dressings in the wringer cover them with boiling sterile water. Carry the re- quisites to the bedside and connect the electric grill or light the sterno. When the water is boiling proceed as in Method I except that the dress- ings are changed every three minutes for fifteen minutes. The treatment is usually repeated in two hours. Points to be remembered: 1. Apply the dressings hot, but do not burn the patient. 2. Apply sterile vaselin or oil to the area if it becomes reddened by continuous applications. Record: 1. Hour and treatment. 2. Duration of treatment and method of application. 3. Any unusual symptoms relating to the wound. Reference: Harmer’s Principles and Practice of Nursing, pp. 307-325. CATHETERIZATION OF THE BLADDER By catheterization of the bladder is meant the withdrawal of urine from the bladder by means of a catheter introduced into the bladder through the urethra. Prescribed: 1. For retention of urine when every nursing measure has been tried to cause the bladder to empty itself in the normal way. 2. For retention with overflow. 3. As an aid to diagnosis. 4. To prevent infection of a wound. Position of patient: Dorsal recumbent position. Requisites: 1. Bath blanket. 2. Catheterization tray with: . Sterile cotton sponges (2). . Sterile kidney basin. . Sterile solution basins (2). . Sterile gauze sponges. . Sterile towels (1 package). . Sterile tray cover. . Sterile catheterization sheet. . Sterile forceps. . Sterile lubricant. . Sterile catheters (2) in catheter sterilizer. 11. Sterile gloves. 12. Flask of green soap. 13. Paper bag. 14. Sheet for draping. 15. Dressing towel (non-sterile). 16. Drop light (if indicated). 10 — OOO TUL LN = 146 NURSING TECHNIQUE METHOD 1 Procedure: "Screen the bed if the patient is in a ward and place her on the bed- pan. Cleanse the external genitals with green soap and warm water, if indicated. Dry the parts with sterile cotton and remove the bed-pan. Wash your hands and prepare bichlorid solution 1: 2000 for disin- fecting the hands and boracic acid solution 2 per cent. for cleansing the vulva. Prepare one-half of the tray by cleansing it with ether and alco- hol by means of cotton pledgets. Cover same with the sterile tray cover (using sterile forceps). Place the basin of boracic acid solution on same and put six cotton sponges in the solution and six beside the basin. Place the sterile kidney basin, the catheters, the catheterization sheet, a sterile towel and a gauze sponge (with lubricant) on the tray and cover it with half of the sterile tray cover (using sterile forceps). Tig. 21.—Catheterization. Preparation of tray when a steel or glass catheter is used. Place the basin of solution for the hands, the paper bag, the sheet, and towel for draping on the other half of the tray and carry it to the ~ bedside. Place the patient in the dorsal recumbent position and drape her with the sheet and towel. Cover the chest with a bath blanket. Remove all but one pillow from under the head of the patient, if possible. Place the bedside table at the foot of the bed (right side) and put the paper bag so that it will be convenient for use. Remove the cover from the sterile tray. Go to the dressing room and scrub your hands accord- ing to Method I. Return to the bedside and immerse your hands in bichlorid solution 1 : 2000 for one minute. Dry them on the sterile towel and with the right hand covered with the sterile towel, remove the towel from the vulva. Separate the labia with the thumb and first finger of the left hand.? Wash down over the meatus toward the anus, making as much pressure 1 This is not necessary the first or second day following operation or delivery. 2Do not allow the fingers to come in contact with the mucous membrane. This may be prevented by covering the thumb and first finger with a cot of cotton. CATHETERIZATION OF THE BLADDER 147 as possible without causing discomfort, using each sponge but once and holding it so that the hand is not contaminated. Do this until the parts are thoroughly cleansed. Immerse your hands in the bichlorid solution and then place the sterile catheterization sheet over the vulva. Place the sterile kidney basin to receive the urine. Separate the labia and wash down over the meatus with a sterile sponge moistened with boracic acid solution. Then without removing the fingers of the left hand from the labia, take the catheter (by the open end) in the right hand, lubricate it, and pass it gently into the urethra. Cease moving the catheter as soon as the urine begins to flow. When the urine ceases to flow, remove the catheter. At the same time place your finger over the open end of the catheter to avoid drip- ping the urine on the bed. Remove the kidney basin containing the urine. Wash the genitals with a moistened sponge and dry the parts with a sterile sponge. Make the patient comfortable and remove the tray. Measure the urine and wash the catheters and sterilize them. Equip the tray for the next treatment. . MEetHOD II With gloves (when a rubber catheter! is used or when the patient may be a source of infection to the nurse). Procedure: Proceed as in Method I as far as and including the preparation of the tray. Place the sterile gloves on the non-sterile side of the tray and carry it to the bedside. Place the patient in the dorsal recumbent position and drape her with the sheet and towel. Cover the chest with a bath blanket. Re- move all but one pillow from under the head of the patient if possible. Place the bedside table at the foot of the bed (right side) and put the paper bag so that it will be convenient for use. Remove the cover from the sterile tray and open the package containing the sterile gloves. Remove the towel from the vulva. Put on sterile gloves and proceed as in Method I. Points to be remembered: 1. Maintain perfect technique, for carelessness may cause cystitis. 2. Never use force when passing a catheter. 3. Remember that pain or the presence of blood usually indicates carelessness. 4. Always examine glass and metal catheters to see that there are no sharp edges. 5. Do not use a glass catheter for a pregnant, unconscious, deli- rious patient, or a small child. 6. Do not contaminate the end of the catheter that is to be in- serted. Record: 1. Hour and treatment. 2. Amount and color of urine. 3. Character and odor. t Gloves are worn when a rubber catheter is used because the soft catheter cannot be grasped far from the tip as a steel and glass catheter can, and the chances for contaminating it are far greater. 148 NURSING TECHNIQUE References: Williams’ Anatoray and Physiology, pp. 421-435. Kimber’s Anatomy and Physiology, pp. 475-502. Harmer’s Principles and Practice of Nursing, pp. 531-540. Pope's Practical Nursing, pp. 432-438. Sanders’ Modern Methods in Nursing, pp. 182-189. BLADDER IRRIGATION OR VESICAL DOUCHE A bladder irrigation or a vesical douche is the washing out of the urin- ary bladder with sterile water or some antiseptic solution by means of a catheter introduced into the bladder through the urethra. Prescribed: 1. To cleanse the bladder of the irritating products of inflammation. 2. To relieve pain and congestion. Solutions prescribed: 1. Boracic acid, 2 per cent. 2. Normal saline (half-strength). 3. Potassium permanganate, 1 : 1000. 4. Silver nitrate, 1 : 1000. 5. Protargol, 1 : 1000 Temperature of solution: From 105° to 108° F Amount of solution: From 1 to 2 quarts. Position of patient: Dorsal recumbent position. MeTHOD 1 (Assisting)! Requasites: 1. Irrigator stand. 2. Bath blanket. 3. Catheterization tray. 4. Bladder irrigation tray with: . Sterile return flow catheter. . Sterile glass graduated reservoir. . Sterile tubing about 2 or 3 feet long, supplied with a stop- cock. . Sterile piece of tubing 18 inches long, of smaller bore, sup- plied with a stop-cock. Sterile piece of tubing 2 inches long, of the same bore as the 18-inch piece. . Sterile glass connection. . Sterile glass funnel. . Sterile basin for return flow. . Sterile pitcher for solution (2 quarts). 10. Sterile thermometer. 11. Sterile gloves. ‘Procedure: Screen the bed, if the patient is in a ward, and place the patient on the bed-pan. Cleanse the external genitals with green soap and warm 11t is the opinion of the writer that only senior or graduate nurses should be permitted to irrigate the bladder. VO 1B» w= BLADDER IRRIGATION OR VESICAL DOUCHE 149 water. Dry the parts with sterile cotton and cover the vulva with a sterile towel. Remove the bed-pan and return to the dressing-room and wash your hands. Prepare boracic acid, 2 per cent., as for catheteriza- tion. Cleanse one tray with ether and alcohol by means of cotton pledgets. Cover same with the sterile tray cover (using sterile forceps). Place the reservoir, tubing, funnel, glass connection, return flow cath- eter, gauze sponge, the catheterization sheet, one sterile towel, the basin of boracic acid and solution, the kidney basin, and the basin for return flow on this tray. Place 6 sponges in the boracic solution and 6 on the tray. Put on sterile gloves and connect one end of the 3-foot piece of tubing with the graduated reservoir and the other end with the glass connec- tion. Close the stop-cock and place the glass funnel in the reservoir. Connect the piece of tubing 18 inches long with the lower projection for the return flow on the metal catheter. (Close the stop-cock to pre- vent it falling off.) Connect the piece of tubing 2 inches long with the upper projection on the return flow catheter. Cover the tray with a sterile towel. Remove your gloves. Place the other requisites on the second tray. Prepare the prescribed solution for the irrigation. Carry the requisites to the bedside. Attach the irrigator stand to the side of the bed. Drape the patient and place the bedside table at the side of the bed, near the foot. Hang the reservoir about 12 inches above the patient. Remove the towel from the vulva when the physician is ready. Prepare the lubricant for use. The physician then places the sterile catheterization sheet after he has put on sterile gloves. Place the paper bag so that it will be convenient. He then cleanses the genitals with moist boracic sponges. Place the kidney basin to re- ceive the urine. The physician then passes the catheter, after lubricat- ing it, and opens the stop-cock, on the lower piece of tubing. When the bladder is empty the physician closes the stop-cock on the lower piece of tubing. Remove the basin of urine and substitute the basin for the return flow. Take the temperature of the solution and pour it into the reservoir. The physician, after expelling the air from the tubing (attached to the reservoir), connects it to the 2-inch piece of tubing attached to the upper projection on the metal catheter. He then permits 100 to 500 c.c. of solution to run slowly into the bladder if distress is not occasioned. (In health the bladder will hold 500 c.c. without discomfort, but when inflamed this may not be possible.) He then opens the stop-cock for the return flow and the solution flows in a continuous stream into and out of the bladder. When the solution returns clear, the stop-cock on the tubing, attached to the reservoir, is closed. The physician removes the catheter when all the solution has returned from the bladder. Pro- ceed then as after catheterization. MeTHop II (For this method one nurse prepares the equipment and irrigates the bladder.) Regquisites: 1. Bath blanket. 2. Catheterization tray. 3. Bladder irrigation tray with the following: 150 NURSING TECHNIQUE . Two rubber catheters (sterile). . Sterile pitcher (2 quarts). . Sterile graduated measure for solution. . Sterile funnel (medium). . Sterile tubing (18 inches long). . Sterile glass connection. (Medicine dropper.) . Sterile graduated basin for return flow (2 quarts). . Sterile gloves. Procedure: Proceed as in Method I, as far as and including the covering of the tray with the sterile tray cover. Place the rubber catheters, the sterile graduated measure for solution, the funnel, gauze sponges, the tubing 18 inches long, the glass connection, the graduated basin for the return flow, one sterile towel, and the catheterization sheet on this tray (using sterile forceps). Prepare the boracic acid and bichlorid solution and sponges as in Method I. Prepare the lubricant and cover the tray. Prepare the solution for the irrigation and carry the requisites to the bedside. Drape the patient as for Method I, placing the paper bag at the foot of the bed. Pour 500 c.c. of the solution from the pitcher into the sterile graduated measure. Remove the towel from the vulva. Put on the sterile gloves and insert the glass connection in the 18-inch piece of tubing. Connect the free end to the glass funnel. Wash the external genitals with moistened boracic sponges and cover the vulva with the aspirating sheet. Place the basin for the urine as for catheterization. Lubricate and pass the catheter, observing the same precautions as for catheterization. When the bladder is empty remove the basin contain- ing the urine and replace it with the graduated basin. With an assist- ant’s help, fill the funnel with solution and expel the air, then check the flow and insert the glass connection in the catheter. Pour in more solution as necessary so that 200 to 400 c.c. will enter the bladder in a slow, steady stream. (Be careful that the funnel does not empty.) Then lower the funnel and allow the solution to return. Refill the funnel and introduce more solution before the bladder is quite empty. Repeat the process until the solution returns clear or until the prescribed amount has been given. Proceed then as after catheterization. Record: 1. Hour. : 2. Amount of urine withdrawn. 3. Amount and strength of solution used. 4. Character of return flow. References: Harmer’s Principles and Practice of Nursing, pp. 539-543. Pope's Practical Nursing, pp. 439-443. COLD APPLICATIONS, BATH, AND PACKS Cold may be applied to the body in the form of: 1. Local applications. ; 2. General applications. Local applications are made by means of: 1. An ice-bag. 2. An ice-coil. OTN UT WN = COLD APPLICATIONS, BATH, AND PACKS 151 3. Cold compresses. 4. Volatile sprays. Local cold applications are prescribed: 1. To produce a purely local effect on the tissues to which the ap- plication is made. -2. To relieve inflammation, congestion, hemorrhage, or pain in a part by controlling the circulation to it. 3. To produce the desired effect on some internal organ or distant part reflexly associated with the area of skin to which the cold is applied. = (Harmer’s Principles and Practice of Nursing.) General applications are made by means of: 1. Cold sponge bath. 2. Cold packs. 3. Brand bath. 4. Spray or slush bath. General cold applications are prescribed: 1. To reduce body temperature. 2. As a nerve and circulatory stimulant. 3. As a sedative. 4. To aid elimination. The degree of cold used depends upon: 1. The age and condition of the patient. 2. The patient's temperature. 3. The part to which the application is to be made. 4. The method of application. Reaction may be retarded by: 1. Extremes of age. 2. Lowered vitality. 3. Obesity. 4. An aversion to cold baths. 5. Exhaustion or extreme nervousness. 6. Cold skin with a high body temperature Reaction may be aided by: 1. Warm surroundings. 2. Warm feet. 3. Friction. 4. The sudden application of cold. 5. Applying heat after the treatment. Symptoms which indicate the treatment is having an undesirable effect: 1. Cyanosis. 2. Intense shivering. 3. Increasing pulse rate. The following schedule may be used when the bath temperature is not pre- scribed. Rectal. Bath. 103.5° F. 90° F. 104° PF. 85° F. 104.5° F. 80° F. 105° PF. 75° F. 105.5° F. 70°F. 106° F. 65° F. 1 Pope’s Practical Nursing. 152 NURSING TECHNIQUE Cold bath, 40° to 70° F.! Cool bath, 70° to 80° F. Tepid bath, 80° to 90° F. Warm bath, 90° to 100° F. Hot bath, 100° and over. References: Sanders’ Modern Methods in Nursing, pp. 113-120 and 123-129 Harmer’s Principles and Practice of Nursing, pp. 216-221 and 374- 391. Pope’s Practical Nursing, pp. 254-259. GIVING A COLD SPONGE BATH A cold sponge bath consists of the application of cold water to a pa- tient’s body, by means of sponge cloths. The treatment is accom- panied by friction applied with the open hand. Duration of treatment: From ten to twenty minutes. Temperature of water: If not prescribed, the temperature depends upon: 1. The patient's age and condition. 2. The patient's temperature. Regquisites: 1. Foot-tub. . Large rubber sheet. . Three bath blankets. . Two towels (bath and face). . Two sponge cloths (about 18 inches square?). . Hot-water bottle and cover. . Ice-cap and cover. . Bath thermometer. Procedure: Be sure that the room is warm. Prepare the hot-water bottle and ice-cap for use. (If the patient has a high temperature, the ice-cap is applied to the head constantly.) Half fill the foot-tub with water the required temperature. Carry the requisites to the bedside. Replace the upper covers with a bath blanket. Turn the patient to one side and cover the bedding and pillow with, first a bath blanket, then the rubber sheet, and over this place another bath blanket. Turn the patient to the opposite side and draw out the rubber sheet and bath blankets. Remove the patient's gown and apply the hot-water bottle to her feet and the ice-cap to her head. Feel her pulse and observe her general condition. (The temperature, pulse, and respirations are usu- ally taken and recorded just previous to the treatment.) Place your watch where it can be seen and note the hour. Sponge the face and neck. Then expose the upper extremities and give light friction for a minute or two. Apply a wet compress to the abdomen and change it every three minutes. Begin sponging the arm nearest you, then the chest and the other arm. Keep the patient's arms away from the sides and sponge the axilla frequently. Do not t Sanders” Modern Methods in Nursing. 2 Small bath towels may be used. COTA UTLH WN GIVING A COLD PACK 153 allow the water to drip from the sponge cloth when sponging and keep up friction. After ten minutes have elapsed cover the upper extremities and expose the legs. Proceed with the lower extremities, allowing five minutes for sponging. Remove the sponge cloth from the abdomen and turn the patient on the side. Sponge the back and thighs for five minutes. Dry the back and thighs and roll the bath blanket and rubber sheet up close to the patient. Remove them from the opposite side by turning the pa- tient on to the dry blanket. Wrap her loosely in the under bath blanket and remove the upper one and draw up the upper bedclothes. Replace the ice-cap and the hot-water bottles and allow the patient to rest for thirty minutes. If she is cold, give her a hot drink and apply friction. Take the after- ~ bath temperature thirty minutes after the bath. Remove the blanket and put on the gown at this time if the patient is warm. Points to be remembered: 1. Keep the feet warm during the treatment. 2. Watch the pulse and color constantly. 3. Observe strict typhoid precautions throughout the treatment, if indicated. Record: 1. Hour and treatment. 2. Duration and temperature of bath. 3. Any unusual symptoms which may occur. 4. After bath temperature. References: Sanders’ Modern Methods in Nursing, pp. 113-115. Harmer’s Principles and Practice of Nursing, pp. 397 and 398. Pope's Practical Nursing, pp. 264-270. GIVING A COLD PACK 9 A cold pack consists of the applications of cold water to a patient’s body by means of a cold wet sheet. The patient is then wrapped in dry blankets to prevent evaporation or left unwrapped according to the effect desired. MEerHOD I Prescribed: To reduce body temperature. Duration of treatment: About twenty minutes. Temperature of water: From 60° to 90° F. Requisites: . Foot-tub. . Large rubber sheet. . Two bath blankets. Muslin sheet. Two towels (1 bath and 1 face). Ice-cap and cover. Two hot-water bottles and one cover. Sprinkling can or whisk room. . Bath thermometer. © NOUR LI 154 NURSING TECHNIQUE Procedure: Proceed as for a cold sponge bath as far as and including the replac- ing of the upper bedclothes with the bath blanket. Fold the muslin sheet lengthwise in narrow folds and put it in the water. Remove the patient's gown. Place the covered hot-water bottles under the covers at the foot of the bed and the ice-cap to her head. Turn the patient on her side and place the bath blanket and rubber sheet under her as for a cold sponge bath. Wring the sheet so that it will not drip and spread it out on the rubber sheet, so that the center of the sheet is in the center of the bed. Turn the patient over on the wet sheet and go to the opposite side of the bed and draw out the bath blanket, the rubber sheet, and the wet sheet. Then wrap the patient’s body snugly in the wet sheet so that every part is in contact with the wet sheet except the feet. Place the uncovered hot-water bottle close to them. Give friction over the sheet during the pack to prevent chilling. Continue the treatment for twenty minutes. Sprinkle the sheet with water (the same temperature as the pack) as soon as it gets warm or when reaction sets in. Keep it continually wet and apply friction throughout the treatment. To remove the pack: Cover the patient with a bath blanket and, under cover of same, re- move the wet sheet and dry the skin. Turn the patient and remove the under clothing as in a cold sponge bath. To prevent the bed from be- coming wet, roll the material from each side to the center and fold it over from top and bottom to the center to confine the water. Place the ‘ice-cap to the patient's head and the covered hot-water bottle to the patient's feet. Serve a hot drink, if indicated. Record: 1. Hour and treatment. 2. Duration and temperature of pack. 3. Any unusual symptoms which may occur. 4. After-bath temperature. MersOD 11 Prescribed: 1. As a nerve and circulatory stimulant. 2. As a sedative in insomnia, the delirium of typhoid or pneumonia, in acute mania and in all forms of cerebral irritation. 3. To aid in elimination. Temperature of water: From 60° to 80° F. Duration of pack: According to the effect desired: 1. The tonic effect is usually attained in fifteen minutes. 2. The sedative effect is usually attained in forty to sixty minutes. 3. The eliminative effect is usually attained in one to two hours. Regquisites: Foot-tub. . Large rubber sheet. Three bath blankets. Muslin sheet. . Two towels (1 bath and 1 face). Spee GIVING A BRAND BATH 155 6. Ice-cap and cover. 7. Two hot-water bottles and one cover. 8. Bottle alcohol. 9. Bath thermometer. Procedure: Prepare the requisites as for Method I. Replace the upper covers with a bath blanket. Turn the patient on her side, and place the bath blanket, rubber sheet, and the second bath blanket under her as for a cold sponge bath. Then remove the gown and apply the hot-water bottles and ice-cap. Wring the sheet so that it will not drip and wrap the patient in it as in Method I. Then wrap the bath blanket (under the patient) smoothly and snugly about her to prevent any evaporation. Cover her with the upper bath blanket and tuck it along the sides of the patient. Bring up the upper covers. Continue the treatment until the desired effect is attained. If the pack is given as a nerve and circulatory stimu- lant, discontinue the treatment after reaction has begun. This is usually attained in fifteen minutes or when the sheet becomes warm. Remove the patient from this pack as in Method I. The neutral or sedative effect is attained in forty to sixty minutes or when the temperature of the pack is raised to body temperature. If the pack is given for this purpose, remove the patient, avoiding all stimuli. The eliminative effect is attained in one or two hours. If given for this purpose, discontinue the pack as soon as the patient shows signs of exhaustion. Remove the patient from this pack as in the hot wet pack. Record: 1. Hour and treatment. 2. Duration of pack. 3. Patient's reaction to treatment. 4. Any unusual symptoms which may occur. References: Sanders’ Modern Methods in Nursing, pp. 117-119. Harmer’s Principles and Practice of Nursing, pp. 390-393. Pope's Practical Nursing, pp. 276-283. GIVING A BRAND BATH A Brand bath consists in immersing a patient in a tub of water the proper temperature. The treatment is accompanied by friction applied with the open hand. Prescribed: In the treatment of typhoid! 1. To regulate and increase the movement of blood through the blood-vessels, thereby preventing or relieving visceral con- gestion and resulting loss of function. 2. To stimulate the nerve centers and relieve them of the toxins which depress vital activities and cause headache, delirium, insomnia, stupor or coma, etc. 3. To relieve congestion and increase the activity of the liver so that it can destroy the toxins brought to it from the intestines and so protect the whole system. 1 Harmer’s Principles and Practice of Nursing. 156 NURSING TECHNIQUE 4. To improve the circulation of the kidneys, thereby preventing nephritis and increasing the elimination of toxins. The vol- ume of urine may be greatly increased. 5. To improve the circulation, the nutrition, and the function of the skin and so increase the elimination of heat and waste prod- ucts and prevent bed-sores. 6. To stimulate respirations. 7. To increase oxidation, including that of toxins so aiding in their destruction and elimination. 8. To increase the flow of digestive juices, the absorption and as- similation of food, thereby improving the appetite, and the nutrition and function of every body cell. 9. To improve the quality of the blood and increase the number of red and white blood-cells. In typhoid the white cell count is low. : 10. To build up vital resistance and cause the destruction and elimination of toxins from bacteria and tissues. 11. To tone up the muscles of the heart and blood-vessels and pre- vent failure due to toxins. 12. To lower the body temperature and to make the patient more comfortable. 13. To prevent complications, bed-sores, intestinal hemorrhage, perforation, pneumonia, or nephritis. Duration of treatment: From ten to twenty minutes. Temperature of water: From 70° to 90° F. Requisites: 1. Portable bath-tub. 2. Stretcher and poles. 3. Rubber ring and piece of bandage. 4. Cotton for ears. 5. Hair-pins, if patient is a female. 6. Large bath towel and safety-pins (to drape loins). 7. Large rubber sheet. 8. Three bath blankets. 9. Three towels (2 bath and 1 face). 10. Hot-water bottle and cover. 11. Ice-cap and cover. 12. Bath thermometer. Procedure: Half fill the tub with water the required temperature. Tie the rubber ring to the upper part of the tub and cover it with a towel. Prepare the ice-cap and hot-water bottle for use. Carry the requisites to the bed- side. Replace the upper covers with a bath blanket. Remove the patient's gown and drape the loins with a bath towel.! Place small cotton pledgets in the ears to avoid the entrance of cold water. Pin up the hair, if the patient is a female. Count her pulse and observe her general condition. 1 Place the bath towel under the patient lengthwise and bring it up between the ks and pin it at the waist and the outside of the thighs like a square diaper on an infant. GIVING A SPRAY OR SLUSH BATH 157 Turn her on her side and place the stretcher without poles under her. Insert the poles through the folds provided for them and, with the as- sistant’s help, lift the stretcher and patient from the bed and lower her gradually into the tub. Remove the bath blanket, covering her as she is lowered into the water. Do not permit any exposure until the patient is in the water. Immerse the patient’s body to the neck, including the shoulders. Support the head on the rubber ring and be sure that all strain is avoided. Apply friction throughout the treatment, avoiding the abdomen. Have an assistant prepare the bed by tightening the under bedclothes and covering them with a bath blanket and the rubber sheet. (Change the bed completely once daily and turn the mattress.) Place the covered hot-water bottle under the covers at the foot of the bed. When the bed is ready and the bath is completed, place a bath blanket over the tub. Remove the pins from the bath towel, draping the loins, and let it remain in the tub temporarily. Raise the stretcher and patient with the assistant’s help and hold them above the tub to drain for a few seconds. Then place the patient on the rubber sheet and remove the stretcher poles. . Dry the patient and remove the stretcher and rubber sheet. Re- move the cotton from her ears. Wrap her loosely in the under bath blanket, remove the upper one, and apply the hot-water bottle to her feet. Draw up the covers and proceed as after a cold sponge bath. Record: 1. Hour and treatment. 2. Duration and temperature of the bath. 3. Any unusual symptoms which may occur. 4. After bath temperature. References: Sanders’ Modern Methods in Nursing, pp. 100-105. Harmer’s Principles and Practice of Nursing, pp. 393-397. Pope’s Practical Nursing, pp. 258-264. GIVING A SPRAY OR SLUSH BATH A spray or slush bath consists in the application of cold water to a patient’s body by means of a spray. The treatment is accompanied by friction applied with the open hand. Prescribed: Sometimes instead of a sponge bath on account of the speedy re- action induced by the percussion of the water upon the skin. Duration of treatment: From ten to twenty minutes. Temperature of water: From 70° to 90° F. Requisites: . Irrigator standard. . Two large pails. Rubber sheet (about 9 feet long). Rubber sheet (about 1 yard square). Bath spray with funnel inserted in open end. Small pitcher. SUR 158 NURSING TECHNIQUE 7. Blocks or pins for Fowler's position. 8. Three bath blankets. 9. Two bath towels. 10. Two heavy blankets for rolls. 11. Large bath towel and safety-pins (to drape loins). 12. Large wash-cloth. 13. Ice-cap and cover. 14. Two hot-water bottles and one cover. 15. Basin for ice. 16. Bath thermometer. Procedure: Fill one pail and the small pitcher with water the required tempera- ture. Prepare the ice-cap and hot-water bottles for use. Have some pieces of ice for reducing the temperature of the water. Carry the re- quisites to the bedside. Remove the upper covers and at the same time cover the patient with a bath blanket. Turn the patient on her side and place a bath blanket, the large rubber sheet and a second bath blanket under her as for a cold sponge bath. Draw the extra length of the rubber sheet through the rods at the foot of the bed. Place the piece of rubber sheet 1 yard square at the foot of the bed under the second large pail. Con- fine the ends of the rubber sheet in the pail. Remove the patient’s gown and drape the loins with a bath towel as for a Brand bath. Ap- ply the ice-cap to her head and the uncovered hot-water bottle to her feet. Place the blankets (rolled) at each side of the patient under the rubber sheet to elevate the sides. Elevate the head of the bed about 4 inches to facilitate drainage. Hang the pail containing the water for the bath on the irrigator standard. Remove the bath blanket covering the patient. Start siphonage and spray the water over the entire body, giving friction throughout the treatment. If possible, have an assistant, so that friction may not be interrupted. Turn the patient slightly from side to side and spray the back. When the time has expired, drain off the water and wipe the rubber sheet with the wash-cloth and bath towel. Let down the sides of the rubber sheet and remove the pins from the bath towel covering the loins. Cover the patient with a bath blanket and remove the loin binder and uncovered hot-water bottle. Dry the patient and turn her on her side and dry the back. Remove the wet bath blanket and rubber sheet by rolling them on each side to the center and folding them downward from the top. Place them in the empty pail. Proceed as after a cold sponge bath. Record: Same as for a Brand bath. References: Sanders’ Modern Methods in Nursing, pp. 115-117. Harmer’s Principles and Practice of Nursing, pp. 397 and 398. Pope's Practical Nursing, pp. 269-274. COUNTERIRRITANTS A counterirritant is an agent used to produce a superficial irritation for the relief of an existing irritation. Page Missing Page Missing APPLYING ABDOMINAL STUPES OR FOMENTATIONS 161 over the abdomen and turn the towel back over the gown. Cover the stupe with the oiled muslin or waxed paper and apply the hot-water bottle. Bring up the sides of the binder and pin it. Change the stupe in thirty minutes and apply another hot-water bottle. Continue the treatment for two hours, unless otherwise prescribed. At the comple- tion of the treatment, cover the abdomen with a pad of Canton flannel to prevent chilling. MEeTHOD II Requistites: 1. Bath blanket. 2. Stupe tray with: . Electric grill. . Large basin. . Stupe wringer and sticks. . Two pieces of flannel. . Oiled muslin. Towel. . Tube of vaselin and gauze squares. Procedure: Half fill the basin with boiling water and carry the tray and other requisites to the bedside. Attach the electric grill and turn on the cur- rent. Prepare the patient and apply the fomentation as in Method I. Place the other piece of flannel in the wringer and after two or three minutes have elapsed use it to replace the piece on the abdomen. Continue the treatment fifteen to twenty minutes, changing the fo- mentation every two to three minutes, without exposing the area. i Dry the abdomen by patting it with the towel and cover it with a pad of Canton flannel. TURPENTINE STUPES Apply them in the same manner as simple hot-water stupes, plus the use of turpentine, which increases the counterirritant effect. Mix the turpentine and oil in a small glass (using one part turpen- tine to two of oil for an adult and one to six, seven, eight, or ten for chil- dren), and apply it to the abdomen by means of a swab of cotton tied to a glass mixing rod. Apply this mixture before every third applica- tion according to the color of the skin. STERILE STUPES Requisites: 1. Bath blanket. 2. Stupe tray with: . Large sterile basin. Large sterile pitcher (for boiling sterile water). Sterile stupe wringer and sticks. Two pieces of flannel (sterile) twice the size of the abdomen. Piece of oiled muslin or waxed paper (to cover the wet flannel). ‘Sterile towels (1 package). Sterile forceps (2). Sterile gauze. PN Ewe 11 é 162 NURSING TECHNIQUE 9. Tube of vaselin. 10. Hot-water bottle. 11. Paper bag for waste. Procedure: Wash your hands. Prepare the requisites for use, observing aseptic precautions. Cover the chest with a bath blanket, and loosen the swathe. Place the paper bag for waste. Remove the abdominal pad and apply the sterile towels. Remove the inner dressing (using the forceps) if soiled, and apply a light gauze dressing over the wound. Apply the stupes (using the for- - Fig. 23.—Applying sterile abdominal stupes or fomentations. ceps) as in Method I and cover them with a sterile towel, and then the oiled muslin and the hot-water bottle. Proceed as in Method I. Points to be remembered: 1. Wring the flannel as dry as possible and apply it gradually to prevent burning. 2. Take special care to prevent burning, particularly when the abdo- men is distended. i 3. Avoid chilling the part before, during, or after the treatment. 4. Use aseptic technique when applying stupes to a wound. PREPARING AND APPLYING POULTICES 163 Record: 1. Hour and treatment. 2. Method of application. 3. Patient's reaction to treatment. PREPARING AND APPLYING POULTICES A poultice or a cataplasm consists of the application of moist heat to the skin by means of a hot moist paste spread between soft muslin. Prescribed: 1. To relieve pain and congestion in pneumonia. 2. To stimulate the absorption of inflammatory products in pneu- monia. 3. To hasten suppuration in infections. Duration of application: About forty-five minutes. Thickness of poultice: 1. For-ehest-and abdomen, § inch thick. 2. Forother areas; 3 inch thick. Temperature of poultice: As hot as the patient can stand without burning. Requaisites: 1. Large board or heavy paper. 2. Utensil for cooking poultice in. 3. Spatula. __4. Flaxseed. 5. Tablespoon. 6. Stove or grill. 7. Towel. 8. Old muslin. 9. Oiled muslin. 10. Mustard. 11. Antiphlogistin. 12. A Small tray with the following: 1. Binder and pins or a bandage. 2. Canton flannel pad. 3. Tube of vaselin and gauze squares. 4. Receptacle for waste. Procedure: . Put the water on to boil (the amount will depend upon the size of the poultice). If a square or oblong poultice is required, cut a piece of muslin twice the size the poultice needs to be plus 2 inches for turning over the edges of the paste. If a chest poultice is required, cut the foundation and cover so that it will fit under the arms and around the neck and be 2 inches larger on all sides than the finished poultice needs to be. Cut the oiled muslin the size of the finished poultice. Spread a towel on the board and over this the oiled muslin. Cover this with the muslin on which the poultice is to be spread. When the water is boiling add the flaxseed to it slowly, stirring the mixture with the spatula. When the mixture is of the proper consistency, that is, when it leaves the sides of the basin or drops clean from the spatula, remove it from the fire and beat it thoroughly to introduce air into it. 164 NURSING TECHNIQUE | Spread it evenly on the muslin foundation to within 2 inches of the edges (if making a chest poultice), and turn the edges of the muslin over the paste. Place the muslin cover over this and fold under the edges. If a square or an oblong poultice is desired, crease the muslin in half and spread the mixture over one-half of the muslin to within 2 inches of the edges. Then turn the edges of the muslin over the paste and fold the other half over the paste so that all the sizes are folded in. Then fold the poultice, including the oiled muslin and the towel, and carry it to the bedside on the tray. To apply: Turn back the covers as necessary. Cover the affected area with the warm towel and place the binder in position. Apply the lubricant and, under cover of the towel, slip the poultice into position. (Apply it gradually and be sure that the temperature is correct.) If the applica- tion is made to one lung, place the patient on the unaffected side. Re- move the towel and secure the binder, but not too tightly. Fold the towel and keep it to roll the poultice in when removing it. To remove: Loosen the pins in the binder. Place the towel over the poultice and remove it under cover of same. If another poultice is prescribed, apply it without exposing the area. If not, dry the skin by patting the towel. Observe the color of the skin and apply the lubricant as indicated. Cover the area with the Canton flannel pad to prevent chilling. Points to be remembered: 1. Have the poultice as light as possible. 2. Have the poultice as hot as can be borne without burning the pa- tient. 3. Avoid exposure of the part during or after the treatment. 4. Never permit the poultice to remain on longer than an hour. Flaxseed: Used for poultices on account of the oil it contains, for it retains heat for a longer period of time than most substances. If the amount of flaxseed is limited, a satisfactory poultice can be made by using equal amounts of bran and flaxseed. Mustard: It is sometimes added to the flaxseed to increase the irritating effect. Remove the lumps from the mustard flour (the proportion of mustard to flaxseed is about 1 to 10 for an adult and 1 to 16 for a child), and dis- solve it in tepid water. Add it to the flaxseed poultice just before spread- ing it. Beat the mixture well, so that the mustard is thoroughly mixed, to avoid burning the patient. Watch the skin closely and remove the poultice when the skin is well reddened, which is usually in fifteen to thirty minutes. Bread: Place thick slices of bread over a sieve and pour boiling water over it. Then place the soft bread between muslin and apply it directly to the affected part. Soap: Pour warm green soap on a piece of soft muslin and apply it directly to the part. APPLYING SINAPISMS 165 O1l: Pour warm sweet oil on a piece of soft muslin and apply it directly to the part. Onion: Boil or fry an onion until it is soft. Apply it between muslin to the affected part. Antiphlogistin: A proprietary preparation composed of kaolin, thymol, boracic 204 oil of peppermint, glycerin, and methyl salicylate. sed: 1. To relieve pain and congestion in pleurisy, bronchitis, and pneu- monia. 2. To relieve pain and swelling in inflammatory conditions of the joints. 3. To relieve pain in toothache. To apply an antiphlogistin poultice to the chest: Place the receptacle containing the antiphlogistin in a basin of boil- ing water. Continue boiling the water until the mixture is thoroughly eated. Prepare the patient in a warm room. Turn her on her side and spread the antiphlogistin as thick and hot as can be comfortably borne over one-half of the thoracic walls. Cover immediately with a cotton-lined cheese-cloth jacket previously made and warmed. Roll the patient over on the dressed side and complete the application. Stitch the front of the jacket. Prepare everything before and work as rapidly as possible. Remove the dressing when it can easily be pulled off. Asa rule, this can be accomplished in twenty-four hours. (The Denver Chemical Manufacturing Company.) References: Sanders’ Modern Methods in Nursing, pp. 131-137. Harmer’s Principles and Practice of Nursing, pp. 207-212. Pope’s Practical Nursing, pp. 486-493. APPLYING SINAPISMS A sinapism is a plaster or a paste of ground mustard seed used for external application. Sinapisms in common use are: 1. Mustard poultice. 2. Mustard plaster or paste. 3. Mustard leaf. Prescribed: 1. To relieve pain and congestion in pleurisy and pneumonia. 2. To relieve nausea and pain in the stomach. 3. To relieve abdominal pain due to flatulence and congestion. 4. To relieve cerebral congestion, headache, and neuralgia. Regquisites: Mustard leaf or paper. Mustard flour. Wheat flour. Small pitcher for tepid water. Utensil for mixing paste. Old muslin. SHUT 43 1D put 166 NURSING TECHNIQUE 7. Three soft towels. 8. Spatula. 9. Spoon. 10. Small basin for tepid water. 11. Small tray. 12. Hot-water bottle. 13. Tube of vaselin and gauze squares. Procedure: Mustard plaster or paste: The following proportions are generally used: 1. For an adult: One part of mustard flour to 3 or 4 parts of wheat flour. 2. For a child: One part of mustard flour to 8 or 10 parts of wheat flour. 3. For an infant: One part of mustard flour to 10 or 12 parts of wheat flour. Prepare the hot-water bottle for use (130° F.). Fill the pitcher with tepid water. Put the mustard flour in the mixing bowl, crush all the lumps, add the wheat flour, and mix thoroughly. Add enough tepid water to make a paste that can be spread without running. Spread the mixture on soft muslin, cut the desired size and shape. Turn in the edges as when making a flaxseed poultice. Cover the hot-water bottle with a towel and place the mustard plaster on it so that it will keep warm. Carry it and the lubricant to the bedside on a small tray. To apply: Turn back the covers as necessary. Cover the affected area with the warm towel. Apply the lubricant and, under cover of the towel, slip the plaster into position. Remove it when the skin is well reddened. This usually occurs in ten to twenty minutes. Watch the skin closely after five minutes have elapsed, for a burn from a mustard application is always the result of carelessness. To remove: Remove it under cover of the towel. Dry the skin by patting the towel. Observe the color of the skin and apply the lubricant as indi- cated. Cover the area with a soft towel to protect the patient's gown. Mustard leaf or paper: A mustard leaf or paper consists of mustard combined with a resinous substance which is spread upon a paper or muslin foundation to which it adheres. To apply: Place the leaf on a small tray with the following requisites: 1. Small basin of tepid water. 2. Tube of vaselin and gauze squares. 3. Two soft towels. Turn back the covers as necessary. Cover the site of application with the towel. Apply the lubricant under cover of the towel. Dip the leaf in the tepid water, allow it to drip for a second or two, and then apply it to the affected area. Cover it with the towel to pro- tect the patient's gown and the bedclothes from moisture. : Watch the skin closely and remove it when the area is well reddened, which is usually in five to fifteen minutes. APPLYING PLASTERS 167 To remove: Remove the leaf under cover of the towel. Examine the area care- fully to be sure that all particles of the mustard have been removed. Apply more lubricant and cover the area with a soft towel to protect the patient’s gown. To remove any adhering portions: Wash thé area with warm water and a gauze compress. Dry it gently by patting and apply the lubricant. References: Harmer's Principles and Practice of Nursing, pp. 214-217. Pope's Practical Nursing, pp. 492-495. APPLYING PLASTERS A plaster is a preparation of drug or drugs combined with a resinous substance which is spread upon a muslin foundation, to which it adheres. It is used as an external application. Plasters in common use are: 1. Mustard. 2. Belladonna. 3. Cantharides. 4. Adhesive. Regquisites: 1. Plasters of various kinds. 2. Cantharidal ointment and collodion. i 1. Belladonna plaster: This contains 3 parts of the extract of belladonna and 7 parts of ad- hesive plaster. Used: 1. For anodyne purposes. 2. To check secretions. 2. Capsicum plaster: Used as a counterirritant for the relief of pain. To apply belladonna and capsicum plasters: Shave the area, if the part is hairy. Cleanse the skin (at the site of application) with warm water and soap and dry it well. : Warm the plaster slightly (if necessary) and place it on the skin. Rub the hand lightly over the area to make it adhere. Be sure that the plaster fits the surface without wrinkles. If the plaster is to be applied to the breast and a breast plaster is not available, cut it circular with an opening in the center to avoid covering the nipple. These plasters are usually left on until the desired effect has been attained. To remove: If the plaster does not come away readily, use a little ether or chloro- form to dissolve the adhesive substance. 3. Cantharides plaster or Spanish fly: Used as a vesicant in the treatment of: 1. Pleurisy with effusion. 2. Arthritis with synovitis. Cantharides act slowly in producing a blister and are very irritating. An important point regarding the use of cantharides is that it is absorbed 168 NURSING TECHNIQUE through the skin and eliminated through the kidneys. If the applica- tion is large, it may cause an acute nephritis. Watch the character and quantity of the urine voided for at least twenty-four hours after the application is made. To apply: The area (if possible) should be over a well-covered surface, plenti- fully supplied with blood- and lymph-vessels. Shave the area, if hairy. Cleanse the skin at the site of application with soap and water, ether, and alcohol. The size of the plaster is always prescribed. It is usually 1 to 2 inches square and seldom exceeds 3 inches square. , Apply it and cover it with a light bandage, a watch glass crystal or a cap made of oiled muslin. Watch the area for the rising of a blister which may appear in four to eight hours. To remove: Soften the edges with sterile oil and remove the plaster very gently. Remove any adhering particles of cantharides by gently oiling the sur- face. Treat the blister according to the directions of the physician. When order edto open the bleb, observe aseptic technique. Cut it with sterile scissors, and receive the fluid in a sterile sponge. Cover it with a sterile dressing and retain it with a bandage. If the bleb is not opened, cover it with a sterile dressing to prevent infection. 4. Cantharidal ointment or cerate: Prepare the field as for a cantharides plaster. Spread the preparation on sterile gauze and apply it directly to the part. Remove it, observing the same precautions as when removing the cantharides plaster. S. Cantharidal collodion: Prepare the field as above. Outline the area with sterile oil or vaselin. Paint the collodion with a sterile camel’s hair brush or a cotton swab. When the collodion is dry, cover it and proceed as for a cantharides plaster. 6. Adhesive plaster: Applied to various parts: 1. To retain dressings. 2. To support, exert pressure, and immobilize a part. To apply: Prepare the site of application in the same manner as for a capsicum or belladonna plaster. To remove: Remove it in the same manner as a belladonna plaster. After the removal bathe the part with warm water and soap, dry it well, and apply talcum powder. References: Sanders’ Modern Methods in Nursing, pp. 149-155. Harmer’s Principles and Practice of Nursing, pp. 296-300 and 338- 342. Pope's Practical Nursing, pp. 503-507. CUPPING Cupping consists in the application to the skin of glass cups in which a vacuum has been created, for the purpose of producing counterirri- CUPPING 169 tation or withdrawing blood. The vacuum may be created by the use of heat, or with a pump or rubber bulb. There are two kinds of cupping: 1. Dry cupping. 2. Wet cupping. Dry cupping is prescribed: 1. To relieve pain and congestion in pneumonia. 2. To relieve pain and congestion in the kidney and to relieve sup- pression. 3. To produce hyperemia in infected areas. Duration of treatment: From ten to twenty minutes. Requisites: Tray with the following: . Six or 8 cupping glasses. . Alcohol lamp and matches. . Glass for alcohol. . Glass for water. . Receptacle for waste. . Rod and cotton for swabs. . Two towels. Gauze. . Flask of alcohol. 10. Canton flannel pad. Procedure: Prepare the tray by placing the cupping glasses on a folded towel on the side of the tray. Pour about 1 ounce of alcohol into 1 glass (distinct in shape from the other one), and the same amount of water into the other glass. Prepare the swab and arrange the requisites on the tray so that they will be convenient. Carry the tray to the bedside. : Draw the patient to the side of the bed (if her condition permits) and make her comfortable. Expose only the part to be treated and cover other parts with a bath blanket, if indicated. The exact area to be cupped should be outlined by the physician. Shave the area, if hairy. Light the lamp. Dip the swab into the alcohol and apply it to the inside of the cup, avoiding the rim. Ignite the swab in the flame and apply it to the inside of the cup. Apply the cup quickly to the affected part just before the flame dies out. Apply from 5 to 8 cups, depending upon the size of the area. When the skin is well reddened, remove the cups by inserting the tip of the finger under the rim of each glass. Wipe the glasses with the gauze sponge and repeat the procedure until the area ‘is well reddened. Continue the treatment the prescribed time. Dry the part gently and apply a lubricant or talcum powder. Cover the affected part with a Canton flannel pad to prevent chilling. Poinis to be remembered: 1. Avoid using too much alcohol. 2. Avoid having too large a flame. 3. Avoid burning the patient by exercising every precaution. 4. Do not allow the part to become a dusky red, as this indicates rupture of the small capillaries. LOTUS WN 170 NURSING TECHNIQUE Record: 1. Hour and treatment. 2. Duration of treatment. 3. Any unusual symptoms which may occur. Wet cupping: Consists in incising the skin and applying cups for the purpose of withdrawing blood. : Prescribed: Very rarely today. It may be used occasionally, to relieve acute congestion or local inflammation of the eye or ear. Requisites: Tray with the following: . Flask ether. . Flask alcohol. . Sterile cupping glasses. . Sterile scalpel. Sterile gauze. . Sterile cotton. . Sterile towels (2 packages). Sterile forceps. Sterile basin (for normal saline). 10. Sterile gloves (optional). 11. Graduated measure for the blood. 12. Adhesive plaster or a gauze bandage. 13. Razor. 14. Suction pump. 15. Paper bag. Procedure: ? Prepare half of the tray for the sterile requisites by cleansing it with ether and alcohol and covering it with a sterile towel. Place the sterile requisites on same and cover them with a sterile towel. Place the non- sterile requisites on the other half of the tray. Prepare normal saline for cleansing the wound. Carry the requisites to the bedside. - Shave the area. Cleanse it with ether and alcohol and apply an al- cohol sponge. The physician then applies sterile towels, makes the in- cision, and applies the cups. They are left on until sufficient blood is extracted. When the treatment is completed, cleanse the wound with normal saline and apply sterile dressings. Points to be remembered: If the vacuum is to be created by means of a flame, do not use ether and alcohol on account of their inflammable qualities. Prepare the field by cleansing with soap and water, and apply a bichlorid com- press. Record: 1. Hour and treatment. 2. Amount of blood approximately withdrawn. References: Sanders’ Modern Methods in Nursing, pp. 142-145. Harmer’s Principles and Practice of Nursing, pp. 334-339 and 345- 346. Pope’s Practical Nursing, pp. 510-515. PREPARATION AND CARE OF THE ACTUAL CAUTERY 171 PREPARATION AND CARE OF THE ACTUAL CAUTERY—APPLICA- TION OF HEATED METAL The Paguelin cautery consists of a hollow platinum point which is screwed onto a hollow metal cylinder and handle. Attached to the handle (which holds a sponge) is a rubber tubing and a soft-rubber bulb covered with netting. By heating the point and squeezing the bulb the fumes of benzin are blown into the point. The degree of heat is thus maintained by gently squeezing the bulb. The metal container is equipped with a valve which may be closed to prevent the escape of the fumes when not in use. : Prescribed: 1. As a rubefacient and vesicant to relieve pain and inflammation in muscular rheumatism. 2. As an escharotic in surgery to destroy the tissues in treatment of chancroid and carcinoma of the cervix. Reguisites: 1. Paquelin cautery. 2. Bottle of benzin. Procedure: Preparation of cautery: Be sure that the cautery is in good condition before taking it to the physician. Select the proper tip and saturate the sponge with benzin if it has dried out. Attach the tubing to the metal cylinder and open the valve. Heat the tip over a flame and squeeze the bulb so that the fumes will be blown into the tip. Avoid touching anything with the heated metal because it is easily dented. Preparation of patient: The preparation of the patient depends upon the purpose of the treatment. If used as an escharotic in the treatment of carcinoma of the cervix, prepare the patient as for a curettage. If used as a rubefacient, do not allow the point to touch the skin, but pass it back and forth until the area is well reddened. If a blister is to be made, prepare the skin previous to the treatment by cleansing it with soap and water and applying a bichlorid compress. Place the patient in a comfortable position and expose the part to be treated, when the physician is ready. After use: Allow the tip to cool gradually. If the tip has been used as an es- charotic bring the point to a white heat to burn off the shreds of tissue which may adhere. Exercise care in handling as the platinum points are costly. The electric cautery: Used instead of the Paquelin cautery. The platinum point is screwed to a handle which may be connected to the electric current. It is more convenient, for when electricity is used it is not necessary to heat the tip first. Heated metal—flatiron: Prescribed: . As a rubefacient to relieve pain and inflammation in treatment of lumbago and other forms of muscular rheumatism. Requisites: 1. Flatiron. 172 NURSING TECHNIQUE 2. Piece of flannel. 3. Bath towel. Procedure: Heat the flatiron so that it will be moderately hot. Take it to the bedside with a piece of flannel large enough to cover the lower portion of the patient’s back. Place the patient in the prone position and cover the shoulders with a bath blanket. Expose the area to be treated. Dry the skin thoroughly and cover it with the piece of flannel. Pass the heated iron back and forth over the area for about twenty minutes. Make light pressure at first and gradually increase it until it is as much as the patient can bear. Raise the flannel from time to time to see that the skin is not becoming too deep a red. References: Sanders’ Modern Methods in Nursing, pp. 147-149. Harmer’s Principles and Practice of Nursing, pp. 327-329. Pope’s Practical Nursing, pp. 506-508. ASPIRATIONS AND PUNCTURES By aspiration is meant the removal of fluids or gases from a cavity by means of an aspirator. An aspirator is an apparatus for removing fluids or gases from a cavity by means of suction. By paracentesis is meant the surgical puncture of a cavity for the removal of fluids. Dropsy is the abnormal accumulation of serous fluid in the cellular tissues or in a body cavity. Ascites: An accumulation of serous fluid in the peritoneal cavity. Hydrothorax: An accumulation of fluid in the thoracic cavity. Pleurisy with effusion: Hydrothorax associated with pleurisy. Empyema: An accumulation of pus in a body cavity especially the chest. Pneumothorax: A collection of air or gas in the pleural cavity. Hydrocephalus: An effusion of liquid within the cranium. Anasarca: An accumulation of serum in the cellular tissues of the body—general dropsy. References: Sanders’ Modern Methods in Nursing, pp. 537 and 538. Pope's Practical Nursing, pp. 549-553. ASSISTING WITH A LUMBAR PUNCTURE A lumbar puncture consists in the introduction of a lumbar puncture needle into the spinal canal for the purpose of removing a portion of the spinal fluid. This procedure may be followed by the injection of serum or certain drugs. Prescribed: 1. For diagnostic purposes. 2. To relieve pressure as in hydrocephalus and meningitis. 3. For the injection of serum and antitoxin as antimeningitic serum and tetanus antitoxin. ASSISTING WITH A LUMBAR PUNCTURE 173 4. To produce spinal anesthesia. 5. For the injection of salvarsanized serum in the treatment of syphilis involving the nervous system. Stte of puncture: Between the fourth and fifth lumbar vertebrze. Position of patient: 1. The lateral position with the patient on his left side, the spine rounded, the head and shoulders bent forward, and the thighs flexed. 2. Asitting posture with the patient sitting upright, the arms crossed in front and the head and shoulders bent forward. (Not used so extensively, because it is difficult to measure the pressure of the fluid.) Fig. 24.—Patient prepared for a lumbar puncture. Requisites: 1. Bath blanket. 2. One enameled tray. 3. Lumbar puncture tray with: 1. Flask ether. 2. Flask iodin. 3. Flask alcohol. . Local anesthetic. (a) Sterile Luer syringe (5 c.c.). (6) Sterile needles. (¢) Sterile medicine glass. (d) Novocain, 1 to 1 per cent. Two sterile lumbar puncture needles in test-tubes. Two sterile test-tubes, marked I and II. Sterile Luer syringe (25 c.c.). Sterile gloves (for physician). . Sterile gauze. > Voorn 174 NURSING TECHNIQUE 10. Sterile cotton. 11. Sterile aspirating sheet. 12. Sterile forceps. 13. Sterile towels (2 packages). 14. Sterile tray cover. 15. Dressing towel (1, non-sterile). 16. Small rubber sheet. 17. Adhesive tape or collodion. 18. Paper bag. Procedure: Wash your hands. Cleanse one tray with ether and alcohol and cover it with a sterile tray cover (using sterile forceps). Place the sterile needles, test-tubes, 25 c.c. Luer syringe, gauze and cotton, and (a), (8), and (¢) under local anesthetic on the sterile tray and cover same with a sterile towel. Place the non-sterile requisites and 1 package of sterile towels and gloves, the aspirating sheet and the scrub-up forceps on the second tray. Carry the requisites to the bedside. Open the wrappers on the towels and gloves so that the physician may dry his hands and put on his gloves. Place the patient in position with the rubber sheet covered with the dressing towel, just below the site of puncture. Cover the shoulders with a bath blanket. Place the paper bag for use. Prepare about 12 inches around the site of puncture by scrubbing it with ether and then painting the field with iodin. (Use the forceps to do so.) The physician, after putting on sterile gloves, then places the as- pirating sheet over the prepared area. The operation is performed by the physician and the nurse's duties consist in anticipating his wants.” Wipe the neck of the bottle contain- ing the novocain with a gauze sponge wet with alcohol. Pour the novo- cain into the sterile medicine glass. The physician then injects the anes- thetic and makes the puncture. Instruct the patient to remain perfectly quiet during the procedure. The physician may request the nurse to hold the test-tube. If he does so, remove same from the sterile table with the sterile forceps or a gauze sponge. When enough fluid has been withdrawn, the physician applies a sterile dressing and retains it with adhesive plaster. Label the specimens with the name, room or ward number, the date, and the physician’s name and send them to the laboratory at once. Keep the patient quiet in bed for twenty-four hours after the treatment to es- tablish equal pressure in the cerebral spinal cavity. Record: 1. Hour and treatment. 2. By whom performed. 3. Quantity and character of fluid withdrawn. 4. Whether obtained under pressure or not. 5. Amount of serum or antitoxin injected. 6. Any unusual symptoms which may occur. References: Williams’ Anatomy and Physiology, pp. 104-133. Kimber’s Anatomy and Physiology, pp. 155-193. Sanders’ Modern Methods in Nursing, pp. 538-541. ASSISTING WITH A THORACENTESIS 175 Harmer’s Principles and Practice of Nursing, pp. 346-352. Pope’s Practical Nursing, pp. 552-566. ASSISTING WITH A THORACENTESIS A thoracentesis or pleurocentesis consists in the aspiration of the chest for the purpose of withdrawing fluid from the pleural cavity. Prescribed: 1. When absorption of fluid fails to occur. 2. To relieve pain, dyspnea, and other symptoms of pressure caused by the accumulation of the fluid. Site of puncture: The site varies somewhat, so unless definite orders are received it is well to prepare from the spine, 1 inch beyond the axilla and from the lower portion of the scapula to an inch above the waist line on the af- fected side. Position of patient: 1. Lying on the unaffected side in a semirecumbent position near the edge of the bed. Place the arm of the affected side on the opposite shoulder, and have her lean forward considerably. Arrange the pillows under the patient so that there will be no strain. 2. Sitting up in bed and leaning forward on a bedside table. Place the hand of the affected side on the opposite shoulder. i METHOD 1 Requisites: 1. Bath blanket. 2. One enameled tray. 3. Thoracentesis tray with: 1. Flask ether. 2. Flask iodin. 3. Flask alcohol. 4. Local anesthetic. (a) Sterile Luer syringe (5 c.c.) (6) Sterile needles. : (¢) Sterile medicine glass. (d) Novocain, % to 1 per cent. 5. Two sterile aspirating needles. 6. Potain’s aspirating apparatus (sterile). 7. Sterile bottle. 8. Sterile gauze. 9. Sterile cotton. 10. Sterile aspirating sheet. 11. Sterile towels (2 packages). 12. Sterile basin (for sterile water to test the apparatus). 13. Sterile gloves (2 pairs). 14. Sterile forceps. 15. Sterile tray cover. 16. Stimulant. 17. Dressing towels (2, non-sterile). 18. Adhesive tape or collodion. 19. Paper bag. 176 "NURSING TECHNIQUE Procedure: Wash your hands. Fill the sterile basin with sterile water. Cleanse 1 tray with ether and alcohol and cover same with a sterile tray cover (using sterile forceps). Place the following sterile requisites on this tray: (a), (6), and (¢) under local anesthetic, the 2 aspirating needles, the cork with metal projections (for aspirating bottle), the sterile tubing, gauze, and cotton and cover same with a sterile towel. Place the non-sterile requisites and the 2 packages of sterile gloves, 1 package of sterile towels, the basin of sterile water, the sterile aspirat- ing bottle, and the scrub-up forceps on the second tray. Carry the requisites to the bedside. If possible, have an assistant. Then put on sterile gloves. It is very important that the aspirating apparatus be tested before use. Do this as follows: Put the cork in the bottle and attach the tubing to the metal pro- jections on the cork. Have a glass connection separating the piece of tubing to be attached to the needle and have this tubing long enough to reach from the bottle on the bedside table to the patient’s chest. Have your assistant attach the other piece of tubing to the projection on the exhaust pump that has an arrow pointing upward. Open the valve in the cork on the same side and close the one on the other side. Have your assistant exhaust the air in the bottle. Avoid contaminating the sterile tray and keep the tubing sterile that is to be attached to the needle. When the pump grows hard to work, place the tubing (to be attached to the needle) in the sterile basin of water and open the valve. Close the other one. If the apparatus is working, the water will flow from the basin into the bottle. Empty the water from the bottle into the basin, change the order of the stop-cocks and exhaust the air in the bottle once more. If the physician is not ready, cover the tray with a sterile towel. Have your assistant prepare the patient by re- moving the gown from the affected side and placing the patient in po- sition, avoiding any unnecessary exposure. Have her protect the bed- clothes with the rubber sheet and dressing towels and place the paper bag for waste so that it will be convenient. Then prepare the field by scrubbing it with ether and painting it with iodin. The physician then places the aspirating sheet after he has put on sterile gloves. He then injects the local anesthetic and the aspirating needle. The injection is made midway between the ribs during inspiration, when the spaces are wider. Coughing during the operation usually indicates that the visceral layer of the pleura has been pricked. The needle is withdrawn to pre- vent injury to the lung. At the completion of the operation the phys- ician applies a sterile dressing. Send the fluid to the laboratory for analysis. Keep the patient quiet in the recumbent position and watch the sputum for signs of blood. Thoroughly cleanse the apparatus and sterilize it. Mer=OD II (When an aspirating apparatus with a suction pump is not available.) Regquaisites: Same as for Method I, minus: ASSISTING WITH ABDOMINAL PARACENTESIS 177 1. Potain’s aspirating apparatus. 2. Sterile basin (for sterile water). and plus: 1. Sterile Luer syringe (50 c.c.). 2. Sterile glass Y connection. 3. Three pieces of sterile tubing (2 pieces 24 inches long and 1 piece 12 inches long). 4. Two sterile stop-cocks. Procedure: Proceed as in Method I except that the syringe is used instead of the aspirating apparatus. Connect the 50-c.c. syringe to the 12-inch piece of tubing. Connect the free end of this tubing to the stem of the Y connection. Place a stop-cock on each of the other pieces of tubing and connect them to the projections on the Y. The aspirating needle is connected to one free end and the other is placed in the specimen bottle "during aspiration. When the physician is ready he inserts the needle into thc cavity. After closing the 2 stop cocks and making negative pressure with the syringe he connects the piece of tubing on the Y projection to the aspirating needle. He then opens the stop-cock on the piece of tubing attached to the needle, and withdraws the fluid by suction. He closes this stop-cock and opens the other one and expels the fluid inte the bottle. He continues in this manner until all the fluid has been with- drawn. Points to be remembered: 1. Watch the patient’s color, pulse, and breathing, for the treatment involves one of the vital organs of the body. 2. Always have in readiness some stimulation. It is sometimes given as a preliminary preparation, especially if no local anes- thetic is used. Record: 1. Hour and treatment. 2. By whom performed. 3. Amount, color, and character of fluid withdrawn. 4. Any abnormal conditions which may occur. References: Williams’ Anatomy and Physiology, pp. 133-137 and 342-365. Kimber’s Anatomy and Physiology, pp. 202 and 348-353 and 369. Sanders’ Modern Methods in Nursing, pp. 547-549. Harmer’s Principles and Practice of Nursing, pp. 351-355. Pope’s Practical Nursing, pp. 558-560 and 857-861. ASSISTING WITH ABDOMINAL PARACENTESIS Abdominal paracentesis consists in puncturing the peritoneal cavity by means of a trocar and cannula (supplied with rubber tubing) for the purpose of removing fluid. Prescribed: For ascites. Sites of puncture: 1. The linea alba, midway between the umbilicus and pubes. 2. The linea semilunaris, just outside the rectus muscle. 12 178 NURSING TECHNIQUE Position of patient: 1. Sitting in a chair or on the edge of the bed with the feet and back well supported. 2. Fowler's position, close to the edge of the bed. 3. On the side of puncture, if made in the linea semilunaris. Requisites: . Comfortable chair for the patient. . Chair for the physician. . Bath blankets (if indicated). . Pail for fluid. . Stimulant. . Laparotomy stockings. . One enameled tray. . Abdominal paracentesis tray with: COON UL WIN = oo 20. 21. 22. 23. 24. 23. Procedure: Flask ether. Flask iodin. Flask alcohol. Local anesthetic. (a) Sterile Luer syringe (5 c.c.). (6) Sterile needles. (¢) Sterile medicine glass. (d) Novocain, 3 to 1 per cent. . Sterile trocar and cannula, supplied with rubber tubing. . Sterile gloves (for physician). . Sterile tray cover. . Sterile towels (2 packages). . Sterile gauze. . Sterile cotton. . Sterile abdominal pad. . Sterile swathe. ] . Sterile bottle or test-tube (for the fluid). . Sterile forceps. . Scultetus binder. . Adhesive tape or collodion. . Dressing towels (4, non-sterile). . Rubber sheets (2). . Paper bag. If a slight preliminary incision is made, the following in- struments will be required: : Sterile scalpel. Sterile needle-holder. Sterile suture needles. Sterile scissors. Sterile tissue forceps. Sterile suture material. Shave the line of incision, if the patient is an adult. Have the patient void urine just before the operation is performed. In some instances an enema and catheterization is prescribed. Wash your hands. Cleanse one tray with ether and alcohol and cover same with the sterile tray cover (using sterile forceps). Place the following sterile requisites on same: (a), (4), and (¢) under local anesthetic, the ASSISTING WITH AN ASPIRATION OF THE PERICARDIUM 179 trocar and cannula, supplied with tubing, gauze, cotton, abdominal pad, sterile test-tube (for fluid) and the instruments and suture material. Cover the tray with a sterile towel. : Place the non-sterile requisites, the package of sterile gloves for the physician, the sterile towels, the sterile swathe and the scrub-up forceps on the second tray. Carry the requisites to the bedside. Open the wrappers on the towels and gloves so that the physician may dry his hands and put on his gloves. Put laparotomy stockings on the patient and place her in position. Turn the upper covers down so that the abdomen is well exposed. Cover the chest with a bath blanket, if indicated. Raise the patient's gown and protect the clothing with the rubber sheets, covered with dressing towels. Place the paper bag for waste. Prepare the area (using forceps) by scrubbing first with ether and then painting the field with iodin. The physician then places the sterile swathe and towels after first putting on sterile gloves. He then injects the local anesthetic and inserts the trocar and cannula. After withdrawing the trocar the liquid flows through the cannula and tubing into the sterile bottle, or test-tube. Receive enough of the fluid in the sterile receptacle for laboratory analysis, then substitute the pail. When the operation is completed, the incision is closed and sterile dressings are applied. The thickness of the dressing will depend upon the amount of drainage. Strap the dressings in position with adhesive tape and apply a scultetus binder as snugly as the patient can stand it. Usually there is considerable drainage. Watch the dressings closely and change them as indicated. Points to be remembered: 1. Be sure that the bladder and intestines are as empty as possible. 2. Be sure that the trocar is sharp and in good condition. ; 3. Watch the patient’s condition constantly, especially when a large amount of fluid is removed, for fainting or collapse may follow. 4. Observe aseptic precautions to prevent infection. Record: : 1. Hour and treatment. 2. By whom performed. 3. The quantity and character of fluid removed. 4. Any abnormal conditions which may occur. References: Williams’ Anatomy and Physiology, pp. 370 and 371. Kimber’s Anatomy and Physiology, pp. 4-202 and 376. Sanders’ Modern Methods in Nursing, pp. 542-547. Harmer’s Principles and Practice of Medicine, pp. 356-359. Pope’s Practical Nursing, pp. 560-566. ASSISTING WITH AN ASPIRATION OF THE PERICARDIUM Aspiration of the pericardium or pericardicentesis consists in the sur- gical puncture of the pericardium for the purpose of withdrawing fluid by means of an aspirator. Prescribed: 1. When absorption of fluid fails to occur. 2. To relieve dyspnea and other symptoms of pressure which en- danger the life of the patient. 180 NURSING TECHNIQUE Stte of puncture: Between the fourth and fifth or fifth and sixth ribs, close to the left margin of the sternum. Position of patient: Due to the critical condition of the patient, his position should be made as comfortable as possible. Regquausites: Same as for aspiration of the chest, Method II. Procedure: If the patient’s chest is hairy, shave the area, but shorten the proc- ess as much as possible. Have a stimulant at hand and prepare hypo- dermoclysis, if indicated. Prepare the requisites and patient as for as- piration of the chest. When the exploring needle shows the fluid to be purulent, the usual operation is the opening of the pericardium in order to drain the abscess. Points to be remembered: 1. Keep the patient quiet during and after the treatment. 2. Watch the patient closely during and after the procedure for signs of syncope, pallor, and changes in pulse and respiration. Record: 1. Hour and treatment. 2. By whom performed. 3. Amount, color, and character of fluid withdrawn. 4. Any unusual symptoms which may occur. References: Williams’ Anatomy and Physiology, pp. 288-303. Kimber’s Anatomy and Physiology, pp. 202 and 233-248. Sanders’ Modern Methods in Nursing, pp. 547-549. Harmer’s Principles and Practice of Nursing, pp. 354-357. Pope's Practical Nursing, pp. 558-566 and 836-841. ASSISTING WITH ASPIRATION OF A VEIN Aspiration of a vein consists in the withdrawal of blood from a vein by means of an aspirator. Prescribed: To obtain a specimen for laboratory analysis for diagnostic purposes. Amount of blood withdrawn: 1. For a seriologic examination. 5 c.c. 2. For a bacteriologic examination, 10 c.c. 3. For a chemical examination, 1 to 15 c.c. Requisites: 1. Small rubber pillow and muslin case. 2. Tray with: . Flask ether. . Flask alcohol. . Sterile aspirating sheet. Sterile Luer syringe. Sterile aspirating needle. . Sterile cotton and gauze. . Sterile forceps (for scrub up). . One of the following (depending upon the analysis): PUT WN ASSISTING WITH A PHLEBOTOMY, OR VENESECTION 181 1. Centrifuge tube. 2. Test-tube. 3. Graduated centrifuge tube. 4. Culture tube or plate with glucose agar. 9. Tourniquet. 10. Adhesive tape or collodion. 11. Paper bag. 12. Alcohol lamp and matches. Procedure: A graduate nurse or technician may aspirate a vein, but it is not the duty of a student nurse. Prepare the arm as for an intravenous infusion. Instruct the patient to repeatedly open and close her hand until the vein is clearly visible. The physician or technician then inserts the needle into the lumen of the vein—holding the needle so as to make an acute angle with the skin of the forearm, with the needle pointing in the direction of the upper arm. If the vein has been properly entered, the blood will usually be seen making its way into the neck of the syringe. The desired amount of blood is then withdrawn by suction with the plunger. Loosen the tourniquet. The physician then withdraws the needle and quickly applies with pressure over the site of puncture a pledget of dry sterile cotton. The patient is then directed to make pressure on the cotton sponge with his free hand for a few moments to arrest the bleeding and to prevent the extravasation of blood from the vein into the tissues under the skin. Ordinarily the only dressing re- quired is a drop of collodion. Points to be remembered: 1. Cleanse the syringe and needle thoroughly with cold water to prevent clotting of blood in syringe and needle. Label the specimen at once and date it. Stopper the tube with a clean cork. Place the tube in an upright position. If the examination is not made the same day, place specimen on ice. If the blood is for chemical examination, place a few crystals of potassium oxalate in the tube to prevent clotting. Invert the tube slowly two or three times to mix it thoroughly. 7. If the blood is taken for culture observe aseptic technique and have all requisites sterile. When the blood is withdrawn, dis- tribute it on culture medium and take it to the laboratory. References: Harmer’s Principles ‘and Practice of Nursing, pp. 508-510. Pope's Practical Nursing, pp. 241-247. Sanders’ Modern Methods in Nursing, pp. 530-532. Todd’s Clinical Diagnosis by Laboratory Methods, pp. 236-409. Kimber's Anatomy and Physiology, pp. 212-233. ASSISTING WITH A PHLEBOTOMY, OR VENESECTION Phlebotomy, or venesection, consists in opening a vein for the purpose of blood letting. Prescribed: 1. To remove toxic blood in uremia and illuminating gas poisoning. The blood is usually replaced by an intravenous infusion or a transfusion. Sty 182 NURSING TECHNIQUE 2. To relieve an excessively high blood-pressure in eclampsia and uremia. 3. To relieve pulmonary venous congestion and dilatation of the right side of the heart in pneumonia. Site of puncture: 1. The median cephalic vein. 2. The median basilic vein. Reguisites: 1. Small rubber pillow and muslin case. 2. One enameled tray. 3. Venesection tray with: 1. Flask ether. 2. Flask alcohol. 3. Local anesthetic (if used). (a) Sterile Luer syringe (5 c.c.). (6) Sterile needles. (¢) Sterile medicine glass. (d) Novocain, % to 1 per cent. 4. Sterile gloves (for physician). 5. Sterile gauze. 6. Sterile cotton. 7. Sterile towels (1 package). 8. Sterile tray cover. 9. Sterile aspirating sheet. 10. Sterile forceps. 11. Sterile glass graduate. 12. Sterile basin for normal saline. 13. Sterile trocar and cannula or needle with rubber tubing attached. 14. Tourniquet. 15. Gauze bandage. 16. Adhesive tape or collodion. 17. Paper bag. If necessary to cut down on the vein, the following instru- ments are required: Sterile hemostats (2). Sterile aneurysm needle. Sterile forceps (2). . Sterile scalpel. . Sterile scissors. . Sterile probe. . Sterile needle-holder. Sterile suture needles. Sterile suture material: (a) Catgut. (6) Silk. (¢) Horse hair. 1000 NOU Lot Procedure: Wash your hands. Prepare the sterile tray as for previous demon- strations. Place the following sterile requisites on same: (a), (4), and (¢) under local anesthetic (if used), gauze, cotton, glass graduate, basin of saline solution (120° F.), trocar and cannula, and the instruments for cutting down on the vein (if necessary to do so). Cover the tray with a QUESTIONS FOR GENERAL REVIEW AND EXAMINATION 183 sterile towel. Place the non-sterile requisites, the package of gloves (for the physician) the sterile towels, aspirating sheet, and scrub-up forceps on the second tray. Carry the requisites to the bedside. Open the wrappers on the towels and gloves so that the physician may dry his hands and put on his gloves. Prepare the patient and field as for an intravenous infusion. The operation. consists in inserting a trocar and cannula or needle (to which rubber tubing is attached) into the vein. The blood then flows into the graduated receptacle. Some- times it is necessary to cut through the skin with a scalpel and expose the vein. In such aninstance it is necessary to suture the wound. Sterile normal saline is used to cleanse the wound, after which a sterile dressing is applied: Record: 1. Hour and treatment. 2. By whom performed. 3. Amount of blood withdrawn. 4. Any abnormal conditions which may occur. References: Sanders’ Modern Methods in Nursing, pp. 530 and 531. Harmer’s Principles and Practice of Nursing, pp. 359-361 and 469- 475. Pope’s Practical Nursing, pp. 563-566, 682-684, 849-855, and 897- 899. ‘ QUESTIONS FOR GENERAL REVIEW AND EXAMINATION (a) Define a douche. (b) Why are douches prescribed? (a) Define a vaginal douche. (b) Describe the vagina. : (a) How is the vagina connected with the internal genitals? (b) What do you understand by the vulva? Describe: (a) The uterus. (b) The Fallopian tubes. (c) The ovaries. Define: (a) The internal os. (b) The external os. (¢) Culdesac of Douglas. y Give the solutions, strength, and temperature commonly prescribed for vaginal ouches. When are vaginal douches contraindicated? ‘What consideration should a nurse show a patient when giving a vaginal douche? What precautions would you observe in infectious conditions? : (a) What dangers are involved in giving a vaginal douche? (5) What would you record after the treatment? (a) Prepare 2 quarts of a § per cent. solution of lysol. On hand a 5 per cent. “solution. (b) Prepare a gallon of silver nitrate solution 1 :3000. On hand a 4 per cent. solution. (a) Prepare 3 quarts of boracic acid solution, 2 per cent. On hand a 4 per cent. solution. (b) Prepare 2 quarts of potassium permanganate 1 :2000. On hand potassium permanganate crystals. (a) Define a pharyngeal douche. (b) When is it prescribed? Give the solutions, strength, and temperature commonly prescribed. (a) What points would you remember in giving the treatment? (b) What would you record after the treatment? (a) Tell in detail how you would put an anesthetized patient to bed. (b) Outline the general nursing care for the first twelve hours after operation. Why is aseptic technique of special importance in gynecologic examination? (a) What preparation would you make for a gynecologic examination? (bh) List the requisites on a gynecologic tray. Why are the following positions used: (a) Dorsal recumbent. (b) Sims’ or left lateral. (c) Lithotomy. (d) Knee-chest or genupectoral. (¢) Standing or erect. 184 NURSING TECHNIQUE What points are to be remembered in draping a patient for a gynecologic examination? What points are to be remembered in shaving a patient in preparation for operation? : List requisites on the preparation tray. How would you prepare the field for the following operations: (a) Laparotomy. (b) Emergency appendectomy. (c) Skin grafting. (d) Abdominal paracentesis. (¢) Lumbar puncture. (f) Aspiration of a vein. (g) Thoracentesis. (%) Trans- fusion. (7) Injection of salvarsan. Define: (a) Perineum. (b) Perineorrhaphy. Outline the nursing care after a perineorrhaphy. If a vaginal douche was ordered after a perineorrhaphy, what kind of a tip would you use? Define: (a) Hemorrhoid. (0) Hemorrhoidectomy. Outline the nursing care after a hemorrhoidectomy. What points are to be remembered in the nursing care following perineorrhaphy and hemorrhoidectomy. (a) How may drugs be administered? (b) Name 10 important rules to be remembered when giving medicines. (a) Name the parts of a prescription. (b) Interpret the following: June 15, 1925. For Miss Ethel Graber: BR. Magnesii sulphatis.............covvvnvn.... 3ij Magnesii carbonatis 5 Spiritus ammonia aromatici [© cccccce aa oJ Agu... 0 Loni anh ona, q. s. ad. 3j—M. Sig.—Dram 1 t. i. d. Dr. H. Vincent. Interpret the following: (a) Give morphin sulphate gr. p. r. n. (8) Give morphin sulphate gr. 3 s. 0. s. (c) Give 1-2-3 enema stat. (a) Why are hypodermic injections given? (5) Enumerate the different methods of administration. / Name one drug which is changed by the secretions of the stomach or intestines. Name one drug which is not readily absorbed in the stomach or intestines. Why are drugs administered intramuscularly in preference to subcutaneously? What sites would you choose for: (a) A subcutaneous injection? (b) An intra- muscular injection? (¢) An intravenous injection? What location would you choose for a subcutaneous injection of serum, anti- toxin or vaccine? What kind of a needle would you choose for: (a) A subcutaneous injection? (b) An intramuscular injection? (¢) Local anesthetic? (a) What dangers attend giving hypodermic injections? (5) How may they be avoided? How would you prepare your syringe and needle before administering hypo- dermic injections? How would you care for them after administering same? What would you record after a hypodermic injection? How would you give gr. 1/200 of atropin sulphate from tablets of gr. 1/150? How would you give gr. } if there were on hand but 2 tablets gr. § and gr. 1? How would you give gr. } of morphin from tablets gr. 1? How would you give gr. § of morphin and gr. 1/200 of atropin from tablets of gr. + and gr. 1/150? (a) Outline the routine preparation of a patient from the time of admittance until she enters the surgery for a laparotomy. (b) What is the purpose of the above preparation? (a) Define proctoclysis. (5) When is it prescribed? What important factors would you consider in giving the treatment? (a) What solutions are used? (b) Describe the position of the patient. (c) What temperature would you have the solution? QUESTIONS FOR GENERAL REVIEW AND EXAMINATION 185 (a) Why is a hypotonic solution given? (b) What would be the effect in giving a hypertonic solution? (¢) Why is a glucose solution given? (a) Classify the different methods for administering proctoclysis. (b) What is the duration of the treatment for Method I and II? What points are to be remembered in giving proctoclysis? What would you record during the treatment? (a) Define hypodermoclysis. (b) When is it prescribed? (a) What solutions are used? (b) What is the temperature of the solution? (¢) How much solution is usually given? (a) What site would you prepare? (b) How would you prepare the field? (a) What are the duties of the nurse in preparing for and assisting with hypo- dermoclysis? (5) What would you record after the treatment? (a) Define an intravenous infusion. (4) When is it prescribed? (a) What solutions are used? (hb) What do you understand by an isotonic solution? (c) A hypertonic solution? (d) A hypotonic solution? (a) What is the site of injection? (5) How much solution is usually injected? Define: (a) Diffusion. (b) Osmosis. (c) Hemolysis. (a) What would result from injecting a hypertonic solution into the veins? (0) A hypotonic solution? (a) What dangers attend an intravenous infusion? (b) What are a nurse's duties in preparing for and assisting with an intravenous infusion? What would you record after the treatment? (a) Give briefly the care of the body after death. (b) What points would you remember in carrying out the procedure? (a) How are the periods of growth divided in the development of a child? (b) Define: (a) Vernix caseosa. (b) Meconium. (c) Colostrum. (¢) What is the average length of the newborn. Give the average gain in length to the first, second, and third year. (d) Give the average circumference of the child’s head at birth and the rate of development the first three years. (e) Describe the two openings or fontanels in the head of the newborn. (a) Give the average weight of the full term baby boy and baby girl. (b) Why is there an initial loss of weight the first few days? (c) When should the newborn have regained his birth weight? (d) How much should a healthy normal baby gain every week? (¢) Why is it unwise for a young mother to weigh her normal baby daily? (a) Give the temperature of the bath water recommended for the newborn and infants. (b) When is the best time for the bath? Is more than one bath daily ever recommended for the healthy normal infant? (¢) What care would you give the eyes of the newborn? (d) To what route of entrance can most infections of the newborn be traced? (e) Give the technique of dressing the cord. (a) Do you approve of the use of oil for baths for the newborn? (6) Do you approve of infants using the same tub in children’s hospitals? (¢) How may the spread of infection in newborns be prevented in our maternity hospitals? (d) What clothing would you recommend the newborn baby to wear during the day and night time? Outline briefly the hygiene of infancy. (a) What would you do if cradle-cap appeared during the early months of infancy? (b) What would you do if there were signs of irritation with excoriations on the buttocks? (¢) How would you care for diapers if it was not possible for you to wash them out immediately after soiling? : (a) At what age should an infant be vaccinated against smallpox? (5) At what age should infants be tested for diphtheria by the Schick test? (a) Name two general applications of moist heat. (b) Of dry heat. (c) Name two local applications of moist heat. (d) Of dry heat. What emergencies are likely to arise during such treatments? Describe the primary and secondary effects of brief general applications of heat. What precautions would you observe when applying heat to the body? (a) Describe the effects of local applications of heat. (0) When are they con- traindicated? 186 NURSING TECHNIQUE What do you understand by the reflex effect of a local application of heat? (a) What do you understand by a hot wet pack? (b) When is it prescribed? Give the duration of the pack and the temperature of the water. (a) Why is water given freely to drink during a hot pack? (5) Would you give hot or cold water? (c) When is water to drink contraindicated when giving hot baths and packs? What symptoms show the treatment is having an undesirable effect? (a) What points would you remember when giving a hot wet pack? (b) What would you record? (@) What do you understand by a hot dry pack? (b) When is it prescribed and what is the duration of same? (a) What do you understand by a hot bath pack? (b) When is it prescribed? (a) Give the duration of the bath and temperature of the water. (b) Give the duration of the pack. State how you would increase the temperature of the water. (a) Why are hot tub baths prescribed? (b) Give the duration of the bath and the temperature of the water. (a) What do you understand by hot dressings? (5) Why are hot dressings applied to a clean wound? (¢) To an infected wound? What points would you remember when applying same? (a) Define catheterization of the bladder. (b) In what conditions is it resorted to? What nursing measures may be used to relieve retention of urine? (a) Describe the bladder. (b) What is the function of the bladder? (c) What is the normal capacity of the bladder? (a) Define cystitis. (b) Retention. (c) Retention with overflow. (d) An- uria. (e) Polyuria. (a) Define dysuria. (b) Suppression. (¢) Oliguria. (d) Pollakiuria. (e) Pyelitis. (f) Nephritis. (a) Describe the urethra. (b) Give the direction of the urethra when the patient is in the dorsal recumbent position. (a) What is the length of the female urethra? (b) Describe the meatus of the female urethra. “In what conditions is it sometimes difficult to find the meatus? (a) What dangers attend catheterization? (b) What are some of the causes of cystitis? 7 (a) List the requisites on the catheterization tray. (b) Describe the position of the patient for the treatment. (a) What points would you remember when catheterizing a patient? (b) What would you record after the treatment? (a) What do you understand by a bladder irrigation or a vesical douche? (b) When is it prescribed? (a) Give the solutions commonly used, with the percentage and temperature. (b) How much solution would you prepare for the treatment? (a) In what conditions are bladder irrigations contraindicated? (b) What would you record after the treatment? (a) Name four ways in which cold may be applied locally to the body. (b) Why are local cold applications prescribed? Describe the action of cold: (2) On the mucous membrane and adjoining tissues. (0) On nutrition and bacteria. Describe the action of cold if prolonged: (a) On the nerves and blood-supply. (b) On nutrition and function. What symptoms and signs are to be avoided in making cold applications? (a) What do you understand by the reflex action of cold? (b) Give two examples. i What do you understand by: (a) The primary action of cold? (b) The tonic reaction? What disastrous effect may be produced through ignorance or carelessness on the ‘part of the nurse, by intense or prolonged cold applications if not properly applied? QUESTIONS FOR GENERAL REVIEW AND EXAMINATION 187 (a) Name four ways in which general cold applications are made to the body. (b) Why are they prescribed? Describe the effects of brief, intense, general applications of cold. (a) How may reaction be aided? (b) What conditions retard reaction? (a) What symptoms show the, treatment is having an undesirable effect? (b) Give the temperature of a cold, tepid, and hot bath. If the bath temperature was not prescribed what schedule would you use? (a) What do you understand by a cold sponge bath? (0) Give the duration of the treatment and the temperature of the water. (a) What points would you remember when giving the treatment? (b) What would you record? J63 What do you understand by a cold pack? (b) Why are cold packs pre- scribed? (a) Give the duration of the treatment and the temperature of the water (Method I). (b) What would you record? (a) Give the duration of the treatment and the temperature of the water (Method II). (b) What would you record? (a) What do you understand by a Brand bath? (b) Why is this bath pre- scribed in the treatment of typhoid? (a) Give the duration of the treatment and the temperature of the water. (b) What would you record? @, What do you understand by a spray or slush bath? (3) Why is it pre- scribed? (a) Give the duration of the treatment and the temperature of the water. (b) What would you record? (a) Define a counterirritant. (b) Give the classification. Name some counterirritants commonly used. (a) Define a stupe. (b) Why are they prescribed? (c) Upon what does the size of a fomentation depend? (a) Define inflammation. = (b) What are the causes of inflammation? (c) What are the symptoms of inflammation? Define: (a) Resolution. (b) Phagocytosis. (c) Suppuration. (a) What points would you remember when applying stupes?* (b) What would you record? : (a) How do stupes relieve pain and congestion in adjoining parts? (4) In internal parts? (c) How do stupes relieve tympanites? (d) Reduce a swelling? (a) Define a poultice. (5) When are they prescribed? (¢) What is the duration of the application? (d) Give the thickness of a poultice. What points would you remember when applying poultices? (a) Define a sinapism. (hb) Why are they prescribed? (¢c) Describe the action of mustard. (d) Describe the effects produced by the use of mustard. (a) Define a plaster. (b) Enumerate some plasters in common use. (a) How would you prepare the skin before applying a belladonna plaster? (b) Give the duration of the application. (a) How would you prepare the skin before applying a cantharides plaster? (b) Give the duration of the application and the time required for the formation of a blister. (¢) How would you remove a cantharides plaster? (a) Why. would you watch the amount and character of the urine for twenty- four hours after making the application? (5) How would you treat the blister? (a) Define cupping. (b) Why is dry cupping prescribed? (¢) What is the duration of the treatment? (d) What precautions would you observe in applying cups? (a) What do you understand by wet cupping? (5) Why is it used? (¢) What precaution would you remember in preparing for the treatment? (a) What do you understand by cauterization? (5) Why is the thermo- and electric cautery used? (a) Define the following: Aspiration, aspirator, paracentesis, dropsy, and ascites. (5) Define the following: Hydrothorax, pleurisy with effusion, empyema, pneumothorax, hydrocephalus, and anasarca. 188 NURSING TECHNIQUE (a) Define a lumbar puncture. (b) When is it prescribed? (¢) What is the site of puncture? (a) Describe the membranes that cover the brain and spinal cord. (5) De- scribe the cerebrospinal fluid. (¢) What is its function? (a) Describe the position of a patient for a lumbar puncture. (b) How would you disinfect the skin? (a) What dangers are involved in a lumbar puncture? (b) When is a lumbar puncture contraindicated? (a) What is the after-treatment following a lumbar puncture? (b) What would you record? (a) Define a thoracentesis. (b) When is the treatment indicated? (¢) What is the site of puncture? (a) Describe the position of the patient for the treatment. (5) How would you prepare the field? Define: (a) The pleura. (b) Pleurisy. (¢) What is the function of the pleura? (a) What are the dangers involved in a thoracentesis? (b) What important points would you remember when assisting with the treatment? (a) What would you record after the operation? (b) What is the after-treat- ment following a thoracentesis? (a) What do you understand by an abdominal paracentesis? (0) When is it prescribed? (c) What is the site of puncture? (a) Describe the position of the patient. (b) How would you prepare the field? (a) Define the peritoneum. (b) What are its functions. (a) What important points are to be remembered in preparing for and assisting with an abdominal paracentesis? (b) What dangers are involved? (c) What would you record after the operation? (a) Define pericardicentesis. (b) When is it prescribed? (¢) What is the site of puncture? (a) Describe the position of the patient. (b) How would you prepare the field? Define: (a) Pericardium. (b) Endocardium. (c) Myocardium. (d) Describe the fluid and amount found in pericardium on postmortem examination. How much fluid may accumulate: (a) In an acute pericardial effusion? (b) In a chronic condition? (a) What points would you remember in preparing for and assisting with an aspiration of the pericardium? (b) What dangers are involved? (c) What would you record after the operation? (a) What do you understand by aspiration of a vein? (5) When is it pre- scribed? (a) How much blood is withdrawn? (b) What points are to be remembered when aspirating a vein for laboratory analysis? (a) What do you understand by a phlebotomy? (b) When is it indicated? (c) What is the site of puncture? (a) How do you prepare the skin? (b) What would you record after the operation? DEMONSTRATIONS Prepare a tray and give a vaginal douche of lysol solution, § per cent. (on hand 5 per cent. solution), postpartum. Prepare a tray and give a vaginal douche of boracic acid solution, 2 per cent. (on hand a saturated solution), preoperative. Prepare a tray and give a pharyngeal douche of normal saline solution. Demonstrate lifting an. anesthetized patient from the stretcher to the bed, placing the stretcher three different ways. Demonstrate placing the patient: (a) In the Fowler position. (0) In the lateral position. (c) In the reversed Fowler position. (a) Prepare a tray and patient for a gynecologic examination (bimanual). (b) Place the patient in the following positions and drape her: 1. Sims’ or left lateral. 2. Lithotomy. 3. Knee-chest or genupectoral. 4. Standing or erect. DEMONSTRATIONS 189 (a) Prepare a tray and demonstrate the preparation of the field for a laparotomy the night previous to operation. (b) Demonstrate the routine procedure the morning of operation. (a) Prepare a tray and demonstrate the preparation of the field for an emer- gency appendectomy. (b) Demonstrate the routine preparation of the field for skin grafting. (a) Prepare the field for a lumbar puncture. (b) For a thoracentesis. (c) For a transfusion. Demonstrate the nursing care: (a) After a perineorrhaphy. (b) After a hemorrhoidectomy. (a) Prepare and give 2 drams of liquid medicine. (b) Prepare and give 1 ounce of castor oil. (¢) Prepare and give 2 drams of licorice powder. (d) Demon- strate giving a konseal. (¢) Demonstrate giving an A. B. S. and C. pill. (a) Demonstrate the preparation of a hypodermic injection of morphin sul- phate, gr. } (on hand tablets, gr. §) and atropin sulphate, gr. 1/150 (on hand tab- lets, gr. 1/200). (b) Demonstrate giving the injection. (a) Demonstrate the preparation of a hypodermic injection of camphor in oil. (0) Demonstrate giving the injection. (a) Demonstrate the preparation of a hypodermic injection of insulin. (b) Demonstrate giving the injection. Demonstrate the routine procedure from the time of admittance to entering the surgery (in preparation of a patient for an appendectomy). (a) Prepare a tray and demonstrate proctoclysis (drop method). (b) Pre- pare a tray and demonstrate proctoclysis (gravity method). (c¢) Prepare a tray and demonstrate proctoclysis (Kelly method). (a) Prepare a tray and patient for hypodermoclysis (one nurse assisting). (0) Prepare a tray and patient for hypodermoclysis (two nurses assisting). Prepare a tray and patient’s arm and demonstrate assisting with an intra- venous infusion. Demonstrate the care of the body after death. (a) Prepare a hot wet pack and demonstrate giving same. (b) Prepare a hot dry pack and demonstrate giving same. (a) Prepare a bath-room for a hot bath pack. (b) Demonstrate giving a hot bath pack. (a) Prepare the bath-room for a hot bath. (6) Demonstrate giving a hot bath. (a) Prepare a tray and apply hot dressing to a thyroidectomy incision (Method I). (b) Prepare a tray and apply hot dressings to an appendectomy incision (Method II). (a) Prepare a tray and demonstrate catheterizing a patient (using a steel or glass catheter). (b) Prepare a tray and demonstrate catheterizing a patient (using a soft-rubber catheter). Prepare the requisites and demonstrate assisting a physician with irrigation of the bladder (using a return flow catheter). Prepare the requisites and demonstrate irrigating the bladder (using a soft rubber catheter and a funnel). Demonstrate giving a cold sponge bath (for the reduction of temperature). (a) Demonstrate giving a cold pack (for the reduction of temperature). (b) Demonstrate giving a cold pack (for sedative purposes in insomnia). Demonstrate giving a Brand bath. Demonstrate giving a spray or slush bath. (a) Apply turpentine abdominal stupes, demonstrating two methods. (8) Apply sterile stupes to an abdominal incision. (a) Apply a mustard poultice to the posterior chest. (b) Apply a flaxseed poultice to the anterior chest. (a) Apply a mustard paste to the nape of the neck. (b) Apply a mustard leaf to the precordium. | (a) Apply a belladonna plaster to the lumbar region. (5) Apply a cantharides plaster to an inflamed elbow-joint. (a) Prepare a tray and demonstrate dry cupping (creating the vacuum by 190 NURSING TECHNIQUE means of heat). (b) Prepare a tray and demonstrate dry cupping (creating the vacuum by means of a suction pump). Prepare a tray and demonstrate assisting with wet cupping. Prepare a thermocautery for use. Iron a patient’s back in treatment of lumbago. Prepare a tray and demonstrate assisting with a lumbar puncture. Prepare a tray and demonstrate assisting with a thoracentesis (using an aspirat- ing bottle). Prepare a tray an syringe). strate assisting with an abdominal paracentesis. Prepare a tray and demon: Prepare a tray and demonstrate assisting with an aspiration of the pericardium. Prepare a tray and demonstrate assisting with an aspiration of the vein. Prepare a tray and demonstrate assisting with a phlebotomy. d demonstrate assisting with a thoracentesis (using a Luer JUNIOR YEAR FIRST SEMESTER 191 Lectures 1 and 2: Lectures 3 and 4: PROCEDURES USED IN MEDICAL NURSING NURSING IN MEDICAL DISEASES Diseases of the Blood, Heart, and Circulatory System. Diseases of the Respiratory System. Lectures 5, 6, 7, and 8: Diseases of the Gastro-intestinal Tract and Lectures 9 and 10: WN = 3 orewin lode 10. HH, 12. 13. 14. 15. 16. 17. 18. Accessory Organs. Constitutional Diseases. OBJECTS OF THE COURSE! 1. To give the nurse a practical understanding of the causes, symp- toms, prevention, and treatment of the commoner medical diseases, so that she may intelligently care for her patients, and give skilled assistance to the physician. 2. To give her skill and precision in the administration of the more advanced nursing treatments and to make her a keen observer and reporter of the symptoms of diseases and the effects of treatments. New Demonstrations: Review: . Assisting with a Transfusion. 1. Hypodermic Injections. . Inhalations. 2. Venesection. . Application of Camphor and 3. Cantharides. Oil to the Chest—Pneu- 4. Aspiration of Pericardium. monia Jacket. 5. Hot Applications. . Application of Cold Com- 6. Sinapisms. presses to the Chest. 7. Turpentine Stupes. . Taking Blood-pressure. 8. Carminative Enemata. . Assisting with a Gastric Lav- 9. Sedative Enemata. age. 10. Dry Cupping. . Assisting with Expression of 11. Mustard Bath. Stomach Contents—Test 12. Cold Sponge Bath. Meals. 13. Cold Pack. . Fractional Method of Gastric 14. Aspiration of Pleural Cavity. Analysis. 15. Saline Enemata. . Preparation of Patient for 16. Intravenous Infusion. Radiography and Fluoros- 17. Knee-chest Position. copy. 18. Hypodermoclysis. Gavage. 19. Nutrient Enemata. Nasal Gavage. 20. Emollient Enemata. Assisting with a Duodenal 21. Abdominal Paracentesis. Feeding. 22. Hot Pack. Gastrostogavage. 23. Hot Tub Bath. Enteroclysis. 24. Preparation of Laboratory Administration of Insulin. Specimens. Vapor Bath in Bed. 25. Lumbar Puncture. Hot-air Bath in Bed. 26. Application of Liniments. The Phenolsulphonephthalein 27. Massage. Test. 28. Counterirritation. t Standard Curriculum for Schools of Nursing. 13 193 194 NURSING TECHNIQUE New Demonstrations: 19. Administration of a Test-meal for Renal Function. 20. Local Hot Wet Pack. 21. Local Electric Light Bath 22. Local Hot-air Bath. 23. Sunlight Bath. References: Hoxie’s Medicine for Nurses. Harmer’s Principles and Practice of Nursing. Emerson's Essentials of Medicine. Osler’s Practice of Medicine. Pope's Practical Nursing. Howell's Text-book of Physiology. ASSISTING WITH A TRANSFUSION (The Paraffin Tube) By transfusion is meant the transfer of blood from one person (the donor) to another (the donee, or recipient). Indicated: 1. For severe hemorrhage. . For shock. . In hemophilia. For furunculosis. In illuminating gas poisoning; it is preceded by a venesection. For septicemia with a positive blood-culture. As a prophylaxis, previous to definite shock-producing operations. . In debilitation from any disease. Before a transfusion the donor's blood is carefully examined and both donor's and donee’s blood are grouped or matched. Amount of blood transfused: 1. Usually between 500 and 800 c.c. for an adult. 2. From 75 to 150 c.c. for a child. ; For transfusing blood the following methods are used: 1. The direct method. 2. The indirect: 1. The paraffin tube. 2. The sodium citrate method. Requisites (using paraffin tubes): 1. Three paraffin tubes (Kimpton-Brown or Vincent). These tubes are sterilized in the autoclave, paraffined and wrapped in double sterile coverings, previous to the operation. . Two small blunt curved scissors. Two small sharp pointed scissors. Four small tissue forceps. Six mosquito hemostats. Six Kelly clamps. Two knife handles. Four blades. . Skin clamps or silkworm gut. Two tubes of plain catgut No. 1. . Local anesthetic: 1. Two Luer syringes. 2. Three needles. 3. Sterile medicine glass. 4. Novocain, 3 per cent. 9 NOUR Lo ROO RNOUALN — ASSISTING WITH A TRANSFUSION 195 12. Sterile table cover. 13. Sterile towels (2 packages). 14. Sterile aspirating sheets (2). 15. Sterile gloves (4 pairs). 16. Sterile gowns (4). 17. Sterile gauze. 18. Sterile cotton. 19. Flask of ether." 20. Flask of alcohol. 21. Sphygmomanometer. 22. Pressure bag. 23. Long-handled drop light. Fig. 25.—Transfusion. Position of donor and donee for a transfusion. 24. Two arm boards or small tables. 25. Two sheets. 26. Adrenalin chlorid (1 c.c.) to combat any symptom of syncope on part of recipient. Procedure: To insure smooth technique it is advisable to have two teams, each composed of an operator and 1 sterile assistant. A non-sterile nurse waits on both teams. (The operators and assistants scrub and dress as for a major operation.) Sterilize the instruments and have 1 sterile assistant. Set up the sterile table, dividing the instruments so that there are two complete sets. Apply the cuff of the sphygmomanometer to the donor's arm and 196 NURSING TECHNIQUE the tourniquet loosely to the donee’s arm. Scrub the fields well with ether and alcohol and apply alcohol sponges and let them remain on the field until the beginning of the operative procedure. The operation is as follows: Procedure on donor: If the vein cannot be clearly seen or palpated, it is advisable to force the mercury in the sphygmomanometer up to 40 or 50 mm., rendering the vein prominent. ~ About 13 c.c. of a 3 per cent. novocain solution is drawn into the Luer syringe and then injected into the skin, producing a wheal about 1 inch in diameter immediately over the vein. A transverse incision 2 inch long is made directly over the vein. The advantage of a transverse incision is that if the vein is injured or not large enough to use the incision can be lengthened instead of making another incision. It also has another advantage. When the patient carries the arm in a flexed position the edges of the wound have a ten- dency to approximate themselves. The overlying subcutaneous tissue exposed in the opening is spread apart by the careful introduction of an ordinary hemostat, spreading the jaws of same apart on entering until the vein is exposed. About § inch of vein is sufficient length of exposure. Two pieces of catgut (No. 1 plain) about 6 inches long are drawn beneath the vein. The vein is tied off proximally, using one of these as a ligature. The other ligature is not tied; a hemostat being applied and grasping both ends is allowed to fall over the side of the arm, its own weight being sufficient to constrict the vein distally. The vein is then grasped in the midline with the point of a mosquito hemostat, care being taken to grasp only the anterior wall of the vessel; the instrument is drawn up slightly and a transverse incision made in the vein by means of the point of a pair of small sharp scissors, the open- ing extending about half-way about the circumference of the vein. Tension is applied to the distal ligature by the assistant during the en- trance into the vein. To verify the entrance this tension is temporarily removed, when the blood will emerge through the cut in the venous wall. A mosquito hemostat is applied to either extremity of the incision in the vein and one also distally, the three acting as guides to the tip of the tube later to be introduced. The tube is then handed to the operator, who introduces the tip, pointing it distally into the lumen of the vein (the mosquito hemostats acting as guides). The sphygmomanometer should register about 40 mm. of pressure, while the patient repeatedly makes a fist at an average rate of about fourteen a minute. The blood flows readily into the tube, if the tip is directly in the lumen of the vein and parallel to the direction of the vessel. Any angulation will tend to obstruct the flow. The next most frequent cause of delay is the introduction of the tip between the coats of the vein. The tube is allowed to fill to capacity. If the tube is completely sealed above, the operator, by holding his finger over the opening near the top of the tube, can prevent loss of blood at the tip, a vacuum being created in the tube after a small amount of blood flows out. As a rule, however, it is necessary for the operator to hold his finger over the opening in the tip while transferring the tube from the donor to the recipient. INHALATIONS 197 Procedure on recipient: The operator and assistant working on the recipient have in the meanwhile entered and prepared the vein in a similar manner, with the exception of tying off the vein distally. (It is well to use a pressure band about the arm of the recipient also before making the skin in- cision, as most frequently, even when the recipient has large veins, they are collapsed, due to exsanguination and allied causes, and are ac- cordingly not readily palpable, much less visible.) The operator and the assistant on the recipient hold the 3 mosquito hemostats applied to the vein of their patient so as to direct the tip of the tube into the lumen of the vein. The operator holding the tube re- moves his finger from the tip of same and introduces it, pointing proxi- mally, while the blood is flowing from the tube. The non-sterile assistant immediately attaches the tube of the press- ure bag to the upper opening of the paraffin tube, sufficient pressure being maintained in the air-bag to result in a gradual emptying of the transfusion tube into the recipient. At least five minutes should elapse in emptying a 350-c.c. tube, in order to avoid overtaxing the right heart. Reaction symptoms must also be watched for, e. g., nausea, vomiting, pain in lumbar region, dyspnea, etc. Any such symptoms make obvious immediate cessation of the transfusion. After the wounds are closed a sterile dressing is applied to each arm and retained with a bandage. Watch the patient carefully after the treatment for adverse symptoms. Some of these are: 1. Chill followed by a rise in temperature. 2. Nausea and vomiting. - 3. Urticaria. 4. Flushed face and headache. Record: 1. Hour and operation. 2. Amount of blood transfused. 3. Any unusual symptoms which may occur. 4. By whom performed. INHALATIONS By inhalation is meant the drawing of air or vapor into the lungs. Inhalations may be dry or moist. Reguisites: 1. Pearl of amyl nitrite. 2. Pearl of aromatic spirits of ammonia. 3. Stramonium leaves and cigarettes. 4. Oxygen tank, flask, 2 pieces of tubing, frame for flask, key, and funnel. 5. Apparatus for steam inhalations. 1. Amy! Nitrite: Prescribed: 1. To relieve an attack of angina pectoris. 2. To relieve an attack of bronchial asthma. Procedure: Crush the pearl or aspirol and hold it a short distance above the patient’s nose. Withdraw it as soon as the effects are produced; or ‘pour 4 or 5 drops of the drug on a gauze compress and proceed in the same manner. Fig. 27.—Inhalation. An inhalation with a pitcher and towel. INHALATIONS 199 2. Aromatic Spirits of Ammonia: Prescribed: To overcome fainting. Procedure: Proceed in same manner as for amyl nitrite inhalation. 3. Stramonium: Prescribed: To relieve an attack of spasmodic asthma. Procedure: : The leaves may be purchased loose or in the form of cigarettes. Instruct the patient to smoke the cigarettes in the same manner as Fig. 28.—Inhalation. An inhalation with a DeVilbiss vaporizer. tobacco and inhale as much of the smoke as possible. Place the loose leaves in a bowl and burn them. Have the patient inhale the fumes. 4. Oxygen: Prescribed: To counteract the effects of depressed breathing. Procedure: Half fill the glass flask with water and insert the cork with glass tubes into the neck of the flask. Connect the glass tube that extends into the water with the shorter piece of rubber tubing and connect the other end to the oxygen tank. Connect the longer piece of tubing with the glass tube that is out of the water and insert the funnel in the free end. 200 NURSING TECHNIQUE Place the flask in the frame for same and place the key on the tank. Carry it to the bedside and, if the tank is small, place it on the bedside table. If the tank is large, place it on the floor near the head of the bed. Turn the key sufficiently to start the oxygen flowing through the bottle at a rate of 40 to 60 per minute. Hold the funnel above the pa- tient’s mouth and nose until the prescribed amount has been given. 5. Steam. Prescribed: To relieve abnormal conditions of the mucous membrane of the re- - spiratory tract. There are three methods used: 1. Pitcher and towel. 2. DeVilbiss vaporizer and cone, or Pelton electric vaporizer. 3. Croup tent and kettle. Reguisites: 1. Pitcher (2 quarts). . Heavy towel. . DeVilbiss vaporizer. Cone of stiff paper. Umbrella, screen, or large cradle. Old piece of blanket. . Two muslin sheets. . Pins and bandage. . Electric grill. 10. Tea kettle or 1-gallon kerosene can. Procedure: If it is not possible to obtain a DeVilbiss vaporizer or an electric grill, a very satisfactory inhalation may be given as follows: Pour boil- ing water into a narrow-necked pitcher and add 2 drams of tincture of benzoin. Arrange a heavy towel around the pitcher and pin it so that the opening will fit around the nose and mouth. To prepare the Pelton vaporizer for use: For each treatment lasting fifteen minutes or less, place in the va- porizer 6 teaspoonfuls of boiling water before turning on the electric current. If a longer treatment is desired, add more water as needed. Attach the cord to a proper outlet or fixture of an electric lighting circuit. (Be sure that the current supplied is that for which the vapor- izer is made and marked. This is usually 110 volts.) Then turn on the current. Place the medicine on the perforated tray in the vaporizer. Take a clean paper inhaling cone such as are furnished with the vaporizer, opening it by gentle pressure of the hand, and place it in the open end of the vaporizer. Place the face close to the cone as soon as the steaming vapor is given off (but not before) and inhale the hot vapor. If the medicated vapor becomes too much weakened during the inhalation, additional quantities of medicine may be added from time to time. Keep the holes in the tray open and replace the wick, if it becomes dirty or clogged. To prepare the DeVilbiss vaporizer for use: Half fill the water container with boiling water, and the lamp with alcohol. Put 1 dram of medicine into the small cup suspended in the water container. It is important in assembling the parts that the small APPLICATION OF CAMPHORATED OIL TO CHEST 201 metal cylinder be placed inside of the solution container. Place a cone of heavy paper over the spout of the vaporizer and continue the treat- ment for fifteen minutes. If the treatment is continuous or for a great length of lime: Arrange a croup tent by means of a screen, a large cradle, or an um- brella. To prepare a screen: Place the screen around the head of the bed so that the wings pro- ject on each side. Tie a heavy piece of twine across the front of the screen from each projecting wing. Cover the top of this foundation with a piece of old blanket. Then arrange two sheets over the top and around the sides so that the steam will be localized and the patient provided with ample ventilation. To prepare a cradle: Place the cradle standing on one end behind the patient so that the sides project on each side of her. Place the blanket and sheets as when arranging the screen canopy. To prepare an umbrella: Cut a piece of blanket the size of the covering of the umbrella. Cut a hole in the center so that the blanket will slip over the handle. Pin the blanket securely to the covering and tie the handle of the umbrella to the frame of the bed so that it will be in the center at the head of the bed. Cover it with the sheets as for the other foundations. Ar- range the opening so that it is in the center at the head of the bed. Place the steam kettle so that the spout is in this opening and projects under the canopy. Points to be remembered: 1. Arrange the electric grill and the steam kettle so that there is no danger of the bed covers or patient coming in contact with the steam or flame. 2. Always line the roof of the canopy with some material that will absorb the moisture. : 3. Arrange the canopy so that there will be ample ventilation and that it will present a neat appearance. APPLICATION OF CAMPHORATED CIL TO CHEST—PNEUMONIA JACKET Camphorated oil is a 20 per cent. solution of camphor in cottonseed oil Prescribed: Locally to relieve pain in inflammation: 1. Of the chest or throat. 2. Of the muscles or in neuralgia. 3. Of the joints from sprains or rheumatism. Requisites: 1. Flask camphorated oil. 2. Pitcher of hot water. 3. Pneumonia jacket. Procedure: Place the flask in hot water, as oily substances are absorbed better and give greater comfort to the patient if they are previously warmed. Wash the area with warm water and soap to remove sebaceous material, as these prevent absorption. 202 NURSING TECHNIQUE Apply the camphorated oil to the affected area, using the open palm of the hand. Continue the treatment for ten minutes as the beneficial effects depend considerably upon the mechanical stimulus of rubbing. Cover the area with a piece of flannel or a pneumonia jacket to prevent evaporation and chilling. Pneumonia jacket: A pneumonia jacket consists of two large flannelette chest protectors basted together and applied as a jacket to the anterior and posterior chest for the purpose of keeping the chest warm. APPLICATION OF COLD COMPRESSES TO THE CHEST Prescribed: In the treatment of pneumonia: 1. To produce a tonic effect. 2. To produce a sedative effect. Temperature of water: 1. For a tonic effect, about 60° F. 2. For a sedative effect, about 70° F. Size of the compress: Shaped to fit around the neck and arms and long enough to extend to the waist line. Duration of treatment: 1. For a tonic effect, one hour. 2. For a sedative effect, two hours. Frequency of treatment: . 1. For a tonic effect, every hour, if the patient's temperature con- tinues high. 2. For a sedative effect, every two hours. Requisites: Tray with: 1. Two compresses (three thicknesses of old linen, cut the re- quired shape). 2. Two pieces of closely woven flannel (about 1 inch larger all around than the compress). 3. Basin (for water). 4. Two bath blankets. 5. One hot-water bottle and cover. Procedure: Prepare the basin of water, the required temperature, and the hot- water bottle for use. Carry the tray to the bedside. If the compress is to be applied to the anterior and posterior chest, protect the under bedclothes by means of a bath blanket. Turn the upper clothes down below the waist line and at the same time cover the patient with the bath blanket. Place the hot-water bottle to the patient’s feet and remove the gown, if necessary. Wring the compress so that it will not drip and apply it (with the flannel protector) to the affected area, so that all parts are in contact with the wet compress and that it is smooth and free from wrinkles. If the anterior and posterior chest is to be covered at the same time, apply the compresses so that they overlap well under the arms and over the shoulders, but be sure there are no bulky folds. Change the TAKING BLOOD-PRESSURE 203 compress according to the effect desired. Make no unnecessary ex- posure to prevent chilling. TAKING BLOOD-PRESSURE Pressure: By blood-pressure is meant the force exerted by the blood against the walls of the vessels. Systolic pressure: The greatest pressure which the contraction of the heart causes in the artery. Diastolic pressure: The lowest point to which the pressure drops between beats. Pulse pressure: By subtracting the figures of the minimal or diastolic pressure from those of the maximal or systolic pressure you obtain the pulse pressure. The pulse pressure gives the excess energy the heart exerts over and above the diastolic pressure, or peripheral resistance. The pulse press- ure indicates the amount of energy which actually carries on the cir- culation. The importance of determining all three pressures, systolic, diastolic, and pulse pressure is at once evident. While a great deal can be derived from an estimation of the systolic reading alone it is equally important to determine the diastolic and pulse pressures. In many cases high or low systolic pressures are com- pensatory and in others what is apparently a systolic pressure within normal limits may prove to be pathologic, when viewed in its relation to diastolic and pulse pressures. There is a reciprocal balance maintained under normal conditions between the systolic pressure and the diastolic pressure, through the vasomotor system. During disease this relation is disturbed and af- fords one of the best means of determining the condition of the cardio- vascular system. Coefficient of pressure: This is determined by dividing the pulse pressure by the systolic pressure. Normal readings: 1. The pulse pressure should equal approximately one-third of the systolic pressure. 2. The diastolic pressure two-thirds of the systolic pressure. 3. The normal coefficient of pressure is from 0.25 to 0.33. The two methods of determining blood-pressure are: 1. The auscultation method. 2. The palpation method. The auscultation method of taking blood-pressure was originated by Kaerskoff of Russia. The accuracy, ease, and simplicity of this method has caused it to be used universally. Frequently the first reading is discarded, using it simply to demon- strate the harmless and painless character of the procedure. The Auscultation Method: METHOD 1 Procedure: bY Sl Place the patient in a comfortable position, reclining or sitting pos- 204 NURSING TECHNIQUE ture. Bare the arm to the shoulder. Have the forearm semi-flexed, and supinated so that there is complete relaxation of these members. (During the reading the patient should not move the arm, forearm, or body.) Apply the end of the cuff containing the rubber pad over the brachial artery and wind the remainder of the cuff around the arm so that each turn covers the previous one. Tuck the end under one of the turns. Then apply the stethoscope. Pump air into the apparatus and raise the pressure in the constricting arm band above the obliteration of the pulse and then slowly release the air and listen with the stetho- scope over the artery about 1 inch below the cuff. Five phases are noted: 1. At first there is no sound heard, but as the pressure is gradually released a sharp clear thumping sound becomes audible (first phase). The first thump is the time of the systolic pressure. 2. A murmur follows the tapping sound (second phase). 3. The murmur in turn is replaced by a second tapping sound (third phase). 4. The tapping sound more or less abruptly becomes dull (fourth phase). This change in the character of the sound indicates the time of the diastolic pressure. 5. Shortly after the fourth phase, all sound disappears (fifth phase). The beginning of the first phase is recognized by all authorities as representing the correct systolic period and the beginning of the fourth phase as the correct diastolic period. MersOD II The Palpation Method: Procedure: Keep the finger on the radial artery, release the valve slightly so the mercury will fall evenly and slowly in the glass tube. The moment you feel the first pulsation of the radial, read the height of the mercury column and it will give the systolic pressure. Allow the mercury to continue falling slowly and note the varying degree of the oscillations of the mercury column. Read the scale at the base of the lowest fluctuation and it gives the diastolic pressure, or when you feel the first full bounding pulse wave at the wrist, read the height of the mercury column which also gives the diastolic pressure. Points to be remembered: 1. Be sure that the patient is in a relaxed, comfortable position and that the cuff is on a level with the heart. . Be sure that the cuff is snugly applied to the bare extremity. . Remember that mental and physical relaxation for a short time before reading is essential. . Take all subsequent observations with the patient in the same position and about the same time of day in relation to meals, etc. 5. Take readings as quickly as possible, as prolonged pressure af- fects their accuracy and is also decidedly unpleasant to the patient. 6. Allow the pressure to fall to zero between observations and per- mit sufficient time to elapse between readings for the venous pressure (stasis) to fall to the normal level. > Ww ASSISTING WITH A GASTRIC LAVAGE 205 ASSISTING WITH A GASTRIC LAVAGE! Gastric lavage consists in washing out or irrigating the stomach by means of a stomach tube or catheter. Prescribed: 1. To remove poisons and irritating material. 2. To relieve nausea and vomiting. 3. To cleanse the stomach preoperative in preparation for gastric operations. 4. To cleanse the stomach postoperative to prevent nausea. Solutions used: 1. Sterile water. 2. Normal saline (half-strength). 3. Sodium bicarbonate, 1 to 5 per cent. 4. Boracic acid, 2 per cent. Temperature of solution: From 95° to 105° F. Quantity of solution: From 1 to 4 quarts. Position of patient: 1. Sitting up in bed or chair. 2. Semirecumbent, if condition is such that the patient cannot sit upright. Requisites: Gastric lavage tray with: 1. Stomach-tube (wrapped). 2. Medium sized funnel (wrapped). 3. Ewald evacuating bulb (wrapped).? 4. Basin, for stomach-tube (wrapped). 5. Large basin or foot-tub (for return flow). 6. Large pitcher, for solution (wrapped). 7. Small flask of glycerin. 8. Medicine glass (wrapped). 9. Glass graduate, for measuring solution (wrapped). 10. Mouth-gag (wrapped). 11. Emesis basin. 12. Gauze sponges. 13. Rubber apron. 14. Rubber sheet. 15. Towels (6). 16. Covered container (sterile). Procedure: Wash your hands and prepare the solution. Connect the funnel to the stomach-tube and place them in the basin and cover with small pieces of ice a short time before using. Carry the tray with the requisites to the bedside. If the treatment is given for the first time, assure the patient that there is no danger. Instruct her to make motions of swallow- ing as the tube is passed into the esophagus and to breathe in deeply. Move the patient to the edge of the bed and make her comfortable, 1 Demonstrate this procedure, having student nurses for the patient, the physician, and the nurse. 2 To be used for the expression of stomach contents. 206 NURSING TECHNIQUE in a semisitting position, if she is not able to sit upright. Tie the rubber apron around the patient’s neck and place the rubber sheet covered with a towel under her head and shoulders. Be sure the clothing around the neck is loose. Remove artificial teeth on a plate, if the patient has them. Give a gauze handkerchief to the patient and place the emesis basin where it can be easily reached. Pour enough glycerin into the medicine glass to half fill it.! (The lubricant can be omitted after the first or second treatment.) Pour 1000 c.c. of solution into the glass graduate. The physician then grasps the tube about 3 inches from the tip? and curves it slightly so that it may follow the curve of the palate. He then passes it along the roof of the mouth, and when the pharynx is reached he instructs the patient to swallow continually and breathe deeply.3 The tube is passed until the mark (indicating the distance from the stomach to the upper incisor teeth) is at the mouth. If the patient has had previous treatments, there is usually no diffi- culty, but if it is the first experience, there is usually considerable gag- ging and discomfort occasioned. When the tube enters the stomach the contents frequently enter the funnel. The funnel may be lowered and the contents drained off. The physician then holds the funnel about 3 inches above the pa- tient’s mouth. Pour in slowly about 500 c.c. of solution. The physician then inverts the funnel and lowers it so that the fluid will siphon back into the foot-tub or basin provided for the purpose. A little more solu- tion may be added if it fails to do so. When all the solution has returned, refill the funnel, according to the wishes of the physician or until satis- fied with results or the required amount has been given. The physician pinches the tube and removes it quickly. Hold the basin to receive it. Make the patient comfortable and remove the equipment. Thoroughly cleanse the gastric lavage tube, taking care that no particles of food are left adhering to the inside of it, especially about the openings. Place it in a basin of cold water and flush it well by means of a glass syringe. Then wash it thoroughly in warm soapy water, using a gauze sponge. Rinse it well and sterilize it for five minutes. Sterilize the funnel, the basin for the tube, and the emesis basin. Care for the other requisites as previously demonstrated and equip the tray for use. Points to be remembered (if the lavage is performed by a nurse): 1. Do not introduce the tube or liquid with force. 2. Do not perform a lavage within three or four hours after a meal, unless specially ordered or in an emergency. 3. Discontinue the treatment if there is blood in the siphoned liquid, if pain is occasioned by the introduction of the tube, or if there is any obstruction in the passage of the tube. Record: : 1. Hour and treatment. 2. Amount and character of the vomitus (if any). 3. Amount of flatus expelled and quantity of mucus. 4. Any unusual symptoms which may occur. 1 The physician may use it if he chooses. Some authorities consider the use of a lubricant undesirable. 2 Holding it as one would a pen (Tod). 8To aid in overcoming nausea. ASSISTING WITH EXPRESSION OF STOMACH CONTENTS 207 5. Amount of water used before the return came clear. 6. By whom performed. ASSISTING WITH EXPRESSION OF STOMACH CONTENTS By expression of stomach contents is meant the removal of the con- tents by passing a tube into the stomach and removing the air from this by means of an Ewald evacuating bulb or a Luer syringe. After a vacuum has been created the pressure within the stomach forces the material (that the organ contains) into the tube. Prescribed: To aid in diagnosis by indicating: 1. The motor power of the stomach. 2. The secretory activity of the stomach. Motor Power By the motor power of the stomach is meant the ability of that organ to pass its contents into the small intestine. The secretory activity: About 2000 c.c. of gastric juice is secreted daily in response to some food stimulus; however, the quantity depends upon the amount of food to be digested. The essential constituents are hydrochlorid acid 1/10 to 3/10 per cent. salts and enzymes, pepsin, rennin, and lipase. Mucus in small amounts is also secreted by the mucous lining. TEST-MEALS Certain foods in the form of test-meals are given and later (at speci- fied times) expressed, to determine the motor and secretory capacities. The residue is then examined quantitatively and chemically. It is customary to give the test-meal in the morning, as the stomach is most apt to be empty at that time. The following are the test-meals most frequently used: 1. Ewald test-meal:! 1. Bread, 35 grams (a roll or slice, without butter). 2. Water or tea, without milk or sugar 300 to 400 c.c. (Tea is not used if the residue is to be examined for blood, as the tannic acid in the tea interferes with the blood-tests.) This meal is given upon an empty stomach in the morning and expressed one hour later, counting from the beginning, not the end of the meal. The residue will measure between 30 and 50 c.c. 2. Riegel test-meal: 1. Bouillon (400 c.c.). 2. Broiled beef steak, 150 to 200 grams. 3. Mashed potatoes, 150 grams. Instruct the patient to chew the food well, as it tends to clog the tube. The residue is expressed in three or four hours. If at the end of that time no return is obtained, the motility is either normal or increased. If a large amount still remains and the food is undigested, the motility is decreased and the digestive power very poor. 1 This test-meal has long been used for the routine examinations. Its dis- advantage is that it introduces, with the bread, a variable amount of lactic acid and numerous yeast cells. This source of error may be eliminated by substituting a shredded whole wheat biscuit for the roll (Todd). 208 NURSING TECHNIQUE Position of patient: Same as for lavage. Requisites: Gastric lavage tray. Procedure: Prepare the tube as for a lavage. If the evacuating bulb is used and it has become hardened, place it in hot water a short time previous to the treatment. Proceed in the same manner as for a lavage as far as and including the passing of the tube (the rubber apron and sheet may be omitted), observing the same precautions. The physician expels air from the Ewald evacuating bulb or Luer syringe and attaches it to the tube. He then withdraws the contents and empties it into the sterile container. The procedure is repeated until all the contents are removed. Cover the jar securely, label it, and send it to the laboratory immediately. If not analyzed immediately, place it on ice to prevent further action of the enzymes or any alteration in the contents. Points to be remembered: Observe the same precautions as for gastric lavage. Record: 1. Hour test-meal was given and kind. 2. Hour test-meal was removed and sent to laboratory. 3. By whom the test-meal was expressed. FRACTIONAL METHOD OF GASTRIC ANALYSIS The fractional method consists in withdrawing the stomach contents at frequent intervals, usually every fifteen minutes, after the administra- tion of a test-meal till the close of digestion. Preparation of patient: Give no food after the 5.30 meal the evening previous. Give water till 6 A. M. of the day of the test. Position of patient: Fowler's position, either in bed or chair. Amount of residuum: From 10 to 100 c.c. Amount withdrawn each time: 5 c.c. at fifteen-minute intervals. Requaisites: . Gastric lavage tray. . Sterile Rehfuss tube. . Sterile glass syringe. . Two test-tubes (60 c.c.) . Ten test-tubes (20 or 30 c.c.). Labels. . Ewald test-meal. Cocain, 2 per cent., in atomizer (if indicated). . Clock or watch. Procedure: Wash your hands and prepare the test-meal. Prepare the tray and tube as for a lavage. Label the test-tubes, “residuum,” ‘‘first,” ‘‘sec- ond,” “third,” etc. Carry the requisites to the bedside and prepare the COTA WN » PREPARATION OF PATIENT FOR RADIOGRAPHY AND FLUOROSCOPY 209 patient as for a lavage. The physician passes the flexible Rehfuss tube and the patient swallows it, assisted by the gravity of the tip. (In some instances in which nausea is present, the throat may be sprayed . with cocain, 2 per cent., just previous to passing the tube.) The tube is passed until the mark indicating that the proper amount has been swallowed (usually 22 to 24 inches) is at the patient’s lips. The glass syringe is then connected and the residuum removed. If no residuum is obtained, sit the patient erect, then turn her on her right and then on her left side. The physician usually passes the tube another inch or so. Usually from 10 to 100 c.c. of residuum is obtained. Then instruct the patient to eat the Ewald test-meal. (There is no need to remove the tube, although some patients prefer to eat the meal without the tube.) If the meal is started at 8.00 a. M., it should be completed at 8.04. The first specimen is removed at 8.15, the second at 8.30, the third at 8.45, and so on, until after changing the patient's position and adjusting the tube, the fluid is free from food particles or until the acidity has returned to the same level as was found in the fasting content. The tube is then removed rather cautiously. If a temporary spasm of the muscles of the throat refuses to allow the tip of the tube to pass, the physician makes gentle but firm traction on the tube and the spasm gradually relaxes. Make the patient comfort- able and send the specimens properly labeled to the laboratory. Points to be remembered: 1. Do not exert too much suction on the tube. 2. Do not allow the patient to swallow too much tube. 3. Remove the tube cautiously to prevent pulling it in two. Record: 1. Hour tube was passed and residuum was withdrawn. 2. Hour the specimens were withdrawn. 3. Sent to laboratory. 4. Any unusual symptoms present. PREPARATION OF PATIENT FOR RADIOGRAPHY AND FLUOROSCOPY By radiography is meant photography with the Roentgen rays. By fluoroscopy is meant an examination by means of a fluoroscope. A fluoroscope is a devise for examining deep structures of the body by means of the Roentgen rays. It consists of a screen covered with crystals of calcium tungstate. Prescribed: To aid in making a diagnosis. EXAMINATION OF THE STOMACH ~The usual procedure consists of a fluoroscopic examination followed by several x-ray pictures taken at various intervals, covering a period of forty-eight hours. The stomach, however, is not visible on account of the organs lying behind it, but by the use of barium sulphate administered in buttermilk, the stomach may be outlined. 1 The rubber apron and sheet may be omitted. 14 210 NURSING TECHNIQUE Prepare the patient as follows: 1. Give a cleansing bath. 2. Give no breakfast the first morning of the gastro-intestinal exam- ination. 3. Place the patient on the bed-pan (or if she is able to walk she may go to the bath-room) before sending her to the x-ray de- partment. 4. Put bedroom slippers and a long gown and a bathrobe on the pa- tient, as she will be required to stand for the fluoroscopic ex- amination. When the patient arrives in the x-ray department she is given 1 quart of buttermilk mixed with 2} heaping tablespoonfuls of barium sulphate. The outline of the stomach is then clearly discerned and any existing deformities seen. After the fluoroscopic examination the patient is placed on the x-ray table and films of the stomach are taken so that a permanent record may be kept. The patient is then taken to her room. The next step is to ascertain whether the stomach empties in the normal time or retains food. This is determined by taking the pa- tient to the x-ray department (six hours from the time the buttermilk and barium sulphate was given). Be sure that the patient has had nothing to eat or drink during that six- hour interval. : When the six-hour film is taken, the patient is taken back to her room. This completes the first day of a gastro-intestinal examination. After the six-hour film has been taken the patient may eat or drink anything; however, do not give a cathartic the first day of the examination. The next step is to take a film to see how far along in the intestinal tract the buttermilk and barium sulphate has gone. This film is taken the next morning and is called the twenty-four-hour film. The patient on this day may have her breakfast and the usual diet, otherwise the preparation is the same as for the first examination. EXAMINATION OF LARGE INTESTINE The next step in a gastro-intestinal examination is to examine the large intestine. Before doing this it is necessary to rid the intestinal tract of the opaque meal. This is accomplished by giving 2 ounces of castor oil on the second day of the examination, which is the afternoon of the day the twenty-four-hour film is taken. Give the patient the usual diet following the administration of the castor oil. The next morning the examination to discern the function and out- line of the large intestine is made in much the same manner as the stom- ach examination. Prepare the patient as follows: 1. Give a cleansing bath. 2. Give the usual breakfast. 3. Place the patient on the bed-pan (or if she is able to walk she may go to the bath-room) before sending her to the x-ray de- partment. 4. Put bedroom slippers and a long gown and a bathrobe on the patient. The patient is then taken to the x-ray department, and an opaque enema of buttermilk and barium sulphate is GAVAGE 211 given. By means of the fluoroscope any deformities are then discovered. After taking a film the patient is allowed to expel the enema. This completes the gastro-intestinal examination. ExaMINATION OF CHEST ~ No special preparation is required. Put a long gown, bathrobe, and slippers on the patient as a fluoroscopic examination of the heart and diaphragm is frequently made. ExAMINATION OF GALL-BLADDER AND KIDNEY No special preparation is required. Give castor oil, 2 ounces to an adult and 1 ounce to a child, the afternoon or evening previous. This clears the intestinal tract of flatus which often obstructs the view of shadows which may indicate calculi. GAVAGE By gavage is meant the introduction of food into the stomach through the mouth or nose by means of a tube. Prescribed: When the patient cannot or will not take food or medicine in the usual manner, as: Following certain operations on the jaw or tongue. In insanity when the patient refuses food. In pharyngeal paralysis. In conditions when the patient is unconscious. In poisoning to introduce an antidote for the poison. . In feeding premature infants. Position of patient: Same as for lavage. Temperature of food: About 100° F. URL Character of food: Liquid or semiliquid. (Peptonized if indicated.) Quantity of food: This varies according to the indications in the individual case. Regquisites: 1. Gastric lavage tray. 2. Graduate containing food. 3. Restraint, if indicated. Procedure: Wash your hands and prepare the food. Prepare the tube as for a lavage. Restrain the patient if necessary, and place the mouth-gag so that it will be convenient for the physician if he wishes to use it. Place a towel around the patient’s neck and pin it with a safety-pin. Give the patient a gauze handkerchief, if she is able to use it. The tube is lubricated by the physician and introduced as for a lavage. Wait a minute before pouring the liquid into the funnel so that the muscular contraction induced by the passing of the tube may subside. The funnel is held about 3 inches above the patient so that food may enter the stomach slowly. As soon as the last of the food has left the funnel, the physician compresses the tube near the patient’s 212 : NURSING TECHNIQUE mouth and removes it. Hold the basin near the patient’s mouth to re- ceive the tube. Make the patient comfortable, keep her quiet and undisturbed after the treatment, so as to avoid the expulsion of the food. Points to be remembered: Observe the same precautions as for a lavage. Record: 1. Hour and treatment. 2. Preparation of food and quantity. 3. Any unusual symptoms which may occur. 4. By whom performed. NASAL GAVAGE Nasal gavage or nasal feeding consists in the introduction of food into the esophagus through the nose. Fig. 29.—Tray equipped for a nasal gavage. Prescribed: 1. Following many operations on the mouth, as cleft-palate, car- cinoma of the tongue, or fracture of the jaw. 2. When patient is obstreperous. 3. When a patient is in coma. 4. In tetanus or meningitis with a locked jaw. 5. In feeding premature infants. Position of patient: 1. Dorsal recumbent position with head bent slightly forward, 2. Fowler's position with head bent slightly forward. ASSISTING WITH A DUODENAL FEEDING 213 Temperature of food: About 100° F. Character of food: Same as for gavage. Quantity of food: Same as for gavage. Regquisites: Tray with: . Rubber catheter (wrapped). Small funnel (wrapped). Flask albolene. . Medicine glass (wrapped). Gauze squares. Emesis basin. Graduate for food (wrapped). . Towel and safety-pin. Procedure: Wash your hands and prepare the food. Connect the open end of the catheter with the funnel. Pour the lubricant into the medicine glass. Carry the tray to the bedside. Place the patient in position and pin the towel around her neck. Dip the catheter in the lubricant and insert it gently, pointing it toward the septum so that about 4 inches is passed into the esophagus. Wait a minute and then pour the food slowly into the funnel. Compress the catheter and remove it as soon as the last of the liquid has left the funnel. Points to be remembered: 1. If obstruction is met in one nostril, withdraw the tube and insert it in the other side. 2. When giving a gavage, be sure that the catheter is in the esophagus and not the mouth. 3. Wait a minute after passing the catheter before pouring the liquid, for nausea may be induced by the irritation of the tube and vomiting may follow. 4. If the patient is unconscious or under the influence of ether, be sure that the catheter is not in the larynx. ; Record: 1. Hour and treatment. 2. Character and quantity of food given. 3. Any unusual symptoms which may occur. EE ASSISTING WITH A DUODENAL FEEDING Duodenal feeding consists of the introduction of food into the duo- denum through the stomach by means of a duodenal tube. This is usually performed by the physician. Prescribed: 1. Sometimes in gastric and duodenal ulcer when it is necessary to keep the stomach empty. 2. In the vomiting of pregnancy. 3. For infants when food given by gavage is not retained. Temperature of food: About 100° F. ° 214 NURSING TECHNIQUE Kind of food: 1. Milk. 2. Eggs. 3. Barley-water. 4. Albumen-water. Position of paiient: As for a lavage until the tube enters the stomach, then on the right side with the hips elevated about 12 inches. Number of feedings: Every two hours until eight feedings have been given. Requisites: 1. Gastric lavage tray. 2. Duodenal tube. 3. Glass syringe. 4. Litmus-paper. 5. Glass of water. Procedure: ; Wash your hands. Prepare the food and strain it. Prepare the tray and patient as for a gastric gavage. When the physician has passed about 16 inches of the tube, give the patient a glass of water to drink (unless water is contraindicated). Turn her then on her right side and elevate her hips about 12 inches with pillows. The tube then works its way into the duodenum, which is usually indicated by the mark on the tube (about 28 inches). The physician aspirates the secretions from time to time to determine the position of the tube. Stomach secretions will be of acid reaction and duodenal secretions will be neutral or alkaline in reaction. When the “ball has passed through the pylorus, the food is drawn into the syringe and slowly injected. The tube is left in place during the course of treat- ment and fastened to the patient’s ear by means of a strip of adhesive. Cleanse the patient's teeth during that time with a mild antiseptic mouth-wash. Record: 1. Hour and treatment. 2. The preparation of food given and the amount. 3. Any abnormal symptoms which may occur. 4. By whom performed. GASTROSTOGAVAGE A gastrostomy is the creation of an artificial gastric fistula and the insertion of a soft-rubber tube for the purpose of introducing food into the stomach. A gastrostogavage is the introduction of food through a gastric fistula. Kind of food: For the first week: 1. Albumen-water. 2. Peptonized milk. 3. Egg-nog. For the second and third weeks: A carefully selected soft diet. After the third week: A more liberal diet. ENTEROCLYSIS, OR COLON IRRIGATION 215 Frequency of feedings: 1. Two ounces every hour for the first week. 2. Six to 8 ounces every two hours after the first week. Temperature of the food: About 100° F. Requisites: ‘ 1. Funnel or glass syringe. 2. Dressing towel. 3. The food. 4. Water. Procedure: Wash your hands and prepare the food. Carry the requisites to the bedside on a tray covered with a towel. If the tube is in the incision, place the dressing towel around the free end of the tubing and attach the funnel to it. Open the stop-cock on the rubber tubing from the incision and allow the fluid to run in very slowly, or connect the glass syringe to the tubing and very carefully introduce the food. In some instances a small amount of water is al- lowed to flow through the tubing immediately after the feeding. Keep the patient quiet for a short time following the treatment. Depending upon the method of operation, the tube may be left in po- sition or removed shortly after the feeding and thoroughly cleansed and sterilized. Some surgeons prefer to remove the tube between feed- ings and others do not remove it for several weeks, depending upon the case. A tube is never left out longer than twelve hours and a nurse should not remove the tube without special orders. Points to be remembered: If the tube should slip out by accident, call the physician so that it may be reinserted. Record: 1. Hour and treatment. 2. Quantity and amount of food given. ENTEROCLYSIS, OR COLON IRRIGATION Enteroclysis consists in injecting fluid into the intestine in a steady stream under low pressure and providing means for the immediate re- turn of all that is not absorbed. Prescribed: To provide the body with fluid. To cleanse the large intestine of mucus, feces, and toxic material. To inject local remedies, as barley-water, tannic acid, and flax- seed tea in inflammatory conditions of the large intestine. To relieve pain in intestinal colic. To supply heat in shock or collapse. To inject an anthelmintic in treatment of worms. To dilute and help eliminate the poisons in uremic poisoning. . To flush the kidneys and prevent nephritis and suppression in bichlorid of mercury poisoning. Solutions prescribed: 1. Normal saline (half-strength). 2. Plain water. PENIS RIO fet 216 y NURSING TECHNIQUE Soda bicarbonate, 1 to 5 per cent. Tannic acid, % per cent. Silver nitrate, 1/10 per cent. Flaxseed tea. (Pour 1 gallon of boiling water over 8 ounces of whole flaxseed. Allow it to stand in a warm place until thickened, then strain it and inject it undiluted at the prescribed temperature.) 7. Barley-water. (Wash 4 ounces of pearl barley in cold water. Pour 1 gallon of boiling water over barley and simmer until reduced to one-half that amount. Strain it and inject it un- diluted at the prescribed temperature.) Temperature of solution: 1. For absorption: Between 100° and 110° F. 2. For inflammation: Between 115° and 120° F. Amount of solution: This depends upon the duration of the treatment. Duration of treatment: From fifteen minutes to several hours. Position of patient: 1. The lateral position. 2. The dorsal recumbent position. 3. The knee-chest position. Oh i ta) er MEeTHOD I Reguausites: . Bath blanket. . Dressing rubber. . One protector. . Pail and stand. . Irrigator standard. . Tray with: : 1. Reservoir (4 quarts) supplied with about 4 feet of tubing and stop-cock. . Double channel colon irrigator. (This may be of metal or soft rubber.) Two pieces of tubing about 6 inches long. Glass connection. . Gauze squares. . Lubricant. : . Large pitcher (4 quarts). Procedure: Wash your hands and prepare the solution. Connect the free end of the tubing attached to the reservoir to the projection for the inflow on the metal irrigator. Connect the two extra pieces of tubing with the glass connection and then join these to the projection on the metal ir- rigator for the return flow. Carry the tray and the other requisites to the bedside. Replace the upper covers with a bath blanket, turning them down to the level of the rectum. Place the patient in position, with the dressing rubber and pro- tector under the buttocks.! Place the pail on the low stool at the side of the bed. Hang the reservoir about 2 feet above the patient. Let the 3 1 A Kelly pad may be used if indicated. QUITE WN = ENTEROCYLSIS, OR COLON IRRIGATION 217 Fig. 30.—Tray equipped for enteroclysis. (Method one.) ; Fig. 31.—Tray equipped for enteroclysis. (Method two.) 218 NURSING TECHNIQUE solution run through the tubing to expel the air. Lubricate the colon irrigator and insert it into the rectum about 4 inches. Wait a minute after inserting it and then open the stop-cock. If the solution does not begin to flow back immediately, stop the flow and see what is wrong. If there is an impaction, report it, and an enema will probably be pre- scribed. Remain with the patient until the flow is properly started and the patient is comfortable. Draw up the covers and remove the bath blanket. Continue the treatment the prescribed time or until satisfied with the results. At the conclusion of the treatment remove the metal irrigator, making pressure on the tubing. Cleanse the external genitals and if the parts are irritated apply some lubricant. Make the patient comfortable. Fig. 32.—Enteroclysis or colon irrigation. MetuoD II Requisites: . Bath blanket. Dressing rubber. One protector. Irrigator standard. . Pail and stand. . Tray with: 1. Reservoir (4 quarts) supplied with about 4 feet of tubing and stop-cock. 2. Two glass connections. 3. Piece of tubing (about 1 foot long). 4. Lubricant. SUR me ENTEROCLYSIS, OR COLON IRRIGATION 219 5. Gauze squares. 6. Rectal tube about 30 F. with an extra hole (for outflow). 7. Catheter about 14 F. (for inflow). 8. Large pitcher (4 quarts). Procedure: Mark the rectal tube, 6 inches from the tip, with a strip of adhesive plaster. Mark the catheter likewise, 3 inches from the tip. Put one glass connection into the free end of the tubing attached to the reservoir and connect this with the catheter. Place the second glass connection in the extra piece of tubing and connect this with the rectal tube. Pre- pare the solution and patient as for Method I. Let the solution run through the catheter to expel the air. Lubricate the rectal tube and catheter as far as the adhesive marks. Insert the catheter in the rectal tube for about an inch and pass them into the rectum as far as the ad- hesive mark on the inflow catheter. Then hold the catheter and gently insert the outflow rectal tube! farther into the rectum until the adhesive ‘marking is reached. This removes the catheter from the rectal tube. Inserting them in this way causes less discomfort than when inserted separately. Proceed then as in Method I. METHOD 111 Regquisites: . Bath blanket. . Kelly pad. . One protector. . Pail and stand. Irrigator stand. . Tray with: 1. Reservoir supplied with about 4 feet of tubing and stop-cock. . Glass connection. Lubricant. Gauze squares. Rectal tube 30 F. . Large pitcher (4 quarts). Procedure: Prepare the solution and patient as for Methods I and 11, except that the patient is placed on the Kelly pad with the outflow in the pail. Connect the rectal tube to the free end of the tubing (attached to the reservoir) by means of the glass connection. Then lubricate the rectal tube and expel the air. Insert it into the rectum from 5 to 6 inches. Allow from 300 to 1000 c.c. of solution to flow slowly into the intestine. Then close the stop-cock and disconnect the glass connection from the rectal tube and allow the solution to siphon off. When all the solution has returned repeat the procedure until the prescribed amount has been given or until satisfied with results. Points to be remembered: 1. Do not allow the fluid to accumulate in the intestine. 2. If the patient complains of pain and it is continuous, stop the treatment. 3. If the patient shows signs of exhaustion, discontinue the treatment. 1 Tt may be necessary to make two extra openings in the rectal tube. Do this by means of a sharp hot iron. QUE WN Sum 220 NURSING TECHNIQUE Record: 1. Hour and treatment. 2. Amount retained and whether flatus was expelled or not. 3. Character of return flow, such as mucus, feces, etc. 4. Any unusual symptoms which may occur. ADMINISTRATION OF INSULIN? Ietin, the trade name of insulin, is manufactured from fresh pancreas glands obtained from slaughter-house animals and supplied as a highly purified, non-irritating aqueous solution. It is put up in 5 cubic centimeter rubber capped vials in three strengths. It is designated as U-10 and contains 10 units per cubic cen- timeter, or 50 units per ampule, U-20 which contains 20 units per cubic centimeter, or 100 units per ampule, and U-40 which contains 40 units per cubic centimeter, or 200 units per ampule. The amount of glucose util- ized per unit of iletin varies widely in different cases and even under varying conditions in the same case. According to most observers, 1 unit of iletin usually enables a severe case of diabetes to utilize from 1 to 2 grams of additional glucose or its equivalent in glucose-forming foods. Action: . The exact mode of action of insulin is not yet known, but it enables a diabetic to transform glucose to glycogen and store this in the liver and enables the muscles and other tissues of the body to utilize glucose in the normal manner. It also directly or indirectly promotes the complete combustion of fats and fatty acids and spares protein catabolism. In accomplishing this it frees the urine of sugar, reduces the blood-sugar, and abolishes acidosis. Indicated: 1. In those cases of diabetes in which the disease is of such severity that dietary treatment alone cannot suffice to produce a nor- mal state of health. 2. In cases of diabetes less severe than this, it should be used to tide the patients over intercurrent infections, illnesses, or times of stress, or to carry such patients through any necessary surgical treatment, including extraction of teeth. 3. In the treatment of diabetic acidosis and coma it is a specific. 4. In treatment of diabetes in children, it is advisable to administer it in the earliest stage and mildest form, owing to the rapidly progressive character of the disease in children. Method of administration: 1. Subcutaneously. 2. Intravenously (in an emergency). Frequency of injections: One, two, or three times daily in definite relation to the meals. It is generally given from fifteen to thirty minutes before the meal, but individual cases may do better with a different time interval. Dosage: No stated dose can be given, as this must be determined in each case by actual trial. Many cases are able’ to regain strength and weight on 10 to 20 units daily and a few of the more severe cases require in excess of 45 units daily. 1 Eli Lilly & Co. VAPOR BATH IN BED 221 Procedure: Wash the rubber cap on the ampule with an alcohol sponge and then perforate it with the sterile hypodermic needle. Invert the ampule and inject a volume of air (equal to the amount of fluid to be withdrawn) into the ampule from the syringe. (This prevents formation of a vacuum within the ampule on withdrawing the contents.) Withdraw the prescribed amount and observe the same aseptic pre- cautions as for any other hypodermic injection. Cleanse the site of in- jection with alcohol and inject the prescribed amount subcutaneously. Precautions: 1. Do not inject insulin intramuscularly or too near the skin surface. 2. Do not make injections repeatedly into the same area, as indura- tion might result and absorption of subsequent injections be hindered. 3. Do not fail to give a meal at the stated time following the injec- tion of the insulin to prevent a hypoglycemia. Warning symptoms of a beginning hypoglycemia: . Sudden and pronounced hunger. . Sudden weakness or fatigue. . A peculiar restlessness or nervousness, often described by the patient as a feeling of “inward trembling’ or the “shakes.” . Pallor or flushing of the face. . Dilated pupils. . Increased pulse rate. (Of diagnostic value in children.) These early symptoms appear usually in one to five hours following an injection and may be made to disappear quickly and further danger may be avoided. Give the patient a little carbohydrate, such as 1 or 2 lumps of sugar or candy, the juice of an orange, half a glass of milk, or a teaspoonful of syrup. If the overdose is sufficiently large and the above corrective meas- ures are not adopted, then the following train of symptoms, all or in part, will follow: . Sweating (this is the most characteristic symptom). Tremor and inco-ordination of muscles. . Anxiety, fear, apprehension, excitement, and emotional dis- turbance. . Vertigo. . Diplopia. . Aphasia, disorientation, delirium, and confusion. Convulsions and collapse. . Low blood-pressure, and low body temperature. . Exitus lethalis. DUH WN = CON UIE wR VAPOR BATH IN BED A vapor bath consists in the exposure of the body to vapor or moist air. If the vapor bath cabinet is not available, a satisfactory treatment may be given to the patient in bed. Temperature of bath: From 120° to 130° F. Duration of bath: 1. From fifteen to thirty minutes when prescribed to increase elimination. 222 NURSING TECHNIQUE 2. From three to five minutes when prescribed as a preparation for a cold bath. Requisites: 1. Two rubber sheets. (One large enough to cover the mattress and the other one large enough to cover the cradles. Make an opening in this sheet to allow the thermometer to project through it. Or two smaller sheets may be substituted by overlapping them.) 2. Two double wool blankets. 3. Four bath blankets. 4. Two cradles 2 feet long, or one 4 feet long. 5. Ice-cap and cover. 6. Basin and compress (for ice-compresses to head). 7. Electric grill. 8. Tea kettle. 0. Steam tubing to reach from the tea kettle to the bed. 10. Thermometer. 11. Two towels (bath and face). 12. Bottle of alcohol. 13. Chair or table for electric grill. 14. Piece of a gauze bandage. Procedure: _ Count and record the pulse. Prepare the ice-cap and ice-compresses. Connect the steam tubing to the spout of the tea kettle, fill it with boiling water and carry it and the other requisites to the bedside. Remove the upper bedclothes and cover the patient with a bath blanket. Remove all but one pillow from under the patient's head. Turn the patient on her side and place the rubber sheet and bath blanket so that they will be high enough to fold over her neck and shoulders and reach considerably above the rim of the cradle. This will prevent air leaving or entering the bath. Remove the patient’s nightgown. Place the cradles so that they extend from the shoulders to beyond the feet. Tie the thermometer to the cradle so that the mark of the prescribed temperature projects slightly above the top of the cradles. Cover the cradles with two bath blankets, placed lengthwise across the bed. Arrange them so that they overlap well. Remove the bath blanket, covering the patient at the same time. Bring the lower bath blanket up well around the patient’s shoulders and neck, and along the side and end of the cradles as far as it will reach. Pin it around the pa- _ tient’s neck and secure it. Tuck all the blankets securely around so there will be no escape or entrance of air. Place a stool or chair at the foot or side of the bed with an electric grill on same. Attach the grill and place the tea kettle of boiling water on it. Place the open end of the tubing under the cradle, and tie it to the frame of the cradle so that the steam will not burn the patient. Place the rubber sheet over the bath blankets and any number of wool blankets may be added to attain the temperature prescribed. Place the ice-cap to the patient's head and apply cold compresses. The temperature and duration of the bath is ordered in each case. The usual procedure is from fifteen to thirty minutes after the prescribed temperature is attained. The temperature usually prescribed is 120° to 130° F. Watch the HOT-AIR BATH IN BED 223 thermometer closely during the treatment and gradually increase the temperature to the prescribed degree. Give water, unless contraindicated. Watch the patient’s condition constantly during the treatment. To remove patient from bath: : When the bath time has expired, remove the source of heat but do not disturb the patient for about thirty minutes. Then remove the blankets, rubber sheets, and cradles. Under cover of a bath blanket rub the patient with alcohol. Remove the rubber sheet and bath blanket under the patient. Put on her gown and replace the upper covers. If the treatment is given as a preparation for a cold bath, remove the patient from the bath as soon as the source of heat is removed and follow with a cold bath. Points to be remembered: 1. Do not leave the patient alone during the treatment. 2 By sure that the steam does not come in contact with the patient’s ody. 3. Watch the patient closely as a vapor bath is more exhausting than a hot-air bath. 4. During the removal of the patient, avoid exposure and chilling. HOT-AIR BATH IN BED A hot-air bath consists in the exposure of the body to a superheated atmosphere. If the hot-air cabinet is not available, a satisfactory treatment may be given to the patient in bed. Temperature of bath: From 120° to 200° F. Duration of bath: From fifteen to thirty minutes. Regquisites: . Two rubber sheets (same as for vapor bath). . Two double wool blankets. . Two bath blankets. Two cradles 2 feet long, or one 4 feet long. . Ice-cap and cover. Basin and compress (for ice-compresses to head). . Electric drop light (double socket) and cord. Thermometer. . Two towels (bath and face). 10. Bottle of alcohol. 11. Piece of gauze bandage. Procedure: Proceed as in a vapor bath in bed as far as and including the placing of the cradles and thermometer. Tie the electric light bulbs to the cradle, so that they are suspended in the center. Cover the cradles with the rubber sheet (omitting the bath blankets), as for a vapor bath. Add any number of blankets necessary to attain the required temperature. The duration and temperature is prescribed in each case. The temperature is frequently increased to 200° F., for the hot air is less vigorous and exhausting than the vapor bath. OPT ONUT GN 224 NURSING TECHNIQUE To remove patient from bath: Remove the patient from the bath in the same manner as from a vapor bath. Points to be remembered: 1. Do not leave the patient alone during the treatment. 2. Do not permit any inflammable material to come in contact with the electric bulb, unless it is covered with a wire frame.- 3. Do not permit moisture to touch the cord. * 4. During the removal of the patient, avoid exposure and chilling. THE PHENOLSULPHONEPHTHALEIN TEST A vital function test is one made to determine the functional capacity of a vital organ. The phenolsulphonephthalein test is one of the most commonly used tests for estimating the renal function. ’ Phenolsulphonephthalein is a harmless, colorless, dye, which is rapidly and almost exclusively eliminated from the body by the kidneys after hypodermic injection. The quantity of the drug eliminated during a given time indicates the excretory capacity of the kidneys, that is, in impaired kidney activity the appearance of the drug in the urine will be delayed and the quantity will be diminished according to the amount of kidney involvement present. In surgical work the test is of great value as, in addition to furnishing information as to the functional ca- pacity of the two kidneys, it is possible to determine the amount of werk performed by each (Morrow). Methods of administration: 1. Subcutaneously (into some part of the trunk free from edema, preferably the lumbar region). 2. Intramuscularly (lumbar muscles). 3. Intravenously. The drug is eliminated as follows: 1. Following a subcutaneous injection: Present in the urine within five to ten minutes; 40 to 60 per cent. being excreted within the first hour and from 20 to 25 per cent. during the second hour. 2. Following an intramuscular injection: Present in the urine in about the same time; but 5 to 10 per cent. more is eliminated during the first hour. 3. Following an intravenous injection: Present in the urine within three to five minutes; 35 to 45 per cent. being eliminated within the first half-hour, and 63 to 80 per cent. during the first hour. METHOD I Requisites: 1. Catheterization tray. 2. Solution of sodium hydroxid, 10 per cent., on a cotton sponge or in a test-tube. 3. Specimen bottles and labels. 4. Ampule of phenolsulphonephthalein. 5. Hypodermic syringe and needles. The intramuscular injection is generally used. THE PHENOLSULPHONEPHTHALEIN TEST 225 The technique is as follows: 1. Give 300 to 400 c.c. of water twenty to thirty minutes previous to the test (to assure a free urinary secretion). . Catheterize the patient and allow the catheter. to remain in the empty bladder. Inject exactly 16 m., or 1 c.c., of the drug (as prescribed) and note the time. Collect the urine in a test-tube containing a drop of a 10 per cent. solution of sodium hydroxid or a cotton sponge saturated with the solution. Note the time of the first faint pinkish tinge. (This gives the time required by the kidney to begin elimina- tion. From three to five minutes is normal.) 5. Withdraw! the catheter and have the patient void? according to the method of administration. Collect the specimens as follows: 1. If administered subcutaneously, collect the specimen two hours after the injection and label it “Two Hour Specimen.” 2. If administered intramuscularly collect the first specimen one hour and fifteen minutes after the injection. Collect the second specimen one hour after the first specimen. Keep both speci- mens separate and label them “First Hour Specimen” and “Second Hour Specimen.” 3. If administered intravenously, collect the first specimen thirty- three to thirty-five minutes after the injection. Collect the second specimen one-half hour after the first specimen. Keep both specimens separate and label them “First Half-hour Specimen” and ‘‘Second Half-hour Specimen.” Bow Reguisites: MEernop II 1. Ampule of phenolsulphonephthalein. 2. Hypodermic syringe and needles. 3. Specimen bottles and labels. The technique is as follows: 1. Give 300 to 400 c.c. of water twenty to thirty minutes previous to test (to assure a free urinary secretion). Have the patient void urine just before the injection of phthalein. Inject exactly 1 c.c. or 16 m. of phthalein’ (intramuscularly— lumbar muscles) and note the time. Have the patient empty the bladder in one hour and fifteen minutes after the injection and label the specimen “First Hour Specimen” and send it to the laboratory. 5. Collect the second specimen one hour after the first and label it “Second Hour Specimen” and send it to the laboratory. To determine the functional efficiency of each kidney, the ureters are catheterized. The technique is as follows: 1. Give 300 to 400 c.c. of water twenty to thirty minutes previous to the test (to assure a free urinary secretion). ! The catheter is left in the bladder in the presence of urinary obstruction. Clamp the free end as soon as the pink color is noted in the test-tube or on the cotton. 2 If this is impossible, catheterize the patient. 15 ga ei 226 NURSING TECHNIQUE 2. Inject exactly 1 c.c., or 16 m., of phthalein (when the patient is in position with a catheter to each kidney) and note the time. 3. If the drug is administered subcutaneously or intramuscularly, collect the urine from each side for one hour from the time of the first appearance of the drug. If the drug is administered intravenously, collect the urine for fifteen minutes after the appearance of the drug. ADMINISTRATION OF A TEST-MEAL FOR RENAL FUNCTION! (Mosenthal) This functional test was originally suggested by Hedinger and Schlayer in 1914, and was later more fully elaborated by Mosenthal. (Archives of Internal Medicine, Nov., 1915.) It is a composite test for substances normally eliminated in the urine, the specific gravity, salt, nitrogen, and water excretion being determined in two hourly periods during the day and for a twelve-hour period at night. It consists of a diet of three meals—breakfast, dinner, and supper (containing approximately 13.4 gm. of nitrogen, 8.5 gm. of salt, and 1760 c.c. of fluids and a considerable amount of purin), to be given at 8 A. M., 12 noon, and § P. M. All food is to be salt free from the diet kitchen. One capsule of salt containing 2.3 gm. of sodium chlorid is furnished with each meal. The salt which is not consumed is returned to the laboratory, where it is weighed and the actual amount of salt taken calculated. Requisites: 1. Seven specimen bottles. 2. Labels. Procedure: At 8 A. M. the morning of the test, allow the patient to empty her bladder. Discard this specimen. Give her the following test-meal im- mediately after emptying the bladder. Breakfast, 8 A. M. Boiled oatmeal. ................ oo 100 grams SUC EL ah ld Bl oe ae i Fed 1 teaspoon MH i ee nna a is 30 c.c. Twoslicesbread...............c.oennts 30 grams each 3 EE EEN Ere Ae COR 20 grams COMBE. i ov ailea sass aha iinis d aires nts vis 160 c.c. SUA ian aa wre aie a 1 teaspoonful BOIL: sea 40 c.c. 7,511 RINE NEN SENET 0 200 c.c ALOT iii die wa aa Sia itinn sein alae vn 200 c.c. Sodigm chlotid. viv. vial fbi nivas 2.3 grams Do not allow the patient any food or fluids of any kind except at meal time, until the test is completed (8 A. M. the next day). Encourage the patient to consume the entire meal, each time if possible. Label the specimen bottles as follows: 1. First specimen. 2. Second specimen. 1 Morrow's Diagnostic and Therapeutic Technic. ADMINISTRATION OF A TEST-MEAL FOR RENAL FUNCTION 227 3. Third specimen. 4. Fourth specimen. 5. Fifth specimen. 6. Sixth specimen. 7. Seventh specimen. Collect the specimens in the labeled bottles as follows: 10 A. M.: First specimen. 12 Mm: Second specimen. Give the following test meal: Dinner, 12 Mm: Meat soup... 180 c.c. Beef steals. . ........ 0. vide rations 100 grams Potato (baked, mashed, or boiled). ...... 130 grams Green vegetables. ..................... as desired Two slices bread. ...................... 30 grams each Butter. he ns eh eae 20 grams den. ih cles pe ny amen 180 c.c. SUL. ii ii i si ee ie as 1 teaspoonful Mille. en a 20 c.c. WVBOL. ss iii sas an a rg es 250 c.c. Pudding (tapioca or rice). .............. 110 grams Sodium chlorid........................ 2.3 grams Collect the specimens as follows: 2 p. M.: Third specimen. 4 p. M.: Fourth specimen. At 5 p. M. give the following test-meal: Supper, 5 p. M. Eggs (cooked any style). ............... Two Two slices bread. ...................... 30 grams each BULLer. . ving fa ie nin em nie aid 20 grams Ben, ee eh a 180 c.c. SWEaE. oo eR ey 1 teaspoonful Mal. ni hes Vie nian sate ae ba ie 20 c.c. Fruit (stewed or fresh) ................. 1 portion WBE. sinter sivas die aioe wala pai adn 300 c.c. Sodium chlorid........................ 2.3 grams Collect the specimens as follows: 6 p. Mm.: Fifth specimen. 8 p. M.: Sixth specimen. 8 A. M.: Seventh specimen. Precautions: 1. Give no food during the night or until 8 o’clock the next morning (after voiding), when the regular diet, treatments and medica- tions are resumed. 2. Send the total amount of urine voided (within each period) to the laboratory upon its completion. The specimens are examined as follows: 1. Quantity and specific gravity of each specimen. 2. Joni and specific gravity of total amount of urine voided in the day. 3. Quantity and specific gravity of the night urine. 1 228 NURSING TECHNIQUE 4. The total day urine for: 1. Sale. 2. Nitrogen. 5. The total night urine for nitrogen only. Record: 1. Hour first test-meal was given and amount of urine voided just previous to eating of meal. Hour and amount of first specimen and sent to laboratory. . Hour and amount of second specimen and sent to laboratory. . Hour second test-meal was given. Hour and amount of third specimen and sent to laboratory. Hour and amount of fourth specimen and sent to laboratory. Hour third test-meal was given. Hour and amount of fifth specimen and sent to laboratory. Hour and amount of sixth specimen and sent to laboratory. Hour and amount of seventh specimen and sent to laboratory. Any mishaps or irregularities which occur in giving the diet or collecting the specimens. All food or fluid not taken during test-meal. LOCAL HOT WET PACK A local hot-wet pack consists in the application of moist heat to a part, by means of a double piece of flannel wrung as dry as possible out of boiling water. Prescribed: 1. To relieve pain and stiffness in inflammatory joints due to rheu- matism. 2. To stimulate the absorption of exudates around joints. Duration of treatment: This varies according to the condition of the patient. Reguaisites: 1. Large pillow covered with rubber and muslin cases. 2. Tray with the following: 1. Basin. 2. Wringer and sticks. 3. Piece of rubber sheeting (large enough to envelop the part). 4. Three pieces of flannel (one the size of the rubber sheeting 3. po In ONS CLS TIN UTE LR ID — Bo and the other two smaller). Two hot-water bottles. Procedure: : Prepare hot-water bottles for use. Place wringer in basin. Put one of the smaller pieces of flannel in wringer and pour boiling water on it. Carry the requisites to the bedside. Place the largest piece of flannel on the pillow. Then place in succession the rubber sheeting and the other small piece of flannel over the largest piece. Then place the pillow under the affected part. Wring the flannel as dry as possible and apply it (to the affected area) as hot as the patient can bear without burning her. Bring up the dry flannel and apply the hot-water bottles. Bring up the rubber sheeting and then envelop the whole in the large piece of flannel. Continue the treatment the prescribed time. If the duration is more than thirty minutes, change the application in thirty minutes. LOCAL HOT-AIR BATH 229 Proceed as when changing abdominal stupes and provide an extra piece of flannel and two hot-water bottles. When the time is over, re- move the pack without exposing the part. Cover the area with a Canton flannel pad to prevent exposure and chilling. Record: 1. Hour and treatment. 2. Duration of treatment. 3. Any unusual symptoms which may occur. LOCAL ELECTRIC LIGHT BATH A local electric light bath consists in the application of dry heat to a part by means of a cabinet supplied with electric lights. Electric light rays are used as a substitute for the sun’s rays, because they closely resemble them in their stimulating and destructive effects. Local electric light baths are prescribed: 1. To relieve pain and stiffness in inflammatory joints due to rheu- matism. 2. To stimulate the absorption of exudates around joints. 3. As a tonic to the skin and tissues. Duration of treatment: From fifteen to thirty minutes, three times daily. Regquisites: 1. Electric light cabinet. 2. Two towels. 3. Comfortable chair. Procedure: Arrange the patient so that she will be comfortable during the treat- ment. Be sure that there is no strain on the muscles of the part being treated. Dry the affected part and place the cabinet in position so that there will be no pressure from the cabinet. Before putting the part in the cabinet, be sure that the lights are turned on. As a rule, in the local bath, there is not enough of the body exposed to the heat to produce pronounced systemic symptoms, but a patient may show signs of weakness and means should be provided for the pa- tient to rest her head during the treatment. Encourage her to drink fluids before and during the treatment to encourage elimination. Cold compresses to the head may be indicated. Continue the treatment the prescribed time. It is usually followed with massage and rest in bed. Record: 1. Hour and treatment. 2. Duration of treatment. 3. Any unusual symptoms which may occur. ” LOCAL HOT-AIR BATH A local hot-air bath consists in the exposure of a part of the body to a superheated atmosphere by means of a hot-air cabinet or an impro- vised one. Prescribed: 1. To relieve pain and stiffness in inflammatory joints due to rheu- matism. 230 NURSING TECHNIQUE 2. To stimulate the absorption of exudates around joints. 3. In the treatment of gout and gonorrheal arthritis. Temperature of air: From 200° to 300° F. Duration of treatment: Prescribed in each case. Requisites: 1. Hot-air cabinet (or an improvised one). 2. Comfortable chair. Procedure: Prepare the patient as for an electric light bath, observing the same precautions. If there are rings on the hand of the affected arm, remove them to prevent burns. Protect the affected part with a fitted flannel covering to prevent it from coming in contact with the asbestos or metal. Gradually increase the temperature and continue it the pre- scribed time. Watch the patient’s general condition constantly and do not leave her alone. Encourage the drinking of fluids, before and dur- ing the treatment. Apply cold compresses to the head, if indicated. Proceed as after a local electric light bath. Record: 1. Hour and treatment. 2. Duration of treatment. 3. Any unusual symptoms which may occur. SUNLIGHT BATH OR HELIOTHERAPY A sunlight bath, or heliotherapy, consists in the exposure of the entire body, or a part of it, to the direct rays of the sun. Prescribed: 1. In ih treatment of tuberculous joints and pulmonary tuber- culosis. 2. As a tonic to the skin and tissues in the treatment of indolent ulcers, infected wounds, and extensive burns. 3. In the treatment of rickets, anemia, and during convalescence from acute infectious diseases. Duration of treatment: Prescribed in each case. As a rule the treatment is continued for five minutes the first day, gradually increasing the time until the prescribed time is attained. Classification of sun's rays: 1. Luminous rays. 2. Heat rays. 3. Actinic or chemical rays. Regquisites: 1. Couch and pillows. 2. Bath blanket. 3. Screen (if indicated). 4. Umbrella. 5. Colored eye glasses or shade. 6. Loin binder and pins (if indicated). Procedure: Do not expose the patient to the direct rays of the sun, but grad- ually accustom her to the fresh air and sunshine. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION 231 On the first day open the windows. On the second day move the bed out on the porch for an hour or two, gradually increasing the time until she can remain out-of-doors all day. Protect the patient's eyes with colored glasses or an umbrella during insulation. If the part being treated is an open wound, protect it with a light gauze dressing and a wire screen to permit free circula- tion of air. If the entire body is to be treated, gradually increase the exposed area each day, beginning with the feet until the entire body has been exposed. Cover the loins with a binder and surround the bed with screens to protect the patient from draughts. If she becomes chilly, move her back to her room at once. Points to be remembered: 1. Do not subject the patient to sudden insolation. 2. Do not expose the area long enough to cause dermatitis, head- ache, nausea, etc. 3. Watch the temperature, pulse, urine, and blood during the treatment. 4. Avoid draughts and chilling of the patient. Record: 1. Hour and treatment. 2. Duration of treatment. 3. Any unusual symptoms which may occur. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION IN MEDICAL NURSING What field in the care of the sick offers greatest scope for mastering the diffi- cult art and science of nursing? Name four important factors in the treatment of every disease upon which recovery mainly depends. (a) What is meant by the word “rest” in the treatment of disease. (b) Why is rest important? What are the objects of the course of medical nursing? Give the nursing care and treatment in anemia. (a) What do you understand by a transfusion? (5) When is it indicated? (a) What methods are used? (b) How much blood is usually transfused? (a) How would you prepare the donor and donee’s arms? (b) What adverse symptoms may follow a transfusion? (¢) What would you record? Give the nursing care and treatment in: (¢) Endocarditis. (5) Pericarditis. (c) Arteriosclerosis. Give the nursing care and treatment in: (a) Aneurysm. (b) Phlebitis. (c) Angina pectoris. (a) Define an inhalation. (b) Why are amyl nitrite inhalations prescribed? Give the nursing care and treatment in pneumonia. (a) What symptoms would you regard as unfavorable? (4) In the care of a pneumonia patient what could a nurse do to prevent heart failure? (a) For what type of pneumonia is the antipneumococcus serum of therapeutic value? (b) Give the technique for the administration of same. When does the crisis occur and what may a nurse do to help a patient through this critical period? What precautions should a nurse use for herself when caring for a pneumonia atient? R How does the nursing care of children differ from adults in the treatment of pneumonia? Give the nursing care and treatment in bronchitis. 232 NURSING TECHNIQUE (a) Why are steam inhalations prescribed? (b) What methods may be used for such treatments? (¢) What precautions would you observe when giving a continuous steam inhalation? Give the nursing care and treatment in: (a) Pleurisy. (b) Asthma. Define: (a) Radiography. (b) Fluoroscopy. How would you prepare a patient for a gastro-intestinal examination by means of the Roentgen rays and the fluoroscope? Give the nursing care and treatment in: (a) Gastritis. (0) Gastrectasis. (c) Ulcer of the stomach and duodenum. (a) Define a lavage. (b) Why is it prescribed? (c) Give temperature, kind, and amount of solution usually prescribed? (a) What points would you remember when preparing for and assisting with a gastric lavage? (b) What would you record? (a) What do you understand by the expression of stomach contents? (b) When is it indicated? (a) What do you understand by the motor power or activity of the stomach? (b) What do you understand by the secretory activity of the stomach? (a) Name two test-meals commonly given. (b) Of what are they composed? (¢) What instructions would you give a patient previous to the eating of a test- meal? : (a) What do you understand by the fractional method of gastric analysis? (b) How would you prepare the patient? (a) Describe the position of the patient. (b) What precautions should be observed during the procedure? (¢) What would you record? (a) What do you understand by a gavage? (b) When is it indicated? (c) What precautions should be observed during the procedure? (a) What do you understand by a nasal gavage? (b) When is it indicated? (c) Describe the position of the patient and give the character and temperature of the food. (a) What precautions would you observe during the treatment? (5) What would you record? (a) What do you understand by a duodenal feeding? (b) When is it indicated? (c) Describe the position of the patient. (a) Define gastrostogavage. (b) Give the quantity and temperature of the food. Give the nursing care and treatment of: (a) Constipation. (b) Diarrhea. (¢) Chronic mucous colitis. (a) Define entereclysis. (b) When is it prescribed? (c) Give the solutions commonly used and the temperature. (a) What is the duration of the treatment? (b) How much solution is injected? (c) Describe the position of the patient. (a) Describe the large intestine. (b) Describe the movements in the large “intestine. (c) Describe the passage of the contents in the large intestine. (a) What points would you remember when giving enteroclysis? * (b) What would you record? Give the nursing care and treatment of: (a) Chronic appendicitis. (5) Jaun- dice. (¢) Acute yellow atrophy. (d) Malignant diseases of the liver. Give the nursing care and treatment of: (a) Acute non-suppurative chole- cystitis. (b) Acute suppurative cholecystitis. (¢) Chronic cholecystitis. (d) Cholelithiasis. Give the nursing care and treatment of: (a) Acute pancreatitis. (b) Acute nephritis. Give the nursing care and treatment of: (a) Uremia. (b) Chronic nephritis. Give the temperature and duration of: (a) A vapor bath in bed. (4) A hot- air bath in bed. (¢) What precautions would you observe in giving such treat- ments? (a) What do you understand by the phenolsulphonephthalein test? (b) How are the specimens collected and labeled if the drug is given intramuscularly? (c) How are the specimens collected and labeled if the drug is administered intra- DEMONSTRATIONS IN MEDICAL NURSING 233 venously? (d) How are the specimens collected and labeled if the drug is ad- ministered subcutaneously? What do you understand by the Mosenthal test-meal for renal function? Give the nursing care and treatment of: (a) High blood-pressure. (5) Diabetes mellitus. (¢) Diabetes insipidus. Give the nursing care and treatment of arthritis. (a) What do you understand by a local hot pack? (5) When is it prescribed and what is the duration of the treatment? (c) What do you understand by a local electric light bath? (d) When is it prescribed and what is the duration of the treatment? What do you understand by a local hot-air bath? (5) When is it prescribed and what is the duration of the treatment? (¢) What do you understand by a sun bath? (d) When is it prescribed and what is the duration of the treatment? Give the nursing care and treatment of: (a) Addison’s disease. (5) Goiter. Give the nursing care and treatment of: (a) Hypothyroidism. (b) Hyperthy- roidism. (c) Hypopituitarism. (d) Hyperpituitarism. Explain the meaning of: (a) Counterirritant. (b) Hematemesis. (c) Pressure sore. (d) Phagocytosis. (¢) Diapedesis. (f) Resolution. (g) Septicemia. (%) Exudate. (7) Toxin. (4) Pus. DEMONSTRATIONS IN MEDICAL NURSING (a) Prepare a sterile table for a transfusion. (b) Prepare the donor and donee’s arm. (a) Prepare the DeVilbiss vaporizer and demonstrate its use. (b) Prepare the electric vaporizer and demonstrate its use. (a) Prepare a steam inhalation with a pitcher and a towel. (5) Prepare a croup tent, demonstrating various methods. (a) Prepare an oxygen tank for use. (b) Demonstrate giving a stramonium inhalation. (a) Demonstrate giving an amyl nitrite inhalation (using an aspirol). (5) Demonstrate giving an aromatic spirit of ammonia inhalation (using the liquid preparation). Apply camphor and oil to the chest. Take the blood-pressure, demonstrating two methods. (a) Prepare the tray and patient for a gastric lavage. (b) Demonstrate passing a gastric tube and lavaging the stomach. (a) Prepare an Ewald test-meal. (b) Prepare a Riegel test-meal. (¢) Demon- strate expressing an Ewald test-meal and prepare the specimen for the laboratory. Demonstrate expressing an Ewald test-meal fractionally and prepare the specimens for the laboratory. (a) Prepare a patient for radiography and fluoroscopy for the first treatment of a gastro-intestinal examination. (b) For the second treatment. (¢) For the third treatment. (d) For the fourth treatment. (a) Prepare a tray for a gastric gavage and demonstrate the procedure. (b) Prepare a tray for a nasal gavage and demonstrate the procedure. (a) Prepare a tray for a duodenal feeding and demonstrate assisting the phys- ician. (b) Prepare a tray for a gastrostogavage and demonstrate the procedure. Prepare a tray and requisites for enteroclysis, demonstrating three methods. Demonstrate giving a vapor bath to a patient in bed. : Demonstrate giving a hot-air bath to a patient in bed. (a) Apply a hot wet pack to an inflamed knee-joint. (b) Demonstrate giving an electric light bath to an inflamed elbow-joint. (a) Demonstrate giving a hot-air bath to an inflamed elbow-joint. (b) Pre- pare a patient for a sun bath (a tuberculous knee-joint). ! For this procedure student nurses represent the patient, physician, and nurse. PROCEDURES USED IN SURGICAL NURSING NURSING IN SURGICAL DISEASES Lecture 1: Introduction. Lecture 2: Wounds and Wound Infections. Burns and Scalds. Lecture 3: Surgical Emergencies. Lecture 4: Minor Surgical Procedures. Lecture 5: Major Surgical Operations and Surgical Complications. Lecture 6: Surgical Conditions Involving Bony and Muscular Systems. Lecture 7: Surgical Conditions of the Alimentary Tract and Accessory Organs. Lecture 8: Surgical Conditions of Thorax and Back. 8 Lecture 9: Surgery of Head and Spinal Cord. Lecture 10: Plastic Surgery. OBjEcTs OF THE COURSE! 1. To give the student nurse a general idea of the nature of the principal surgical diseases, their symptoms and treatment, so that she may care for surgical patients intelligently, be of the greatest possible assistance to the surgeon in dressings and surgical treatments, and be able to act promptly and wisely in emergencies. 2. To give her skill in elementary surgical procedures and bandaging, and to establish good habits of surgical technique. New Demonstrations: Review: 1. Care of the dressing room. 1. Sterilization of instruments 2. Local hot-water bath. and glass utensils. 3. Continuous hot-air bath. 2. Disinfection and sterilization 4. Neutral or sedative bath. of rubber goods. 5. Alcohol sponge bath. 3. Putting on rubber gloves. 6. Application of tourniquet. 4. Assisting with a surgical dress- 7. Assisting with tracheotomy. ing. References: 5. Application of hot dressings. Warnshuis, Principles of Sur- 6. Hypodermic injection. gical Nursing. 7. Stimulating enemata. Harmer’s Principles and Prac- 8. Proctoclysis. tice of Nursing. 9. Hypodermoclysis. Stoney’s Bacteriology and Sur- 10. Intravenous infusion. gical Technic. 11. Transfusion. Pope’s Practical Nursing. 12. Reversed Fowler's position. Smith's The Operating Room. 13. Amyl nitrite, aromatic spirits Colp and Keller's Text-book of of ammonia and oxygen in- Surgical Nursing. halations. Parker and Breckinridge’s Sur- 14. Sinapisms. gical and Gynecologic Nurs- 15. Skin preparation for treat- ing. ments and operations. 1 Standard.Curriculum for Schools of Nursing. 234 CARE OF THE DRESSING-ROOM 235 References: Review: MacCallum’s Text-book of 16. Aspirations and punctures. Pathology. 17. Lumbar puncture. Warbasse’s Surgical Treatment. 18. Abdominal paracentesis. Cotton's Dislocation and Joint 19. Thoracentesis. Fractures. 20. Preparation of patient for Woolf's Principles of Surgery for operation. Nurses. 21. Ether bed. 22. Care of anesthetized patient. 23. Postoperative positions. 24. Abdominal stupes. 25. Air, water, and fracture beds, sand-bags, cradles, Brad- ford frame, splints, exten- sions, and fracture cart. 26. Velpeau and stump-ankle bandages. 27. Strapping ankle and knee. 28. Gastric lavage. 29. Expression of gastric contents and test-meals. 30. Nasal gavage. 31. Bandages of the head. 32. Preparation of the field for skin grafting. CARE OF THE DRESSING-ROOM The junior nurse with a probationer’s assistance cares for the dressing room and makes inventory the last of every month. The daily routine is as follows: . 7.00 A. Mm. Sterilize water. . Clean the inside of instrument sterilizer with soda carbonate solution and sapolio once daily. Polish the outside of the sterilizers as often as indicated to keep them bright. 3. Sterilize the brushes and orange wood sticks and equip the hand preparation tray. Scrub the sink and see that the supply of towels equals the demand. 4. Clean and equip the treatment and dressing trays. (The trays are, however, to be left in perfect condition at the completion of every dressing and treatment.) . Clean and equip the solution tray. The tray is to be equipped as follows: . Flask of bichlorid solution, 1 : 1000. . Flask of boric acid (saturated solution). . Flask of lysol, 5 per cent. . Flask of normal saline. Thermometer jar containing bichlorid solution 1 : 1000 with chemical thermometer and mixing rod in the so- lution. . One, 1000-c.c. glass graduate. . One, 1-ounce glass graduate. - DO = wn GU WN = SON 236 NURSING TECHNIQUE 8. One minim glass graduate. 9. One 500-c.c. enameled graduate (sterile). 6. See that the following supplies are on hand: Red and black ink, pens, doctors’ and nurses’ order books, chart sheets, blotters, ruler, and specimen labels. 7. Have all orders (including special nurses) for pharmacy prescrip- tions in the dressing room by 9 aA. M. The junior nurse takes them to the pharmacy at this time and calls for them at 10 A. Mm. Fig. 33.—Dressing-room. LOCAL HOT-WATER BATH A local hot-water bath consists in immersing a part of the body such as the arm or foot in a basin of hot water for the prescribed time. Prescribed: In the treatment of infected wounds or extensive burns: 1. To relieve pain. 2. To keep the parts clean. CONTINUOUS HOT-AIR BATH 237 Duration of bath: : 1. From thirty minutes to several hours. 2. Continuously. Solutions generally used: 1. Normal saline. 2. Boracic acid, 2 per cent. 3. Sterile water. Temperature of solution: From 100° to 110° F. Reguisites: 1. Arm bath-tub. 2. Dressing towel. or 1. Foot-tub. 2. Small rubber sheet. 3. Small blanket. Procedure: Prepare the solution and carry the requisites to the bedside. Ar- range the patient so that she is comfortable and well supported. If the arm bath-tub is used, place it on the bedside table near the pa- tient and after the arm is in the tub place the cover on same and arrange the dressing towel so that the edges of the tub will not press on the arm. If a foot-tub is used, cover the tub (after the affected part is in the water) with the rubber sheet and place the blanket over this. If the bath is continuous, maintain a temperature of 100° F. Prepare fresh solution every six hours and scrub the tub once daily and thoroughly disinfect it. If the bath is of short duration, a temperature of 110° F. may be attained. When the treatment is completed, remove the affected part from the tub and pat it dry with a sterile towel. Apply sterile dressings and make the patient comfortable. CONTINUOUS HOT-AIR BATH A continuous hot-air bath consists in the exposure of the body to hot air for an indefinite period of time. Prescribed: In the treatment of burns: 1. As a tonic to the skin and tissues. 2. To prevent irritation of the affected area by dressing and ex. posure to varying degrees of temperature. Temperature of bath: From 90° to 95° F. Requisites: 1. Two rubber sheets (same as for hot-air bath). 2. Two bath blankets. 3. Three muslin sheets. 4. Two cradles, each 2 feet long or one 4 feet long. 5. Electric drop light (double socket) and cord. 6. Ice-cap and cover. 7. Sterile sheets. 8. Thermometer. 9. Extra blankets (if necessary). 238 NURSING TECHNIQUE Procedure: Proceed as in a hot-air bath in bed as far as turning the patient on the side. Then place the rubber sheet, bath blanket, and muslin sheet under the patient so that an equal amount will be on each side. Stretch these tightly under her and tuck them along the sides. (The rubber sheet and bath blanket may be omitted, if indicated.) Place sterile sheets under the patient's body if there are burns on the under surface. Place the cradles over the patient's body and arrange the thermometer and electric drop light as previously demonstrated. Place the rubber sheet over the cradles as in a hot-air bath. Cover this with the two muslin sheets (placed crosswise) so that air will not enter or leave the improvised cabinet. Add additional covers, if neces- sary to maintain the temperature. Place the ice-cap to the head if indicated, and give water freely. Watch the thermometer and be sure the temperature does not exceed 98° F., for heat elimination will be interfered with and serious result may follow if continued for an indefi- nite period of time. A dry crust forms over the area and prevents infection. If, however, resistance is lowered, infection may occur under this crust. If symptoms indicate this, a neutral or sedative bath is usually prescribed. Be sure that the area is protected with sterile covering and that the patient is not chilled in removing her for treat- ments or evacuation of the bowels and bladder. NEUTRAL OR SEDATIVE BATH A neutral or sedative bath consists in immersing the patient in a tub of water, the proper temperature for the prescribed time. Prescribed: 1. For disorders of the nervous system, as insomnia and the excite- ment of mania. 2. For certain forms of skin diseases. 3. For extensive burns. 4. For infected wounds and bed-sores. Temperature of water: From 92° to 97° F. Duration of bath: 1. From fifteen minutes to several hours. 2. Continuously. Solutions used: 1. Boracic acid, 2 per cent. 2. Normal saline. 3. Plain water. Regquisites: Portable tub. Stretcher and poles. . Rubber ring. One woolen blanket. Two bath blankets. Rubber sheet. Gauze bandages. . Sheet or dimity spread. . Bath thermometer. O00 STON L300 ot ALCOHOL SPONGE BATH 239 10. Hair-pins. 11. Cotton for ears. 12. Loin binder and pins. 13. Two towels (bath and face). 14. Sterile sheets, if indicated. Procedure: Put enough water in the tub so that the entire body (except the head) will be immersed. Tie the rubber ring to the head of the tub and cover same with a towel. Replace the upper clothes with a bath blanket. Remove the patient’s gown and apply a loin binder. Pin up the hair, if the patient is a female, and put cotton in the ears. Place the stretcher under the patient and insert the poles as for a Brand bath. If the bath is given for burns, apply vaselin to the skin to prevent the effects of maceration. Put the patient in the tub as in a Brand bath. If the bath is to be continuous, tie the stretcher to the top and bottom of the tub so that the patient is well supported. Be sure the patient is comfortable and that all strain is prevented. Tie two strips of bandages across the tub and cover it with the wool blanket. If given for insomnia, quiet is essential, and subdued lighting is required. Disturb the patient as little as possible and avoid conversation. If the treatment is continuous, cover the blanket with a sheet or dimity spread so that it will have a neat appearance. When the patient has been in the tub the prescribed time, remove her and place her in bed. Proceed as in a Brand bath. Prepare the bed (while the patient is in the tub) by placing the rubber sheet and then the blanket on the bed. Place sterile sheets over the bath blanket, if there are burns on the under surface. When the bath is continuous, change the water every twelve hours and clean the tub thoroughly. Remove the patient when necessary for evacuation of the bowels and bladder, but prevent chilling by making no unnecessary exposure. Precautions: 1. Be sure to maintain a neutral temperature during the treatment. 2. Avoid exposure and chilling when removing the patient from the tub. ALCOHOL SPONGE BATH An alcohol sponge bath consists in the application of diluted alcohol to the surface of the body, by means of a sponge cloth. It is given when one wishes to avoid moving or turning a patient. Prescribed: 1. To reduce the temperature. 2. To refresh and comfort the patient. Duration of bath: From fifteen to twenty minutes. Composition of bath: 1. Water, 3 parts. 2. Alcohol, 1 part. Temperature of bath: As indicated (according to the age and condition of the patient). Requisites: 1. Bath blanket. 2. Four bath towels. 240 | NURSING TECHNIQUE 3. Ice-cap and cover (if bath is given to reduce the temperature). 4. Hot-water bottle and cover (if indicated). 5. Basin for alcohol. 6. Wash-cloth (18 inches square). Procedure: Prepare the alcohol and water at the desired temperature. Prepare the ice-cap and hot-water bottle for use. Carry the requisites to the bedside. Replace the upper covers with a bath blanket. Remove the gown and swathe and apply the hot-water bottle and ice-cap if indi- cated. : Place bath towels along the patient's sides and under her arms. Expose the upper extremities. Wet the sponge cloth slightly and sponge as when giving a cold sponge bath, except that each part is given its full share of sponging at one time. Apply the alcohol to the patient's back with the hand instead of the wash-cloth, exercising care so that the bedclothes do not become dampened. If the patient shivers, give friction. Proceed in like manner with the lower extremities. When the bath is completed, cover the patient with the bath blanket, remove the bath towels, and put on the gown. Take the after- bath temperature, a half-hour after the bath, if the treatment is given to reduce the temperature. Record: 1. ‘Hour and treatment. 2. Any unusual symptoms which may occur. 3. After-bath temperature, if given to reduce the temperature. APPLICATION OF TOURNIQUET A tourniquet is an appliance used’ to compress the blood-vessels. It is made of thick strong elastic, provided with a mechanical device by which it can be clamped and held to prevent slipping. There are many kinds, named from their inventors. Improvised tourniquet: 1. Plain rubber tubing. 2. Gauze bandage. 3. Folded handkerchief. 4. Necktie. Used: 1. To control hemorrhage. 2. To distend veins for intravenous injections and aspirations. Regquisites: 1. Tourniquet. 2. Improvised ones. To apply: Procedure: 1. For arterial hemorrhage: Protect the part to which the tourniquet is to be applied by a fold of towel or a piece of gauze to prevent pinching and bruising the skin. Apply the tourniquet between the heart and the bleeding point. Insert a small hard pad under the tourniquet over the exact point of digital pressure. Fasten the tourniquet tightly, ASSISTING WITH TRACHEOTOMY 241 but do not leave it on more than an hour. If the services of a surgeon are not secured in that time, apply a dressing and tight bandage to the wound and loosen the tourniquet. The forma- tion of a clot usually prevents further hemorrhage. 2. For venous hemorrhage: Apply the tourniquet in the same manner exch that venous hemorrhage is checked below the bleeding point, that is, between it and the periphery. 3. For intravenous injections: Apply the tourniquet in the same manner with sufficient pressure to distend the veins but not tightly enough to stop the pulsation in the arteries. Loosen the tourniquet as soon as the physician injects the needle into the vein. 4. An improvised tourniquet: Fold a large handkerchief diagonally and roll it. Place a small hard pad in the center of it and apply this with the hard pad over the course of the artery. Tie the handkerchief with a double knot and insert a scissors or a stick in the knot and twist it until the bleeding ceases. A small square of cardboard inserted under the knot will prevent the skin being twisted in the bandage. ASSISTING WITH TRACHEOTOMY Tracheotomy is a term used for the operation in which an artificial opening is made into the trachea, and a double tracheotomy tube is inserted through which the patient breathes. Indicated: For the relief of dyspnea caused by: 1. The presence of foreign bodies. 2. Growths within the larynx or trachea. 3. Injuries to the larynx or trachea. 4. Diphtheritic membrane, when intubation fails because the membrane extends down low in the trachea. Stte of operation: This depends upon: 1. The seat of obstruction. 2. The urgency of the operation. Position of patient: 1. Dorsal recumbent position with a sand-bag or hard pillow under the neck and the head perfectly straight, falling backward. 2. In an emergency, the dorsal recumbent position with the head hanging over the edge of a table. (Restrain a child first by wrapping her snugly in a bath blanket.) Reguisites: 1. Sand-bag. 2. Tray with the following: . Flask ether. . Flask iodin. . Flask alcohol. . Sterile scrub-up forceps. . Sterile rubber gloves (1 pair). . Sterile towels (2 packages). Somp wr 1 242 NURSING TECHNIQUE 7. Sterile tray cover. 8. Sterile gauze. 9. Sterile cotton. 10. Sterile tape (2 pieces about 24 inches long). 11. Sterile basins (2) for normal saline and sterile water. 12. Sterile scalpel. 13. Sterile bistoury. 14. Sterile sharp retractors (2). 15. Sterile tenacula (2). 16. Sterile artery clamps (2). 17. Sterile thumb forceps (2). 18. Sterile curved probe. 19. Sterile tracheotomy tube (the required size). 20. Sterile tracheal forceps. 21. Sterile tracheal dilator. 22. Sterile needle-holder. 23. Sterile cutting-edge needles (2). 24. Sterile catgut No. 2. 25. Local anesthetic: (a) Sterile syringe. (6) Sterile needles. (¢) Sterile medicine glass. (d) Novocain, 3 per cent. 26. Bag for waste. : Procedure: This depends upon the condition of the patient. If time permits and the neck is hairy, shave the area and cleanse it with ether and paint with iodin. Surround the area with sterile towels. In an emerg- ency the operation may be performed with a pocket knife, but if time permits, prepare a sterile tray with solutions and place the sterile requisites on it. The physician then puts on sterile gloves, and makes an incision in the skin and superficial and deep fascia. He exposes the muscles and separates them. The narrow bistoury is then used to make an incision into the trachea. All bleeding is controlled before opening the trachea, if the condition of the patient permits. However, this may be omitted until after the tube is introduced, if the patient’s life is in danger. The physician then places sterile gauze between the wound and the plate of the outer tube and inserts sterile tape into the projections on the tube and secures it around the patient’s neck. He then covers the opening of the tube with a gauze compress moistened with normal salt solution. Postoperative care: Temperature of room: From 70° to 80° F. Procedure: Prepare a tray with the following: 1. Sterile basin containing normal saline. 2. Sterile basin containing sterile water. 3. Sterile curved probe or feather. 4. Sterile forceps. 5. Sterile cotton and gauze. 6. Bag for waste. Keep the head slightly lowered to prevent the inhalation of mucus QUESTIONS FOR GENERAL REVIEW AND EXAMINATION 243 and pus. Remove the inner tube every fifteen minutes to one or two hours as indicated. Thoroughly cleanse it by means of a curved probe and gauze or a small sterile brush. Keep gauze moistened with normal saline over the opening of the tube. Steam inhalations and a croup tent are frequently prescribed and give great relief by moistening and warming the air. Give liquid or semiliquid food for the first two or three days. (Nasal feeding may be necessary.) Give soft diet after a few days if the patient can swallow it with ease. Points to be remembered: 1. Do not leave the patient alone as long as there is any danger of the tube becoming clogged. - 2. Change the compress over the opening of the tube as soon as it is soiled with secretions or becomes dry. 3. Swab the mucus away from the opening of the tube by means of a sterile gauze sponge, but do not allow the loose threads to get into the tube. 4. Remove, cleanse, and boil the inner tube as indicated according to the secretion. If there is a large amount, it may be neces- sary to provide a second inner tube. 5. Do not remove the outer tube at all and do not clean the inner tube with a cotton swab when it is inserted. A feather may be used if it is not too moist and is not inserted too far. 6. Constantly watch the position of the tube and the patient's color, respirations, and pulse. Removal of tube: 1. In diphtheria as soon as there is free inspiration through the larynx with the wound closed. 2. For foreign bodies, the tube is usually removed in twenty-four hours. Record: 1. Hour and operation. 2. Quantity and character of mucus and membrane expelled. 3. Any unusual symptoms which may occur. 4. By whom performed. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION IN SUR- GICAL NURSING What are the objects of the course of surgical nursing? Give the routine care of the dressing room. (a) Define a wound. (b) Give the classification. (c) What dangers attend accidental wounds? Why are hot dressings applied: (a) To a clean wound? (b) To aninfected wound? Define: (a) Inflammation. (b) Suppuration. (c) Pyemia. (d) Thrombosis. (e) Phlebotomy. (f) Tympanites. (g) Tympanitis. (a) What do you understand by a local hot-water bath? (b) Why is it pre- scribed? (a) Give the duration of the bath. (4) Name the solutions commonly pre- scribed with the temperature of same. Give the nursing care and treatment of burns of the first, second, and third degree. Why is an extensive superficial burn much more serious than a deep burn’ of limited area? (a) Why are continuous hot-air baths prescribed? (0) What is the temperature of the bath? } : 244 NURSING TECHNIQUE (a) What do you understand by a neutral or sedative bath? (b) When is it prescribed? (c) Give the duration, solutions, and temperature of the bath. (d) What is the essential difference in a continuous bath and one of short duration? (a) What emergency care would you give severe burns? (0) What general care to the patient? Name some of the complications and sequela of operations generally. (a) Define shock and give the symptoms. (0) How may shock be prevented to a large extent? (c) Give the nursing care and treatment of same. (a) What are the symptoms of hemorrhage? (b) Give the nursing care and treatment of same. (a) Give the treatment for anesthetic sickness if persistent. (b) What nursing measures would you use to relieve retention of urine? (¢) What are the symptoms of retention with overflow. Give the nursing care for fecal impaction. Give the nursing care and treatment of: (a) Tympanites. () Peritonitis. (a) What preventive nursing measures may be used before and after operation to prevent pneumonia? (b) What symptoms suggest pneumonia? (a) Why should a nurse be on her guard to watch the amount of urine and the urinalysis following an operation? What is the nursing care and treatment of acidosis? Define: (a) Thrombus. (0) Embolus. (¢) What distressing accident may occur postoperative, which gives no warning or time for treatment? (a) What are the symptoms of thrombophlebitis? (b) Give the nursing care and treatment. Give the nursing care and treatment of: (a) Harelip and cleft-palate. (b) Operations on the tongue. Give the nursing care and treatment of: (¢) Exophthalmic goiter. (b) Breast amputation. Give the nursing care and treatment of: (a) A closed abdrminal wound free from infection or drainage. (b) Abdominal wound with drainage. Give the nursing care and treatment following: (¢) Herniotomy. (b) Gas- trostomy. Give the nursing care and treatment following: (a) A gastro-enterostomy. (b) Operations on the gall-bladder and ducts. : (a) When is an alcohol bath prescribed? (b) Give the composition, temperature, and duration of the bath. (a) When is a tracheotomy indicated? (b) How would you prepare the field of operation? (c) Describe the position of the patient. (d) Give the postoperative treatment. Give the nursing care and treatment of: (a) Erysipelas. (0) Tetanus. (a) What can you say about the postoperative care of the aged? (5) How does it differ from the care given other postoperative cases and why? * DEMONSTRATIONS IN SURGICAL NURSING Prepare a local boracic acid bath for the forearm (using an arm bath-tub). Prepare a normal saline bath for an infected foot (using an ordinary foot-tub). Demonstrate giving a continuous hot-air bath in the treatment of burns of the lower extremities. Demonstrate giving a neutral bath in the treatment of burns of the lower extremities. Demonstrate giving an alcohol bath, postoperative for the reduction of tem- erature. P (a) Demonstrate the application of a tourniquet for the purpose of distending the vein for an intravenous infusion. (b) Demonstrate the application of a tourni- quet to control venous and arterial hemorrhage of the arm. (a) Prepare a tray and patient for a tracheotomy. (b) Prepare a tray and demonstrate the care of the tube (postoperative). Demonstrate giving an immunizing injection of tetanus antitoxin. NURSING PROCEDURES USED IN GYNECOLOGY GYNECOLOGIC NURSING Lecture 1: Introduction. Anatomy and Physiology of the Re- productive Organs in Review. Lecture 2: Diseases of the Reproductive Tract. Lectures 3 and 4: Gynecologic Operations. OBJECTS OF THE COURSE! 1. To give the student an intelligent understanding of the diseases of the generative organs and the various forms of operative treatment for surgical conditions of same. 2. To enable the student to become more familiar with the par- ticular nursing procedures in this branch of work. New Demonstrations: Review: 1. Preparation of a vaginal smear. 1. Gynecologic tray. 2. Assisting with the insertion of 2. Preparation of patient for D. pessaries, tampons, and pack- C. and laparotomy. ing. 3. Preparation of patient for 3. Assisting with an intra-uterine hemorrhoidectomy. douche. 4. Care of perineorrhaphy. 5. Vaginal douche. 6. Preparation of patient for gy- necologic examination. 7. Gynecologic positions. 8. Catheterization. 9. Sitz-bath. 10. Preparation of thermocautery. References: Williams’ Anatomy and Physiology. Kimber’s Anatomy and Physiology. Harmer’s Principles and Practice of Nursing. Young's Text-book of Gynecology. Morrow's Diagnostic and Therapeutic Technic. Hirst’s Manual of Gynecology. Parker and Breckinridge’s Surgical and Gynecological Nursing. Cragin’s Essentials of Gynecology. Howell's Text-book of Physiology. TAKING A VAGINAL SMEAR Micro-organisms are examined under the microscope in a stained or unstained condition and either dead or alive. The /langing drop is used for examining live bacteria and the smear for dead bacteria. Requaisites: Tray with: 1. Two glass slides (sterile). 2. Sterile applicator in test-tube. 1 Standard Curriculum for Schools of Nursing. 245 Hx 246 NURSING TECHNIQUE 3. Labels. 4. Gauze. 5. Adhesive plaster. Procedure: Write the following data on the label: 1. “Vaginal smear.” 2. The patient’s name and room or ward number. 3. The date. 4. The physician's name. Carry the tray to the bedside. Place the patient in the dorsal recumbent position and drape her. Separate the labia with the thumb and first finger of the left hand and insert the applicator well into the vagina, holding it with the right hand so that it will come in contact with the pus or secretions. Then rub the swab over the surfaces of two of the glass slides so as to spread the material in a thin film. When the specimens are dry, place them face to face with the sur- faces separated by a piece of the applicator stick. Wrap the slides in a piece of gauze, and secure the label with small adhesive strips. Take them to the laboratory. Record: 1. Hour. 2. “Vaginal smear.” 3. Sent to laboratory. ASSISTING WITH THE INSERTION OF PESSARIES, TAMPONS, AND PACKING A pessary is an appliance made of inflated or hard rubber in a variety of shapes and placed in the vagina to correct uterine displace- ment. Regquisites: 1. Various kinds of pessaries. 2. Sterile towels. 3. Sterile gloves. Position of patient: 1. Dorsal recumbent position. 2. Knee-chest or genupectoral position. Procedure: A pessary is always inserted by a physician and a nurse's duties consist in preparing the patient and requisites. Sterilize a ring pessary by boiling it, but a hard-rubber pessary will not retain its shape if placed in boiling water. Disinfect it by washing it with soap and water. Then rinse it and place it in bichlorid solution 1 :1000 for one hour. Rinse it in sterile water and place it on a sterile towel. Prepare the patient as for a vaginal examination and place her in the dorsal recumbent position unless otherwise ordered. Occasionally a nurse is told to remove a pessary. The procedure is as follows: Prepare the patient in the same manner as when the pessary is inserted. Put on a sterile rubber glove and surround the area with a sterile towel. Introduce the index- and middle finger of the right ASSISTING WITH INSERTION OF PESSARIES, TAMPONS, PACKING 247 hand into the vagina, bend the index-finger over the anterior bar of the pessary, give it a slight turn and pull it down gently. A tampon is a plug made usually of cotton, gauze, or lamb’s wool, and used in surgery to plug such cavities as the nose and vagina. Tampons are used in gynecologic work: 1. To control hemorrhage. 2. To apply medication to the siding walls and cervix. 3. To support the uterus. Position of patient: 1. Dorsal recumbent position. 2. Sims’ or left lateral position. 3. Knee-chest or genupectoral position. Requisites: . Sterile tampons (of lamb’s wool or absorbent cotton). . Medication if prescribed. Sterile medicine glass. . Sterile bivalve speculum. . Sterile uterine forceps. . Sterile towels. . . Sterile gloves. . Bag for waste. Sheet and towel for draping. Procedure: Prepare the patient as for a gynecologic examination. The phys- ician, after putting on sterile gloves, places the sterile towels in position and passes the speculum, holding it with his left hand. He takes the tampon with the dressing forceps held in the right hand and passes it into the vaginal cavity. He then withdraws the speculum and loops the ends of the string together. Anticipate the physician's wants as for a gynecologic examination. To remove a tampon: Make traction on the string and remove the tampon carefully. To prepare tampons: DOTA ULER WIN = MEeTHOD I Cut a strip of absorbent cotton so that it will be 1 inch thick, 3 inches wide, and 6 inches long. Roll it and tie it in the center with linen thread. Leave the ends about 6 inches long and tie them together. MgTHOD II Cut a strip of absorbent cotton the same size as for Method I. Place the linen thread (which should be 16 inches long) across one end of the strip so that an equal length will project on each side. Then make a roll and tie the ends together, near the cotton roll. Make another knot near the ends of the thread. Merson IIT Kite-tail tampon: Proceed in the same manner as in Method I. (Use very small pieces of cotton instead of the large strip.) Tie several of these small pieces of cotton in the center (as in Method I) in a long string, resembling a kite tail. 248 NURSING TECHNIQUE Record: 1. Hour tampon was inserted and number (single or kite tail). 2. Hour tampon was withdrawn and number. 3. Any odor if evident. Vaginal packing: : This is done by the physician but in an emergency a nurse should know how to proceed. Position of patient: 1. Dorsal recumbent. 2. Sims’ or left lateral. 3. Knee-chest or genupectoral. Regquisites: 1. Sterile vaginal packing. 2. Sterile towels. 3. Sterile bivalve speculum. 4. Sterile uterine forceps. 5. Sterile gloves (if time permits). Procedure: Prepare the patient as for a gynecologic examination. Surround the area with a sterile towel and pass the bivalve speculum. Hold it with the left hand. Then insert the vaginal packing (into the space between the cervix and the vaginal walls) with the uterine forceps held in the right hand. Withdraw the speculum and pack the rest of the cavity.’ To assist with the removal of vaginal packing: Regquisites: Tray with: 1. Sterile towels. 2. Sterile gloves (optional). 3. Sterile uterine forceps. 4. Sterile kidney basin. 5. Sterile vaginal pads. 6. Paper bag. Procedure: Prepare the patient as for a gynecologic examination. Remove the vaginal pad and cover the vulva with a sterile towel. Place the paper bag for waste. Open the wrapper containing the sterile kidney basin. Remove the towel, screening the vulva, and place the kidney basin close to the vagina when the physician is ready to proceed. The physician then “removes the packing by means of his gloved fingers or the uterine dressing forceps. Record: 1. Hour packing was inserted and number of strips. 2. Hour packing was removed and number of strips. 3. Any odor if evident. ASSISTING WITH AN INTRA-UTERINE DOUCHE An intra-uterine douche is a stream of plain or medicated water directed into the uterine cavity under low pressure, by means of an intra-uterine douche nozzle. ASSISTING WITH AN INTRA-UTERINE DOUCHE 249 Indicated: 1. In treatment of septic conditions, affecting the uterus. 2. To control hemorrhage. 3. To cleanse the uterus after curettage and other intra-uterine operations. Solutions prescribed: 1. Sterile water. 2. Normal saline. 3. Boracic acid, 2 per cent. 4. Lysol, § to § per cent. 5. Potassium permanganate, 1 : 1000. 6. Silver nitrate, 1 : 1000. Temperature of solution: From 110°to 120°F., depending upon the purpose for which it is given. Quantity of solution: From 1 to 2 quarts. Height of reservoir: From 1 to 2 feet above the patient. Position of patient: 1. Dorsal recumbent position. 2. Lithotomy position. Regquisites: . Irrigator stand. Sheet and bath blanket (for draping). . Laparotomy stockings. . Kelly pad and protector. Pail and stand. Two enameled trays. Flask of green soap. . Flash light. . Sterile pick-up forceps. . Sterile pitcher (for sterile water for external douching). . Sterile pitcher (for lysol, & per cent. solution, for external douching). . Sterile pitcher (2 quarts, for douche solution). . Sterile gauze sponges. . Sterile cotton. . Sterile towels (3 packages). . Sterile gloves. . Sterile tray cover. ‘ . Sterile thermometer. . Sterile gown (optional). . Sterile bivalve speculum. . Sterile uterine forceps. . Sterile return flow dilating nozzle. . Sterile tenaculum. . Sterile scissors. . Sterile gauze packing. 26. Sterile reservoir supplied with tubing and stop-cock. Procedure: An intra-uterine douche is always given by the physician. A nurse's duties consist in preparing the patient and requisites. . DO = = md ed fd pd pe pt BBN BNO NN UH WN = 250 NURSING TECHNIQUE If possible there should be two nurses to assist with this treatment, unless the physician has an assistant. Have the patient void urine. Put laparotomy stockings on her unless the treatment is given in an emergency. Wash your hands and prepare tray No. 1 by scrubbing it with ether and alcohol. Then cover it with a sterile tray cover (using sterile forceps) and place sterile requisites No. 20 to 26 inclusive on it and cover them with a sterile towel. Prepare the solutions and place them and the non-sterile requisites on the second tray. Carry all requisites to the bedside. While your assistant is scrubbing her hands, place the patient in position and drape her. Place the Kelly pad (covered with a pro- tector) under the buttocks and arrange the drain in the pail. Have your assistant scrub the external genitals’ with green soap and sterile water (using gauze sponges). Then pour the lysol solution 1 per cent. over the vulva. The physician then places the sterile towels after putting on sterile gloves. He connects the intra-uterine douche nozzle to the tubing attached to the reservoir and closes the stop-cock. ; Hang the reservoir about 1 foot above the patient and pour the prescribed solution into the reservoir. The physician then injects the nozzle (with the solution flowing) into the uterus. Watch the reservoir so that it does not empty during the procedure. When the cervix is dilated, as in postpartum cases, a glass douche nozzle is usually used, but in other cases a return flow nozzle is neces- sary. The physician dilates the cervix by expanding the wires after the nozzle is introduced into the uterus. When the prescribed amount has been given the physician dries theex- ternal genitals with gauze sponges and in some instances packs the cavity. Apply a sterile pad at the completion of the treatment and make the patient comfortable. Points to be remembered: 1. Provide good lighting. 2. Cleanse the parts as though preparing for an operation on the genitals. (This may be omitted following delivery.) 3. Do not hang the reservoir too high. 4 Do not throw away the return flow until it has been inspected by the physician. Record: 1. Hour and treatment. 2. Kind and strength of solution. 3. Character of return flow. 4. By whom given. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION IN GYNECOLOGIC NURSING What are the objects of the course in gynecologic nursing? (a) Give the essential female organs of generation. (b) Give the accessory organs of generation. 1 A vaginal douche is sometimes included in the scrub up. DEMONSTRATIONS 251 (a) What do you understand by the vulva and what does it include? (5) What are the functions of the female generative organs? Define: (a) Puberty. (b) Ovulation. (¢) Menstruation. (d) Menopause. (¢) Conception. (f) Pregnancy. (a) What is the function of the mammary glands? (5) Describe the structure. . Define: (a) Amenorrhea. (b) Dysmenorrhea. (c) Menorrhagia. (d) Metror- rhagia. : Give the nursing care and treatment for: (a) Vulvitis. (b) Pruritis. Give the nursing care and treatment for: (a) Chancre. (b) Chancroid. (c) Venereal warts or condolomata. Give the nursing care and treatment for: (a) Inflammation of the Bartholin glands. (5) Tumors of the vulva. Give the nursing care and treatment for: (a) Parasites. (b) Vaginismus. ef: (a) Pessary. (b) Tampon. (¢) Why are tampons used in gynecologic work? (a) Define an intra-uterine douche. (b) When is it indicated? (¢) Why should a nurse not assume the responsibility of giving an intra-uterine douche? (a) What solutions are used and give the temperature? (b) What points would you remember in preparing for and assisting with an intra-uterine douche? (c) What would you record? What emergencies may follow operations on the pelvic organs? What first-aid treatment would you give for uterine hemorrhage? What precautions would you observe in caring for a patient having gonorrhea? What is a good routine local and general postoperative care of perineorrhaphy? DEMONSTRATIONS Prepare a vaginal smear for the laboratory. Demonstrate the preparation of a patient for the insertion of a pessary. Prepare a tampon, demonstrating various kinds. (a) Prepare the requisites for an intra-uterine douche. (b) Prepare the patient for the treatment. Lecture 1: Lecture 2: Lecture 3: Lecture 4: Lecture 5: Lecture 6: Lecture 7: Lectures 8 and 9: Lecture 10: ND 00 ~I ON Ut > Ww NURSING PROCEDURES USED IN COMMUNICABLE DISEASES Typhoid Fever. Scarlet Fever, Measles, German Measles. Smallpox, Cowpox, Chickenpox, Erysipelas. Diphtheria, Tonsillitis, Septic Sore Throat. Influenza, Whooping-cough, Mumps, and Colds. Cerebrospinal Meningitis, Infantile Paralysis. Malaria, Yellow Fever, Typhus, Amebic Dysentery, Bubonic Plague, and Hookworm. Tuberculosis. Social Economics and Educational Factors in Pre- vention and Treatment of Communicable Dis- eases. OBJECTS OF THE COURSE! 1. In most infectious diseases the nursing care is the most impor- tant part of the treatment; hence, the nurse needs to be thor- oughly informed on the nature of these diseases, and on every point that would help her to give intelligent nursing care and to prevent the spread of disease to others. 2. Especially in public health nursing the nurse is expected to de- tect early signs of the infectious diseases, so she ought to be familiar with the symptoms of all the commoner infections, and should know the local regulations for the handling of such cases. 3. It is very important that she should also recognize the social and economic aspects of this whole question of preventable dis- eases, and should appreciate her responsibilities and oppor- tunities in the campaign to eradicate them. New Demonstrations: . Sanitation of sick-room—hy- giene of patient and nurse. . Disinfection of excreta. bed linen, dishes, utensils, and bath water. . Special care of the mouth and nose. . Sprays. . Medicated baths. . Nasal douche. . Aural douche. . Eye douche, and instillation of drops. Review: . Hypodermic injections. . Pressure sores. . Making a patient comfortable. Cold sponge bath. Cold pack. Brand bath. . Saline enemata. . Sedative enemata. . Administration of 10. 11. 12. ! supposi- tories. Aspiration of vein. Fomentations. Inunctions. 1 Standard Curriculum for Schools of Nursing. 252 SANITATION OF SICK-ROOM—HYGIENE OF PATIENT—NURSE 253 New Demonstrations: Review: 9. Application of hot compresses 13. Continuous bath. to eyes. 14. Pharyngeal douche. 10. Application of cold compresses 15. Dry cupping. to eyes. 16. Hot bath. 11. Vaccination and care of 17. Hot pack. wound. 18. Vapor bath. 12. Taking nose and throat cul- 19. Hypodermoclysis. tures. 20. Proctoclysis. 13. Applications of cold and heat 21. Care of the body after death. to throat. 22. Inhalations. 14. Assisting with intubation. 23. Croup tent. 15. Preparation for artificial pneu- 24. Tracheotomy. mothorax. 25. Foot bath. References: 26. Lumbar puncture. Paul's Nursing in Acute Infec- 27. Mustard bath. tious Fevers. 28. Nutrient enemata. Harmer’s Principles and Prac- 29. Gavage. tice of Nursing. 30. Cantharides. Pope’s Practical Nursing. 31. Sinapisms. ' Stevens’ A Manual of the Prac- 32. Enteroclysis. tice of Medicine. 33. Alcohol bath. Myers’ The Care of Tuber- 34. Klondike bed. culosis. 35. Sun bath. SANITATION OF SICK-ROOM—HYGIENE OF PATIENT—NURSE By isolation is meant the separating of persons suffering from com- municable diseases, or carriers of the infecting organism, from other persons, so as to prevent the direct or indirect conveyance of the infectious agent to susceptible persons. A carrier is a person who, without symptoms of a communicable disease, harbors and disseminates its specific micro-organism. A contact is any person or animal known to have been sufficiently near to an infected person or animal to have been exposed to transfer of infectious material directly or by articles freshly soiled with such material. By disinfection is meant the process of destroying the vitality of pathogenic micro-organisms by chemical or physical means. Concurrent disinfection consists of the disinfection of excreta (im- mediately after its discharge from the body) and all infective matter throughout the course of a disease. Terminal disinfection consists of the disinfection of a room or house after the recovery of a patient from an infectious disease. By fumigation is meant a process by which the destruction of insects, as mosquitoes and body lice, and animals, as rats, is accomplished by the employment of gaseous agents. By quarantine is meant the limitation of freedom of movement of persons or animals (who have been exposed to communicable diseases) for a period of time equal to the incubation period of the disease to which they have been exposed. 254 NURSING TECHNIQUE By renovation is meant (in addition to cleansing) such treatment of the walls, floors, and ceilings of rooms or houses as may be necessary to place the premises in a satisfactory sanitary condition. Fomiles are substances such as towels and sheets that have become contaminated and transmit infection. By delousing is meant the process by which a person and his personal apparel are treated so that neither the adults nor the eggs of Pediculus corporis or Pediculus capitis survive. The Sick-room: If strict isolation is required, permit no one but the physician and nurses to enter the sick-room. If possible select a room and bath (remote from the other rooms) for the patient. Use the bath-room as a utility room and boil the dishes on an electric grill in the bath- room. Keep the room well ventilated and sunny, and properly screened from flies. Keep the gowns for the physician and nurses in the bath-room. Fold them so that the contaminated side will be on the outside. Sprinkle sweeping preparation on the floor or cover the broom with a damp duster to prevent the dust flying about. Gather the dust in a news- paper and burn it. Wash the door knobs and dust the room daily with a damp cloth. Keep the broom and dust cloth in the room at all times and disinfect them at the end of quarantine. Isolate (with the patient) all utensils used in the sick-room. Disinfect them after use and if possible keep them in a disinfectant when not in use. Allow only such toys, books, and magazines in the room as can be destroyed at the end of quarantine. Permit no pets to enter the room. “Concurrent disinfection,” or disinfection during disease, is more impor- tant than disinfection after the patient is ready to be discharged, therefore, destroy all discharges capable of transmitting the disease, disinfect the patient's bed and body linens, and properly wash all dishes and dispose of all food remnants. The patient: Give the patient a cleansing bath daily unless otherwise ordered. Give the mouth, nose, buttocks, and perineum special care, since these parts are the sources of infection. When desquamation begins (for any of the exanthemata) anoint the body daily with some bland substance. When isolation is discontinued, give the patient a cleansing bath and a shampoo. Wrap her in a clean sheet or bath blanket which has not been in the isolation department and take her to another room and dress her. The nurse: Observe hygienic rules to guard your own health when attending a patient suffering from a communicable disease. Avoid fatigue and take proper nourishment at regular intervals. Arrange with the attending physician so that you can be immunized against the disease unless you have previously had the disease or been immunized. Wear a gown that will completely cover the uniform, when attending the patient. When leaving the sick-room thoroughly wash your hands and remove the gown before leaving the zoom. SPECIAL CARE OF THE MOUTH AND NOSE 255 DISINFECTION OF EXCRETA, BED LINEN, DISHES, UTENSILS, AND BATH WATER Feces and urine: m Add an amount of chlorinated lime solution, 5 per cent., equal to the amount of the stool or urine, mix it, and allow it to stand covered against flies for an hour before emptying it into the sewer. Formalin, 5 per cent., or carbolic acid, 5 per cent., may be used in the same manner. Eyes, nose, mouth, or throat secretions: Receive such secretions on bits of cloth or paper napkins and place them immediately in a paper bag. Destroy them by burning once or twice daily. Sputum: Use paper sputum cups (if possible) and burn them, otherwise pro- ceed as when disinfecting feces or urine. Bed linen: Do not remove infected linen in a dry state from the sick-room. Place it in carbolic acid solution, 5 per cent., or formalin, 5 per cent., for two hours, before sending it to the laundry. Bath water: If a tub-bath is given, disinfect the water by adding 1 pound of chlorid of lime to the half-filled bath-tub. Mix it well and allow it to stand for one hour before emptying it in the sewer. If a sponge bath is given, proceed in the same manner, using 1 or 2 ounces to the half or three-quarters filled tub. Dishes: Isolate all dishes used for the patient and boil them in a basin kept exclusively for that purpose. Utensils: Isolate all utensils such as bath-tub, thermometer, bed-pan, urinal, rectal tip, etc., and disinfect them after use. 3 Points to be remembered: 1. Disinfectant solutions have very little power of penetrating into the interior of solid masses: therefore the material such as feces or sputum must be broken up and thoroughly mixed with the disinfectant. 2. Very few disinfectants act immediately, even in strong solutions; therefore allow sufficient time for the disinfectant to act. 3. Hot germicidal solutions are more powerful than cold solutions of the same strength. SPECIAL CARE OF THE MOUTH AND NOSE Special care of the mouth and nose is required in all conditions in which there is a high body temperature. The mouth, if neglected, will become dry, coated, and cracked. Infection of the ears, tonsils, and parotid glands may be the result. The nose too becomes inflamed and the secretions form crusts and scabs. Requisites: Tray with the following: 1. Towel. 2. Emesis basin. 256 NURSING TECHNIQUE . Bottle of mouth-wash. . Small glass. . Wooden applicators with cotton swabs or mosquito artery forceps and cotton swabs (wrapped in clean towel). Gauze squares (wrapped in clean towel). Paper bag. Lubricant. Glass of fresh water and drinking tube. Procedure: For mouth: Wash your hands. Pour a small amount of mouth-wash in the small glass. Dilute it according to directions. Place the towel under the patient's chin. Dip the applicator in the mouth-wash and press it against the glass so that the mouth-wash does not drip from the applicator. Clean the teeth, the tongue, and the roof of the mouth thoroughly, using as many applicators as are indicated. If the patient cannot extend the tongue, grasp it between the finger and thumb, which have been previously covered with gauze. Allow the patient to rinse her mouth with the antiseptic solution and follow it with plain water if desired. Support her head, hold the emesis basin, and assist the patient to use the drinking tube to save her strength. Dry the face with a towel and apply a lubricant if indicated. If the mosquito artery forceps and cotton swabs are used do not dip the forceps in the mouth-wash, but pour a small amount on the swab. After use, remove the wet swab from the forceps by means of a dry swab. Then proceed with another swab moistened with solu- tion. Continue until the mouth is clean. Wipe the forceps with a dry sponge until it is perfectly clean, then allow it to remain in alcohol, 60 per cent. for thirty minutes. Sterilize it by boiling once daily. Cleanse the mouth thoroughly each A. M. and p. M. and once during the night. Cleanse it lightly each time after nourishment has been taken. For nose: Keep the nose clean and moist by means of an applicator and lubri- cant. Caution the patient against picking her nose. SPRAYS A spray consists of a liquid, minutely divided and used as a means of applying medication to the throat and nose. Prescribed: 1. For inflammation of the nose and throat. 2. For ulceration of the lining of the nose and throat. Solutions sometimes used: 1. Argyrol, 10 to 25 per cent. . Neosilvol, 5 to 10 per cent., combined sometimes with adrenalin, 1: 1000. LENO view . Glycothymoline. . Campbhor, gr. ito v. Menthol, gr. i to v. Albolene, q. s., gr., oz. j. 2 3 4 MEDICATED BATHS 257 5. An alkaline solution: Sod. ni dram ss. Sod. salicylatis | __ Sod. chloridi | pa gh. Glycerin. : Aqua, aa q. s. oz. ij. Misce et Sig., nasal spray. 6. An antiseptic, stimulant, and deodorant solution: RB. lodi, gr. ij. Pot. iodidi, gr. v. Zinc sulphocarbolatis, gr. x. Aqua. Glycerin aa, oz. j. Sig.—Spray nose and throat. Temperature of solution: 100° F. Requisites: 1. Hand atomizer. 2. Prescribed solution. 3. Sterile gauze. Procedure: To spray the nose: Be sure that the atomizer is in good working order. Warm the solution to 100° F. If the patient desires to administer the spray, he may be permitted to do so, but see that it is properly applied. Insert the tip of the atomizer just within the vestibule and hold up the nostril gently on the tip of the atomizer. Then spray the solution, using very little force. To spray the throat: Turn the tip of the atomizer downward and place it far back on the tongue, but do not touch the pharynx. Instruct the patient to say “ah” four or five times, and during that time spray the throat rather forcibly. Care of atomizer: Cleanse the tip with a dry cotton sponge and then an alcohol sponge. Keep it covered with a sterile compress between treatments. If used for another patient, clean it thoroughly and disinfect it by boiling. MEDICATED BATHS A medicated bath consists in immersing the patient's body in a tub of water to which various substances have been added, such as mustard, sulphur, bran, soda, starch, etc. Prescribed: . 1. To alleviate skin affections. 2. As a nerve and circulatory stimulant. Temperature of water: Depends upon purpose of bath. 1. Those used to alleviate skin affections. Between 92° and 98° F. 2. Those used as a nerve and circulatory stimulant (with the excep- tion of mustard). Between 70° and 80° F. 3. Mustard baths. Between 90° and 100° F. 17 238 NURSING TECHNIQUE Quantity of water: Bath tub, one-half to three-fourths its capacity. Duration of bath: 1. From ten to thirty minutes. 2. Continuously in treatment of burns. The quantity of the medicament and the duration of the bath: Generally prescribed in each case. The following prescriptions may be used if the amount is not specified: 1. Boric acid: Prepare a 2 per cent. solution. Dissolve the boracic acid powder or crystals in a small amount of hot water and add it to the bath water. . Soda bicarbonate: Prepare a 5 per cent. solution. Dissolve the soda bicarbonate in a small amount of hot water and add it to the bath water. . Sulphur: Sulphurated potash is used for this purpose. Prepare a § to % per cent. solution. Dissolve the sulphurated potash in a small amount of hot water 4nd add it to the bath water. . Bran: Tie 2 pounds of bran in a loose muslin bag and place it in a deep basin. Pour boiling water on it and let it stand from ten to fifteen minutes. Press the moisture from the bran and add all the fluid to the bath water. . Starch: Mix 1 pound of cornstarch with cold water and prepare it in the usual way by adding boiling water. Boil it one or two minutes and add it to the bath water. . Mustard: For an adult: Use 1 tablespoonful of mustard to 1 gallon of water. For a child: Use one-half this amount. For an infant: Use one-fourth this amount. Tie the mustard flour in a loose muslin bag and place it in a basin of tepid water. Squeeze the bag well and add the mustard water to the bath water. . Saline: Prepare a 2 per cent. solution of sea salt or, if thisisnot available, practically the same results may be attained by using a 2 per cent. solution of ordinary salt. Dissolve the salt in a small amount of hot water and add it to the bath water. . Nauheim bath: This is an artificially prepared bath used as a substitute for the mineral water of Nauheim, Germany, a famous water resort. The composition and directions are given on the packages when purchased. Procedure: Prepare the patient and the tub of prescribed solution as when giving a Brand bath. When giving alkaline, emollient, or sulphur baths, do not apply friction during the bath, but allow the patient to lie quietly in the bath for the time prescribed. When the bath time is completed, wrap the patient in a warm sheet and dry her gently by patting over the sheet. NASAL DOUCHE 259 When giving sea salt and mustard baths, proceed in the same manner until the patient is wrapped in the sheet. Then apply brisk friction until the patient is thoroughly dry. NASAL DOUCHE A nasal douche consists of a stream of plain or medicated water directed into the nasal cavity under low pressure. Prescribed: 1. In the treatment of rhinitis and sinusitis. 2. To remove foreign bodies. Solutions used: 1. Boracic acid, 2 per cent. 2. Normal saline. 3. Soda bicarbonate, 2 per cent. 4. Potassium permanganate, 1/10 per cent. Temperature of solution: 105° to 115° F. Position of patient: 1. Dorsal recumbent position, with head turned to side and the nostril into which the tip is inserted uppermost. 2. Sitting in a chair with the head flexed on the chest. Requisites: 1. Irrigator stand. 2. Tray with: L. Sterile reservoir, supplied with tubing and stop-cock. 2. Sterile nasal tip. 3. Basin for return flow. 4. Dressing rubber. 5. Dressing towel and safety-pin. 6. Gauze handkerchief. Procedure: Wash your hands and prepare the prescribed solution. Connect the nasal tip to the tubing attached to the reservoir and close the stop- cock. Cover the tray and carry it to the bedside. Place the patient in position and protect the bedding and patient’s clothing with the rubber sheet covered with the dressing towel. Hang the reservoir from 4 to 6 inches above the patient. Instruct her not to talk or swallow and to breathe through the mouth and keep it open. Give her the gauze handkerchief. If there is an obstruction in one nostril insert the tip in the other nostril first. Continue the treatment until satisfied with results or the prescribed amount has been given. Stop the flow occa- sionally during the treatment to allow the patient to swallow. Caution her not to blow her nose for a few minutes after the treatment. Points to be remembered: 1. Do not use force, for infection of the sinuses and middle ear may result. 2. Insert the nozzle tightly enough to prevent the return of fluid from the nostril being treated. Record: 1. Hour and treatment. 2. Kind and strength of solution. 3. Character of the return flow. 260 NURSING TECHNIQUE AURAL DOUCHE An aural douche consists of a stream of plain or medicated water directed into the auditory canal under low pressure. Prescribed: 1. For inflammation of the auditory canal and middle ear. 2. To cleanse discharging ears. 3. To remove foreign bodies and cerumen from the auditory canal. Solutions used: 1. Boracic acid, 2 per cent. 2. Normal saline. 3. Soda bicarbonate, 2 per cent. Temperature of solution: From 100° to 105° F. Position of patient: 1. The dorsal recumbent position with the head turned to the side so that the affected ear is uppermost. 2. Sitting in a chair with the head erect. Requisites: 1. Irrigator stand. 2. Tray with: 1. Sterile reservoir supplied with tubing and stop-cock. Sterile aural douche tip with return flow. Piece of tubing about 18 inches long. Kidney basin. Sterile cotton. Dressing rubber. _ Dressing towel and safety-pin. . Paper bag. Procedure: Wash your hands and prepare the prescribed solution. Connect the aural douche tip to the tubing attached to the reservoir and close the stop-cock. Attach the 18-inch piece of tubing to the projection on the douche tip for the return flow. Cover the tray and carry it to the bedside. Hang the reservoir so that it will be about 12 inches above the patient. Place the patient in position and arrange the dressing rubber and towel so that the clothing and bedding will be protected. Place the tubing for the return flow in the kidney basin. Expel the air from the nozzle and insert the tip gently into the auditory canal. If the patient is an adult, pull the auricle upward and backward and, if a child, pull the auricle downward and backward to make the canal straight. If pain, nausea, or dizziness is occasioned, lower the reservoir. If the condition is not improved, discontinue the treatment. Other- wise continue the treatment until satisfied with results or the pre- scribed amount has been given. Dry the auricle thoroughly and make small conical pledgets of cotton and insert them in the ear. Change them frequently until dry. Points to be remembered: 1. Do not use force. 2. Avoid making pressure on the drum. NOU EYE DOUCHE—INSTILLATION OF DROPS 261 Record: 1. Hour and treatment. 2. Kind and strength of solution. 3. Character of the return flow. 4. Any unusual symptoms which may occur. EYE DOUCHE—INSTILLATION OF DROPS By irrigation of the eyes is meant the washing out of the conjunc- tival sac by means of: 1. A soft-rubber bulb. 2. The eye-dropper. 3. The undine. 4. A soft-rubber catheter! attached to the tubing of a reservoir by means of a glass connection. Prescribed: For conjunctivitis. Solutions used: 1. Boracic acid, 2 per cent. 2. Normal saline. 3. Potassium permanganate, 1/50 per cent. 4. Bichlorid of mercury, 1/100 per cent. Temperature of solution: From 90° to 95° F. Position of patient: 1. The dorsal recumbent position with the head turned slightly and the unaffected eye uppermost. : 2. Seated in a chair with the head in the same position. 3. If the patient is a child, restraint may be necessary. Place the child on its back across an assistant’s lap with its legs around her waist. Instruct the assistant to restrain the child's legs with her elbows and to securely hold its hands. Hold the child’s head between your knees. MEeTtHOD 1 (When using a soft-rubber bulb or eye-dropper.) Requisites: Tray with: . Sterile cotton. . Small sterile basin. . Sterile soft-rubber bulb or eye-dropper. . Kidney basin. . Paper bag. . Dressing rubber. Dressing towel and safety-pin. Procedure: Wash your hands and prepare the solution. Cover the tray and carry it to the bedside. Place the rubber sheet covered with the dressing towel so that the bedding and patient’s clothing will be pro- tected. The patient may hold the kidney basin to the side of her face 1 See page 335 (diseases of the eye) for this demonstration. NOU who 262 NURSING TECHNIQUE unless the discharge is very infectious! Moisten a pledget of cotton and carefully cleanse the lids to remove the secretions. Separate the lids with the thumb and fingers of the left hand, but avoid making pressure on the eyeball. Direct the flow from the inner canthus outward. Flush the conjunctival sac until all secretions are removed. Then cleanse and thoroughly dry the lids. MEeTHOD II (When using an undine.) Requisites: Tray with: . Sterile cotton. . Sterile undine. Kidney basin. Paper bag. Dressing rubber. . Dressing towel and safety-pin. Procedure: Wash your hands and prepare the solution. Fill the undine with the prescribed solution (100° F.). Proceed as in Method I, directing the flow from the inner canthus outward. Points to be remembered: 1. Instruct the patient to look up and down without moving the head. 2. Do not permit the solution to fall upon the eyeball with force. 3. Avoid touching the eye with the bulb or dropper. 4. Do not allow the solution and discharge to flow down the lacrimal duct to the nose. SUE mm Record: 1. Hour and treatment. 2. Kind and strength of solution. 3. Character of return flow. By instillation of drops in the eye is meant the careful dropping of medication on the center of the everted lower lid by means of a medicine- dropper. Prescribed: 1. For examinations of the interior of the eye. 2. In treatment of diseases of the eye. Position of patient: 1. Sitfing in chair with the head slightly tilted backward. . 2. In the dorsal recumbent position, with the head tilted so that the unaffected eye is uppermost. Regquisites: Small tray with: 1. Bottle of medicine. 2. Sterile medicine-dropper. 3. Sterile cotton. Procedure: Wash your hands. 11n this instance it is well to have an assistant. APPLICATION OF HOT COMPRESSES TO EYES 263 Place the patient in position. Draw into the medicine-dropper as much drug as will be required. Then evert the lower lid by gently placing the index-finger of the left hand in the center of the lower lid just below the lashes. Instruct the patient to look upward and then permit the prescribed number of drops to fall on the everted lid. (As a rule, 2 drops are sufficient, as anything in excess is wasted.) Allow the patient to close the eyelids and then dry the cheek and lids. Hold a small pledget of cotton over the lacrimal duct to prevent the medica- tion from entering same. Precautions: 1. Do not allow the tip of the medicine-dropper to touch any part of the eye. 2. Do not allow the drops to fall on the cornea. 3. Do not use the same dropper for different medicines, without thoroughly cleansing and disinfecting it. 4. by not allow the medication to come in contact with the rubber ulb. Record: 1. Hour and treatment. 2. Kind and quantity of medicine instilled. APPLICATION OF HOT COMPRESSES TO EYES Prescribed: In inflammatory conditions of the eyelids or eyeball. Temperature of water: From 120° to 130° F. Duration of treatment: From ten to fifteen minutes, changing compress every half minute. Frequency of treatment: Every one or two hours. Stze of compress: 1. For inflammation of the eyelids. Large enough to cover the lids and over the cheek. (Do not cover the eyebrow or extend the compress over the nose.) Heat applied to the latter area would increase the congestion in the eyelids and cause con- gestion in the nasal cavity and ethmoid cells, thus predis- posing them to infection and disease (Harmer). 2. For inflammation of the eyeball. Large enough to cover the lids and extend above the eye to the forehead (not to the cheek). Thus they will dilate the supra-orbital artery and drain the other branches of the ophthalmic, thus relieving inflammation and congestion of the eyeball (Harmer). Reguisites: Tray with: . Sterile basin. . Alcohol lamp or sterno and matches. . Gauze compresses. . Support for basin. . Dressing towels (2). Thermometer. Bag for waste and forceps (if indicated). NOU WN 264 NURSING TECHNIQUE 8. Rubber gloves (if indicated). 9. Tube of vaselin. Procedure: Wash your hands. Half fill the basin with sterile water, the re- quired temperature. Cover the tray and carry it to the bedside. Ar- range the support for the basin and light the lamp, so that the tem- perature of the water will be maintained. Remove all but one pillow from under the patient's head and if possible move her to the edge of the bed. Place a towel around the patient's neck and another at the side of the face to catch any water which may run down. Place the gauze compresses in the hot water and take the tem- perature of the solution. Squeeze the water from one compress and apply it to the affected eye. Proceed with the second compress, changing them every half minute, for fifteen minutes. Apply sterile vaselin before the treatment, if the eyelid is tender, or apply the com- presses over oiled silk. If both eyes are to be treated and there is suppuration present, treat each eye separately, using a different bowl and a different hand for each eye. Do not use the compress a second time and remove them with the forceps. (Rubber gloves may be worn.) Dry the lids very gently when the treatment is finished. APPLICATION OF COLD COMPRESSES TO EYES Prescribed: In inflammatory diseases of the eyelids and conjunctiva. Solutions used: 1. Sterile water. 2. Boracic acid (saturated solution). Duration of treatment: From ten to fifteen minutes, changing compress every half minute. Frequency of treatment: Every one or two hours. Size of compress: Large enough to cover the closed eyelids and to extend over the cheek (not over the brow in order not to congest the eyeball). Reguisites: Tray with: 1. Sterile basin. 2. Gauze compresses (six for one eye). 3. Dressing towels (2). 4. Bag for waste and forceps (if indicated). .. Rubber gloves (if indicated). 6. Tube of vaselin. Procedure: Wash your hands. Place a block of ice in the sterile basin and a small amount of boracic acid solution. If one eye is to be treated, six pads will be needed. Moisten them and place them on ice in regular order. Carry the tray to the bedside. . Prepare the patient as for hot compresses. Squeeze the water from the compress and apply it to the affected eye. Replace it with a second one in half a minute. Place the removed VACCINATION AND CARE OF WOUND 265 one on the ice and apply the other compresses in such order that the one placed on the eye has been the longest on the ice. If both eyes are affected, place 12 compresses in two rows. Apply sterile vaselin to the lids if the treatment is to be continued for a long time. : - Observe the same precautions as for hot compresses, if there is any discharge from the eyes. VACCINATION AND CARE OF WOUND The United States Public Health Service advises the following pro- cedure in order to secure the best results from vaccination and to pre- vent possible complications. The vaccine: Obtain the freshest possible vaccine. Keep all vaccine packages, pending use, in a metal box in actual contact with the ice. Preparation: Thoroughly cleanse the skin of the upper arm or leg, with soap and water if not seen to be clean, and in any case with ether or alcohol (not denatured ethyl alcohol containing phenol) on sterile gauze. After evaporation of the alcohol or ether, place a drop of the virus upon the cleansed skin. To expel the virus from a capillary tube: Push the tube through the small rubber bulb which accompanies it, wipe it with an alcohol sponge, and break off one end, using sterile gauze; break the other end inside the rubber bulb. Close the hole in the latter with the finger as the bulb is compressed to expel the virus. Grasp the undersurface of the arm or leg with your left hand so as to stretch the skin where the virus has been placed. Keep the skin thus stretched throughout the process. Methods: (2) The method of incision, or linear abrasion. By means of a sterilized needle or other suitable instrument, held in the right hand, make a scratch (not deep enough to draw blood) through the drop of virus, 1 inch long and parallel with the - humerus. Then gently rub in the virus with the side of the needle or some other smooth sterile instrument. Some tinged serum may ooze through the abrasion as the virus is rubbed in, but this should not be sufficient to wash the virus out of the wound. (6) The multiple puncture method. Hold a sterile needle nearly parallel with the skin and press the point through the drop of virus so as to make about six oblique pricks or shallow punctures, through the epidermis to the cutis (but not deep enough to draw blood). Confine the punctures to an area not more than § inch in diameter. With method (a) it is advisable to expose the arm after vaccination to the open air but not to direct sunlight, for fifteen minutes before the clothing is allowed to touch it. With method (#4) the virus may be wiped off immediately. The wound: : Make the original vaccination wound as small as possible and , guard against all injury to the vaccinated arm. Avoid any covering * 266 NURSING TECHNIQUE which is tight or more than temporary, as it tends to macerate the tissues during the ‘‘take.” Apply no shield or other dressing at the time of vaccination. Cus- tomary bathing and daily washing of the skin may be continued, so long as the crust does not break. The application of moisture to the vaccinated area should not be enough to soften the crust. If an early reaction of immunity is to be watched for, the patient should report on the first, second, fifth, and seventh days after vac- cination. Otherwise, the patient should report on the ninth day, or sooner if the vesicle, pustule, or crust breaks. Every effort should be made to prevent such rupture. However, should the vesicle, pustule, or crust break, and the wound thus becomes open, daily moist dressings with some active antiseptic, such as mercuric chlorid or dilute iodin (1 part tincture of iodin in 9 parts of water) should be applied. Under no circumstances should any dressing be allowed to remain on a vac- cination wound longer than twenty-four hours, and no dressing should be applied as long as the natural protection is intact. On account of possible fouling by perspiration and to lessen the chances of exposure to street dust, primary vaccination should be per- formed preferably in cool weather. In order to encourage proper surgical treatment, no charge should be made for the after-care of a vaccination wound nor for revaccination in case the first attempt should prove unsuccessful. Although appar- ently trivial, vaccination is an operation which demands skill in per- formance and care in after-treatment in order to avoid the rare, but serious, complications. For the prevention of these complications vaccination (a) Should be performed with strictly aseptic technique. (4) Should cover the smallest possible area for each insertion. (¢) Should be treated without any covering which permits macera- tion. A child should be vaccinated by the time it has reached the age of six months, and the operation should be repeated at about six years of age and whenever an epidemic of smallpox is present. Caution: It has come to the attention of the Public Health Service that de- natured ethyl alcohol containing phenol has been used for the purpose of cleansing the skin at the site of vaccination against smallpox. The Bureau believes that such procedure would materially decrease the likelihood of securing successful ‘takes’ from vaccine, and suggests that cleansing the skin with soap and water is preferable, but if another agent is desired, ether may be used. TAKING THROAT AND NOSE CULTURES By a culture is meant the propagation of micro-organisms for sci- entific study. Requisites for throat culture: Tray with the following: 1. Sterile applicator in test-tube. 2. Tube containing culture-medium. 3. Tongue depressor. APPLICATIONS OF COLD AND HEAT TO THROAT 267 Bag for waste. Sputum bowl. Drop light (if necessary). Gauze handkerchief. . Labels. Procedure: Do not use an antiseptic mouth-wash for two hours previous to the taking of the culture. Place the patient so that the throat will be in good light. Have her open her mouth widely. Depress the tongue so that a good view of the throat is obtained. “Remove the swab from the test-tube, holding it in the right hand. Pass it into the mouth and, when in contact with the affected area, twirl it between the fingers, so that all parts of the swab may be touched by the secretions of the throat. Pass the swab back as far as possible, in cases in which the exudate is confined to the larynx. Remove the cotton plug from the culture tube without contaminat- ing it, and insert the swab and rub it back and forth over the slanted surface of the serum. Twirl the swab so that all parts of it will come in contact with the serum, but do not break the surface of the medium. Place the swab and tongue depressor in the bag for waste and destroy them in the incinerator. Label the culture tube with the patient’s name, room, or ward num- ber, the physician’s name, the date, the part or organ the pathologic material was obtained from, and send it to the laboratory immediately. Requisites for nose culture: 1. Sterile applicator in test-tube. 2. Gauze handkerchief. 3. Tube containing culture-medium. 4. Labels. Procedure: Do not use an antiseptic spray for two hours previous to the taking of the culture. Place the patient in a good light and tilt the head slightly backward. Remove the swab from the test-tube and pass it into the nostril. Twirl it so that all parts of the swab may be touched by the secretions of the nose. Proceed then as when taking a throat culture. Label the culture tube and send it to the laboratory immediately. Precautions: 1. Do not allow the sterile applicator to come in contact with any- thing but the part from which the culture is taken. 2. When a throat and nose culture is taken, diphtheria is frequently suspected, therefore burn the tongue depressor, gauze handker- chief, and swab at once. emo Ue Record: 1. Hour. 2. Throat or nose culture taken. 3. Sent to laboratory. APPLICATIONS OF COLD AND HEAT TO THROAT Cold compresses are prescribed: 1. To relieve pain and congestion, as in tonsillitis. 2. To check hemorrhage. 268 NURSING TECHNIQUE Temperature of water: About 50° F. y Duration and frequency of treatment: Prescribed in each case. Regquisites: } Tray with the following: 1. Basin. 2. Two small bath towels. 3. Oiled muslin or waxed paper. 4. Two dressing towels. Procedure: Prepare the basin of water the required temperature and place it on the tray with the other requisites and carry them to the bedside. Re- move all but one pillow from under the patient’s head and cover the re- maining one with a dressing towel. Loosen the clothing at the patient's neck and protect it with a dressing towel. Wring the bath towel from the cold water and apply it double to the throat. Cover it with oiled muslin or waxed paper. (The effect is first a contraction and toning up of the blood-vessels and lessening of the blood-supply in the part, thus relieving congestion and pain. As the compress warms the blood- vessels again dilate, bringing fresh blood to the part, while at the same time the warmth has a very soothing effect on the nerves. This alter- nate contraction and dilatation of the blood-vessels with the constant withdrawal of wastes and renewal of the blood-supply gives great relief to the patient, stimulates the absorption of inflammatory products, and greatly promotes healing—Harmer.) If the compress is applied for hemorrhage, change it every half minute until the hemorrhage is controlled. If the compress is applied for the relief of pain and congestion, allow it to remain on the area until warmed to body temperature and almost dried. Renew it by a second application unless otherwise ordered. Hot compresses are prescribed: In inflammatory conditions: 1. To promote leukocytosis. 2. To lessen the sensibility of the nerve endings in the skin and by reflex action to relieve deep-seated pain. 3. To hasten suppuration when that condition is inevitable. Duration of treatment: For fifteen minutes, changing compress every two or three minutes. Frequency of treatments: Every one or two hours. Regquisites: Tray with the following: . Basin. Electric grill or sterno and matches. Support for basin. Stupe wringer and sticks. Two small bath towels. Two dressing towels. Oiled muslin or waxed paper. Piece of Canton flannel. PIS UuR Wg ASSISTING WITH INTUBATION AND EXTUBATION 269 Procedure: Prepare the basin of hot water and place it on the tray with the other requisites. Carty them to the bedside and arrange the support for the basin. Connect the grill or light the lamp so that the temperature of the water will be maintained. Prepare the patient as for a cold compress. Proceed in the same manner as for abdominal stupes, changing the compress every three minutes for fifteen minutes. Dry the area carefully at the completion of the treatment and cover it with a piece of Canton flannel for ten or fifteen minutes to prevent chilling. Record: 1. Hour and treatment. 2. Method of application. 3. Duration of treatment. ASSISTING WITH INTUBATION AND EXTUBATION Intubation consists of the introduction of a hard-rubber or gold- plated tube into the larynx through the glottis to secure free respira- tion for obstruction in the larynx or upper portion of the trachea. Indicated: In inflammatory and edematous conditions of the glottis, when marked dyspnea and cyanosis is present. Position of patient: 1. If the patient is a child, sitting upright on the nurse’s lap with the child’s feet held securely between the nurse’s crossed legs and the child’s head resting on the nurse's right shoulder. An as- sistant standing behind the child grasps the head firmly, holding it up and backward as though holding it by the head. Re- straint by means of a sheet or bath blanket is sometimes neces- sary before placing the child in position. 2. If the patient is an adult, horizontally on the bed or table with a small sand-bag placed under the neck. Duration of operation: From five to ten seconds and not exceeding fifteen seconds. Requisites: 1. Small sand-bag. 2. Tray with the following: 1. An intubation set consisting of: (¢) Mouth gag. (6) An introducer. (¢) An extractor. (4) A set of several hard rubber or metal tubes, graded from 1 to 12 indicating the size of the tubes, at- tached to the obturators. . Silk thread. Head mirror. Drop light. Emesis basin. . Gauze handkerchiefs. . Scissors. - . Adhesive tape. 00 TOV Wo 270 NURSING TECHNIQUE Procedure: Wash your hands. Sterilize the instruments and place them on a sterile tray. Carry the requisites to the bedside. The physician selects a tube of a size corresponding to the age of the patient, if the patient is a child, and if an adult, he usually selects the largest size. He then threads it with a piece of silk, 2 or 3 feet long, and inserts the obturator into the intro- ducer. The position of the patient is an extremely important part of the operation and this is strictly the nurse's responsibility. If the light is not good, prepare for reflected lighting. Place the pa- tient in position. The physician then inserts the mouth-gag between the patient's teeth. He passes his left index-finger into the patient’s mouth, depresses the tongue, and holds the epiglottis forward. He then introduces the tube into the mouth, through the glottis into the larynx, guiding it by his finger without any force. He removes the obturator from the tube (holding it in place with his finger) as soon as it is in po- sition. He then removes the introducer with the obturator attached, and pushes the tube well into the larynx. If the tube is properly placed, there will be a great deal of mucus secreted. Hold the child’s head to one side so that it may be expelled. If the tube is in the esophagus, no improvement will take place. It is then removed by making traction on the silk thread. A second at- tempt is made when the patient has recovered his breath. If the tube is properly placed, there will be some coughing and the breathing and color of the patient rapidly improves. The silk thread may be removed or secured by means of adhesive tape to the ear. Watch the child constantly and do not leave her alone. FEEDING INTUBATED PATIENTS Kind of food: Liquid or semiliquid. Position of patient: Lying on the table or bed with the head lower than the body. Methods of feeding: 1. From a spoon. 2. Nasal feeding. 3. Rectal feeding. Procedure: If the patient is an adult, place a pillow under the shoulders and if the patient is a child, allow the head to extend beyond the edge of the table or bed and slightly backward. Then feed her slowly from a tea- Spoon. If the patient is an infant, administer the food from a nursing bottle. ExtuBATION (In diphtheria the tube is usually removed in three to seven days.) Procedure: Place the patiert in the same position as for intubation. The phys- ician inserts the mouth-gag and proceeds in the same manner as for in- tubation, except that the extractor is passed into the lumen of the tube. PREPARATION FOR ARTIFICIAL PNEUMOTHORAX 271 The jaws of the extractor are separated and the tube withdrawn. After the removal of the tube, the physician watches the patient for about an hour to be sure that the parts do not swell and cause difficulty in breath- ing. Record: 1. Hour and operation. 2. Quantity of mucus expelled. 3. Any unusual symptoms which may occur. 4. Hour of extubation. 5. By whom performed. PREPARATION FOR ARTIFICIAL PNEUMOTHORAX Pneumothorax: An accumulation of air or gas in the pleural cavity. Artificial pneumothorax: The introduction of nitrogen gas into the pleural cavity for the purpose of creating enough pressure to collapse the lung and give it complete rest. Indicated: 1. In pulmonary! tuberculosis with an active involvement of a con- siderable portion of one lung, with little or no involvement on the other side. 2. In rapidly progressive cases and in cases that do not improve under the usual hygienic and climatic treatment. Position of patient: Lying on unaffected side with arm placed on opposite shoulder as for a thoracentesis. Site of injection: A point as far away from the diseased seat as possible so as to avoid adhesions. Quantity injected: 1. From 200 to 400 c.c. (12 to 24 cubic inches) for the first treatment. 2. From 300 to 600 c.c. (18 to 36 cubic inches) for the second treat- ment. 3. From 800 to 1000 c.c. (48 to 60 cubic inches) for the third treat- ment. Frequency of injections: Every second or third day until complete collapse of the lung is obtained. This is determined by x-ray examination and by disap- pearance of the respiratory murmur. The treatment is then repeated once or twice a month, depending on the rapidity with which the gas is absorbed. Requisites: . Tank of nitrogen gas. . Sterile pneumothorax needle. . Sterile gauze. . Sterile cotton. . Sterile aspirating sheet. . Sterile gloves (1 pair). . Sterile tray cover. ! Morrow’s Diagnostic and Therapeutic Technic. NOt Who = 272 NURSING TECHNIQUE 8. Sterile towels. 9. Sterile forceps. 10. Sterile scalpel. 11. Flask ether. 12. Flask alcohol. 13. Flask iodin. 14. Local anesthetic. (a) Sterile Luer syringe. (6) Sterile needle. (¢) Sterile medicine glass. (d) Novocain, § per cent. 15. Adhesive tape. 16. Collodion. 17. Bag for waste. 18. Two enameled trays. Procedure: The physician usually prescribes morphin, gr. to 1 (hypodermically a half hour before the operation). Prepare a sterile tray and place the sterile requisites on it. Cover it with a sterile towel. Place the non-sterile requisites on a second tray and carry them to the bedside. Prepare the field of operation as for a thoracentesis. The physician then places the aspirating sheet or sterile towels after putting on sterile gloves. He then injects the local anesthetic and inserts the needle through the intercostal spaces into the pleura at a depth of about 1 inch. The nitrogen gas is then introduced. When the treatment is completed, the needle is withdrawn and pressure is made over the site of injection to prevent the escape of gas into the subcutaneous tissues. A collodion dressing is applied and this is covered with gauze and re- tained with adhesive tape. The usual procedure is to keep the patient in bed for twenty-four hours following operation. Record: 1. Hour and operation. 2. Quantity of gas injected. 3. Any unusual symptoms which may occur. 4. By whom performed. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION IN THE NURSING CARE OF COMMUNICABLE DISEASES What are the objects of the course of communicable diseases? What important and common factors govern the treatment and nursing care in infectious diseases? (a) What do you understand by putting a patient “on precautions”? (b) What do you understand by isolation? (¢) What diseases are usually isolated? (d) What diseases are put on precautions? (a) What do you understand by a carrier? (b) What do you understand by a contact? Define: (a) Disinfection. () Concurrent disinfection. (¢) Terminal disin- fection. (d) Fumigation. (¢) Quarantine. (f) Renovation. (g) Fomites. (kh) Delousing. (i) Sterilization. : What specific precautions may be taken by the nurse and others exposed as, for instance, in diphtheria, typhoid, and smallpox? Give the hygiene of the patient and nurse in communicable diseases. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION 273 How would you disinfect the following when they are capable of transmitting infection? (a) Feces and urine. (b) Eye, nose, mouth, or throat secretions. (c) Bed linen. (d) Bath water. (¢) Dishes and utensils. x (a) Why would you give the mouth and nose special care in nursing com- municable diseases? ~ (5) What would be the result if these parts were neglected? (a) Give the source of infection in typhoid fever. (b) How would you care for a patient’s mouth in typhoid fever? (c) Give the nursing care and treatment in typhoid fever. What are the symptoms of: (a) Intestinal hemorrhage in typhoid. (5) Per- foration. (c) What would you do for these pending the arrival of the physician? (a) What is the source of infection in scarlet fever? (b) Give the nursing care and treatment. (a) Define a spray. (b) When is it indicated? (a) Name four complications of scarlet fever. (0) How may these be prevented? (a) What nursing measures may be used to relieve itching and burning of the skin? (b) What do you understand by medicated baths? (c) When are they prescribed? (a) Give the temperature of the water. (b) Give the duration of the bath. (c) In preparing a soda bicarbonate or bran bath how much would you use to relieve itching and burning of the skin? (a) What do you understand by a nasal douche? (b) When is it indicated? (c) Give the solutions used and the temperature. (d) What complication may be the result of faulty technique, when giving a nasal douche? (a) What do you understand by an aural douche? (0) When is it indicated? (¢) Give the solutions and temperature commonly prescribed. (4) What points would you remember when giving the treatment? Why would you give special care to the diet in scarlet fever? (a) What is the source of infection in measles? (6) Give the nursing care and treatment. (a) What complications may accompany or follow measles? (5) Give the care of the eyes. (a) What solutions are used for irrigating the eyes? (b) Give the temperature of solution and describe the position of the patient for the treatment. 0 What precautions would you observe? (a) When are hot compresses to the eyes indicated? (b) Give the duration and frequency of the treatment. (c) Give the size of the compress and the tem- perature of the water. (a) When are cold compresses to the eyes indicated? (0) Give the duration and frequency of the treatment and the size of the compress. (a) Give the source of infection in smallpox. (b) Give the nursing care and treatment in smallpox. (a) How would you prepare the field for vaccination? (5) How would you care for the wound if the pustule or crust ruptures? Give the nursing care and treatment of: (a) Cowpox. (b) Chicken-pox. (c) Erysipelas. : (a) What is the source of infection in diphtheria? (4) Give the nursing care and treatment. (c) What test is used to determine immunity to the diphtheria germ? (a) What complications may accompany or follow diphtheria? (5) Why is a nourishing diet important in diphtheria? (a) How would you prepare the field for an injection of antitoxin? (b) What precautions would you observe in taking a nose and throat culture? (a) Why are cold throat applications prescribed? (b) Why are hot throat applications prescribed? Why is convalescence in diphtheria a very critical period? (a) Define intubation. (b) Describe the position of the patient for the treat- ment. (c) What is the duration of the treatment? (a) Give the nursing care of an intubated patient. (b) Describe the position of the patient for extubation. 18 274 NURSING TECHNIQUE Give the nursing care and treatment of: (a) T onsillitis. (db) Septic sore throat. (c) Influenza. (a) What is the most dreaded complication of influenza. (b) In the con- valescent period after influenza, what nursing measures could assist the patient to recover? Give the nursing care and treatment of: (a) Whooping-cough. (b) What complications are to be feared in whooping-cough? (¢) What important point should a nurse bear in mind in relation to the diet in whooping-cough? (¢) What is the source of infection in mumps? (b) Give the nursing care and treatment of same. (¢) What are the complications of mumps? (@) What is the source of infection in cerebrospinal meningitis? (b) Give the nursing care and treatment of same. (c) What important points would you observe in the care and management of such a case? (a) What complications are feared in meningitis? (b) How would you prepare the patient for an injection of antimeningitic serum? (a) What is the source of infection in infantile paralysis? (b) Give the treat- ment and nursing care of same. Give the nursing care and treatment of: (a) Malaria. (b) Yellow fever. (c) Typhus. Give the nursing care and treatment of: (a) Amebic dysentery. (b) Bubonic plague. (c) Hookworm. Give the nursing care and treatment of pulmonary tuberculosis. (a) What do you understand by an artificial pneumothorax? (b) When is it indicated? (¢) Describe the position of the patient for the treatment. (b) What is the site of injection and how would you prepare field? Name the bacilli which cause diphtheria, tuberculosis, cholera, meningitis, influenza, and lockjaw. DEMONSTRATIONS IN COMMUNICABLE DISEASES Demonstrate disinfecting the following: (a) Feces and urine. (b) Bed linen and bath water. (c) Dishes. Demonstrate how you would care for the mouth and nose in nursing «om- municable diseases. ; Demonstrate spraying the nose and throat. Demonstrate giving a soda bicarbonate sponge bath for the purpose of allaying the itching and burning in scarlet fever. Demonstrate giving a bran bath for the same purpose. (a) Demonstrate how you would care for the eyes in measles. (b) Demon- strate the instillation of eye-drops. (a) Apply hot compresses to the eyes. (b) Apply cold compresses to the eyes. Demonstrate vaccination for smallpox. Demonstrate taking a nose and throat culture. Demonstrate the application of: (a) Cold compresses to the throat in treat- ment of diphtheria or scarlet fever. (b) Hot compresses to the throat in treat- ment of peritonsillar abscess. (a) Prepare a tray and requisites for intubation. (b) Demonstrate holding a child for the treatment. (¢) Demonstrate feeding an intubated patient. Demonstrate the preparation of a patient for artificial pneumothorax. NURSING PROCEDURES USED IN UROLOGY Lectures 1 and 2: Anatomy and Physiology of the Genito-urinary Tract in Review. Lectures 3 and 4: Diseases of the Urinary Tract. Lecture 5: Test-meals for Nephritic Function. OBJECTS OF THE COURSE 1. To teach the student nurse to be familiar with the methods of elimination of systemic poisons, and to be ever watchful that she may detect the earliest signs of the failure of the function- ing of the kidneys, as they are filters of these poisons and few diseases can be conquered without their aid. 2. To make the student familiar with the different tests of function as well as the many chemical and bedside tests which she carries out in whole or in part as the results of many of these tests depend upon accuracy of execution. 3. To make her skilful in nursing patients who have had urologic operations, as these are most difficult from a nurse's standpoint and most demanding of nursing care. New Demonstrations: Review: 1. Preparation of patient for radio- 1. Sitz-bath. graphy and pyelography. 2. Hot baths. 2. Preparation for cystoscopy and 3. Sedative enemata. catheterization of the ureters. 4. Hypodermic injection. 3. Bladder instillation. 5. Vaginal douche. 4. Urethral injection. 6. Catheterization. 5. Preparation for continuous 7. Bladder irrigation. catheterization. 8. Phenolsulphonephthalein test. 6. Catheterization of a male pa- tient. . References: Harmer’s Principles and Practice of Nursing. Morrow's Diagnostic and Therapeutic Technic. Hirst’s Manual of Gynecology. PREPARATION OF PATIENT FOR RADIOGRAPHY AND PYELOGRAPHY By radiography is meant photography with the Roentgen rays. By pyelography is meant radiography of the kidney and ureter after filling these structures with an opaque substance. Indicated: In diseases of the genito-urinary tract: 1. As an aid in the diagnosis and location of vesical, ureteral, and renal calculi. (The success of the picture, however, depends to a large extent upon the composition of the calculus.) 2. As an aid in the diagnosis and location of vesical tumors and sacculations. 3. To ascertain the size or deformity of the renal pelvis. 275 276 NURSING TECHNIQUE Preparation of patient: 1. Give castor oil, 2 ounces (if patient is an adult) the afternoon or evening previous. 2. Give castor oil, 1 ounce (if patient is a child) the afternoon or evening previous. (This cathartic is given to clean the in- testinal tract of flatus, as this often obstructs the view of shadows which might indicate calculi.) 3. Give the patient a cleansing bath and put on a long gown, the . morning of the examination. 4. Place the patient on the bed-pan (if she is able to walk she may go to the bath-room) and cleanse the genitals before sending her to the x-ray department. PREPARATION FOR CYSTOSCOPY AND CATHETERIZATION OF THE URETERS By cystoscopy is meant the examination of the interior of the bladder by means of a cystoscope. Indicated: In diseases of the urinary tract as an aid in diagnosis and treatment. The ureters are catheterized: 1. To ascertain whether blood or pus in the urine has its source in the kidney or ureter and from which side it comes. 2. To aid in recognizing stricture or calculus of the ureter. 3. To determine whether one or both kidneys are diseased and if so which one. 4. To determine the function of one or both kidneys. Preparation of patient: The day before examination: 1. Send a catheterized specimen of urine to the laboratory (if the patient is a female) or a voided specimen (if the patient is a male). Start a twenty-four-hour specimen and exert every effort that the specimens are not lost. Give urinary antiseptics if prescribed for fifteen to eighteen hours previous to the examination to render the urine sterile. . Give castor oil, 1 ounce at 2 p. M. . Urge water, 1 glass an hour (no ice). . Give a soap-suds enema. Give a cleansing bath. Give a sitz-bath, once or twice, if the patient is suffering from frequency and painful urination. . Give bromids (if prescribed) to allay nervousness. . Make an attempt to subdue the fear and dread of the patient going to the cystoscopic room. Morning of examination: 1. Give a soap-suds enema. 2. Make no local preparation. 3. Give a female patient a vaginal douche—bichlorid, 1 :8000, or lysol, per cent. 4. Give morphin, gr. } to 1, one-half hour previous to the examina- tion, unless otherwise ordered. VL NOUR Ww NN CYSTOSCOPY AND CATHETERIZATION OF URETERS 277 5. Urge water. Give 1 or 2 glasses of water preceding the examina- tion. 6. Have the patient void before leaving the room. 7. Put laparotomy stockings on the patient. Fig. 34. —Cystoscopy. Preparation of the cystoscopic room for a cystoscopy. Requaisites for cystoscopic room: 1. Requisites for scrub up: 1. Pitcher of sterile water. 2. Flask of green soap. 3. Flask of alcohol. 4. Sterile gauze sponges. 2. Sterile gloves (2 pairs). 3. Sterile cap and gown. 4. Sterile table cover. 278 NURSING TECHNIQUE . Sterile gauze and cotton sponges. . Sterile D and C sheet or plain sheet. . Sterile towels (2 packages). . Two Ses pans (18 inches long, 12 inches wide, and 2 inches deep). 9. One sterile (4-ounce) specimen bottle for residual urine. 10. Two sterile (1-dram) specimen bottles for urine from each kidney marked right and left. 11. Sterile medicine glass. 12. Sterile hypodermic syringe and needles. 13. Sterile reservoir and 4 feet of tubing supplied with a stop-cock. 14. Sterile cystoscope. 15. Two sterile elastic catheters, marked right and left. 16. Sterile lubricant. 17. Sterile graduated measure (500 c.c.) for capacity and residual urine. 18. Sterile urethral dilator (for female). 19. Sterile rubber-tipped forceps. 20. Rheostat. 21. Sterile urethral syringe. 22. Sterile ureter syringe. 23. Sterile sodium bromid, 20 per cent. 24. Sterile olive oil. 25. Silver nitrate, 1 per cent. 26. Sterile sodium hydroxid, 15 per cent. 27. Ampule of phenolsulphonephthalein. 28. Biniodid tablets. 29. Novocain, 1 : 200. 30. Sterile boracic acid, 2 per cent. } For reservoir not around 31. Sterile water. ' standard. 32. Irrigator standard. Procedure: It is the nurse's duty to attend to the comforts of the patient in the cystoscopic room. The treatment is sometimes very long and a general anesthetic is rarely administered. Prepare the sterile table before the arrival of the patient. Prepare the solutions as ordered by the physician. Place the ir- rigator standard to the right of the physician and hang the reservoir about 18 inches above the patient. Place the rheostat to the left of the physician and the sterile table to his right. Have at hand the receptacle for measuring capacity and residual urine. Place the patient in the lithotomy position with a pad under the buttocks. Be sure that the metal on the table is not in contact with the patient's body. Have a protector under the patient’s knees to prevent a shock. Scrub the field with green soap and sterile water and rinse it well with sterile water. Follow with an antiseptic solution as prescribed by the physician. Drape the patient with a sheet twisted in the center and brought around and tucked under each leg. Place three sterile towels over the pubic region so that two run parallel with the patient’s body and overlap each other 3 inches and the third is crosswise above the pubic region. Give the physician his cap, gown, and gloves. Turn on the rheostat, being careful to turn on the proper attachment. The physician then 00 ION f BLADDER INSTILLATION 279 injects 1 : 200 novocain solution in the urethra by means of the urethral syringe. Anticipate the physician's wants and act quickly during the procedure of dilating the urethral orifice and passing the cystoscope. After-care: . Give morphin, gr. (per hypo.) p. r. n. unless otherwise ordered. . Give a sitz or warm tub bath immediately after the cystoscopy and two or three times daily for bladder irritation or pain. . Urge water (no ice). . Apply a hot-water bottle to the kidney and bladder region. . Give urinary antiseptics (if prescribed) for two or three days fol- lowing the examination. BLADDER INSTILLATION By instillation is meant the process of injecting a small quantity of antiseptic solution into the bladder and allowing it to remain there. Prescribed: In the treatment of cystitis. Solutions used: 1. Argyrol, 5 to 25 per cent. 2. Mercurochrome, 1 to 5 per cent. 3. Protargol, % to 1 per cent. 4. Potassium permanganate, 1 : 5000 to 1 : 3000. Temperature of solution: From 95° to 100° F. Quantity injected: 5 c.c. to 8 ounces. Frequency of injections: Daily or as indicated. Requisites: 1. Catheterization tray. 2. Bladder irrigation tray. 3. Sterile instillation syringe or funnel. 4. Sterile medicine glass. 5. Prescribed medication. Procedure: The patient is usually catheterized and the bladder irrigated with _ boracic acid solution, 2 per cent. Prepare the requisites and patient and proceed as for catheteriza- tion and bladder irrigation. Wipe the neck of the bottle (containing the prescribed solution) with an alcohol sponge. Pour the prescribed amount into the sterile medicine glass. If the patient is a female, fill the syringe with the solution and inject it very slowly into the catheter. If a funnel is used, connect it with the catheter and pour the medica- tion slowly into the funnel and allow it to flow into the bladder. If the patient is a male, the physician injects the medication. Pro- ceed as after catheterization. Record: 1. Hour. : 2. Amount of urine withdrawn. 3. Bladder irrigation (if treatment is given) with percentage and amount of solution. Dis WwW DO = 280 NURSING TECHNIQUE 4. Kind, amount, and percentage of prescribed medication instilled. 5. If pain is caused by instillation. Ht. John’s Hospital No.i6s6 SUMMARY CHART Name Miss Mory Smith Room___207 Nurse. A jon_dan.i 102 i Physi Deblall Days in hospital 124 8 128124 8 124 812 8124 812 DIASTOLIC w = 2 o @o w «© a a o o pl o SYSTOLIC, Stools. Urine Fig. 35.—Graphic sheet demonstrating the method of recording the fluid intake in ounces and the urinaray output in cubic centimeters. Intake, output, and blood-pressure are to be done in red ink; temperature, pulse, and respiration are to be done in black ink. URETHRAL INJECTION 281 URETHRAL INJECTION Solutions are injected into the urethra in the treatment of urethral diseases. Solutions used: 1. Potassium permanganate, 1 : 5000 to 1 : 3000. 2. Protargol, § to 1 per cent. 3. Argyrol, 5 to 25 per cent.- 4. Merecurochrome, 1 to 5 per cent. 5. Sedative injections of cocain. Temperature of solution: From 95° to 100° F. Quantity injected: From 10 minims to 10 c.c. Frequency of injections: From three to six times daily. Fig. 36.— Urethral injection. Tray equipped for a urethral injection. Requisites: 1. Catheterization tray. 2. Sterile glass urethral syringe (10 c.c.). 3. Sterile medicine glass. 4. Prescribed medication. Procedure: Have the patient void urine just before the injection. Prepare the patient and requisites as for catheterization of the bladder. If the pa- tient is a female, gently inject about 30 minims of prescribed medica- tion into the urethra. The medication escapes into the bladder. If the patient is a male, the physician injects from 15 minims to 10 c.c. of prescribed medication into the urethra and holds the meatus together for three to five minutes to keep the medication in contact with the mucous membrane. He then allows it to escape in the kidney basin. Proceed as after catheterization. 282 NURSING TECHNIQUE Record: 1. Hour. 2. Amount of urine voided. 3. Kind, amount, and percentage of prescribed solution injected. PREPARATION FOR CONTINUOUS CATHETERIZATION By continuous catheterization is meant the drainage of the bladder (for a brief period of time) by means of a retained catheter. Indicated: : 1. After operations upon the urethra to prevent infected urine from coming in contact with raw surfaces. 2. In obstruction caused by a large prostate, when the repeated passage of the catheter causes spasm or hemorrhage. Regquaisites: Catheterization tray. Sterile self-retaining catheter. Sterile stilet. . Two or 3 feet of tubing. . Bottle for urine. . Glass connection. . Adhesive tape. 8. Piece of bandage. - Procedure: Prepare the tray and patient as for catheterization of the bladder. The physician inserts the stilet into the catheter to obliterate the pro- jecting wings. He then passes it and, when in position, removes the ni This allows the catheter to expand and prevents its being with- rawn. Fix the catheter in place with adhesive tape and connect it to the tubing by means of the glass connection. Insert the open end of the tubing in the bottle and tie it to the frame of the bed by means of a gauze bandage. Every twenty-four hours the catheter is removed. Thoroughly cleanse and sterilize it for reinsertion. Keep close watch so that the eye of the catheter does not become blocked with blood-clots after the operation and obstruct the flow of urine. Thoroughly cleanse the bottle every twenty-four hours. Record: 1. Hour catheter was inserted. 2. Amount and color of urine obtained per catheter in twelve hours. 3. Character and odor. 4. Any unusual symptoms which may occur. NOUR we CATHETERIZATION OF MALE PATIENT The circumstance is very rare that will make it necessary for a fe- male nurse to catheterize a male patient, however, in an emergency she should know how to proceed. Indicated: 1. In complete retention. 2. In partial retention, when the residual urine amounts to more than 60 c.c. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION 283 Position of patient: _ The dorsal recumbent position with shoulders slightly elevated. Regquisites: 1. Catheterization tray. 2. Soft-rubber or silk catheters (2). Procedure: Prepare boracic acid, 2 per cent., as when catheterizing a female pa- tient. Prepare a small basin of green soap and another of sterile water. Place cotton pledgets in the sterile water and boracic acid solution. Carry the tray (covered) to the bedside. Prepare the lubricant. Re- place the upper covers with a sheet and cover the patient's chest with a bath blanket. Place the patient in position and drape him. Put on sterile gloves. Raise the penis to an angle of about 60 degrees. Draw back the prepuce (foreskin) and cleanse the glans (head of penis) with cotton pledgets and soap and water followed by boracic acid, 2 per cent. Lubricate the catheter and pass it slowly into the bladder through the urethra. It may be necessary to wait a moment when about 6 inches of the catheter has been introduced. Observe the same precautions as when catheterizing a female patient and never use pressure on the catheter. Rather allow it to slide into the bladder by its own weight. : Pain or blood during catheterization usually means carelessness on the part of the nurse. Proceed as after catheterization of a female patient. Record: 1. Hour and treatment. 2. Amount and color of urine. 3. Character and odor. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION IN UROLOGY What are the objects of the course of urology? What organs are included in the urinary system? (a) What is the size and shape of the kidney? (b) What do you understand by the pelvis of the kidney? (c) What is the function of the kidneys? (a) What is the function of the ureters? (b) What is the function of the bladder? (¢) What is the normal capacity of the bladder? (a) What is the length of the urethra? (b) What is the average quantity of urine secreted in twenty-four hours? (c) What is the specific gravity of urine in health? Define: (a) Micturition. (b) Retention. (c) Anuria. (d) Polyuria. (e) Oliguria. (f) Suppression. (g) Retention with overflow. Define: (a) Specific gravity. (b) Pyelitis. (c) Cystitis. (d) Nephritis. (e) Pollakiuria. Define: (a) Radiography. (b) Pyelography. (a) When is pyelography indicated? (b) What preparation would you give the patient for such a treatment? (a) Define cystoscopy. (b) When is it indicated? (c) What preparation would you give the patient the day previous to the treatment? (d) The morning of the examination? Give the after-care following cystoscopy. (a) When is catheterization of the ureters indicated? (b) What do you under- stand by a bladder instillation? (¢) When is it indicated? 284 NURSING TECHNIQUE (a) What solutions are used for a bladder instillation? (b) Give the tem- perature of the solution and the amount injected. (a) What preparation would you make for a urethral injection? (b) What solutions are used? (c) Give the temperature and amount injected. (a) What do you understand by continuous catheterization? (b) When is it indicated? ; (a) What does pain or the presence of blood usually indicate when passing a catheter? (b) What precautions would you observe when catheterizing a male patient? DEMONSTRATIONS Prepare the cystoscopic room for a cystoscopy and demonstrate assisting with same. Demonstrate instilling argyrol, 10 per cent., into the bladder. Prepare the requisites and patient for a urethral injection of protargol, 3 per cent. (30 minims). * Prepare a tray for the insertion of a self-retaining catheter. ashe out a chart, demonstrating keeping a record of the intake and output of fluids. JUNIOR YEAR SECOND SEMESTER 285 PROCEDURES USED IN OBSTETRIC NURSING Lecture 1: Introduction. Lecture 2: Physiologic pregnancy. Lecture 3: Changes in the Maternal Organism During Pregnancy. Lecture 4: Disorders and Diseases of Pregnancy. Lecture 5: Mechanism and Conduct of Normal Labor. Lecture 6: Operative Delivery. Lecture 7: Accidents and Complications. Lecture 8: The Puerperium. Lecture 9: Pathologic Puerperium. Lecture 10: Social Aspects of Obstetric Nursing. 9. 10. ® No Rm NR OBJECTS OF THE COURSE! 1. To make the nurse intelligent and competent in the nursing care of obstetric cases, both normal and abnormal, and in the care of small babies. No . To enable the nurse to advise and instruct mothers in the care of their own health, both before and after child-birth, and in the conditions necessary for the rearing of healthy children. 3. To arouse an interest in obstetric nursing and a keener appre- ciation of its importance, not only to individual mothers and babies, but to the welfare of the race. 4. To arouse an interest in the social aspects of obstetric work, and to develop a wholesome and helpful attitude toward such sex problems as the nurse meets in connection with her work. delivery. Routine care of the infant. Care of the premature baby. References: , De Lee's Obstetrics for Nurses. Davis’ Obstetric Nursing. Van Blarcom’s Obstetrical Nursing. 5. To establish a definite connection between previous work in surgical technique and obstetrics. New Demonstrations: Review: . The layette. 1. Care of the newborn. Bathing Preparation during the first infants and small children. stage of labor. 2. Application of binders. Making an obstetric bed. 3. Catheterization. Preparation of the baby’s 4. Preparation for an intra-uterine crib. ; douche. . Preparation during the second 5. Stupes. stage of labor. 6. Local application of heat. . Preparation of delivery room. 7. Local application of cold. . Preparation during the third stage of labor. Care of the patient following 1 Standard Curriculum of Schools of Nursing. 287 288 NURSING TECHNIQUE THE LAYETTE The following list of clothing will be found adequate in caring for the newborn baby: 1. SONA UIE WI —_ Four straight flannel bands, 6 inches wide and 24 inches long, Four silk and wool bands with shoulder straps, size 1. Five dozen diapers, 18 inches square. . Four silk and wool shirts, size 2. . Four flannel petticoats, Gertrude style. Four flannelette nightgowns. Eight simple dresses of soft material, 27 inches long. Three pairs of silk and wool stockings. Cloak and cap. Four blankets for wrapping the baby. PREPARATION DURING THE FIRST STAGE OF LABOR Labor may be divided into three stages or periods, the duration of which may vary from a few moments to several days of pain. The first stage begins with the onset of labor and terminates when the cervix is completely dilated. The second stage begins when the cervix is completely dilated and terminates with the birth of the child. The third stage begins with the birth of the child and terminates when the placenta is expelled. A nurse's duties during this stage of labor are as follows: Preparation of the patient: 1. 2 oo =x ON UH w 10. 11. 12. 13 Notify the physician as soon as the patient goes into labor. Give a soap-suds enema in bed so that it can be expelled into a bed-pan. Repeat in twelve hours if the patient is in the first stage of labor. . Give a shower or sponge bath and put on a freshly laundered gown and tuck it up well under the patient’s arms. . Place the patient on a bed-pan and drape her with a clean sheet. . Scrub your hands for three minutes. . Shave the vulva,' suprapubic region, and inner surface of the thighs. . Scrub your hands for three minutes. . Scrub the vulva, suprapubic region, and inner surface of the thighs thoroughly with green soap and sterile water, and then lysol solution, 1 per cent. . Cover the vulva with a sterile towel, remove the bed-pan and dry the patient's back and thighs. If a vaginal examination is made at this time, place a sterile towel under the buttocks. Put on freshly laundered stockings and a dressing gown and slippers and allow the patient to be up and about the room. Braid her hair (if long) in two braids. Place the bed-pan under the patient and enccurage her to void every four hours. Watch for bladder distention. Encourage the patient to drink water freely,” if patient is a primapara. 1 Some physicians prefer to have the nurse clip the pubic hairs instead of shaving. 2 Do not give water or nourishment if there is any prospect of an anesthetic. MAKING AN OBSTETRIC BED 289 14. Give liquid nourishment with toast or crackers! every four hours if patient is a primapara. 15. Take the maternal temperature, pulse, and respiration every four hours and the fetal heart rate every two hours. 16. Thoroughly wash the vulva with a solution of lysol, 1 per cent., before and after each vaginal examination. 17. Notify the physician: . If the membranes rupture. . If there is bulging of the perineum. . When the pains are at three-minute intervals. . If the patient complains of headache, is restless, or has an elevation in temperature or an increase in pulse rate. If there is hemorrhage or a prolapsed cord. If the fetal heart tones exceed 150, are irregular, or less than 116. Preparation for the physician: Have in readiness the following requisites: . Sterile orange wood stick. . Sterile nail brushes (2). . Flask of alcohol, 60 per cent. . Sterile basin and cotton balls (for alcohol). Sterile towels. . Sterile gloves. . Rubber apron. . Sterile gown and cap. MAKING AN OBSTETRIC BED Requisites: . Three freshly laundered sheets. . One dimity spread. . One double wool blanket. . One pillow case. . Two rubber sheets (one large enough to cover the entire mattress, the other to be used under the draw sheet). - Quilted pad (large enough to cover the large rubber sheet). . Bed (equipped with springs). . Mattress (covered with muslin case). . One pillow (covered with muslin case). 10. One large pad. Procedure: Place the mattress in position. Then proceed to make the bed in the same manner as when making a closed bed as far as, and including the muslin draw sheet. Proceed with the upper clothes as when making an open bed. Fan the covers to the foot of the bed. Slip the pillow into the case and place it on the bed. Place the large pad over the draw sheet. Place the hot-water bottle (with water 140° F.) under the covers at the foot of the bed a short time before the patient is brought from the delivery room. OO iW ! Do not give water or nourishment if there is any prospect of an anesthetic. 19 290 NURSING TECHNIQUE PREPARATION OF THE BABY’S CRIB The newborn baby’s crib may be a heavy wire one or a wicker bassin- ette. The preparation of the crib is as follows: Regquisites: . Hospital crib or bassinette. . Hair mattress covered with a muslin case. . Rubber sheet (large enough to cover the entire mattress). Quilted pad (large enough to cover the rubber sheet). Muslin sheet. One or 2 lightweight blankets. . Two hot-water bottles and covers. Procedure: Place the mattress in position and cover it with the rubber sheet. Place the bed-pad over this and cover same with the muslin sheet so that 6 inches will extend beyond the mattress at the head and foot of the bed. Tuck it under the mattress at the top and bottom, make square corners on the sides and tuck it securely under the mattress along the sides. Half-fill the hot-water bottles with water 130° F., and place them in the crib and cover them with the blankets. PREPARATION DURING THE SECOND STAGE OF LABOR When the cervix is completely dilated, the pains occur usually at two-minute intervals. The membranes may rupture and a blood-tinged vaginal discharge is observed. The patient is taken to the delivery room, is placed in bed and not left alone. A nurse's duties during this stage of labor are as follows: 1. Scrub your hands for three minutes. 2. Scrub the vulva, suprapubic region, and inner surface of the thighs with green soap and sterile water and then lysol solution, 1 per cent. . Put on laparotomy stockings, and place a sterile delivery pad under the buttocks. . Put the patient in the lithotomy position and cover her with the sterile delivery sheet or sterile towels. . Anticipate the physician's wants, and act quickly. When an emergency arises, each nurse should know her duty and im- mediately proceed to do her part without further instruction. (If there are two nurses, it may be necessary for one to scrub up and act as sterile assistant.) : . When the baby is completely born, a sterile kidney basin may be placed close to the vaginal outlet to receive any blood which may be lost during the third stage of labor. wn os Ww [=)) PREPARATION OF THE DELIVERY ROOM With the onset of the second stage of labor, the preparation of the delivery room is as follows: PREPARATION OF THE DELIVERY ROOM 201 On sterile table: fp ROVE UIE WIN . One short obstetric forceps (Simpson's). . One long obstetric forceps (Simpson's). . One axis-traction forceps (Tarnier’s). . One intra-uterine douche nozzle. . Two volsellum forceps. . Two scissors. Two long artery forceps. Six short artery forceps. . Two tissue forceps. . Two needle-holders. . Six suture needles. 12. 13. 14. 13, 16. 17. 18. 19 20. 21. 22, 23. 24. Fig. 37.—Preparation of the delivery room for labor. One long uterine packing forceps. One bi-valve speculum. Two Sims’ specula. Two tenacula. ‘One soft-rubber catheter. Suture material (silkworm-gut or catgut). Towel clips (4). Three Voorhees bags. One large glass syringe. Three bougies. One placenta basin. One small basin (for boracic and cotton balls for eyes). Reservoir, tubing, and stop-cock (for douche). 292 NURSING TECHNIQUE 25. Two pieces of cord tape (12 inches long). 26. Six towels. 27. Delivery sheet or 4 drape sheets. 28. Delivery pad. 29. Sterile gauze sponges. 30. Perineal pads. On first non-sterile table: First shelf: 1. Doctor’s caps. 2. Doctor’s gown. 3. Doctor's gloves. 4. Sterile towels. Second shelf: Two tubs (for resuscitating baby). On second non-sterile table: . Laparotomy stockings. Two hand straps. Two straps for pulling. Two stirrup straps. Bead necklace for baby. Sphygmomanometer. Stethoscope. Pelvimeter. Hypodermic tray with: 1. Three syringes, 20, 10, and 5 c.c. 2. Long and short needles. “3. Adrenalin. 4. Pituitrin. 5. Ergotole. 6. Camphor-in-oil. 10. Scrub-up tray with: 1. Sterile gauze sponge. 2. Flask of green soap. 3. Pitcher of sterile water. 4. Pitcher of lysol solution, 1 per cent. Anesthetic table: 1. Two cans of ether with automatic dropper. 2. Two ether masks. 3. Olive oil. 4. Ether towels. 5. Air way. Have convenient: 1. Oxygen tank. 2. Bed-pan in cabinet. 3. Baby's bed with hot-water bottle 115° F. and blanket. 4. Solution basin with lysol, 1 per cent., for physician’s hand. 5. Basin for waste. : PREPARATION DURING THE THIRD STAGE OF LABOR During the third stage of labor, which is a critical time, the nurse’s duties are usually as follows: ; 1. If requested by the physician, palpate the uterus and keep him informed as to its condition. Give gentle massage if it is too soft. 000 NOC Go w © No «oa CARE OF THE PATIENT FOLLOWING DELIVERY 293 . Remove the infant and provide a sterile pad for under the pa- tient’s buttocks. . Provide a sterile receptacle for the placenta and after it has been expelled, keep it for the physician's inspection. Be sure that the placenta is examined by the physician and make a note of it on the record. . Have in readiness 1 dram of ergot or a hypodermic of pituitrin or ergot to stimulate uterine contractions, if indicated. . If there are no lacerations of the birth canal, cleanse the external genitals and apply a sterile pad. Put on a clean gown and be sure that the patient is warm. Take her temperature, pulse, and respiration and give her a warm drink unless she has taken an anesthetic. Remove the patient to her room and make her comfortable in bed. CARE OF THE PATIENT FOLLOWING DELIVERY The general care of the patient following delivery is much the same as that given to any surgical patient. It is important to remember, however, that first, last, and all the time during the puerperium the nurse must consistently practice asepsis in every thing that concerns the genitals and breasts of the mother.! The routine care is as follows: 1 Keep the patient flat on her back with one pillow under her head for eight hours. Be sure that the uterus is firm and watch carefully for hemorrhage. . Restrain the leg movements by means of a towel or bandage if there are perineal stitches. . Take temperature, pulse, and respiration every four hours for 2 3 4. 5 three days and then b. i. d., if normal. Give liquid diet for twelve hours following delivery, soft diet for three days, and then a light general diet. . Eight hours following delivery, wash the breasts with soap and water, then bichlorid, 1 :500, which is allowed to dry in. Cover the nipples with a square of sterile gauze and apply a loose breast binder to prevent the gland from sagging.? . Put the baby to the breast every eight hours until the milk comes in, then every four hours, during the day, but not dur- ing the night. If it really seems necessary, the child may be put to the breast once during the night.3 Wash the nipple before and after each nursing, using sterile applicators moistened with saturated boric solution. . Dress the vulva, observing aseptic technique every four hours and following each bowel movement and urination. . If possible, give a full sponge bath every day. . Encourage the patient to try to void urine from five to eight hours after delivery. Catheterize after eight hours, if various expedients have failed. ! DeLee’s Obstetrics for Nurses. 2Tbid. 3 Ibid. 4 Ibid. 294 NURSING TECHNIQUE 10. Give 15 minims of fluid extract of cascara sagrada or 30 minims of aromatic fluid extract of cascara sagrada, after the ten o'clock nursing on the third night following delivery, unless otherwise ordered. Give an enema of soap-suds in the aA. Mm. if the cascara is not effectual. 11. If a perineorrhaphy has been performed, receive special orders regarding the diet, the bowels, cathartics, and enemata. ROUTINE CARE OF THE INFANT The nurse should never forget two facts about the baby!: 1. It is very easily chilled. 2. It is a ready prey to the hosts of bacteria that attack it upon en- trance into the world. The care is as follows: At birth: 1. Drop 1 minim of a 25 per cent. argyrol in each eye. 2. Weigh and avoid chilling. ; 3. Oil with warm oil and avoid exposure. : 4. Dress the umbilical cord stump, observing aseptic technique. 5. Take the temperature. 6. Mark the infant for identification by means of the bead necklace. 7. Wrap a blanket around the infant. Place a diaper under the buttocks and place him in his bed. 8. Keep him warm by means of a hot-water bottle 115° F., and watch him closely for six hours. 9. Give a cleansing sponge bath of warm oil or warm water. 10. Put to breast eight hours after birth, then every eight hours until the milk comes in.? 11. Report to the physician if the infant does not urinate within thirty-six hours. Routine care: 1. Take the temperature daily. If it is over 100° F. or under 97°F., take it every four hours. 2. Weigh the infant daily. 3. Give a daily sponge bath each morning before the second feeding. When the cord has dropped and the umbilicus healed, a tub bath may be given. 4. Cleanse eyes daily with sterile cotton moistened with saturated solution of boric acid. 5. Report to the physician any abnormal condition of the bowels or bladder. * CARE OF THE PREMATURE BABY The salient features of the care of the premature are’: 1. Keeping the tiny morsel of humanity evenly and constantly warm. 1 DeLee’s Obstetrics for Nurses. 2 Ibid. 3 Ibid. CARE OF THE PREMATURE BABY : 295 2. Providing sufficient easily assimilable nourishment and an abun- dance of water. 3. Supplying fresh air, warmed and moistened. 4. Preventing infection, especially of the lungs and gastro-intestinal tract. Give premature care to: 1. A baby born three weeks before the normal end of pregnancy. 2. A baby weighing less than 2300 grams. Routine care: 1. Anoint the body daily with warm benzoinated lard and quickly wipe it off with a warm towel.! 2. Wash the face and buttocks occasionally with warm water. 3. Take the temperature, change the diaper, and clean the buttocks with warm oil every four hours. 4. Give 5 to 20 drops of warm sterile water every hour with a medicine-dropper. If the child retains this, increase the amount to 30 or 40 drops. Eight hours after birth, give 1 dram of mother’s milk; sixteen hours after, give 2 drams, and twenty-four hours after, again give 2 drams.? 5. One to 2 drams of warm sterile water may be given half-way be- tween feedings after the first twenty-four hours. 6. Weigh every other day and avoid exposure in every possible way. 7. Give breast milk by gavage or medicine-dropper as ordered. The amount and number of losin are usually prescribed as follows: For INrants WEIGHING LESS THAN 1800 Grams (3 Pounps, 12 OUNCES) . Number of Amount of each feeding. Total food. Days. feedings. ie Drams. Cie, Drams. Ce. Lo 10 13 6 15.5 62 hides cies 10 23 11 27.5 110 Poutrehoo o.oo 0 10 32 12.5 31.5 126 hd ol. a 9 b a y § 1% Snr 5 in 8 Fighth, ............. 9 61 | 25 57 228 Ninth... ............ 8 8 31.5 63.5 254 Wenth............... 8 8% 33 66 264 Eleventh. ........... 8 9 35 70 280 Twelfth... .......... 8 91 38 75 300 Thirteenth. .......... 8 10 40 80 320 Fourteenth. ......... 8 10% 43 86 344 1DeLee’s Obstetrics for Nurses. 2 Ibid. 206 NURSING TECHNIQUE For INFANTS WEIGHING FROM 1800 TO 2000 GrAMS (3 PounDs, 12 OUNCES TO 4 Pounps, 3 OUNCES) Nunther of Amount of each feeding. Total food. Days feedings. Drams. Cx. Drams. Ce. Second. 10 3 12 30 120 Third............ Wier 10 41 17 43 172 i 1 er I A 10 6 24.5 61.5 246 Bh. eva 9 8 30.5 70 280 Sigthoy s.r... an 9 3 34 77 308 Seventh, ........... 8 103 42.5 85 340 Bighth.............. 8 11% 45 90 360 Nth 8 12 48 96 384 Tenth... ......... 8 12% 51 102 408 Fleventh. ........... 8 131 54 108 432 Twelith. ............ 8 14 56 112 448 Thirteenth. ......... 8 141 58 116 464 Fourteenth. . ........ 7 17 68.5 120 480 For INFANTS WEIGHING FrOM 2000 TO 2500 GRAMS (4 Pounps, 3 OUNCES TO 5 Pounps, 4 OUNCES) 1 Number of Amount of each feeding. Total food. ays feedings. Drams. ce. Drams. Cee Becond...... i... 10 4 16.5 41 164 Tudo 10 6 24.5 61 244 Tourth:..,.........: 9 8 31.5 74 296 Teh... 9 1 37 84 336 Sethi. o.oo. 9 10 41 92 368 Seventh... .......... 8 12 45 95 380 Fighth.............. 8 12% 48.5 97 388 Nth: ou 8 13 51.5 103 412 Tenth. ..ir. i... .an 8 13% 52.5" 105 420 Eleventh. ........... 8 14 55 110 © 440 Twelfth. ............ 7 163 66 116 464 Thirteenth... ....... 7 17 70 120 480 Fourteenth. ......... 7 17% IA! 124 496 8. Clean eyes daily with moist boric pledgets and the nostrils with applicators dipped in albolene. 9. Change position of baby by turning him from side to side every four hours. 10. Keep the room temperature between 68° and 70° F., with a humidity of 55 per cent.! Clothing: Requisites: 1. Flannel band and safety-pins. 2. Sterile requisites for cord. 3. Flannel cape with a hood. 1 Cutler’s Pediatric Nursing. GENERAL REVIEW AND EXAMINATION QUESTIONS 297 4. Woolen blanket. 5. Lamb's wool comforter. Procedure: Put on the flannel band, observing aseptic technique. Place a flannel cape with a hood, having a draw string, under the baby and slip a pad of cotton under the buttocks to serve as a diaper. Draw up the string in the hood and pin the cape around the baby so that air may not enter. Wrap a woolen blanket around the infant so that the head is well protected. Place him in the basket and cover with a lamb’s wool com- forter. The basket: Requisites: . Large clothes-basket. - One quilted pad and tapes (to line the basket). . One hair pillow. - Oiled muslin (24 inches square). . One quilted pad (to cover the oiled muslin). . One muslin sheet. . Seven hot-water bottles and covers. . One bath thermometer. Procedure: Line the sides of the basket with the quilted pad and secure it with pieces of tape. Place the pillow in the bottom of the basket and protect it with the oiled muslin. Cover this with the quilted pad and muslin sheet. Place 6 hot-water bottles with water, 115° F., around the sides of the basket, so that there will be two on each side and one at the top and bottom. The seventh bottle may be placed near the baby’s feet. Place the bath thermometer under the woolen blanket covering the baby and keep the temperature of the basket between 80° and 90° F., by refilling 2 hot- water bottles every hour. OTN UT WN GENERAL REVIEW AND EXAMINATION QUESTIONS IN OBSTETRIC NURSING How may the nurse help to reduce the number of maternal deaths in child- birth, to diminish the amount of invalidism of the mothers, to prevent blindness, to save the babies, and to provide them with healthy, vigorous bodies at the start of their earthly careers? Describe the normal female pelvis. Name the female organs of reproduction. Define: Puberty, menopause, ovulation, menstruation. How may the signs and symptoms of pregnancy be divided? How may the approximate date of pregnancy be estimated? Give the hygiene of pregnancy. (a) Name some of the common discomforts during pregnancy. (b) How may these be relieved? How would you prepare a room for a home delivery? List the sterile and non-sterile requisites for a home delivery. How would you sterilize the dressings in a private home? Of what articles of clothing should a layette consist? : 2) What do you understand by labor? (6) Give the three periods or stages of labor, 208 NURSING TECHNIQUE What do you understand by: (a) A nullipara. (b) A primigravida. (c) A primipara. (d) A multipara. What do you understand by the: (a) Presentation of the fetus? (b) Position of the fetus? How may the presentation and position of the fetus be ascertained? What do you understand by: (a) Attitude. (b) Engagement. (c) Lightening. What are a nurse’s duties during the first stage of labor? What is the usual duration of the first stage of labor? What are a nurse’s duties during the second stage cf labor? What is the usual duration of the second stage of labor? What dangers may attend the third stage of labor? What are a nurse’s duties during this time? Give the immediate after-care of the patient. ‘What would be your method of procedure if a postpartum hemorrhage occurred in the absence of the doctor? (a) Define eclampsia. (b) What symptoms precede eclampsia? Give the routine care of the infant from birth until the cord drops. Give the care of the premature in regard to clothing, bathing, food, activity, and air. . 5 What should a mother eat and drink who has not enough breast milk for her aby? What is phlebitis? Give the principal points in its nursing care. ‘What advice would you give the mother who is unwilling to nurse her baby? Give the nursing care during the normal puerperium. Give the nursing care following a perineorrhaphy. Give the personal hygiene of the nursing mother. Define mastitis. Give the symptoms and treatment. Define: Galactorrhea, agalactia, lactation. What is the usual procedure for drying up the breasts? DEMONSTRATIONS Make an obstetric bed (for delivery in a private home). Make an obstetric bed (for a patient following delivery in a hospital). Prepare a crib for an infant following birth. Demonstrate the preparation of a room for delivery in a private home. Demonstrate the preparation of the delivery room for delivery in a hospital. Demonstrate the preparation of a patient during the second stage of labor. Prepare a basket for a premature infant. Demonstrate the care of the genitals following delivery. Demonstrate the care of the breasts following delivery. Demonstrate the care of the newborn. NURSING PROCEDURES USED IN DISEASES OF INFANTS AND CHILDREN Lecture 1: The Physical Development of the Normal Child from Birth to Adolescence. Lecture 2: The Feeding of Normal Children. Lecture 3: Disorders of the Digestive Tract in Infancy and Childhood. Lecture 4: Disorders of the Respiratory System in Infancy and Child- hood. Lecture 5: Infectious Diseases in Infancy and Childhood. Lecture 6: The Psychology of Childhood. Lecture 7: Constitutional and Nervous Disorders in Infancy and Child- hood. Lecture 8: Surgical Conditions in Infancy and Childhood. Lecture 9: Social Aspects of Children’s Diseases. I~. Oo hw OBJECTS OF THE COURSE! 1. To help the nurse to understand something of the physical and mental development of normal children and the essential principles of child hygiene and management, so that she may intelligently care for normal children and teach others to care for them properly. 2. To teach her the principal diseases which affect children, what their special manifestations are, and how to adapt nursing measures to meet the needs of sick children. 3. To make the student nurse intelligent, skilful, and exact in the preparation of infant feedings, and to emphasize the impor- tance of proper feeding as a therapeutic measure in the diseases of infancy. 4. To give a good sound basis for later work in connection with milk depots, baby welfare, school nursing, and other fields of work where knowledge and skill in children’s nursing are of essential importance. 5. To give the student some appreciation of the causes and social aspects of infant mortality, and secure their interest and co- operation in the conservation of child life. New Demonstrations: Review: . Making a closed crib. Opening 1. Care of the newborn. Bath- a closed crib. ing infants and small chil- . Making a crib with a child in it. dren. Preparation of milk formule. 2. Preparation of a child for a Recipes. physical examination. Taking a child's temperature, 3. Assisting with an examination pulse, and respirations. of the ear, eye, nose, and . Care of a child's mouth and throat. teeth. 4. Care of the hair. ! Standard Curriculum for Schools of Nursing. 299 300 NURSING TECHNIQUE New Demonstrations: Review: 7. Care of the buttocks in infancy 5. Hypodermic injections. and childhood. 6. Klondike bed. 8. Preparation of urine specimens 7. Inhalations—croup tent. for analysis. 8. Nose and throat cultures. 9. Special procedures. 9. Preparation of vaginal smears. 10. Enemata. 11. Proctoclysis. 12. Enteroclysis. 13. Aspirations. 14. Counterirritation. 15. Catheterization. 16. Cold baths, packs, and ap- plications. 17. Hot baths, packs, and appli- cations. 18. Gavage. 19. Lavage. 20. Intubation. 21. Tracheotomy. References: : McCombs’ Diseases of Children for Nurses. Ruhrih’s Manual of Diseases of Children. Cutler's Pediatric Nursing. Grulee’s Infant Feeding. Lucas’ Children’s Diseases for Nurses. Holt’s Diseases of Infancy and Childhood. Hess's Infant Feeding. MAKING A CLOSED CRIB Requisites: Linen, piled in order on bedside table. . Double wool blanket. _ Two rubber sheets (one large enough to cover the entire mattress, the other to be used under the draw sheet). . Quilted pad (large enough to cover the large rubber sheet). Hospital crib, equipped with springs. Mattress, covered with a muslin case. . Two head pillows, covered with rubber cases.! Procedure: Lower both sides of the crib. Place the mattress in position and cover it with the large rubber sheet. Place the bed-pad over this and cover same with a sheet so that 12 to 18 inches will extend beyond the mattress at the head of the bed. Be sure that the sheet is straight and that there is the same amount on each side. Tuck it under the mattress at the top of the bed (beginning in the center) and make a square corner at the side. Tuck it under the mattress along the side at which you are standing. Put on the draw rubber so 1 A baby does not need a pillow until he is old enough to sit up. Children should be taught from birth to sleep without pillows. All pillows should be covered with rubber cases, except when used for older children. NON WN = MAKING A CRIB WITH A CHILD IN IT 301 that it will be 6 inches from the top edge of the mattress and tuck it tightly under the side of the mattress. Cover this with the draw sheet, folded double and tuck it under the mattress. Place the top sheet with the hem wrong side up and turn it under the width of the hem. Place it so that the upper edge of the sheet is on a line with the top edge of the mattress and the center fold in the center of the bed. Tuck this sheet under the mattress at the foot of the bed and make a square corner at the side. Tuck it under the mattress along the side. Place the double blanket so that its upper edges will be 6 inches from the top of the mat- tress. Tuck it under the mattress at the foot of the bed and make a square corner at the side. Tuck it under the mattress along the side. Place the spread so that its upper edge is even with the rim of the mattress at the top. Tuck it under the mattress at the foot, make a square corner, and tuck it along the side. Go to the opposite side of the bed and fold the spread and other covers back. Proceed in the same manner as on the first side." Slip the pillows into the cases so that the corners fit well. Press and smooth them so that they lie perfectly flat. Then place them on the bed, so that the second pillow is lying flat on the first one, and the seam edges are to the head of the bed. Arrange them so that the open ends of the pillow cases are on the side away from the door. Put up both sides of the crib when the bed is completed. Points to be remembered: : 1. Have all requisites at hand before beginning work. . Be sure that the mattress and pillows are well protected. - Be sure that the under clothing is tight and free from wrinkles. . Arrange the upper clothes so that they can be turned down with- out disturbing the under clothes. . Save time and energy. . Keep the surroundings neat during the work and do not consider the task completed until the chairs and table are in position and the shades adjusted. 7. Be sure that the finished crib is neat and if making more than one, have them uniform. To open the crib: Open the crib at the sides to within 15 inches of the foot. Turn the spread back over the blanket and the upper edge of the sheet, over this fold. Face the foot of the bed and grasp the upper edge of the clothes on either side between the thumb and fingers with the thumbs on top. Fold the covers down to the center of the bed and then back toward the head so that a double fold is made. AAU hw MAKING A CRIB WITH A CHILD IN IT Requisites: 1. A Chase doll in a hospital crib. 2. A complete change of linen. 3. A bath blanket. Procedure: Have the temperature of the room from 70° to 72° F. Carry the linen to the bedside and place it on the bedside table, Place 1 or 2 chairs so that they will be convenient for the bedclothes, Lower the sides of the crib. Loosen the bedclothes on all sides and re- 302 NURSING TECHNIQUE move the spread. Fold it and place it on the chair. Remove the wool blanket and cover the child with the bath blanket. Remove the upper sheet and pillows, unless the child’s illness is such that it requires the child to be propped up all the time. Proceed then as when making a bed with an adult in it. When the bed is completed, put up the sides of the crib before leaving the child. Points to be remembered: 1 be sure that the upper clothing is not too tight over the child’s ect. 2. Be sure that the under clothing is tight and free from wrinkles. 3. Keep the surroundings neat during work and do not consider the to completed until everything has been returned to its proper place. . Avoid knocking the bed during work. _ Do not throw soiled linen on the floor under any circumstances. Never put a child on another's bed while his crib is being made. ok PREPARATION OF MILK FORMULA The modification of milk is the adaptation of milk to the nutritive requirements of the individual infant.! This is made possible by the addition of water, diluents, sugar, etc., and these modifications are unlimited. Certified milk? is a milk of the highest quality of uniform composi- tion obtained by clean methods from healthy cows under special super- vision of a medical milk commission. It should not contain more than 10,000 bacteria per cubic centimeter and should not be more than thirty-six hours old when delivered. Pasteurized milk is milk which has been heated to 65° C., or 150° F., and retained at that temperature for twenty minutes and then rapidly chilled. Pasteurization? kills all the pathogenic bacteria and from 98 to 99 per cent. of the other bacteria. b Sterilized milk is milk which has been boiled from three to twenty minutes. Inspected milk is clean fresh milk which contains not more than 100,000 bacteria per cubic centimeter. It is delivered in sterile con- tainers and kept at a temperature not exceeding 50° F. The cows from which it is obtained are cared for under clean con- ditions and physically examined by a qualified veterinarian. Market milk* is milk that is not certified or inspected and is of un- known origin. Principles which underlie the modification of cow’s milk for infant feeding are two®: | 1. To change the cow’s milk into one resembling human milk as closely as possible. 2. To adapt the milk to the nutritive requirements and digestive possibilities of the individual infant. 1 Holt’s Diseases of Infancy and Childhood. 2 Cutler’s Pediatric Nursing. 3 Grulee’s Infant Feeding. 4 Cutler’s Pediatric Nursing. 5 DeLee’s Obstetrics for Nurses. | PREPARATION OF MILK FORMULAE . 303 Composition of human and cow's milk: Human. Cow's. apa a 4.0 per cent. 3.5 per cent. Piotein. a0 00 1.5 per cent. 4.0 per cent. HE Sa 7.0 per cent. 4.3 per cent. Salt va or 0.2 per cent. 0.7 per cent. Water. thus ii 87.3 per cent. 87.0 per cent. Care of nursing bottles: Immediately after use, rinse the bottles in cold water. Then clean them thoroughly by means of a brush and soap and water, and rinse them well. Before filling them with the formula, sterilize them by boiling for fifteen minutes. Care of nipples: Immediately after use, rinse the nipples in cold water, turning them inside out. Wash them thoroughly by means of a brush and warm water and soap and rinse them well. ~ Sferilize them by boiling for three minutes and place them dry in a covered sterile container. Requisites for preparation of formule: 1. One gas stove. 2. One ice-box. 3. One sink with running water (hot and cold). 4. One large table. 5. Double boiler (1 quart). 6. Milk bottles (8). 7. Bottle brush. 8. Nipples (8). 9. Nipple brush. 10. Two enamel sauce pans (large and small). 11. Wire rack for 6 bottles. 12. Chapin cream dipper. 13. Milk siphon. 14. Dairy thermometer in alcohol, 70 per cent. 15. Covered enamel container for nipples. 16. Milk bottle opener. 17. Handling forceps in alcohol, 70 per cent. 18. Jar of non-absorbent sterile cotton. 19. Three enamel graduates: 1000 c.c., 500 c.c., and 30 c.c. 20. Two enamel funnels (large and small). 21. Two enamel pitchers (large and small). 22. Three strainers (fine, medium, and coarse). 23. One enamel tray. 24. Wooden spoons (large and small). 25. Metal spoons (teaspoon and tablespoon). 26. Fork. 27. Plate. 28. Potato ricer. 29. Dish-pan. : ! DeLee’s Obstetrics for Nurses. 304 NURSING TECHNIQUE 30. Tea kettle. 31. Ivory soap on a dish. 32. Dish towel and dish cloth. 33. Sterile towels. 34. One quart bottle of whole milk. 35. Lime water. 36. Sodium citrate. 37. Essence of pepsin. 38. Milk sugar. 39. Karo sugar. 40. Pearl barley. 41. Barley flour. 42. Rolled oats. 43. Rice. 44. Lactic acid, U. S. P., 75 per cent. 45. Sodium chlorid. 46. Fairchild’s peptonizing tubes. 47. Nail brushes. 48. Gown. 49. Cap (large enough to cover hair). Procedure: . Scrub your hands. Put on cap and gown. _ Sterilize bottles, nipples, and utensils for sterile formule. . Sterilize water and prepare diluent. " Dissolve the carbohydrate in water before adding the milk. _ Have all requisites near at hand. _ Wash off neck of milk bottle before removing cap. _ Do not add milk to a warm diluent. Use a wooden spoon when stirring boiled mixtures. . Use aseptic technique when preparing diluents or formulae not boiled after being mixed. . Non-sterile utensils may be used and aseptic technique is not required when formula are boiled routinely after mixing. _- ~ OWVKENO RECIPES Whey: Put 1 pint of milk in a saucepan and heat it to 98° F. Remove it from the fire and add 2 teaspoons of essence of pepsin or 2 junket tablets. Stir it sufficiently to mix the ingredients, then cover it and allow it to stand until thick. Then break up the mixture with a fork and strain it through gauze. Cereal water: Put 2 rounded tablespoons of rolled oats! in a saucepan and add 3 teaspoon of salt and 600 c.c. of cold water. Place it directly over a low flame and boil until 300 c.c. are left. This will take about one hour. Strain the mixture, bottle and cork it, and put it on ice. Lactic acid milk:* To 1 pint of whole raw milk, add 1 dram of lactic acid U.S. P., 75 per cent. Use a medicine-dropper and stir constantly and vigorously 1 Rice or pearl barley may be substituted. 2 McCombs’ Diseases of Children for Nurses. TAKING A CHILD'S TEMPERATURE, PULSE, AND RESPIRATIONS 305 until all the lactic acid is used, 1 drop at a time. If Karo or other form of sugar is to be used, add it after the lactic acid. Strain through a fine sieve, bottle, and place it on ice. Heat in water 90° F. The prepa- ration must be made according to the above directions, otherwise a large curd forms, which is not desirable. Peptonized milk: Dissolve the contents of one Fairchild’s peptonizing powder in 4 ounces of cold water and then add 12 ounces of fresh cold milk. Place the mixture in a water-bath 110° F., for fifteen minutes, then place it on ice. Beef juice: Remove all the fat from % pound of lean round steak and broil it on both sides for about three minutes, turning it frequently to pre- vent burning. Cut it into small pieces and place it in the potato ricer and press out the juice. Season with a very little salt and place the glass of beef juice in a pan of water 130° F., until warmed through. Or the juice may be placed on ice if not served immediately. Barley water: Mix 25 grams of barley flour, with 100 c.c. of cold water. When a smooth paste is formed, add 400 c.c. of boiling water gradually, and al- low it to boil for twenty minutes over a low flame. Then strain the mixture and add enough water to make up the 500 c.c. TAKING A CHILD'S TEMPERATURE, PULSE, AND RESPIRATIONS Requisites on thermometer tray: 1. Several thermometer jars (plainly marked with each child's name), containing bichlorid solution, 1 :1000 and having a small pad of cotton in the bottom of each jar. 2. Several rectal thermometers. 3. Two covered containers (one supplied with clean cotton and the other for waste, marked ‘‘cotton’” and ‘“‘waste’’). 4. Pad and pencil. 5. Tube of vaselin. Procedure: Turn the child on his side or, if this is not possible, the temperature may be taken with him in the dorsal recumbent position. If restraint is necessary, the child may be placed flat on his abdomen. Take the thermometer from the solution, wipe it, shake it down if necessary, lubricate the bulb and insert it gently in the rectum! 1 inch and hold it in position for three minutes. Remove it and wipe the anus and the thermometer free of lubricant. Place the thermometer in the jar and record it at once. Wash the thermometer and jar daily with soap and water and pre- pare fresh solution. On the discharge of a child wash the thermometer in soap and water and place it in bichlorid, 1 : 1000 for twenty-four hours. Sterilize the jar by boiling it. Requasites for taking pulse and respirations: Watch with a second hand. ! Direct it slightly backward if the child is lying on his side and downward if lying on his abdomen. 20 306 NURSING TECHNIQUE Procedure: If possible, count the pulse and respirations, when the child is asleep. Place two or three fingers over the radial artery (making slight pressure) when counting the pulse in an older child, and over the carotid, temporal, or femoral artery in a small child. When taking the respira- tions, proceed as for an adult except that the hand may be placed di- rectly over the chest. : CARE OF A CHILD’S MOUTH AND TEETH It is not necessary to wash a healthy child’s mouth until after the teeth have appeared, as the normal secretions of the mouth keep it clean. After the appearance of the teeth, an applicator wound with cotton and dipped in sterile water or boracic acid may be used twice daily to keep the mouth in a healthy condition. A thorough cleansing each morning and evening by means of a tooth- brush and paste is recommenedd after a child is two years of age. The convalescent child may brush his own teeth, if properly supervised. Routine care of mouth and teeth: Requisites: 1. Emesis basin. 2. Tooth paste or powder. 3. Enameled cup. 4. Tooth-brush. 5. Towel. Procedure: Wash your hands and pour some warm normal salt solution into the enameled cup. Arrange the towel under the child's chin. Place some powder or paste on the dry brush and allow the child to brush her teeth until all surfaces of the teeth and gums have been gone over eight times. Then allow her to rinse her mouth with the salt solution. Give any assistance necessary by adjusting and holding the basin. Wipe the child’s mouth and remove and care for the requisites. Special care of mouth and teeth: Special care of the mouth is required in all conditions in which there is a high body temperature. It will be necessary for the nurse to clean the teeth and mouth of a very sick child or one with an elevated tem- perature. Requisites: 1. Glass of fresh water and drinking tube. 2. Tray with the following: . Towel. . Emesis basin. . Small glass for solution. . Wooden applicator with cotton swabs or mosquito artery forceps and cotton swabs (wrapped in a clean towel). . Gauze squares (wrapped in a clean towel). Paper bag and safety-pins. Lubricant. Tongue blades (wrapped in a clean towel). CARE OF THE BUTTOCKS IN INFANCY AND CHILDHOOD 307 Procedure: Wash your hands. Pour a small amount of mouth-wash in the small glass and dilute it according to directions. Pin the paper bag to the side of the bed. Place the towel under the child’s chin. Dip the applicator in the mouth-wash and press it against the side of the glass so that the mouth-wash does not drip from the applicator. Clean the teeth, the tongue, and the roof of the mouth thoroughly, using as many applicators as are indicated. Insert the tongue blade and use it as in- dicated to hold the cheek away from the teeth. If the child cannot extend his tongue, grasp it between the finger and thumb which have been previously covered with gauze. Allow the child to rinse her mouth with the antiseptic solution and follow it with plain water if desired. Dry the child's face with a towel and apply a lubricant if indicated. If the mosquito artery forceps and cotton swabs are used, proceed in the same manner. At the completion of the treatment, sterilize the small glass and for- ceps by boiling them. CARE OF THE BUTTOCKS IN INFANCY AND CHILDHOOD Special care of the buttocks is required in infancy and childhood since excoriation of these parts may be caused by soiled diapers. Requisites: 1. Basin for soiled diapers. 2. Tray with the following: . Jar of cotton balls. 2. Jar of 5 per cent. lysol solution containing forceps. 3. Flask of sterile oil. 4. Flask of unsterile oil. 5. Container of various sized safety-pins. 6. Small basin for oil. 7. Paper bag. Procedure: Carry the requisites to the bedside. Remove one or more cotton balls from the jar by means of the forceps. Place them in the small basin and pour a very small amount of unsterile oil over them. If the buttocks are excoriated, use sterile oil. Turn back the covers and re- move the pins from the diaper. Wipe the buttocks free of feces with the soiled diaper and place it in the basin for that purpose. Place a clean diaper under the child’s buttocks. Squeeze the cotton sponge against the side of the basin (using the forceps) so that it will not drip with oil. Take it in the fingers, using as many as are necessary and thoroughly cleanse the genitals and buttocks. Points to be remembered: 1. Always change a diaper immediately following a defecation. 2. Never dip a cotton ball back into the oil after it has been used. 3. Do not infect the urinary tract on girl babies when cleaning the buttocks. 308 NURSING TECHNIQUE PREPARATION OF URINE SPECIMENS FOR ANALYSIS Requusites: 1. Restraining bands for legs. 2. Test-tube. 3. Adhesive tape. 4. Safety-pins. To collect a specimen from a baby boy: Procedure: Be sure that the genitals are clean. Prepare the test-tube by covering the open end with a narrow strip of adhesive tape to prevent it injuring the parts. Place the penis in the test-tube and to secure it wrap narrow strips of adhesive tape from the tube up well over the pubis. Tie the tapes of the restraining band tightly to the side of the crib and fasten the bands around the infant’s ankles with safety-pins. To collect a specimen from a baby girl: Proceed as above as far as and including the covering of the test-tube with adhesive tape. Cut a piece of adhesive so that it will be 3 to 4 inches square. Make a hole in the middle and pass the test-tube through. Secure it with an adhesive strip. Cut out a triangular piece from the adhesive square so that the rectum will not be covered. Place it in position so that the opening of the tube is directly over the meatus, with the triangular opening over the rectum. Stick the edges of the adhesive around the vulva and secure it by means of narrow adhesive strips. Place the re- straining band in position as for a baby boy and elevate the hips on a small pillow. x : SPECIAL PROCEDURES HYPODERMOCLYSIS Solutions used: 1. Normal saline. 2. Glucose solution, 5 per cent. Quantity injected: From 100 to 500 c.c. Temperature of solution: 105° F. Site of injection: Same as for an adult. Regquisites: Same as for an adult except the needles, which should be 18 to 20 gage, 11 inches long. Procedure: Proceed as when preparing the treatment for an adult except that restraint is sometimes necessary. INTRAVENOUS INFUSION Solutions used: 1. Normal saline. 2. Glucose solution, 5 per cent. Temperature of solution: 105° F. SPECIAL PROCEDURES 309 Quantity injected: From 50 to 500 c.c. Sites of injection: 1. The median cephalic vein. 2. The median basilic vein. 3. The external jugular vein (for a small baby). Regquisites: : Same as for an adult except the needle, which should be 20 to 26 gage, 11 inches long. Procedure: Proceed as when preparing the treatment for an adult, except that restraint is sometimes necessary. ProcrocLysis Methods: 1. The drop method (10 to 20 drops per minute unless otherwise prescribed). 2. The Kelly method. Solutions used: 1. Plain water. 2. A hypotonic solution (normal saline, half-strength). 3. Glucose, 5 per cent. Temperature of solution: 100° F. Duration of treatment: Method I: For two or three hours, discontinuing it for the same length of time, and repeating the treatment until discontinued by the physician. Method II: Under two years, 1 to 3 ounces every three hours. Over two years, 3 to 4 ounces every three to four hours. Position of patient: 1. The dorsal recumbent position. 2. Fowler’s position. 3. Lying on the left side. Requisites: Same as for an adult except the soft-rubber catheter, which should be 8 to 10 F. Adhesive tape is sometimes necessary. Procedure: Proceed as when giving the treatment to an adult. For a very small child it may be necessary to wrap adhesive tape around the catheter and secure it to the buttocks, so that it will be retained. Hor WET Pack Duration of pack: From fifteen to twenty minutes. Temperature of water: 120° F. Requisites: Same as for an adult. Procedure: Proceed as when giving the treatment to an adult. 310 NURSING TECHNIQUE CoLp Pack Duration of pack: 1. For the reduction of temperature, fifteen to twenty minutes. 2. For a sedative effect, one hour. Temperature of water: 100° F. Reguaisites: Same as for an adult. Procedure: Proceed as when giving the treatment to an adult. Watch his general condition and take the pulse frequently. : CoLp SPONGE BaTtH Duration of bath: From fifteen to twenty minutes. Temperature of water: 90° F. Regquisites. Same as for an adult. Procedure: Proceed as when giving the treatment to an adult. CATHETERIZATION Position of child: Dorsal recumbent. Requisites: Same as for an adult except that a soft-rubber catheter 8 to 10 F. is used. Procedure: For a baby girl: Proceed as when catheterizing an adult, except that two nurses may be necessary if the child is active or in need of restraint. For a baby boy: Proceed as when catheterizing an adult, observing same precau- tions. ABDOMINAL STUPES OR FOMENTATIONS Regquisites: Same as an adult. Procedure: Proceed as when applying stupes to an adult, except that special precautions are necessary to prevent burning a child's tender skin. FLAXSEED POULTICE Regquisites: Same as for an adult. Procedure: Proceed as when applying a poultice to an adult. LUMBAR PUNCTURE Site of punciure: Between the third and fourth, or fourth and fifth, lumbar vertebrae. SPECIAL PROCEDURES 311 Position of child: 1. The lateral position with the child on his left side and the spine rounded, the head and shoulders bent forward and the knees drawn up. 2. A sitting posture with the child sitting upright, the head and shoulders bent forward and the buttocks brought over to the edge of the bed. Reguisites: Same as for an adult except the lumbar puncture needles, which should be 18 to 20 gage and about 3 inches long. A sheet for restraint and a bath blanket for covering the child’s shoulders are usually necessary. Procedure: Prepare the requisites as for an adult. Be sure that the room is warm. Remove the child's gown and cover him with a bath blanket. Fold the sheet lengthwise in small folds of 6 or 8 inches and place it under the child so that an equal amount will be brought up under his knees and around the back of his neck. Stand on the opposite side from the physician and bring the two ends of the sheet together so that the child's back is well arched. ABDOMINAL PARACENTESIS Site of puncture: The linea alba, midway between the umbilicus and pubes. Position of child: 1. Sitting in a chair or on the edge of the bed, with the feet and back well supported. 2. Fowler's position, close to the edge of the bed. Regquasites: Same as for an adult except that the trocar and cannula should be 18 to 20 gage and about 3 inches long. Procedure: Proceed as for an adult, except that restraint by means of a bath blanket, pinned around the child's arms and legs, is usually indicated. : THORACENTESIS Stte of puncture: Same as for an adult. Position of patient: Same as for an adult. Regquisites: Same as for an adult. Procedure. Proceed as for an adult except that restraint by means of a sheet, folded as for a lumbar puncture and used in the same way, is usually indicated. : VENIPUNCTURE Sttes of puncture: 1. The median cephalic vein. 2. The median basilic vein. 3. The external jugular vein. 4. The popliteal vein. 312 NURSING TECHNIQUE Requisites: Same as for an adult except the needles, which should be 20 to 26 gage, and about 13 inches long. Procedure: Restraint by means of a bath blanket may be necessary, otherwise proceed as for an adult, if the site of puncture is the median cephalic or median basilic veins. If the external jugular vein is used, the tourniquet will not be needed, but restraint is usually indicated. Elevate the child's shoulders on a pillow, lower his head, and turn it to one side and hold it in position. If the popliteal vein is used, place the child in the prone position. Ex- pose and prepare the inner side of the bend of the knee and use restraint as necessary. GASTRIC LAVAGE Solutions used: Same as for an adult. Temperature of solution: 100° F. Quantity of solution: From 1 to 4 pints. Position of child: 1. In an upright position on a nurse's lap. 2. On the right side in bed. Regquisites: 1. Bath blanket. 2. Tray with: 1. Soft-rubber catheter! (wrapped in a sterile towel) 10 to 20 F. For a premature baby use No. 10 F.2 For the child six months use Nos. 12 to 14 F. For the child one year use No. 16 F. For the child eighteen months use Nos. 16 to 18 F. For the child two years use No. 20 F. 2. Glass funnel. 3. Plain glass connection. : 4. Piece of rubber tubing, 6 inches long, of such bore that it can be connected to the funnel. 5. Rubber sheet. 6. Large basin (for the siphoned fluid). 7. Large pitcher (2 quarts). 8. Graduated measure. 9. Gauze sponges. 10. Towels (4). 11. Mouth-gag.? Procedure: Restrain the child by means of a bath blanket, and proceed in the 1 The Nélaton catheter is recommended by Hess (Hess's Principles and Practice of Infant Feeding. 2 Cutler’s Pediatric Nursing. 3 A good substitute for a mouth-gag is an empty spool held between the teeth with the tube run through the hole in it. (McCombs’ Diseases of Children for Nurses.) GENERAL REVIEW AND EXAMINATION QUESTIONS 313 same manner as for an adult, passing the tube slightly beyond the cardiac opening. The entrance of the tube into the stomach may be indicated by a gush of air through it or by the presence of curdled milk in itt GAVAGE Temperature of food: 100° F. Quantity of food: This depends upon the age of the child. Position of child: Dorsal recumbent. Regquisites: 1. Bath blanket. 2. Tray with: . Soft-rubber catheter (wrapped in a sterile towel). Glass syringe. . Plain glass connection. . Piece of rubber tubing about 6 inches long. Towels (4). Food in graduated bottle or measure. . Gauze sponges. . Mouth-gag. Procedure: Connect the glass syringe to the 6-inch piece of tubing. Join this to the catheter by means of the plain glass connection. Remove the plunger from the syringe. ~~ Restrain the child if necessary and proceed as when passing the tube for a lavage. After the tube is in the stomach raise the syringe about 18 inches above the child to permit the escape of gas. Then pour the required amount of food from the measure or bottle into the syringe, and allow it to enter the stomach very slowly. In the case of thick foods it will be necessary to gently force the fluid into the catheter with the plunger of the syringe. PNOAUIR LN = GENERAL REVIEW AND EXAMINATION QUESTIONS IN DISEASES OF INFANTS AND CHILDREN Why has the present era been called the “century of the child”? What do you understand by the word “pediatrics”? Are the problems which confront the nurse in the management of children different from those encountered among adults? Are the methods of treatment different? What are the essential qualifications of a good pediatric nurse? How may the development of the child be divided? What congential malformations would you look for in the newborn? What is the average weight of the full-term baby girl and boy? Why is there an initial loss of weight the first few days? Why is it unwise for a young mother to weigh her normal baby daily? Give the average increase in weight during the first six months of the normal baby’s life. During the second six months. During the second year. During the third year. Give the usual order in which the deciduous teeth appear. ! Cutler’s Pediatric Nursing. 314 NURSING TECHNIQUE Give the usual order for the appearance of the permanent teeth. Give the normal temperature and rate of the pulse and respirations of the newborn, of a child one year old, two years old, and six years old. Define: (a) Puberty. (b) Adolescence. (c) Hygiene. (¢) How may the approach of puberty in the girl be characterized? (b) How may the same condition be characterized in the boy? Give the hygiene of puberty. (a) Describe an ideal nursery in a home. (b) In a hospital. What clothes are required for the newborn? How would you launder: (a) Garments which contained some wool? (b) Diapers? At what age should the baby’s clothes be shortened? Write a 1000-word paper on an ideal children’s ward. What do you understand by aseptic pediatric nursing technique? How long should a child be isolated after admission to a hospital? List the requisites on a tray for a physical examination. How would you care for such requisites after use, as a percussion hammer and a tape measure? What important points would you remember during a physical examination of a child? Give the care of thermometers on a pediatric ward. Why should every child in the hospital have the exclusive use of a thermometer? What clothing is necessary for a sick child from one month to two years of age? Give the oral hygiene of infancy and childhood in health. In illness. How would you treat pediculi or nits in a child’s hair? What do you consider the most important branch of pediatrics? Define malnutrition. What is the cause of malnutrition? Give the treatment. Define food. Give the classification and function of food. Define calorie, vitamin, metabolism, agalactia, and colostrum. What is the natural and ideal food for infants? Name some contraindication to nursing an infant. What do you understand by the artificial feeding of infants? Name the requirements of an artificial food. What do you understand by modified milk? How may the curds in cow’s milk be made to resemble mother’s milk? What do you understand by sterilized, pasteurized, certified, market, inspected, and peptonized milk? Give the care of milk after delivery. What consideration should be given proprietary foods or so-called “Infant Foods”? Name some common dilutions of milk. Name some of the methods of modifying milk. Give the number of feedings in twenty-four hours and the amount of milk for each feeding of the newborn. What requisites are needed for the preparation of ordinary milk mixtures? Describe an ideal nursing bottle and nipple. Give the care of nursing bottles. Give the care of nipples. How would you prepare a bottle of modified milk for use? How would you proceed if a healthy infant refused his formula? If a sick infant refused his formula? How would you prepare a formula in a home? ‘What instructions about formule would you give a young mother whose infant had been discharged from the hospital? How would you prepare whey? How would you prepare 5 per cent. cereal water? How would you prepare lactic acid milk? How would you peptonize milk? How would you prepare and feed thick cereal to an infant? How would you prepare beef juice? How would you prepare barley-water? ‘When would you give orange and tomato juice and how much would you give? DEMONSTRATIONS 315 What food other than milk would you give an infant during the first year? Give a daily schedule of food for a child a year old. Give the care of the buttocks in infancy and childhood. Give the technique for collecting a specimen of urine: (a) From a baby girl. (b) From a baby boy. Do you think it important to carefully observe a baby’s stools? What would you note and record regarding stools? How would you prepare a child for hypodermoclysis? What requisites would you need? How much solution is usually injected? How would you prepare a child for an intravenous infusion? What site is usually chosen? What requisites would you need? What requisites would you need when administering proctoclysis to a child? How does the technique differ from that used for an adult? Give the temperature of the water and the duration of the treatment when applying heat to a child in the form of a hot-wet pack to produce diaphoresis. Does the technique differ from that used for an adult? How much mustard would you use in a bath given for convulsions? Give the temperature of the water and the duration of the treatment. Why are cold baths and packs used in pediatric nursing? Give the tempera- ture of the water used for a cold pack. How long would you continue the treat- ment? Give the temperature of the water used for a sponge bath, given for the reduc- tion of temperature. How long would you continue the treatment? List the requisites necessary to catheterize a baby girl. Does the technique differ from that used for an adult? Give the technique for catheterizing a baby boy. Does the technique when applying stupes to a child’s abdomen differ from that used for an adult? - Does the technique differ when applying a flaxseed poultice to a child’s chest from that used for an adult? What requisites would you have on hand for a lumbar puncture? Give the site of puncture. How would you prepare the field? Describe the position of the child. What requisites would you have on hand for an abdominal paracentesis? Give the site of puncture. Describe the position of the child. What requisites would you have on hand for a thoracentesis? Give the site of puncture. Describe the position of the child. What requisites would you have on hand for a venipuncture or aspiration of a vein? Give the site of puncture. How much blood is usually withdrawn? De- scribe the position of the child. What sized catheter would you use for a gastric lavage? Describesthe position of the child for the treatment. What solutions are commonly used? What sized catheter would you use for a gavage? Describe the position of the child for the treatment. DEMONSTRATIONS Make a closed crib. Make a crib with a child in it. Demonstrate taking a child’s temperature, pulse, and respirations. Demonstrate the care of a child’s mouth and teeth in health. Demonstrate the care of a sick child’s mouth and teeth. Demonstrate the care of the buttocks in infancy. Prepare a test-tube for collection of urine from a baby boy and girl. Demonstrate restraining a child for a physical examination. Demonstrate restraining a child for lumbar puncture. NURSING PROCEDURES USED. IN OCCUPATIONAL, VENEREAL, AND SKIN DISEASES NURSING IN OCCUPATIONAL, SKIN, AND VENEREAL DISEASES Lectures 1 and 2: Occupational Diseases. Lecture 3: Venereal Diseases, Syphilis. Lecture 4: Gonorrhea. Lecture 5: Diseases of the Skin, Introduction. Lecture 6: Lesions of the Skin. Lecture 7: Common Skin Diseases. Lecture 8: Social Aspects of Skin and Venereal Diseases. OBJECTS OF THE COURSE! 1. To make the student nurse familiar with the outstanding features of the diseases in question, so that she may be able to care for Sa cases intelligently and skilfully, and assist in preventive work. 2. To help her to understand the social significance of these diseases and to secure her interest and co-operation in removing the social and economic causes which contribute so largely to their development. New Demonstrations: Review: 1. Assisting with the administra- 1. Assisting with a lumbar punc- tion of salvarsan. ture. 2. Mercurial inunctions. 2. Hypodermic injections. 3. Assisting with the administra- 3. Application of ointments. tion of neosalvarsan. 4. Preparation of the actual cau- 4. Preparation for a Swift-Ellis tery. Sa treatment. 5. Treatment for pediculi. 6. Medicated baths. References: Bulkley’s Manual of the Skin in Health and Disease. Chapin’s Sources and Modes of Infection. Morrow's Social Diseases and Marriage. Broadhurst’s Bacteria in Relation to Man. Rosenau’s Preventive Medicine and Hygiene. ASSISTING WITH THE ADMINISTRATION OF SALVARSAN Salvarsan (arsphenamin) is the trade name of the Ehrlich-Hata prep- aration commonly called “606” because it represents that number in 1 Standard Curriculum for Schools of Nursing. 316 ASSISTING WITH THE ADMINISTRATION OF SALVARSAN 317 the series of compounds prepared by Ehrlich. It is a yellow powder containing about one-third of its weight of arsenic. It rapidly oxydizes on exposure to air and is, therefore, prepared in vacuum tubes. It dis- solves easily in cold water with a strongly acid reaction. As the acid solution is very painful the substance is converted immediately before injection into a sterile solution of slightly alkaline reaction by the addi- tion of sodium hydroxid solution, 15 per cent. Prescribed: 1. In the treatment of primary, secondary, and tertiary syphilis. 2. In the treatment of recurrent fever, frambesia, filaria, and ma- laria. Methods of administration: 1. Intramuscularly. 2. More frequently, intravenously. Sites of injection: 1. Intravenously: (a) Median cephalic vein. (6) Median basilic vein. 2. Intramuscularly: In the gluteal muscles. Dosage: 1. Intravenously: (a) For infants, 0.02 to 0.05 gram. {6) For children, 0.1 to 0.2 gram. (¢) For women, 0.3 to 0.4 gram. (d) For men, 0.4 to 0.5 gram. 2. Intramuscularly: (2) From 0.3 to 0.5 gram. (6) From 0.1 to 0.2 grams suspended in oil and given every second day until a total of 1.2 gram has been injected. Frequency of treatment: The frequency is determined by the stage of the disease and the gen- eral condition of the patient. Temperature of solution: From 65° to 80° F. Preparation of patient: Patients should not ingest food for four to six hours before and after the treatment. Position of patient: Dorsal recumbent position. Height of reservoir: From 2 to 3 feet. Duration of treatment: About ten minutes, if given intravenously. Requisites: 1. Iron tripod. 2. Small rubber pillow covered with a muslin case. 3. The “606” tray with: 318 NURSING TECHNIQUE 1. Two sterile burets graduated in 10 c.c. (outlet at bottom). . Tubing to fit burets (1 piece 3 feet long). (1 piece 1 foot long). (2 pieces 15 inches each). 3. Plain glass connection. 4. Three-way stop-cock. 5. Glass funnel. 6. Filter paper. 7. Glass stoppered mixing cylinder (60 c.c.) 8. Glass mixing rod. 9. Luer slip-joint connection (for needle). 10. Salvarsan needle. 11. File. 12. Scalpel. 13 14 15 16 17 [SS] Sterilize in autoclave. . Thumb forceps. . Medicine glass. . Medicine-dropper or pipette. . Sterile table cover. . Sterile aspirating sheet. 18. Sterile gauze sponges. 4. Tray No. 2 with: . Flask doubly distilled sterile water. 2. Flask sterile normal saline. 3. Flask alcohol. 4. Flask ether. 5. Flask sodium hydroxid, 15 per cent. g Adhesive tape or flask collodion. 8 9 fb . Ampule of salvarsan. . Receptacle (for ampule). . Alcohol lamp and matches. 10. Tourniquet. 11. Gauze bandage. 12. Sterile scrub-up forceps. 13. Sterile gauze sponges. 14. Sterile cotton. 15. Sterile gloves (2 pairs). 16. Sterile towels (1 package). 17. Bag for waste. Procedure for an intravenous injection: A nurse’s duties for an intravenous infusion or injection consists in preparing the requisites and the patient, as the injection is always given by the physician. Wash your hands and proceed as follows: Place the ampule of sal- varsan in the receptacle for same and pour enough alcohol on it to cover it well. Carry the requisites to the bedside. Provide an extra bedside table and place the tripod in the center of it. Loosen the corks in the flasks. Remove the patient’s arm from the nightgown if necessary and apply the tourniquet loosely. Place the arm on the small pillow. Place the paper bag for waste and open the gauze sponges. Scrub the anterior and sides of the arm (using scrub-up forceps) with ether and alcohol. Then place an alcohol sponge over the area and allow it to remain until ASSISTING WITH THE ADMINISTRATION OF SALVARSAN 319 the physician is ready. Open 2 packages of sterile gloves, the package of sterile towels, and the wrapper on the “606” tray. Put on sterile gloves. Place the table cover around the iron tripod and the aspirating sheet over the prepared arm. Place the gauze sponges on the sterile table. Pass the 2 burets through the metal fixtures of the tripod and ex- ercise great care to prevent contamination of your hands. (The two pieces of tubing 15 inches long have been previously con- nected to the upper projections on the three-way metal stop-cock and . the piece 1 foot long on the lower projection. The glass connection has been inserted in the free end of this piece of tubing and the piece of tubing 3 feet long has been connected to the other end of the glass con- nection. The needle then has been inserted in the free end of this piece of tubing.) Connect the open ends of the two pieces of tubing to the outlets on the burets and close the stop-cock. Remove the wire from the needle. Pour a small amount of normal saline into the left buret and test the needle. Place the glass funnel in the right buret and the filter-paper in the funnel. The physician prepares the solution after putting on sterile gloves. The preparation is as follows: About 50 c.c. of the doubly distilled sterile water is put into the sterile glass stoppered mixing cylinder. The ampule of salvarsan is then removed from the alcohol (with forceps), dried with a sterile gauze sponge, and opened with the file. It is then sprinkled on the surface of the water and stirred or shaken until thoroughly dissolved. To this solution which is free from gelatin- ous particles and absolutely clear is added about 16 drops of 15 per cent. sodium hydroxid solution. The medicine-dropper or pipet is used and a precipitate is formed which should immediately redissolve on agitation. To the clear yellow solution which is thus produced, sufficient sterile distilled water or sterile normal saline, prepared from chemically pure sodium chlorid and doubly distilled water is added to make the total volume from 100 to 200 c.c. The solution is then filtered and injected slowly, immediately after preparation. Plain normal saline is sometimes injected first to insure the needle being in the vein. The injection is sometimes followed up by normal saline so that none of the solution is left in the tubing. Draw up the tourniquet (so that venous circulation is restricted) when the physician is ready to inject the solution. Loosen the tourniquet when the needle is in the vein. After the needle is with- drawn, paint the area with flexible collodion or apply a sterile compress and retain it with a gauze bandage or adhesive tape. Procedure Jor an intramuscular injection: Cleanse the field first with ether and then paint it with iodin. In sensitive patients the site of injection may be anesthetized by an in- jection of 2 c.c. of a 1 per cent. novocain solution prior to the intra- muscular administration of the salvarsan. Intramuscular injections may be made with a slightly alkaline sal- wvarsan solution. For this purpose only about 5 c.c. of fluid is required. For its preparation 0.5 gram of salvarsan, for example, should be well triturated with 15 drops of a 15 per cent. sodium hydroxid solution in a 320 NURSING TECHNIQUE sterile mortar and diluted with distilled water to the desired volume. The injection is made deeply and very slowly. The sciatic nerve must be carefully avoided. After the injection cover the area with a sterile compress and gently massage the part to aid in the distribution of the fluid. Hydropathic measures, such as moist compresses or hip baths, may be successfully employed to prevent after pain. (Metz Labora- tories. Keep the patient in the recumbent position and do not give food for several hours. The administration of salvarsan may be followed by a severe reaction. This is characterized by: 1. Headache. 2. Nausea. 3. Malaise. 4. Chills. 5. Severe muscular pains. Points to be remembered: 1. Do not use the contents if the ampule is faulty or damaged. 2. Use only doubly distilled sterile water and do not use tap or spring water. 3. Do not use hot water for the preparation and do not heat the salvarsan solution under any circumstances. Record: 1. Hour and treatment. 2. Method of administration. 3. Dosage. 4. Any unusual symptoms which may occur. MERCURIAL INUNCTION In the constitutional treatment of syphilis mercury is frequently prescribed by the inunction method. Sites of tnunction: Select a site where the skin is thin (to aid absorption) as: First day: Right and left calves. Second day: Right thigh. Third day: Left thigh. Fourth day: Abdomen. Fifth day: Chest. Sixth day: Right arm and forearm. Seventh day: Left arm and forearm (Baketel). Duration of treatment: Twenty minutes. Frequency of treatments: Daily for seven days. Amount of ointment: Prescribed in each case (usually from % to 1 dram). Regquisites: 1. Mercurial ointment (prepared in waxed paper for a course of treatments). 2. Rubber glove. ASSISTING WITH ADMINISTRATION OF NEOSALVARSAN 321 Procedure: Cleanse the skin with hot water and soap and dry it well to favor absorption. Put on a rubber glove to prevent absorbing the poisonous drug yourself. Apply a little of the ointment at a time and with a circular movement continue rubbing until the prescribed amount has disappeared. The usual procedure is to clothe the patient in woolen undergarments and change them at the completion of the seven-day treatment, when giving the cleansing bath. After the inunction on the seventh day give the patient a hot soapy bath and continue another course on the following day. The inunctions are continued as long as the case demands. Record: 1. Hour and treatment. 2. Site of application. ASSISTING WITH THE ADMINISTRATION OF NEOSALVARSAN Neosalvarsan (neo-arsphenamin) is the trade name of an arsenic preparation called also “914.” It is a yellow powder which dissolves readily in water of room temperature. "It is less toxic than salvarsan and neutral in reaction. Methods of administration: 1. Intravenously. 2. Intramuscularly. Sites of injection: 1. Intravenously: (a) Median cephalic vein. (6) Median basilic vein. 2. Intramuscularly: The gluteal muscles. Dosage: 1. For children, 0.15 to 0.3 gram. 2. For women, 0.45 to 0.6 gram. 3. For men, 0.75 to 0.6 gram. Frequency of treatment: This depends upon the stage of the disease, the constitution, and age of the patient. As a rule, there is an interval of at least a week between treatments. Temperature of solution: From 68° to 71.6° F. Preparation of patient: The patient should not ingest food for four to six hours before and after the treatment. Position of patient: Dorsal recumbent position. Duration of treatment: About five minutes. 21 322 NURSING TECHNIQUE Requisites: ; 1. Small rubber pillow covered with a muslin case. 2. The neosalvarsan tray with: Sterile glass-stoppered mixing cylinder (25 cc). Sterile cylindrical graduate (25 c.c.). . Sterile glass funnel. . Sterile filter-paper. Sterile file. Sterile Luer syringe. _ Sterile rubber connection for above with metal slip joint. . Sterile needles (2) Sterile medicine glass. 10. Sterile forceps. 11. Sterile scalpel. 12. Sterile glass mixing rod. VE NOUR mE Sterilize in autoclave. 1. Flask doubly distilled sterile water. 2. Flask alcohol. 3. Flask ether. 4. Adhesive tape or flask collodion. 5. Ampule of neosalvarsan. 6. Receptacle for ampule. 7. Tourniquet. 8. Gauze bandage. 9. Sterile scrub-up forceps. 10. Sterile gauze sponges. 11. Sterile cotton. 12. Sterile gloves (for physician). 13. Sterile towels (1 package). 14. Sterile aspirating sheet. 15. Bag for waste. Procedure: A nurse's duties consist in preparing the requisites and the patient, as the injection is given by the physician. Wash your hands and proceed as follows: Place the ampule of neosalvarsan in the receptacle for same and pour enough alcohol on it to cover it well. Carry the requisites to the bedside. Loosen the corks in the flasks. Remove the patient's arm from the nightgown if necessary and apply the tourniquet loosely. Place the arm on the small pillow. Place the paper bag for waste and open the gauze sponges. Scrub the anterior and sides of the arm (using scrub-up forceps) with ether and alcohol. Then place an alcohol sponge over the area and allow it to remain until the physician is ready. . Open the wrappers containing the sterile towels, the aspirating sheet, the physician’s gloves, and the wrapper around the neosalvarsan tray. The physician then places the aspiration sheet, after he has put on the sterile gloves. He prepares the solution as follows: The required amount of drug is put into the 25-c.c. glass-stoppered mixing cylinder. Then the necessary amount of doubly distilled sterile PREPARATION FOR A SWIFT-ELLIS TREATMENT 323 water is added in the proportion of 0.15 gram to at least 25 c.c. of doubly distilled sterile water, or 0.4 per cent. saline solution. (In some instances a concentrated solution may be employed. For this purpose 0.45 to 0.5 gram is dissolved in 10 c.c. to 15 c.c., 0.75 to 0.9 gram in 15 c.c. to 25 c.c. doubly distilled sterile water, and the injection made with a syringe instead of by gravity.) The solution is stirred with the mixing rod until thoroughly dissolved. It is then filtered into the cylindrical graduate from which it is drawn into the Luer syringe and injected very slowly. For an intramuscular injection of neosalvarsan an approximate 5 per cent. solution should be used. For each 0.15 gram about 3 c.c. of doubly distilled sterile water is required, as 1 gram of neosalvarsan dis- solved in 20 c.c. of water gives an isotonic solution. Before administering the intramuscular injection it is advisable to decrease sensibility by injecting 5 c.c. of £ per cent. novocain solution. An injection of neosalvarsan may be followed by a reaction similar to that of salvarsan, therefore keep the patient quiet and watch him for several hours following the treatment. Points to be remembered: 1. Use only doubly distilled sterile water. 2. Do not heat the solution under any circumstances. Record: : 1. Hour and treatment. 2. Method of administration. 3. Dosage. 4. Any unusual symptoms which may occur. PREPARATION FOR A SWIFT-ELLIS TREATMENT “In cerebrospinal syphilis and the parasyphilitic diseases the Spirochzeta pallida is present in the tissues of the central nervous sys- tem. There is little, if any, excretion of arsenic from the blood into the cerebrospinal fluid after the intravenous administration of salvarsan. Salvarsan and neosalvarsan, injected directly into the subarachnoid space, are too irritating and dangerous. The serum of patients who have received salvarsan intravenously has a definite inhibitory action on the growth of the Spirochzta pallida. Its maximum effect is reached one hour after the intravenous injection and is increased by heating to 132° F., or 36°C.” Drs. Homer F. Swift and Arthur W. M. Ellis, New York physicians of the Rockefeller Institute, have developed the method of injecting the salvarsanized serum intradurally in the treatment of general paresis. The procedure is as follows: 1. Salvarsan or neosalvarsan is injected intravenously, usually in a maximum dose. 2. One hour later 40 c.c. of the patient's blood is withdrawn by venous puncture. This is allowed to coagulate, after which it is centrifuged. : : 3. The next day 12 c.c. of the clear serum are removed by means of a pipet and mixed with 18 c.c. of sterile normal saline and heated for half an hour at a temperature of 132° F., or 56° C. 324 NURSING TECHNIQUE 4. Lumbar puncture is performed and 15 c.c. of spinal fluid is with- drawn. 5. This is followed by the injection of 30 c.c. of diluted serum, at body temperature, into the subarachnoid space. 6. The foot of the bed is raised for one hour. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION IN OCCU- PATIONAL, SKIN, AND VENEREAL DISEASES What are the objects of the course of occupational, skin, and venereal diseases? (a) What do you understand by an occupational disease and give three ex- amples? (0) Is it compulsory for physicians to report specific occupational dis- eases as they do infectious diseases? (a) How may occupations be classified? (8) Do occupational dusts induce a pathologic condition? ~(c) What irritating gases may cause occupational diseases? (a) How would you insure freedom from infection through the handling of rags? (b) What parasitic diseases may be transmitted through hides, hair, and polluted soil? What are the functions of the skin? Describe the structure of the skin. Describe the blood-supply of the skin. Give the classification of nerves found in the skin. Name the appendages of the skin. (¢) Define a lesion. (b) What do you understand by a primary lesion? (c) What do you understand by a secondary lesion? (a) Name the primary lesions. (b) Name the secondary lesions. (a) When is salvarsan indicated? (b) How is it administered. (c) What is the site of injection? (a) What is the dosage? (b) How is the frequency of the treatments deter- mined? (c) Give the temperature of the solution. (a) What preparation would you give the patient? (b) Describe the position of the patient for the treatment. (a) What nursing measures may be used to prevent pain following an intra- muscular injection of salvarsan? (b) What are the symptoms of a severe reaction following an intravenous injection of salvarsan? What points would you remember in preparing for and assisting with the administration of salvarsan? : How may mercury be administered in the treatment of syphilis? (a) Give the site of inunction. (b) Give the duration of the treatment. (a) Why should a nurse wear a glove when giving a mercurial inunction? (b) Why is a different site chosen for each treatment? J (a) How is neosalvarsan administered? (b) Give the site of injection and the osage. Give the frequency of the treatment and the temperature of the solution. (a) What preparation would you give the patient? (b) What points would you remember in preparing for and assisting with the administration of neo- salvarsan? : What do you understand by the Swift-Ellis treatment? DEMONSTRATIONS Demonstrate preparing for and assisting with the administration of salvarsan (intravenously). Demonstrate giving a mercurial inunction. Demonstrate preparing for and assisting with the administration of neo- salvarsan (intravenously). ‘ FIRST SEMESTER ~ <4 js > oh © Zz, 2) w NURSING PROCEDURES USED IN MENTAL AND Lecture Lecture Lecture Lecture Lecture Lecture Lecture Lecture Lecture Lecture 10: Lecture 11: NERVOUS DISEASES NURSING IN MENTAL AND NERVOUS DISEASES 1: wn O 00 3 ON Wt x Review Anatomy and Physiology of the Central Nervous System. Neurology: Disorders of the Cord. : Neurologic Conditions Associated with Abnormal Mental States. s : Organic Reaction Types. Delirium and Infectious Exhaustive States. States of Defect: Idiocy and Imbecility. Dementia Praecox. Manic-depressive Psychoses. Psychasthenia and Hysteria. Psycho-analysis in Diagnosis and Treatment. Social Aspects of Mental Diseases. OBJECTS OF THE COURSE! 1. To teach the student nurse the relationship between mental and physical illness and the application of general nursing prin- ciples to mental nursing. 2. To teach the underlying causes of mental disease with modern methods of treatment available both in the hospital and in the community and to endeavor to overcome the stigma attached to mental illness or mental hospital care. 3. To train the nurse in observation of symptoms as expressed in early childhood and in later life through the behavior of pa- tients, so that the early signs of mental illness may be under- stood and appreciated, and so that she may give active and intelligent co-operation in movements for the prevention of mental illness. 4. To teach the importance of directed habits of thought, desirable associations and proper environmental conditions in early childhood, and to show the relationship of make up to mental disorders. 5. To assist in developing resourcefulness, versatility, adaptability, and individuality in the nurse. To emphasize qualities es- sential to success in mental work and the importance of special training in this branch of nursing. ! Standard Curriculum for Schools of Nursing. 327 328 NURSING TECHNIQUE New Demonstrations: Review: . Medicated baths. . Pressure sores. . Assisting with the administra- tion of salvarsan and neo- salvarsan. 4. Mercurial inunctions. 5. Hypodermic injections. 6. Lumbar puncture. 7. Swift-Ellis treatment. 8 9 10 1. Restraint of patients. 2. Giving a spinal douche. WN = . Continuous baths. . Cold pack (Method II). . Cold sponge bath. 11. Gavage. 12. Nasal gavage. References. Bailey's Nursing Mental Diseases. Lippincott’s Mental Medicine and Nursing. Bowers’ Manual of Psychiatry. RESTRAINT OF PATIENTS Various forms of restraint formerly employed for the control of mani- acal and delirious patients have been discontinued in many hospitals * today and hydrotherapy substituted with satisfactory results. Some hospitals do not permit the use of restraint. In others its use is governed by very strict rules. Appliances used for restraint: 1. Straight jacket or camisole. 2. Leather wristlets and anklets. Substitutes for these are: 1. Two sheets for restraining shoulders and thighs. 2. Four pieces of soft muslin, 1 yard square, for restraining hands and feet. Procedure: To restrain the shoulders: With an assistant’s help fold a sheet cornerwise. Then grasp it by the two corners and twirl it in opposite directions until a straight band is formed. Pass this under the patient’s shoulders so that an equal amount is on each side of the bed. With the assistant’s help bring the ends of this band under the patient’s arms near the axillee. Then bring the ends up over the shoulders and under the band. Cross them and tie them securely to a bar at the head of the bed. To restrain the thighs and legs: With an assistant’s help fold a sheet lengthwise in two. Place it across the thighs, so that an equal amount will be on each side of the bed. Wrap the sides around the bars at the sides of the bed and secure it by pinning it with safety-pins. To make a clove-hitch: Fold a soft piece of muslin (a yard square) cornerwise and twirl it until a straight band is formed. GIVING A SPINAL DOUCHE 329 Then make a figure-of-8, with both ends on top, but extending in the opposite directions. Put the loops together and pass them over the hands. Protect the wrists with sheet wadding or cotton and draw the ends of the bandage tightly enough to prevent the hands from slipping through. Then make a knot in both ends about 1 foot from the wrist and tie the ends to the frame of the bed on each side. The legs may be restrained in the same manner. Points to be remembered: 1. Do not restrain a patient (except in extreme emergency) with- out a physician's orders. 2. Make restraint as little obvious as possible and use no more than necessary. 3. Never leave a patient unwatched even though restrained. 4. Be sure that circulation is not impeded. 5. Pad all appliances to prevent chafing and ulceration. 6. Be sure that the legs and arms are not restrained in an uncom- fortable position. 7. Do not restrain the chest, if possible to avoid it. 8. Watch the patient, if violent, so that the padding does not be- come displaced. 9. Fasten the restraint so that the patient cannot reach the knot or buckle. 10. Watch the patient’s general condition and feel the pulse fre- quently if the patient is struggling. GIVING A SPINAL DOUCHE A spinal douche consists of a stream of water directed against the area covering the spine. Temperature of water of spray: 1. For a tonic effect, from 40° to 70° F. 2. For a sedative effect, from 95° to 100° F. 3. For an analgesic effect, from 100° to 120° F. Duration of treatment: Depends upon purpose of treatment. Temperature of water in foot-tub: From 110° to 115° F. Position of patient: 1. Sitting on a seat in the bath-tub, if the douche is given in the bath-room. 2. The lateral position, if the douche is given in bed. Reguisites: ‘ Foot-tub. Bath seat or plain board or box. Rubber pillow and case. Bath spray and twine. Two bath blankets and safety-pin. Bath mat. Chair. Two bath towels. . Thermometer. . Bedside table. Peron untan — 330 NURSING TECHNIQUE Procedure: If the patient is able to go to the bath-room, prepare the room as follows: Have the bath-room warm. Attach the spray to the faucet and tie it on to make it secure. Half fill the foot-tub with water 110° F. and place it in the large bath-tub. Arrange the bath seat or board so that the patient may sit with her back toward the faucet. Cover the seat with a small rubber pillow and arrange the chair so that it will be con- venient for the patient to sit on when the treatment is finished. Cover the seat of the chair with a bath towel and place a bath mat on the floor at the side of the tub. If the treatment is given in bed, prepare the bed and patient as for a spray or slush bath and place a hot-water bottle at the patient's feet. If the patient is permitted, she may walk to the bath-room or she may be wheeled in a chair. : When in the bath-room place a bath blanket around her so that the opening is at the back. Pin it together with a safety-pin. Remove her gown and slippers. Assist her into the tub and have her sit-on the seat with her feet in foot-tub. Place the bedside table in position so that she may lean forward and rest her arms if she desires. Arrange the blanket so that the chest and thighs are covered and the back well ex- posed. Spray the water up and down the back for the length of time prescribed. If the douche is given for a tonic effect, spray the back with hot water (testing it on your hand) for one minute and follow it with a cold appli- cation for a half a minute, using as much force as is obtainable. If the douche is given for a sedative effect, spray the back with water of body temperature so that there will be no stimuli. Use very little force. If the douche is given to relieve pain, begin it at body temperature, increasing it gradually to the maximum degree. Use little force and move the spray constantly to prevent burning. When the treatment is completed, remove the table and dry the upper part of the patient. Replace the wet blanket with a dry one. Assist the patient out of the tub and dry the thighs and buttocks. Have her sit on the chair and put on her gown. Dry her feet and put on her slippers. If the treatment is given in bed, proceed as after a spray or slush bath. Point io be remembered: Avoid burning the patient by testing the temperature of the water on your arm first. Record: 1. Hour and treatment. * 2. Duration of treatment. 3. Degree of temperature of spray. 4. Patient’s reaction to treatment. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION IN NURSING MENTAL AND NERVOUS DISEASES ‘What are the objects of the course of mental and nervous diseases? ‘What are the functions of the nervous system? Define: (a) Insanity. (b) Neurology. Name the divisions and coverings of the brain, DEMONSTRATIONS 331 Define: (a) Hallucination. (b) Delusion. (c) Illusion. (d) Romberg’s sign. (e) Aphasia. Define: (a) Neuron. (b) Neuralgia. (c) Neuropathic. (d) Disorientation. Why is mental nursing far more difficult and exhausting than general sick nursing? . Why does mental nursing demand special qualifications? What qualifications should a nurse possess who desires to do this branch of nursing? Why does the observation of symptoms present many difficulties in mental nursing? What are some of the more difficult conditions and situations which confront perplex, and test the ingenuity and resourcefulness of the nurse engaged in mental nursing? (a) Give the management of convulsions. (b) What observations should the nurse make in regard to convulsions? (a) How would you handle an excited patient? (5) How would you proceed when it is necessary to forcibly carry out orders? How would you take a cudgel or other dangerous instrument or weapon from a threatening patient? Give the care of suicidal patients. (a) Name some of the common dangers to be guarded against in mental nursing? (b) How should accidents and emergencies be met? Give the nursing care and treatment for: (az) Senile psychosis. (b) Psychosis with arteriosclerosis. (¢) Paresis. Give the nursing care and treatment for: (a) Juvenile paresis. (b) Cerebral syphilis. (¢) Tabes dorsalis. Give the nursing care and treatment for: (a) Psychosis with brain tumor. (b) Traumatic psychosis. (c) Psychosis with Huntington’s chorea. Name some of the forms of alcoholic psychoses. Give the nursing care and treatment for: (a) Delirium tremens. (b) Kor- sakow’s psychosis. Name some drugs valued in medicine for their physiologic action which pro- duce serious mental disturbances when their use is continued. Give the nursing care and treatment for drug psychoses. Give the nursing care and treatment for: (a) Infective exhaustive psychoses. (b) Manic depressive psychosis. (¢) Dementia pracox. (a) Do you approve of the use of restraint in mental nursing? (b) What pre- cautions would you observe if restraint was absolutely necessary? Give the nursing care and treatment for: (ez) Paranoia. (b) Epilepsy. ‘What do the psychoneuroses include? Give the nursing care and treatment for: (a) Neurasthenia. (b) Psychasthenia. (¢) Hysteria. Define: (a) Idiot. (b) Imbecile. (c) Cretinism. (d) Hydrotherapy. (e) Psychotherapy. (f) Hypnotism. (g) Psycho-analysis. ‘What treatments may be prescribed in nursing mental and nervous diseases? DEMONSTRATIONS Demonstrate improvising means of restraint for the hands, feet, shoulders, and thighs. Demonstrate giving a spinal douche: (1) For a tonic effect. (2) For a sedative effect. (3) For the relief of pain. NURSING PROCEDURES USED IN DISEASES OF THE EYE NURSING IN DISEASES OF THE EYE Lecture 1: Review Anatomy and Physiology of the Eye. Lecture 2: Diseases of the Eye. Lecture 3: The Observation of Early Symptoms in Diseases of the Eye and Marked Abnormalities. OBJECTS OF THE COURSE! 1. To give the student nurse a knowledge of the ordinary defects of the eye and the prevention and results of same. 2. To enable her to efficiently care for patients with diseases of this organ. 3. To stimulate an interest in this branch of nursing which will lead nurses into this field equipped for further specialization and for preventive and educational work. New Demonstrations: Review: 1. Application of ointments and 1. Preparation of patient for ex- powders to the eyes. amination of the eye. . Restraint of children. . Preparation of patient for op- eration. . Eye douche—Instillation of drops. 2. Care of artificial eyes. 2 3 4 5. Application of hot compresses 6 7 3. Irrigation of the conjunctival sac in gonorrhea ophthalmia and ophthalmia neonatorum. to the eyes. . Application of cold compresses to the eyes. . Irrigation of the conjunctival sac. References: Manhattan Eye, Ear, Nose, and Throat Nursing. Davis and Douglas’ Eye, Ear, Nose, and Throat. Lewis’ The Ophthalmic Nurse. APPLICATION OF OINTMENTS AND POWDERS TO THE EYES Ointments are prescribed: In inflammatory diseases of the lids, conjunctiva, or cornea. Regquisites: Tray with: . Small sterile basin (for boracic solution). Sterile cotton. Sterile toothpick applicators (wound tightly). . Sterile ointment. . Bag for waste. . Dressing towel. t Standard Curriculum for Schools of Nursing, 332 CARE OF ARTIFICIAL EYES 333 Procedure: Wash your hands. Prepare boracic acid solution, 2 per cent. (about 110° F.). Carry the tray to the bedside. Place the towel across the patient's shoulders. Thoroughly cleanse the lids of all discharges, scales, and crusts (using the cotton sponges moistened in the boracic acid solution). Separate the lids slightly by the fingers of the left hand and apply the prescribed amount of ointment to the lids by means of the applicator. Evert the lower lid and roll the ointment off the applicator on to the conjunctival surface. If the application of the ointment is prescribed for the conjunctiva or cornea, massage the lids gently to spread the ointment over the surface of the eyeball. Powders are prescribed: 1. Antiseptics, to prevent and overcome infections of the eye. 2. Irritants, to improve the circulation and promote the absorption of inflammatory products in indolent ulcers of the cornea. Regquisites: Tray with: . Small sterile basin (for boracic solution). . Sterile cotton. . Sterile toothpick applicators (wound loosely). . Sterile powder. . Bag for waste. . Dressing towel. Procedure: Proceed as when applying ointments, as far as and including the cleansing of the lids. Then dip the toothpick applicator into the powder. Separate the lids with the left hand and shake the powder into the eye by gently tapping the applicator with the forefinger. Instruct the pa- tient to close the lids and not to rub the eyes. Wipe off any excess powder or tears which may be caused by the irritating powder. ON ULES ON = CARE OF ARTIFICIAL EYES Artificial eyes should not be worn until all irritation of the eye socket and lids (caused from the operation) has subsided. Artificial eyes should be given special care to prevent breakage or roughening of the surface. They should be removed at night and washed. Procedure: To insert the eye: “Place the left hand flat upon the forehead and with the tips of the two middie fingers raise the upper eyelid. With the right hand, push the edge of the artificial eye beneath the upper lid, which may now be released by the fingers and allowed to drop upon the eye. The latter must then be supported by the fingers of the left hand, while with the right hand the lower lid is drawn forward and made to secure the lower edge of the shell, thus holding it firmly in place.” (Manhattan Eye, Ear, Nose, and Throat Text.) To remove the eye: “Draw down the lower lid with the middle finger of the left hand. 334 NURSING TECHNIQUE Then with the right hand place the end of a small blunt instrument under the edge of the artificial eye, which is made to slip forward over the lower lid, when it will readily drop out. This maneuver must be carried out with care, as the eye can very easily be destroyed by drop- ping on a hard surface.” (Manhattan Eye, Ear, Nose, and Throat Text.) IRRIGATION OF THE CONJUNCTIVAL SAC IN GONORRHEAL OPH- THALMIA AND OPHTHALMIA NEONATORUM Gonorrheal ophthalmia is an acute and severe purulent conjunctivitis due to gonorrheal infection. Ophthalmia neonatorum is a severe conjunctivitis of the newborn. Both conditions are highly infectious and threaten the loss of sight. For AN ApuLt Requisites: Tray with: . Sterile cotton. Sterile undine (for boracic acid, 2 per cent.). Kidney basin. Paper bag. Dressing rubber sheet. Two dressing towels and safety-pins. Rubber gloves. Goggles. . Gown. Procedure: Expert nursing care is necessary in these conditions to prevent the spread of infection. Protect yourself by wearing a gown, goggles, and rubber gloves. Protect other patients by isolating the patient. Pratect the unat- fected eye with a Buller shield made as follows: “Place a watch glass between two squares of adhesive plaster so that the piece attached to the outer or convex surface of the watch glass is somewhat the larger, and the center of each is cut out so as to allow the glass to be seen through. Place the shield over the unaffected eye and fasten the exposed adhesive surface carefully to the skin of the nose, brow, and cheek, leaving an opening for ventilation of the eye at the Le and outer angle.” (Manhattan Eye, Ear, Nose, and Throat Text. Prepare the boracic acid (110° F.) and carry the requisites to the bedside. Cover the bed and patient's clothing with the rubber dress- ing sheet and towels. Place the patient in position with the kidney basin arranged so that it will catch the return flow. Cleanse the external portions of the eye with boracic acid, 2 per cent. (95° F.), and cotton pledgets (using fresh pledgets of cotton each time) and place them immediately in the bag for waste. Evert the lower lid as follows: ‘‘Place a finger or thumb upon the lower lid, just below the lashes, and direct the patient to look upward and at the same time press downward, exposing the conjunctival surface.” (Manhattan Eye, Ear, Nose, and Throat Text.) Then thoroughly irrigate the conjunctival sac, using the undine. Evert the upper lid as follows: DONOVAN fe IRRIGATION OF CONJUNCTIVAL SAC IN GONORRHEAL OPHTHALMIA 335 “Direct the patient to look downward without inclining the head forward, and at the same time grasp the lashes of the upper lid between the thumb and forefinger of one hand and with the other place a small pencil, pen-holder, or applicator horizontally along the upper part of thelid. Then draw the lid downward and forward and at the same time press the pencil or applicator downward with the other hand.” (Man- hattan Eye, Ear, Nose, and Throat Text.) Proceed in the same manner with the upper everted lid. Dry the lids thoroughly with cotton pledgets. Disinfect all linen before sending it to the laundry and sterilize all articles used for the treatment im. mediately after use. Wash your hands and avoid touching your eyes at all times. For AN INFANT As ophthalmia neonatorum does not usually manifest itself before the third day a prophylactic treatment is given in suspected cases im- mediately after birth. ~ This is known as Credé’s treatment. - Requisites: Tray with: 1. Flask of nitrate of silver, 2 per cent. 2. Flask of normal salt solution. 3. Sterile cotton. 4. Sterile medicine-droppers (2). Procedure: Warm the normal salt solution (100° F.). Instill 1 or 2 drops of silver nitrate in each eye immediately after birth and flush them with normal salt solution. When the diagnosis has been made the irrigations are usually pre- scribed every fifteen minutes to two hours depending upon the amount of discharge. Regquisites: Tray with: . Sterile cotton. . Sterile reservoir with tubing and stop-cock. . Sterile glass connection. . Sterile catheter. . Kidney basin. Paper bag. . Dressing rubber sheet. . Dressing towels and safety-pins. . Rubber gloves. 10. Goggles. 11. Gown. 12. Irrigator standard. 13. Bath blanket and safety-pins (for restraint). Solutions: 1. Normal saline. 2. Boracic acid, 2 per cent. 3. Bichlorid of mercury, 1 : 10,000. 4. Potassium permanganate, 1 : 5000. Procedure: Wash your hands and prepare the prescribed solution (100° F.). OCROTRAUIH WI 336 NURSING TECHNIQUE Connect the catheter to the tubing from the reservoir by means of the glass connection. Carry the requisites to the bedside. Restrain the infant if necessary and place him crosswise of the bed. Place the dressing rubber covered with a dressing towel under the in- fant’s head and protect the other clothing with the dressing towel. Place the child on its side so that the treated eye is low. Place the kidney basin under the side of the infant's face. Hang the reservoir about 1 foot above the infant. Have an assistant hold the child’s head in position and protect the other eye with a dry cotton sponge over the Buller shield. Cleanse the external portions of the eye with boracic acid (using cotton pledgets) as for an adult. Then evert the lower and upper lids and irrigate from the inner canthus outward until the eye is free from discharge. : Proceed in like manner with the other eye if both are affected. Precautions: 1. Do not exert pressure on the eyeball. 2. Do not allow the solution to fall directly on the eyeball. 3. Protect the unaffected eye, if one eye only is diseased. Record: 1. Hour and treatment. 2. Kind and strength of solution. 3. Character and amount of discharge. QUESTIONS FOR GENERAL REVIEW AND EXAMINATION IN DISEASES OF THE EYE What are the objects of the course of diseases of the eye? (a) Of what does the visual apparatus consist? (b) Name the accessory organs of the eye. (¢) What do you understand by the palpebral fissure? (a) What is the function of the eyelids? (5) What do you understand by the | Meibomian glands? Describe the lacrimal apparatus. (a) What is the function of the tears? (b) How may the secretion of tears be increased? (a) What muscles are included in the extrinsic group? (0) In the intrinsic group? What nerves are supplied to the eye. What bones form the orbit of the eye? Name the three coats or tunics which compose the eyeball. Name the three refracting media or humors which are contained in the eyeball. Name four abnormal conditions which interfere with refraction. (a) When are ointments indicated in diseases of the eyes? (b) When are powders prescribed? Give the care of artificial eyes. (a) What care would you give a newborns eyes? (b) What disease of the eyes is responsible for a large percentage of the blindness in our institutions? What do you understand by: (a) Gonorrheal ophthalmia? (b) Ophthalmia neonatorum? (a) What do you understand by Credé’s treatment? (0) What are the symp- toms of ophthalmia neonatorum? (c) When does it usually manifest itself? (a) Why is complete isolation necessary when this condition exists? (b) Is a purulent discharge from the eyes of the newborn immediately after birth always a gonococcal infection? (a) Do you think it necessary to report any discharge from the eyes of a new- DEMONSTRATIONS 337 born baby? (b) Is true ophthalmia neonatorum always a gonococcal infection? (c) What dangers would you avoid when irrigating an eye affected with same? DEMONSTRATIONS (a) Demonstrate the application of ointment to the eye. (b) Demonstrate the application of powder to the eye. Demonstrate the insertion and removal of an artificial eye. Demonstrate irrigating the eye in gonorrheal ophthalmia, using an undine. Demonstrate irrigating the eye in ophthalmia neonatorum, using a catheter and a reservoir. 22 NURSING PROCEDURES USED IN DISEASES OF THE EAR, NOSE, AND THROAT NURSING IN DISEASES OF THE EAR, NOSE, AND THROAT Lecture 1: Review Anatomy and Physiology: Ear, Nose, and Throat. Lecture 2: Diseases of Mouth, Pharynx, and Larynx. Lecture 3: Diseases of Ear. Lecture 4: Diseases of Nose and Accessory Sinuses. Lecture 5: The Observation of Early Symptoms in Diseases of Ear, Nose, and Throat, and Marked Abnormalities. OBjEcTs OF THE COURSE! 1. To give the student nurse an understanding of the care and treatment of the ear, nose, and throat in normal and abnormal conditions. 2. To enable her to safely and efficiently care for patients with af- fections of these organs. 3. To arouse an interest in this branch of nursing which will lead nurses into this field, equipped with a basis for further special- ization, and for preventive and educational work. New Demonsirations: Review: 1. Instiilation of drops, removal of 1. Preparation of patient for ex- cerumen and foreign bodies amination of the ear, nose, from the ear. and throat. 2. Assisting with a myringotomy. 2. Preparation of patient for op- 3. Leeching. eration. References: 3. Care of the mouth and nose. Manhattan Eye, Ear, Nose, 4. Pharyngeal douche. and Throat Nursing. 5. Taking throat and nose cul- Davis and Douglas’ Eye, Ear, tures. Nose, and Throat. 6. Assisting with intubation. 7. Assisting with tracheotomy. 8. Nasal gavage. 9. Sprays. 10. Nasal douche. 11. Aural douche. 12. Application of heat and cold to throat. 13. Inhalations. INSTILLATION OF DROPS, REMOVAL OF CERUMEN AND FOREIGN BODIES FROM THE EAR By instillation of drops in the ear is meant the careful dropping of medication into the auditory canal by means of a medicine-dropper. 1 Standard Curriculum for Schools of Nursing. 338 Page Missing Page Missing Page Missing Page Missing /~ Putting ST. JOHN'S HOSPITAL SCHOOL OF NURSING. Record of Nursing Practice NAME. iJ fiainri casgenionnirenmmonbenis FRESHMAN YEAR Preliminary Period Class Room Ward Preliminary Period £1888 | ward Care of sick r d—bath room Care of utility r linen room Lifting patient from bed to stretcher] Making patient Care of sick room utensils. Care of sick room" after discharge of] patient - of patient for night. Preparation for and assisting with i iring a bed ! Lettering and Charting - ———— Opening a closed bed. W Physical inati isti Examination of eye—ear—nose and Making a closed bed roa isti Turning mattress with patient in Care and of flowers. Uses of various devises: 1 Care of patient each morning when Making a 's bed. bath is not glven. Giving and g bed pan A hetic bed—tabl Douching a patient Klondike bed Feeding patients. Serving liquids - Making a bed with patient in it__. Preparation for administration of last Sacraments for Catholic patient. ._|. Tain ing the temperature. ....... the Care and disinfection of "thermome- ters. Alt Suater Siaciue beds—fracture ol "and use of hot water bottle—| electric pad. Care and use of ice cap—ice ct Separation of hands for treatments —care of hands—nails_..___.___ Clstning = sherd izing rubber goods—| glass utens ‘Taking the pulse. Counting the hi Cleani Preparation > os assisting with, surgical dressing. Care of beds—beddi A jon of binders. Admission of patient Removing and replacing pillows. Removing and putting on night gown Care of mouth and teeth Care of patient's Dismi: patient. Preparation of specimens for labora- tory. Care of hair. Care of Foot bath Giving a ies Eh pati Sitz bath Moving patient up in bed E Sitting patient up in bed Sitting patient up in chair Enemas —moliont simian 8 e. Enemata — nutrient — oil — anthel- Putting patient back t of Canying patient on {Pts mide with Admini of Review... Review. ‘Written inati Oral sabi Nursing practice AVErage.uuucniunesunmmnnenmnneaala Nursing practice Average Second Semester Second Semester Douches—vaginal Pharyngeal douche i 8. Preparation of field for operation and| patient to bed Care of patient following ‘hemorrhoi-| dectomy and Admin fon of faedich Care of ized patient. Gynesdlogical examination (assist-| ing) 343 “Hypodermoclysis (assisting). FRESHMAN YEAR Second Semester Class Room Ward Second Semester Class Preparation of patient for operation. Proctoclysis (various methods) Intravenous infusion (assisting) __... Care of the body after death_._.___ Care of the new born—bathing in- fants and small childre Hot Wet PatK. occ ane rnrvaamnslene HOUBEY PAK aiionins dome oniiieenn Hot bath pack... Hottubbath. o.oo... HOt resi. connie wwe weve nimn sn Review. i ras tis esd m nnn ‘Written examination... Nursing practice examination. _____ Average. __ Catheterization of the bladder... Bladder irrigation (assisting) _ Preparation for and irrigati bladder. Cold sponge bath. Brandt bath. mabe Counterirritants—stupes IEE method: ri Poultices —sinipisms erat Plasters — belladonna — eae Dry cupping. Cold pack (various methods) Abdominal —turpentine stupés (two Soray or slush bath. «devi dans ]ii ds cantharides|_____.. Suites Wet cupping (assisting) ..._._.._...[....... Sanam. Lumbar puncture (assisting) ..._...|.____.. mone Thoracentesis (assisting) nmnetn Abdominal paracentesis FE moi, Pericardicentesis (assisting)... Phlebotomy or venesection (assist- Oral examination... Average Nursing practice examination. (assisting) .|....... ELEMENTARY BANDAGING Making and rolling bandages... Making various knots. ma. Spiral reverse of leg and foot......|._..... Application of the following bandages: Tri: and cravat. Four tailed and scultetus bandages. Gauntlet-demigauntlet.________.__ Slings—Velpeau _.__ Circular and spiral ASAE Figure of eight of lez and foot... ...... Figure of eight of shoulders and 2 yt Recurrent head bandage.........._|....... ms Bm ODHAUE Of JOWtn mini am So wm wise shen Spica (hand and arm) _______._______ Spiral reverse of arm__.___________ Figure of eight of arm and elbow. _ Spica of shoulder ELEMENTARY Barton's bandage and eye bandage..|...._._ EEA, ‘Written examination. _._.__......}......_ Talla Nursing practice examination .._.|... defined, 215 Method I, 216 Method II, 218 Method III, 219 Comfort, patient’s, physical and mental, means of securing, 45 requisites for, 45 Communicable diseases, demonstrations in, 274 nursing procedures used in, 252 objects of course, 252 questions for review and examina- tion in, 272 Compresses, cold, to chest, application of, 202 to eyes, application, 264 to throat, application, 267 hot, to eyes, application, 263 to throat, application, 268 Concurrent disinfection defined, 253 Conjunctival sac, irrigation of, in gon- orrheal ophthalmia and ophthalmia neonatorum, 334 Constipation, causes, 81 defined, 80 Contact defined, 253 Continuous catheterization defined, 282 preparation for, 282 hot-air bath, 237 defined, 237 Convalescent’s bed, making, 24 Corrigan’s pulse, 36 Counterirritant defined, 158 Counterirritants, 158 Counting the breathing, 37 Cradle for inhalations, to prepare, 201 Cradles defined, 60 Credé’s treatment, 335 Crib, closed, making, 300 for newborn, preparation of, 290 to open, 301 with child in it, making, 301 Culdesac of Douglas defined, 106 Culture defined, 266 Cultures, nose, taking, 267 throat, taking, 266 Cupping, 159, 168 dry, 169 wet, 170 Cystoscopic room, preparation of, for cystoscopy, 277 Cystoscopy defined, 276 ~ INDEX Cystoscopy, preparation of cystoscopic room for, 27 : of patient for, 276 DEATH, care of body after, 133 Decubitus. See Pressure sore. Delivery, care of patient following, 293 douche following, 102 room, preparation of, 290 prepared for labor, 291 Delousing defined, 254 Demonstrations in communicable dis- eases, 274 in diseases of ear, nose and throat, 342 of eye, 337 of infants and children, 315 in elementary procedures, 188 in nervous and mental diseases, 331 in nursing technique, 96 in obstetric nursing, 298 in occupational, skin, and venereal diseases, 324 in surgical nursing, 244 in urology, 284 DeVilbiss vaporizer, inhalation with, 199 to prepare for use, 200 Diastole defined, 35 Diastolic pressure, 203 defined, 35 Dicrotic pulse, 36 Diseases, communicable, demonstrations in, 274 examination questions in, 272 nursing procedures used in, 252 of ear, nose, and throat, demonstra- tions in, 342 examination questions in, 341 nursing procedures in, 338 of eye, demonstrations in, 337 examination questions in, 336 nursing procedures in, 332 of infants and children, demonstra- tions in, 315 examination questions in, 313 nursing procedures in, 299 surgical, demonstrations in, 244 examination questions in, 243 nursing in, 234 Dishes, disinfection of, 255 Disinfection, concurrent, defined, 253 defined, 253 of bath water, 255 of bed linen, 255 of dishes, 255 of eye, nose, mouth, and throat secre- tions, 255 23 353 Disinfection of feces and urine, 255 of sputum, 255 of utensils, 255 terminal, defined, 253 Dismissal of patients, 92 Dorsal recumbent position, 109 in gynecologic examinations, 111 draping for, 112 Double T-binders, application, 69 Douche, aural, 260 defined, 260 defined, 101 eye, 261 intra-uterine, assisting with, 248 defined, 248 nasal, 259 defined, 259 pharyngeal, defined, 108 prescribed for, 108 solutions for, 108 spinal, defined, 329 giving, 329 vaginal, 101 contraindicated, 106 Gosicain of patient during, dangers involved, 107 defined, 101 outline for study, 103 prescribed for, 101, 106 precautions in infection, 107 procedure, 102 solutions for, 101, 106 vesical, 148 ‘ Douches prescribed for cavities, 101 for external parts, 101 Douching patient externally, 29 Draping, methods of, in gynecologic ex- aminations, 112 Dressing, abdominal, procedure, 68 arm or leg, procedure, 68 hot, application of, 144 surgical, assisting with, 67 Dressing-room, 236 care of, 235 Drop method of proctoclysis, 123 Drops, instillation of, in ear, 338 defined, 338 in eyes, 262 defined, 262 Dropsy defined, 172 Drugs, how administered, 116 irritant, 159 Dry cupping, 169 pack, hot, 140 Duodenal feeding, assisting with, 213 defined, 213 Dusting, 20 Dyspnea, 37 354 EAR, diseases of, demonstrations in, 342 examination questions in, 341 nursing in, 338 examination of, assisting with, 53 position of patient for, 53 preparation of child for, 53 foreign bodies in, removal, 339 instillation of drops in, 338 defined, 338 operations, preparation of field, 115 removal of cerumen from, 339 Edematous respiration, 37 Electric cautery, 171 light bath, local, 229 defined, 229 pad, preparation of, 62 Emergency operations, preparation of field, 115 Emollient enema, defined, 85 giving, 86 prescriptions for, 85 Empyema defined, 172 Enema, anthelmintic, defined, 88 prescriptions for, 88 antiseptic, defined, 89 prescriptions for, 89 astringent, defined, 89 carminative, commonly prescribed, 84 defined, 83 giving, 83 tray equipped for, 84 classification, 77 cleansing, 77 giving, 77 tray equipped for, 78 outline for instruction on, 79 prescribed for, 77 defined, 77 emollient, defined, 85 giving, 86 prescriptions for, 85 giving to infant, 79 to small child, 79 nutrient, defined, 87 giving, 87 prescriptions for, 87 oil, defined, 88 giving, 88 prescriptions for, 88 position of patient for receiving, 77 quantity of liquid for cleansing, 77 to be retained, 77 saline, defined, 89 sedative, defined, 85 giving, 86 prescriptions for, 85 stimulating, defined, 86 giving, 86 prescriptions for, 86 INDEX Fri, temperature of the solution, Enteroclysis defined, 215 Method I, 216 Method II, 218 Method III, 219 Epispastics, 159 Erect position in gynecologic examina- tions, 112 draping for, 113 Escharotics, 159 Ether bed, preparation of, 57 Eupnea, 37 Evacuant suppository, 91 Evacuating enema, giving, 77 tray equipped for, 78 outline for instructions on, 79 prescribed for, 77 Ewald evacuating bulb, to sterilize, 66 test-meal, 207 Exaggerated Fowler’s position, 110 Examination, gynecologic, methods of draping for, 112 positions for, 111 preparation of patient for, 110 in medical nursing, questions for, 231 in surgical nursing, questions for, 243 of chest, fluoroscopic and radio- graphic, 211 of ear, eye, nose, and throat, assisting with, 53 position of patient for, 53 preparation of child for, 53 of eye, position of patient for, 53 preparation of child for, 53 of gall-bladder and kidney, fluoro- scopic and radiographic, 211 of large intestine, fluoroscopic and radiographic, 210 of nose and throat, position of patient for, 53 preparation of child for, 54 of stomach, fluoroscopic and radio- graphic, 209 physical, assisting with, 51 methods employed, 51 of child, preparation for, 52 questions for, 93, 183 in diseases of ear, nose, and throat, 341 of eye, 336 of infants and children, 313 in gynecologic nursing, 250 in nervous and mental diseases, 330 in nursing procedures in communi- cable diseases, 272 in obstetric nursing, 297 INDEX Examination questions in occupational, venereal, and skin diseases, 324 in principles and practice of nursing technique, 93 in urology, 283 Excreta, disinfection of, 255 Excretory organs, failure of function, 80 of body, 80 Expiration, 37 Expression of stomach contents, assist- ing with, 207 defined, 207 Extension, 61 External os defined, 105 respiration, 37 Extubation, assisting with, 270 in diphtheria, 270 Eyes, application of ointments and pow- ders to, 332 artificial, care of, 333 to insert, 333 to remove, 333 cold compresses to, application, 264 diseases of, demonstrations in, 337 examination questions in, 336 nursing procedures in, 332 douche for, 261 examination of, assisting with, 53 position of patient for, 53 preparation of child for, 53 hot compresses to, application, 263 instillation of drops in, 262 defined, 262 irrigation of, defined, 261 when using soft-rubber bulb or eye- dropper, 261 undine, 262 operations on, preparation of field, 115 secretions, disinfection of, 255 FaurenuEIT and Centigrade scales com- pared, 35 to convert Centigrade to, 35 to Centigrade, 35 Fallopian tubes defined, 105 Fastigium, 33 Feces, disinfection of, 255 preparation of, for analysis, 75 Feeding, duodenal, assisting with, 213 defined, 213 intubated patients, 270 nasal, defined, 212 patients, 29 Feet, brace for, to improvise, 47 care of, in admission of patient, 70 Fever, continuous, 33 course of, 33 decline period, 33 355 Fever, defervescence period, 33 defined, 33 intermittent, 33 invasion period, 33 onset period, 33 periods of, 33 remittent, 33 stages of, 33 stationary period, 33 symptoms present, 33 types of, 33 Field of operation, preparation of, 113 Flatiron, application of, 171 Flaxseed poultice, 164 in infancy, 310 Flowers, care and arrangement of, 27 Fluoroscope defined, 209 Fluoroscopic examination cof chest, 211 of gall-bladder and kidney, 211 of large intestine, 210 of stomach, 209 Fluoroscopy defined, 209 preparation of patient for, 209 Fomentations, 159 abdominal, applying, 159 in infancy, 310 sterile, 161 turpentine, 161 Fomites defined, 254 Foot-bath, 71 giving, 71 in bed, 72 out of bed, 72 indications for, 72 mustard, 73 Foreign bodies in ear, removal, 339 Fowler’s position, 110 Pryeriong) method of gastric analysis, 8 Fracture board, 60 cart, 61 Frame, Bradford, 61 Freshman year, first semester, pre- liminary course, 17 Fumigation defined, 253 GALL-BLADDER and kidney, examina- tion of, fluoroscopic and radiographic, 211 Gastric analysis, the fractional method, 208 i preparation of, for analysis, 5 lavage, assisting with, 205 defined, 205 in infancy, 312 tube, to sterilize, 66 Gastrostogavage defined, 214 356 Gastrostomy defined, 214 Gavage, 211 defined, 211 in infancy, 313 nasal, defined, 212 Genitals, operation on, douche follow- ing, 102 Genupectoral position in gynecologic examinations, 111 draping for, 112 Giving carminative enema, 83 cleansing or evacuating enema, 77 enema to infant, 79 to small child, 79 foot-bath, 71 hypodermic injections, 118 sitz-bath, 73 spinal douche, 329 spray or slush bath, 157 tub bath, 56 Glass utensils, cleaning of, 66 steriliztion of, 66 Gloves, rubber, dry, to put on, 65 sterilization of, 65 to patch, 65 wet, to put on, 65 Gonorrheal ophthalmia defined, 334 irrigation of conjunctival sac in, 334 Grafting skin, preparation of field, 115 Graphic sheet demonstrating method of recording fluid intake and urinary out- put, 280 Gravity method of proctoclysis, 125 Gynecologic examination, methods of draping for, 112 positions for, 111 preparation of patient for, 110 nursing, demonstrations in, 251 objects of course, 245 procedures used in, 245 questions for review and examina- tion, 250 Har, care of, 40 to wash in bed, 41 Hands and nails, care of, 64 preparation of, for operations and treatments, 64 Hanging drop, 245 Hard-rubber goods, to sterilize, 66 Head, physical examination of, assisting with, 51 Heat, dry, forms applied in, 137 forms applied in, 137 how applied, 137 irritants, 159 moist, forms applied in, 137 Heated metal, application of, 171 INDEX Heliotherapy, 230 defined, 230 Hemorrhage, arterial, tourniquet for, 240 venous, tourniquet for, 241 Men priheiteern nursing care after, Horizontal recumbent position, 109 Hot applications, 137 bath pack, 141 baths, 137 compresses to eyes, application, 263 to throat, application, 268 dressings, application of, 144 dry pack, 140 packs, 137 tub bath, 143 wet pack, 138 in infancy, 309 local, 228 defined, 228 Hot-air bath, continuous, 237 defined, 237 defined, 223 in bed, 223 local, 229 defined, 229 Hot-water bath, local, 236 defined, 236 bottle, preparation of, 62 Hydrocephalus defined; 172 Hydrothorax defined, 172 Hygiene of nurse in communicable dis- eases, 253 of Retlert in communicable diseases, 2 of ward, 19 Hypodermic injections, dangers to be avoided, 119 giving, 118 intramuscular, 120 sites for, 119 9s. subcutaneous, 119 intravenous, sites for, 119 methods of administration, 118 needles for, 119 preparation of field, 115 prescribed for, 119 problems on, 121 procedure, 119 requisites, 119 subcutaneous, 120 sites for, 119 Hypodermoclysis, assisting with, 126 defined, 120 in infancy, 308 methods, 127, 128 when prescribed, 126 Hypoglycemia, beginning, warning symp- toms of, in insulin administration, 221 INDEX IcE suppository, 91 to make, 91 Ice-cap, preparation of, 63 Ice-coil, 63 preparation of, 63 Tletin defined, 220 Infant at birth, care of, 204 bathing, 134 care of buttocks, 307 routine, 294 diseases of, demonstrations in, 315 nursing procedures in, 299 questions for examination and re- view, 313 giving enema to, 79 irrigation of conjunctival sac in, for ophthalmia neonatorum, 335 premature, bed for, 297 care of, 294 clothing for, 296 feeding, 295 shower bath for, 136 sponge bath for, 135 tub bath for, 136 weighing from 1800 to 2000 grams, feeding, 296 from 2000 to 2500 grams, feeding, 296 less than 1800 grams, feeding, 295 Infections in newborn, 136 Infusion, intravenous. See Intravenous infusion. of quassia, to make, 88 Inhalation, 197 amyl nitrite, 197 aromatic spirits of ammonia, 199 defined, 197 oxygen, 199 steam, 200 stramonium, 199 with DeVilbiss vaporizer, 199 with Pelton electric vaporizer, 198 with pitcher and towel, 198 Injection, urethral, 281 Injections, hypodermic. dermic injections. of salvarsan and neosalvarsan, prep- aration of field, 115 Insertion of pessaries, tampons, and packing, assisting with, 246 Inspected milk, 302 Inspiration, 37 Instillation, bladder, 279 defined, 279 of drops in ear, 338 defined, 338 in eyes, 262 defined, 262 Instruments, cleaning of, 66 See Hypo- 357 Instruments, sterilization of, 66 Insulin, administration of, 220 action of, 220 dosage, 220 frequency of injections, 220 indications for, 220 methods, 220 precautions in, 221 warning symptoms of beginning hypoglycemia, 221 Internal os defined, 105 respiration, 37 Intestine, large, divisions of, 82 examination of, fluoroscopic and radiographic, 210 functions, 82 structure of, 81 Sms douche, assisting with, 8 defined, 248 Li infusion, assisting with, 29 defined, 129 in infancy, 308 preparation of field, 115 when prescribed, 129 injection, tourniquet for, 241 Intubated patients, feeding, 270 Intubation, assisting with, 269 defined, 269 Inunction defined, 89 mercurial, for syphilis, 320 Irrigation of bladder, 148 of colon, 215 defined, 215 Method 1, 216 Method II, 218 Method III, 219 of conjunctival sac in gonorrheal oph- thalmia and ophthalmia neona- torum, 334 of eyes, 261 defined, 261 when using soft-rubber bulb or eye- dropper, 261 undine, 262 Irritant drugs, 159 Isolation defined, 253 nurse, hygiene of, 254 of patient, 254 of sick-room, 254 JACKET, pneumonia, application of, 201 Junior year, first semester, procedures used in medical nursing, 191 second semester, nursing proced- ures, 285 358 KErry method of proctoclysis, 125 Kidney. and gall-bladder, examination 7 fluoroscopic and radiographic, 211 each, functional efficiency of, to deter- mine, 225 operations, preparation of field, 114 Kite-tail tampon, 247 Klondike bed, indications for, 59 making, 59 Knee-chest position in gynecologic ex- aminations, 111 draping for, 112 Knees, brace for, to improvise, 47 LABOR, first stage, 288 preparation during, 288 preparation for physician, 289 of patient for, 288 second stage, 288 nurse’s duties during, 290 preparation during, 290 stages of, 288 third stage, 288 preparation during, 292 Laboratory specimens, preparation of, for analysis, 75 Lactic acid milk, 304 Laparotomy, preparation of field, 114 Laryngoscopy, position of patient for, 53 preparation of child for, 54 Lateral position, 110 Lavage, gastric, assisting with, 205 defined, 2035 in infancy, 312 tube, to sterilize, 66 Layette, 288 Leech, to apply, 341 to remove, 341 Leeching, 340 § defined, 340 Leg dressing, procedure, 68 operations, preparation of field, 115 Legs, physical examination of, assisting with, 52 Lifting’ patient from bed to operating cart, 50 Light, electric, bath, local, 229 defined, 229 Linen, bed, disinfection of, 255 room, care of, 27 Liniment defined, 90 to apply, 90 Liquids, serving, 29 Lithotomy position in gynecologic ex- aminations, 111 draping for, 112 Local anesthetic, needle for, 119 INDEX Local anesthetic, to inject, 120 electric light bath, 229 defined, 229 hot wet pack, 228 defined, 228 hot-air bath, 229 defined, 229 hot-water bath, 236 defined, 236 Lubricants for dry mouth, 40 Lumbar puncture, assisting with, 172 defined, 172 in infancy, 310 MAKING closed crib, 300 crib with child in it, 301 Klondike bed, 59 obstetric bed, 289 Many-tailed binder, application, 69 Market milk, 302 Mose operations, preparation of field, 11 Mattress, air, 60 uses of, 60 care of, 27 changing, with patient in bed, 55 turning, with patient in bed, 54 water, 60 uses of, 60 Medical diseases, nursing in, 193 nursing, demonstrations, 233 procedures used in, 191 questions for review and examina- tion, 231 Medicated baths, 257 defined, 257 Medicine case, cleaning, 26 Medicines, administration of, 116 abbreviations and symbols used, 118 by mouth, 116 procedure, 117 Mental and nervous diseases, nursing procedures used in, 327 Mercurial inunction for syphilis, 320 Metal, heated, application of, 171 Micro-organisms, examination of, 245 Milk, certified, 302 cow’s, modification of, principles un- derlying, 302 formule, preparation of, 302 human and cow’s, composition of, 303 inspected, 302 lactic acid, 304 market, 302 modification of, 302 pasteurized, 302 peptonized, 305 peptonizing for nutrient enema, 87 INDEX Milk, sterilized, 302 Modification of milk, 302 Morning care of patient without bath, 55 Mosenthal’s test-meal for renal func- tion, 226 Motor power of stomach defined, 207 Mouth and teeth, child’s, care of, 306 care of, 40 dry, lubricants for, 40 : operations, preparation of field, 115 secretions, disinfection of, 255 special care of, 255 temperature, taking, 34 when not to take, 34 thermometer tray, requisites on, 33 Mouth-washes, 40 Moving patient up in bed, 46 if convalescing and not neces- sary to support head, 46 if heavy, 46 if in need of support, 46 when small, 46 Murphy method of proctoclysis, 125 Mustard bath, 258 foot-bath, 73 leaf or paper sinapism, 166 plaster or paste sinapism, 166 poultice, 164 Myringotomy, assisting with, 339 defined, 339 Nat brushes, sterilization of, 64 Nails and hands, care of, 64 Nasal douche, 259 defined, 259 feeding, 212 defined, 212 gavage, 212 defined, 212 Nauheim bath, 258 Neo-arsphenamin, administration of, 321 defined, 321 Neosalvarsan, administration of, assist- ing with, 321 by intramuscular injection, 323 dosage, 321 preparation of solution, 322 defined, 321 Nervous and mental diseases, nursing procedures used in, 327 Neutral bath, 238 defined, 238 Newborn, bath for, 134 bed for, 290 care of, 134 clothing for, 288 crib for, preparation of, 290 first oil bath, 134 . 359 Newborn, infections in,136 oil bath for, first, 134 second, 135 ophthalmia of, irrigation of conjunc- tival sac in, 335 premature, care of, 294 - second oil bath, 135 Night, preparation of patient for, 56 Nightgown, to put on, 39 to remove, 39 “014,” 321 Nipples, care of, 303 Nose cultures, taking, 267 diseases of, nursing in, 338 examination of, assisting with, 53 position of patient for, 53 preparation of child for, 54 operations, preparation of field, 115 secretions, disinfection of, 255 special care of, 255 to spray, 257 Nurse, hygiene of, in communicable dis- eases, 253 isolation, hygiene of, 254 Nursing bottles, care of, 303 care after hemorrhoidectomy, 115 after perineorrhaphy, 115 essential principles, 44 gynecologic, demonstrations in, 251 objects of course, 245 procedures used in, 245 questions for review and examina- tion, 250 in medical diseases, 193 objects of course, 193 in surgical diseases, 234 objects of course, 234 medical, demonstrations, 233 procedures used in, 191 questions for review and examina- _tion, 231 obstetric, demonstrations in, 298 objects of course, 287 procedures used in, 287 questions for review and examina- tion, 297 procedures used in communicable dis- eases, 252 demonstrations, 274 objects of course, 252 questions for review and ex- amination in, 272 in diseases of ear, nose, and throat, 338 demonstrations, 342 objects of course, 338 questions for review and examination, 341 of eye, 332 360 Nursing procedures used in diseases of eye, demonstrations, 337 objects of course, 332 questions for review and ex- amination, 336 of infants and children, 299 demonstrations, 315 objects of course, 299 questions for review and examination, 313 in mental i nervous diseases, 32 demonstrations, 331 objects of course, 327 questions for review and examination, 330 in occupational, venereal, skin diseases, 316 demonstrations, 324 objects of course, 316 questions for review and examination, 324 in urology, 275 demonstrations, 284 objects of course, 275 questions for review and ex- amination, 283 surgical, demonstrations i in, 244 objects of course, 234 procedures used in, 234 questions for review and examina- tion, 243 technique, defined, 19 demonstrations, 96 essential points in, 19 introductory, 19 objects of course, 19 questions for review and examina- tion, 93 Nutrient enema defined, 87 giving, 87 prescriptions for, 87 and OBSTETRIC bed, making, 289 nursing, demonstrations i in, 298 objects of course, 287 procedures used in, 287 questions for review and exan na- tion, 297 Occupational diseases, cedures in, 316 demonstrations, 324 examination questions in, 324 objects of course, 316 Odors, prevention of, precautions for, 20 Oil bath for newborn, first, 134 second, 135 nursing pro- camphorated, 201 INDEX Oil enema defined, 88 giving, 88 prescriptions for, 88 poultice, 165 rancid, 134 Ointment, application of, 89 to eyes, 332 cantharidal, applying, 168 defined, 89 method of application, 90 prescribed for, 90 Onion poultice, 165 Operating cart, lifting patient from bed to, 50 Operations, abdominal, preparation of field, 1 and treatments, preparation of field for, 113 on genitals, douche following, 102 preparation of patient for, 121 Ophthalmia, gonorrheal, defined, 334 irrigation of conjunctival sac in, 334 neonatorum, defined, 334 irrigation of conjunctival sac in, 334 Orange wood sticks, sterilization of, 64 Orthopnea, 37 Otoscopy, position of patient for, 53 preparation of child for, 53 Ovaxles defined, 105 Pack, cold, 150 giving, 153 in infancy, 310 hot, 137 bath, 141 dry, 140 wet, 138 in infancy, 309 local, 228 defined, 228 Packing, insertion of, assisting with, 246, [7 248 vaginal, assisting with, 248 removal, assisting with, 248 Pelsis operations, preparation of field, 1 Palpation method of determining blood- pressure, 204 Paquelin cautery, 171 Paracentesis, 172 abdominal, 177 assisting with, 177 defined, 177 in infancy, 311 Paraffin tube, transfusion by, assisting with, 194 Pagesis general, Swift-Ellis treatment | gon, 3 23 INDEX Pasteurization, 302 Pasteurized milk, 302 Patient, admission of, 69 after delivery, care of, 293 anesthetized, putting to bed, 109 care of, each morning when bath is not given, 55 carrying on chair made with hands, 49 comfort, physical and mental, means of securing, 45 requisites for, 45 condition, changes in, manifestations, 45 dismissal of, 92 douching externally, 29 feeding, 29 giving a tub-bath, 56 hygiene of, in communicable diseases, 253 in bed, changing mattress, 55 giving cleansing bath to, 43 hot-air bath for, 223 making bed, 30 turning mattress, 54 vapor bath for, 221 washing hair, 41 intubated, feeding, 270 isolation of, 254 lifting from bed to operating cart, 50 moving up in bed, 46 pediculi on, 70 personal belongings, care of, 71 position of, for examination of ear, 53 of eye, 53 of nose and throat, 53 for giving enema, 77 for lumbar puncture, 173 preparation of, for cystoscopy and catheterization of ureters, 276 for gynecologic examination, 110 for labor, 288 for night, 56 for operation, 121 for radiography and fluoroscopy, 209 and pyelography, 275 putting back in bed, 49 restraint of, 328 sitting up in bed, 47 in chair, 48 Pediculi corporis, destruction of, pro- cedure, 71 on patient, classification of, 70 treatment, 41 Pediculus capitis, 71 corporis, 70 pubis, 71 Pelton electric vaporizer, inhalation with, 198 361 Pelton electric vaporizer, to prepare for use, 200 Peptonized milk, 305 Peptonizing milk for nutrient enema, 87 Pericardicentesis, assisting with, 179 defined, 179 Pericardium, aspiration of, with, 179 defined, 199 Perineorrhaphy, nursing care after, 115 Pessaries, insertion of, assisting with, 246 Pessary defined, 246 Pharyngeal douche defined, 108 prescribed for, 108 solutions for, 108 Phenolsulphonephthalein defined, 224 how eliminated, 224 test defined, 224 Phlebotomy, assisting with, 181 defined, 181 Physical examination, assisting with, 51 methods employed, 51 of child, preparation for, 52 Pillows, care of, 27 to remove, 38 when patient is in need of support, 38 assisting is not in need of support, 38 to replace, 39 when Pi ont is in need of support, 9 is not in need of support, 39 Plaster, adhesive, 168 applying, 167 belladonna, 167 cantharides, 167 capsicum, 167 Pleurisy with effusion defined, 172 Pleurocentesis defined, 175 Pneumonia jacket, application of, 201 Pneumothorax, artificial, defined, 271 preparation for, 271 defined, 172, 271 Polypnea, 37 Position of donor and donee for trans- fusion, 195 of patient for examination of ear, 53 of eye, 53 of nose and throat, 53 for giving enema, 77 for lumbar puncture, 173 Positions, postoperative, for patient in bed, 109 used for gynecologic examinations, 111 methods of draping, 112 Dean positions for patient in bed, 109 Poultice, antiphlogistin, 165 applying, 163 362 Poultice, bread, 164 flaxseed, 164 in infancy, 310 mustard, 164 oil, 165 onion, 165 preparing, 163 soap, 164 Powders, application of, to eyes, 332 Premature infant, bed for, 297 care of, 294 clothing for, 296 feeding, 295 Preparation and care of actual cautery, during first stage of labor, 288 second stage of labor, 290 third stage of labor, 292 for artificial pneumothorax, 271 for continuous catheterization, 282 for Swift-Ellis treatment, 323 of anesthetic bed and table, 57 of baby’s crib, 290 of child for examination of ear, 53 of eye, 53 of nose and throat, 54 for physical examination, 52 of delivery room, 290 of electric pad, 62 of field for operations and treatments, 113 of hands and arms for operations and treatments, 64 of hot-water bottle, 62 of ice-cap, 63 of ice-coil, 63 of Jhonny specimens for analysis, of milk formule, 302 of patient for cystoscopy and cath- eterization of ureters, 276 for gynecologic examination, 110 for labor, 288 for night, 56 for operation, 121 for Iiographey and fluoroscopy, 09 and pyelography, 275 of poultices, 163 of urine specimens for analysis, 308 Pressure, coefficient of, 203 diastolic, 203 defined, 35 normal readings, 203 pulse, 36, 203 sore, aggravated by, 42 causes, 42 defined, 42 patients in danger of developing, 42 INDEX Pressure sore, preventive measures, 42 treatment, 43 when sloughing, treatment, 43 where developed, 42 systolic, 203 defined, 35 Procedures used in communicable dis- eases, 252 in diseases of ear, nose, and throat, 338 of eye, 332 of infants and children, 299 in gynecologic nursing, 245 in medical nursing, 191 in obstetric nursing, 287 in occupational, venereal, and skin diseases, 316 in surgical nursing, 234 in urology, 275 Proctoclysis, 122 defined, 122 drop method, 123 gravity method, 125 in infancy, 309 Kelly method, 125 methods, 122 Murphy method, 125 positions for, 123 solutions for, 123 when prescribed, 122 Prone position, 110 Pulse, child’s, taking, 305 Corrigan’s, 36 defined, 35 dicrotic, 36 force of, 36 frequency of, 35 infrequent, 36 intermittent, 36 normal rates, 35 pressure, 36, 203 regular, 36 running, 36 taking, 35 points to be remembered, 36 procedure, 36 things to note, 35 thready, 36 to breathing, ratio of, 37 to temperature, ratio of, 36 water hammer, 36 where taken, 36 Puncture, lumbar, assisting with, 172 defined, 172 in infancy, 310 Punctures, 172 preparation of field, 115 Putting anesthetized patient to bed, 109 patient back in bed, 49 INDEX Pyelography defined, 275 preparation of patient for, 275 QUARANTINE defined, 253 Quassia, infusion of, to make, 88 Questions for review and examination in communicable diseases, 272 in diseases of ear, nose, and throat, 341] of eye, 336 of infants and children, 313 . in gynecologic nursing, 250 in medical nursing, 231 in nervous and mental diseases, 330 in obstetric nursing, 297 in occupational, venereal, and skin diseases, 324 in principles and practice of nurs- ing technique, 93, 183 in surgical nursing, 243 in urology, 283 RADIOGRAPHIC examination of chest, 211 of gall-bladder and kidney, 211 of large intestine, 210 of stomach, 209 Radiography defined, 209, 275 preparation of patient for, 209, 275 Rancid oil, 134 Recipes, 304 Rectal suppositories, classification, 91 temperature, taking, 34 thermometer tray, requisites on, 34 tube, high, to sterilize, 66 Rectum described, 82 operations on, preparation of field, 114 Removal of cerumen from ear, 339 of foreign bodies from ear, 339 Renal function, estimating, 224 phenolsulphonephthalein test for, 224 test-meal for, administration of, 226 Renovation defined, 254 Respiration, accelerated, 37 Cheyne-Stokes, 37 child’s, taking, 305 defined, 37 edematous, 37 external, 37 internal, 37 stertorous, 37 Restraint, appliances used for, 328 of patients, 328 of shoulders, 328 of thighs and legs, 328 363 Reversed Fowler’s position, 110 Rhinoscopy, position of patient for, 53 preparation of child for, 53 Riegel test-meal, 207 Room, cleaning, after discharge of pa- tient, 25 cystoscopic, preparation of, 277 delivery, preparation of, 290 prepared for labor, 291 dusting and cleaning, 20 isolation, 254 linen, care of, 27 sanitation of, in communicable dis- eases, 253 temperatures, 20 Rubber catheters, to sterilize, 65 dressing sheets, to sterilize, 66 gloves, dry, to put on, 65 sterilization of, 65 to patch, 65 wet, to put on, 65 goods, cleaning of, 64 hard, to sterilize, 66 sterilization of, 64 Rubbing back, 39 Rubefacients, 159 SALINE bath, 258 enema defined, 89 Salivation, mouth-wash for, 40 Salvarsan, administration of, assisting with, 316 by intramuscular injection, 319 by intravenous injection, 318 dosage, 317 methods, 317 preparation of solution, 319 reaction to, 320 defined, 316 Sand-bags, 60 Sanitation of sick-room in communi- cable diseases, 253 Screen for inhalations, to prepare, 201 Scultetus binder, application of, 69 eond semester, elementary procedures, 9 Se gy activity of stomach defined, 0 Sedative bath, 238 defined, 238 enema defined, 85 giving, 86 prescriptions for, 85 Senior year, first semester, 325 Serum, to give, 121 Serving liquids, 29 Shower bath for infant, 136 Sick-room, isolation of, 254 364 Sick-room, sanitation of, in communi- cable diseases, 253 Sigmoid flexure defined, 82 Silk catheters, to sterilize, 66 ureter catheters, to sterilize, 66 Sims’ or left lateral position in gyne- cologic ~~ examinations, 111 E draping for, 112 Sinapisms, applying, 165 mustard leaf or paper, 166 plaster or paste, 166 Sitting patient up in bed, 47 when bed has adjustable back- rest, 47 has not back-rest, 47 in chair, 48 if heavy and in need of support, if help is needed on account of height of bed, 48 if small and in need of support, 48 Sitz-bath, 73 giving, 73 prescribed, 73 “606,” 316 Skin diseases, nursing procedures in, 316 demonstrations, 324 examination questions in, 324 objects of course, 316 grafting, preparation of field, 115 Slush or spray bath, giving, 157 Smear, 245 vaginal, taking, 245 Soap poultice, 164 suppository, 91 Soda bicarbonate bath, 258 Sordes defined, 40 Sore, pressure. See Pressure sore. Spanish fly, 167 Specific suppository, 91 Specimens, laboratory, preparation of, for analysis, 75 Spinal douche defined, 329 giving, 329 Splint, 61 when applying, points to remember, 61 Sponge bath, alcohol, 239 defined, 239 cold, giving, 152 in infancy, 310 for infant, 135 Spray or slush bath, giving, 157 Sprays, 256 defined, 256 for nose, 257 for throat, 257 Sputum, disinfection of, 255 INDEX Sputum, preparation of, for analysis, 75 Stadium, 33 Standing position in gynecologic exam- inations, 112 draping for, 113 Starch bath, 258 Sterile stupes, 161 Sterilization of bougies, 66 of Ewald evacuating bulb,66 of gastric lavage tube, 66 of glass utensils, 66 of hard rubber goods, 66 of high rectal tube, 66 of instruments, 66 of nail brushes and orange wood sticks, of rubber catheters, 65 dressing sheets, 66 gloves, 65 goods, 64 of silk catheters, 66 ureter catheters, 66 Sterilized milk, 302 Stertorous respiration, 37 Stimulating enema, defined, 86 giving, 86 prescriptions for, 86 Stomach contents, expression of, assist- ing with, 207 defined, 207 examination of, fluoroscopic and radiographic, 209 motor power of, defined, 207 operations, preparation of field, 114 secretory activity of, defined, 207 Straight binders, application, 69 Stripping and airing bed, 21 Stupes, 159 abdominal, applying, 159 in infancy, 310 sterile, 161 turpentine, 161 Sulphur bath, 258 Sunlight bath, 230 defined, 230 Sun’s rays, classification of, 230 Suppositories, rectal, classification, 91 Suppository, anodyne, 91 astringent, 91 defined, 91 evacuant, 91 ice, 91 to make, 91 soap, 91 specific, 91 urethral, 92 vaginal, 91 Surgical department, temperature of, 20 diseases, nursing ir, 234 INDEX Surgical dressing, assisting with, 67 nursing, demonstrations in, 244 procedures used in, 234 questions for review and examina- tion, 243 Swift-Ellis treatment, defined, 323 preparation for, 323 Symptom defined, 45 Symptoms, classification of, 46 Syphilis, mercurial inunction for, 320 Systole defined, 35 Systolic pressure, 203 defined, 35 TABLE, anesthetic, preparation of, 57 Taking blood-pressure, 203 child’s temperature, pulse, and respira- tions, 305 throat and nose cultures, 266 temperature, 33 : vaginal smear, 245 Tampon defined, 247, insertion of, assisting with, 246 kite-tail, 247 to prepare, 247 to remove, 247 used for, 247 T-binders, application, 69 Teeth and mouth, child’s, care of, 306 care of, 40 Temperature, axillary, taking, 35 bath, 44 body, measuring, 33 defined, 33 mouth, taking, 34 when not to take, 34 of child, taking, 35, 305 of rooms, 20 rectal, taking, 34 taking, 33 ; to pulse, ratio of, 36 ‘Terminal disinfection defined, 253 Test, phenolsulphonephthalein, 224 vital function, 224 Test-meals defined, 207 Ewald, 207 ii renal function, administration of, 26 Riegel, 207 Thermometer, clinical, defined, 33 mouth, requisites on tray, 33 rectal, requisites on tray, 34 Thoracentesis, assisting with, 175 defined, 175 in infancy, 311 Thready pulse, 36 Tint, cold compresses to, application, 6 365 Throat cultures, taking, 266 diseases of, nursing in, 338 examination of, assisting with, 53 position of patient for, 53 preparation of child for, 54 hot compresses to, application, 268 secretions, disinfection of, 255 to spray, 257 Thyroidectomy, preparation of field, 114 To patch gloves, 65 Tongue operations, preparation of field, 115 Tourniquet, application of, 240 for arterial hemorrhage, 240 for intravenous injections, 241 for venous hemorrhage, 241 defined, 240 improvised, 241 Tracheotomy, assisting with, 241 defined, 241 Traction, 61 : Transfusion, blood, position of donor and donee for, 195 preparation of field, 115 procedure on donor, 196 on recipient, 197 using paraffin tube, assisting with, Tray equipped for carminative enema, 84 for enteroclysis, 217 for evacuating enema, 78 for nasal gavage, 212 for sedative, stimulating, nutrient or emollient enema, 86 for urethral injection, 281 thermometer, mouth, requisites on, 33 rectal, requisites on, 34 Treatments and operations, preparation of field for, 113 Trendelenburg position in gynecologic examinations, 112 Tub bath for infant, 136 giving, 56 : to female, 57 to male, 57 hot, 143 Turning mattress with patient in bed, 54 Turpentine stupes, 161 Tyla, Brand bath in treatment of, UMBRELLA for inhalations, to prepare, 201 Ureter catheters, silk, to sterilize, 66 Ureters, catheterization of, preparation of patient for, 276 Urethral injection, 281 suppository, 92 366 Urine, disinfection of, 255 specimens, collecting from baby boy, 308 girl, 308 preparation for analysis, 76, 308 Urology, demonstrations in, 284 nursing procedures used in, 275 questions for review and examination in, 283 : Utensils, disinfection of, 255 glass, cleaning of, 66 sterilization of, 66 Uterus defined, 104 VACCINATION, 265 care of wound, 265 methods, 265 preparation for, 265 Vaccine, care of, 265 to give, 121 ~ Vagina and cervix operations, prepara- tion of field, 114 defined, 104 how connected with internal genitals, 104 structure and direction of, 104 Vaginal douche contraindicated, 106 consideration of patient during, 107 dangers involved, 107 defined, 101 outline for study, 103 precautions in infection, 107 prescribed for, 101; 106 procedure, 102, solutions for, 101, 106 packing, assisting with, 248 removal, assisting with, 248 smear, taking, 2435 suppository, 91 Vapor bath defined, 221 INDEX Vapor bath in bed, 221 ! Vein, aspiration of, assisting with, 180 defined, 180 Venereal diseases, demonstrations, 324 examination questions in, 324 nursing procedures in, 316 Venesection, assisting with, 181 defined, 181 Venipuncture in infancy, 311 Venous hemorrhage, tourniquet for, 241 Ventilation defined, 19 of ward, 19 important points in, 20 Vesical douche, 148 Vesicants, 159 Virus, to expel, from capillary tube, 265 Vital function test defined, 224 Vulva defined, 104 WARD, care of, 19 dusting and cleaning, 20 hygiene of, 19 temperature of, 20 ventilation of, 19 important points in, 20 Washing bed after discharge of patient, 25 hair in bed, 41 Water, barley, 305 bath, disinfection of, 255 cereal, 304 hammer pulse, 36 hot-, bath, local, 236 defined, 236 mattress, 60 uses of, 60 Wet cupping, 170 pack, hot, 138 in infancy, 309 Whey, 304 BERKELEY LIBRARIES C029409k89