|
Laxative enemas sometimes are necessary. The best laxa¬tive enema is one of olive oil. Six ounces of oil at a tempera¬ture of 95 degrees may be used, being injected by means of a bulb or hard-rubber syringe, or a funnel and soft rectal tube. Usually it is better to follow the oil enema within half an hour with a simple water enema, or with an enema of soapsuds, using pure Castile soap and removing the floating suds. If a slightly more stimulating enema is desired, half an ounce of glycerin may be added to an equal amount of warm water, injecting it as advised for the oil enema. We do not advise this enema for children or infants, but the oil enema is satis¬factory for all ages.
In giving enemas to children a flexible nozzle should be used if the child is restless, otherwise the smallest hard-rubber nozzle. For infants the bulb syringe is best. Children usually require from half a pint to one pint of water, infants usually not over two ounces. Be sure to expel all air from the tube when the fountain syringe is used and see that the bulb is completely filled with water when that is used; otherwise the entrance of air into the rectum will cause pain.
The same procedure as given above may be used for older children, but infants and small children are held on the lap.The best time to give an enema is in the morning before beginning the toilet, or before preparing the patient for the night. If it is not effective it may be repeated within half an hour, or immediately if the patient is not weak.
Place the water in the reservoir of the enema outfit, hold the nozzle over the bedpan, open the clamp (or stop-cock) to allow the air to escape and to warm the tube. Close it when the water appears at the nozzle. Apply a small amount of vaseline (or oil) to the nozzle. Suspend the bag or can two feet above the patient if it is not to be held. Gently insert the nozzle into the rectum, in a slightly forward direction. With¬draw a little distance if there is obstruction, inserting again. Forcible insertion is always to be avoided. The nozzle should enter about three inches. Open the clamp and allow the water to flow gently. If the patient complains of pains, pinch the tube, close the clamp, or lower the bag, increasing the flow again as the pain subsides. For best results the enema should be retained for five or ten minutes. A folded towel pressed against the bowel outlet will reduce the desire to expel before this time.
If the bedpan is to be used turn the patient on the back, bend the knees, assist in elevating the hips and place the pan in position. Turn up the end of the towel which has been placed on the rubber sheet over the edge of the bedpan as an added precaution against soiling the bed and draw up the covers. On removing the bedpan put in its place a second warmed bedpan, irrigate the anus (first irrigating the vulva in a female patient), remove the pan and dry thoroughly; then remove the towel and rubber sheet. Or the anus and vulva may be bathed from a basin with a special cloth.
If a commode is to be used instead of the bedpan have it near the bed, put on the patient’s stockings, slippers and bath-robe and assist to the commode. Cover the legs, place a low stool under the feet and place in front of the patient a low chair for use in case of faintness. Place a blanket about the patient if necessary for additional warmth.
In giving the enema have the equipment ready and con¬veniently arranged. The articles required are: a fountain syringe or enameled irrigating can, with tubing, clamp and nozzle, rubber sheet, towels, vaseline, warmed bedpan or commode (slop-jar), toilet paper, pitcher containing two quarts of water at the desired temperature (about 95 degrees F.), and a small pitcher or vessel containing warm water for cleansing. Remove all pillows except, if the patient especially desires it, a small one, and all covers except one blanket and the sheet.
Place the rubber sheet, covered with a bath towel, under the patient turned to the left side with the knees flexed, the right somewhat more than the left. If necessary, however, the patient may remain on the back; and in obstinate cases of constipation the knee-chest position may be used if the strength of the patient will permit.. The enema should be administered under cover if possible.
ENEMAS.—During normal life bowel waste may be kept moving by exercise and adjustment of the diet. But during sickness, because of the complete inactivity and the more re¬stricted and less bulky diet, it is usually necessary to give enemas. Otherwise absorption of poisonous substances pro- duced in this waste will retard the progress of cure and may cause various additional disturbances. Nurses are trained to give various kinds of enemas, for different effects: not only simple cleansing enemas, but laxative, cathartic, nutritive, stimulating, sedative, astringent, antiseptic, etc. But the physical culturist will not use any but the simple cleansing enema and, perhaps, the mild laxative enema. (See also under Water and Health.
RUBBING THE PATIENT.—Often nothing is quite so sooth¬ing to a bedfast patient as a general rubbing. It relieves tensions, quiets the nerves, improves the circulation, relaxes muscles and tends to improve skin health. When giving this treatment it is usually better to use a little oil or powder on the hands. The entire hand should be used, giving equal pressure with all parts of it, as this is not a massage treat¬ment. This rubbing is a different procedure.
In rubbing the forehead rub outward from the middle with the fingers of the two hands at the same time. Over the eye¬lids use the tips of the ringers, rubbing outward with light pressure. The hands may travel from the forehead to the sides of the head, back of the ears and down the neck. Forthe arm, hold the arm up by the wrist with one hand and rub full length with the other. For the lower extremities face the foot of the bed and draw the hands upward toward and to the thighs, one leg at a time.
If the abdomen is to be rubbed, as often is done in case of constipation, stroke upward on the right side, across the upper abdomen and down on the left side. The back is rubbed with the patient on the side of the bed facing the nurse, rubbing first being lengthwise of the spine and then with curving, upward-outward strokes to cover progressively the entire spine and the back from the hips to the shoulders. Circular movements, sliding the skin over the underlying mus¬cles, are then made about the shoulders and lower part of the back. Often the patient lies face down for this rub.
Temperature-Reducing Baths may be prescribed by the physician or may be considered necessary by those caring for patients themselves according to the teachings of physical culture. Either cold or cool water or alcohol may be used, preferably water. The patient and the bed are prepared as for the bath described above, except that a rubber sheet is placed on the bed under the under sheet and a cold turban, frequently renewed, is applied to the head.
Constant friction is given during the bath and the water, instead of being wiped off, is allowed to evaporate, to augment the cooling effect. Tender spots and the abdomen should not be vigorously rubbed. Usually eight to ten minutes is devoted to sponging the front of the body and an equal time to the back, with the patient lying on one side. In completing the bath it is usually beneficial to place a hot-water bottle at the feet, and to leave the additional blanket, removing both (usually) after about half an hour, then replacing the gown. At this time the temperature, pulse and respiration should be taken and recorded.
Foot-baths often are beneficial for relieving congestion root-Baths
elsewhere, for headaches and colds and to stimulate circula- congestion tion of the lower extremities. The bath may be given to a bed patient by turning back the covers to the knees and put¬ting the feet gently into a foot-tub half full of water at the right temperature, the tub being set on an extra folded blanket or a rubber cloth (or both) in the bed. The covers should be drawn over feet and tub after the feet are in the water. Additional water may be added to the tub to raise or lower the temperature as required, the patient’s sensations necessarily being considered as far as possible.
(more…)
Usually the teeth and the mouth should be cleansed after the face is bathed. The patient does this if possible, other-wise the nurse does it with gauze over a finger, or applicators with cotton tips. The patient rinses the mouth with mouth wash, expectorating in a special curved basin adjusted under the chin.
The proper care of the hair is neces¬sary for the comfort of the patient. It may be taken care of after teeth and mouth are cleansed. or after the bath’ is completed. If the hair is long it should be parted from the fore¬head to the nape of the neck and braided on each side just back of the ear, first be ing brushed carefully and combed gently. Bobbed hair requires merely brushing and combing. If the hair is neglected for only a few days it becomes tangled and is difficult to straighten. If the patient dislikes to have the hair braided, it may be rolled into a bunch and secured on top of the head. The hair and the scalp should be washed weekly, with the patient lying across the bed if possible.
Tub baths are serviceable for cleanliness, to increase or decrease temperature, to soothe the nerves, or to relax the muscles. They may be used for helpless patients by having the bath ready in a room at suitable temperature and carrying him to and from the bath, but a bed-bath is usually better for such patients. A less helpless patient may require assistance in going to, returning from, getting into and out of, the bath. Usually the nurse should assist during the bath by giving friction and applying the soap, perhaps the flssh-brush and in drying. If the patient takes his own bath the nurse should be within call.
Wash the face and dry, then the neck and ears, using care not to drip water on the patient. Bathe the arms, hands, armpits, chest and abdomen in this order, drying and covering each part before proceeding to the next. The patient’s hand may be placed in the water and remain for a few moments, the nails being cleansed with the nail-brush and perhaps an orange stick, but do not use the nail-file until after the bath is completed. When the arms are bathed and dried wrap them in folds of the lower blanket. Before bathing the ab¬domen add additional water to raise the bath temperature, as this region usually is sensitive to cold.
Now turn the patient to one side and bathe and dry the back of the trunk, then the thighs to the middle and dry, repeating on the other side. With the patient again on the back one leg is first uncovered, bathed and dried, then the other. The feet may be placed in the basin when washing them and the legs. If a nail-brush is used it should not be the one used for the hands. In bathing the soles use firm strokes to prevent tickling. Carefully bathe the external genitals if they have not been bathed previous to the bath. With a male patient (unless helpless), the basin and cloth are placed in position for him and he bathes himself while the nurse is busied elsewhere or steps from the room.
At each region follow tlie warm bath with a cool one be¬fore drying. If alcohol is used it should be rubbed on each part after the drying that follows the cool bath. Then a simple dusting powder may be applied if desired, especially to the back. Upon completion of the bath and removal of the basin last used, first remove the under blanket and replace the gown. Then draw up and adjust the upper bedclothes, remove the upper cover blanket, and replace the pillows after shaking them.
During sickness there should usually be an even longer time between meals and baths than ordinarily, especially if there is any digestive trouble or disturbances in the abdomen. Never less than an hour should elapse after a bath before a meal, or after a meal before a bath. An hour and a half to two hours will usually be better. The room in which the bath is given should be warmer than usual. Either the windows should be closed or screens or high-backed chairs placed to prevent drafts. In summer, as a rule, no additional heat is necessary. Everything required should be in readiness before the bath is begun. If any special bath—that is, for, a special purpose—is to be given, it is usually better that the physician direct it, or fully describe the method, though those who have studied the subject should be able to give special baths without difficulty.
GIVING A BED-BATH.—One should have ready a large basin (or a foot-tub), a smaller basin, a slop-jar, a large pitcher, a face towel, two wash-cloths (one for the face and neck and the other for the body), two or three bath towels, two small blankets, preferably old ones, soap, powder, alcohol. and necessary bed and body linen, with, perhaps, comb and brush, nail-brush, nail-rile and scissors. The larger basin con¬tains hot water, say 104 to 106 degrees. The pitcher also con¬tains hot water at a somewhat higher temperature. During the bath some of the water is emptied from time to time into a convenient vessel and replaced by wrater from the pitcher to maintain a fairly uniform temperature. The smaller basin contains cold water, used to cool the hot water as may prove necessary.
Loosen the bedding and draw the patient to the side of the bed most convenient to work from. Remove the pillows entirely and place a soft bath towel under head, neck and shoulders. Lay one blanket in folds upon the patient’s chest and draw it down over his body, while carrying the top covers to the foot of the bed. Roll the second blanket close to the patient’s side and draw it under him. Remove the nightgown, the patient being under cover and between the two blankets.
« Previous Page — Next Page »
|
|