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In bathing small children, be especially careful that they are not exposed to cold or drafts; dry them well and see that while one part is being bathed the rest is protected with adequate cov¬ering of light material. Change the personal and bed linen often enough to be always clean and dry. A child may be so easily put on another bed or a couch while the bed is being made that this may be done without disturbing it, even during high fever. In such cases, however, it would perhaps be better, be¬fore moving, to reduce the temperature by the use of the sponge bath.
Always hold a child’s head when there is vomiting, as it is comforting and relieves the strain. Assist the vomiting by giving a little water or other emetic (See Emetics, Section 5) and tickling the throat if necessary, when there is strenuous retching. In case of frequent urination without control, rub¬ber pants may be used over the diaper; or a bath towel may be pinned about the abdomen with a good-sized knot at the back so the child will sleep in some position other than on the back, this change often being beneficial. Never give food during a fever, unless this is due to tuberculosis. Fruit juices, un¬sweetened, are permissible, however, and often beneficial. Take a child up as little as possible when it is acutely ill. Chil¬dren are soon spoiled and make life miserable for themselves and their mothers or nurses, even after a short illness, if they have been “nursed” in arms too much—and almost any amount is too much. Besides, the handling of the child definitely ag¬gravates the disease.
The above are some of the simple things to consider in nursing children. Each case of childhood illness will call for its own details of nursing, as will each adult illness. But chil¬dren respond so readily that perhaps special care should be taken to see that they get proper nursing.
Often it is necessary to restrain a child, either for exami¬nation or to keep it from disturbing dressings, or scratching some infected or other place that should not be touched. For the latter purpose mittens may be put on the hands, with tapes to attach to the sides of the bed, holding them loosely yet so that the part to be protected cannot be reached. Or the mittens may be fastened with safety-pins to a suitable part of the undershirt or elsewhere. A sheet may be folded cor-nerwise under the child, brought about the body and pinned, so as to confine the arms.
In the case of small children a mailing, or other similar cylindrical tube, may be placed over the arm (over clothing) and attached by tapes. A splint, well padded, may be se¬cured along the outer side of the arm, attached above andsbelow the elbow and, in case of a strong child, at the elbow also. The arm may then be moved at the shoulder but not bent at the elbow.
To restrain for examination, an excellent method is to place the child on the lap, pass your arms under the little arms and then hold the forehead with the hands. Another fully satisfactory method is to hold the child on the lap, pass one arm in front so as to secure both arms, then use the other hand to restrain the head. In both methods the child, facing front with the nurse, is facing the doctor. If at all possible, how¬ever, the confidence of the patient should be obtained first so there will be a minimum of fright or of struggling.
To secure quiet and as a safeguard in the event of the de¬velopment of an infectious disease, isolate children if there is even moderate fever. If children are in perfect health it may be they will have natural immunity to all or most infec¬tious diseases. But all children are not in such health—in fact few are; so nothing is to be gained by exposing the other children in the family to infection. At the first sign of dis¬ease if a child is taken from solid food or milk, and given nothing more than fruit juice and water; if it has a bath in warm water, an enema and rest, the sickness will not likely be long nor will it seriously endanger the patient or others.
Tact and an abundance of patience are necessary in nursing children. There must be a genuine sympathy, but it should be directed toward the ultimate good of the patient rather than to the gratification of immediate transient desires. Hence judicious firmness will he necessary. A capacity for observation is necessary, also; for especially in the case of infants and young children no information will be given consciously by the patient regarding the nature of various troubles that may arise. That is, the patients cannot interpret and explain their feelings; therefore the nurse will need to observe signs of change or progress.
The movement of the hand to some part of the body, the character of the cry, the position of the body, the response to various influences (light, sound, food, etc.)—the nurse may use all for the purpose of obtaining the information she needs. The control of the voice is even more important than in nursing adults. The child is sensitive to the voice and will be influ¬enced by inflections and the slightest evidence of irritation or excitement. The strange nurse should take charge gradually, the mother or family nurse giving way little by little, so the child will not be thrust suddenly into a strange atmosphere and so the nurse may have the child’s confidence.
The various diseases and disorders of childhood are taken up in Section 7 of this volume and in Vol. VIII in regular alphabetical order with those of adults; hence they need not be specially considered here.
Some things that grown or fairly mature patients may do while convalescing may be mentioned here. Games for two, such as dominoes, checkers and various card games, especially cribbage, are excellent if not too exciting. Solitaire may be played by the patient himself part of the time. “Cut-out” and other puzzles may be worked with. If he has a collection of snapshot pictures these may be put into an album and cap-tioned; or a scrap book may be filled with any material of interest. Drawing and coloring or painting; wood or leather carving; whittling blocks and wood for little cottages, log cabins, bird-houses, or toys; clay modeling; tatting, knitting, crocheting, basket-weaving, picture framing; making calen¬dars or small lamp-shades, trimming hats, making ribbon flow¬ers or articles from crepe paper or sealing wax, etc., etc.—all these are excellent.
Working with potted flowers, watering and light weeding, planting seeds and other light work will be possible later, also perhaps light bench work for men patients. The interest must be maintained, while always guarding against fatigue. Ten¬sion during any pastime must not be allowed; the work must be changed, or, if necessary, rest must be insisted upon.
An excellent way to entertain patients is to read to them. However, care must be taken to read rather slowly, never loudly, but in a well modulated voice and distinctly, to face the patient and guard against reading too long at a time. Newspapers should not be allowed to rattle, and sensational news should be avoided. Select a good variety of general news, heeding as much as possible the patient’s desires, unless these run toward the sensational. Magazine articles and stories and wholesome books also may be read, if the patient is interested in them, and the chances are that he will be. Avoid all reading material in which there is reference to sick¬ness or abnormality.
Get out frequently and gather some new interests to bring back to the sick-room, but keep away from gossip. Elderly patients, as a rule, are in even greater need of enter¬tainment or light occupation than younger people during ill¬ness, for they are inclined to feel neglect keenly and also to feel that the neglect is because they are “unnecessary anyway.” This need is often not taken into consideration sufficiently.
Patients must be protected from those who have even the least injurious effect, whether immediate or later. When Arisitors first are permitted and often throughout the period of convalescence, it will be better to restrict the number allowed in the sick-room at a time to one. Continually turning the head, or even the eyes, to observe two or three or more visitors is wearying in itself. When combined with having to hear different voices, one or more of which is likely to be harsh and strident, or unduly loud, with clashes of voices as various ones attempt to speak at the same time, the patient is certain to be exhausted and made nervous. One visitor, placed con¬veniently so the patient does not face the light in looking at him, will not physically tire or irritate him unless he is re¬quired to do too much talking. All sick-room calls should be short, and the intervals between them should be regulated according to the patient’s condition and the effects of company.
ENTERTAINING THE PATLEXT.—One important need of patients, whether acutely or chronically ill, is diversion. This helps to pass time and keep up the spirits. During severe ill¬ness there is such a depressed or abnormal condition of the body and the mind that attempts at diversion will meet with no response and will result in positive injury. But during convalescence, especially during protracted or chronic illness, diversions are definitely helpful.
If such patients are allowed to make themselves useful, either in their own care or other¬wise, they will feel less helpless than when waited on “hand and foot” and will gain more rapidly—provided, of course, these small things are within their capacity. Xothing is better for the mentality and morale than having the hands occupied at something that requires moderate mental concentration. Each patient will have to be treated in this matter according to his own peculiarities and conditions; but patient and nurse working together can usually devise some interesting and not only harmless but beneficial program.
One must, of course, be careful not to allow a patient to overdo in anything undertaken. Normal convalescence is steady, even though, at times, it may be slow: but there should be no sliding back, no loss of improvement made. If the pa¬tient’s small activities cause weariness there will be irritability and depression, bence discouragement. A mistake often made is to endeavor to entertain a patient, or keep hiin occupied, practically all his waking hours. There should be many hours every day when his time is his own, to relax and day-dream, to plan for the future, to sleep or to occupy himself in any other way he chooses.
There are times during acute illness when visitors cannot be allowed, even members of the immediate family. But when his condition i*ffl permit, visitors, bringing in some fresh con¬tact with the outside world, may be of much benefit to the patient. But such visits must be refreshing1, brightening and encouraging, comforting and reposeful, or they will tire and irritate the patient and retard his progress. A visitor is help¬ful if he or she is cheerful and does most of the entertaining without dominating the scene. The patient should not feel under any obligation to entertain the visitor. If any such effort is made the call will be detrimental.
TEMPTTNG THE APPETITE.—It being the duty of nurses to prepare foods and see that patients get them, a vicious prac¬tice not only encouraged but insisted upon by many physi¬cians has developed. This is tempting the appetite when the patient has little or no desire for food. Thousands and hun¬dreds of thousands of patients have doubtless been hurried, literally, into untimely graves and a great many more greatly retarded in their convalescence and recovery by this practice. With only a few exceptions lack of or reduced appetite indi¬cates that the body not only does not need food but cannot utilize it. To feed Under such circumstances is to add further to the enervation and toxemia—the underlying conditions re¬sponsible for the vast majority of illnesses.
It is perfectly proper to make food attractive and interest¬ing to the patient. This may be done by varying the diet as much as the circumstances and the illness will permit. The manner of cooking or otherwise preparing may be varied, also, and the foods may be served in dainty, unexpected ways. The tray, the dishes, the linen all may be, in fact should be, ar¬ranged attractively. Flowers may be added to enhance the attractiveness of the whole and even the bread may be varied in cut and character, sometimes appearing as toast and some¬times in sticks, triangles and squares instead of slices. If a certain food that cannot be injurious is persistently craved it may be given, the amount depending upon its nature and the patient’s condition. These things are all legitimate “appetite tempters,” and aids to digestion.
But the practice of giving jellies and jams and preserves, or condiments, pickles or other vinegared products or of giving tidbits between meals or some alcoholic or other beverage before meals, even in minute quantities, or various other sub¬stances having no actual food value but producing their ef¬fect upon the appetite by unnatural stimulation—all these are to be condemned. The trained and the practical nurse now¬adays are not so likely to give these things as is the family nurse—that is, some member of the family, especially the mother, through her misguided love. She is the chief culprit. Foods attractively served, with an agreeable aroma and flavor, plus honest appetite created by the body’s genuine need for food, are all the appetizers any patient needs or should have.
THE CONVALESCENT DIET will naturally depend upon the nature, duration and severity of the previous illness, the pa¬tient’s inherent strength and recuperative powers, as well as age, sex, size, etc. But generally speaking all the foods so far listed may be used by convalescents from most diseases, as well as chicken and fish (moderately), oysters, baked pota- toes, root vegetables other than potatoes, green vegetables and salads. A great many people doubtless will be on the milk diet during their convalescence, in which case other foods, except fruit juices, will not be used. If the patient is taking milk for half a day, with one meal in addition, the above foods, except meat in any form and fish or other sea food, may be taken at this meal.
SOFT DIET includes the foods mentioned above and also bread and butter; bread and milk; cereals, either dry in milk, or milk and cream well cooked: custard, soft and baked; eggs coddled, poached and soft-boiled: fruits stewed and in purees; milk pudding, milk soups, oyster stew and toast (pre¬pared with cream, milk or water); many vegetables in puree form, and the broths of vegetables.
Eggs have been given to patients for “ages,” it being pre¬sumed that because they are soft and more or less easily di¬gested they are suitable for practically all forms of illness. As a matter of fact, it is better for the invalid to abstain from egg wThites. The yolks provide every element and every vita¬min required and hence are valuable, but many individuals cannot take this part of the egg. Such persons should leave the entire egg alone, for there is no virtue in the white. Oysters also should be avoided by the majority, though they are usually less likely than eggs to cause intestinal and other disturbances.
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