APPLIANCES AND METHODS FOR THE SICK-ROOM
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 the body, 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 comes should 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 them comfortable, 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.
[Illustration: FIG. 18.--SHOWING FOOT-SLING FOR SUPPORTING PATIENT IN
THE UPRIGHT POSITION. (_Sanders "Modern Methods in Nursing."_)]
Supports called _bed cradles_ are used to keep the weight of the bed
covers from sensitive parts of the 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
should be 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.
[Illustration: FIG. 19.--ADJUSTABLE BED REST.]
Adjustable tables are convenient for patients who are able to sit up in
bed. These tables are supported on one side only so that they may extend
over the bed. Another kind of bedside table has short legs and stands
directly on the bed. Such a table can easily be made at home from a wide
board with supports six or eight inches high nailed to each end. A lap
board supported by heavy books may serve for temporary use. Indeed,
home-made substitutes are often as good as expensive apparatus or even
better. If sick-room appliances must be bought, it is well to remember
that simple standard designs are best. Complicated apparatus is soon out
of order, and is generally a trial both to the patient and to those who
must adjust it. Persons taking care of chronic patients may often obtain
valuable suggestions in regard to appliances by consulting a visiting
nurse or the superintendent of the local hospital.
[Illustration: FIG. 20.--ADJUSTABLE TABLE.]
BEDPANS are utensils to receive bowel and bladder discharges of patients
lying in bed. Enamel bedpans are better than porcelain, although more
expensive. The shape known as the "Perfection" is best for general use.
A "slipper" bedpan, although harder to clean and ordinarily less
comfortable, may be preferable if it is especially difficult or
undesirable to raise the patient. The square or douche pan is preferred
by some people, and is especially useful when the quantity of discharge
is large, as after an injection.
When a patient asks for the bedpan it should be brought if possible
without a moment's delay, not only because no other form of neglect
makes a patient realize her helplessness more acutely, but also because
the desire to use it often passes quickly and delay may encourage the
habit of constipation. If the patient does not ask for the bedpan, the
attendant should offer it at suitable times. Bedpans should be warmed
before use. An easy way to warm one is to let hot water run over it; the
outside should afterward be dried.
To place the bedpan, first flex the patient's knees and push the night
gown up; place one hand under the patient's hips, raise them slightly,
and with the other hand slip the pan into place. If the patient is
entirely helpless two persons are needed to lift her. Place a pad or
folded cloth between the patient's back and the pan; then lower the
patient gently. Before removing the pan, bring toilet paper, water and
two pieces of soft old muslin or gauze. A patient, if able, prefers to
use the toilet paper without assistance; her hands should afterward be
thoroughly washed. If she is unable, the attendant must do everything
needed. After the patient has been cleaned as thoroughly as possible
with paper raise her hips with one hand and then remove the pan; it is
important to raise her first because the skin often adheres and may be
injured if the pan is suddenly pulled away; carelessness in managing the
bedpan has caused more than one bed sore. Then remove the pan with one
hand and cover at once. Turn the patient, if helpless, on her side, wash
the parts with one piece of old muslin, thoroughly dry them with the
other, and either burn or thoroughly wash both pieces afterward.
Empty the bedpan and clean it at once; ordinarily one can clean it
without wetting or soiling the hands. Use cold water first, removing all
adhering solid particles with a tightly rolled piece of toilet paper. Do
not use a brush for this purpose. After using cold water, rinse the pan
thoroughly in hot water, and at least once a day wash it well in hot
soapsuds. Directions for disinfecting the pan will be given later, but
remember that a properly kept pan needs no deodorant solution. Glass
urinals should be provided for men, and kept clean in the same way.
Contents of both bedpan and urinal should always be carefully inspected;
neither should be emptied in the dark.
DAILY ROUTINE IN THE SICK-ROOM
Obviously the routine of a patient's day must vary according to her
condition, her preferences, and the amount of time the attendant has to
give her. The temperature, pulse, and respiration must be taken and all
medicine, nourishment, and treatment given at the exact times ordered,
but the attendant should learn whether or not the doctor wishes her to
wake the patient for food or treatment. Good management in the sick-room
depends upon foresight and planning, and therefore it is well to keep in
mind the following suggestions:
Vitality is lowest in the early morning, hence baths and treatments,
especially if they are fatiguing or painful, should if possible be left
until after breakfast. Patients often wake early and wait, weak and
miserable, for the day to begin. A hot drink at this time may give
relief and enable the patient to sleep again. Even though breakfast time
is near, nourishment should be given as soon as the patient wakes. She
may not admit that she is hungry, but her nourishment should not be
delayed until the family breakfast is ready, or still worse, finished.
Before breakfast the bedpan should be offered, the patient's face and
hands should be washed, her teeth brushed, her hair tidied, the bed
straightened, and the room put in order. These services should require a
few minutes only. The room if properly arranged at bed time needs only a
little attention now unless untidy work has gone on during the night;
disorder in a sick-room is as unnecessary in the early morning as at any
other time.
After the patient has finished her breakfast she may rest, or if
allowed, read her mail or the newspaper while the attendant prepares for
her day's work; about an hour after breakfast the patient should be
bathed, unless she prefers her bath in the evening. After the bath some
form of light nourishment should be given, even to a patient who has
regular meals. If a patient is able to sit up in a chair, the best time
for her to do so is generally just after the bath and toilet have been
completed; but if she feels tired she had better wait until afternoon.
The bed room can be better aired and cleaned if it is possible to take
her into another room; and she herself generally profits by a change of
scene.
The doctor should definitely state when and for how long a patient may
sit up for the first time after an illness, and an amateur who may be
ignorant of the dangers involved should not assume the responsibility of
deciding. When a patient is to sit up for the first time, put on her
stockings, slippers, and wrapper before she leaves the bed. Arrange an
arm chair with pillows in the seat and at the back, bring it close to
the bedside and cover it with a large blanket unfolded. The chair may
face either the head or the foot of the bed. Help the patient to a
sitting position on the extreme edge of the bed, with her feet hanging
down. Next, standing in front of her and supporting her well, let her
slip down until she stands upon her feet, then let her turn, and gently
lower her into the chair. See that the patient while sitting up is
warmly covered, and that her foot-stool, pillows, etc., are adjusted
comfortably. Move her chair so that the outlook may be as interesting as
possible, and at least a little different from the view from the bed.
Most patients like to look out of the window; children and old people
enjoy it particularly.
If the patient shows signs of fatigue, she should go back to bed even
before the appointed time. To help her back to bed, reverse the process
of helping her out. A footstool may be needed if the bed is high, or
two people to lift her if she is weak or heavy. When a patient is in bed
no one should ever sit on the bed, lean against it, use it as a table
for folding linen, making pads, etc., take hold of the bed posts in
passing, or touch the bed unnecessarily in any way.
The best time for visitors is the last of the morning or the early
afternoon. A judicious visitor may do an immense amount of good,
especially to a chronic patient; indeed, she may be the only ray of
light in a dark day. Subjects of conversation should be pleasant, but
not too stimulating or exciting. The visitor should be prepared to carry
the burden of the conversation, to drop topics skillfully that seem to
involve fatigue or excitement, and either to go or to stop talking if
the patient seems tired. Visitors should remember to talk naturally and
cheerfully on ordinary topics, and to avoid excessive sympathy and
labored attempts to cheer the patient. They should also remember that
few patients bear well even the mildest forms of teasing. The patient's
room is not the place to discuss personal or family troubles; yet it is
only too often chosen for such purposes, probably because the complainer
knows that in it an audience is always to be found.
Visitors not belonging to the family should not be present in the
sick-room during treatment of any kind, unless their help is required;
neither, as a rule, should they stay during the patient's meals. A
member of the family may stay with advantage if the patient tires of
eating alone, but casual visitors almost invariably offend by undue
urging if the patient's appetite is poor, or by facetious remarks if it
is good.
Ordinarily only one visitor should be admitted at a time, since a weak
patient may be tired merely by looking from one to another. If it is
desirable to limit the call, the attendant should tell the visitor
beforehand how long to stay, or arrange a signal for the visit to end.
To announce baldly in the sick-room that the patient is tired and the
visitor must go, will only elicit aggrieved protests from both. In
illness lasting only a day or two all visitors should be discouraged;
during colds, because they are communicable; during general fatigue,
headaches, digestive upsets, and painful menstruation, because rest and
quiet are highly desirable. Visitors at such times too frequently give
injudicious sympathy, and may actually delay the recovery of patients
who enjoy playing the rôle of interesting invalid.
The time when a trustworthy visitor is present may be the best time for
the attendant to rest. The patient should be told when the attendant is
going, and approximately when she will return. It is a mistake to slip
away while the patient sleeps; she seldom fails to wake before the time
scheduled and to resent the desertion. Surprises of any kind, pleasant
or unpleasant, are seldom good for patients.
Toward the end of the afternoon the patient is probably tired,
especially if she has not slept during the day. When fever is present
her headache and restlessness increase as the day goes on, but it should
be remembered that uncomfortable beds and too heavy covers cause much of
the restlessness attributed to fever. Rubbing the back and legs with
alcohol, giving a tepid sponge bath, remaking the bed or changing her
position may help to soothe her.
The evening should be kept free from excitement, and every possible
effort should be made to encourage sleep. It is a mistake to think that
a better night results from keeping a sleepy patient awake all the
evening; sick people should sleep when they can. Just before bedtime the
attendant should prepare her own cot, and then make the following
preparations for the patient to sleep: wash the patient's face and hands
or give a sponge bath if it is desired, brush the hair, change the night
gown, brush crumbs from the bed, tighten the sheets or remake the bed if
necessary, rub the back and other pressure points with alcohol, shake
the pillows, give liquid nourishment, preferably hot, cleanse the mouth,
and give the bedpan. See that the patient's feet are warm, the bed
covers right, the room ventilated properly and in good order, and the
light extinguished or arranged for the night. If the patient is inclined
to be wakeful a hot foot bath may help her, or sponging the entire
length of the spine for fifteen minutes, using very hot water and long
downward quiet strokes. No conversation should be encouraged during
preparations for the night. Patients in bed all day often lose the habit
of sleeping at the regular time, and lie awake far into the night from a
vague feeling that someone else is coming or something further is to be
done for them. Consequently last of all ask the patient if she wants
anything more; if not, say good-night, go out and stay out, at least
until she has had a chance to go to sleep. She is thus helped to realize
that nothing further is likely to happen, and that it is time to go to
sleep.
Toward morning the patient grows weaker. More bed covers will probably
be needed, and they may often be added without waking her. Night at the
best is a dreary time for the sick. Pain and weariness and
discouragement are less bearable in the darkness; nervous fears and
morbid fancies defy control. Never is kindness more needed or more
appreciated than it is by those who lie awake and watch for the morning.
EXERCISES
1. Name all the causes, direct and indirect, of pressure sores.
2. Why are pressure sores generally more serious than injuries of equal
extent to the skin of a well person?
3. Where are pressure sores most likely to occur and what are their
symptoms?
4. What measures should be employed to prevent pressure sores?
5. Describe ways to support a person lying down in bed.
6. Describe ways to support a person sitting up in bed.
7. How may the weight of the bedclothes be removed from any particular
part of the body?
8. How should a bedpan be cared for?
9. Describe in detail a day's routine either of yourself the last time
you were ill in bed, or of another patient personally known to you.
Could the plan of the day have been improved, and if so, in what ways?