Protection of the Mattress and Pillows.—In all cases of sickness the mattress must be adequately protected. Neglect is inexcusable and may cause expense and trouble as well as discomfort to the patient.
—In all cases of sickness the mattress must be adequately protected. Neglect is inexcusable and may cause expense and trouble as well as discomfort to the patient.
The following may be used to protect the mattress or pillows: large quilted pads, small pads of cotton batting covered with old muslin or cheesecloth, slip covers for the mattress, rubber sheets and pillow-cases, old blankets and quilts that may be washed easily. Heavy wrapping paper, builders' paper, and newspapers serve well in emergencies, or for a short time.
Rubber Sheets and Pillow-cases.—Soft rubber cloth, single or double faced, is most frequently used when it is necessary to protect the bed from discharges. It may be purchased by the yard. Rubber sheets should not be used unless they are really necessary. They are hot and uncomfortable, and increase the tendency to perspire. When used, a rubber sheet should be 1 yard wide or wide enough to reach from the lower edge of the pillows down to the patient's knees, and long enough so that it can be tucked in securely on both sides of the bed. Rubber sheets may be cleaned by laying them on a flat surface and washing on both sides with soap and water, using a small brush if necessary. After rinsing they should be wiped, and when thoroughly dry they should be rolled rather than folded, to prevent the rubber from breaking.
—Soft rubber cloth, single or double faced, is most frequently used when it is necessary to protect the bed from discharges. It may be purchased by the yard. Rubber sheets should not be used unless they are really necessary. They are hot and uncomfortable, and increase the tendency to perspire. When used, a rubber sheet should be 1 yard wide or wide enough to reach from the lower edge of the pillows down to the patient's knees, and long enough so that it can be tucked in securely on both sides of the bed. Rubber sheets may be cleaned by laying them on a flat surface and washing on both sides with soap and water, using a small brush if necessary. After rinsing they should be wiped, and when thoroughly dry they should be rolled rather than folded, to prevent the rubber from breaking.
Rubber pillow-cases are used for a patient who perspires profusely, or who has a discharge of any kind from the head or neck, and also when substances which may wet or stain the pillow are applied to the head. They should be put on nextto the pillow, securely fastened with tapes, snap hooks, or buttons, and covered with the regular pillow slip.
Rubber sheets and pillow-cases are not durable. They should be used carefully, and frequently examined for holes or worn places by holding them up to the light. Even a pin hole near the center may render a rubber sheet or pillow-case as useless as a sieve.
Sheets.—Sheets of ample proportions are necessary for comfort, and important for sanitary reasons as well. For a bed of the dimensions mentioned in this lesson sheets should be three yards long, and two yards wide. A safe rule for any bed is to have the sheets one yard longer and one yard wider than the mattress. A sheet of these dimensions is large enough to be tucked under the sides and foot of the mattress, while at least twelve inches are left to fold over the blankets at the top. Cotton sheets are as good as linen for general use, or even better, and are far less expensive.
—Sheets of ample proportions are necessary for comfort, and important for sanitary reasons as well. For a bed of the dimensions mentioned in this lesson sheets should be three yards long, and two yards wide. A safe rule for any bed is to have the sheets one yard longer and one yard wider than the mattress. A sheet of these dimensions is large enough to be tucked under the sides and foot of the mattress, while at least twelve inches are left to fold over the blankets at the top. Cotton sheets are as good as linen for general use, or even better, and are far less expensive.
Draw sheetsare used to cover rubber sheets, and to protect beds when the rubbers are not used. In hospitals special draw sheets are usually provided, but an ordinary sheet folded answers every purpose. New and expensive sheets should not be used for draw sheets, since they are morelikely than other sheets to become stained. Draw sheets should be wide enough to extend about four inches beyond the rubber sheet at the top and bottom.
are used to cover rubber sheets, and to protect beds when the rubbers are not used. In hospitals special draw sheets are usually provided, but an ordinary sheet folded answers every purpose. New and expensive sheets should not be used for draw sheets, since they are morelikely than other sheets to become stained. Draw sheets should be wide enough to extend about four inches beyond the rubber sheet at the top and bottom.
Pillow Covers.—Pillow covers are generally made of cotton, but persons who can afford the cost frequently prefer linen, especially in hot weather. Unless fastened with buttons or tapes, a pillow case should be several inches longer than its pillow. It should be wide enough to slip on easily, but not so wide that it wrinkles or allows the pillow to turn. If it is too small the pillow will become hard and uncomfortable. These small things, unimportant as they are to the well, may cause much discomfort to a restless or nervous patient.
—Pillow covers are generally made of cotton, but persons who can afford the cost frequently prefer linen, especially in hot weather. Unless fastened with buttons or tapes, a pillow case should be several inches longer than its pillow. It should be wide enough to slip on easily, but not so wide that it wrinkles or allows the pillow to turn. If it is too small the pillow will become hard and uncomfortable. These small things, unimportant as they are to the well, may cause much discomfort to a restless or nervous patient.
Blankets.—All wool blankets are both light and warm, and are consequently the most comfortable bed covering. But unless they can be dry cleaned frequently, it is better to select blankets made from one part wool and two parts cotton. Blankets containing equal parts of wool and cotton are warmer, but are more injured by washing. Very light blankets of wool or outing flannel are useful in summer. Double blankets should always be cut in two and bound at the ends, since single blankets are easier than double blankets to handle and wash. Patients are frequently too warmly covered by day. Too much warmthis enervating, it causes the patient to perspire, and makes him restless and more susceptible to draughts and to changes of temperature. Two light blankets are warmer and more comfortable than one heavy blanket.
—All wool blankets are both light and warm, and are consequently the most comfortable bed covering. But unless they can be dry cleaned frequently, it is better to select blankets made from one part wool and two parts cotton. Blankets containing equal parts of wool and cotton are warmer, but are more injured by washing. Very light blankets of wool or outing flannel are useful in summer. Double blankets should always be cut in two and bound at the ends, since single blankets are easier than double blankets to handle and wash. Patients are frequently too warmly covered by day. Too much warmthis enervating, it causes the patient to perspire, and makes him restless and more susceptible to draughts and to changes of temperature. Two light blankets are warmer and more comfortable than one heavy blanket.
Comforters and Quilts.—Heavy cotton comforters are burdensome without being correspondingly warm. Eiderdown quilts or those padded with wool are good for a patient who sleeps out of doors, or whose room is kept at a low temperature. Bed covers that cannot be laundered readily should be protected by basting on both sides of the top a wide piece of muslin or linen, which can be removed and washed.
—Heavy cotton comforters are burdensome without being correspondingly warm. Eiderdown quilts or those padded with wool are good for a patient who sleeps out of doors, or whose room is kept at a low temperature. Bed covers that cannot be laundered readily should be protected by basting on both sides of the top a wide piece of muslin or linen, which can be removed and washed.
Counterpanes.—White dimity counterpanes are desirable, since they are light in weight, easily laundered, and inexpensive. A heavy counterpane is uncomfortable at any time, and still more uncomfortable in sickness. If a light spread is not available, a sheet makes a good substitute. A counterpane should be wide enough to cover the sheets and blankets at the sides when the bed is open, and long enough to protect the bedding at the top and bottom.
—White dimity counterpanes are desirable, since they are light in weight, easily laundered, and inexpensive. A heavy counterpane is uncomfortable at any time, and still more uncomfortable in sickness. If a light spread is not available, a sheet makes a good substitute. A counterpane should be wide enough to cover the sheets and blankets at the sides when the bed is open, and long enough to protect the bedding at the top and bottom.
All methods of making beds for the sick are based upon a few underlying principles. Theaim in every case is to obtain the following results with the least expenditure of time and labor: first, to secure comfort for the patient, and to eliminate all causes of friction, irritation, or pressureupon his skin; next to keep the covers firmly in place, so that the bed will not easily become disarranged; then to protect the mattress, and last, to secure as good an appearance as possible.
Fig. 12.—The Draw Sheet in Place.(From "Elementary Nursing Procedures," California State Board of Health.)
To Make an Unoccupied Bed, proceed as follows: remove the pillows and covers one at a time, and place them on chairs, near an open window if possible. Brush the mattress and then set it up on its ends to air, or turn it back over the foot board. Wipe the bedstead with a damp cloth. Replace the mattress after it has aired, turning it from side to side and from end to end on alternate days. Cover the mattress, unless it is enclosed in a slip cover, with a white quilted pad or an old blanket, and then spread the lower sheet over the mattress, so that the middle fold of the sheet lies upon the center of the mattress in a straight line from the head of the bed to the foot. Tuck the sheet under, first at the top and then at the bottom, drawing it so that it is firm and tight. If the sheet is of proper length tuck fourteen or sixteen inches under at the top, but take care to cover the mattress at the foot also. Next tuck the sheet under at the side, folding its corners to make a neat finish like an envelope. Place the rubber sheet, if it must be used, across the bed, with its upper edge where the lower edge of the pillows will come. A draw sheet somewhat widerthan the rubber sheet is needed next; an ordinary sheet, folded once the long way of the sheet, may be used, with the fold toward the head of the bed. Tuck both rubber and draw sheet securely under the mattress at the side. In some cases the rubber sheet may be placed next to the mattress, and covered by the mattress pad and lower sheet. Place the draw sheet as directed, whether the rubber is used or not. After the lower, rubber, and draw sheets have been adjusted on one side of the bed, go to the opposite side, draw them over smoothly, and tuck them under the mattress as tightly as possible.
, proceed as follows: remove the pillows and covers one at a time, and place them on chairs, near an open window if possible. Brush the mattress and then set it up on its ends to air, or turn it back over the foot board. Wipe the bedstead with a damp cloth. Replace the mattress after it has aired, turning it from side to side and from end to end on alternate days. Cover the mattress, unless it is enclosed in a slip cover, with a white quilted pad or an old blanket, and then spread the lower sheet over the mattress, so that the middle fold of the sheet lies upon the center of the mattress in a straight line from the head of the bed to the foot. Tuck the sheet under, first at the top and then at the bottom, drawing it so that it is firm and tight. If the sheet is of proper length tuck fourteen or sixteen inches under at the top, but take care to cover the mattress at the foot also. Next tuck the sheet under at the side, folding its corners to make a neat finish like an envelope. Place the rubber sheet, if it must be used, across the bed, with its upper edge where the lower edge of the pillows will come. A draw sheet somewhat widerthan the rubber sheet is needed next; an ordinary sheet, folded once the long way of the sheet, may be used, with the fold toward the head of the bed. Tuck both rubber and draw sheet securely under the mattress at the side. In some cases the rubber sheet may be placed next to the mattress, and covered by the mattress pad and lower sheet. Place the draw sheet as directed, whether the rubber is used or not. After the lower, rubber, and draw sheets have been adjusted on one side of the bed, go to the opposite side, draw them over smoothly, and tuck them under the mattress as tightly as possible.
Next spread the upper sheet over the bed so that its upper edge reaches to the upper edge of the mattress, and its middle crease lies over the middle line of the mattress, and place it right side down, so that the smooth side of the hem will be uppermost when the sheet is turned over the blankets. Place the blankets so that their upper edges lie a little higher than the place where the lower edge of the pillow will come, and tuck them in firmly at the bottom and sides. If the blankets are not long enough to tuck in at the foot, place the lower blanket as directed and the upper blanket five or six inches lower than the first. When tucked in, the upper blanket holds the lower one in place fairly well. Placethe counterpane evenly and smoothly, tuck it under at the foot, turn its corners neatly, turn its upper edge under the upper edge of the blankets and fold the upper sheet down over the whole.Last of all, shake the pillows and place them neatly on the bed.
Fig. 13.—The Closed Bed.(From "Elementary Nursing Procedures," California State Board of Health.)
Practice is necessary before it is possible to make a bed quickly and well, and a certain amount of proficiency in making an unoccupied bed should be acquired before undertaking to make a bed with a patient in it. One should learn to work in an orderly way, without confusion, unnecessary motion, or jarring of the bed.
To Change a Patient's Pillows.—Stand preferably on the right side of the bed and slip the left arm under the patient's shoulders, supporting his head in the hollow of the arm. Raise him slightly and remove the pillows one at a time with the right hand, drawing them outward on the left side of the bed. Place a small pillow under his head. Shake the pillows, change the cases if necessary, and replace them on the left side of the bed, ready to be drawn back into position. Raise the patient as before, remove the small pillow and draw the others into place. It is sometimes better to hold the patient on the upper pillow while removing and replacing the under one.
—Stand preferably on the right side of the bed and slip the left arm under the patient's shoulders, supporting his head in the hollow of the arm. Raise him slightly and remove the pillows one at a time with the right hand, drawing them outward on the left side of the bed. Place a small pillow under his head. Shake the pillows, change the cases if necessary, and replace them on the left side of the bed, ready to be drawn back into position. Raise the patient as before, remove the small pillow and draw the others into place. It is sometimes better to hold the patient on the upper pillow while removing and replacing the under one.
Lifting a Patient in Bed.—Patients tend to slip down toward the foot of the bed, and they should be raised if unable to help themselves. To raise the patient, instruct him to flex his knees and to press his feet firmly upon the bed; place one armunder his shoulders, as when changing pillows, the other arm under the thighs, and lift him upward without jerking. The lifting can be done more easily by two people, and with less discomfort to the patient: if he is entirely helpless two people are necessary. Two people should proceed as follows: LetAplace her left arm under the patient's head and shoulders as before, her right arm under the small of his back; letBplace her right arm also under the small of his back and her left arm under his thighs, and at a signal let them lift together. In this way the weight is so evenly distributed that a heavy person can be lifted without great difficulty.
—Patients tend to slip down toward the foot of the bed, and they should be raised if unable to help themselves. To raise the patient, instruct him to flex his knees and to press his feet firmly upon the bed; place one armunder his shoulders, as when changing pillows, the other arm under the thighs, and lift him upward without jerking. The lifting can be done more easily by two people, and with less discomfort to the patient: if he is entirely helpless two people are necessary. Two people should proceed as follows: LetAplace her left arm under the patient's head and shoulders as before, her right arm under the small of his back; letBplace her right arm also under the small of his back and her left arm under his thighs, and at a signal let them lift together. In this way the weight is so evenly distributed that a heavy person can be lifted without great difficulty.
To Turn a Patient in Bed.—A patient may be turned toward or away from you. In turning a patient toward you, place one hand over his farther shoulder and the other over his hip, and turn him toward you. Then flex his knees slightly. To turn a patient from you, pass one hand as far as possible under the shoulders, and the other as far as possible under the thighs. Then raising the patient slightly, draw him back toward you, turning him at the same time, and then flex the knees. Lastly place a pillow firmly against his back to support it.
—A patient may be turned toward or away from you. In turning a patient toward you, place one hand over his farther shoulder and the other over his hip, and turn him toward you. Then flex his knees slightly. To turn a patient from you, pass one hand as far as possible under the shoulders, and the other as far as possible under the thighs. Then raising the patient slightly, draw him back toward you, turning him at the same time, and then flex the knees. Lastly place a pillow firmly against his back to support it.
To change the sheets while the patient is in bedproceed as follows: First collect the freshlinen and place it conveniently near the bed. Then draw the bedclothes from beneath the mattress, raising the mattress meanwhile with one hand to prevent jarring the bed. Remove first the spread and then the upper blanket if there are two, fold each once and place it on a chair. Hold the remaining blanket in place with one hand, while with the other you draw the upper sheet out from under it; then fold the edges of the blanket up over the patient to keep them out of the way. The upper sheet, unless soiled, may be folded once and used again as a draw sheet. Next remove all the pillows, unless the patient prefers to keep one. Then move the patient toward one side of the bed and turn him on his side so that he faces the edge nearest him. Roll the draw sheet and rubber sheet together if both are to be removed, or separately if the rubber sheet is to remain on the bed; then roll the bottom sheet throughout its entire length, and bring the three sheets, all rolled as flat and as tightly as possible, close to the patient's back. Pleat about half of the fresh lower sheet lengthwise and place the pleated portion as close as possible to the rolled soiled sheets. Tuck in the other half of the fresh sheet at the top, bottom and side, draw the rubber sheet if it is to be replaced back over the fresh lower sheet, arrange the fresh draw sheet in place, tuck it in atthe side, and roll its free portion close to the patient's back. The fresh side of the bed is then ready for the patient. Lift his feet back over the rolled sheets keeping his knees flexed, then turn him back over the rolled sheets on to the fresh smooth part, remove the soiled sheets and arrange the fresh ones in place on the side where the patient has just been lying. Be careful to keep him well covered with the blanket. After the lower sheets are in place and firmly tucked in, spread above the blanket the fresh upper sheet, and over the sheet spread the second blanket. Hold the sheet and blanket in place with one hand while using the other hand to draw out the first blanket from beneath the sheet. In this way the patient is constantly covered by a blanket. Place the blanket just removed above the other and finish the bed according to the directions given for an unoccupied bed, using special care, however not to draw the covers too tightly over the patient's feet.
proceed as follows: First collect the freshlinen and place it conveniently near the bed. Then draw the bedclothes from beneath the mattress, raising the mattress meanwhile with one hand to prevent jarring the bed. Remove first the spread and then the upper blanket if there are two, fold each once and place it on a chair. Hold the remaining blanket in place with one hand, while with the other you draw the upper sheet out from under it; then fold the edges of the blanket up over the patient to keep them out of the way. The upper sheet, unless soiled, may be folded once and used again as a draw sheet. Next remove all the pillows, unless the patient prefers to keep one. Then move the patient toward one side of the bed and turn him on his side so that he faces the edge nearest him. Roll the draw sheet and rubber sheet together if both are to be removed, or separately if the rubber sheet is to remain on the bed; then roll the bottom sheet throughout its entire length, and bring the three sheets, all rolled as flat and as tightly as possible, close to the patient's back. Pleat about half of the fresh lower sheet lengthwise and place the pleated portion as close as possible to the rolled soiled sheets. Tuck in the other half of the fresh sheet at the top, bottom and side, draw the rubber sheet if it is to be replaced back over the fresh lower sheet, arrange the fresh draw sheet in place, tuck it in atthe side, and roll its free portion close to the patient's back. The fresh side of the bed is then ready for the patient. Lift his feet back over the rolled sheets keeping his knees flexed, then turn him back over the rolled sheets on to the fresh smooth part, remove the soiled sheets and arrange the fresh ones in place on the side where the patient has just been lying. Be careful to keep him well covered with the blanket. After the lower sheets are in place and firmly tucked in, spread above the blanket the fresh upper sheet, and over the sheet spread the second blanket. Hold the sheet and blanket in place with one hand while using the other hand to draw out the first blanket from beneath the sheet. In this way the patient is constantly covered by a blanket. Place the blanket just removed above the other and finish the bed according to the directions given for an unoccupied bed, using special care, however not to draw the covers too tightly over the patient's feet.
Fig. 14.—Changing the Draw Sheet.(From Pope "Home Care of the Sick," American School of Home Economics, Chicago.)
To Move a Patient from One Bed to Another.—On the fresh bed have the lower sheets in place but not the upper covers. Place the two beds close together side by side, and draw one mattress a little over the place where the two sides meet. Loosen the draw sheet under the patient, roll it on both sides close to the body and draw him gently over by means of this sheet, moving hisshoulders at the same time. If the beds are unequal in height, use firm pillows or folded blankets to make an inclined plane.
—On the fresh bed have the lower sheets in place but not the upper covers. Place the two beds close together side by side, and draw one mattress a little over the place where the two sides meet. Loosen the draw sheet under the patient, roll it on both sides close to the body and draw him gently over by means of this sheet, moving hisshoulders at the same time. If the beds are unequal in height, use firm pillows or folded blankets to make an inclined plane.
Fig. 15.—Changing a Patient from One Bed to Another.(From Pope "Home Care of the Sick," American School of Home Economics, Chicago.)
If the beds differ greatly in height and indeed in most cases, it is better to carry the patient from one bed to the other. At least two people are needed; one alone should never attempt to carry anyone heavier than a small child. One method for lifting is as follows: Let two bearers,AandBstand on the same side of the bed. If the patient is to be moved into the right side of the fresh bed let both bearers stand on the right side of the occupied bed; if he is to go into the left side of the fresh bed, let them both stand on the left side of the occupied bed. LetAplace one arm under the patient's shoulders and her other under the small of his back, whileBplaces one arm under his hips and the other just below his knees. Draw the patient to the edge of the bed, instruct him to place his arms about the shoulders ofAand to hold the body rigid, and then lift together at a given signal, keeping his weight well up on the chests of the bearers.
Whenever a patient must be turned, lifted, carried, or moved in any way, let him know beforehand just what you intend to do so that he may not be startled, and also that he may coöperate if possible. Grasp him firmly butgently, avoid pinching the skin, and move him steadily and smoothly, avoiding jerks and false starts. Do not attempt alone more than your strength is amply sufficient to accomplish, and endeavor at all times to handle the sick with the utmost gentleness and consideration.
Bathing is necessary in sickness no less than in health. It stimulates and equalizes the circulation, is soothing in feverish conditions, is refreshing to most people, and by affording a certain amount of exercise it lessens the fatigue of lying in bed. Moreover, without frequent bathing it is impossible to keep the skin in good condition, since scales of dead skin, oily matter, and solid substances left by perspiration collect on the surface of the body when a person is lying still in bed as well as when he is leading an active life. The common belief that sick people are likely to catch cold from bathing is quite unfounded; every patient, unless his condition is such that the doctor orders otherwise, should have one complete cleansing bath each day. In addition to the regular cleansing bath other kinds are often prescribed as medical treatment.
Atub bathif allowed by a patient's condition, is the most satisfactory kind, but special precautionsmust be taken to guard her from fatigue and chill. The bath room and everything to be used should be made ready before she leaves her bed. Necessary clothing and toilet articles should be collected and arranged conveniently, a chair covered with a blanket and also a bath mat should be placed beside the tub, and the temperature of the bath room should be regulated so that it is about 70° F., or a little lower if the room is likely to become overheated as the bath proceeds. The bath water should be drawn last. Its temperature, tested by a thermometer, should be between 96° and 100° at the beginning, and may be increased if desirable.
If the patient is weak, wash and dry her face, neck, and ears, and if necessary cut the finger and toe nails before she leaves the bed, in any case before she enters the tub. As soon as the patient has left the bed, strip it and leave it to air; then assist her into the bath room and help her carefully into the tub. Do not allow her to stay in the water more than ten minutes at most, and stop the bath at once if she shows the slightest sign of faintness, dizziness, exhaustion, difficult breathing, marked change of color, or other unusual symptom. Indeed, if the patient is weak or her reaction to the bath uncertain, as when she takes her first tub bath after an illness, someone shouldalways be within call to help the attendant in case of need. A faint, heavy patient in a bath tub is an impossible load for one person to handle.
While the patient is in the tub, soap her well, brush her finger and toe nails, rinse, and rub her to stimulate the circulation. Then help her from the tub, seat her in the chair, draw the blanket closely about her from neck to feet, dry her with warm towels, exposing the body as little as possible, and, if she is to return to bed, put on a fresh night gown, and wrapper and slippers. Next place the lower sheet, the draw sheet, and one pillow on the bed as quickly as possible, help the patient into bed, keeping her well covered with a blanket, and finish making the bed. If she seems chilly, give a hot water bag and hot drink and leave the blanket next her in place. After the patient has been made comfortable, clean the tub and put the bath room in order.
Even patients supposedly able to take tub baths without assistance should not lock the bath room door nor be left alone a long time.
Bed Bath.—Practice is essential in order to give a bed bath skillfully. The aim is to make the patient thoroughly clean and thoroughly dry, without chilling, fatiguing, or exposing her, without making the bed damp, and without unnecessaryhaste or delay. One method of giving a bed bath follows, but any method that accomplishes these aims is likely to be satisfactory.
—Practice is essential in order to give a bed bath skillfully. The aim is to make the patient thoroughly clean and thoroughly dry, without chilling, fatiguing, or exposing her, without making the bed damp, and without unnecessaryhaste or delay. One method of giving a bed bath follows, but any method that accomplishes these aims is likely to be satisfactory.
First see that the room is about 70° F. and likely to remain so, and exclude draughts. Collect everything to be used, including a blanket to cover the patient, an old blanket or large bath towel to protect the bed, at least two other towels, one a bath towel and the other a face towel, two wash cloths, soap, nail brush, powder, alcohol, comb and brush, nail file, scissors, etc.; fresh bed and personal linen; a large basin containing water at 105°, a jug of hotter water, and a slop jar. Remove the upper bed clothes except one blanket, which should cover the patient constantly during the bath, and spread them where they will air; remove all the pillows but one, and place the bath blanket under the patient as the under sheet is placed in bed making. If a bath blanket is not used, keep the bath towel under the part that is being bathed by moving the towel from place to place.
Next remove the night gown in the following way: Let the patient lie on her back, with her knees flexed; draw the gown up as far as possible, then raise or get her to raise her hips so that the gown may be drawn up above the waist. Next raise her head and shoulders with one arm and draw the night gown up to the neck with theother; remove one sleeve, draw the gown over the head and then off the other arm.
Fig. 16.—Washing a Patient Without Exposure.(Sanders "Modern Methods in Nursing.")
The patient is now ready for the bath. Wet the wash cloth thoroughly, but hold it gathered in the hand so that it will not drip. Wash the face, neck, and ears first, dry them thoroughly, and next, using the second wash cloth, wash the arms and hands, chest and abdomen, giving particular attention to the armpits and navel. Raise theblanket slightly with one hand to keep it from becoming damp, but expose the patient as little as possible; the arms and legs need not remain covered while being washed. Dry each part thoroughly before washing the next. Next turn the patient on her side and wash the back, the buttocks, and upper part of the thighs; give special attention to the fold between the buttocks. Then turn the patient on her back, and wash the thighs, legs, and feet. If it is important to move the patient as little as possible, leave the back until last so that the under sheet may be changed without turning her again. Cut the toe nails if necessary before washing, and clean them carefully afterward. Unless there is a reason to the contrary, wash the hands and the feet in the basin, first protecting the bed with a towel, newspaper, or clean wrapping paper. Be sure to clean well between the toes, and to dry the feet thoroughly; they may need some friction. Throughout the bath empty and refill the basin as necessary.
Wash the genital region last. Let the patient lie upon her back with knees flexed and separated, or upon one side with the knees flexed and one slightly raised. Patients who are able may take this part of the bath themselves with whatever assistance may be necessary. The attendant, however, must either do it herself or make surethat the patient does it thoroughly. To neglect a helpless patient is always unkind, and no less unkind when the motive is a mistaken sense of modesty. If discharge from the genitals is present use absorbent cotton, or clean, soft old cloth to wash the parts, and burn it afterward. It is sometimes desirable to place the patient on a bedpan and rinse the parts by a gentle stream of warm water poured from a jug. After the attendant has completed this part of the bath she should wash her own hands thoroughly.
After the bath rub the patient with alcohol. If a complete alcohol rub is impossible, at least rub the points where pressure comes, especially the back. After the rub apply a little toilet powder if the patient desires it. When the toilet is complete remove the bath blanket, remake the bed and put the room in order.
Care of the Mouth and Teeth.—In sickness the mouth and teeth require more than ordinary attention; indeed, the condition of a patient's mouth is a fair index to the quality of the care she is receiving. If the patient can brush her own teeth she should do so in the morning, at night, and after meals. At those times the attendant, without waiting to be asked, should bring her a towel, tooth-brush, cup of tepid water, tooth paste or powder, and a small basin or dish to receive theused water. The process is generally more thorough when the patient does it herself, and even a patient unable to sit up can brush her teeth successfully if the nurse holds the powderand cup of water, and provides a basin shallow enough for the patient to use by turning her head to one side.
—In sickness the mouth and teeth require more than ordinary attention; indeed, the condition of a patient's mouth is a fair index to the quality of the care she is receiving. If the patient can brush her own teeth she should do so in the morning, at night, and after meals. At those times the attendant, without waiting to be asked, should bring her a towel, tooth-brush, cup of tepid water, tooth paste or powder, and a small basin or dish to receive theused water. The process is generally more thorough when the patient does it herself, and even a patient unable to sit up can brush her teeth successfully if the nurse holds the powderand cup of water, and provides a basin shallow enough for the patient to use by turning her head to one side.
Fig. 17.—The Nurse Assisting the Patient in Brushing the Teeth.(From "Elementary Nursing Procedures," California State Board of Health.)
The attendant must cleanse the mouth of a patient who is unable to do it herself. If this cleansing is neglected, a dark tenacious substance collects upon the teeth and gums, composed chiefly of food particles, bacteria, mouth secretions, and worn out cells of the mucous membrane. Once formed it is difficult to remove, hence the mouths of all patients and especially those who have fever, must receive proper care from the very beginning of illness. Cotton swabs are convenient for cleansing the mouth; they are made by winding a small piece of absorbent cotton upon a match or wooden tooth-pick.
To cleanse the mouth of a helpless patient, take to the bedside the mouth wash prescribed by the doctor, a towel to protect the bedclothes, several swabs, and a receptacle for used swabs; the latter should be a strong paper bag or several thicknesses of newspaper. Clean the tongue, gums, teeth, and spaces between the teeth gently but thoroughly, using especial care if the gums are tender. Dip only clean swabs in the solution, discard each one after using it once, and burn it afterward. Let the patient rinse her mouth after cleansing it if she is strong enough. If the mouthis very dry, encourage her to drink more water. Notify the doctor if the gums and tongue crack or bleed since he may wish to order a special mouth wash. Cold cream or boracic ointment may be used if the lips are dry and cracked.
False teeth should be thoroughly brushed and cleansed, and kept in cold water if taken out during the night.
Care of the Hair.—Long hair, if neglected, becomes tangled and matted in a surprisingly short time. Unless the patient is actually in a dying condition she is not too sick to have it properly attended to at least once a day. Before combing the hair protect the pillow with a towel; then part the hair in the middle from the forehead to the nape of the neck, and draw it to either side. Begin to comb at the ends, holding the strand of hair firmly in one hand placed between the head and the comb; in this way tangles can be removed without hurting. After combing and brushing the hair, braid it in two braids, beginning near the ears; draw it as tightly or loosely near the head as the patient prefers, but remember that tight braids mean fewer tangles. If the hair is heavy or badly tangled the patient may be too much fatigued to have it all combed at one time; in this case braid the part that has been finished and complete the work later.
—Long hair, if neglected, becomes tangled and matted in a surprisingly short time. Unless the patient is actually in a dying condition she is not too sick to have it properly attended to at least once a day. Before combing the hair protect the pillow with a towel; then part the hair in the middle from the forehead to the nape of the neck, and draw it to either side. Begin to comb at the ends, holding the strand of hair firmly in one hand placed between the head and the comb; in this way tangles can be removed without hurting. After combing and brushing the hair, braid it in two braids, beginning near the ears; draw it as tightly or loosely near the head as the patient prefers, but remember that tight braids mean fewer tangles. If the hair is heavy or badly tangled the patient may be too much fatigued to have it all combed at one time; in this case braid the part that has been finished and complete the work later.
To Wash the Hair of a Bed Patient.—The hair of a patient can be successfully washed in bed if sufficient care is taken not to chill or tire the patient, or to wet the bed. The following articles are needed: one small jug of strong soap suds made by dissolving a pure soap in hot water, one large jug of hot water at about 112° F., one jug of cold water, a slop jar or foot tub, one long rubber sheet or piece of enamel cloth, and several towels including at least one bath towel. Let the patient lie as near the edge of the bed as possible. Roll one small towel lengthwise, place it below the hair at the back of the neck, bring it up above the ears to the forehead and pin tightly, in order to catch water that might wet the face and neck. Next make a kind of trough of the large rubber by rolling its long edges inward for a few inches. Place this across the bed under the patient's head so that her neck rests on the lower roll. Raise by means of pillows the end of the rubber trough that lies toward the middle of the bed, in order to prevent water from running into the bed or collecting under the patient's head. Let the other end of the rubber extend over the edge of the bed down into the slop jar or foot tub, which may be placed on a chair or stool. Then wash the hair and scalp with the soap solution, and rinse them thoroughly with water from the large jug. Squeezeas much water as possible from the hair, remove the rubber and substitute a heavy bath towel, and rub and fan the hair until dry. A shampoo in bed is tiring. Do not attempt it unless the patient is strong enough to stand not only the shampoo itself, but also a complete change of bed clothing, which will almost certainly be necessary if the attendant has been careless or clumsy in the slightest degree.
—The hair of a patient can be successfully washed in bed if sufficient care is taken not to chill or tire the patient, or to wet the bed. The following articles are needed: one small jug of strong soap suds made by dissolving a pure soap in hot water, one large jug of hot water at about 112° F., one jug of cold water, a slop jar or foot tub, one long rubber sheet or piece of enamel cloth, and several towels including at least one bath towel. Let the patient lie as near the edge of the bed as possible. Roll one small towel lengthwise, place it below the hair at the back of the neck, bring it up above the ears to the forehead and pin tightly, in order to catch water that might wet the face and neck. Next make a kind of trough of the large rubber by rolling its long edges inward for a few inches. Place this across the bed under the patient's head so that her neck rests on the lower roll. Raise by means of pillows the end of the rubber trough that lies toward the middle of the bed, in order to prevent water from running into the bed or collecting under the patient's head. Let the other end of the rubber extend over the edge of the bed down into the slop jar or foot tub, which may be placed on a chair or stool. Then wash the hair and scalp with the soap solution, and rinse them thoroughly with water from the large jug. Squeezeas much water as possible from the hair, remove the rubber and substitute a heavy bath towel, and rub and fan the hair until dry. A shampoo in bed is tiring. Do not attempt it unless the patient is strong enough to stand not only the shampoo itself, but also a complete change of bed clothing, which will almost certainly be necessary if the attendant has been careless or clumsy in the slightest degree.
Hot foot bathsproperly speaking are medical treatment, but they are taken by many persons to relieve colds, headache, or insomnia. Let the patient sit, well wrapped, with her feet in water at about 105°, and then increase the temperature gradually by adding hotter water. Take care to add hot water slowly and not to pour it directly upon the patient's feet or ankles; otherwise she may be scalded. Mustard may be added to the bath water in the proportion of one tablespoonful of mustard to each gallon of water. If mustard is to be used make it into a smooth paste with cold water, thin the paste with warm water, and when thin enough to pour easily add it to the bath water and stir well. The bath may continue for 10 to 20 minutes, and the feet should be dried afterward without friction. The patient should go to bed at once; she should not wander about, clearing away herfoot bath, doing forgotten things, getting herself chilled, and losing all the good effects.
properly speaking are medical treatment, but they are taken by many persons to relieve colds, headache, or insomnia. Let the patient sit, well wrapped, with her feet in water at about 105°, and then increase the temperature gradually by adding hotter water. Take care to add hot water slowly and not to pour it directly upon the patient's feet or ankles; otherwise she may be scalded. Mustard may be added to the bath water in the proportion of one tablespoonful of mustard to each gallon of water. If mustard is to be used make it into a smooth paste with cold water, thin the paste with warm water, and when thin enough to pour easily add it to the bath water and stir well. The bath may continue for 10 to 20 minutes, and the feet should be dried afterward without friction. The patient should go to bed at once; she should not wander about, clearing away herfoot bath, doing forgotten things, getting herself chilled, and losing all the good effects.
A foot bath may be given easily to a patient in bed. Bring to the bedside a blanket, a towel, the tub filled with water, and something with which to protect the bed; this may be a rubber sheet, bath towel, old blanket folded, or several thick clean newspapers. Loosen the upper covers at the foot of the bed, fold them back above the patient's knees, and cover her legs and feet with the extra blanket making it overlap the bed clothing so that it will not slip. Flex the patient's knees, put the bed protector under her feet, place the tub on the side of the bed, raise the legs and feet with one hand and arm, and slide the tub into place with the other, raising the elbow in such a way that it keeps the blanket out of the water. Lower the feet slowly into the water, fold the towel, and place it over the edge of the tub in order to protect the patient's knees from the cold rim; then tuck the blanket closely about the tub and legs and proceed as before. After the bath use the towel, unless it is wet, to receive the feet when they are withdrawn from the tub. Remove the tub, dry the feet thoroughly, cover them warmly, and remake the bed.
Cool Sponge Bath.—For feverish patients doctors often order cool sponge baths. In orderto give a cool sponge bath, first protect the bed thoroughly, but leave the patient uncovered except for a towel laid over the hips. Use cool water, or cool water and alcohol, and have the wash cloth as wet as it can be without dripping. Bathe the body without friction, using long, light strokes, and leave each part wet until the bath has been completed. Do not use soap. Sponge in this way the arms, legs, chest, and back, but not the abdomen, for ten to twenty minutes, giving special attention to the neck and inner side of the arms and legs, because in those places large blood vessels lie nearer the surface of the body. After finishing the bath dry the body by patting it gently with towels.
—For feverish patients doctors often order cool sponge baths. In orderto give a cool sponge bath, first protect the bed thoroughly, but leave the patient uncovered except for a towel laid over the hips. Use cool water, or cool water and alcohol, and have the wash cloth as wet as it can be without dripping. Bathe the body without friction, using long, light strokes, and leave each part wet until the bath has been completed. Do not use soap. Sponge in this way the arms, legs, chest, and back, but not the abdomen, for ten to twenty minutes, giving special attention to the neck and inner side of the arms and legs, because in those places large blood vessels lie nearer the surface of the body. After finishing the bath dry the body by patting it gently with towels.
Take the patient's pulse occasionally during the bath, and stop the bath at once if the patient's pulse grows weaker, if she shivers violently, or if her face, fingers, or toes turn a bluish color. Babies react rapidly to cool sponging; for a baby use tepid water, sponge for five minutes only, and watch the child closely during the bath.
Patients who are confined to bed even for a few days often suffer acutely from muscular tension, from pressure, and from fatigue due to lack of exercise. Indeed, many a sick person is surprised to find that the bed which had seemed so infinitely desirable can change into a place of torment after a few short days of illness. "Bed-weariness" is hard to bear in any case of illness, but it is doubly hard for persons who are really helpless.
Unless the patient is an experienced sufferer he often has no idea what should be done to make him comfortable; while an equally inexperienced helper, though full of good will, is often discouraged to find that the arrangement she had thought perfect soon fails to satisfy her restless patient. But if she is willing to devote thought and ingenuity to removing small annoyances, she can do many things to alleviate his misery.
Bed sores, or pressure sores, are caused by continued pressure upon the skin. The weight of thebody, or of a part of the body, if it comes for a long time upon one place finally interferes with the circulation in the tissues on which the part rests, and consequently interferes with the nutrition of the affected part. Any tissue to which the blood is not bringing all its necessary food supply tends to lose its tone, to become weak, and if the condition persists, to break down altogether.
, or pressure sores, are caused by continued pressure upon the skin. The weight of thebody, or of a part of the body, if it comes for a long time upon one place finally interferes with the circulation in the tissues on which the part rests, and consequently interferes with the nutrition of the affected part. Any tissue to which the blood is not bringing all its necessary food supply tends to lose its tone, to become weak, and if the condition persists, to break down altogether.
The direct cause of bed sores then is pressure, and pressure is aggravated by moisture, wrinkles in the bed clothes, crumbs or other hard particles, lack of cleanliness, friction of any kind, or by rough, careless handling. Bed sores occur most often over bony prominences, such as the end of the spine, elbows, heels, shoulders, hips, ankles, and knees, but they may form anywhere, even on the ears or back of the head. They are more likely to appear on thin, aged, or depleted patients. These painful and serious sores can be prevented almost always by faithful care. When they occur, they result in the great majority of cases purely from negligence, and a person who knows the danger and yet through carelessness allows one to develop upon a patient may justly feel herself disgraced.
Prevention of bed sores depends upon keeping the skin dry and clean and upon relieving pressure by special devices and by turning the patient frequently. The parts where pressure comesshould be washed at least twice daily with warm water and soap, rubbed frequently with alcohol to improve the circulation and to keep up the tone of the skin, and powdered with a little good toilet powder. Much powder is likely to do harm by collecting in hard, irritating particles. The bed should be kept constantly dry and smooth, and free from crumbs, lumps, wrinkles, or other inequalities. Prolonged pressure should be relieved by turning the patient often,—once every waking hour is not too often if the body is emaciated,—and by pillows, pads, and rings.
Small pillows or thick pads of cotton should be placed under the patient's back and shoulders, between the knees and ankles when he lies on his side, and in other places where sores are likely to develop. Rubber rings are useful, but few patients like them for a long time. They should not be inflated more than necessary to raise the affected part from the bed; if much inflated, they are uncomfortable and may do harm. The ring may be covered with a muslin pillow case, or it may be wound smoothly with long strips of bandage or old muslin. Ordinary cotton batting wound with strips of muslin may be made into rings and used to remove pressure from heels, elbows, or other parts. These cotton rings are less heating than pads, and give better support.
The first sign of a bed sore is either redness of the skin or a dark discoloration like a bruise. Every point where a bed sore may form should be inspected daily. If the slightest symptom of a sore appears, the patient must not lie on the affected part, and every effort should be made to keep the skin from breaking; vigorous rubbing at this stage is dangerous, and will by no means make up for previous neglect. The condition should be reported to the doctor at once. If in spite of all efforts the skin does break, a peculiarly difficult kind of open wound results which must be treated and dressed according to the doctor's directions.
Devices to Give Support.—The variety and number of pillows one patient can use is almost unlimited. A weak patient when lying on his side should have his back supported by a pillow. When he lies on his back a pillow should be placed under his knees to lessen muscular tension, and if he may be raised in bed, several pillows are needed to support him comfortably. A back rest is useful for a patient who can sit up in bed. Satisfactory back rests of several types can be purchased, or one may be improvised from a straight chair placed on the bed bottom side up, so that its legs lie against the head of the bed and its back forms an inclined plane. Back rest and chair alike should be covered by several pillows to make themcomfortable, and other pillows should be used to support the patient's arms.
—The variety and number of pillows one patient can use is almost unlimited. A weak patient when lying on his side should have his back supported by a pillow. When he lies on his back a pillow should be placed under his knees to lessen muscular tension, and if he may be raised in bed, several pillows are needed to support him comfortably. A back rest is useful for a patient who can sit up in bed. Satisfactory back rests of several types can be purchased, or one may be improvised from a straight chair placed on the bed bottom side up, so that its legs lie against the head of the bed and its back forms an inclined plane. Back rest and chair alike should be covered by several pillows to make themcomfortable, and other pillows should be used to support the patient's arms.
A person who is sitting up in bed always tends to slip down toward the foot. This tendency may be corrected by using a foot rest, knee pad, or pillow. A hard pillow may be placed in the bed at the foot for the patient to brace his feet against; or a short board, well padded, may be arranged as follows for the feet to rest against: Fasten ropes to the board, as the ropes of a swing are fastened to the seat; set the padded board on edge at a convenient point below the patient's feet, and hold it in place by tying the ropes of the "swing" to the head of the bed. A pillow may be used in the same way, either at the feet or under the knees, by folding it over a long strip of muslin, the ends of which are then tied to the sides of the bed, brought up to the head, and there tied to prevent slipping. A cylindrical cushion six or eight inches in diameter and as long as an ordinary pillow, stuffed with firm material, may also be used for this purpose. It should be held in place by strips of strong muslin or ticking sewed to the ends of the cushion and tied to the head of the bed. The cushion should have a washable cover.
Fig. 18.—Showing Foot-sling for Supporting Patient in the Upright Position.(Sanders "Modern Methods in Nursing.")
Supports calledbed cradlesare used to keep the weight of the bed covers from sensitive parts ofthe body, generally the feet or abdomen. They are semi-circular pieces of wood or iron fastened together so that they will stand up. A satisfactory cradle may be improvised as follows: Cut a barrel hoop in two, cross the halves at right angles and tie them together firmly; place the cradle over the affected part under the bed clothes. A smaller cradle may be made by taking sections that are less than half of the barrel hoop. If used for one foot only, the cradle shouldbe small enough not to interfere with the motion of the other foot; if used for both feet, it should be large enough to allow some freedom of motion. Since the cradle leaves an air space, the feet should be wrapped in a piece of soft flannel. A cradle used for the protection of the abdomen should extend a little beyond the body on each side.