PART I HOME NURSING (Part 4)

on to the bed. If a patient is to be lifted on to a couch or easy- chair, it must be placed with the head toward the foot of the bed and near enough so that the persons lifting need take only a few steps. They should stand both on the same side of the bed and carrv hands and J.° change the patient arms well under the shoulders and buttocks of the0300"011, patient, and then by simply wheeling about the couch can be reached. MECHANICAL APPLIANCES For a patient who is to sit up in bed the bed-rest is a very useful article, and the best kind is that hav- ing a simple wooden frame with canvas support. This The bed- can be put at various angles as desired, and with a hair pillow at the bottom to give firm support to the lower part of the back, and a small pillow for the head, the patient can be made comfo'rtable. It is best for him to have either a pillow under the knees or one to brace the feet against, so there need be no feeling 38 HOME NURSING of effort to keep from slipping toward the foot of the bed. The knee-pillow also gives great relief to a patient The knee- suffering from any abdominal pain, as it supports the legs in a flexed position and so relaxes the muscles of Canvas and Wood Bed-Rest the abdominal wall. The pillow should be a feather one, medium-sized, and not too thick, and it is best to have it covered with a rubber case under the linen one. A pillow tucked close to the back when the pa- tient is lying on one side or against the abdomen if A Cradle to Lift the Clothes there is pain there, when in the same position, relieves the strain somewhat and is found grateful to him. Small, soft pillows made of absorbent cotton, if noth- ing better is at hand, are much appreciated by patients, and can be tucked in various places to relieve pressure, CARE OF BED PATIENTS 89 as between the knees when lying on the side or to lift an elbow or shoulder from the mattress. In arranging pillows to take the place of a bed- rest it is necessary to have four or five of good size, Substitute ° - for the and they should be piled with each additional one bed rest placed behind the others in order to give the firmest support. A very useful though not elegant substitute The Iron Standard Bed Table for a bed-rest is a straight-backed chair inverted so that the back makes an inclined plane against which pillows can be laid. A bandage or other stout piece of cloth which is long enough if fastened securelv to An aid t0 » t> 'a patient the foot of the bed serves as assistance to a patient not able to raise himself easily, alone. In some cases a frame known as a "cradle," which can lift the bedclothes from a sensitive bodv 40 HOME NURSING A cradle to lift the clothes or limb, is very much needed. These can be bought cheaply, but a very satisfactory one can be made in a short time by means of three or four split barrel- hoops wound tightly with bandage and fastened at the ends to two straight pieces of board about one and a % The Wooden Leaf Bed Table half feet long. This placed in the bed over the affected part affords relief and comfort. There are two kinds of bed-tables. One has an Bed tables iron standard which can be drawn close to the bed, and a wooden leaf reaching over it which can be fastened at any desirable height by means of a screw. Trabaud Back Protector on Douche Pan The other is a simple, light, and low table which can be placed on the bed with the legs resting on either side of the patient's body. A very good table can be fashioned with a cutting-board and a few books placed on either side of the patient to give it support. CARE OF BED PATIENTS 41 A great need has been met in the appliance known as the "Trabaud Back Protector," which is a cushion Device to remove that can be attached to the douche or bed-pan, and pressure 1 from the removes entirely the pressure upon the spine. It can sPine also be used as a pillow after it has been detached from the pan if desired. Ill ENEMATA, SUPPOSITORIES, AND DOUCHES Administration— The Laxative Enema— The Purgative Enema— The Nutritive Enema— The Starch Enema— The Turpentine Enema— Rectal Irrigation- Suppositories— Douches— Gargles, Sprays, and Inhalations— Care of Utensils Defini- tion of enemata Laxative Nutritive Sedative Astringent Emollient Anti- spasmodic Anthel- mintic Antiseptic THE general term injection indicates the introduc- tion of fluids into the body. When they are carried into the intestines through the rectum we speak of giving enemata, though the general term injection is commonly made a specific one, and used instead of enema. There are many different kinds of enemata, as there are various purposes in their use. The classi- fication as given in Isabel Hampton's "Text-Book on Nursing" is as follows : Simple laxative and purgative enemata. Nutritive enemata for the introduction of nourish- ment. Sedative enemata for local or systematic effects. Astringent enemata, which check hemorrhages and diarrhoea, e. g., hot water or ice water, solution of alum or nitrate of silver. Emollient enemata for soothing irritated and pain- ful mucous membranes. Starch and certain drugs are used in solution for this purpose. Antispasmodic enemata, to relieve flatulence, in which, for example, turpentine is used in solution. Anthelmintic enemata for destroying worms: salt, turpentine, and quassia are used in solution in this way. Antiseptic or germicidal enemata, used in the vari- ous forms of dysentery. (42) ENEMATA 45 THE LAXATIVE ENEMA The laxative enema may be better if the bowels are particularly sluggish, and the use of olive or cotton- The meth- seed oil or a little glycerine will usually be sufficient oil enema to correct the difficulty. Six ounces of oil should be warmed to blood heat by placing it in a vessel of hot water and then very slowly injected by means of a hard rubber syringe with a soft rubber tube attached to the nozzle. It is important that the oil be given with great deliberation, in order that it should be re- tained easily. The warming of the oil is necessary for the same reason, because oil injected cold will cause pain and there will be an intense desire to reject it at once. The use of the hard rubber syringe is better, □ Hard Rubber Syringe because oil is injurious to the soft rubber and a bag once used for oil enemata is soon destroyed. The oil enema is best given at night and followed by a soap-suds enema in the morning, though if for any reason it seems more convenient, the oil may be given in the morning and retained for an hour or two previous to the soapy enema. One should be somewhat cautious in the use of glycerine, since its effect is to increase the peristaltic Care in action of the bowels, and in some cases its irritating fnem"ne properties are so great as to cause an inflammation of the mucous membrane lining the intestines, producing pain and diarrhcea. In such a case much relief can be afforded by an irrigation of the bowel with normal 46 HOME NURSING salt solution, the use of which will be spoken of later. The glycerine enema is usually given in amounts varying from half a teaspoon to half an ounce and diluted with an equal quantity of warm water. It is seldom necessary to follow a glycerine enema with a soap-suds one, as with the use of oil. THE PURGATIVE ENEMA A purgative . enema is made with drugs,, such as turpentine, castor oil, or Rochelle salts. In obstinate cases of constipation, the enema may be given high up in the bowel by the use of a soft rubber catheter or • rectal tube attached to the end of the syringe and in- serted six or eight inches. The bowels should not be allowed to become ac- Caution customed to the habitual use of the enema, as by so tifeTnema doing the natural action is weakened. Various means of overcoming the tendency to constipation will be cited in a later chapter. THE NUTRITIVE ENEMA The nutritive enemata are resorted to when feeding by the stomach needs to be suspended or supplement- ed by additional nourishment to be administered per rectum. Concentrated foods are employed and the Concen- physician in charge of the case will usually wish to suggest the formula for use. Two simple formulae are as follows : i. One whole egg, Pinch of table salt, Three ounces of peptonized milk, Half an ounce of brandy. Or, 2. The whites of two eggs, Two ounces of peptonized milk. ENEMATA 47 Each one of these makes about four ounces, the amount that should be given at one time. It should not be given oftener than once in four hours or six times in the twenty-four hours. The frequency, how- ever, will be regulated by the physician, according to the special requirements of the patient. The absorptive power of the rectum is less than that of anv other part of the intestines. This kind of Nutritive J r enema enema therefore should be given as high as possible, g^en^as using the rectal tube or soft rubber catheter for the possible purpose. A simple enema should precede the first nutritive one, in order to clear out the bowel, so that ready ab- sorption of the nutritive substance can take place. If there is a continued use of the nutritive enema, we shall find that some part remains unabsorbed in the bowel, causing irritation of the mucous membrane as it decomposes. It is therefore necessary that the in- testines should be flushed with warm water as often After care as once in twelve hours in order to free the bowels of the unabsorbed material. Medication may be given rectally when it is likely not to be retained if given by mouth. It should always be given with the tube inserted at least six inches. In case of hemorrhage from the bowels, hot water or ice water injections may be ordered and should be given with a fountain syringe hung rather low so that the force of the stream of water will not be too great. THE STARCH ENEMA In cases of dysentery or diarrhoea, a starch or gruel enema is frequently useful. The starch should be How made cooked as for laundry use and thinned till it can pass easily through the syringe. It should be given slowly and gently through a rectal tube. 48 HOME NURSING Guard against burning THE TURPENTINE ENEMA The turpentine enema may be given in cases of distressing flatulence and frequently affords great re- lief. Ten drops to a pint of water is the amount gen- erally used, and it should be very thoroughly mixed with the water, in order to guard against the possibil- ity of burning. RECTAL IRRIGATION Rectal irrigation differs only from enemata in that the water is not meant to be retained in the bowel, the object being merely to wash out the irritating sub- stances there which may be the occasion of a diar- rhoea. The water is allowed to run slowly into the Rectal Tube with Return Flow The tube for rectal irrigation bowel and may be expelled at once. It should be con- tinued until the flow of water is clear, showing that the bowels are freed from irritating matter. A rectal tube with return flow is convenient for giving an irrigation, since it obviates the necessity of inserting the tube several times, though if done care- fully this need cause little irritation. A salt solution (one teaspoon of common salt to a SUPPOSITORIES 49 pint of warm water) is generally used for irrigation, as it is at the same time somewhat stimulating. In The salt r 1 i n -i 1 solution cases of shock or collapse or with very weak patients, enema the saline or salt solution enema is often ordered. In- troduced in this way it is taken up quickly by the tis- sues and increases the volume of the blood supply, which has become depleted and thus renders the heart's action more normal. For the green stools so common in the case of babies, rectal irrigation twice a day at first, and as the stools improve once a day, together with careful feed- ing, is often a means of entirely correcting the trouble. SUPPOSITORIES Suppositories are small solid cones of various sizes, usually made of cacao butter and medicated. These are largely used for introducing into the rectum to take the place in a measure of enemata, and, though retaining their shape under ordinary conditions, melt readily at the heat of the body. The suppository should be oiled with vaseline and carried with the index ringer gently into the rectum, introduc- The finger should be inserted its entire length, and if the sup- • , -1 1 . r - p°sit»ry the patient at the same time bears down as if to expel it, a certain amount of suction is produced which car- ries it further up into the bowel. By holding the finger, after it has been removed, a moment over the opening to the rectum till the bowel has become accustomed to the foreign body, there will be less likelihood of its being expelled. A suppository should act in fifteen or twenty minutes, and meantime the patient should remain quiet in the recumbent position. Vol. 3 50 HOME NURSING DOUCHES By the term douche is meant "a jet of fluid direct- ofedouches e<^ with a certain amount of force upon a limited sur- face external or internal." Those given internally are the nasal, aural, and vaginal douches. Douches may be either of plain water or medicated, and are given for cleanliness, to reduce inflammation and for the purpose of stimulation. The vaginal douche of plain water given for clean- doSe1 Hness should be tepid, and a quart or a quart and a half is a sufficient quantity. The hot douche, ordered to check hemorrhage or to allay inflammation of the pel- vic organs, is given in larger quantity — from two to four quarts being the amount usually used — and at a Douche Pan temperature ranging from 1120 F. to n8° F., according as the patient can bear the heat. The prolonged appli- cation of the hot water causes after the first expan- sion of the blood-vessels a contraction which is more or less lasting and by that means hemorrhage is checked. Any medication which is to be given in the douche Position should be included in the last quart. It is necessary patient that the patient should be in a recumbent position as a douche is of very little effect if taken sitting. Further- more it is always advisable that she remain lying down for a half-hour after the douche, as it has a somewhat weakening effect upon the tissues. DOUCHES 51 Douche pans may be bought at little cost, or in case of emergency a new tin pan large enough for the pa- tient's buttocks to rest in can be utilized successfully. The fountain syringe is generally preferred for giving douches, as the flow of water is steady and under low pressure. If used after operative cases, it is wiser to hang the bag rather low so that the force of the stream may not be too strong upon the bruised tissues. The best nozzle is the glass one, which can be kept absolutely clean bv boiling for twenty minutes. Care The glass " . ° , , , , nozzle best must be taken in the use of glass or metal nozzles, that they are not inserted too hot, as they retain the heat, and there is danger of burning the delicate membrane lining the vagina. The water 'must be allowed to pass through the tube before the nozzle is inserted, to expel the air and Glass Nozzle cold water as in the case of any injection. The per- forations of the nozzle should always be at the side, Use ex- never in the end as in that used rectally, since in that case there would be danger of injecting the fluid into the uterus and thus causing serious trouble, particular- ly in confinement cases, where the mouth of the uterus remains partly open. For douching the ear, a medicine dropper makes a very good nozzle. It can be attached to the tube of a in douch- £ . . ri in& the eal fountain syringe and the flow can be governed by pressure of the fingers. It is important here, as in vaginal douching, that the force of the stream of water is not too great. By drawing up the tip of the ear very gently, the auditory canal is straightened, giving 52 HOME NURSING more ready access to the inflamed area. Cold water should never be injected into the ear. The same precaution against the use of too great Nasal force in douching is applicable to the nasal douche, as and neces- there is danger of perforation of the extremely delicate sary care or j tissues, if care is not exerted in its use. The use of the nasal douche should never be made habitual. Physi- cians who make a specialty of ear diseases object par- ticularly to this method of treatment, since it often sets up an inflammation of the ear. If an attempt is made to blow the water forcibly out of the nose, one can feel it distinctly in the passage leading to the