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DIAGNOSIS.—It is impossible to over-emphasize how im¬portant a matter it is to diagnose a case correctly. Often the cause of a disorder is much more deeply rooted than perhaps appears at first glance, as, for instance, in some cases of diges- tive disorder. If not due to deficient food intake, a poorly nourished, emaciated body is positive evidence of insufficient assimilation, the food simply passing through the digestive tract with little or nothing absorbed. Absorption itself may be at fault, or digestion may be so defective that the food is not prepared for absorption. Perhaps the functions are af¬fected through mental or physical strain, worry or various other causes: but naturally, digestive disorders in most cases have their origin in errors of diet and other deleterious habits.
In case the patient being nursed has a communicable disease, care must be taken to avoid carrying any infection from the sick-room. As an attendant must leave the sick¬room from time to time it is advisable for her to wear a boudoir cap or a dust-cap, and a light wrap over her dress while in the sick-room, removing them when leaving the room. At the doorway of the room a sheet should be hung on the outside and kept sprinkled with some efficient disinfectant. This sheet covers the entrance into the sick room when the door is opened.
In communicable diseases it is essential that those attending the patient maintain their own health at the highest possible standard, that they under no circumstances neglect thoroughly to wash their hands or other parts of the body which may come in contact with the patient, and also that they keep each elimi-native outlet of the body free to perform its functions. That physicians and nurses themselves become so rarely infected while handling those who are affected by communicable diseases is in a large measure due to the resisting powers with which their own physical condition provides them and also to the sanitary precautions they observe.
Aside from this, the attendant must be constantly on the lookout for danger signals of failing vitality. As such a con¬dition develops the temperature usually drops rapidly to normal or below normal without any apparent improvement in the general condition^ and the patient’s heart and respiration begin to fail. The pulse becomes rapid, barely palpable (thready), the face assumes an anxious look, the lips, nose, hands and feet become bluish (cyanotic), cold and clammy, respiration becomes labored and rapid (over 35 a minute), a rattling sound in the throat is heard with each breath, and, if able to expectorate, the patient brings up a pink or red, foamy, sticky fluid. Energetic steps must be taken if the patient in such a condition is to be saved.
First, he should be propped up in bed in a sitting or partial sitting position and hot packs applied to his extremities or to the entire body and the treatment described in this volume for heart-failure immediately instituted.
Here we wish to put stress on the statement that no person can be an efficient nurse who does not take particular care of herself. To be cheerful, to be able to do a patient full justice, she must take care of her own health first. She, therefore, must commit no dietetic errors, must have sufficient sleep and outdoor exercise, and finally, in case of a communicable disease, must avoid all unnecessary exposures to infection on the part of herself or others.
Do NOT TREAT SYMPTOMS ONLY.-—In treating disease one should not treat only the symptoms, such as fever, chills, in- flammation, spasm.s, etc. These are simply the inevitable con¬sequences of the inability of the vital force to control the affected tissues in a natural or healthy manner. These symp¬toms should aid us in locating the tissues or structures altered character through influences at variance with their normal condition. For instance, a “cold” is an eliminating process, an attempt upon the part of Nature to get rid of poisons and impurities.
At any time in the course of an illness several complica¬tions may arise, such as hemorrhage, convulsions, and coma. All such complications call for immediate and expert action. In such cases a trained nurse is of incalculable value. How¬ever, if for any reasons such a nurse is not available the person who assumes the responsibility of attending the sick should try to prepare for all these emergencies by reading up beforehand everything relating to the particular disease and possible com¬plications, as given in this volume.
In the course of a serious illness the patient usually becomes more or less helpless. Hence the need of an attendant whose duty it becomes to look after all his bodily comforts and to watch his condition carefully and critically. The principles of nursing have been sufficiently covered in Volume VII (Sec. 3.) to acquaint anyone with the essentials.
It is well for the nurse or the attendant to familiarize her- • self with a sick-room chart. This is easy to keep and is a great convenience in following the course of the disease, as it will show the temperature, pulse-rate, respiration rate, bowel move¬ments, kidney actions, treatment instituted, amount of food and water taken, amount of sleep the patient has had- and any other important matters necessary to record for the informa¬tion of the physician.
Of all the various functions of the human body the circu¬lation of the blood is perhaps the most vital. Coldness of the surface always indicates recession of the blood to internal organs; so the greater the surface affected and the degree of coldness, the more serious the condition thus manifested is likely to be. A hot head and cold hands indicate brain con-of gestion. A hot abdomen and cold feet indicate intestinal con- gestion. Heat over the chest or upper portion of the back coincident with cold extremities denotes lung trouble.
A cold nose often signifies intestinal torpidity. One cheek hot and the other cool shows nervous fever, or sometimes pneumonia. Both cheeks flushed may show hectic fever. As our health depends upon the equalization and purity of the blood stream, the first step toward relief is the equalization of the circula¬tion and the free functioning of the secretions and excretions.
In every case of disturbance of health the predisposing causes must be considered, for if the blood is pure and the organism has sufficient vitality no disease is likely to develop. A sore throat will arise only when there is a lack of resistance, or when there are accumulated wastes. Such a condition as cold, wet feet may be regarded as the immediate cause, though the primary causes are of the kind enumerated in detail under Colds.
The temporary chilling of a healthy body or any part of it will have little harmful effect, though prolonged interference with the circulation will be likely to cause trouble.
Health is bodily ease. “Ease” implies freedom from physical disturbances and a normal, natural condition of all parts. In health every function is performed easily, without interference or hindrance from any cause whatever. Disease implies unnatural conditions, with restriction of or inter¬ference with functions. To be continuously ailing is no longer considered a credit to one’s intelligence. Pain and illness, dis¬comfort and depression are evidences of derangement of the body. Irregularity of functional action must be traced to its source and corrected.
“A stitch in time saves nine” is an old saying that applies here. Learn to recognize diseases in their early stages, through the instructions offered in these pages, nip them in the bud, and you will have little to fear. When we understand the body and its needs, each of us may be practically absolute master of his own health and happiness. “A cool head, warm feet and open bowels” is a simple but fairly good observance to preserve health, and to regain it when lost.
DISEASES are classified in various ways. In or¬ganic diseases the structure of an affected organ of the body is altered. In functional disease there is no visible change in structure, but failure of organs or parts of the body to perform their functions. When a communicable disease occurs in a certain locality more or less constantly it is said to be endemic. When it affects a very large part of a community it is said to be epidemic; when an epidemic spreads over a large stretch of a continent or of the world it is called a pandemic. Detached cases of a com¬municable disease in a given locality are spoken of as sporadic. An acute disease is sudden and rapid in its development; when slow or gradual, the disease is said to be chronic.
Curative methods of treating disease may be hygienic, dietetic or manipulative, or combinations of these. Preventive methods usually are hygienic and dietetic, but sometimes other methods also are applied.
Pathology is the study of disease. Etiology considers the causes of disease, which may be internal or external, specific, primary, or secondary, predisposing and exciting. Symptom¬atology is the study of the various symptoms and signs whereby the disease is detected and diagnosed; these may be objective or subjective. Objective symptoms are those evident to the observer or examiner, while subjective symptoms are those that are apparent only to the patient himself. Diagnosis is deter¬mination of the nature of disease, while prognosis is the fore¬cast of the outcome of a disease.
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