NURSING TECHNIC
MARY C.WHEELER, R.N. 
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NURSING  TECHNIC
          BY


  MARY C. WHEELER, R.N.

SUPERINTENDENT OF ILLINOIS TRAINING SCHOOL FOR NURSES,

         CHICAGO, ILLS.
32 SPECIALLY PREPARED ILLUSTRATIONS UNDER

  PERSONAL SUPERVISION OF THE AUTHOR
ACADEMY
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LIBRAE
PHILADELPHIA AND LONDON

J. B. LIPPINCOTT COMPANY


         9/9 
COPYRIGHT  1918,  BY J. B. LIPPINCOTT COMPANY
Electrotyped and Printed by J. B. Lippincott Company
The  Washington Square  Press, Philadelphia, U.S.A. 
PREFACE
  These notes have been brought together with the
hope that the teaching of the fundamentals of nursing
technic may be more nearly  standardized in Schools
of Nursing.
  We have sought to place before  the  students the
main objects of any nursing procedure, to induce them
to think and  plan for the comfort of the patient, and
to note the  value  of  the  procedure to the patient,
together  with the mechanical  process of getting the
materials  together,  and their  proper use.
  We have devoted much time to the various methods
in order  to find out those which could be successfully
used together with the greatest economy of time, effort
and materials.
  Thanks are especially due Miss Sarah Warwick (de-
ceased),  Miss Myra Tucker,  Miss S. Lillian Clayton,
Miss Eleanore E. Hamilton, Miss Susan K. Lane, Miss
Daisy  Urch, and Miss  Hattie J. Robinson.   These
nurses have all been instructors in the Illinois Training
School for Nurses,  through succeeding years.
                        Mary C. Wheeler, R.N.
May, 1918. 
 
CONTENTS
CHAPTER                                              PAGE
   I. Housekeeping..................................   n
          Order of the Ward; Care of Bath Rooms, Lava-
          tories and  Utility Rooms; Care  of  Plumbing;
          Care of Bed  Utensils;  Care of Rubber  Goods;
          Care in Communicable  Diseases; Stains.
   II. Beds...........................................   28
          Cleaning Empty Beds; Carbolizing Empty Beds;
          To  Cleanse Beds Infected With Vermin; Bed-
          Making; Air and Water Beds; Fracture Bed;
          Operation Bed; Klondike Bed.
  III. Baths..........................................   47
          Cleansing  Baths;  Baths in Hyperpyrexia; Baths
          for  Elimination; Sweat Bath; Child's Bath; In-
          fant's Cleansing Bath.
  IV. Patient.........................................   78
          Contents of Nurse Basket;. Charting and Record-
          ing; Temperature, Pulse, Respiration; To Place
          and Remove  a Bed Pan; To Make an Occupied
          Bed; Enemata (Clysters); Methods of Making a
          Patient Comfortable; Handling Patients After
          Fractures; Handling Patients with Hemorrhage;
          Handling  Patients  with  Sprains; Care  of the
          Mouth; Care of Hair;  Care of Nails;  Care of
          Back;  Pressure-Sores (Decubita); Application of
          External Heat; Application of External Cold;
          Feeding Patients; Care of Surgical  Cases Before
          and After Operation; Symptoms.
   V. Medicinal Topics...............................  158
          Rules for Giving Medicine; Inunctions; Supposi-
          tories; Counter-irritants; Hypodermic Injections;
          Administration of Antitoxin; Lavage; Gavage;
          Nasal Feeding; Test Meals; Steam Inhalations.
                                                   7 
8                      CONTENTS
  VI.  Dressing  Room................................. 182
          Duties of Dressing Room Nurse; Sterile Supplies;
          Solutions;  Binders;  Triangular Bandage  and
          Slings; Positions and Draping for Examinations;
          Application of Hot Dressings; External  Douche;
          Vaginal Douche; Catheterization; Vesical Douche;
          Irrigation of Eye;  Aural  Irrigation; Mouth and
         Throat Irrigation;  Nasal Irrigation; Hot  Dress-
          ings  for  the  Eye; Cold Compresses for Eye;
          Hypodermoclysis;   Phlebotomy  or  Venesection;
          Intravenous Infusion.
 VII.  Specimens..................................... 225
          Preparation of Specimen Bottles; Vaginal Smears;
          Cultures.
VIII.  Emergencies.................................. 230
          Artificial  Respiration;   Syncope;  Convulsions;
          Hemorrhage; Isolating Patients; Cramp  in  the
          Back  of  Leg; Singultus; Foreign Body in Eye;
          Splinters;  Heat   Stroke;  Poison  Cases;  Care
          of the Dead.
  IX.  General  Topics................................ 240
          Admission of Patients into Cook County Hospital;
          Nurses' Rules for  Discharging Patients; Nurses'
          Rules for Receiving New Patients; What Student
          Nurses Should Know Before Going  on  Junior
          Night Duty; Organization for Handling a Large
          Group of Injured  Persons; Organization of Fire
          Department; In Case of Fire. 
ILLUSTRATIONS
FIG.                                                 page
 i. Ticking Sewed on Both Sides of Rubber Sheet.........  17
 2. Removal of Bed-Clothes............................  33
 3. Brushing Mattress.................................  33
 4. Turning Mattress from Head to Foot.................  34
 5. Dusting Bed Frame................................  34
 6. Making Bed.......................................  36
 7. Toe Plaits in Upper Sheet...........................  36
 8. Placing Blankets...................................  37
 9. Boxing Blankets for Unoccupied Bed.................  37
10. First Movement in Squaring Corners.................  38
11. Second Movement in Squaring Corners...............  38
12. Third  Movement in Squaring Corners................  38
13. Finishing Box  Corner...............................  38
14. Tucking in Bedspread..............................  39
15. Finishing Corner with Hanging Spread...............  39
16. Making Line for an Oblique Corner..................  39
17. Finished Oblique Corner and Passing to Other Side of
        Bed..........................................  39
18. Dusting Bed Frame on Opposite Side of Bed..........  41
19. Making Bed on Opposite Side........................  41
20. Finished Bed and Dusting Bed-side Table............  42
21. First Patient  Receiving Entrance Slab-bath.  Second
        Patient Having Hair Dried Before Being Sent to the
        Ward.........................................  52
22. Portable Electric Light Frame for Giving Sweat Baths  70
23. Sweat  Bath Frame Covered with Water Glass........  70
24. Nursing in Connection with Maternity Department....  76
                                                 9 
io                  ILLUSTRATIONS
25.  Thermometer Basket and Ice Cap Rack.............  86
26.  Morning Airing of Bed.............................  92
27.  Side Pieces on Bed for Restraint.................... 119
28.  Laparotomy Sheet................................. 183
29.  Sterile Vaseline and Beck's Paste in Glass Syringes Used
        for Dressings.................................. 187
30.  Detail of Gynecological Sheet Used in the Operating
        Room......................................... 201
31.  Pocket Formed by Holding Lower Lid for the Eye Drop 214
32.  Paraffin Treatment of Burns........................ 221 
     NURSING  TECHNIC

                  CHAPTER I

               HOUSEKEEPING

             ORDER OF  THE WARD
A. Object:
     I.  For cleanliness  as a  precaution against con-
         tamination.
     2.  For order as an aid to more efficient work.
B. Articles  necessary:
     i.  Waste basket lined with paper.
     2.  Whisk broom.
     3.  Basin of water.
     4.  Cloth duster.
     5.  Laundry soap.
C. General  order, 7.15 A.M.:
     1.  Note temperature of ward.
     2. Regulate ventilation.
     3.  Adjust window shades to uniform height, re-
         move articles from  sills at the same time.
     4. Beginning at right side of ward, remove bed
         utensils and cleanse.
     5. Remove  refuse,  with  whisk  broom,  into
         basket, from tables, floor.
     6. Morning airing of beds: place pillows at head
         of bed with open  ends  of  pillow-case on
         mattress.   Fold  top covers down half-way,
         and then  over the  foot of the bed.
     7. Empty beds : draw spreads tightly and arrange
         pillows.
                                          11 
12
NURSING TECHNIC
D.  General order, with  morning care of patients:
      i. Nothing to be  kept between mattress  and
         springs.  Towel and wash-cloth to be folded
         neatly and kept on the rod at the head of bed,
         on  side away from the ward door.
     2. Wrappers, coats, trousers, extra blankets, etc..
         to be folded  neatly and placed under pillow,
         or on  rod at head of bed.
     3. When extra rod at head of bed: place slippers
         on this rod, on the side away  from the ward
         door.
        When no extra rod at head of bed: place slip-
         pers  between side rod of  bed-frame and
         springs, at the  head, of the bed, away from
         the ward door.
     4. Soap is to  be  wrapped in paper and  kept on
         lower  shelf of table.
     5. Bed-pans and  urinals must  not be placed on
         tables, chairs or floor.   They must be left in
         the bed until  taken directly to the lavatory.
     6. Tables:  all  personal belongings  of  patients,
         magazines, bags of fruit, etc., must be kept on
         the lower shelf  of  the  bed-side table.  The
         top must be  kept clean for trays,  drinking
         glass and flowers.
     7.  Nothing is ever to be placed or left on radiators,
         window sills  or floor.
E. General order,  11  A.M. and  4 P.M.:
     1. Regulate ventilation.
     2. Note temperature of ward.
     3. Place beds  in line, 6 to 12 inches from wall,
         with castors  turned toward head of bed. 
       CARE OF BATH AND UTILITY ROOMS      13

     4. Adjust window shades to uniform height.  Re-
         move articles from sills at same time.
     5. Beginning at  right side of  ward, remove bed
         utensils and cleanse.
     6. Empty beds : draw spreads tightly and arrange
         pillows.
     7. Place chairs uniformly.
     8. Extra blankets and clothing to be folded neatly
         and placed under pillow.
F. The order of the ward includes the care to be given
         all corridors in that they are kept  free from
         refuse,  and the cleaning of  tables, chairs.
         drinking fountains  and  the dusting of win-
         dow-sills, etc.


  CARE  OF  BATH  ROOMS, LAVATORIES AND
                 UTILITY ROOMS
A. Faucets:
     1. Nickel, clean with soap and water. Rub dry
     2. Brass, clean with  metal polish.
B. Set bowls, basins, sinks:
     1. Clean with cloth, laundry soap and water,  or
         with scouring powder, which does not scratch
         the enamel.
     2. Pour a solution of sal soda, 12 drams to 1 quart
         of water, in waste pipe, every few days,  to
         keep it free from  accumulation  of grease
C. Hoppers and toilets:
     1. Flush.   Clean with stiff,  long-handled  brush,
         then with a cloth,  laundry soap and  water,
         or use  scouring powder  on cloth. 
14              NURSING TECHNIC
D. Bath-tubs:
     i.  Clean with laundry soap and water, or, if very
         greasy, use a small quantity of  kerosene on
         the cloth, followed by hot  water  and soap,
         to remove the odor.
E. Bed-pans, urinals,  emesis basins,  aside from
    usual cleaning:
     I.  Put to soak in a deep sink.
         a. Clean thoroughly by scrubbing with soap
              and water or with scouring powder.
         b. Rinse  thoroughly,  disinfect  with  liquor
              cresol compound I  per  cent.,  or with
              other disinfectant.
         c. Rinse with very  hot water.
     2.  Cleanse  as above  and  place  in  the  bed-pan
         sterilizer with opening downward.   Sterilize
         for  ten minutes, remove, dry, and  place in
         rack.
F. Waste cans:
     i.  After being emptied, cleanse, air.
     2.  Line with several  thicknesses of newspaper or
         insert  a heavy paper bag and tightly cover,
         while in use.
G. There should be no accumulation  of any materials
     allowed in  the utility rooms.  The cleaning and
     supplies  should  be  checked  daily.   Nothing is
     clean  that can be made  cleaner.
              CARE OF PLUMBING
Report defects at once.
Never allow water either to run or drop  from faucets, 
CARE OF  BED UTENSILS
15
  as it results in unnecessary waste of the water supply
  and unnecessary  wear of the faucets.
Use sal  soda solution, 12 drams of  soda to 1 quart of
  water, to  keep  pipes free from grease.
Avoid throwing  coffee  or tea  grounds, hair, thread,
  cotton, cakes of soap, etc., into any sink or toilet.
            CARE OF BED UTENSILS
A. Bed-pans:
     1.  Cover, remove to utility room, examine  con-
         tents, empty.
     2.  Rinse  with  cold  water,  using  brush,  if
         necessary.
     3.  Rinse with hot water.
     4.  If  an odor remains,  pour in 3 to 4 ounces of
         solution chlorinated  soda or  liquor cresol
         compound and  rinse with  hot water.
     5.  Place in  rack.
B. Urinals:
     1.  Same as  bed-pans.
C. Wash basins:
     1.  Clean with soap and water or scouring soap, if
         necessary, dry and place in rack.
D. Emesis basins, containing vomitus:
     1.  Save for  specimen, if so ordered.  If  specimen
         not ordered, examine contents, empty, clean,
         disinfect, dry and place in rack.
E. Pasteboard sputum cups:
     1.  Gather in paper bags or newspaper cornucopias
         and place in receptacle for burning. 
16
NURSING TECHNIC
            CARE OF RUBBER GOODS
A.  General instructions:
      i. Rubber appliances are expensive and need con-
          stant attention.
      2. Avoid sticking pins into any rubber goods.
      3. Prolonged exposure to heat destroys it.
      4. Acids corrode it.
      5. Oil and grease cause it to become  soft and
          partially dissolved.
      6. Rinse thoroughly after the use of soap.
      7. Never use sand-soap on rubber, as it scratches.
      8. Because   unused   rubber  becomes  dry  and
          cracks  easily, from time to  time, soak  it in
          cold water.
      9. Folding cracks it; all rubber sheeting should be
          rolled  or hung on bars.
B.  Cleaning:
      1. Clean all articles after  using, at once and  in
          cold water.
      2. If scrubbing is necessary, use soap and  tepid
          water.
      3. Rinse off the soapsuds thoroughly, with  tepid
          water.
      4. If an odor remains, immerse in a solution  of
          formaldehyde, 2 per cent., for 30 minutes.
      5. Rinse in cold water.
C. Boiling:
      1. Rubber boiled in soda water becomes softened,
          while  boiled in  salt  water,   it   becomes
          hardened.
     2. Protect  articles by laying them on a  piece  of
          muslin  in  the sterilizer. 
                                                                                    iMl'tv.ii'1*!''': 4
                                                                                    kVuuiiua..i........J|

Fig  i—Ticking  sewed on both sides of rubber sheets saves rubber sheeting, clings to  under sheets.
d thus avoids  the  use  of  safety pins at the four corners; a saving in time, materials and infected fingers.
and  thus avoids 
18
NURSING TECHNIC
     3.  Boil thin articles,  as  gloves, nipples,  etc.,  3
         minutes.
     4.  Boil heavier articles,  as colon  tubes,  etc.,  5
         minutes.
     5.  Hard  rubber tubes should be allowed to cool
         immediately,  being  careful that  they  are
         placed in  such a way as to not alter their
         shape, while  soft.
D. Chemical disinfection:
     1.  Use 2 per cent, solution of formaldehyde for
         one  hour.  Rinse in cold sterile water.
E. Drying and putting away:
     1.  Leave thoroughly dry and in as cool place as
         possible.
     2.  Tubing: stretch repeatedly  to  squeeze mois-
         ture  from the inside  and hang up by  one
         end.
     3.  Air beds, cushions,  ice-bags,  ice-caps, hot-
         water bags, etc.: clean, when inside  is per-
         fectly dry, keep the double surfaces apart
         by inflating with air, pour into the inside a
         small quantity of smooth powder, or insert
         paper or old muslin.
     4.  After hot-water bags and ice-bags  have been
         used,  hang with the  open end downward,
         or ice-bags may be placed on  wooden racks.
     5.  Ice coils,  when clogged,  may  be cleaned by
         allowing warm soda solution (bicarbonate of
         soda one  dram, water one  pint)  to pass
         through the tubing.  Rinse with warm water
         and  hang up  so that the tubing will not
         be bent. 
       CARE IN  COMMUNICABLE DISEASES     19

     6. Gloves:  clean,  boil,  dry,  and  powder both
         surfaces.
     7. Mark rubber  goods  with a  fresh  stick of
         lunar caustic, slightly dampened.  No mark
         will be visible, at first, but by laying it aside
         or placing it in the light, the mark will show
         plainly and cannot be eradicated.  It does no
         harm to the rubber.


      CARE IN COMMUNICABLE DISEASES

  In  case  of typhoid  fever,  all patients  should be
screened,  so that flies  cannot come  in  contact with
them or  with any of  their excretions.  Vaccination
against typhoid fever is advisable.
  Vaccination  against smallpox is compulsory.
  In order to find out  which patients are carriers of
typhoid and to report such cases to the department of
health, it is required of the senior internes to make  a
fecal and  urine  analysis before  discharging typhoid
convalescents.  Two analyses should be made at an
interval of 48 hours.
  When caring  for a  case  01 syphilis, see that there
are  no abrasions  of  the skin  on any  part of the
body, which have not had  an application of an oint-
ment made of lanolin and bichloride of mercury, 33^
per cent.   After cleaning the hands,  re-apply to any
open places.
  The following rules  should always be carried out
when caring for communicable diseases, such as typhoid
fever, epidemic meningitis, measles, scarlet  fever, tu-
berculosis, anterior poliomyelitis, syphilis, etc.: 
20
NURSING TECHNIC
A.  Nurse:
      i. Pin uniform sleeves so as to bare the forearm.
      2. Cover clothing with rubber apron and muslin
          gown.
      3. Wash hands  and see that there are  no un-
          protected abrasions of the skin.
      4. When patients are badly infected, use rubber
          gloves.
      5. After caring  for  patient,  soak hands  in car-
          bolic, y2 per  cent.,  for two minutes,  then
          scrub hands  with green soap and water.  Use
          nail  file.   Rinse hands  again in carbolic  ^2
          per cent, and alcohol.
      6. Never touch  screens,  bed, door-knobs, soap,
          face, hair, eyes, nose, etc., before disinfect-
          ing hands.
B.  Care of linen:
      1. Never place soiled  linen  on  chairs, table  or
          hold it  against  the uniform.  Place it di-
          rectly in bags  used for that  purpose.
      2. Transfer  to  can,  sprinkle with formalin  40
          per cent, and allow to stand for 10 hours.
      3. Know that the cover of the can fits tightly, and
          send to laundry.
C. Stools, urine, bath-water:
      1. Place in covered cans.
     2. Disinfect  with  a  freshly made  solution  of
          chlorinated lime, 5 per cent.  (20-gallon can
          requires  3-4 oz.), and allow  to stand for at
          least one hour.
     3. Excretions must be mixed with disinfectant
          solution, double its own volume. 
CARE IN  COMMUNICABLE DISEASES      21
     4.  Stools should be broken  so that the disinfect-
         ant may come in contact with all portions.
     5.  To bath-water add carbolic sufficient  to make
         Yz per  cent.
     6.  Keep vessels well covered.
     7.  In the utility  rooms, have a separate place for
         the care of utensils used in the care  of all of
         these cases.
D. Dishes:
     1.  Keep  separate.
     2.  Garbage  should be  placed in  paper  bags or
          cornucopias and burned, or disinfected with
          formalin.
     3.  After dishes have been  used they should be
          boiled,  then washed with soap and water.
E. Discharges from nose, throat, etc.:
     1.  These should be received in gauze or paper and
          burned.
F. Brushes, bed-pans, urinals, basins:
      1. Keep separate, boil in utensil sterilizer.
G. Thermometers:
      1. Keep separate.
     2. Disinfect with 5 per cent, carbolic and alcohol.
H. Rectal tubes, ice-bags, etc.:
      1. Clean with soap  and water.
     2. Disinfect with 5 per cent,  carbolic for one
          hour.
I. Visitors:
      1. All visitors should be excluded from patients
          suffering from  highly contagious diseases.
      2. Children should always be barred. 
22
NURSING TECHNKJ
                      STAINS
  Prevent all stains, but in case of accident, attempt to
remove them at once.
A. Acids:
     i. Strong acids char or stain wood and linen and
         destroy the polish on wood and marble.  Neu-
         tralize at once with ammonia.
     2. Weak acids: neutralize with weak ammonia or
         soda  bicarbonate solution.
     3. Acids  which have removed the  color  from
         goods: the color can be brought back by the
         use of chloroform.
     4. Acids may burn the skin: dilute the acid, at
         once, by  holding the hand under cold run-
         ning  water  and neutralize with  ammonia
         water or soda bicarbonate solution.  In case
         of carbolic acid burns, apply alcohol, at once.
B. Alcohol on varnished surfaces:
     I. Apply camphorated oil or olive oil. If stain is of
         long standing, rub well with sweet oil, 1 part,
         and alcohol, 1 part.  Polish well with sweet oil.
C. Bichloride of mercury on linen:
     1. Soak in  Labarraque's solution or chlorinated
         soda  solution, several hours. As soon as the
         stain is removed, wash and rinse, at once, as
         soda  is injurious to linen.
D. Blood stains:
     1. On sheets: while still wet, soak in cool, salty
         water, salt 1 dram to 1 pint of water.  Wash
         with  soap and water.  If  the blood stains are
         dried, use same  method, but allow to soak
         for a longer time. 
STAINS
23
    2. On dressings and bandages: soak in chlorinated
         soda solution, rinse thoroughly.
    3. On mattresses and pillows :
         a. Remove small  stains  with  peroxide of
             hydrogen.
         b. Remove large  stains by applying an un-
             boiled, thick, cold-water starch-paste to
             the spot and  allow to stand until  dry.
             Brush.   Wash thoroughly  with brush
             and   hot   water,  soap   and  a  little
             ammonia.
         c. In case the stain is not removed with one
             application, repeat as often as necessary.
     4. On blankets :  remove in the same  manner as
         for sheets, but wash  with  warm water and
         soap.
     5. On rubber goods: remove in the same manner
         as for sheets.
     6. On wood: wash with cold  water betore it has
         dried.  Use ammonia water or peroxide of
         hydrogen.
E. Fruit stains on linen:
     1. Peach and pear stains become indelible if linen
         is  dried  and laundered before removal.
     2. To remove: wash in hot water in which a little
         soda  has been  dissolved, or  pour boiling
         water through the stain.
F. Feces:
     1. On linen :  rinse with cold water at once.  Soap
         well and  allow to soak in  cold, soapy  water
         and then boil in  the same. 
24
NURSING TECHNIC
G. Grease, glue, grass stain, tar:
     i.  Grease on unpainted wood: apply solution of
         sal  soda, dissolved in cold water.  Wash off
         with hot water or scrub with cold water and
         then with ammonia and sand-soap.
     2.  Grease on porcelain:  use kerosene with soap
         and water.
     3.  Axle grease on linen : grease well with lard and
         wash in tepid water.
     4.  Tar,  paints, water-proof ink:  same  as axle
         grease.   Benzine to remove tar.
     5.  Glue : soak in vinegar and wash in soapy water.
     6.  Grass stains: soak in alcohol and wash in usual
       '  way; or apply lemon juice and salt,  place in
         the sunshine  and wash.
H.  Ink, black:
     1.  On linen: remove small spots with lemon juice
         and salt or  with  ink eradicator, or  with
         chlorinated soda solution, or with weak oxalic
         acid solution.   Rinse thoroughly, at once, with
         clear water.
     2.  On wood: remove excess with blotting paper
         or  with starch-paste; when no more can be
         absorbed, rub with  lemon and salt.   Wash
         with cold or  tepid water.
   Ink, red:
     Wash in cold water, then in hot water.  Results
       usually unsatisfactory.
   Ink, indelible:
     Use  a  weak potassium  permanganate solution,
       then wash.  Results usually  unsatisfactory. 
STAINS
25
I.  Iodine:
     1.  On  linen:  fresh  stain,  wash  in cold,  soapy
         water.  On linen: old stain, apply cold starch-
         paste and sponge  with ammonia  water or
         alcohol.
     2.  On  wood: unpainted or unvarnished, cover
         with  cold starch-paste  until iodine  is  ab-
         sorbed.  Wash with ammonia and water.
     3.  On skin: rub well with alcohol and water.
J.  Iron rust  (prevention is the best rule):
     1.  On linen:
         a. Dampen with cold  water, apply  salts of
              lemon and  let  it remain for some time.
              Wash with clear  water.
         b. Apply lemon juice and salt and let it stand
              in the sunshine.
         c.  Apply cream of tartar paste and let  it
              stand in the sunshine.  Repeat as often
              as necessary.
     2.  On porcelain: use 10 per cent, hydrochloric
         acid.   Remove acid with carbonate of  soda
         (washing soda, 3 tablespoonfuls of soda to
         1 quart of water).
     3.  On marble: use salts of lemon,  moisten  with
         clear water and let it stand until the stain
         fades.
K. Medicines on linen:
     Wash in cold water immediately, or use alcohol.
L. Mildew (prevention is the best rule):
     1.  Apply lemon juice and sunlight or lemon juice
         and salt  or chlorinated soda.   Repeat  as
         often as  necessary. 
26
NURSING TECHNIC
     2. Wet with strong soap-suds, cover with a paste
         of soap or powdered chalk or chalk and salt,
         then place in strong sunlight.  Results usually
         unsatisfactory.
M.  Oil:
     i. On marble: wash with soda bicarbonate solu-
         tion.  Apply paste of whiting and ammonia
         and  let  stand  for  24  hours.   Repeat if
         necessary.
     2. On linen: use kerosene, then soap and water.
         If spots  are small, cut with ether and wash.
     3. Carron oil on linen: stains are difficult to re-
         move.   Use only old linen when carron oil is
         ordered.  Turpentine  may remove if  used
         while stain is fresh.
N.  Potassium permanganate:
     1. Use chlorinated soda solution or  apply weak
         oxalic solution.   Rinse thoroughly.
O.  Paint:
     1. Wet:  on woolen goods, rub with another part
         of the garment  or rub with  benzine.
     2.  Dry:  use  benzine or turpentine.
P.  Silver nitrate:
     1.  Remove  from  hands with potassium  iodide
         solution.
     2.  Remove from linen with argyrol or bichloride
         of mercury solution, 1-500.  This will prob-
         ably not prove permanent.   Iodide of potas-
         sium  solution   will   remove  permanently.
         Rinse thoroughly.
     3. Silver nitrate solution on  unfilled wood  sur-
         face : stain not removable. 
STAINS
27
Q. Tea and coffee on linen:
     1.  If clear, remove at once with cold or boiling
         water.
     2.  If it contains milk or cream, wash first in cold
         water, then in boiling water.
R. White spots on  polished surfaces:
     1.  Sponge with spirits of camphor.
     2.  Follow by rubbing with oil and turpentine or
         oil and alcohol.
     3.  Rub with olive oil or camphorated oil. 
CHAPTER II
                     BEDS

            CLEANING EMPTY BEDS
A. Object:
     i. Clean bed.
     2. Prevention of infection.
B. Time:
     i. After death of patient.
     2. After discharge  of patient.
     3. In case of vermin.
C. Articles necessary:
     1. Newspaper.
     2. Laundry soap or whiting, mixed to a soft paste,
         in a bowl.
     3. Paper bag.
     4. Two cloths.
     5. Hand brush.
     6. Basin with warm water.
     7. Whisk broom.
D. Method:
     1. Remove all bed  clothing.
     2. Brush mattress  thoroughly and on both sides,
         both tufts and seams.  Brush the dust into a
         paper bag or cornucopia, held to the side of
         the bed.
     3.  Fold mattress once  and  push toward  foot of
         bed.
     28 
CARBOLIZING EMPTY BEDS
29
     4. Protect floor with newspaper.
     5. Clean  head and sides of frame with laundry
         soap or whiting, using brush, if frame is very
         dirty.
     6. Wash  with clean  warm water.
     7. Push folded mattress toward head of bed and
         proceed in the same way, cleaning the frame
         and  foot of bed.

          CARBOLIZING EMPTY BEDS
A. Time:
     1. After  discharge of patient.
     2. After  death of patient.
     3. In case of vermin.
B. Articles necessary:
     1. Same  as in cleaning bed.
     2. Two  and one-half  per cent,  carbolic  acid
         solution.
C. Method:
     1. Remove all bed-clothes.
     2. Brush both sides of mattress with whisk broom
         dampened in 2]/2 per cent, carbolic solution.
         Expose to air or sunshine until dry, or  send
         to sterilizer.
     3. Place  pillows on  lower half of mattress and
         brush  both  sides  with same solution.  Air
         until dry; do  not put pillow in the sun, as
         the  heat melts the oil in  the feathers and
         masses  them.
     4. Fold mattress over pillows from head to foot
         of bed. 
30
NURSING TECHNIC
     5. Brush  springs  with  whisk broom.  Carbolize
          upper part of bed  and springs with 2l/2 per
          cent, carbolic solution and  dry with a clean
          cloth. Never use bichloride of mercury solu-
          tion  on  metals.
     6. Move  folded mattress to head of bed.
     7. Carbolize  springs  and lower half of bed.
     8. Apply  phenol, 95 per cent., or cedar oil prep-
          aration (cedar oil,  1 oz.; turpentine, 1 pt.) to
          cracks of  bed with oil can.
     9. Mattress  and  pillows should  be  inspected
          frequently for  stains,  and  tears  or  rips
          in the ticking.  Stains  to  be  removed  and
          repairs  made by  the  nurse  in charge  of
          the beds.

 TO CLEANSE BEDS  INFECTED  WITH VERMIN
A. Articles necessary:
     1. Same as in  cleaning bed.
B. Method:
     1. Remove bed-clothes, without shaking.
     2. Place linens in hot water.
     3, Place blankets  in  cold or tepid  water.
     4. Protect floor with sheet.
     5. Brush  and  inspect mattress and pillows for
          vermin.
     6. Clean bed as before directed.
     7. Apply cedar oil preparation to all cracks.
     8. Requisition  for plumber to use torch. 
BED-MAKING
31
                   BED-MAKING
A. Object:
     1.  Cleanliness.
     2.  Firmness.
     3.  Smoothness.
     4.  To meet needs of patient.
     5.  Comfort of patient.
     6.  Appearance.
B. General instructions:
     1.  All  articles  should  be ready  for  use  before
         beginning to  make the bed  and  all articles
         used  should  be put  away in  their  proper
         places and in order.
     2.  An  empty bed should be  made from one  side,
         going around the  foot  of  the bed not more
         than  twice,  during the process.
     3.  Time allowed,  10 minutes.
C. Articles necessary:
     I.  Clean linen arranged on chair in the order it is
         to be used.  The upper  sheet may be used as
         a draw sheet.
     2.  Laundry bag.   If not a portable bag, the same
         may  be attached to the back of a chair.
     3.  Paper  bag or  cornucopia,  made from news-
         paper, pinned to laundry bag.
     4.  Whisk broom.
     5.  Basin  containing tepid water and cloth for
         duster.
     6.  One straight-back chair.
D.  Method:
     1.  Place chair with the back in line with the side
         of  the bed  by which you  are standing. 
           NURSING TECHNIC

2.  To remove linen:
    a. Loosen all bed covers.
    b. Remove pillows, changing the more soiled
        pillow slips.
    c. Place pillows flat on chair seat, with open
        ends away from door.
    d. Remove  each piece  of  bed covering by
        doubling the top toward the foot,  thus
        bringing the upper surface inside, and
        fold a second time, in the opposite direc-
        tion,  lift from bed and place  on  chair
        back  (Fig.  2).
    e. Brush  mattress,  inspecting  seams  and
        tufts,  accumulated dust being brushed
        into paper bag (Fig.  3).
    /. Turn mattress and brush (Fig. 4).
    g. Dust all parts of bed frame with dampened
        cloth (Fig.  5).
3.  To make bed: Replace bed clothes in the order
        of their removal.
    a. Place fold of lower sheet on centre line of
        mattress and unfold.
    b. Have the narrow hem of the sheet  even
        with  the lower  border of the mattress
        and draw  the wide  hem  of the sheet
        toward head of bed.
    C. Tuck sheet under head  of mattress, bring-
        ing it as far under as possible ; tuck one
        side of sheet under side of mattress, as
        far as possible, and square the corner at
        head of bed. 
Fig. 2.
               Fig. 3.

Fig. 2.—Removal  of bed-clothes.
    Fig.  3.—Brushing mattress. 
Fig. 4.
                  Fig.  5.

Fig. 4.—Turning mattress from head to foot.
         Fk..  5. — Dusting bed frame. 
          BED-MAKING                 35

 d. Adjust rubber and draw sheet  12 inches
     from head of mattress and tuck them
     well under the mattress, beginning at the
     mfddle of the  width.
 e. Place centre fold  of  top sheet on centre
     line of mattress  and unfold.  Draw the
     wide hem end of the sheet toward head
     of bed, leaving a sufficient amount at the
     foot  to tuck  well under  the  mattress
     (Fig. 6).
f. Make an inverted  plait at the foot of the
     bed and tuck in the sheet under the foot
     of the  mattress  and square  the  corner
     (Fig- 7).
g. Place  lower blanket in same position as
     top sheet and tuck it  under the  mattress
     at least 4  inches.
h. Place  upper blanket  with  upper border
     within 6 inches of top of mattress (Figs.
     8 and 9).
*. To square  the  corners.  Bring  out the
     covers in  a straight  line with the upper
     border of the foot of the mattress (Fig.
     10).  Fold this crease evenly along the
     upper side border of the mattress  (Fig.
     11).  Tuck in the clothes hanging below
     the edge  of the  spring, with  the  free
     hand  (Fig. 12).  Pull downward on the
     outside of the fold and tuck the remain-
     ing portion as  far under the mattress as
     possible, the full length of the  mattress
     (Fig. 13). 
Fig. 6.—Making bed.  Showing edge of lower sheet  even with mat-
             tress, and rubber sheet with ticking at ends.
Fig. 7.—Toe plaits in upper sheet. 
Fig. 8.
               Fig. 9.

       Fig. 8.—Placing blankets.
Fig. 9.—Boxing blankets for unoccupied bed. 
Fig.  io.
Fig. 12.
Fig. 13.
    Fig. 16.—To  square  corners:  First movement, extend a  fold in the
bed-spread continuously with the line of the upper border of mattress.
    Fig. 11.—Second  movement  in  squaring corners, making  the first
line even with the upper border of mattress.
    Fig. 12.—Third movement in squaring corners, tucking in lower part
of spread.
    Fig. 13.—Finishing box cornet. 
Fig. 14.
Fig. is.
Fig. 16.
Fig. 17.
Fig. 14.—Tucking in bed-spread.
Fig. IS-—Finishing corner with hanging spread.
Fig. 16.—Making line for an oblique corner.
Fig. 17.—Finished oblique corner and passing to opposite side of bed. 
40
NURSING TECHNIC
/.  If one  blanket  only  is used, place as in
    " g."  Should more than two blankets be
    used, all but the top blanket  should be
    placed in position of upper blanket as in
    "h"
k.  Fold  top  sheet  over  upper  border  of
    blankets.
/. Place the spread evenly, covering all of the
    blanket, and tuck very tightly under the
    foot of mattress and  square the corners
    (Figs. 14, 15, 16, and 17).
m. Pass around  foot  of bed  to  make  the
    opposite side.
n.  Fold all  loosened covers,  excepting  the
    bottom sheet, neatly back over one-half
    of made bed and proceed in bed-making
    as on opposite side (Figs. 18 and 19).
0.  Place pillow, crosswise, on bed and draw
    on pillow slip.  Fit corners of pillow well
    into corners  of slip.   Press it with the
    palms of hands until flat.   Never hold
    pillow between the teeth.
p.  Place the  pillow at the head of the  bed
    with  the  seam  along the upper border
    and the open ends of the case away from
    the   ward door,  leaving  it  in  a  flat
    position.  Flatten the second pillow as
    the first and lift it in a standing position
    on  the first pillow, with the seam along
    the lower border and  the open end away
    from the ward door, with any extra folds
    of pillow case at the back of the pillow. 
Fig. 19.—Making bed on opposite side. 
JMUKSSilMU iECHMlU
q.  Straighten bed-side table.
r.  Leave  bed in  line  with  castors turned
    toward head of bed (Fig- 20).
s.  Replace chair in position.
t.  In preparing an  empty bed for a new pa-
    tient, every article should be clean.
             AIR AND WATER BEDS
A. Object:
     1. To equalize pressure, thus lessening the danger
          of pressure-sores.
     2. To afford comfort to the patient.
B. General instructions:
     1. Avoid  sticking pins into either air or  water
          beds.
     2. If an air bed, keep properly inflated with air,
          not too hard.
     3. If water bed, keep the water 100 degrees F. 
FRACTURE BED                43
C. Method:
     1.  Cover springs of ordinary bed with  fracture
         boards.
     2.  Place air  or  water beds  over  hair  mattress.
     3.  Boards  should  be fitted to sides  of bed, to
         prevent patient from falling out.
     4.  If an airbed,  inflate with ordinary force pump.
     5.  If a water bed,  fill with water, temperature of
         no degrees F., by  a hose  attached  to  a
         faucet or by  water  taken to bedside  and
         poured in through a  funnel.
     6.  Make as an  ordinary  bed.

                 FRACTURE  BED
A. Object:
     1.  To afford a rigid position for the affected part.
     2.  To avoid moving the patient.
     3.  To afford comfort to  the patient.
     4.  To prevent sagging of the mattress.
     5.  To protect the  mattress.
B. General instructions:
     1.  Have supports  properly placed.
     2.  Have little or no weight of bed-clothes over
          fracture.
C. Articles necessary:
     1.  Wooden fracture boards of convenient width
          and 2 inches longer than the width of the
          bed frame.
     2.  Usual articles for making empty bed.
     3.  Bed  linen, as required.
     4.  Extra  rubber sheet and cradle. 
44
NURSING TECHNIC
D.  Method:
     i. Place fracture boards below  the spring under
          the seat of  fracture, resting the ends on the
          bed frame.
     2. Make as an  ordinary bed.
     3. If patient has been anesthetized, make as an
          operation bed.
     4. If the fracture is of the hip,  place extra small
          rubber sheet and  folded muslin sheet under
          the hips.
     5. Place cradle  over fractured  part  of body to
          relieve patient  of weight of bed-clothes.


                 OPERATION BED
A.  Object:
     1. To have a bed  so made that a patient can be
          quickly placed in the same.
     2. To provide external heat so as to assist in re-
          covery from shock or to prevent  shock.
     3. To afford comfort to the patient.
B.  General instructions:
     1. Use clean linen.
     2. Place rubber sheet  so  as  to  protect the mat-
          tress, in case of hemorrhage.
     3. Heat bed one-half hour before patient is re-
          turned  from operating  room.
     4. Never  leave  the hot  water  cans  in the  bed
          after the patient  is returned.
C. Articles necessary:
     1. Linen, as  for an empty bed.
     2. Small rubber sheet for head of bed. 
KLONDIKE BED
45
     3. Two hot water cans one-half full of water 115
         degrees F., and covered with flannel.
     4. Towel; three or four cloths for handkerchiefs.
     5. Kidney basin.
D. Method:
     1. Make  an ordinary  empty bed.
     2. Protect head  of  bed  with  small rubber sheet
         covered with muslin  sheet; the lower border
         of this protection  should extend to just below
         the shoulders and be well tucked under the
         mattress at both  sides.
     3. Place  top covers  on bed without tucking in.
     4. Fold covers back from foot and  one side, mak-
         ing a flat fold eight to ten inches wide.
     5. Place  one hot water can  at foot and one  in
         middle of bed.
     6. Tuck  in side of bed next to door of ward.
     7. Place  small basin, cloths and towel on bedside
         table.
     8. Time  to make up bed, 8 minutes.
     9. When patient returns:
         a. Remove hot water cans.
         b. Roll bed-clothes, with open side away from
              door of ward; beyond middle of bed.
         c.  Remove  perineal suit immediately, wrap
              in blanket and cover.


                 KLONDIKE BED
 A. Object:
      1. To prepare a bed  for a tuberculosis patient or
          others, who for any reason sleep out-doors. 
46
NURSING TECHNIC
B. Method:
      i.  Place a piece of fibre paper between springs
          and mattress.
      2.  Tuck in muslin sheet on all sides of mattress.
      3.  Over sheet,  place a  woolen blanket, so  that
          an  edge comes to one  edge of  mattress,
          leaving over one-half of the blanket hanging
          from edge of bed.
      4.  Place a second woolen blanket  so that its edge
          will come to the edge of the opposite side of
          bed and hang as in 3.
      5.  On these  is placed  a bed  protector.
      6.  Place three  pillows at head of bed, one  flat,
          the  other  two  slanting,  with  open  ends
          toward same  side of bed.
      7.  Place two cotton blankets  so that one will be
          higher on the pillows than the other.
      8.  Have patient assume a comfortable position
          in the bed,  no.ting that she is suitably clothed.
      9.  Cover patient with the cotton  blankets, tuck-
          ing the same in well about the shoulders.
     10.  Over these  draw the two  woolen blankets,
          tucking  in each one at the opposite side of
          the mattress.
     11.  Tuck all blankets in at the foot of the bed.
     12.  Place sheet of fibre paper and  woolen blanket
         over all and tuck in well on all sides of  bed.
     13.  Finally cover the entire bed with a sheet made
          of khaki cloth.
     14.  If  hot water bottles are needed  in the  bed,
          place them before the  woolen blankets have
          been adjusted. 
CHAPTER III
                     BATHS

               CLEANSING BATHS
A. Classification:
     i.  Bed bath.
     2.  Tub bath.
     3.  Slab bath.
     4.  Shower bath.
B. Object:
     1.  Cleanliness.
     2.  Comfort of  patient.
     3.  To quiet the nerves.
     4.  To change the circulation.
     5.  To stimulate the sweat glands.
     6.  To assist in preventing pressure sores.
C. General instructions:
     1.  Do not give bath within one hour after eating.
     2.  Temperature of room may  be higher, but not
         lower than 72 to 74 degrees F.
     3.  The room should be ventilated but no draught.
     4.  Temperature of water from 90 to 105 degrees F.
     5.  Avoid unnecessary exposure or chilling.
     6.  If patient chills or is exhausted after or during
         bath, give hot drinks, apply external heat and
         allow patient to rest.
     7.  Examine patient  for objective symptoms, such
              as:
         a.  Rash.
47 
48              NURSING TECHNIC
         b.  Swellings.
         c.  Discolorations.
         d.  Pressure sores.
         c.  Discharges.
         /.  Abrasions.
         g.  Vermin.
     8. Record cleansing bath after the same has been
         given, with the result of the observations as
         in  7.
     9. General instructions for bed bath :
         a.  Wet  and soap the wash cloth, holding the
              corners in the hand so that they will not
              drag over the patient.
         b.  After washing any part of the body, rinse
              and dry.
         c.  When drying the  skin, do  not drag the
              towel  over  the skin, but pat as if using
              blotting paper.
         d.  Use  even,  long, firm strokes.
         e.  The  patient made comfortable  by a bath,
              compliments the nurse by going to sleep.
D. Articles  necessary for bed bath:
     1. Nurse basket.
     2. Two bath blankets.
     3. Clean linen.
     4. Laundry  bag and  paper bag.
     5. Basin of  hot water.
     6. Foot tub, if  necessary.
E. Method:
      1..  Place screens about the bed.
      2.  Remove top  covers, placing  blanket over
          patient. 
CLEANSING BATH
49
 3. Remove pillows in such instance as the con-
     dition of patient will allow.
 4. Turn patient and put second blanket under-
     neath.
 5. Place rubber sheet and towel under head.
 6. Place towel over chest.
 7. Wash face, ears, neck and under  chin.   Do
     not use soap  unless requested.
 8. Cleanse eyes by using cotton pledgets, one for
     each eye.
 9. Cleanse mouth.
10. Cleanse  nostrils by  using  lubricant  on
     applicators.
11. Bathe chest.
12. Place patient's arm on  towel  and  cleanse.
     Place hand in basin of water and cleanse
     Brush nails with  soap  suds, cut and then
     brush again.   Dry.
13. Bathe second arm and hand.
14. Place towel over chest, turn down blankets
     and cleanse abdomen.
15. Change water.
16. Cleanse  thigh and leg.
17. Cleanse  one foot  in  foot  tub, remove and
     place on towel, dry  and care for nails.
18. Cleanse  second  leg and foot.
19. Turn patient, cleanse back, rub with alcohol
     and powder.
20. Change water and finish  the bath.
21. If patient's feet are very dirty, place in foot
     tub while bathing  other  parts of body  or
     apply olive oil and wrap in towel to soften
     the dirt.
A. 
5«
NURSING TECHNIC
     22.  Replace gown, make  up bed—dusting  the
          frame—and comb hair.
     23.  Put all articles away in their proper places
          and leave patient comfortable.
F. Tub bath:
         General instructions:
          Never add hot water to the prepared bath
            when the patient  is in the  tub.
          In case a patient feels faint when in the tub,
            let  the  water out of the tub, lower  the
            head and cover with a blanket.   Do  not
            try to lift a heavy body out  of a tub.
          When a patient is ready to leave the tub,
            spread a towel on the bottom of the tub,
            wash  away the soap-suds from the  bot-
            tom and side of the tub and  place a towel
            over the side of the tub.   This is done to
            avoid slipping.
          Do not  leave a patient in a tub of water
            longer  than 10  minutes unless special
            orders to the contrary are given.
          Never allow  a patient to go into the bath-
            room alone and lock the door.
     Articles necessary  for tub bath:
       1.  Warm bathroom and tub filled with water of
           desired temperature.
       2.  Towels, soap, clothing.
     Method:
       1.  Take patient to bathroom in wheel chair or,
           if able, allow to walk.
       2.  Drape patient with sheet or  with large bath
           towel. 
CLEANSING BATHS
5i
       3.  Place in  tub and cleanse thoroughly.
       4.  Upon getting out of tub, drape with sheet
           or blanket and dry.
       5.  Return to bed and have patient rest for a
           short time.
       6.  Record cleansing bath and observations.
G. Slab bath:
     When giving  the initial bath in the  receiving
       department,  there  are  always  two  persons
       present.
     Preparation for bath:
       I.  Remove  clothing while  patient is still  on
           cart or wheel chair.
       2.  Wrap blanket about patient and lift upon the
           slab.
       3.  Remove  the blanket and cover the  patient
           with  a small   sheet  provided  for  that
           purpose.
       4.  Place feet in tub  of warm water. This helps
           to  keep the patient warm and also allows
           the feet to soak, if very dirty.
     Method:
       1.  Face, neck  and  ears  are washed by  one
           person  while the other lathers the body.
       2.  One person on either side of table, proceed
                as  follows:
           a. Wash arms and hands.
           b. Trunk
           c. Legs and feet.
       3.  First person sprays body well with clear,
           warm   water, while  second  person gives
           shampoo.  When completed, wrap head in
           towel (Fig. 21). 
Fig. 21.—First patient receiving entrance slab bath.- Second patient having hair dried before being sent to the ward. 
CLEANSING BATHS
53
       4.  Remove patient  irom the slab to a wheel
           cart, exchanging the wet sheet for the dry
           sheet.  Cover with small blanket and dry
           thoroughly, under cover.
       5.  While the patient is being dried, the second
           person dries the hair, combs and braids.
           Clean nails.
     Method of sending patient to ward:
       1.  Remove covers and replace with:
           a. Sheet.
           b. Blanket.
           c. Spread.
           d. Place pillow under head.
           e. Signal for orderly.
       2.  Patient is then taken to  the waiting room,
           from which place he is transferred to the
           ward by the orderly.
II.  Shower bath.   Method:
     1.  Patient's clothing is removed, seated on a low
          stool in the shower bath with feet in a tub of
          warm  water.
     2.  Body is lathered, after  which  the spray is
          turned on  and the patient assists as much as
          possible.
     3.  Back is  washed by nurse, after which the head
          wash is given.
     4.  Spray is turned  off, patient placed in a chair,
          body dried.  Dress.
     5.  The  hair is  dried, combed, nails cleaned.
     Time allowed,  15 to 20 minutes.
I.  Pediculi on body:
     1.  Dailv bath with laundry soap and water. 
54
NURSING TECHNIC
     2. Follow with bichloride of mercury, 1-2000.
     3. Shave if necessary.

           BATHS IN HYPERPYREXIA
A.  Object:
     I. To stimulate general circulation, oxidation and
         nutrition.
     2. To  help  equalize circulation of  internal  and
         peripheral organs.
     3. To assist in eliminating toxic material.
     4. To reduce temperature.
     5. To afford comfort to the patient.
     6. To aid in the prevention  of bed sores.
B. Time:
     I. Whenever the temperature is 102.5 degrees F.
         and above.
C. Types:
     1. Sponging.
     2. Packing.
     3. Tubbing.
D. General instructions:
     1. Do not allow  the patient  to be in a draught.
     2. Encourage the patient to breathe deeply during
         the treatment.
     3. Give plenty of cool water to drink.
     4. Apply cold to head.
     5. Apply heat to feet to prevent chilling and to
         counterbalance temperature between central
         and peripheral portions of  the body.
     6. Use  friction for the same  reason as for the
         application of heat to feet.  Always use fric-
         tion when giving cold packs or tubbings and 
BATHS IN HYPERPYREXIA
55
         it  may  be necessary in  sponging and  other
         packs.
     7.  After all cold applications, leave the patient in
         blankets until reaction takes place.
     8.  During any of the treatments, watch for evi-
         dences of shock:
         a.  Weak, irregular  pulse.
         b.  Pallor about the mouth.
         c.  Cyanosis of finger nails.
         d.  Slow and shallow respirations.
     9.  In case of shock, stop treatment, apply external
         heat, report condition to head nurse at once.
E. Record:
     1.  Pulse and respiration just before giving  treat-
         ment.
     2.  Hour beginning treatment.
     3.  Kind and length of treatment.
     4.  Pulse and temperature every 15 minutes during
         treatment.
     5.  Temperature, pulse and respiration 30 minutes
         after treatment, noting, especially, the quality
         of the pulse.
     6.  The general and nervous condition  of  the
         patient.
     7.  Any adverse symptoms  arising during  treat-
         ment.
F. Sponging:
     1.  Articles necessary:
         a.  Two blankets.
         b.  Two towels.
         c.  Small rubber sheet.
         d.  Sponging cloth, two moist compresses. 
56              NURSING TECHNIC
    e. Hot  water can.
    /. Cool drinking water and tube.
    g. Basin with ice, protected from the air.
    h. Basin with tepid  alcohol solution, 25  per
         cent.
    i. Alcohol, 50 per cent., for external use.
2.  Method:
    a. Remove covers as in bed-patient's bed.
    b. Remove all pillows not necessary  to  the
         patient's comfort.
    c. Place blanket  under patient and  remove
         gown.
    d. Hot water can to  feet.
    c. Sponge face and neck.
    f. Cold  compresses  to head,  changed  fre-
         quently.
    g. Expose one arm,  cover  with a thin layer
         of sponging solution,  using long, rhyth-
         mical strokes, from hand to axilla, using
         slight pressure.
    h. Sponge opposite arm.
    i. Fold blanket down to hips, exposing chest
         and abdomen.
    /. Sponge chest and  abdomen, avoiding  any
         pressure  on abdomen.
    k. Fold  blanket over abdomen.
    /. Wring towel out of sponging solution  and
         place over chest with ends in axillae.
    m. Expose and sponge each leg.
    n. Repeat in the same order, each time going
        over the  surface.
    0. Time allowed: five minutes  for each arm 
BATHS IN HYPERPYREXIA
57
             and leg, seven  minutes for chest and
             abdomen. ■This  includes time for chang-
             ing compresses on head, chest and giving
             drinks of water.
         p. Turn patient on  side; sponge  back and
             buttocks  for  seven minutes;  rub dry
             with alcohol.
         q. Fold blankets to  centre of bed, ^urn pa-
             tient on back and remove blanket.
         r. Rub  remainder  of body with  alcohol.
         s. Make bed; leave hot water can to feet and
             cold to head.
         t. If reaction  does not take place, place be-
             tween  blankets.
G. Packing. Warm pack:
     i.  Articles necessary:
         a. Two blankets,  two towels, spread,  clean
             sheets.
         b. Long, short and small rubber sheets.
         c. Basin with ice, two moist compresses.
         d. Water to drink and  drinking tube.
         c. Hot  water can, basin for wet sheet.
         /. Alcohol, 50 per cent.
     2.  Method:
         a. Remove covers  and  gown  as  in  bed-
             patient's bed.
         b. Remove all pillows not necessary for pa-
             tient's comfort.
         c. Place blanket and rubber sheet under pa-
              tient  to  centre  of  bed,  having  upper
             edges  coming high  above shoulders.
         d. Prepare dry sheet by  rolling  the  edges 
58
NURSING TECHNIC
           toward the centre and again roll, loosely,
           from the sides toward centre.
       e. Wring this sheet out of water as hoi as can
           be borne by the hands.
       /. Enclose in short rubber sheet and carry to
           bedside in basia
       g. Place wet sheet in same position as blanket
     ,     in " c," turn patient on the prepared side
           of bed, quickly draw  the rubber sheet,
           blanket and  half  of wet sheet  from
           under.
       h. Cover patient well with blankets,  folding
           the wet sheet around arms and  legs so
           that no two surfaces of  skin are in con-
           tact.  Do not cover feet with wet sheet.
       i. Fold  edges of  lower blanket over upper
           blankets and  place hot water can to feet
           and cover well.
       j. Bring rubber sheet down over shoulders,
           protecting the neck.
       k.  Place clean sheet over bed and tuck it in at
           the foot only, squaring corners.
       I.  Allow patient to remain in pack 45 minutes,
           changing  head  compresses and giving
           water, frequently.
       m.  Remove patient from pack, dry and give
           alcohol rub.
       n.  Make bed, observe usual  precautions and
           record.
Packing.   Tepid pack:
   1. Proceed as in warm pack, except before wrap-
       ping patient in wet sheet, place a towel across 
BATHS IN HYPERPYREXIA
59
         the hips.   Wring sheet from  water 98  to
         100 degrees F.
     2.  Leave patient exposed in wet covering.
     3.  Sprinkle  with tepid  water, if sheet becomes
         dry, using a small watering pot, or sprinkle
         with water from a pitcher,  using  the hand.
Packing.  Cold pack:
     1.  Articles necessary:  same as for warm pack,
         except  a  larger  supply of  ice, and a sea
         sponge.
     2.  Method:  proceed as in warm pack, except be-
         fore wrapping the patient in wet sheet, place
         a  towel across hips.  Wring  sheet out  of
         water 98  to 100 degrees F.
     3.  Sprinkle  with water, gradually  cooled to  70
         degrees F.
     4.  Wrap towel about  hand, grasp a piece of ice
         and iron  patient's body  with same.   Use
         friction with the free hand, closely following
         the ice.
     5.  Turn patient on side and iron back with ice
         before removing from pack.
     6.  Continue treatment for 20 minutes.
     7.  Wipe up water  with  sea sponge, if necessary.
         Remove patient from pack and leave between
         blankets  for one-half  hour.
     8.  Proceed as directed in other packs.
H. Tubbing:
     1.  Types:
         a.  Tepid,  temperature  85 degrees  F.
         b.  Warm, temperature 90 to 100 degrees  F. 
6o
NURSING TECHINC
2.  Articles necessary:
    a. One long rubber sheet.
    b. Tubbing sheet.
    c. Two blankets.
    d. Muslin sheets.
    e. Three towels.
    f. Two moistened compress cloths.
    g. Basin with extra amount of ice.
    h. Drinking water with drinking tube.
    i.  Siphon  (a large  rubber tubing)  and sea
         sponge.
    /.  Prepared  hot  water can.
    k. Alcohol, 50 per cent.
3.  Method:
    a. Take and record pulse.
    b. Remove  covers  and  gown  as  in  bed-
         patient's bed.
    c. Fold together and place under patient:
         1.  Blanket.
         2.  Rubber sheet.
         3.  Tubbing sheet.
         4.  Muslin sheet, placing this sheet cross-
             wise of bed.
    d. Place towel over hips and wrap patient in
         muslin sheet; fold top blanket about feet.
    e. Roll sides of tubbing sheet toward the pa-
         tient and tie corners  to the  four corners
         of the bed.
    /. Cold compresses to head.
    g. Pour in water, avoiding the patient's face.
    h. LTse friction on the  body.
    i.  Reduce  temperature of water by using ice, 
BATHS FOR ELIMINATION
61
             but do not allow the ice to remain in one
             place or too close to the patient's body.
         /.  Give water to drink freely.
         k. One nurse  turns and supports patient, on
             one side, having the patient covered with
             blanket, which  was folded about the
             feet.   Iron patient's back with ice.
         /.  The second nurse  removes ice  and the
             water with siphon and sea sponge.
         ;//. Remove rubber and  muslin  sheets  and
             dry body.
         n. Allow  patient to remain one-half hour be-
             tween blankets  with hot water can to
             feet and cold compresses to head.
         o. Take pulse and record, every ten minutes
             during the entire bath.
         p. The bath itself should not take more than
              15 to 20 minutes.
         q. Give alcohol rub and make bed.
         r. Take temperature, pulse and  respiration,
             record  and note general conditions.
         j. This treatment is  usually given typhoid
             patients,   therefore   observe   typhoid
             precautions.

            BATHS FOR ELIMINATION
A. Object:
     1.  To  relax muscular tension.
     2.  To  act as a  nerve  sedative.
     3.  To  change  the circulation.
     4.  To  induce  perspiration  and elimination.
     5.  To  afford comfort to the patient. 
62
NURSING TECHNIC
B. General instructions:
     i.  Apply  cold  to  the head  and  keep the  feet
         warm,  thus  preventing  the  dilatation  and
         congestion of  the cerebral blood-vessels.
     2.  Avoid burning the patient.
     3.  Watch for symptoms of heat prostration:
         a. Soft, weak, irregular pulse.
         b. Giddiness,  flushed  face, sighing respira-
              tion.
     4.  Avoid  exposing patient while the covers are
         being removed.
     5.  Give plenty of  hot drinks, unless liquids are
         restricted.
C. Types:
     1.  Hot tub  bath.
     2.  Hot pack.
     3.  Hot-air bath.
     4.  Alcohol sweat.
     5.  Medicated bath.
D. Record:
     1.  Hour; kind  of treatment; condition of patient
         during  treatment; result.
     2.  Take  and record pulse; observe the condition
         of the patient every 15 minutes for baths and
         packs and every  10 minutes  for  alcohol
         sweats  and hot-air  baths.
E. Hot tub bath:
     1.  General instructions:
         a. Avoid having the temperature of the room
              too low.
         b. Never raise the  temperature  of  the water
              while the patient is in the tub, except by 
        BATHS FOR ELIMINATION          63

        adding from some receptacle and not by
        means of the hot water inlet.
    c. Watch for giddiness or faintness.
    d. If  faintness occurs and the patient is not
        too heavy, remove patient from tub and
        put to bed; if patient is heavy, allow the
        water to drain  from the tub,  place pa-
        tient in a  reclining position  until the
        heart action is restored.
    e. If  using a hot tub bath for a  child, never
        place the small  tub on the stove and the
        baby or child in the tub while on stove.
2.  Articles necessary:
    a. Two blankets.
    b. One muslin sheet.
    c. Rubber sheet.
    d. Towels.
    c. Rubber ring  in pillow case or other sup-
         port for head.
    /. Basin with ice and compresses.
    g. Prepared hot drink, usually lemonade.
    h. Wheel chair.
    i. Hot water can.
    /. Alcohol.
3.  Method:
    a. Drape patient with sheet and  protect with
         blanket.
    b. Assist patient into wheel chair.
    c. Prepare the  bed,  protecting same with
         rubber sheet and blanket and open  for
         the  return of patient; have hot water can
         at foot. 
64
NURSING TECHNIC
          d. Have tub  filled with water, temperature
              from  95  to  105 degrees F.
          e. Assist patient  into tub.
          /. Cover  tub  with blankets, pinning closely
              about neck.
          g. Support head  with rubber  ring.   Apply
              cold  compresses.
          h. If patient  is unable to recline in  the tub
              because of its shape or size, a hammock
              can be made with a sheet tied to the
              plumbing so as  to support the back.
          i. Allow  patient  to  remain  in tub  for 10
              minutes.
          /. Remove, wrap in  warm blanket and wheel
              patient to bed.   Cover well.
          k. If patient does not respond readily, use a
              steam  inhalation to assist in inducing
              perspiration.
          /. Continue cold  to the head, heat to the feet,
              keep well covered, and  give hot drinks.
              Leave in  blankets for 30 minutes.
          m.  See that the  room is well ventilated; if
              the  patient  sleeps, do  not disturb but
              watch  character  of pulse, amount of
              perspiration  and  general condition.
          n. Remove blankets  and rubber  sheet, dry
              body, give alcohol rub.
          0. Put on gown, cover well and allow patient
              to rest.
F. Hot pack:
     1.  Articles necessary:
          a. Five blankets;  one  worn woolen. 
         BATHS FOR ELIMINATION          65

     b. Rubber sheets;  2  long,  1  short, 1 small
         square.
     c. One clean muslin sheet.
     d. Cold moist compresses in basin with ice.
     e. Towels.
     /. Hot drink and drinking  tube.
     g. Prepared hot water  can.
2.  Method:
     a. Know that there is boiling water ready.
     b. Take and record pulse.
     c. Proceed  in protecting bed  as in giving a
         warm pack.
     d. Fold the worn woolen blanket as a sheet is
         folded  for a cold pack.
     e. Wring this woolen blanket from the boil-
         ing water  as  follows:  keep the  folded
         ends of the blanket dry  by hanging them
         over  the edge  of the tub and pour the
         boiling water  over  the balance  of the
         blanket which  is  in  the  tub.    Two
         nurses wring out the blanket, each grasp-
         ing an end and  turning  it in opposite
         directions.
     /. Fold this blanket in  the small  rubber
         sheet,  place in  a basin and carry to the
         bedside.
     g. Remove  the hot blanket  from  the  sheet,
         shake  it slightly  and cover the patient
         with  the same.  Allow no surfaces  of
         the body to come together, tucking it in
         well between the arms and the body and
         between the legs. 
66
NURSING TECHNIC
         h. Cover  with long rubber sheet,  blankets,
              bringing the under rubber sheet up over
              the  shoulders and tucking the  upper
              rubber sheet well  under  the shoulders.
              See that the blankets are well tucked
              in about the neck  and sides of body.
         i. Change  compresses  on head frequently.
         ;'. Give hot drinks freely  unless liquids are
              restricted.
         k. Take pulse every 15 minutes.
         /. Allow  patient to remain in pack for 45
              minutes.
         m. Remove  as in the  after care of a warm
              pack,  being careful not  to expose the
              patient.
         n. Rub patient dry.
         0. Allow  patient  to  remain  between  dry
              blankets for one-half hour, leaving two
              over and one under  the  patient.  Roll
              the  sides of the blankets  closely  to the
              body.
         p. Sponge with warm  water,  dry, rub with
              alcohol.
G. Hot-air bath:
     1.  Articles necessary:
         a. Six blankets.
         b. Rubber sheets ; 2 long,  1 small.
         c. Towels; safety pins;  cold moist  com-
              presses.
         d. Two cradles.
         e. Board with hole for pipe to be  placed at
              foot of bed. 
         BATHS FOR ELIMINATION          67

     f. Hot-air pipe covered  with asbestos.
     g. Alcohol lamp, filled and placed in a bucket.
     //. Matches.
     i.  Hot drink.
     ;'.  Alcohol.
     k. Articles  for cleansing bath.
2.  Method:
     a. Take and record  pulse.
     b. Fold and   remove  bed  covers,  placing
         blanket over patient.
     c.  Place  rubber sheet  and  blanket under
         patient.
     d. Fold upper  blanket even with sides of pa-
         tient and place cradles so as to support
         the bed-clothes over  full length of body.
     e.  Place board, for pipe,  at  foot of bed.
     /.  Place blanket, rubber sheet and then three
         blankets over cradles.
     g. Fold the  first  blanket over  the  feet, to
         keep the heat from  coming into direct
         contact with the skin.
     h. Place alcohol lamp in  bucket and light.
    i.  Adjust pipe  over lighted  lamp with  the
         arm through the hole in  the  foot-board,
         folding the blankets and rubber sheets
         about it, closely.
    ;".  Pin the lower blanket about the neck with
         safety pins.
     k.  Tuck the upper blankets  closely  over  the
         under blanket.
    /.  Fold the rubber sheet  and blankets as in
         the hot pack. 
68              NURSING TECHNIC
         in. Place extra blankets and sheet over all.
         n. Change  cold  compresses  on  head  fre-
              quently.
         o. Take pulse and record every 10 minutes.
         p. Give  hot drink frequently.
         q. Allow patient  to remain in hot-air  bath
              for  one hour.
         r. Remove as from hot pack.
H. Alcohol sweat:
     i.  Articles necessary:
         a. Six blankets.
         b. Rubber sheets; 2 long and 1 small.
         c. Towels.
         d. One muslin sheet.
         e. Safety pins.
         /. Cold moist compresses in basin with ice.
         g. Hot drink and drinking tube.
         h. Alcohol.
         i.  Seven bricks, evenly heated as hot as  pos-
              sible without  " hissing,"  covered  with
              woolen bags.
         ;'. Articles as for cleansing bath.
     2.  Method:
         a. Take and  record pulse.
         b. Fold and  remove bed covers and at the
              same time place blanket over patient.
         c.  Protect pillow with towel and small  rub-
              ber sheet.
         d. Place  under patient, blanket, rubber sheet
              and  blanket.
         e. Fasten  under  blanket around  patient's
              neck with  safety  pin. 
BATHS FOR ELIMINATION
69
         /. Cold compresses on head.
         g. Place rubber sheet over blanket.
         h. Fold covers back from one side and draw
              under blanket into double fold alongside
              of body.
         i.  Place three  bricks on blanket,  outside of
              fold, and  one  at feet, the width of the
              hand from any portion  of  the patient's
              body.
         ;.  Raise rubber sheet and blanket and pour 1
              ounce of alcohol on each brick.
         k. Cover quickly with the edge of the blanket.
         /.  Fold  the  first blanket, that  is over the
              patient,  under  the bricks,  being care-
              ful  to lift the  bricks and  not to  push
              them.   Be very careful that  the bricks
              are  not  near  enough to the  body for
              the  escaping steam to burn the patient.
         m. Repeat on the opposite side.
         n. Complete   by  placing  the  two  extra
              blankets  and  muslin  sheet   over  the
              patient.
         0. Give  hot   drinks  frequently,  if  not
              restricted.
         p. Take pulse  every  10 minutes and record.
         q. Allow patient to remain in sweat for one
              hour.
         r. Remove as from hot pack.
I  Medicated  bath:
     1.  Mustard:
         a. Put one-fourth pound  of mustard into a
              muslin bag, tie and place it in a tub of 
Fig. 22.
Fig. 23.
    Fig.  22.—Portable  electric  light frame  for  giving  sweat baths, used
instead of hot bricks.
    Fig.  23.—Sweat bath frame covered, with water glass and  ice packs
for head,  on bed-side table. 
SWEAT BATHS
7i
             warm water, making about 15 gallons of
             mustard solution.
         b. Patient to be placed in bath  and upon
             removal sponge the body quickly, with
             clear water, to remove any particles of
             mustard and dry.
         c. Allow patient to remain between blankets
             for 30 minutes.
         d. In case the patient is not able to be placed
             in bath tub, the patient can be prepared
             and cared for in the same manner as in
             giving  a warm  pack,  using  a blanket
             wrung  out of mustard solution instead
             of wrung  out of boiling water.

                   SWEAT BATH
   A frame is made of  gas  piping, carrying eight
shielded electric light bulbs.   (Figs. 22 and 23.)
A. Articles necessary:
     1.  Three long rubber sheets.
     2.  Four blankets.
     3.  Electric light frame.
     4.  Prepared hot water can.
     5.  Moist,  cold compresses.
     6.  Hot drinks.
B. Method:
      1. Take  and record pulse.
      2. Remove bed-clothes, as  for general bath.
      3. Protect bed  with long  rubber sheet,  under
           patient.
      4. Place patient between blankets ; allow pillows
           according to patient's  condition. 
72
NURSING TECHNIC
       5. Place frame in position over body, covering it
           with 2 blankets and 2 rubber sheets, placed
           lengthwise.
       6. From  the opening at the foot  of the frame,
           withdraw  the blanket covering the patient.
       7. Turn on the lights and regulate the tempera-
           ture to 90 to 100 degrees F.
       8. Place hot water can to feet.
       9. Fold bottom blanket and rubber sheet upward
           over lower edge of frame. Fold the blankets
           over shoulders  and feet.  Fold the covers
           over the frame, under the sides of the frame,
           under the neck and feet of patient.
     10. Finish with extra blanket over frame  and
           spread.
     n. Change cold compresses  on head frequently
           and give  hot drinks.
     12. Watch patient's condition carefully  and take
           and record pulse every  10 minutes.
     13. Allow patient to remain in sweat from 35 to
           45 minutes.
     14. Turn  off  lights, remove frame and  blankets,
           and  wrap in blankets for one-half hour.
     15. Make up patient as usual.  Record length of
           sweat and results.
                 CHILD'S BATH
A. Articles necessary:
     1. For child:
         a. Tray containing  soap  solution, powder,
             boric  solution, albolene, applicators,  cot-
             ton  pledgets, needle, thread,  thimble,
              scissors, comb, brush. 
CHILD'S BATH
73
          b. Towel, washcloth, diapers,  shirt, stock-
              ings, petticoat,  dress.
          c. Thermometer for each child.
     2. For nurse:
          a. Rubber apron.
          b. Flannel apron.
B. General instructions:
     i. Do not use the general bath tub; use slab  or
          shower when possible.
     2. Have all articles within easy reach.
C. Method.
       i. Prepare bath water,  ioo  degrees F., in irri-
           gator and hang above  child.
       2. Place child on slab covered with rubber pad
           and  diapers.
       3. Turn  child  on  abdomen and  unfasten all
           garments.
       4. Turn on back, remove garments by drawing
           over feet.
       5. Remove shirt and band if any, and diaper.
       6. Wash  face, then head, using soap,  and rinse
           well.
       7. Soap body, rinse, using washcloth and spray.
       8. Wrap  in dry towel and pat dry.
       9. Cleanse mouth with boric solution, using cot-
           ton around  forefinger.
     10. Cleanse nostrils  with applicators dipped  in
           albolene.
     11. Apply olive oil behind ears, if ears are close to
           head.
     12. Apply olive oil to scalp, if scurvy. Then wash
           with soap and water. 
74
NURSING TECHNIC
      13. Cut nails, when necessary, to avoid scratching.
      14. If female child, separate labia, cleanse parts
           with applicator and albolene.
      15. If male child, retract foreskin, remove all sub-
           stances with applicator and albolene.
      16. Use of powder depends upon doctor in charge.
           In  many cases, powder is used to cover up
           carelessness.
      17. Put on shirt, and fasten by sewing it, stock-
           ings, diaper.
      18. Put  on underskirt and  dress  together,  over
           feet.
      19. Turn  child  on  abdomen  and  : ew  or  tie
           clothing.
     20. Safety pins are only used in diaper and per-
           haps on stockings.
     21. Place in  bed, see that  the child is warm.
D.  Record:
      1. Stools.
     2. Urinations.
     3. Discharges.
     4. Weight before bath.

           INFANT'S CLEANSING.BATH
A. Articles necessary:
     1. Clothing.
         a. Dress.
         b. Petticoat.
         c. Shirt.
         d. Band.
         e. Diapers.
         /. Safety pins. 
CHILD'S BATH
75
     2. Towel and washcloth.
     3. Bath apron.
    , 4. Basket for soiled clothing.
     5. Toilet  articles:
         a. Tub,  slab or table.
         b. Water 105 degrees F. and soap.
         c. Albolene.
         d. Cotton  and gauze
         e. Applicators.
         /. Saturated solution of boric acid.
         g. Witch hazel for buttocks.
         h. Sterile talcum powder and shaker.
B. Method:
       1. Bathe on lap or table, table or slab preferable.
      2. Have all articles ready.
      3. To undress baby: turn face  downward, untie
           garments,  turn  on back and  remove gar-
           ments over feet (Fig. 24).
      4. Place clean diaper under baby.
      5. Wrap in bath apron, restraining the hands in
           same.
      6. Wash face and pat dry.
      7. Soap and  wash  head,  holding  it  over tub.
           This is all the soap that is used.
      8. Rinse well and dry.
      9. Unwrap baby, place left hand under head and
           shoulders.
     10. Grasp feet with right  hand and put baby in
           tub.
     11. Hold in  such a manner  that it floats,  rather
           than to have" it  rest on the buttocks.
     12. Dash water over baby with cloth, paying par-
           ticular  attention to creases. 
    Fig. 24.—Nursing in connection with maternity department, showing
morning care of babe. 
CHILD'S BATH
77
13. Spread towel smoothly over lap, again grasp
      feet and  lift from water.
14. Place towel and apron over baby and pat until
      dry.
15. Dry creases carefully.
16. Dry navel  with  applicator.
17. Use absorbent  cotton, powder and  a gauze
      compress over navel.
18. Apply shaker flannel band.
19. Put on two diapers, shirt, petticoat and dress.
20. Cleanse  nose  with  applicator  dipped  in
      albolene.
21. Irrigate eyes with boric acid solution.
22. Place in crib and turn skirt over feet.  Dresses
      and skirt are made long for this purpose.
23. Nothing is  done  to the mouth as long as it is
      clean.
24. A baby should be turned but four times dur-
      ing the  entire operation. 
CHAPTER IV
                    PATIENT

         CONTENTS OF NURSE BASKET

  Each student nurse is responsible for her own basket,
which is to be left in perfect order after each time it is
used.
A. Object:
     To have necessary articles for morning toilets and
       baths, thus saving time and effort and promot-
       ing efficiency.
B. Articles necessary:
      i.  Small rubber sheet to protect pillow.
      2.  Towels and washcloths.
      3.  Paper bags or cornucopias made from news-
           paper.
      4.  Soap in  dish,  whisk broom, hand brush.
      5.  Mouth wash in glass, labelled, covered, and
           fresh solution and sponges each morning.
       6. Combs, fine and coarse.
      7.  Alcohol, 50 per cent.
      8.  Vaseline.
      9.  Castor oil.
     10.  Talcum  powder.
     11. Stearate of zinc or boric powder, if  neces-
           sary.
     12. Tongue depressors, if necessary.
   78 
CHARTING AND RECORDING          79
          CHARTING AND RECORDING
A. Object:
     1.  To keep  an exact record of a patient's con-
         dition.
     2.  To aid the physician  in arriving at a  correct
         diagnosis.
     3.  To aid in following the course of a disease.
B. Types:
     I.  History of all patients upon admission.
     2.  Daily  record  sheet, on which is  recorded all
         symptoms, treatments and diets.
     3.  Temperature charts.
C, General instructions:
     1.  Record and chart accurately,  concisely and
         neatly.
D. Method:
     1.  History sheets; lettered in black ink.
         a. Two nurse's record sheets: fill out number
              of ward, name, date, A.M. or P.M., hour
              of admission to hospital, manner of com-
              ing to ward, temperature, pulse, respira-
              tion and general condition.
         b. One  doctor's first record sheet with  pa-
              tient's history, ward number, date, hour
              of  entrance to hospital, age, occupation,
              religion, attending doctor's name, senior
              and junior internes' names and name of
              the nurse.
         c. Doctor's record sheets, as many as  are/e-
              quired,  without patient's history.
         d. One  standing order sheet 
8o
NURSING TECHNIC
    e. One temperature chart, in Medical Ward,
         if patient is on charting list.
2.  Record sheets: lettered in black ink:
    a. Ward number and name of patient.
    b. Date in spaces as marked for  same with
         temperature and pulse, making a dash
         in spaces for hour and pulse.
         Ex.:    Date.    Hr.  T.  P.  R.
                  9      —  n  —  '17.
    c. A.M. or P.M. on line below, in space for
         hour.
    d. Hour  under hour.
    c. T. P.  R. in  spaces so marked; rectal or
         axillary temperature marked  with A or
         R just below  the line of temperature;
         the number of tenths of a degree  above
         figures, as 102 JL
                      R
    /\ All remarks and treatments on  the  left
         side of the space so marked.
    g. All diets with the exact amount of liquids
         taken  (if patient is  on liquid diet)  on
         right side of same  space.
    h. All defecations  and urinations in spaces
         marked Def.  and Ur.
         1. The amount of urine and defecations
             from typhoid and pneumonia cases
             to be recorded at once.
         2. Those on the four-hour temperature
             list to be recorded at  4  A.M.  and
            4 P.M.
         3. Those not on the four-hour list to be 
CHARTING AND RECORDING
81
            recorded A.M. and P.M.  The gen-
            eral condition of the patient is to be
            recorded at the same time.
        4.  The amount of urine is to be recorded
            for all patients
            c.  While in the recovery room.
            b.  For all typhoids, until the  tem-
                perature  has been normal for
                at least five days.
            c.  For all uremia cases.
    Record sheets, lettered in red ink:
      a. All medication (including all saline  or
          tap water  enemata to be retained),
          noting time, amount, how given and
          whether retained  or expelled.
      b. Daily  summary of  hours, amount  of
          liquid taken.  These to be recorded
          between the lines drawn with red ink,
           following the last  record made up to
          midnight.
3.  Clinical charting:
    a.  Letter in black ink on four-hour tempera-
          ture chart:
        Name of patient.
        Date.
        Number of ward.
        Time of day—A.M., P.M.
        Hour,  8, 12, 4, 8.
        Pulse and respiration.
         Kind  of treatment  given in hyperpy-
           rexia,  lettering from above the 106-
           degree line, in the space of time, when
 6 
82              NURSING TECHNIC
             given.   Dot and dotted  connecting
             lines, showing temperature after each
             treatment, dotted directly from tem-
             perature taken just previous to  treat-
             ment.
      b. Letter in red ink:
          All dots and  straight  lines of all tem-
             peratures.
          On admission chart, a  line from left
             hand marginal  line to  dot  showing
             admission temperature.
          " On admission " lettered directly above
             and  from that line at left of marginal
             line.
      C. Letter in black  ink on daily  chart:
          All headings, as above.
          A.M. and  P.M. in  space between  lines,
             opposite hour.
          Pulse and  respiration.
      d. Letter in red ink on daily chart:
          All dots and  connecting lines  showing
             temperature, using one space for A.M.
             and  one space for P.M.  temperature.
             Chart for two weeks after admittance.

  TEMPERATURE, PULSE, RESPIRATION
Time when taken:
  I. Every four hours.
      a. All  new  patients.
      b. Patients as ordered by attending physician.
      c. All patients with temperature of ioo and
          above. 
       TEMPERATURE, PULSE, RESPIRATION      83

     2. Afternoon: all  patients not on the four-hour
         list.
B. Object:
     1. To obtain  actual knowledge of  the  physical
         condition of the patient by comparison with
         normal conditions.
     2. As an aid in  making  a true  diagnosis  and
         prognosis in  disease.
C. General instructions:
     1. Observe  accurately.
     2. Know the relative value of facts as observed.
     3. Be able to describe these conditions accurately.
D. Temperature:
     1. Normal temperature of adult is from 98 to 99
         degrees F.,  maintained by a balance between
         heat production and heat elimination.
     2. Varies slightly  with age, time of day and tem-
         perament.
     3. Increased by excitement, exercise and the ab-
         sorption  of  food and  toxines.
     4. Decreased  by sleep, rest, lowered vitality,  per-
          spiration and exposure to cold.
     5. Deviations above normal:
         a.  Slight fever, 99 to 100 degrees F.
         b.  Fever, 100 to  103  degrees F.
         c.  Pyrexia, 103 to 106 degrees  F.
         d.  Hyperpyrexia, 106 degrees F. and over.
     6. Deviations below normal:
         a.  Subnormal, 97 to 98 degrees F.
          b.  Collapse, 95  to 97  degrees F.
         c.  Algid  collapse, 95  degrees and below. 
84
NURwSING TECHNIC
E. Pulse.  An intermittent* distention and contrac-
      tion of an artery due to a wave of blood being
      forced through it, because of the contraction
      of the heart.
     i.  Found  wherever an artery  comes near  the
           surface:
         a. Wrist, radial.
         b. Side of  neck, carotid.
         c. In  front of ear, temporal.
         d. In children, take pulse on ankle, dorsalis
             pedis.
     2.  Pulse rate:
         a. Men, 60 to 70.
         b. Women, 70 to 80.
         c. At birth, 120 to 140 (DeLee), 130 to  160
             (Pope).
         d. Children between 1 and 7 years, 80 to 120.
         e. Children over 7 years, 80 to 90.
F. Respiration:
     1.  Object:
         a. To remove carbon dioxide from the blood.
         b. To supply  oxygen  to  the blood.
         c. To carry  off waste materials which  re-
             sult  from combustion going on in  the
             tissues.
         d. Removes heat from the body.
         e. Assists  in  the  circulation of  the  body
             fluids.
     2.  Rate:
         a. Normal:  ratio of respiration  to pulse I
               to 4.
             Man, 16 to 18.
             Woman, 18 to 20. 
       TEMPERATURE, PULSE, RESPIRATION     85

              Infants, 38 to 44 (DeLee).
              Children, 20 to 25.
G. To take temperature:
     1. General instructions:
         a.  See that the mercury in thermometer is as
              low as 95 degrees F. before using it
         b.  If patient has had a hot or a cold drink, do
              not take temperature for twenty  minutes
              afterwards.
         c.  Never use thermometer that has been used
              for a patient with an infectious disease
              for another patient,  without disinfecting
              it.
         d. Never use a  rectal thermometer for tak-
              ing temperatures by mouth. When pos-
              sible, use  colored or  larger  bulbs for
              rectal temperature.
         e.  Take temperature, per rectum, of  a child,
              delirious  or  unconscious patient,  or  of
              one breathing through the  mouth.
         f.  Do not leave  children, hysterical  or de-
              lirious  patients  alone  while   taking
              temperature.
         g.  When temperature is  taken by mouth, the
              patient should be warned to avoid biting
              off the end of the thermometer.  In case
              this  accident happens, every  particle
              should  be saved  and  the accident re-
              ported to the head-nurse at once.
         h.  In shaking down the mercury in  a ther-
              mometer, avoid  any motion  near  the
              patient,  bed  frame, chair back,  etc.,
              or giving the thermometer a sudden jar. 
NURSING TECHNIC
i. Avoid putting  any  thermometer  under
    running hot or cold water.
;. The thermometer basket  must always be
    left clean, with plenty of fresh solution
Fig. 25.—Thermometer basket and ice cap rack.

     and  the  allowed  number  of  ther-
     mometers (Fig. 25).
k. Never  allow  patient  to  insert  rectal
     thermometer.
/.  Never  take  temperature per  rectum, if
     rectum is diseased. 
  TEMPERATURE, PULSE,  RESPIRATION     87

2. Articles necessary:
    a. An accurate open-faced watch.
    b. For taking mouth temperature:
         Thermometer basket with  four glasses:
           One  with a small quantity of cotton,
             carbolic, 5 per cent., thermometers.
           One  with a small quantity of alcohol,
             50 per cent.
           One  with clean  cotton pledgets.
           One  empty  glass for  soiled cotton
             pledgets.
    c. For taking rectal temperatures:
         Thermometer basket with  four glasses:
           One  with a small quantity of cotton,
             bichloride of mercury solution 1  to
             1000.
           One  with clean  cotton pledgets.
           One  with sweet  oil for lubrication.
           One  empty glass for soiled  pledgets.
3. Method:
    a. Mouth temperature:
         1. Remove  thermometer  from  carbolic
               solution,  dry with cotton.
         2. Place in alcohol.
         3. Dry  with clean cotton.
         4. See  that the  mercury  stands 95 de-
               grees F.  or below.
         5. Place thermometer under tongue of
               patient.
         6. Allow  thermometer  to  remain   in
               place one full  minute and with
               the lips closed. 
NURSING TECHNIC
    7.  Remove,   wipe,  read,  shake down
           the mercury to 95 degrees, place
           in  carbolic solution  and record.
b.  Axillary  temperature: this  temperature
    registers about  one degree lower than
    the mouth temperature:
    1.  Dry axilla.
    2.  Place  thermometer,   prepared   as
           for mouth temperature, in axilla
           and draw the arm over chest to
           form  closed  cavity, being care-
           ful that no  fold of gown is  left
           in axilla.
    3.  Leave in axilla for five minutes.
    4.  Remove,  clean,  read,  shake  down
           the mercury to 95 degrees, place
           in  carbolic  solution and  record.
c.  Rectal   temperature:  this   temperature
         registers about  one-fourth degree
         higher than the mouth temperature:
     1. Remove  from bichloride of mercury
           solution, 1 to 1000.
     2. Dry and  see that the mercury is as
           low as 95 degrees  F.
     3. Place in oil.
     4. Insert  in  rectum, leaving  for  five
           minutes.
     5. Clean, read,  shake  down, place in
           bichloride solution,  record.
A rectal temperature  is  to be  indicated by
   placing a capital R to the right and  just
   below the line of the temperature record. 
TEMPERATURE, PULSE. RESPIRATION     89
         An axillary temperature  is to be indicated
           with  a  capital  A,  placed  in  the  same
           position.
         All temperatures over 100 or below 97,  or
           unusual  changes in pulse and respiration,
           must be listed and reported to  the  head-
           nurse at once.
         A report  of  abnormal  temperatures  must
           carry a record of the pulse and respiration.
         A list of  " No defecations and urinations "
           must be handed to the head-nurse after the
           P.M. temperatures have been taken.
         Example:
           Bed.     T.        P.    R.     Def.   Ur.
            5       104      140   40      o '     o
           45                    No def. for 2 days.
H. To count pulse:
     I.  General instructions:
         a. Be sure that the watch is accurate.
         b. Be alert.
         c. Cultivate a sense of touch and rhythm.
         d. Be sure the hands are warm and  dry, for
              the patient's comfort.
         e. Learn  to count  accurately, with  three
              fingers along the path of the artery.
     2.  Method:
         c. Place the index, middle and third fingers
             along  the  path  of the artery,  making
              slight pressure.
         b. Continue the fingers on the artery  for one-
             half minute, to get the rhythm of pulse
              while  counting  the  respirations of  pa- 
90
NURSING TECHNIC
              tient,  without  his knowledge of  this
              being  done.
         c. Count pulse for one whole minute, divided
              into  quarters, noting  whether or  not
              there  is the same  rate in each quarter.
         d. When  accuracy has been developed,  one
              may count for one-half or for one-fourth
              minute, except when the patient is very
              ill, when  the full minute is advisable.
         e. Record.
I.  To count respiration:
     i.  General instructions:
         a. Be sure that the watch is accurate.
         b. Observe accurately.
         c. Count without the patient's knowledge.
         d. Respirations  which number above 40  and
              below 10 indicate a serious condition,
              and must be reported to the head-nurse
              at once.
     2.  Method:
         a. Place fingers  on wrist as if counting pulse,
              to prevent patient realizing that the  res-
              pirations  are being counted.
         b. Count  the  rise and fall of chest or ab-
              domen for  one-half minute and double
              the count for one minute.
         c. Record.

      TO PLACE AND REMOVE A BED PAN
 1. Always have the bed pan clean, warm and covered.
 2. Flex patient's knees.
 3. Support the back by  slipping one  hand under the 
TO  MAKE AN OCCUPIED BED
9i
     sacrum and with the other hand place the bed pan
     in  position.
4. Know that the bed pan is in proper position, either
     by sight or touch.
5. If necessary for the comfort of a thin patient, place
     a piece of cloth on the pan, to protect the back.
6. For  the comfort of a  very  sick  patient, place a
     folded bath towel or a small pillow under the small
     of  the back.
7. Cleanse and dry  vulva and rectum.
8. In removing the bed pan, support the back by slip-
     ping one hand under the sacrum and with  the
     other  hand remove the bed  pan.
9. When the gown is long, pull it down under  the
     back,  after removing the bed pan, and leave it
     without wrinkles and  adjust the bed-clothes.
10. In giving urinal,  lift the bed-clothing at the side of
     the bed and place the utensil within easy reach of
     patient's hand.
11. Always leave the body and bed linen clean and dry.
12. Always have the bed pan or urinal covered when it
     is  being removed to the utility room.
13. Note and record contents  of  bed  pan  and urinals.

         TO  MAKE AN OCCUPIED BED
A. Object:
     1.  To  meet the needs of the patient.
     2.  To  keep the bed dry and clean.
     3.  To  keep the bed free  from wrinkles.
     4.  To make the patient comfortable (Fig.  26).
B. General instructions:
     1.  Have all necessarv articles  ready, including 
Fig. 26.—Morning airing of bed. 
TO  MAKE AN OCCUPIED BED
93
         clean linen, nurse basket, and other articles
         as for making an empty bed.
     2.  Avoid jarring the patient.
     3.  Avoid having the covers uncomfortably tight.
C. Method:
      1. Loosen all  bed covers  from the  sides of the
          bed, not by reaching over the  patient.
      2. Remove bedding, as  follows:
         a, Fold and remove  spread.
         b. Fold and  remove extra blankets.
         c. Remove  extra  pillows, allowing one  or
              two only.
         d. Allow the second  blanket to remain  in
              place.
         e. Fix the  blanket by having the patient hold
              the  upper border or tuck it under the
              shoulders.  Fold  the upper border  of
              the  upper sheet toward the foot of the
              bed; then fold  it a  second time from
              the  centre  toward the foot and with-
              draw  it from the foot of the  bed.
      3. Move patient  to one side of bed,  or better,
          turn on side, flexing  the knees  and making
          comfortable.
      4. Place soiled  draw sheet  in irregular folds
          along the body.
      5. Brush rubber  draw sheet  and, if moist, dry.
      6. Turn rubber draw sheet over patient's body.
     • 7. Place lower sheet in  irregular folds close to
          patient's body.
      8. Brush mattress ; dust bed frame. 
94
NURSING TECHNIC
 9. Unfold the clean sheet,  not  allowing it to
     touch the floor.
10. Place over mattress, having centre fold in the
     centre line of bed, the same as in making an
     empty bed,  making  irregular folds  of the
     further half of the sheet, fitting it  closely
     to the folds of the  sheet  to be removed.
11. Tuck in the lower sheet and square the corners
     as for an empty  bed.
12. Bring   down  the  rubber draw  sheet  and
     tighten, cover with draw sheet, having the
     centre fold  of sheet in centre line of bed
     and tucking the balance of the sheet under
     the mattress as far as possible.
13. Turn or move the patient to clean side of bed.
14. Always turn the patient toward  you,  having
     the body beyond the centre  of  the bed and
     support with one hand while the other hand
     is used in flexing the knees, seeing that the
     patient is well balanced and comfortable.
15. If the patient  is irresponsible, he should never
     be left without being guarded in some way.
16. The nurse passes to the other  side of the bed.
17. Remove draw sheet.
18. Dry, straighten and turn  rubber sheet over
     patient's body.
19. Remove lower sheet, brush mattress, dust bed
     frame.
20. Make up this  side of bed the same as the first
     was made.
21. Put on clean gown. 
TO MAKE AN OCCUPIED BED
95
     22.  Replace the covers, squaring the corners.
     23.  Adjust pillows.
     24.  Time allowed will depend upon the condition
          of the patient.
D. To change  pillows:
     1. To remove:
         a.  Slip one arm under head, with hand under
             far shoulder blade, raise patient slightly.
         b.  With free hand remove pillow by drawing
             it out from the opposite side of the bed,
             then placing it on the  near side of the
             bed; remove arm from under head.
     2. To replace:
         a.  Place pillow in nearly upright position at
             head of the further side of the bed.
         b.  Support patient, as above.
         c.  With free hand, draw pillow under  the
             head.
E. To change gown, under cover:
     1. Open gown:
         To remove when both arms  are free:
           a. Untie and remove sleeve furthest from
               you.
           b. Slip gown over chest toward you.
           c. Remove other sleeve  and draw from
               under cover.
         To replace:
           a. Pass your hand through sleeve.
           b. Grasp patient's hand nearest you.
           c. Draw arm through sleeve.
           d. Proceed with second arm in the same
               way. 
96             NURSING TECHNIC
      e.  Tie close to the patient's body and leave
          without wrinkles.
    To remove in case one arm is injured:
      a.  Remove the sleeve from the injured arm
          last and when replacing the gown, re-
          place it first.
2.  Closed gown:
    To remove:
      a.  Have  patient lie  on back with knees
          flexed.
      b.  Draw lower edge of gown to hips.
      c.  If  possible, have patient raise hips and
          then draw gown well up towards head.
          If patient is unable to raise hips, place
          one hand under hips,  raise  and draw
          gown up with free hand.
      d.  Lift shoulders with one hand and draw
          gown up about neck.
      e.  Have patient bend elbow and draw off
          sleeve of gown nearest you.  Remove
          opposite sleeve, raise head and remove
          gown from over the head;  or, slip
          gown off over the raised head, having
          the arms  raised above the  head, and
          then slip both sleeves  from arms.
    To replace :■
      a.  Draw  on one sleeve, usually  on the in-
          jured arm first, then  draw the body
          of the gown over the head, then draw
          on the second sleeve.   Or place both
          arms in the sleeves and then draw it
          over the head and put in place. 
           TO MAKE AN OCCUPIED BED         97

F. To make a bed-patient's bed, when the linen is
      not to be changed:
     a.  Remove the bed covers in order and place on
         chair.
     b.  Leave blanket over patient.
     c.  Remove pillows.
     d. Turn patient on side.
     e.  Brush draw sheet and fold over patient's body
     /.  Brush rubber  sheet and  fold over  patient's
         body.
     g.  Brush lower  sheet  and  fold over  patient's
         body.
     h. Brush mattress.
     i.  Clean bed springs and dust frame.
     ;.  Replace the linens in order, making them tight
         and smooth.
     k.  Turn patient to opposite  side of bed and rub
         patient's back.
     I.  Proceed to  opposite side  of  bed and make it
         the same  as the first  half.
     m. Replace the  bed  covers  and  square   the
         corners.
     n.  The  covers of a  bed-patient's  bed  should
         never  be  just turned  back  and the  linens
         smoothed.  Each article  should be removed.
         This helps to  air the bed linen, adds  to the
         patient's comfort as well as having done a
         finished piece  of work.
7 
98
NURSING TECHNIC
              ENEMATA  (CLYSTERS)

A. Object:
      i. To  cleanse large intestine.
      2. To  destroy germs.
      3. To  contract tissues.
      4. To  relieve flatulency.
      5. To  soothe.
      6. To  afford nourishment.
      7. To  destroy worms.
      8. To  act as a sedative.
      9. To  stimulate.
      10. To  relieve thirst.
B. Types:
      1. To be expelled:
          a.  Colonic flushing and medicated purgative.
          b.  Carminative.
          c.  Antiseptic.
          d.  Anthelmintic.
      2. To be retained:
          a.  Emollient.
          b.  Nutritive.
          c.  Stimulating.
          d.  Sedative.
          e.  Astringent.
          f.  Enteroclysis.
C. General instructions:
      1. Have all necessary articles in readiness.
      2. Have  correct   solution  and  exact  amount
          ordered.
      3. Have temperature of solutions from 100 to 105
          degrees F. 
ENEMATA
99
     4.  Do not hurry or use force when inserting an
         enema tip or rectal  tube.  There  may be a
         nervous contraction  of the sphincter muscle
         upon the insertion of the tip or tube. If this
         occurs, wait a few moments and then proceed.
     5.  If the rectal tube becomes clogged by feces,
         withdraw slightly and  re-insert  or remove
         and  let the solution pass through it, then
         re-insert.
     6.  Always let the solution run slowly and if there
         is  pain  following, wait a minute or two by
         shutting off the flow  and then proceed.
     7.  If a second enema is ordered because the first
         enema has not  been  expelled,  siphon off the
         first fluid by inserting the rectal tube, allow-
         ing it to remain placed for not more than ten
         minutes.
     8.  In cases of impacted  rectum, when it seems
         necessary to use  the finger to break up the
         contents of the  rectum, cover the finger with
         a finger cot, or if this is not available, fill the
         finger-nail with hard soap and have the finger
         well protected with vaseline.
     9.  In case the hands become odorous from care of
         patient, wash with soap and water, then with
         warm water and dry mustard for five minutes
         and rinse well.
D. Colonic flushing:
     1.  Articles necessary:
         a.  Blanket, rubber and small  sheets for the
              protection of the bed. 
IOO
NURSES TECHNIC
    b. Irrigator,  rectal  tube  or enema  tip, or
         pitcher and funnel.
    c. Vaseline, toilet paper, bed pan and cover.
    d. Solution as ordered.  Solutions commonly
           used:
         Soap  suds, made from hot water and
           ,soap  jelly.   Never  use laundry or
           " green"  soap.   The  froth  should
           always be removed.
         Normal  saline.
         Medicated, as ordered.
2.  Positions:
    a. When patient is able to turn on side, place
         on left  side, knees drawn up  close to
         abdomen.
    b. When  patient  is  unable to  turn  on side,
         dorsal position  with knees flexed.
    c. Place in  knee-chest position  (genu-pec-
         toral) only upon special order, and watch
         pulse.
3.  Methods:
    a. Place screens.
    b. Place patient in position.
    c. Protect bed with  small rubber and muslin
         sheets.  Turn down bed clothes,  cover
         patient with blanket.
    d. When  using irrigator,  place same  about
         eight  inches  above the patient's  body.
         Expel the air from the tube by  letting
         the solution run through  the tube into
         the bed  pan until it runs warm.   Pinch
         the tube tightly near the tip to be in- 
ENEMATA
roi
              serted.  When funnel and pitcher are to
              be  used, never allow the funnel to be-
              come empty and do not raise the funnel
              more than eight  inches  above the pa-
              tient's body.
         c.  Lubricate the tip or tube with vaseline.
         f.  Lift the edge of blanket and gently insert
              the tip or tube, then withdraw slightly
              before allowing the solution to flow into
              the rectum.
         g.  High flushing, insert the rectal tube about
              two inches, allow the solution to  flow
              while  the  tube is inserted  about  eight
              inches.   Low flushing,  follow  the  same
              procedure,  except that the tube is in-
              serted about four  inches.
         h.  Allow the solution to flow slowly.
         i.  Clamp tube, remove the tip or tube quickly
              but gently and place it on paper.   Keep
              the patient in the  same position and en-
              courage the retention of the solution for
              twenty minutes.  Place patient on  back
              and adjust bed pan.
         ;'.  After the enema has been expelled, remove
              bed pan and cover it.
         k.  Cleanse and dry the  patient, make  com-
              fortable ; ventilate room.
E. Medicated purgative enema:
     i.  Oil.  Given to soften feces:
         a.  Sweet  oil,  4 to 6 ounces,  heated to 100
              degrees F. in bowl. 
102
NURSING TECHNIC
         b.  Prepare same articles as for colonic flush-
             ing,  except  use  a hard rubber syringe
             with a catheter attached to tip instead of
             irrigator or  funnel with colon tube.
         c.  Give high and follow in two to six hours
             with colonic flushing.
     2.  1-2-3 enema.
         a.  Magnesium sulphate, 1 ounce;  glycerine,
             2  ounces; hot water,  3 ounces.
         b.  Dissolve magnesium sulphate  in the hot
             water, stirring until dissolved and then
             add the glycerine.  Double this formula
             for a 2-4-6 enema.
         c.  Give the same as an oil enema.
     3.  Milk and molasses enema, given to relieve fer-
         mentation.  Mix warm  milk and  warm mo-
         lasses,  seven ounces of  each.   Encourage
         patient to retain  for twenty minutes and fol-
         low with a warm water enema, one pint.
F. Carminative  enema:
     [.  Turpentine,  1 dram;t sweet oil,  1 ounce; egg
         albumen  from 1 egg; warm water, quantity
         sufficient to make one pint.  Make an emul-
         sion by adding the turpentine to the oil, drop
         by  drop, stirring constantly.    Cut the egg
         albumen  with scissors or knife and add to
         the emulsion.  Add  warm water.  Give the
         same as  an oil enema.   Encourage the pa-
         tient to retain this enema for one hour.
     2.  Asafetida: tincture  asafetida,  1 dram;  tur-
         pentine, 1 dram.   Add to a 1-2-3 enema. 
ENEMATA
103
G. General instructions:
     1.  The following are to be given with a catheter,
          funnel, pitcher, or graduate.
     2.  Not more than six ounces of any solution is to
          be  given at one  time, as more than  this
          amount  may excite  peristalsis.
     3.  Solution is to be given very slowly.
     4.  Patient  is to be kept quiet.
     5.  If there is a  possibility of the enema being
          expelled, pressure may be made  on the anus
          with a hot compress.
H.  Emollient enema:
     1.  Starch enema.
          a. Dissolve one teaspoonful of starch in cold
             water.
          b. Add, slowly, six  ounces of boiling water.
          C. Boil for one or two minutes; cool to  100
              degrees F.
          d. If  opium is ordered, add it  just  before
              giving, not while heated.
I. Nutritive enema:
     1.  When  nutritive  enemata  are given,  a daily
          purgative enema  should be given, at least
          one hour before the nutritive.
     2.  When  peptonized  milk is ordered,  prepare
          properly  in   accordance  with   directions.
          Always warm this  milk in  a  double boiler,
          never  allowing it  to be placed directly above
          a flame.
     3.  When egg white is ordered, cut it with scissors
          or a knife and add to the base.
     4.  When brandy or whiskey  is ordered,  add the 
104
NURSING TECHNIC
         same to the base  at  the bedside.   These
         often curdle the milk, upon  standing.
     5.  A pinch of salt should  be  added to  nutritive
         enemata.
J.  Stimulating enema:
     1.  Watch pulse.
     2.  Warm, strong, black coffee, six to eight ounces,
         may be used.
     3.  Whiskey, one ounce, or  brandy, one ounce, in
         warm normal salt solution may be used.
K.  Sedative enema:
     1.  Chloral or bromides  may  be ordered,  to  be
         given dissolved in normal salt solution, warm,
         three ounces.
     2.  Always make  the  patient  comfortable and
         ready for the night  before giving a sedative
         enema.
L. Astringent enema:
     1.  Dissolve alum, gr. xxx,  in hot water, one pint.
M.  Enteroclysis:
     1.  Keep at  least one quart  of  hot  normal salt
         solution in irrigator.
     2.  Place can from six to  fourteen inches  above
         patient and  regulate flow so as to permit one
         pint of  solution to enter the intestines  in
         sixty minutes.
     3.  Keep tube  from  irrigator  on hot water bag
         near edge of bed, or the hot water bag may
         be  tied about  the  irrigator or an electric
         light bulb or a bottle, of very hot water may
         be  placed in the solution to  keep solution
         warm. 
        MAKING A PATIENT COMFORTABLE     105

       METHODS OF MAKING A PATIENT
                  COMFORTABLE
A. General instructions for the nurse:
     The nurse should  work  easily, smoothly,  quietly
       and with long, even strokes, rather than with
       short,  jerky or  fussy  movements.
     The touch should be firm, gentle  and effective.
     Use the whole hand, not fingers only, in handling
       patients and have the hands smooth, warm and
       dry.
     Never touch the bed unless there is a reason for it.
     Avoid jerking or jarring a patient.
     The  voice  should be  modulated,  never high-
       pitched, rasping or loud.  Avoid whispering.
     Never discuss a patient's condition in her pres-
        ence, even though  in  coma.
     Never discuss another patient's condition before
        any patient.
     Do  not  startle  patients  by sudden noises or by
        an unexpected approach.
     Satisfy the questions of patients, whenever  pos-
        sible,  in  accordance with  good judgment and
        common  sense.
     Never go out of a room without leaving it  in a
        better condition, more agreeable for the patient
        and with a happier atmosphere than when you
        entered.
     Whenever  possible,  complete  a piece of work,
        leaving it in a finished condition, before start-
        ing another piece  of work.
     When planning sleep and rest  for your  patient,
        consider the  following points: 
106              NURSING TECHNIC
  a. Voice : that it should be low but not whisper-
       ing, and as little conversation taking place
       as  possible.
  b. Shoes: that  there  should  be rubber heels
       worn, that  shoes  should  not be squeaky;
       that the tread  should be  light, but not to
       walk on tip-toes.
  c. Leaky  faucets or running water should be
       controlled.
  d. Windows and  doors  should be  properly
       closed and opened,  the rattling of  win-
       dows and  slamming of doors should be
       controlled.
  e. Hinges and  castors can  be oiled to  avoid
       unnecessary noise.
  /. The plan  of  the rooms and the wind can be
       studied  so that ventilation can be had with-
       out draughts.
  g. The temperature of the room always needs
       control.
  h. Turn out or shade bright lights from pa-
       tient's  eyes.  Shield the  eyes  from  the
       flicker of candlelight.
When  planning to lift and carry a patient, con-
  sider the following points:
  a. In moving or readjusting a patient,  always
       have all articles ready,  warm, dry, and in
       a convenient place.
  b. Fold all  bed and body  clothes so that the
       patient  will never be exposed or hampered
       by  them.
  c. The nurse's  feet should be placed far apart
       and well supported on the floor. 
       MAKING A PATIENT COMFORTABLE     107

       d. Her knees should be flexed and then straight-
           ened  as the patient is lifted.
       e. Always flex  the body at the hips; the body
           does not flex at the small of the back and
           by attempting to bend  the  back  and lift,
           the muscles of the back are unnecessarily
           strained.
       f. When two persons are carrying a  patient,
           always step in unison.
       g. Do not lift the patient alone, if the patient
           is heavy or unmanageable.
       h. When  lifting  a  patient,  reach  beyond  the
           centre of weight.
       i. Remember that the shoulders and hips  are
           the heaviest  parts of the  body and there-
           fore give the best support to them.
       ;'. When lifting, support the framework of the
           body and  do not pull on the muscle and
           skin nor allow the hands to slip.
B. To lift  and carry:
     1.  Dress patient  in comfortable clothes or wrap
         in a blanket,  protecting the  feet.
     2.  Place one arm  under patient's shoulder, with a
         firm hold under the opposite axilla.
     3.  Place opposite arm under thigh.
     4.  Have patient grasp shoulder of nurse.
     5.  Lift  and hold on  chest  so that the patient's
         head is above the shoulder of the nurse.
     6.  When two nurses are lifting, they should both
         be  on  the  same  side  of the patient,  the
         tall nurse lifting  the upper portion  of  the 
io8
NURSING TECHNIC
         body.  Place one arm under the shoulder of
         the  patient,  the  second  arm  under the
         hips.   The  second  ntrse  places  one  arm
         under the lumbar region and the second arm
         supports the knees.  Lift,  carry, step, bend
         and lower patient, in unison.
     7.  When four persons are required for lifting and
         carrying,  two  persons  should  be  opposite
         each other, the hands clutched together under
         the shoulders and  the buttocks, the buttocks
         and  the  knees.
C. To lift patient toward head of bed:
     1.  Stand as previously directed.   Place patient
         in dorsal position and, when possible, flex
         knees,  with  the soles of  the feet flat on the
         bed. The palms of the hands  may be placed
         downward on bed or be used to  grasp the
         shoulders of the nurse, or the  head of the
         bed.
     2.  Place right hand well under back, the heavy
         part of  the  patient's  shoulder and   back
         being  supported with the upper arm and
         shoulder of  the nurse; place the left hand
         below  the hips.
     3.  Lift firmly and gently toward  head of bed.
     4.  If two persons are required  to  lift, take same
         position  as  " To  lift  and carry" and lift
         toward head of bed.
     5.  If patient is able, have patient flex knees, then
         place one arm under the nurse's  right arm
         and the other over the nurse's left shoulder. 
MAKING  A  PATIENT COMFORTABLE
         In this way the weight will not be so great
         for the nurse,  because the patient partially
         lifts herself.
     6. To pull the mattress toward the  head of the
         bed: flex the knees of the patient and  have
         the patient grasp the rods at the head of the
         bed; the nurse  stands at the head of the bed
         and  grasps  the sides  of the mattress.  The
         patient and the nurse  draw up  at the same
         time, placing the  mattress  in position  with
         little effort for  either.  The mattress may be
         adjusted toward the foot of the bed simply
         by pulling the  same.
D. To lift an injured leg or arm:
     i. Never grasp  an  injured  limb from above or
         change the position of a limb by grasping the
         fingers or toes.
     2. Never place the  hands directly under the in-
         jured portion.
     3. When lifting an injured part, place both hands
         beneath the injured limb,  on  either side of
         the injury, and raise slowly and gently.  If
         the entire body is being lifted and one person
         is  responsible for the injured limb, it should
         be lifted so that the same position is continued
         as  the  body is in before  the  patient was
         changed in  position.
     4. In  cases  of  fracture,  before application  of
         splint, the hands should make slight tension
         when lifting, so that the ends of the broken
         bone are kept somewhat apart. 
no
NURSING TECHNIC
E. To undress a patient in bed:
      i.  Protect bed with blanket.
      2.  Cover with blanket.
      3.  Remove shoes.
      4.  Loosen buttons, hooks, etc.
      5.  Loosen clothing from upper part of body, re-
          moving as many articles as possible, at one
          time.
      6.  Place clothing on back of chair.
      7.  Put on gown.
      8.  Remove clothing from lower part of body.
      9.  When garments cannot be removed whole, rip
          the seams rather than cut them.
     10.  Garments which must be opened all the way
          down,  should be torn, not cut.
     11.  To  remove  tight-fitting shirts, remove  as
          closed  night gown.
     \2.  If a portion of the body is injured, remove
          the clothing from the uninjured  side,  first.
F. To dress a patient in bed:
     1. See  that all articles necessary are warm, dry,
         in  a convenient place and in  the  order  of
         their adjustment.
     2. If the garment is closed, like a shirt, first make
         a roll from the neck of the garment to the
         hem; draw on the sleeves, slip this roll over
         the head and beneath the  shoulders. Draw
         it smoothly underneath the body.
     3. If the clothing opens all the way down, draw
         on the sleeve  on the side away from  you,
         turn patient toward  you.
     4. Pull  garment well up  on  the  shoulder and 
        MAKING A PATIENT COMFORTABLE      in

         tuck the body of the garment closely under-
         neath the back.
     5.  Turn patient on back and slightly to opposite
         side;  draw the garment beneath the body,
         slip on second sleeve and adjust.
     6.  To put  on a stocking:  turn leg of stocking
         back over the foot.  Draw on the foot and
         then draw  the balance of the stocking up  on
         the leg.  Do not pull at the top.
G. To place a back-rest:
     1.  Place the folded back-rest at head of bed, back
         of pillows,  or pillows removed, if permissible,
         in such a way that it can  easily be  brought
         under the head and shoulders of the patient.
     2.  Stand on left side of bed and raise patient to
         a sitting position.  Support patient with the
         arm in front of patient's chest and over the
         shoulder, with the patient's head against the
         shoulder of the nurse.
     3.  With the  free hand withdraw  all of  the pil-
         lows, draw down the back-rest and fasten.
     4.  Adjust the pillows to  cover the lower edge of
         the back-rest, making it comfortable by fill-
         ing in  the  hollow places with  small  pillows
         or pads.
     5.  A back-rest may be made  from a sheet by fold-
         ing it diagonally and placing the apex under
         the patient, bringing the base up around the
         shoulders.   The patient being  raised to a
         sitting position, the corners of the sheet may
         be fastened to the foot of the bed. This will
         not do for a very heavy patient. 
112
NURSING TECHNIC
H.  Supports:
     i.  A blanket, rolled  over a strong bandage, pro-
         tected by a small rubber sheet  and covered
         with  a  muslin  sheet,  relieves abdominal
         tension when placed under the  knees.  The
         ends  of the bandage should be  long enough
         to tie to the head of the bed or to the springs
         at the sides of the bed.
     2.  A pillow, protected with a rubber cover, and
         a muslin sheet or pillow  case,  may be used
         in supporting the feet  or raising  the bed-
         clothes from the toes.
     3.  When a patient is  able to help herself, a strong
         bandage, three or four inches wide, of tick-
         ing, may be tied to the bar at the foot of the
         bed.  The  patient may hold to this for sup-
         port while a back-rest is being adjusted  or
         may raise herself into the sitting position.
     4.  Bedclothes can be raised from any part of a
         patient's body by the use of cradles.   These
         are made by crossing two half  circles, such
         as from barrel hoops, covered with bandages.
     5.  To avoid foot drop, a piece of heavy canvas
         can be sewn to two uprights of  a cradle, the
         support padded  and bandaged to fit the feet,
         the cradle  held in position with bandages so
         that the feet will be supported.
I. To readjust pillows:
     1.  Slip arm under the patient's shoulder and back,
         raise, and turn or rearrange the pillows.
     2.  Pillows can often be comfortably arranged bv
         placing them in  the  form  of an inverted  V, 
        MAKING A PATIENT COMFORTABLE     113

         with the pillows overlapping at the apex, Ai
         for the support of  the head, and the back
         resting on the mattress.
J.  To place patient in Fowler's position:
     1.  Elevate  head of bed  to the  required height,
         by  means of  mechanical  adjustment or by
         putting it on a protected table or chair.
     2.  See that the support is firm.  If the legs of the
         bed are elevated on blocks of wood, have the
         castors removed,  or  better,  have  hollow
         places  made in the top of the blocks,  large
         enough to  fit the  castors.
     3.  Prevent  the patient from slipping down in bed
         by placing a trough-shaped support, made of
         boards, under the mattress at the knees.
K. To move patient from one side of bed to the other:
     1.  Flex knees of patient.
     2.  Place one hand and arm, obliquely, under the
         patient's back, carrying the hand  well down
         under  the back so that the patient's shoulder
         rests in the hollow of the nurse's shoulder.
     3.  Slip opposite hand well under back, just below
         shoulders.
     4.  Draw the upper part of  the body toward you.
     5.  Slip one hand under lower part  of back, the
         opposite hand just below the hips and draw
         the lower part of the body toward you.
L. To turn patient without draw sheet:
     1.  Stand at the side of the bed toward which the
         patient is to be turned.
     2.  Carry the arms over the patient's body, slip-
      8 
114
NURSING TECHNIC
          ping  one hand under  the shoulder and the
          other under  the hip.
     3. Gently but firmly roll patient toward you, being
          careful that the patient is lying squarely and
          comfortably on shoulder and hip.  The lower
          leg should be extended  and the upper leg
          flexed and  resting on the  bed  for  partial
          support.
     4. In case the patient is to be left on the side, the
          hips should be moved  toward the centre of
          the bed.
     5. A small thin pillow may  be placed between the
          knees or under the abdomen.
     6. If desired,  a pillow  may be placed lengthwise
          from shoulder  to  hip, having  less  feathers
          in the side of the pillow next to the patient,
          then folded and  tucked well under the back,
          for support.
M.  To turn a patient  with a draw sheet:
     1. Have the draw sheet under shoulders and hips.
     2. Patient must be near the centre or further side
          of bed.
     3. Grasp the ends of the draw sheet from the far
          side  of the bed and turn the patient toward
          you.
     4. Patient may be supported as directed above.
N. To turn patient with lifting sheet:
     Fold a strong sheet lengthwise twice and again,
       crosswise.  Placed under a patient in the same
       manner as a draw  sheet is placed, it is helpful
       in lifting a patient toward the head of the bed, 
MAKING A PATIENT COMFORTABLE
"5
       on the bed-pan, into a wheel chair and also to
       turn on side.
O. To get patient up in chair:
     i.  General instructions:
         a. If a patient is gotten up out of bed for the
              first time, take pulse before and after get-
              ting her up.
         b. Do not allow patient to sit up for  more
              than 20 or 30 minutes, the first attempt.
          c. Place chair parallel with bed, the back of
              the  chair toward the head of the bed or
              the  foot of the bed, or the back of the
              chair against the foot of the bed, thus
              being in the same line.   If the chair is
              to be placed at right angles with the bed;
              this  is preferable at the foot.
     2.  Articles necessary:
         a. Chair.
         b. Two  pillows.
         c. Two  blankets.
         d. Slippers.
         e. Safety pins.
     3.  Method:
         a. Arrange chair with blankets and cushions.
         b. Place  pillow at back,  with open ends of
              pillow case downward.
         c. Place blanket, diagonally, over all.
          d.  Place second blanket, lengthwise, over
              bed.
         e. Fold down covers in the usual way.
         /. Wrap patient in blanket, which reaches to
              axilla. 
n6
NURSING TECHNIC
      g. Put on slippers.
      h. Assist or lift into chair.
      i.  For protection  or comfort, cover  shoul-
           ders with  cape  or  extra blanket.
      ;.  Fold blanket over feet and pin securely.
      k. Support feet on stool if  desired.
      /.  Count pulse as  soon as patient is up and
           again within 10 minutes or 15 minutes.
To move patient from one bed to another:
  1.  Beds of equal height:
      a. Remove top covers,  leaving blanket over
           patient.
      b. Loosen draw sheet, folding it back on side
           of bed nearest second bed.  Move patient
           to edge of bed.
      c. Tuck  other side of draw  sheet  about
           patient.
      d. Have second bed without draw sheet.
      e. Place beds  close together, fasten   them
           securely.
      /. Standing on further side of second bed,
           move patient  over by pulling the  draw
           sheet and patient.
  2.  Beds of unequal height.  Two nurses required.
      a. Place beds at right angles, head of unoccu-
           pied bed to the foot of patient's bed.
      b. Wrap patient in blanket, covering feet and
           tucking edge under back.
      c. Nurses stand on the same side  of bed,
           position same  as for lifting and carrying
           patient.
      d. Urge  patient to  become rigid. 
       MAKING A PATIENT COMFORTABLE      117

         e. Hold  loose end of blanket to cover back.
         /. Carry, in  unison, to clean bed, lower and
              cover.
Q. To change or  turn mattress with patient in bed:
     Two to four  nurses required:
      1.  One or two nurses on  either side of bed.
      2.  Have three pillows ready and necessary linen.
      3.  Remove spread, upper blanket and pillows.
      4.  Loosen the bottom sheets and roll them  to-
           gether  with the upper sheet and  blanket,
           close to the patient's  sides  and under feet.
      5.  First nurse draws patient to  her side of bed.
      6.  Second nurse draws  mattress towards  her,
           thus supporting the  patient  on the  bed
           while one-half of the springs is free  from
           the mattress.
      7.  First nurse places the three  pillows, length-
           wise, on springs, and draws patient  from
           the mattress on to the pillows.
      8.  Second nurse removes mattress or turns mat-
           tress and readjusts it  on the springs.
      9.  First nurse grasps the  roll  of bedclothes and
           draws  the patient to  side of freshly turned
           or new mattress.
      10.  Patient  is then lifted  to centre of bed, bed
           further made by both  nurses.
R. Restraining patients:
      1. Object:
         a.  To prevent patients  injuring themselves.
         b.  To prevent patients from getting out of
              bed. 
n8              NURSING TECHNIC
General instructions:
  a. Never restrain patients  unless absolutely
      necessary,  or in accordance  with  the
      doctor's orders.
  b. Always  make  restraint  effectual  because
      careless restraint is worse than none.
  c. Prevent  any restraint from becoming too
      tight.
  d. Watch for and prevent  chafing and pres-
      sure sores.
  e. If violent, care must be taken that there
      are enough able-bodied persons at hand
      to hold patient.
  /. Do not  fasten  one side  of the body only.
      One hand and one foot, on opposite sides
      of the  body may be  restrained.
  g. To prevent chafing,  when leather straps,
      armlets or anklets are  used,  pad  the
      same with cotton or gauze and  bandage,
      prior to adjustment.
  h. Fasten securely but not too tightly.
  i. Never fasten hands to head of bed.
Types:
  a. Sideboards.
  b. Sheets.
  c. Handcuffs, anklets, straps.
  d. Strait-jackets.
Method:
  a. Sideboards:  securely fasten the  mechan-
      ical sides to bed  (Fig. 27).  Or secure a
      board,  1 in. thick, 14 in. high, 2 in. longer
      than the bed, with  holes in each  end.
      Fasten securely with a rope  to head  and
      foot of bed or alnnor tV>*» ci«4»c 
MAKING A PATIENT COMFORTABLE      119

  b.  Sheets:
      1. Fold two sheets, diagonally, placing
           one underneath the patient's waist
           and the other over the abdomen.
           Twist  the ends of  the  two sheets
           together, close to the body, draw
           the ends through the links of the
           springs and tie under the springs.
Fig. 27.—Side pieces on bed for restraint.
2.  Place folded sheets, one over the ab-
     domen and one over the knees, se-
     curing them by twisting the ends
     around the bars on  the side of the
     bed.   The knees should  be  well
     padded.
3.  A sheet placed lengthwise across the
     patient may be used and  fastened
     as above, bringing it high up under 
NURSING TECHNIC
     the axillae and low down to the feet.
4. Fold a sheet diagonally and place be-
     low the shoulders.   Bring the ends
     up under the axillae, over shoulders
     and then under the pillow.  Cross
     the  ends,  twist and tie to bar at
     head of bed.   Usually  restraint of
     the  lower  part of the body is also
     necessary.
5. Clove hitch: with a large triangular
     bandage or with a small  sheet folded
     diagonally, make two loops, form-
     ing  a figure-of-eight, with one end
     up and the other end  down.   Put
     loops together with free ends on in-
     side, pass  them over hand or foot,
     twist ends together  and make knot
     12 inches  from extremity  and  tie
     ends to bedstead.  If not properly
     applied, it will either not hold or
     shut off the circulation. It may be
     used on both feet by putting a loop
     around each ankle and  twisting the
     ends once around  that portion of
     the  sheet  which  is between the
     ankles and carrying it to the foot of
     the bed.
6. Camisoles,  strait-jackets:  make  of
     heavy canvas for adults or of heavy
     muslin  for children. Apply accord-
     ing to instructions,  noting  general
     instructions.
7. Anklets and handcuffs of leather are 
    HANDLING PATIENTS WITH HEMORRHAGE 121

                  made with lock and key.  They fit
                  nearly  any  ankle  or  wrist,  are
                  strapped to the bed.  Always have
                  a definite place for the key in each
                  ward and never lose the key.

   HANDLING PATIENTS AFTER FRACTURES
1.  Avoid moving patient whenever possible.
2.  Keep all fractures of extremities straight.
3.  After a fracture has been set, avoid moving the frac-
    tured part from the position in which it was placed.
4.  As ordered, apply cold to control hemorrhage, check
    inflammation  and relieve pain.
5.  When patient is able to be up,  keep all  fractures
    immobilized with proper supports.

  HANDLING PATIENTS WITH HEMORRHAGE
1.  In an emergency, make pressure over arteries to
    control hemorrhage, then get assistance.
2.  Report all  patients with hemorrhage symptoms to
    the head-nurse at once.
3.  After operation, watch for signs of external hemor-
    rhage on  dressings, over incision.
4.  If in  doubt as  to increase  of  blood-stain  on dress-
     ings, outline the  stain with a soft pencil, time the
     increase.
5.  Do not  change dressings,  without  a written order
     from the doctor.
6.  Never allow heart stimulation to be given without
     an order  from the doctor.
7.  Symptoms:
      Growing pallor. 
122
NURSING TECHNIC
     Weak, shallow, sighing  respiration.
     Thirst.
     Restlessness.
     Dizziness.
     Weakening of pulse beats, which become rapid
        and irregular.
     Falling temperature.
8. Treatment  usually ordered:
     Absolute quiet.
     Application of cold or heat.
     Elevation of part of body sustaining hemorrhage.
     If  hemorrhage  is  abdominal,  give  nothing by
        mouth, elevate foot of bed.

     HANDLING PATIENTS WITH SPRAINS
i. Affected part should be kept at rest until orders are
    given  for exercise.
2. Joints are usually elevated and treated  with  hot or
    cold applications.
3. Sprain of an ankle is usually treated by strapping
    the ankle with adhesive, and kept at rest.

              CARE OF THE MOUTH
A. Time:
     1. Daily, with morning and evening  care.
     2. Patients who are very ill must have the mouth
         cleansed before and after each  feeding in
         addition to  the regular care.
     3. In  accordance with the doctor's orders.
B. Object:
     1. Cleanliness, comfort and a  sense of freshness.
     2. To avoid the accumulation of bacteria, which
         may be swallowed with the food. 
               CARE OF THE MOUTH            123

     3. To  prevent  ulceration of the mouth and in-
          fection of  ears.

C. General  instructions:
     1. Always wash your  hands  before  and after
          cleansing  a  mouth.
     2. Use fresh solution and clean sponges for each
          cleansing.
     3. Never  dip a sponge in the  mouth  solution  a
          second time.
     4. Do not injure the  mucous membrane lining the
          mouth.

D. Articles necessary:
     1. Tray with:
          a.  Covered glass  containing  solution and
              sponges.
          b.  Glass with  applicators  and tongue  de-
             pressors.
          c.  Small basin and glass of fresh water.
          d. Towel and paper bag.
     2. Tooth  paste and  brush, glass of fresh  water
          and a small basin.

E. Method:
     1. If condition permits, patient may care for his
          own mouth by using the tooth brush.
     2. For bed patient,  place towel under patient's
          chin.
     3. Cleanse teeth, roof, sides of mouth and tongue,
          changing sponges as frequently as necessary.
     4. When possible, allow the  patient to rinse the
          mouth with fresh water. 
I24
NURSING TECHNIC
     5.  All waste to be placed in the paper bag.
     6.  When patient refuses to open teeth, a tongue
         depressor or handle of spoon,  covered with
         gauze, may be  used to pry  the mouth open,
         leaving the  instrument  between  the  teeth
         while cleansing the mouth.
F. Solutions used:
     1.  For general use :
         a.  Listerine and water, one  part to three.
         b. Boric acid,  glycerine  and  lemon  juice,
              equal parts.
         c.  Dobell's solution, 50 per cent.
         d. Boric solution, 3 per cent.
         c.  Normal saline.
         /.  Weak soda bicarbonate solution.
     2.  For a neglected mouth :
         a.  Peroxide of  hydrogen,  50 per cent.  Rinse
              mouth thoroughly. Do not use too  often.
         b. Apply  lemon  juice and  glycerine,  equal
              parts, and leave for ten minutes. Cleanse
              thoroughly.
         c.  Mix glycerine and peroxide of hydrogen,
              two drams of each, and add soda  bicar-
              bonate gr. v.  Apply to  tongue and
              mouth, leave for  ten minutes and then
              cleanse with any  good  mouth wash.
     3.  For dry mouth :
         a.  Albolene and boric acid, equal parts,  mixed
              with a little  lemon juice and  apply.
         b. Irrigate with  normal  salt  or weak soda
              bicarbonate solution. 
CARE OF HAIR
, 125
     4.  For dry tongue with sordes:
          a. Apply lanolin, vaseline,  or  lanolin  and
              vaseline,  equal  parts,  or other simple
              ointment, and leave for 20 minutes.
          b. Cleanse mouth and teeth with mouth wash.
          c. Leave lanolin  on  lips  and  tongue, if
              necessary.
G. Record exact  condition of mouth, when special
      cleansing is necessary.

                  CARE OF HAIR
A. Object:
     1.  Comfort.
     2.  Cleanliness.
     3.  Tidiness.
B. General instructions:
     1.  Examine for pediculi  or nits.
     2.  Avoid pulling.
     3.  Always  wash and carbolize comb after use on
          each patient.
C. Ccmbing:
     1.  Time: morning and evening, if  possible.
     2.  Articles necessary:
          a. Towel; combs, fine  and coarse,
     3.  Method: '
          a. Protect pillow  and upper  part of covers
              with towel.
          b. If possible, part  hair in middle  for  two
              braids.
          c. If tangled:
              Wet with alcohol, 50 per cent.
              Separate into small sections and comb, 
126
NURSING TECHNIC
                beginning at the ends.  Grasp the sec-
                tion being combed, with the left hand
                and comb  gently.
         d. Braid in any way comfortable to patient
              and fasten ends.
D. Bed shampoo:
     i.  Articles necessary:
         a. Blanket.
         b. Rubber sheet or Kelly pad.
         c. Four towels, comb.
         d. Small rubber sheet folded  inside of towel.
         e. Bottle of soap solution.
         /. Pail for drainage.
         g. Two pitchers of water; one with 105 de-
              grees F.,  other  90 degrees F.
     2.  Method:
         a. Remove all but one small  pillow, placing
              rubber sheet  and towel under head.
         b. Place blanket over patient, turning covers
              over foot of  bed.
         c. Turn patient on  side  with back towards
              nurse.
         d. Have head  of patient well  to edge of bed,
              hips in centre.
         e. Protect bed with  large rubber sheet, roll-
              ing sides to form a drainage pad, or use
              Kelly pad and cover with towel.
         /. Protect eyes with towel.
         g. Make lather with soap solution, wash and
              rinse thoroughly.
         h. Lather,  wash   and rinse  thoroughly a 
CARE OF HAIR
127
             second  or third  time  as necessary  to
             clean.
         i. Use the warmer water at first and then
             the cooler water.
         ;'. Squeeze  water from hair,  cover  with
             towel, remove Kelly pad or large rubber
             sheet and place  in  pail.
         k.  Fan and rub until dry.  Comb.
E. Tub shampoo:
     1. Articles necessary:
         c. Towels, soap solution and comb in bath-
             room.
     2. Method:
         a. Wrap towel about neck and shoulders and
             have patient protect eyes with towel.
         b. Let patient sit with head resting over edge
             of tub.
         c. Shampoo as in bed.
F. Pediculi on  head:
     1. Articles necessary: same as for shampoo, Tr.
         Quassia or Tr. Larkspur.
     2. Method:
         a. If pediculi not abundant, shampoo first.
         b.  If  pediculi abundant, wet  scalp  and hair
             with Tr. Quassia or Tr. Larkspur.
         c. Apply towel or triangular bandage and
             allow to remain  8 or 10 hours.
         d.  Shampoo.
         e. Repeat treatment,  if  necessary.
         /. Record hour of  treatment and  kind of
             tincture used. 
128
NURSING TECHNIC
                 CARE OF NAILS

Clean  with nail-file daily.
Scrub with brush, warm water and soap.   Clean with
  nail-file.
If very dirty,  after scrubbing, peroxide of hydrogen
       and an orange stick are effective.
Cut finger nails, rounding at top.
Cut toe nails, square across top.

                  CARE OF BACK
A.  Time:
     i. At time of bath, if bath is given.
     2. With morning care and evening care.
     3. After each involuntary defecation  and urina-
          tion.
     4. When the skin of back is in poor condition.
B.  Object:
     1. Comfort of patient.
     2. Prevention of bed-sores.
     3. Cleanliness.
     4. Stimulation  of the circulation of the blood in
          the skin.
     5. Evaporation of moisture.
C. General instructions:
     1. When  rubbing the  back,  avoid jarring  the
          body.  Steady the patient  with the free hand.
     2. Rub with long, even strokes and with the palm
          of the hand.  Never wear rings.
     3. Never allow the alcohol or other solution  to
          drip on the skin. 
CARE OF BACK
129
D. Articles necessary for evening care:
     1.  Blanket.
     2.  Whisk-broom and paper bag.
     3.  Towel, washcloth,  soap.
     4.  Basin of water.
     5.  Castor oil.
     6.  Alcohol,  50 per cent., warmed  by placing the
         bottle in hot water.
     7.  Powder.

E. Method:
     1.  Turn patient on one side.
     2.  Place blanket over  patient, turn covers down
         half-way and then fold over foot of bed.
     3.  Brush draw sheet free from crumbs, straighten
         and tighten both  lower  and draw sheets.
     4.  Turn patient  on  opposite  side,   brush and
         smooth bedclothes as  on opposite side  of
         bed.
     5.  Place towel close to back for protection of bed.
     6.  Wash and dry back.
     7.  Rub  back with alcohol until dry.
     8.  When  a  definite reddened area is  noted, in-
              dicating undue pressure, moisture or lack
              of care:
         a. Change position of patient.
         b. Relieve pressure by the use of air or water
              mattress, air cushions, pillows or cotton
              rings.
         c. Avoid rubbing  the tender area.   Alcohol
              may be dabbled on the area  and the sur-
              rounding skin may be rubbed with alco- 
130
NURSING TECHNIC
              hoi, always rubbing away from the edges
              of the  reddened area.  Powder.

          PRESSURE-SORES (DECUBITA)
A.  Causes:
      I. Predisposing:
          a. Lowered vitality.
          b. Continued  high fever.
          c. Impaired circulation.
          d. Extreme emaciation.
     2. Immediate:
          a. Moisture.
          b. Uncleanliness.
          c. Wrinkles and crumbs.
          d. Pressure, due to patient having  been  left
              in one  position for too long a time.
B. Prevention:
     i. Protect all  bony  prominences  by  relieving
          pressure.
     2. Keep bed dry, clean, and free from wrinkles.
     3. Change position of  patient frequently, when-
          ever possible.
     4. Give special care to back.
C. Treatment:
     1. Never  fail  to  report  reddened  spots  and
          abrasions to head-nurse at once.
     2. Record  all   pressure-sores,  with time  and
         method of  dressing.
     3. For redness and slight abrasions of skin:
         a.  Wash with  soap and tepid or room-tem- 
PRESSURE-SORES
131
              perature water and dry by patting and
              not by rubbing towel on skin.
         b. Apply castor oil, Tr. Benzoin Compound,
              or powder.
     4.  For deep pressure sores:
         a. Relieve  pressure.
         b. Cleanse with irrigations.
         c. Hot boric acid dressings.
         d. Direct exposure to the air.
         c. Special orders by attending physician.
D. Medications which are often ordered to be used:
     Irrigations:
       a.  Peroxide of hydrogen.
       b.  Boric acid.
       c.  Normal salt.
       d.  Iodine.
       c.  Permanganate of potassium.
     Powders:
       a.  Talcum.
       b.  Boric acid.
       c.  Stearate of zinc.
       d.  Bismuth.
       e.  Lycopodium.
     Drugs:
       a.  Balsam of Peru.
       b.  Castor oil.
       c.  Beef peptonoids.
       d.  Zinc oxide ointment.
       e.  Bismuth subnitrate and castor oil.
       f.  Tr.  myrrh, 50  per cent.
       g.  Tr.  benzoin compound. 
132
NURSING TECHNIC
      APPLICATION OF EXTERNAL HEAT
A. Object:
     i.  To supply  heat  to  the  body when vitality is
          low or after exposure to cold.
     2.  To relieve pain.
     3.  To equalize the  circulation of the blood.
     4.  To provide comfort to the patient.
B. General instructions:
     1.  See that whatever  container is used does not
          leak.
     2.  Have stopper attached  to container with tape
          or string.
     3.  Never use boiling water or extreme heat.
     4.  To burn a patient by having the containers too
          hot, improperly placed or leaky, is criminal.
     5.  Do not leave heat appliances in the bed of an
          unconscious or delirious patient.  Use heated
          blanket instead.
     6.  In case a patient has  been burned, report  to
          the  head-nurse at once.
C. Method:
     1.  Fill  cans  and bags one-half  full of water,
          heated not  more than 115 degrees F.
     2.  Express the air  from a rubber bag by placing
          it against the side  of a solid surface, pressing
          the upper half until the water comes to  the
          neck.  Put  in  stopper.
     3.  Cover with a flannel  cover, enclosing top of bag.
     4.  Place the  top of bag or  can  away  from  the
          patient. 
APPLICATION OF EXTERNAL COLD
     5.  Do not place the container between the arms
         and  sides of body  or  between the legs  or
         under the back or opposite joints.
D. Care of bags:
     1.  Remove cover and empty.
     2.  Hang  them with the  open end downward  to
         dry.
     3.  See " Care of Rubber Goods."

      APPLICATION OF EXTERNAL COLD
A. Object:
     1.  To cause local contraction of superficial blood-
         vessels.
     2.  To arrest suppuration.
     3.  To equalize the circulation of the blood.
     4.  To relieve congestion and pain.
     5.  To afford comfort to the patient.
     6.  To stop hemorrhage.
B. Types:
     1.  Compresses.
     2.  Ice bags.
     3.  Ice caps.
         a. Helmet shaped, for head.
         b. Long and narrow, for head  and neck.
         c. Round  and  oval for other parts of body.
     4.  Ice coil.
C. General instructions:
     1.  Keep all applications cold.
     2.  Cover rubber articles with  thin  muslin  or
        gauze. 
H4
NURSING TECHNIC
     3.  Do not allow ice to stand in water.  Drain off
         the water.
     4.  Protect  ice  from the  air,  to  avoid  undue
         melting.
     5.  Keep applications  in their  proper position so
         as to avoid irritation of the patient.
     6.  Support ice bags or caps so that they will not
         cause pressure on sensitive parts.
D. Compresses:
     1.  Articles necessary:
         a. Small  rubber sheet.
         b. Towel.
         c. Two or more pieces of muslin or gauze,
              with the ragged edges turned in, so as
              to make  the required size  to cover the
             place to  which the  compress is  to be
             applied.
         d. Piece of ice placed in a colander and cov-
              ered  with  flannel.   Place  colander in
             basin.
     2.  Method:
         a. Protect pillow or bed  with rubber  sheet,
             covered with towel.
         b. Moisten the compresses.
         c.  Place on ice to cool.
         d. Keep  at least one  compress on the  ice
             while others are being used.
         e.  Change frequently.
         /.  When the compress is long, as when placed
             on forehead, fold  the ends  of compress
             upward and under, to avoid water drip-
             ping  on ears or bed. 
        APPLICATION OF EXTERNAL COLD      135

E. Ice bags and caps:
     1.  Articles necessary:
          a. Ice bag and cover.
          b. Stout bag in which to crush ice.  Wooden
              mallet.
          c. Colander, tablespoon.
     2.  Method:
          a. Crush ice to uniform size of hickory nut.
          b. Place  in colander  and pour just enough
              water over it to remove the sharp edges.
          c. Fill bag half full, using the spoon.
          d. Expel air and secure top to avoid leakage.
          e. Tie in a square of gauze, bringing diagonal
              corners together.
          /. Apply.   If ordered over the heart and the
              patient is in a sitting position,  place the
              bag in a sling and pin it to the gown.
F. Ice coil:
      1. Articles necessary:
          a. Ice coil.
          b. Funnel.
          c. Gauze.
          d. Four-tailed bandage.
          e. Pail of ice  water, containing ice.
          /. Small pitcher.
          g. Empty pail.
      2. General instructions:
          a. Keep  funnel covered  with gauze to pre-
              vent the dirt from the melting ice en-
              tering the tubing.
          b. If  tubing becomes clogged, cleanse with
              soda solution. 
136
NURSING TECHNIC
          c. Keep ice in pail.
     3. Method:
          a. Place  pail of ice water on small stand,
              one  and  one-half  foot  higher  than
              patient.
          b. Cover with sheet to exclude air and  to
              look neat.
          c. Place empty pail on floor on opposite side
              of bed.
          d. Place  ice  coil  in desired position, securing
              with four-tailed bandage.
          e. Attach funnel to one end of tubing and
              place in pail  of ice-water.  Put  other
              end  in empty pail.
          /. To start siphonage,  compress rubber tub-
              ing one foot  below funnel,  fill funnel
              with water  and  lower it  quickly into
              pail.   Release pressure before any air
              can be admitted into funnel.
          g. If tubing seems to be  clogged, squeeze
              coil several  times or pinch the tubing
              on the opposite side of the bed.
          h. The flow  can  be> regulated by  loosely
              knotting the tubing or compressing  it
              by a  string, hemostats, etc.

               FEEDING PATIENTS
A. General instructions:
      1.  Choose the kind of diet which meets the needs
           of  the patient.
      2.  Follow the doctor's prescription  for food. 
FEEDING PATIENTS
»37
 3.  Consider the likes of the patient, in  serving
     and seasoning.
 4.  Select food  according to  health, age and to
     meet other needs of patient.
 5.  Select food principles and not stimulants.
 6.  Select food known to be easily digested.
 7.  Do not give too many varieties at one time.
 8.  Serve food only when properly cooked, never
     greasy, under-done or over-done.
 9.  Do not ask the patient to eat just at medicine
     time or when a treatment is being given.
10.  Keep the patient in a cheerful frame of mind.
11.  Use diplomacy rather than force in getting a
     patient to take food.
12.  Before  serving a  tray,  remove  medicine
     glasses, emesis basins,  etc.,  from the bed-
     side table and place the tray in  a convenient
     position for the patient to reach.
13.  If the  patient is sleeping, avoid awakening
     for food unless it is essential.
14.  See that the patient is in a comfortable posi-
     tion,  hands and  face having been  washed
     before  being served.
15.  When preparing and serving a tray, the nurse
     should see that she  is immaculate.
16.  When  feeding  a patient, do  not drop par-
     ticles of food  in transit.
17.  Encourage the  patient to  masticate the food
     well.
18.  Do not  hurry the patient.
19.  Do  not  serve the dishes too well filled; a
     second serving is preferable. 
NURSING TECHNIC
20. Serve  food  to  very sick  patients often and
      in small quantities.   This excites the  appe-
      tite  and digestion.
21. Serve food promptly.
22. Have dishes clean, whole and properly placed
      on a  tray  which has been made to look
      attractive.
23. Serve hot foods hot and on hot dishes.
24. Serve cold foods cold and on cold dishes.

 Feeding  patients when in a  reclining position:
1. Place one corner of the napkin under the chin
    and protect the gown and sheet.  Dry mouth
    with  napkin, as necessary.
2. In giving liquids, pour a small quantity into a
    glass, raise  the head slightly by slipping the
    arm and hand under the pillow.  If the head
    is raised too far forward,  it makes it difficult
    for the patient to swallow.
3. Drinking  tubes:  ideal  drinking glasses are
    preferable to  lifting  the head  unless the
    patient is too  weak to draw  fluid through
    a tube.  Always  clean a tube, at once,  after
    its use.
4. Never use a glass tube  in  feeding a delirious
    patient.  A dessert spoon  may  be used in
    feeding a delirious or unconscious patient.
    Pass the spoon back in the mouth, pressing
    the tongue gently down with  the spoon and
    the food will generally be swallowed. Carry
    but a  small amount of  food in the spoon and
    do not  feed too  fast. 
CARE OF SURGICAL CASES
139
CARE OF SURGICAL CASES BEFORE AND AFTER
                   OPERATION
A. Woman's Ward:
     1. General instructions:
         a. In all cases, give full bath, braid hair in
             two braids.
         b. For mastoid cases, shave hair two inches
             around  area  where  incision  is to  be
             made.
         c. For breast cases, shave from collar bone to
             line of diaphragm, including axilla and
             arm, which is shaved to the elbow.
         d. For all vaginal cases, shave vulva and two
             inches  beyond the line  of  pubic hair.
             Give iodine douche, using 2 drams tinc-
             ture of iodine to 2 quarts of water,  105
             degrees F.
         e. For abdominal cases, shave abdomen and
             vulva.
         /. For  special disinfection of the  skin and
              dressings to be used,  comply  with  the
             orders  of the staff doctors.
     2. Other preparations before operation:
         a. Soft diet, the evening before operation.
         b. Castor oil to be given 10 hours before time
             fixed for operation.
         c. Omit meal just preceding.
         d. Water may be given up to within one hour
             fixed for operation.
         e. An enema of  2  quarts of  soap-suds into
             which  has been stirred  30  minims  of 
140
NURSING TECHNIC
        turpentine.  This is to be given 4 hours
        preceding the hour fixed  for the opera-
        tion and to be given in the knee-chest
        position, when possible.
    f.  The nurse is responsible for the  patient
        being catheterized  when ordered, or to
        see that the patient voids urine within
        one-half hour before  the time sent to
        the operating room.
    g.  Perineal  suit, consisting  of leggings and
        cap, is to be put on just before leaving
        the ward.
    h.  False teeth,  jewelry  and  hairpins are re-
        moved.  Special care is to be  taken of
        the teeth and jewelry.
    i.  Nurse records the time sent to the operat-
        ing room and the hypodermic  as given,
        when ordered.
    ;'.  When the patient is wanted in the operat-
        ing  room, the nurse  accompanies  her
        and takes  the record  sheet.
3.  After care, in Recovery Department:
    a.  When  ordered,  normal saline,  one  pint,
        with  or  without spiritus  frumenti,  one
        ounce, per rectum.
    b.  Take  pulse  and  respiration  every  10
        minutes during first hour.  Take pulse
        and respiration every 20  minutes  dur-
        ing  next  3  hours.   Take  pulse  and
        respiration  every  4 hours for next 36
        hours.
    c.  Take temperature  every  four hours, per 
CARE OF SURGICAL CASES
141
             rectum, if no saline is given.  If saline
             is given,  take temperature  every four
             hours, per orem, if patient is conscious.
             If  patient  is  unconscious  and  saline
             given, take temperature per axilla.
         d. Day of operation, sips of hot water may
             be given, or chipped ice.  A gradual in-
             crease of  hot  water, cold water, weak
             tea and albumen water may  be given, in
             the following  12 hours.  If not nause-
             ated, milk,  soups  and  custards may
             then  be  added, providing  the  patient
             is not a  laparotomy.   Soft diet in 24
             hours.
         e. Laparotomy cases may have the liquids as
             above for the  first 12 hours, slightly in-
             creased liquids for the first 72 hours un-
             less otherwise ordered by the attending
             physician.
         /. In case the patient is unable to void urine
             within  8 hours, catheterize  and every
             8 or 12 hours after, if ordered by  the
             attending   physician.    Measure  and
             record   urine  for  48  hours  after
             operation.
         g. If  wet or dry dressings need to be applied,
             use sterile  forceps.
         h. After removal  of  vaginal  packing, give
             sterile douche, lysol, l/2 per cent.
B. Men's Ward:
     Junior interne prepares  male patients.   Other
       orders the same. 
142
NURSING TECHNIC
                  SYMPTOMS*
The ability to recognize symptoms depends upon:
  The intelligence of the observer.
  Practice.
The symptoms outlined are given to develop the power
  of observation on the part of the student.   Symp-
  toms are recorded to  aid the physician in making a
  diagnosis  or  to detect the malingerer.
Symptoms are:
  Objective, namely, evident  to  the  senses of  the
    observer.
  Subjective,  namely,  felt or  known only  by  the
    patient.
Objective Symptoms:
  A.  General:
       i. Gait.
       2. Consciousness or coma,  complete or partial.
     * 3. Apparent  degree of  illness.
     * 4. Obese, emaciated, and to what degree.
       5. Mental condition.
       6. General appearance of face, noting:
            a. Swelling.
            b. Puffiness under or about eyes.
     *      c. Paralysis.
     *      d.  Apparent pain.
            e. Apparent weakness.
            /. Muscular contractions.
            g. Risus sardonicus.
     *      h.  Sunken temples.
  * Symptoms which are starred are not to be recorded on
the history  sheets. 
SYMPTOMS
H3
  *      i. Relaxed jaw.
     7. Tremors:
         a.  Fine, as in exophthalmic goitre.
  *      b.  Coarse, as in delirium tremens or paral-
             ysis agitans.
     8. Paralysis:
  *      a.  Flaccid type.
  *      b.  Spastic type.
     9. Lying with eyes  half closed or unevenly
         closed.
  * 10. Loss  of the  power  of  speech—aphasia
         (Gould).
B. Position of patient:
  *  1.  Sitting posture as in cardiac and respiratory
         diseases.
  *  2.  Dorsal recumbent with knees flexed as in
         peritonitis   and   following    abdominal
         sections.
     3.  Continuously lying on the affected side, as
         in pneumonia, pleurisy,  appendicitis.
     4.  Lying  on  abdomen,  suggesting  abdominal
         pain, colic.
     5.  Leg flexed on affected side  as in hip-joint
         disease and appendicitis.
   *  6. Continuously  slipping down in bed, as in
         typhoid fever and the terminal  stages of
         many diseases.
   *  7. Remaining too quiet, as in exhaustion.
     8. Head drawn backward, as in meningitis
     9. Oposthotonos, as  in  tetanus and strychnia
          poisoning. 
144
NURSING TECHNIC
   * 10. Head drawn to one side, as in wry neck—
          torticollis.
C.  Restlessness:
      i. Tossing to and fro—jactitation.
      2. Twitching condition of  muscles—subsultus
          tendinum.
      3. Picking at the  bed-clothes—carphologia.
      4. Muscular  twitchings, as  in the approach of
          convulsions.
   *  5. Startled movements, as  upon the approach
          of persons unexpectedly or sudden noises.
   *  6. Yawning.
D.  Mental conditions:
      1. Depressed.
      2. Apathetic.
      3. Anxious.
      4. Irritable.
      5. Excited.
      6. Wandering.
      7. Delirious:
          a. Low  and muttering.
          b. Noisy and screaming.
          c. Constant or occasional.
     8. Unconscious.
  *  9. Fearful.
  * 10. Cheerful.
E.  Appetite:
      1. Loss of—anorexia.
     2. Extensive  or perverted, as in gluttony.
     3. Thirst. 
SYMPTOMS
145
F. Sleep and insomnia:
     1. Sleep continuous and restful.
     2. Sleep disturbed  and restless.
     3. Night cry,  as  in  children  with hip-joint
         disease.
   *  4. Insomnia  is grave,  if long continued.
   *  5. Patient's thoughts during insomnia.
   *  6. Sleep and sepsis seldom go hand in hand.
G. Skin:
     1. Color:
         a. Yellow, jaundice.
         b. Pale.
         c. Flushed, general or hectic.
         d. Waxy.
         e. Cyanosed.
         f. Spotted.
         g. Soapy yellow,  suggesting cancer.
         h. Ashen grey as  of death.
   *      i. Bronzed.
     2. Dry and hot,  as in  fever.
     3. Moist and hot,  as  in fever.
     4. Moist and cold, as in shock.
     5. Cold  extremities  or cold portions of  the
        body.
     6. Erythema,  macules,  papules,  pustules,
         vesicles, crusts, scars,  umbilications,  ab-
         scesses,  abrasions,  ulcers, discolorations,
         desquamation,  swellings, edema,  wheals,
         appearance of palms,  appearance of soles
         of feet and between toes and fingers, scalp. 
146
NURSING TECHNIC
     7.  Sweating:
         a.  Extreme weakness, as noted when tem-
             perature falls.
         b.  Night sweats, as in tuberculosis.
         c.  High temperature with wet skin, which
             is an alarming symptom.
         d.  High temperature with dry skin, which
             is a less alarming symptom.
         e.  Head sweating, as in rachitis.
         /.  Joint sweating, as in arthritis.
  *      g.  Veins visible.
  *      h.  Arteries twigged, suggesting high blood-
             pressure.
     8.  Excessive sensitiveness of the skin—hyper-
         esthesia.
  *  9.  Baldness—alopecia.
H. Face:
     1.  Expression:
         a.  Anxious, as in  hemorrhage, shock and
             cardiac complications.
     2.  Pinched appearance about nose.
     3.  Pale area about the mouth.
  *  4.  Special appearance accompanying sepsis.
I. Eyes:
  *  1.  Sunken, as in tuberculosis.
     2.  Heavy, dark circles under eyes.
  *  3.  Prominent, as in exophthalmic goitre.
  *  4.  Secretion and  discharge of tears—lacrima-
         tion.
  *  5.  Inflamed lids.
     6.  Puffiness about eyes, indicating circulatory
         or toxic  conditions. 
SYMPTOMS
147
  *  7. Wandering or rolling of eye-ball; twitching
         of eye-ball or lids.
  *  8. Squinting (strabismus) or frowning, some-
         times seen in meningitis.
  *  9. Glazed appearance, as when patient is mori-
         bund.
     10. Color of sclera:  bloodshot, or yellow as in
         jaundice.
    11. Pupils even or uneven.
    12. Size of pupils.
    13. Pupils dilated, as when patient is in real pain
         or suffering from  mental disturbance or
         fright.
    14. Pupils  contracted, as  in  a bright  light or
         morphinism.
  * 15. Reflex action.
J. Mouth:
  *  1. Odor  of  breath.
     2. Sordes.
     3. Gums : swollen, bleeding, tender, blue line on
         border of teeth  as  in lead poisoning.
  *  4. Ecchymosis, seen along the line of gums, as
         in scurvy.
  *  5. Koplik's  spots on outer border of gums and
         inner border of  cheeks, indicating measles.
  *  6. Prominences, like shot, on roof of mouth, as
         in small-pox.
  *  7. Mucous patches.
     8. Corrosive patches, indicating certain poisons.
     9. Excessive salivation.
  * 10. Inflammation of the mouth—stomatitis.
    11. Sprue or thrush. 
148
NURSING TECHNIC
  * 12.  Noma—cancer.
K. Tongue:
     1.  Dry or moist.
  *  2.  Swollen, indented by teeth.
     3.  Coated: white, brown, yellow, sometimes
         nearly black.
     4.  Distribution of coating.
  *  5.  Strawberry tongue, as in scarlet fever.
     6.  Dry and coated, as in fevers.
  *  7.  Syphilitic ulceration or cancer.
L. Throat:
  *  1.  Laryngeal or pharyngeal inflammation.
  *  2.  Tonsils:   enlarged,   swellings,  abscesses,
          cheesy exudate, white or grey patches ex-
         tending over fauces.
  *  3.  Adenoids.
     4.  Hemorrhage,  following operations.
M.  Voice:
      1. Hoarseness, as with " cold."
   *  2. Thick, as with enlarged tonsils.
   *  3. " Nasal," as with growth in nasal passages.
   *  4. " Whiskey " voice.
   *  5. High-pitched, as in hysteria.
     6. Loss of voice—aphonia.
     7. Incoherent: may be due to:
          a. Dullness  of comprehension.
          b. Lack of interest.
          c. Slowness in response.
N.  Hands and feet:
      1. Extra or missing fingers or toes.
     2. Webbed fingers and toes. 
SYMPTOMS
149
  *  3. Finger ends clubbed,  as  in tuberculosis  or
         chronic heart disease.
  *  4. Joints clubbed, as in gout.
     5. Finger nails:
         a.  Skin underneath  cyanosed, as in heart
              disease.
  *      b.  Thickened  and ribbed,  as in tubercu-
              losis.
  *      c.  Thin, brittle and dry, as in cases  of
              lowered vitality.
O. Abdomen:
     1.  Swollen and distended, locally or generally.
  *  2.  Hollowed out, as in wasting diseases.
     3.  Distended  with  gas  or  air1—tympanites—
         (Dorland).
  *  4.  Dropsy of the  abdominal cavity—ascites—
         (Dorland).
     5.  Noise  made  by flatus in the bowel—bor-
         borygmus—(Dorland).
  *  6.  In tympanites, note the hollowed  or inflated
         portion of the trunk at the lower end of
         the  breast bone—scrobiculus cordis.
  *  7. Boat-shaped—scaphoid—as in meningitis.
P. Muscles:
     1. Incoordination.
     2. Twitching, spasm.
     3. Stiffness.
     4. Loss  of  control.
     5. Muscular pain—myalgia.
     6. Rigidity.
     7. Contractions.
     8. Diminution of size—atrophy. 
150              NURSING TECHNIC
Q. Bones:
     i. Joints:
         a.  Grating sound, upon moving.
         b.  Stiffness.
         c.  Pain accompanying motion.
         d.  Sweating of joint as in arthritis.
  *      e.  Abnormal growths at  ends of  long
             bones as at wrists and ankles.
         f.  Knee:
             Knock knee—genu valgum.
  *          Bow leg—genu varum.
             Backward bending—genu recurvatum,
               as in  locomotor ataxia.
  *  2. Club feet—talipes.
     3. Chest deformities  (Berry) :
  *      a.  Rachitic rosary.
  *      /;.  Harrison's groove.
  *      c.  Pigeon breast.
  *      d.  Funnel chest.
  *  4. Spine curvature  (Berry) :
         a.  Round back—kyphosis.
  *      b.  Hollow back—lordosis.
         c.  Lateral curvature—scoliosis.
     5. Asymmetrical development.
     6. Open anterior fontanel.
  *  7. Prominent forehead with square appearance.
  *  8. Delayed dentition.
R. Vomitus:
     1. Retching.
     2. Quiet and without effort.
     3. Strained or forcible.
     4. Projectile. 
SYMPTOMS
ISI
       5.  Relation to food ana medicine.
       6.  Contents:   undigested  food,  bile,  mucus;
           fecal matter,  stercoraceous; blood, coffee
           grounds.
       7.  Amount.

  S.  Sputum:
       1.  Quantity.
       2.  Odor.
       3.  Expectoration with or without cough.
       4.  White,glairy, viscid, green, purulent, mucoid,
           ropy, tenacious,  " prune-juice."
       5.  Containing blood, as in tonsillectomy or gas-
           tric ulcer; frothy and pink, as in pulmonary
           hemorrhage.
       6.  Dark green,  characteristic of  gangrene  of
           lung; copious, purulent and with foul odor.
       7.  Characteristic of tuberculosis; odor, white,
           flecked with yellow or tinged with blood,
           viscid.

T. Feces:
       1.  Hard, dry, encrusted, bullet-formed.
       2.  Semi-formed or soft stool.
       3.  Liquid, as in diarrhea; "pea-soup," or "rice-
           water," as in poisonings.
       4.  Odor: characteristic,  as in  typhoid,  carci-
           noma, abscess in bowel or rectum.
       5.  Frequency: due to  over-eating,  water,  at-
           mospheric changes, mental  shock, drugs.
       6.  White or clay color, indicating lack of bile.
       7. Red or black, due to drugs.
       8. Tarry stool, suggesting presence of  blood. 
'52
NURSING TECHNIC
     9. Blood-tinged, as in typhoid, dysentery,  or
         bleeding hemorrhoids.
    10. Mucus, as in colitis, giving a shiny and slimy
         appearance.
    11. Parasitic: may  contain pin, round  or tape
         worms.
    12. Pain with defecation—tenesmus.
    13. Flatus.
    14. Involuntary stools.
    15. Undigested food, Lienteric stool.
U. Urine:
     1. Color:
         a.  Normal: straw, amber, yellow.
         b.  Abnormal:
             Dark red, dark brown, blood tinged.
             Dark, in fever; light, in hysteria.
             Yellowish-brown, presence of  bile.
             Drug reactions: bright red—logwood;
               bright  orange—senna  or rhubarb;
               olive green—iodoform,  salol, guaia-
               col, carbolic.
    2. Odor:
         a.  Normal, characteristic.
         b.  Abnormal:
             Odor of decomposition, as in  chronic
               cystitis.
             Sweet odor or sugary, as in diabetes.
             Drugs and various foods give  a  char-
               acteristic odor, as  asparagus.
    3. Quantity:
         a.  Normal: healthy  adult, 40  to 50  fluid-
             ounces in 24 hours; healthy child, 2 to 
SYMPTOMS
153
              14 years, 15 to 40  fluidounces in 24
              hours.
         b. Increased: in diabetes, copious drinking
              of fluids, drugs, excitement.
         c  Decreased—anuria: in kidney complica-
              tions, after diaphoresis, diarrhea and
              hemorrhage.
     4.  Sediment:
         a. Finely powdered  sediment  indicating
              abnormal constituents.
         b. Gravel.
         c. Calculi.
         d. Pus.
         e. Brick-dust deposit in diaper of infant.
     5.  Note:
         a. Suppression.
         b. Retention.
         c. Retention with overflow.
         d. Incontinence.
         e. Involuntary.
V. Temperature:
     1.  Degree  varies with  the disease, rising or
              falling  gradually or suddenly.
         a. Continuous:  remains high  with slight
              variations, as in pneumonia.
         b. Remittent: remains  above normal, but
              with considerable difference  between
              highest  and  lowest  points,  as  in
              typhoid.
         c. Intermittent: alternately  rises  to  high
              point and  falls to normal and below,
              as in malaria. 
154              NURSING TECHNIC
       2. Returns to normal:
           a. By crisis: a direct fall from a high tem-
                perature  to  normal  or  subnormal
                within a few hours, accompanied by a
                decrease in pulse and  in  respiration
                rates, as in pneumonia.
           b. By  lysis: gradual  return  from a high
                temperature to normal,  taking several
                days, as in typhoid.

W. Pulse:   An  intermittent  distention  of  the
        arterial walls which acts in accordance with
        each heart beat:
       I.  Characteristics  to  consider  when taking
                pulse:
           a. Rate: slow, normal or subnormal; quick,
                ioo to 120;  rapid,  120 to 140; run-
                ning,  140 and above; galloping;  flick-
                ering; water-hammer.
           b. Force: strength of beat, as weak, strong,
                sluggish, forcible.
           c. Volume: amount of blood which passes
                through the artery,  depending partly
                upon  the extensibility of the wall,  as
                large, small, wiry,  thready,  cordy.
           d. Rhythm : regular or irregular in rhythm,
                force or volume, intermittent or  di-
                crotic, regularly intermittent.
           e. Compressibility, whether  or  not it may
                be  obliterated, temporarily,  by  pres-
                sure.
           f. Tension: low,  pulse full, but  soft and 
                  SYMPTOMS                  155

              easily compressed; high, pulse full be-
              tween  beats  and  resistant  to finger
              pressure.
X. Respiration:
     1.  Characteristics to be considered:
         a. Rapid or slow.
         b. Shallow  or deep  (thoracic or  abdom-
              inal).
         c. Regular  or irregular.
         d. Accompanied  with  pain,  constant or
              spasmodic.
         e. Mouth breathing.
         f. Inability  to breathe except in an  upright
              position.
         g. Difficult  breathing—'dyspnea,   orthop-
              nea.
     2.  Sound accompanying respiration:
         a. Wheezing, as in bronchitis  and asthma.
         b. Sighing,  as in air-hunger, shock,  col-
              lapse or hemorrhage.
         c. Grunting, as in pneumonia.
         d. Stertorous, as in pneumonia.
         e. Cheynes-Stokes,  as  in  uremia   and
              paralysis.
         /. Coughing, without effort or rasping.
         g. Hiccoughing, serious, if long continued.
         h. Sneezing.
         i.  Panting.
         /'. Snoring, as in alcoholism and nephritis.
         k. Biot's, as in meningitis.
         /.  Mucus rattle in throat. 
156
NURSING TECHNIC
Subjective symptoms:
  A.  General:
       i. Hunger.
       2. Thirst.
       3. General malaise,  or tiredness.
       4. Exhaustion.
       5. Nervousness.
       6. Nausea.
       7. Dizziness.
       8. Sense of  falling.
       9. Numbness.
      10. Tenderness.
      11. Extremities "asleep."
      12. Palpitation of the heart.
      13. Prickling  and tingling of the throat, etc.
      14. Dryness of throat.
      15. Cramps in extremities.
      16. Itching.
  B.  Pain:
       1. Locality, as headache.
       2. Time (as nocturnal bone-pain of syphilis).
       3. Duration.
       4. Relieved or increased by the application of
            heat   or  cold,  change  of  position,  or
            pressure.
       5. Nature:
            a.  Slight.
            b.  Severe.
            c.  Acute.
            d.  Dull.
            e.  Sharp. 
SYMPTOMS
157
         f. Darting.
         g. Burning.
         h. Throbbing.
         i. Steady.
         ;*. Spasmodic.
         k. Stinging.
C. Special senses:
     1.  Eyes:
         a. Sensitiveness to light—photophobia.
         b. Disorder, as seeing " spots," etc.
         c. Loss of vision, due to disease, age, brain
              lesions.
     2.  Nose:
         a. Coryza.
         b. Loss of smell, as in nasal infections.
     3.  Ears:
         a. Loss of hearing, as in  infections, use of
              quinine.
         b. Ringing and buzzing in ears.
D. Chills or rigors:
     Record time,  duration and  severity of seizure.
     Take and record temperature at beginning of
       chill and every half-hour during chill and for
       two hours after chill. 
CHAPTER V
             MEDICINAL TOPICS

         RULES FOR GIVING MEDICINE
Medicine Cabinet Must Be Kept Locked When
                   Not In  Use
 i .  Never talk to anyone or allow anyone to talk to you
     while giving medicine.
 2.  Keep your mind on the work in which you  are
     engaged.
 3.  Remember that there is  an element of danger in
     every drop of medicine.
 4.  Read  your orders carefully and  be  sure  you
     understand them.
 5.  Never give a drug in the dark or in dim light.
 6.  Never give or use a drug of any kind that is not
     plainly  labelled.
 7.  Never  give  a  pill,  capsule  or tablet  that  has
     accidentally been  spilled or  escaped  from  its
     container.
 8.  Never give a medicine which you have a shadow
     of doubt about; find out about it  or omit.
 9.  Verbal orders by doctors to student nurses are not
     allowable.
10.  Shake liquid medicines before pouring them out.
11.  Regular medicine glasses and droppers should be
     used  to measure  liquid  medicine.
12.  Keep separate medicine glasses for  oil  and strong-
     smelling J----
     158 
RULES FOR GIVING  MEDICINE
13.  Never allow  one patienlt to  carry medicine  to
     another.
14.  Always record medicine,  but never record  a dose
     as given until patient has actually taken it.
15.  When  giving  liquid  medicines to an  unconscious
     patient, drop it far back on the tongue, using a
     dessert spoon.
16.  Never give a delirious or unconscious patient a pill
     or  powder placed  on the  tongue.   Give after
     dissolving it in water.
17.  Dilute fluid medicine as a rule.
18.  Some cough remedies should be given undiluted,
     while other remedies,  as  iron,  arsenic,   dilute
     acids, and digitalis  should be well diluted.  Never
     dilute more than necessary.
19.  Give acids and medicines containing iron through
     a glass tube.
20.  Never mix or give  at the same time medicines
     which change color or  form a precipitate when
     put together, nor put tablets in liquid medicines.
21.  Make a dose of medicine as palatable as possible.
22.  In diluting a medicine use hot or ice cold  water.
23.  A disagreeable flavor may be made  less noticeable
     if the patient holds the nostrils closed while tak-
     ing  it and  then breathes deeply several  times
     while the nostrils are still closed.
24.  Castor oil,  and other oils except croton oil, may be
     given in lemon juice, milk, coffee, brandy,  sherry
     and whiskey.
25.  Oleum Tiglii  (croton oil) may be given  on sugar
     or in prepared olive oil,  proportion of 1 to 7.
26.  Powders may  be  given in syrup, glycerine, jam or 
i6o
NURSING TECHNIC
     honey, or placed far back on the tongue and swal-
     lowed with a drink of water.
27. To test whether pills or triturate tablets are fresh,
     pulverize them.  If not readily  pulverized, the
     drug is not fresh.
28. Keep all poisons on a shelf in the cabinet, locked, if
     possible.
29. Tablets and pills, if ordered, are given dissolved to
     typhoid patients.
30. Sleep-producing medicines:
     Prior to fulfilling these orders, have the patient
       ready for sleep;  bed comfortable, treatment
       given,  temperature  taken,  visitors excluded,
       ventilation as perfect as possible.  After the
       medicine  is given, add  the  finishing  touches,
       give a drink of water, adjust light.  Keep room
       quiet.
31. The five rights  should be learned and closely
     adhered to by every nurse, as a student and as a
     graduate, when giving medicines;  namely:
       The right medicine, in the
            right amount,  in  the
            right way, at the
            right time, to the
            right patient,  and record.

                  INUNCTIONS
A. Object:
     1. To administer a drug through  the skin.
B. General instructions:
     1. A large  surface of the body  is  rubbed well
         with warm oil when ordered for the patient 
SUPPOSITORIES
161
         whose condition is  poorly nourished.   No
         especial  precautions  other  than  ordinary
         cleanliness need to be  observed.
     2.  In giving mercurial inunction, never apply the
         ointment  to  the same spot  on consecutive
         days.  Care  of  the  nurse  in handling these
         patients is extremely necessary.
C. Method:
     i.  Select the less  hairy portion  of the body, as in
         the space  in front of both elbows, and on the
         surfaces of both thighs.
     2.  Cleanse the portion of skin to which the inunc-
         tion is to  be applied.
     3.  Apply  the  inunction  and rub it  into the skin
         thoroughly.
     4.  When mercuric ointment is ordered, it may be
         rubbed in by the use of the-flat portion of a
         glass stopple  or by a rubber-gloved hand.

                 SUPPOSITORIES
A. Object:
     1.  To administer a drug through the rectum.
B. Method:
     1.  Have patient lie on left side  and  do not expose
         the body.
     2.  Lubricate the index finger with oil or vaseline.
         The warmth  of  the fingers and rectum melts
         the surface of the  suppository.
     3.  Pass  it into the  rectum beyond the  internal
         sphincter muscle.
     11 
162
NURSING TECHNIC
     4.  In case  of infectious  diseases, always protect
          the finger with a finger cot.
     5.  If the odor clings to the hand wash the hand
          with soap and water, then  rub on dry mus-
          tard while hand is still wet,  then wash again.

              COUNTER-IRRITANTS
A. Object:
     1.  To dilate the blood-vessels of  the skm.
     2.  To relieve inflammation and pain.
B. Types:
     1.  Rubefacients cause redness of skin:
          a. Dry heat.
          b. Moist heat:
              Fomentations or stupes.
              Poultices.
              Baths.
          c. Friction with  hand  alone,  and  with  lini-
              ments.
          d. Medication.
     2.  Vesicants cause blisters on skin :
          a. Medication.
          b. Heat.
C. Precautions:
     1.  Watch action  carefully, and in  case of un-
          toward results, report  at once to  the head-
          nurse.
     2.  When applications are made  of  turpentine or
          cantharides,  note  the  amount  and  color of
          urine and pain in voiding.
     3.  If skin seems sensitive or very red from  con- 
COUNTER-IRRITANTS
163
         tinued application, apply sweet oil or vaseline
         to the surface.
D. Method:
     1.  Dry heat:
         a. Apply to the affected area hot water bag
              with small amount of  very hot water—
              not boiling water.
         b. Remove when skin is well reddened.
     2.  Moist heat:
         a. Hot fomentations:
              Articles necessary:
                Three  pieces  of  thick,  soft flannel,
                  for stupe cloths,  twice  the size of
                  area to be covered.
                Piece of rubber sheeting one-half size
                  of flannel.
                Binder and safety pins.
                Blanket.
                Wringer.
                Two basins in  which to heat cloths.
              To abdomen:
                Prepare flannel from boiling water in
                  same way as for hot dressing, take
                  to  bedside in wringer and  basin.
                Place blanket   over  patient, folding
                  bedclothes  down  half-way;  turn
                  gown over chest.
                Place binder under back,  then  rubber
                  sheet near.
                Take  cloths  from  wringer,  shake
                  quickly, place on abdomen, cover
                  with rubber, turning in  the edges. 
NURSING TECHNIC
         Cover  with dry  flannel  and  pin
         binder  just tight enough to  hold
         cloths in place.
       Change hot  cloths every two  hours,
         unless otherwise ordered.
       Keep abdomen covered when replac-
         ing heated flannel.
       When treatment is stopped, leave dry
         flannel  over abdomen 4 to 6 hours.
    To breast:
       Cut a  hole  in  the centre of  stupe
         cloths to prevent nipple being cov-
         ered.
       Parchment  paper  is  better as  pro-
         tective  than rubber  sheeting.
b.  Turpentine stupes:
    To abdomen:
       Before applying hot cloths, apply solu-
         tion  of turpentine  and  olive oil
         (1-7) with applicators  to abdomen
         and cover with a piece of thin mus-
         lin; then  apply hot  fomentation.
         Solution of turpentine to be re-ap-
         plied every eight hours.
c.  Mustard plaster or sinapism:
    Articles  necessary:
       Mustard.
       Flour.
       Tepid water.
       Thin  muslin  cloth a little more  than
         twice the size ordered.
       Towel.
       Plaster board, or newspaper. 
COUNTER-IRRITANTS
165
Preparation:
  Take mustard 1 part, flour  3 to 6
    parts  for an  adult, or mustard 1
    part and flour 12 parts for  a child.
  Mix to a thin paste with tepid water.
  Have the  muslin ready, creased  in
    half, and about 1 to 2 inches on the
    four sides; place on plaster board
    or on a  newspaper and spread the
    paste  over  one-half of the  muslin
    as  outlined by creases.   Fold the
    other half over the paste with the
    edges of both sides folded  in.  In-
    sert the third  edge into  the sides
    already  folded,  thus  making all
    edges even  and holding the  plaster
    as put in the cloth.  If desired, the
    edges  may be  basted with  long
    stitches.
  Carry to the  patient  by placing  in a
    warm towel, or on a warm plate,  or
    in a warm  basin.
  Apply to  the skin  and  cover  with
    towel.
  Use binder to hold in place, if neces-
    sary.
  Leave 15 or 20 minutes or until the
    skin is well reddened; avoid blister-
    ing.
Method of removing:
  Wash skin with soap and warm water,
    and if  skin is too irritated, apply 
NURSING TECHNIC
         vaseline  or  oil  and  cover  with
         muslin.
      If the skin is very sensitive, add white
         of egg or sweet oil when mixing the
         plaster, to prevent blistering.
d. Flaxseed poultice:
    Articles necessary:
      Boiling water.
      Flaxseed meal.
      Muslin  double  the size  of  finished
         poultice, and allow for folding in at
         the sides.
      Piece of dry flannel.
      Binder and safety pins.
      Towel.
      Saucepan and large spoon  for prep-
         aration.
    Preparation:
      Add the flaxseed meal very slowly to
         the water boiling over a flame, stir-
         ring all of the time.  When mixture
         is thick  enough  to  fall in  a mass
         from  the spoon, remove  from fire
        and beat until light.
      Proceed as with mustard  plaster.
      Roll in flannel, cover with towel and
        take to bedside.
      Apply to  area slowly, as great  heat
        may thus be borne by the patient.
      Cover with flannel and hold in place
        with binder.
      Change  every  two hours. 
COUNTER-IRRITANTS
167
              To remove:
                Wash skin with soap and warm water
                  and dry by patting with cloth.
                Leave dry  flannel on the area  from
                  4 to 6 hours.
         e. Tincture of iodine:
              Articles necessary:
                Medicine glass with tincture of iodine.
                Applicators  with  cotton  or gauze on
                  end.
                Kidney basin to be used as a tray.
                Gauze.
                Alcohol, 95  per cent., or sweet oil.
              Method:
                Outline  the area  to be painted with
                  the swab moistened in the iodine.
                Paint the surface thus outlined with
                  tincture of iodine and allow it to
                  dry.
                Apply  second coat in same  way, if
                  ordered.
                Cover with gauze.
                If  irritation is too severe, wash area
                  with cotton  dipped in alcohol or
                  sweet oil.
E. Vesicants:
     1.  Cantharides plaster:
         a. Precautions:
              Use no larger piece of plaster  than or-
                dered, as too much cantharides may
                be absorbed and cause acute nephritis. 
NURSING TECHNIC
  Watch and measure urine for 24 hours
    after applying.
  Never apply plaster over broken skin.
  Never apply adhesive plaster  or tight
    bandages over cantharides plaster, as
    it may prevent blister  from forming.
Articles necessary:
  Basin with warm water and green soap.
  Alcohol, 50 per cent.
  Towel.
  Binder and safety pins.
  Plaster  one inch square, unless  other-
    wise ordered.
  Never apply without exact size and lo-
    cation  being  prescribed by physician.
Method of applying:
  If plaster is not perfectly  fresh, oil its
    surface before applying.
  Clean skin with  soap and water, fol-
    lowed by alcohol.
  Cut corners of plaster round, and apply.
  Use bandage to hold  in  place if neces-
    sary.
Method of removing:
  Leave on for 4 to 8 hours,  if ordered.
  If there is no blister in 8 hours, remove
    and apply flaxseed poultice, which will
    usually produce blister.
  Have a tray with:
    Scissors (sterile).
    Zinc oxide ointment.
    Gauze. 
HYPODERMIC INJECTIONS          169
               Adhesive.
             Remove plaster carefully, without tear-
               ing skin.
             Clip lower surface of blister.
             Press  serum  out  gently  with  cotton
               sponge.
             Take up serum with sponges.
             Apply  dressing of  zinc oxide, and  if
               ordered, strap with adhesive.

           HYPODERMIC  INJECTIONS
  Drugs for this use are put up in concentrated form
(tablets).  Dose  usually  J/2  to  }i  that ordered by
mouth.
A. Object:
     1.  To obtain prompt action of a drug, giving quick
         relief from unfavorable symptoms.
     2.  To administer a drug when the person is un-
         able to swallow.
     3.  To prevent irritation of the mucous membrane
         of the stomach or  rectum.
B. General directions:
      1. Give fresh drug only; if not  fresh, an abscess
           is liable to result.
      2. Always expel the air from the barrel.
      3. Have everything sterile.
      4. Never boil a drug in water.
      5. If two drugs are ordered, draw in first drug,
           expel air,  wash minim graduate with alco-
           hol and sterile water, measure second drug
           in glass and  draw  it in the barrel. 
170
NURSING TECHNIC
      6. If less than four minims of any drug is to be
          given, inject it into the deepest muscles.
      7. Give vertically  deep into  the  muscles: digi-
          talis, quinine,  bichloride of mercury, ergot,
          arsenic  compounds, owing to their irritat-
          ing nature.
      8. Always give digitalis well diluted.
      9. When giving hypodermics  at frequent  in-
          tervals,  inject  into the arms or legs, always
          rotating in the same order, giving only once
          in each place.
     10. Insert the needle in direction of the heart and
          in fleshy  parts of  body only,  as on  outer
          surface of  arms, legs, thighs;  never over
          the bony  portions.
     11. After giving injection, massage around, not
          over the site of puncture.
     12. Occasionally a  capillary is punctured, which
          reddens an area about the site of puncture.
          This disappears  like any bruised spot.
     13. Always report  to the head-nurse if  a needle
          is broken at the time of giving injection, and
          save it  for inspection.
     14. Keep a small string tied in one end of wire to
          prevent it from becoming  lost.
     15. Leave wire in needle.
     16. Oil the piston with a drop of sterile sweet oil
          occasionally.  It may be necessary to soak
          the entire syringe in oil.
     17. Leave hypodermic tray in faultless condition.
C. Types:
     1. Subcutaneous. 
            HYPODERMIC INJECTIONS          171

     2.  Antitoxin serums.
     3.  Hypodermoclysis.
     4.  Lumbar injections.
     5.  Intravenous.
D. Drugs commonly used subcutaneously:
     1.  Morphine sulphate.
     2.  Atropine sulphate.
     3.  Strychnine sulphate  and nitrate.
     4.  Apomorphine.
     5.  Nitroglycerine.
     6.  Pilocarpine hydrochloride.
     7.  Hyoscine hydrobromide.
     8.  Brandy.
     9.  Ether.
     10.  Camphorated oil.
     11.  Caffeine sodium benzoate.
     12.  Digitalis.
     13.  Digitaline.
 E. Articles necessary:
     Tray carrying:
        1. Carbolic, 5 per  cent.
        2. Alcohol, 95 per cent.
        3. Sterile water.
        4. Alcohol lamp.
        5. Two glasses, one with matches,  one for
            burnt matches.
        6. Standard, with spoon attached.
        7. Forceps in lysol, 2 per cent.
        8. Receptacle with sterile sponges.
        9. Receptacle  with  hypodermic  syringe and
             needles  with  wires. 
172
NURSING TECHNIC
      10. When solutions are used, bottles containing
           the drugs, except ergot, quinine, iron and
           arsenic.
      II. When  tablets are used, bottles  containing
           same in different strengths.
F. To prepare:
     I.  Boil the needle in spoon attached to standard.
     2.  Disinfect barrel by  using:
         a. Carbolic  solution, then
         b. Alcohol, then
         c. Sterile water,
         d. And note that there is no leakage.
     3.  If the drug is in tablet form, measure 10 or 15
         minims of sterile  water  in the barrel, then
         empty this water into the spoon in which is
         placed the  tablet  in order  to  dissolve the
         same, then draw the solution into the barrel.
     4.  Expel the air  by holding the syringe in an
         upright position and pressing the piston gently
         upward until the solution is near the exit.
     5.  Attach the needle by use  of  forceps.
     6.  Again hold the syringe in  an upright position
         with the needle pointing upward and press-
         ing  the  piston  gently  until a  small drop
         appears  at the end of  the needle.
     7.  Carry to  bedside  with needle  covered with
         cotton wet  with  alcohol, 95 per  cent.
G. To give:
     1.  Cleanse  the site of puncture with cotton mois-
         tened with alcohol.
     2.  Take up and  hold firmly,  between thumb and
         first finger of left hand, a cushion of muscle. 
ADMINISTRATION OF ANTITOXIN      173
     3.  Insert needle quickly,  almost vertically, and
         in the direction of the heart.
     4.  Withdraw needle  slightly, and allow solution
         to be injected by pressing the piston gently.
     5.  Withdraw needle, massage area gently with a
         sponge.
H. To clean hypodermic  syringe:
     1.  Proceed as when preparing to give hypodermic
         except allowing the needle to be attached to
         the barrel.
     2.  Remove needle and insert wire, always leaving
         the tray in unquestionable condition.
I.  Record:
     Hour,  drug and amount (hypo.) in red ink.

       ADMINISTRATION OF ANTITOXIN
  Injection  is usually given subcutaneously, in tissues
of the thigh, abdomen or chest, along the posterior
line below the scapula and down to the waist line.  It
is  sometimes given intravenously; if  so, it is done by
the interne.
A. Articles necessary:
     1.  Tincture  iodine.
     2.  Applicators.
     3.  Two medicine glasses.
     4.  Collodion  dressing.
     5.  Antitoxin.
B. Method:
     1.  Give in side most convenient for patient.
     2.  Paint the part with iodine.
     3.  The needle should be pointed  upward, plunged
         slowly, and the contents forced upward until 
174
NURSING TECHNIC
         all air is expelled and a drop of the antitoxin
         serum appears on the point of the needle.
     4.  Catch a good firm hold of the flesh, then insert
         the needle quickly,  through the skin, which
         is  held firmly between  the  thumb and index
         finger.
     5.  Slowly inject  the serum.
     6.  Withdraw the needle quickly.
     7.  Apply collodion dressing.

                     LAVAGE
A. Object:
     1.  To wash the inside of the stomach.
     2.  To remove poisons and irritating matter.
     3.  To relieve nausea.
B. General instructions:
     1.  Gain the confidence of the patient
     2.  When inserting the stomach tube, do not use
         force and avoid striking the posterior wall of
         the pharynx.
     3.  When pouring in the fluid,  do not allow the
         funnel to become empty.
     4.  Discontinue  the  treatment  at once, if  blood
         appears during siphonage.
C. Articles necessary:
     1.  Sterile stomach  tube and funnel.
     2.  Pail or large jar.
     3.  Two rubber sheets.
     4.  Towel.
     5.  Kidney basin.
     6.  Two cloths for handkerchiefs.
     7.  The solution ordered by the  doctor at the tern- 
LAVAGE
175
         perature required; if sterile water is ordered,
         prepare two pitchers, 105 and 115 degrees F.,
         respectively.
     8. Basin containing ice,  to cool the tube.
     9. Cork, piece of roller bandage or spool, to put
         between the teeth, when necessary.
D. Method:
       1. Cover rubber sheet with towel, turning it over
           the edge, and place  it about the  patient's
           neck.
      2. Place pail on floor near patient, under which
           is a second  rubber  sheet,  for the protection
           of the floor.
      3. Estimate the  distance from the mouth to tHe
           stomach of the  patient  and  measure  this
           length, approximately, on  the tube and allow
           two inches more.
      4. Have the patient  in such a position  as to
           allow the esophagus to be in a straight line.
      5. Have the head  of the patient supported  and
           insert the tube.
      6. When the tube  reaches the  pharynx,  urge the
           patient  to breathe deeply and swallow  fre-
           quently and continue to gently press  the
           tube  until  the  estimated point has been
           reached.
      7. Never use force.
      8. Pour the solution into the funnel,  holding the
           funnel not too high  above  the patient's head.
           Continue  until a pint  has been introduced
           into the stomach. Then lower the tube over
           the pail before the  solution has entered the
           stomach and siphon. 
176
NURSING TECHNIC
      9. Repeat in accordance with the doctor's orders
           or until the water returns clear.
     10. When removing tube, pinch it tightly, so that
           any  water in the tube may not drop back
           into the trachea.
E. Record:
     1.  Time and treatment given.
     2.  Character of solution first returned.
     3.  Amount of water used before a clear return.
     4.  Any abnormal conditions present.

                     GAVAGE
A. Object:
     1.  To introduce food into the stomach.
B. Articles necessary:
     1.  As for lavage, except the pail and one rubber
         sheet.
     2.  Six to eight ounces of prepared food in a glass
         graduate or pitcher, according to  the doctor's
         orders.
C. Method:
     1.  Introduce tube as for lavage.
     2.  Pinch the tube, wait a few seconds before  in-
           troducing the food, noting respirations.
     3.  Pour the liquid into the  funnel slowly and at
         the side.
     4.  Pinch the tube, withdraw it gently but quickly.
     5.  Have the patient  remain  quiet  after the
         treatment.
D. Record:
     1.  Hour of  feeding.
     2.  The  preparation of  food  given and amount.
     3.  Result. 
NASAL FEEDING
177
                 NASAL FEEDING
A. Object:
     1. To introduce  food into the stomach, through
          the nasal passages.
B. Ordered:
     1. When patient is unmanageable.
     2. When patient is in coma.
     3. Following some operations.
C. General instructions:
     1. Keep patient in a recumbent  position.
     2. If there is difficulty in inserting the catheter
          into one nostril, try the other.
     3. Watch  the tube that it does not coil  in  the
          mouth.
     4. Avoid getting the tube in the trachea.
     5. Hold funnel  to ear  or invert  it into  water,
          before pouring in the fluid.
     6. Watch  the face of the  patient;  if  cyanotic,
          withdraw the tube at once.
D. Articles necessary:
     1. Small catheter with small funnel.
     2. Sterile vaseline.
     3. Glass filled with water.
     4. Towel.
     5. Cloth for handkerchief.
     6. Graduate glass containing warm food.
E. Method:
     1. Place patient's head  so that the esophagus is
          in a straight line.
     2. Place towel about neck, with  one end protect-
          ing pillow at side of head. 
i78
NURSING TECHNIC
     3. Insert tube into nostril and down into esoph-
          agus.
     4. Test, to know that the patient is not breathing
          through the catheter.
     5. Pour food into the funnel slowly.
     6. Pinch the catheter when withdrawing..
     7. When feeding a small child, wrap it tightly in
          a sheet or blanket to control any struggle on
          its part.

                  TEST MEALS
A.  Object:
     1. To aid diagnosis by determining:
          a. Motor function of stomach.
          b. Reaction of gastric juice.
          c. Absorbing power of stomach.
B.  General directions:
     1. Give on empty stomach.
     2. See that patient does not take  anything after-
          wards, until meal is removed.
     3. Caution  patient  to  masticate  slowly  and
          thoroughly.
     4. Remove promptly at time desired.
     5. When  removing—precautions   same  as   for
          lavage.
C. Types:
     1. Ewald's  test breakfast:
         a. Two small pieces of  dry toast.
         b. Eight ounces of clear tea.
         c. Remove in one hour, or as ordered. 
STEAM  INHALATIONS
179
    2. Boas' test breakfast:
         a. Six ounces strained oatmeal gruel.
         b. Remove in one hour.
    3. Motor meal:
         a. A  dinner  served of foods  that  have a
             great deal of cellulose, such as vegetables
             with fibre—turnips, cabbage, etc.
         b. Fruits with skins, etc.
         c. Small serving of meat.
         d.  Remove in 7 hours.
D. Articles   necessary  for  removing  (aspirating
      stomach):
     1.  Same as for lavage—except stomach pump and
         drainage pail and  rubber  sheet.
     2.  Sterile stomach tube with aspirating bulb.
     3.  Sterile specimen bottle.
E. Method:
     1.  Prepare patient and pass tube as in lavage.
     2.  Expel  air from bulb, attach to tube—it must
         be air tight.
     3.  When  bulb is fully  expanded,  detach, empty
         contents into  specimen  jar, and repeat  until
         all contents are removed.
     4.  Cover jar securely, tag, and send to laboratory.
F. Record:
     1.  Hour test meal given, and kind.
     2.  Hour test meal removed, and sent to laboratory.

              STEAM INHALATIONS
A.  Object:
     1.  To relieve spasmodic breathing.
     2.  To disinfect bronchial secretions. 
i8o
NURSING TECHNIC
     3.  To stimulate  expectoration.
     4.  To afford comfort to the patient.
B. Types:
     1.  Pitcher and towel method.
     2.  Tea-kettle and cone.
     3.  Croup tents.
C. Pitcher and towel:
     1.  Pour prescribed drug into pitcher of boiling
          water.
     2.  Wrap pitcher with heavy towel, leave a small
          opening through which the vapor can be
          inhaled.
D. Tea-kettle and cone.   When the inhalation is to
      be continued for some time:
     1.  Pour medicated water into kettle and keep it
         boiling  over a gas or alcohol flame.
     2.  Attach  to spout of kettle the small end of a
         cone  of stiff  paper, or a piece of  rubber
         tubing with a funnel on free  end,  which is
         placed  conveniently for  patient  to  inhale
         steam.
E. Croup tents:
     1.  General instructions:
         a. Have steam directed away from patient's
             face.
         b. Avoid danger of fire, from lamp.
     2.  Articles necessary:
         a. Four sticks, four or five feet long.
         b. Eight bandages or heavy cord.
         c.  One  blanket.
         d. Two or three sheets.
         e.  Bucket. 
STEAM INHALATIONS
181
    f.  Two or three bricks.
    g. Alcohol lamp.
    h. Tea-kettle with medication, as ordered.
    i.  Rubber tubing, with  funnel attached.
    ;'.  Safety and common pins.
3.  Method:
    a. Tie the lower ends of sticks firmly, with
         bandage or strong cord,  to each corner
         of bedstead, below  mattress.
    b. Stretch bandage tightly from free ends of
         sticks,  to  form  the basis  for pinning
         blankets and sheets  for canopy.
    c. Place blanket, lengthwise, at head of bed,
         outside of frame, so that the lower edge
         comes to the edge of the mattress.
    d. Fix the rubber tubing, with  funnel, to
         blanket above the  patient's  head  and
         directed away from the face.  It may be
         placed  at the side of the  bed, if desired.
    e. At  right  side of bed, place  a sheet length-
         wise, with  the lower border just below
         the line of the mattress. Pin on bandage,
         using as many  sheets as necessary to
         make the tent.   Pin the edges of the
         sheets  together over the bed neatly.
    /. Fold back one corner of sheet on top of
         canopy, to admit air.
    g. Place bucket, containing the alcohol lamp
         and tea-kettle containing the solution, at
         head of bed, supported by the bricks.
     h. Attach free end of tubing.  Light lamp. 
CHAPTER VI
                DRESSING ROOM

     DUTIES  OF DRESSING  ROOM  NURSE
A.  Day nurse:
     i. Assists with dress cases.
     2. Is responsible for the application of hot dress-
          ings.
     3. Prepares  extra  dressings to be  sterilized and
          has them ready to send to the sterilizing room
          at 5.30 P.M.
     4. Prepares protective strips.
     5. Sterilizes  vaseline and  oil  preparations.
     6. Keeps jars, etc., supplied with suture material.
     7. Is responsible  for  the fulfilment  of  extra
          orders.
B. Night nurse:
     1. Every night:
          a. Cleans dressing room furniture and dress-
              ing cart.
          b.  Boils  water, in cans, for  sterile water
              supply.
          c. Sterilizes all pitchers, basins,  irrigators
              and  douche cans. Pitchers, basins and
              irrigators  are put in sterile bags and
             properly placed; douche cans, covered
             with a sterile towel,  are placed bottom
             side  up on a shelf which has been cov-
             ered with a sterile towel.
    182 
Fig. 28.—Laparotomy sheet showing strips of gauze pinned in right hand pockets, and as used, placed in left hand pockets. 
184
NURSING TECHNIC
         d. Sterilizes douche points,  glass  catheters
              and all glass utensils used in dressings,
              by cleaning and boiling.
     2.  Once a week:
         a. Fumigates.
         b. Re-sterilizes all supplies.
     3.  Twice a week:
         o. Sterilizes all dressing jars, by boiling or
              steam.
         b. Makes  sterile stock salt solution.
     4.  As necessary:
         a. Prepares the following solutions:
              Carbolic, 5 per cent.
              Bichloride of mercury, 1 to 500.
              Alcohol, 50 per cent.
              Lysol, 2 per cent.
              Green soap.
              Boric acid solution.
         b. Prepares patients for operations.
         C. Gives A.M. douches and irrigations.
         d. Orders hypodermoclysis set.
         e. Leaves  dressing-room ordered  and  sup-
              plied.

                STERILE  SUPPLIES
A. Object:
     1.  To have supplies "surgically clean," i.e.,  to
         prepare and handle them in such a manner as
         to prevent them  carrying infection.
B. General instructions:
     1.  Sterilized articles should never come in contact
         with any unsterile articles.  Should an article 
STERILE SUPPLIES
185
          be contaminated,  it  must  be  resterilized
          before being used.
C. Preparation of sterile supplies:
     1. Steam:
          Cover,  in envelope fashion, towels, sheets,
            gowns,  sponges, dressings,  gloves, etc.,
            with closely woven material large enough
            for all edges to overlap.
          Do not make these packages too compact.
          Use as few pins as possible, quilting the pins
            through the  cover, having only the head
            exposed.
          Bags with draw-strings are best for covering
            basins, pitcher, etc.
          Place in autoclave for 1 hour,  under twenty
            pounds pressure.
     2. Boiling:
          a. Rubber  articles, as  catheters  or colon
              tubes: Cleanse articles.   Fold or tie in
               muslin and place in a large quantity of
               salted water.
          b. Medicinal agents in jars or  bottles: Place
               the jars or bottles in a  receptacle, pro-
              tecting the bottom with muslin and cov-
              ering with as much tepid  water as pos-
              sible without  floating the  jar or  bottle.
              Loosen the lid or cork.
          c. Pitchers, basins, etc.: Clean  and place in a
              receptacle sufficiently large to cover with
              water.  Cover receptacle.
          d. Instruments:  Cleanse each  instrument
               separately,  carefully and  thoroughly, 
186
NURSING TECHNIC
              avoiding the sharp edges.   Wrap sharp
              instruments  in  cotton  or  gauze sepa-
              rately.  Place the heavier instruments in
              lower part  of rack,  rolled in towel or
              muslin.    Place more  delicate  instru-
              ments,  carefully  wrapped,  on  top of
              heavier  instruments.
          e. Glass: Cleanse, protect in muslin, place in
              a large  amount of tepid water.
          /. Oil: The  same as for medicinal agents.
     3.  To disinfect instruments, basins,  pitchers,  etc.,
              chemically:
          a. Immerse  small  instruments  in  carbolic
              acid, 95 per cent., and  then neutralize
              thoroughly in alcohol, 95 per cent. Rinse
              in sterile  water.
          b. Glass  catheters,  douche  points,  rubber
              goods,  medicine   stoppers,  medicine
              glasses,  irrigating  tips,  should never be
              chemically sterilized in 95  per cent,  car-
              bolic acid.
          c. Pitchers, basins, irrigators, and sometimes
              towels or  muslin, are disinfected by im-
              mersing in  bichloride of mercury,  1 to
              1,000, or  carbolic acid  solution, 5 per
              cent., for one hour.
E. Handling  sterile supplies:
     1.  Forceps   for  handling   sterilized  materials
          should be cleansed, boiled and  placed  in a
          sterile  jar  containing  fresh lysol solution,
          2 per cent.  This  must be done daily, or in
          case of accident, more often.   Never allow 
STERILE  SUPPLIES
187
the hand or  arm to pass  across an  open
sterile receptacle or  disinfected  field.   If
articles are  in cover, remove the  pins, open
carefully, holding the sterilized corners un-
derneath the package.   Never  touch  the in-
side of  the cover.   The contents may be
removed by forceps into  a  sterile basin, or
they may be  dropped  upon  the disinfected
field, or  removed by a disinfected hand.
   Fig. 29.—Sterile vaseline and Beck's paste in glass syringes used for
dressings, showing cover for end of syringe.
2.  Keep the articles covered by a sterile cloth or
     towel, or when in basin one basin may cover
     another.  Always hold the basin by pressing
     the hands  on  the  sides,  or holding  it  by
     placing the hands beneath the bottom of the
     basin; never grasp it with the fingers over
     the rim. 
188
NURSING TECHNIC
     3.  Sterile pitchers:  Keep  covered with  sterile
          towel or cloth.  Grasp at the  lower part of
          handle or support bottom on the hand; never
          grasp by the lip.
     4.  Sterile supply jars:  Lift the lid  straight up
          from the  jar,  and  remove contents with
          forceps.  If necessary to put lid down, place
          with the bottom side up, so that  the inner
          rim will not come in contact  with any un-
          sterile thing.  In replacing lid on jar, avoid
          striking it  against the sides  of the jar.
F. Pouring solution:
     1.  When the bottle is full, remove stopple by lift-
          ing  the same between the first  and  second
          fingers  of the  right hand  with  the palm
          upward.
     2.  Clean the mouth of the bottle with  disinfectant
          solution  on  sponge,  then grasp the  bottle,
          having the label side toward the palm, and
          pour the solution.
     3.  Wipe off the mouth, set the bottle in  its  proper
          place, label visible, and drop  the stopple  in
          position.
     4.  In case of large bottle,  remove stopple, place it
          inverted on table and  use both hands in pour-
          ing solution  and follow the foregoing rules
          as to other procedures.
     5.  In case  no  disinfectant is  available, a small
          amount of solution may be poured from the
          mouth of the bottle to cleanse the same, hold-
          ing over a sink  or basin, and never over the
          floor. 
SOLUTIONS
189
G. Disinfection of hands for catheterization and ward
       dressings:
     1. Wash hands and arms to elbows with soap and
          running water and clean nails.
     2. Then scrub each hand with a stiff brush for two
              minutes in  the  following order:
          a. Forearm and wrist.
          b. Knuckles and back of hand.
          c. Back and sides of  fingers, separately.
          d. Thumb and palm  of hand and  inside  of
              fingers.
          e. Nails.
          /. Clean  nails  with  blunt-pointed  orange-
              wood stick.
          g. Scrub  forearm  and hands in the same
              order for one minute each.
          h. Rinse hands and soak in lysol solution two
              minutes. To prepare lysol solution, use
              forty minims  of lysol  to one pint  of
              sterile water in a sterile basin.
     3. Precaution:
          a. Keep hands held so that there is no pos-
              sible way of touching any article,  or if
              necessary to wait for any length of time,
              fold  same in a sterile towel.

                    SOLUTIONS
   Note.—These formulae are sufficiently accurate for
 practical  purposes.
 Bichloride of mercury (corrosive sublimate) :
   One to five hundred, bichloride of mercury, drams 2,
     by weight.
   Sodium chloride,  drams 10, by weight. 
190
NURSING TECHNIC
  Cold sterile water,' gallon  1.
  Dissolve the bichloride and sodium chloride in one-
    half pint of sterile  water.   Filter  this into suffi-
    cient sterile water  to  make  one gallon.   This
    solution  may also  be made without  the sodium
    chloride.
Boric acid (boracic acid) :
  Saturated  solution contains about 6  per cent, boric
    acid.  Dissolve 7 ounces of  boric acid crystals
    in 1 gallon  of sterile water.
Carbolic acid (phenol) :
  Ninety-five per  cent.:  Measure 3  drams of hot
    water and add melted carbolic acid crystals suffi-
    cient to  make 8 ounces.   Mix  thoroughly until
    clear.  Filter,  if necessary.
  Five per cent.: Measure 7  ounces of the 95 per cent.
    carbolic  acid and add sufficient cold  sterile water
    to make  1 gallon.  Mix  thoroughly.
Dakin's solution:
  Prepare two solutions, as follows:
    1. Chloride  of lime, ounces 2; water,  gallons 2^4.
    2. Sodium bicarbonate,  4^2 ounces; sodium car-
         bonate, A.y2 ounces; water, 2 gallons.
  Allow  each to stand 24 hours, before mixing.  Pour
    off the clear solution and  strain.  Keep in dark
    bottles or jugs.
Formaldehyde (formalin) :
  One per cent.:  Measure 6l/2  drams liquid formal-
    dehyde and add sufficient  cold sterile  water  to
    make I quart.
  One to one thousand:  Measure 38 minims  liquid
    formaldehyde and add sufficient cold sterile water
    to make 1 quart. 
SOLUTIONS
191
Green soap:
  Green soap, 1 pint; water, 1 pint.  Boil and stir until
    dissolved.   It should be  the  consistency of syrup.
Locke's solution (given as an enema or hypodermo-
       clysis):
  Sodium chloride, gr. 276.
  Calcium chloride, gr.  7.
  Potassium chloride, gr.  13.
  Sodium bicarbonate, gr. 9.
  Dextrose,  dr. y2.
  Distilled water,  pt. 4.
Lysol:
  Two per cent.: Lysol,  drams 5 ; sterile water, 1 quart.
Salt:
  Stock:  Sodium  chloride,  iy2 ounces by  weight;
    water, 8 ounces.   Boil in a closed vessel for 15
    minutes.   When cool, add sufficient sterile water
    to make 8 ounces.   Strain through  sterile cotton
    into a sterile bottle  and keep well stoppled.
  Normal:  Measure 1 ounce and 3^3 drams of stock
    solution and add sufficient sterile water to make
    1 quart.  Normal salt solution should carry 127^2
    grains of salt to 1 quart of water.
                  Solution  Table
1-500   Use I   gr. or 1 m to 1 oz. or 16  gr.  or 16 m to 1 pt
1-1000  Use  y2 gr.       to 1 oz. or 8  gr.  or  8 m to 1 pt
1-2000  Use  J4 Sr-       to * oz- or 4  gr- or  4 m to 1 pt
1-3000  Use  Y(, gr.       to 1 oz. or 22/z gr.        to 1 pt
1-4000   Use  Y& gr.       to 1 oz. or 2  gr. or  2 m to 1 pt
1-5000  Use 1/10 gr.        to 1 oz. or 1^ gr.        to 1 pt
1-10,000 Use 1/20 gr.        to 1 oz. or  1/4 gr-        to 1 pt 
192              NURSING TECHNIC
                 Percentage Table
 I Per cent. Use  5 gr. to I oz. or  76 gr.          to I pt.
 2 Per cent. Use 10 gr. to 1 oz. or 153 gr. ( 2^2 dr.) to 1 pt.
 3 Per cent. Use 15 gr. to 1 oz. or 230 gr. ( 3^ dr.) to 1 pt.
 4 Per cent. Use 20 gr. to 1 oz. or 308 gr. (5   dr.) to 1 pt.
 5 Per cent. Use 24 gr. to 1 oz. or 384 gr. ( 6>2 dr.) to 1 pt.
10 Per cent. Use 48 gr. to 1 oz. or 768 gr. (13   dr.) to 1 pt.

                     BINDERS
A.  Object:
      1.  To keep applications and surgical dressings in
          place.
     2.  To make compression.
     3.  To limit motion.
     4.  To afford support and comfort to the patient.
B.  Precaution:
      1.  Carelessly and inefficiently applied binders are
          worse than none.
C. Types:
     1.  Scultetus for abdomen.  2. Straight for ab-
              domen. 3. T binders.  4. Straight binder
              for chest.
          1. Scultetus:
              a.  Pass half of bandage  (rolled) under
                  patient in such a way that centre of
                  bandage will come to centre of back.
              b.  Apply  bandage from above  toward
                  pubes, folding strips alternately and
                  obliquely.
              c.  Place two safety pins at end which is
                  folded over last.
              d.  Place one  safety  pin in  centre of 
BINDERS
193
         bandage so that it holds all  folds,
         except the first two.
2.  Straight abdominal binder:
    a. Fold over front edges to fit form of
         patient.
    b. Quilt  pins  down centre with pins
         crosswise of abdomen.
    c. Adjust  two perineal straps to hold
             abdominal bandage in place.
         1.  Pin ends  of  each  strap   under
             lower  edge  of  binder,  two
             inches from  median line,  in
             front.
         2. Bring down smoothly over  groin,
             around  each  leg  to  back  of
             binder, and pin as in front.
3.  T binders for perineum:
    a. Bring  up, over perineum, the  strip
         attached to back of  straight  band,
         which encircles the waist, to hold
         dressings in place.
    b. Pin to binder, in front.
4.  Straight binder for chest:
    a. If for  compression,  place cotton be-
         tween and  under breasts.
    b. After bringing breasts in  proper posi-
         tion,  away from axillae, pin tightly,
         beginning at centre of bandage, then
         pinning  from  the lower  edge of
         bandage, to the upper edge.
    c. Pin straps over shoulders and  darts
         under both breasts.
    d. Have pressure even. 
194
NURSING TECHNIC
      TRIANGULAR BANDAGE AND SLINGS
  These  are made of muslin, one yard  square and
doubled diagonally in the  shape of a triangle.  The
diagonal  line  is known  as the  base  and  the  corner
opposite, the apex.
A. To apply to injured forearm:
     i.  Flex the arm in the desired position.
     2.  Carry the base of the triangular bandage from
         2 to 3 inches beyond the median line,  on the
         injured side of the body.
     3.  Support arm and hand by bringing the ends  to
         the back of neck and tie, or fasten to cloth-
         ing with safety pin.
     a. Bring apex of triangle around elbow and fasten
         it back of the elbow.
B. To apply, as a support, if arm is injured:
     i. Fold sling in shape of  a  cravat by bringing
         apex of triangle to its  base and  fold  several
         times, until three inches  wide;  place wrist
         in centre of sling and fix the ends at back
         of neck.   Pin it a  few inches  above the
         wrist, to the clothing.
C. The triangular bandage, of different sizes,  is also
      used to fix dressings on hand, foot or head.
     The base is  laid under wrist or ankle, the apex
       brought over fingers or toes, the ends crossed
       and brought around, tied on the upper  side.
     When used for  the head,  the centre of the  base is
       placed opposite the injured part, the apex made
       to cover the  dressings, the ends crossed and
       brought around, tied at centre of the base in a
       reef  knot. 
POSITIONS FOR EXAMINATIONS
195
      There is no part of the body where this triangular
        bandage cannot be used.

•POSITIONS AND DRAPING FOR EXAMINATIONS
 A. Object:
      1. To protect the patient during examination and
          treatment.
      2. To aid in examining  different parts of  the
          body with comfort to the patient.
 B. General instructions:
      1. Avoid all unnecessary exposure of any portion
          of the body to be examined or treated.
      2. Protect a patient from other patients in a ward
          by the use of screens.
      3. Have  ready suitable basins,  soap and  clean
          towels for use of examining physician, before
          and  after examination.
 C. Types:
      1. Throat.    2. Chest.   3. Abdominal.   4. Ex-
               tremities.  5.  Rectal.  6. Vaginal.
           1. Throat:
               a.  General instructions:
                   1.  Have patient in position so  that a
                        strong light, at the examiner's
                       back, can  be thrown upon the
                       throat  of  the patient.
                   2. If examiner  uses head mirror,
                       have  light  always  in   front,
                       either natural or  artificial.
                   3. When there is  much  coughing,
                       the nurse or examiner may pro-
                       tect the eyes with  spectacles. 
NURSING TECHNIC
b.  Articles necessary:
    i.  Tray containing:
        a. Towel.
        b. Tongue depressors or spoon..
        c. Wooden  applicators wound
             with absorbent cotton.
        d. Paper  bag  or  basin  for
             soiled depressors.
        e. If solution is ordered, have
             solution  in  medicine
             glass.
c.  Method:
    i.  Place  towel over  patient's chest
        and  shoulders.
    2.  Always hold the tongue depres-
        sor in the middle so that the
        fingers do not touch the portion
        which is to go into the patient's
        mouth.
    3.  After  a tongue depressor  has
        been used,  it  should  never be
        placed on a chair, table or bed,
        but immediately  in a paper bag
        or in a  piece of  paper  and
        burned.
    4.  To hold a towel or napkin under
        the chin during a simple exam-
        ination of throat, tie a loose
        knot  in one  corner and insert
        in the neck of gown  or dress.
    5. To restrain a child during an ex-
        amination of the throat: 
POSITIONS FOR EXAMINATIONS        197

            a. Fold backward one corner of
                 a sheet and place this bias
                 under  the  chin.   Then
                 wrap  the sheet about  the
                 child so that the arms  are
                 restrained at the sides and
                 seat the child on the lap so
                 that  the  weight  of  the
                 child  holds  the  sheet in
                 place.
             b. The  child's   head  can be
                 placed  against   the   left
                 shoulder of  the nurse and
                 her left hand  hold it' in
                 place.
             c. The nurse's feet crossed over
                 the child's  feet,  completes
                 the restraint.
2.  Chest:
    a. General instructions:
        1. Have room  warm  and free from
             draughts.
        2. Have your hands warm.
        3. In cold weather use blankets for
             protection of the patient during
             examination; in  warm weather
             sheets may  be used.
        4. Always have patient  turn  face
             away from the  side the doctor
             is examining.
        5. Use auscultation towel, if doctor
             so desires, 
198
NURSING TECHNIC
b.  Method:
    i.  Up patient:
        c. Remove  all clothing from
             upper part of  body.
        b. Place  sheet,  folded  shawl
             fashion, about  shoulders,
             pinning it in  front.
        c. Have patient sit on stool or
             chair, so that the front and
             back are accessible.
        d. If doctor examines  front of
             chest, fold sheet back over
             shoulders;  if   back,  the
             sheet  is  turned  around,
             opening in back, and then
             folded over shoulders.
    2.  Bed patient:
        a. Always hold towel  between
             patient's face and doctor's
             head.
        b. If patient is able to sit up,
             drape as for  up patient.
        c.  If not  able to sit up, either
             remove gown  and place a
            towel over chest,  or  roll
            hem of gown up, inside of
            gown, to the neck so that
            it does not interfere with
            the  examination, and cover
            same with towel.
        d. To examine the  back, turn
            patient on side most com- 
POSITIONS FOR EXAMINATIONS
199
              fortable and roll gown up
              in same manner and cover
              body with towel.
Abdominal:
  a. General instructions:
      1. Have patient empty bladder  just
          previous to examination.
      2. Have patient lie straight in  bed,
          on back, knees flexed to relax
          abdominal muscles.
  b. Method:
      1. Turn all  bedding back, except
          sheet, nearly to knees and cover
          patient with towels or blanket.
      2. Fold  sheet snugly and smoothly
          across pubes and groins.
      3. Place  towel  over abdomen, at
          the  same  time drawing   up
          gown  and  rolling it  just above
          the  waist line.
      4. During  the   examination,  the
          towel  is  removed  from  the
          abdomen.
Lower extremities:
  a. Method:
      1. Loosen bedding from foot of bed.
      2. Fold spread and blanket upward.
      3. Leave the sheet  to use for pre-
          venting unnecessary  exposure
          of extremities.
     4. When both legs are being exam-
          ined, bring sheet between thighs. 
NURSING TECHNIC
        5. When  necessary to turn patient
             on side to examine  thigh, pro-
             tect the patient with extra sheet
             or towel between thigh and over
             buttocks.
5.  Rectal:
    a. General instructions:
        1. Have  rectum empty  and clean,
             having given enema, if ordered.
    b. Method:
        1. Place  patient  in  dorsal,  knee-
             chest, Sim's  or  dorsal-lithot-
             omy  position, draping as for
             vaginal examination.
        2. When  necessary, have ready rec-
             tal speculum,  with sterile oil or
             vaseline for lubrication,  small
             cotton sponges,  sterile rubber
             gloves and paper bag for waste.
6.  Vaginal:
    a. General instructions:
        1. Have  towels,  sheets, sterile
             gloves, instruments and  lubri-
             cants prepared.
        2. Have patient urinate  just before
             examination.
        3. Have rectum empty.
        4. Have external parts scrupulously
             clean.
        5. Have  patient  relax as  much as
             possible, by taking  a  series of
             long, deep breaths. 
Fig. 30.—Detail of gynecological sheet used in the operating room. 
202
NURSING TECHNIC
                  6.  Protect the patient's  sensibilities
                      and sense of modesty by con-
                      trol of  speech and facial ex-
                      pression.
D. Positions:
     i.  Dorsal:
         a. Patient flat on  back,  one  pillow  under
              head.
         b. Knees separated and slightly flexed.
     2.  Lithotomy:
         a. In bed: patient on back, across  bed, but-
              tocks slightly beyond  the  edge of mat-
              tress, hips slightly elevated with pillows;
              knees flexed on abdomen  and fastened
              in position  by a  strap or by  a folded
              sheet, passing upward over one shoulder
              and  down over the opposite,  and pinned
              about flexed knees.
         b. On examining table: patient arranged the
              same except without  the  leg  support;
              the feet are  placed in stirrups on each
              side of table at foot of same.
     3.  Knee-chest or genu-pectoral:
         a. Place  patient on examining  table.
         b. Allow one small  pillow, only,  for head.
         c. Patient rests  on chest and  knees,  knees
              slightly separated; face turned on side,
              resting on pillow ;  thighs perpendicular;
             arms free on both sides.  Watch  pulse.
     4.  Sim's:
         a. Patient lies on left side; right  knee  flexed
              higher than left and drawn up  nearly to 
          POSITIONS FOR EXAMINATIONS       203

              abdomen;  left knee slightly flexed; left
              arm is drawn under the side  to  back;
              right arm  free, in  front.
     5.  Standing:
         a. Patient stands with knees separated about
              10 inches, one  foot on  a  low stool  or
              rung of chair.
     6.  Trendelenburg:
         a. Patient  lies  on back, on examining table,
              thighs elevated  on  incline plane,  45 de-
              grees, legs, from knees down,  on other
              side of plane from thighs.
         b. To prevent patient from slipping, shoulder
              supports are used.
         c. Be careful, when lowering table,  to watch
              the position of arms, hands, and skin  of
              patient that they are not caught between
              the upper  part and frame of table.
E. Draping for dorsal and knee-chest positions:
     1.  Loosen clothing and tuck  back,  out of the way.
     2.  Place  draping sheet diagonally  over patient.
     3.  Flex  knees  and  keep them  well  separated.
         Twist  the  opposite corners about each foot
         and  fasten on the outside.
     4.  Place  a  folded towel under buttocks.
F. Draping for other positions:
     1.  Sim's: cover patient with draping sheet, hav-
         ing prepared the clothing and placed a towel
         under  buttocks.
     2.  Standing: drape  sheet about body, after having
         the  clothes out of the  way,  with  the open
         side of the sheet convenient for the examiner. 
204
NURSING TECHNIC
       APPLICATION OF HOT DRESSINGS
A. Object:
     I. To produce hyperemia.
     2. To promote suppuration.
     3. To soften  necrotic tissues and  aid in their
         removal.
     4. To relieve  pain.
B. General instructions:
     1. Keep dressings hot.
     2. Apply as hot as can be comfortably borne.
     3. Avoid burning patient.
     4. If affected area becomes reddened by continu-
         ous application,  anoint  with  vaseline.
C. Articles necessary:
     1. Dressings, made of cotton and gauze.
     2. Stupe wringer.
     3. Basin.
     4. Parchment paper, moistened.
     5. Cotton.
     6. Roller, triangular or many-tailed bandage.
     7. Paper bag,  for waste.
D. Method:
     1. Place dressings in stupe-wringer and bring to
         boiling point, in basin of  boric solution.
         (Boric acid,  1 ounce, to water, 1 quart.)
     2. Wring  the  dressings dry, while in  the stupe-
         wringer.
     3. Carry the stupe-wringer, with  enclosed dress-
         ings, in a basin  to the bedside.
     4. Remove soiled dressings, putting them  in bag.
     5. Remove  dressings from wringer,  shake  out
         once and  apply to the affected area. 
EXTERNAL DOUCHE             205
    6. Cover with moistened parchment paper, cotton
         and apply bandage.
    7. Change  every two hours,  unless  otherwise
         ordered.
    8. A hot water bag  may often be  used close to
         the dressings, to keep them hot for a longer
         period of time.   An  electric  light bulb,  on
         an extension cord, may be held a little dis-
         tance from small dressings,  to  keep them
         warm.  An electric light bulb should never
         be left closely covered, as it then becomes a
         likely cause of fire.

              EXTERNAL DOUCHE
A. Object:
     1.  To cleanse parts.
B. General instructions:
     1.  Avoid scalding patient.
     2.  Use aseptic  technic.
C. Articles  necessary:
     1.  Pitcher of  sterile  solution,  covered  with a
          sterile towel, enclosing one sterile pad  and
          seven sterile sponges.
     2.  Douche pan, paper bag.
D.  Method:
     1.  Prepare patient the same as for vaginal douche.
     2.  Wrap thumb and  forefinger with sponges.
     3.  Separate labia and pour solution  over parts,
          slowly  and  with force.   Hold  pitcher  18
          inches above patient.
     4.  Remove  douche pan, dry, re-adjust dressing
          and binder. 
206
NURSING TECHNIC
               VAGINAL DOUCHE
A. Object:
     i.  To cleanse vagina.
     2.  To arrest local hemorrhage.
     3.  To relieve inflammation.
B. Time:
     1.  When ordered by the doctor.
C. Types:
     1.  Cleansing and stimulating.  Solutions  usually
              ordered:
          a. Sterile water, temperature 105 degrees F.;
             quantity, 2  quarts.
          b. Normal  salt  solution.
          c. Lysol solution, y2 per cent.
          d. Iodine solution: dram 1 to water 2 quarts.
          e. Potassium permanganate solution,  made
              by putting  the crystals in gauze and let-
              ting them dissolve in water until  it is the
              color of royal purple.
          f. Bichloride of mercury, 1 to 4000, followed
              by sterile  water.
     2.  Reducing inflammation and arresting hemor-
              rhage.
          a. Salt solution.
          b. Sterile water, temperature no to 120 de-
              grees  F.; quantity, 2  quarts.
D. General instructions:
      1. Have  the   solution prepared  in the  exact
           strength and temperature ordered.
      2. Avoid burning  the patient when giving hot
           douches  by allowing the solution to run 
VAGINAL DOUCHE
207
          more slowly and with less force than when
          giving the usual douche.
     3. Do not allow air to be injected into the vagina
          with the  flow  of the solution.
     4. Do not give  douche, if patient is menstruat-
          ing, unless ordered by the doctor.
     5. Have the douche pan warmed or place a cover
          over the pan on which the patient's buttocks
          rest.
     6. Examine douche nozzle and know that  it is
          not rough, cracked or broken.
     7. Always give a douche to  patient while  in  a
          recumbent  position; never when in a sitting
          position.
     8. Have douche can  elevated  not more than two
          feet above the patient, so that the  solution
          will not run with too great a force.
     9. For infectious  cases,  elevate the  can  just
          enough to allow the solution to flow; protect
          self by wearing rubber gloves.
     10. Have patient remain quiet one hour  after
          giving douche.
     n. Always sterilize all articles, except thermom-
          eter, by boiling.
     12. Always disinfect hands before and after giv-
          ing douches.
E. Articles necessary:
     1. Graduate measure.
     2. Thermometer, disinfected with carbolic,  5 per
          cent., and alcohol,  50 per cent., and rinsed
          with sterile water.
     3. Blanket. 
208             NURSING TECHNIC

     4.  Douche pan.
     5.  Tray with:
         a. Sterile  towel  in  which is wrapped two
             glass  douche points, sterilized by boiling
             five minutes, and nine sterile  sponges.
         b. Paper bag.
         c. Douche can, covered, containing  solution
             as ordered.
F. Method:
      1. Place screens about bed.
      2. Pin paper  bag to bed
      3. Fold all covers, except sheet,  down half-way
           over foot of bed.  Cover chest with blanket
           and drape.
      4. Place douche pan under patient.
      5. Cleanse  external genitals with sponges.
      6. Attach nozzle to tubing.
      7. Wrap thumb and forefinger of left hand with
           sponges.
      8. Separate and hold external labia  apart with
           wrapped  fingers and let solution run  through
           tubing until it is warm and allow  a  small
           amount to flow over the exposed parts.
      9. Control the flow by pinching  the  tubing and
           insert  douche point, gently,  into  vagina,
           pointing  it  downward  and  backward, not
          allowing  it to touch the external parts.
     10. Remove  the nozzle  from the vagina before
          the solution has all been used; allow the
          balance of the solution to  drain  into the
          douche pan; remove nozzle from  tubing,
          wrap in paper and place in receptacle used
          for soiled points. 
CATHETERIZATION
209
     n.  All solution should drain from vagina before
          removing douche pan, the parts dried.
     12.  If there are perineal stitches, dry with sterile
          sponges, being careful not to pull or irritate
          them.
G. Care  of articles:
     1. Clean douche pan and tubing.
     2. Douche cans are sterilized each night; between
          times, the inside must be kept sterile.
     3.  Leave stop-cock open.
     4.  Cleanse and boil nozzle.
H. Record:
     1.  Hour given; kind and strength of solution used.
     2.  Character of return flow.

               CATHETERIZATION
A. Object:
      1. To remove urine from the bladder
B. Time:
      1.  When ordered by the  doctor.
C. General instructions:
      1.  Avoid catheterizing, if patient  can be induced
               to urinate, unless definitely ordered. Try
               the following ways:
          a.  Allow water to run from a faucet within
               hearing of patient.
          b.  Pour, gently, warm water over the vulva.
          c.  Have hot water  in the bed pan.
          d. By partially sitting up, if  allowable.
          e.  By allowing patient to dabble hands in hot
               water.
      14 
210
NURSING TECHNIC
         f. Apply hot water bag over bladder.
         g. Allow a slight whiff of ammonia.
     2.  Never catheterize without written orders.
     3.  Use aseptic technic.
     4.  Never use force when inserting a catheter.
     5.  If bladder is greatly distended, draw no more
          than one pint of urine at one time, to avoid
          danger of  collapse of bladder wall.
     6. Never catheterize a delirious or a pregnant pa-
          tient  with  a glass catheter;  use  a rubber
          catheter.
     7.  Always inspect a glass catheter and know that
         it is not rough, cracked or broken.
     8.  Always use screens and drape.
D Articles necessary:
     1.  Tray on  which are:
         a. One sterile towel in which are wrapped
              nine dry sterile sponges.
         b. Two sterile glass  or  rubber catheters, as
             necessary.
         c. Basin containing  warm boric  acid solu-
              tion,  2 per cent.
         d. Paper bag.
         e. Douche  pan or sterile kidney basin.
         /. Rubber gloves for infectious cases.
         g. For specimen, have ready a sterile bottle
             and sterile tubing attached to catheter.
E. Method:
      1. Place screens about bed.
      2. Place patient in dorsal recumbent position and
           drape. 
CATHETERIZATION
211
 3. Place bedside table at the foot of bed, right
      side.
 4. Pin paper bag on bed, within reach.
 5. Disinfect hands.
 6. Place towel over hips.
 7. Cleanse external genitals with boric solution
     and sponges.
 8. Wrap thumb and finger of  left hand  with
     sponges.
 9. Separate and hold external labia apart  with
     wrapped fingers.
10. Cleanse surface with sponges, wiping down-
      ward and using each sponge but once.
n. Cleanse internal labia in same manner.
12. Wipe meatus with clean sponge  and place a
      second clean sponge just below the meatus.
13. Inspect and then  insert  catheter,  without
      force, directly into meatus,  asking patient,
      at this time, to breathe deeply,  as an aid in
      inserting the catheter.
14. In case the catheter touches any unsterile sur-
      face, use another catheter.
15. If necessary, gentle pressure with hand, over
      bladder, may  assist in  the  urine being
      expelled.
16. When  removing, in order to retain the urine
      in the catheter, close the open end of a glass
     catheter or pinch a  rubber catheter with the
     fingers.
17. Cleanse parts with boric solution, dry  and
     leave patient in a  comfortable condition.
18. Measure the urine, or  if a specimen is to be 
212
NURSING TECHNIC
          retained, estimate the amount retained for
          same.
     19. Wash and boil the catheters.
F. Record:
     1. Hour: amount of urine in  urine column, in-
         dicating " per cath."   In remarks  column,
         note character of urine; if there is blood, pus
         or a sediment, note whether it is mixed with
         the urine or whether at the beginning or end
         of the flow.

               VESICAL DOUCHE
A. Object:
     1. To cleanse bladder.
B. Time:
     1. When ordered by doctor.
C. General instructions:
     1. Same as  for catheterization.
     2. Do  not over-distend  bladder  with cleansing
         solution.
D. Articles necessary:
     1. As for catheterization and sterile glass funnel
         with six-inch rubber tubing attached.
     2. Sterile boric acid  solution or normal salt solu-
         tion, 105 degrees F.
E. Method:
     1. Catheterize patient  and  without  withdrawing
         catheter, attach rubber tubing with funnel, to
         same.
     2. Pour in solution,  slowly, six to eight ounces,
         without  injecting  air. 
IRRIGATION OF THE EYE
213
     3. Invert funnel, before it is empty, and siphon
         two-thirds of the amount given.
     4. Pour  in four to five ounces and  siphon.
     5. Repeat until solution returns clear, using from
         twelve to sixteen  ounces.
              IRRIGATION OF EYE
A. Object:
     1. Cleanliness.
     2. Control of infection.
B. General instructions:
     1. In cases where there is a copious discharge, the
         nurse- should  protect  herself  by  wearing
         gown, rubber gloves, and in some cases the
         eyes may  be  protected  by  the  use of eye-
         glasses.
     2. If  patient is able, irrigation should be done in
         dressing-room.  If patient is unable to go to
         dressing-room, prepare for bedside care.
     3. Always use glass irrigator and irrigating points
         unless medicine  droppers are specified.
     4. If  only  one eye is  to be  treated, protect the
         other eye by use of pad or dressing. If both
         eyes are to be treated, a sterile  point should
         be used for each  eye  and the hands of the
         nurse cleansed before any procedure, between
         the care of the eyes and after the care.
     5.  Always direct the stream from the  inner toward
         the outer canthus of the eye and dry with cot-
         ton,  wiping in the same direction.
     6.  Never use force in opening the eyelids or allow
         the stream of  solution  to  flow from a height
         more than eight  inches above the patient. 
Fig.  31.—Pocket formed by holding  lower lid for the eye drop. 
              IRRIGATION OF THE  EYE          215

C. Articles necessary:
     1. Glass irrigator.
     2. Sterile irrigating points.
     3. Rubber sheet, Kelly pad or kidney basin.
     4. Solution as ordered.
     5. Receptacle for  waste, when Kelly pad or rub-
          ber sheet is used.
D.  Method:
     1. For bedside care, protect pillow.
     2. Place head so that injured eye is near edge of
          bed.
     3. Irrigate the  lids  until the lids can be opened
          without force and  continue  irrigation  until
          clean, holding the  lids apart.  Dry.
     4. Thoroughly  cleanse  and sterilize  utensils and
          put in place.
E.  Application of medicine to eye:
      1. In  using  unguentum, apply  with  usual sterile
          applicator.
     2. In using solutions : grasp lower lid with thumb
          and index-finger and pull lid  away from eye-
          ball gently. Drop solution into this triangular
          pocket and have patient close eyelids.
     3. To evert the lower lid, place thumb near mar-
          gin, press it  downward, while patient looks
          upward. To evert upper lid, hold lashes with
          thumb and index-finger of right hand, draw
          lid  downward,  having patient  look down-
          ward ; place a thin pencil, tooth-pick, hat-pin,
          horizontally across it and  turn  the lid back
          over implement. 
216             NURSING TECHNIC
               AURAL IRRIGATION
A. Solutions usually ordered:
     i.  Weak soda bicarbonate.
     2.  Normal salt.
     3.  Boric acid, 3 per cent.
B. General instructions:
     1.  Never  put anything cold in the ears.
     2.  Never  put  a pointed instrument into the ears.
     3.  Avoid pressure.
     4.  Report pain or dizziness.
     5.  Temperature of solution, 105 degrees F.  for
          cleansing; no degrees F. to relieve  pain or
          inflammation.
C. Articles necessary:
     1.  Irrigator and tubing, 1  point.
     2.  Kidney basin.
     3.  Cotton pledgets.  Gauze pledgets.
     4.  Towel  and rubber sheet or papers
D. Method:
     1.  Patient may lie down  or  be seated  as  com-
          fortable.
     2.  Protect pillow with rubber sheet and towel, if
          patient is on bed.
     3.  Place kidney basin and have patient hold same
          in place.
     4.  Irrigate ear gently, at low pressure, merely for
          external cleanliness; irrigator not more than
          one foot above patient.
     5.  Dry the ear with pledgets.
     6.  Irrigate gently,  again,  and dry the auditory
          canal with pledgets.  While irrigating, make
          the canal as straight as ppssible by holding of 
MOUTH AND  THROAT IRRIGATION      217
         a child's ear downward and backward  and
         that of an adult upward and backward.
     7.  Use medication, as ordered.
     8.  Insert small pointed pledgets of gauze.
E. For  earache:
     1.  Irrigate frequently  with warm  soda  bicar-
         bonate solution.
     2.  Instil 5 per cent, carbolic and glycerine.
     3.  Insert, loosely, absorbent cotton.
     4.  Apply external heat.
     5.  If pain is  located in the mastoid region, apply
          cold, never heat, without a special order from
          the doctor.
       MOUTH AND THROAT  IRRIGATION
A.  Articles necessary:
      1. Irrigator.
     2. Tubing, with or without point.
     3. Tongue depressor.
     4. Basin.
      5. Table.
     6. Sheet.
 B.  Solutions usually ordered.  Temperature 105  to
        118 degrees F.:
      1. Peroxide  of  hydrogen, 25  per cent.
      2. Potassium permanganate, pale wine  color.
      3. Normal salt.
      4. Sodium bicarbonate, one dram to one quart of
          water.
      5. Boric acid, 2 per cent.
      6. Antiseptic, 25 per cent.
      7. Iron and potassium chlorate, 25 per cent.
      8. Dobell's, 50 per cent. 
218
NURSING TECHNIC
C. Method:
     i.  Pin sheet about child and place on table, face
         downward.
     2.  Protect  head with left hand, over hopper or
         basin.
     3.  Insert tubing in mouth with right hand.  Irri-
         gate.
     4.  Cleanse  face and dry.

              NASAL IRRIGATION
A. General instructions:
     1.  Have irrigator only from three to eight inches
         above  patient,  to  prevent washing  the  dis-
         charge into Eustachian tube.
     2.  Instruct patient to breathe  through the mouth
         only.
     3.  Do not  allow  patient  to  blow the nose while
         filled with solution nor attempt to swallow.
     4.  Do not place a glass tube in nostril.
B. Articles necessary:
     1.  Same as for aural irrigation.
C. Solutions usually used:
     1.  Normal  salt.
     2.  Boric acid.
     3.  Sodium  bicarbonate.
D. Method:
     1.  Pin sheet about child and place on table, face
         downward.
     2.  Irrigate  the  nose gently.
     3.  Cleanse  with pledgets.
     4.  Application or insufflation of calomel powder. 
COLD COMPRESSES FOR THE EYE      219
         HOT DRESSINGS FOR THE EYE
A. Articles necessary:
     1.  Alcohol lamp.
     2.  Small basin of boiling water.
     3.  Sterile towel.
     4.  Gauze in circular pieces, size of eye.
     5.  Forceps.
     6.  Kidney basin or paper bag for waste.
B. Method:
     1.  Place gauze in boiling water.
     2.  Remove gauze with forceps.
     3.  Place between the folds of towel to  partially
          dry.
     4.  Remove soiled dressing and place hot dressing.
     5.  Do not use gauze more than once if there is a
          discharge from the eye.
     6. In cases where the heat and moisture are re-
          quired, an electric  light bulb may be used to
          keep the dressings hot,  by placing the lighted
          bulb near the dressings and supported.

        COLD COMPRESSES  FOR THE EYE
A.  Articles necessary:
      1. Gauze, cut circular, a little larger than the area.
     2. Ice in basin and  supported, for drainage, and
          covered.
     3. Forceps.
     4. Paper bag.
B.  Method:
      1. Place several  pledgets of moistened gauze on
          the ice.
      2. Pin paper bag to head of mattress. 
220
NURSING TECHNIC
     3.  Change  compresses every two  minutes.
     4.  If any discharge, do not use the compress but
         once.
     5.  Do not allow the compress to cover bridge of
         nose.
     6.  When available, a partially filled, small ice bag
         can be placed over the moistened gauze.

              HYPODERMOCLYSIS
A. Object:
     1.  To replace lost blood after hemorrhage.
     2.  To stimulate the heart's action.
     3.  To assist in eliminating toxic materials.
     4.  To fill   the  blood-vessels and  maintain  the
         blood-pressure.
B. General instructions:
     1.  Take pulse  before and  after  treatment  and
         record.
     2.  Use aseptic  precautions.
     3.  Expel air from tubing before inserting needle.
     4.  Do not  allow the  solution which is to be used
         to become cold.
     5.  Know exact amount  being given to patient.
     6.  Usually not more than one pint of solution is
         introduced in one place.
C. Articles necessary:
     1.  Always  have ready in box, marked  "Trans-
              fusion set ":
         a. Two sterile brushes.
         b. Two sterile towels.
         c. Two dozen sterile applicators.
         d: Two aspirating needles with wires. 
FlG. 32.—Paraffin treatment of burns. 
222             NURSING TECHNIC
          c. One bag  with two sterile dressings,  two
              sterile   collodion  dressings,  and  four
              small sponges.
          /. Two sterile towels containing:
              In first, one sterile pint graduate glass.
              In second, one sterile irrigating can.
              Tubing to be sterilized by  boiling with
              needle at the time of use.
          g. Bottle with bichloride of mercury solu-
              tion, i  to  iooo.
          h. Alcohol, 50 per cent.
     2. At time of giving:
          a. Green soap and sterile water.
          b. Thermometer, disinfected.
          c. Salt solution,  sterile,  one quart, 120 de-
              grees F. in sterile graduate.
          d. Salt solution, sterile, one  quart,  114 to
              120 degrees F. in irrigating can.
          e. Paper bag.
          /. Tincture of iodine.

       PHLEBOTOMY OR VENESECTION
A.  Object:
     1. To  relieve arterial or venous engorgement.
     2. To  relieve  congestion or edema of the lungs.
     3. To  remove toxic  material.
B.  General instructions:
     1. Have everything sterile.
     2. Take  and record pulse before and after treat-
          ment.
C.  Articles necessary:
       1.  Instruments  which should  be boiled  or car-
           bolized. 
INTRAVENOUS INFUSION
223
      2.  Rubber tourniquet.
      3.  Rubber sheet.
      4.  Four sterile towels.
      5.  Two or three sterile dressings.
      6.  Bandage.
      7.  Collodion.
      8.  Green soap  and sterile water.
      9.  Alcohol, 50 per cent.
     10.  Bichloride of mercury solution, 1  to 1000, or
          tincture of  iodine.
     n.  Sterile glass graduate.
D. Method:
      1. Cleanse  the  skin of the  arm between  the
         middle of the  arm and middle of the fore-
         arm with green soap and water.
     2.  Place rubber  under patient's  arm which is
         covered with sterile towel.
     3.  Apply alcohol.
     4.  Apply bichloride of mercury or  tincture of
         iodine as ordered.
     5.  Tourniquet is applied by the doctor.
     6.  Cover tourniquet with sterile towel and place
         another  sterile towel similarly around fore-
         arm just below elbow.
     7.  Have sterile graduate glass ready.
     8.  After  required  amount  of  blood has  been
         drawn, apply collodion dressing and bandage.
            INTRAVENOUS INFUSION
A.  Object:
      1. As  for hypodermoclysis.   The action of sa-
         line  by this  method  is  quicker than by
          hypodermoclysis. 
224
NURSING TECHNIC
B. General instructions:
     i.  Same as for hypodermoclysis.
     2.  An extra  precaution in expelling the air  is
         necessary, as entrance of air into a vein may
         cause death.
C. Articles necessary:
     i.  As for hypodermoclysis, and
     2.  Rubber sheet.
     3.  Bandage.
     4.  Tourniquet.
     5.  Instruments  which  should  be  boiled  or  car-
         bolized.
D. Method:
     1.  Skin prepared as usual.
     2.  Doctor applies the tourniquet.
     3.  Doctor inserts  cannula in vein.
     4.  Solution to be kept warm and amount noted.
     5.  Tourniquet removed.
     6.  Wound  covered  with collodion dressing and
         bandage  applied. 
CHAPTER VII
                   SPECIMENS

    PREPARATION  OF SPECIMEN BOTTLES
A. Object:
     i.  To have ready,  sterile  receptacles  for  speci-
         mens.
     2.  To prevent the contamination of the specimen.
B. General instructions:
     i.  Use no cracked receptacle.
     2.  Secure the right kind of receptacle for each
         kind of specimen.
     3.  Avoid  cracking  bottles.   Heated  bottles are
         readily cracked by  placing  them  in cold
         water  or  in a  draught, and cold bottles are
         readily cracked by placing them in hot water
         or  in  a heated place.
     4.  Stopples must be fitted tightly.
C. Types:
     1.  Urine specimens:
         a. A.M.,  six- to eight-ounce bottle.
         b. Twenty-four-hour,  two-  to   four-quart
              bottle.
     2. Sputum:
          a.  Small, wide mouth bottle.
          b.  Paper sputum cup.
     3. Stomach contents:
          a.  Wide  mouth bottle, one pint.
          b.  Emesis basin, well covered.
is
22s 
226
NURSING TECHNIC
     4.  Feces.
         a. Wide mouth bottle, one pint.
         b. Paper sputum cup.

D. Method:
     1.  To boil bottles: put hot water in the receptacle
         in which the bottles are to be boiled and allow
         it to come to the boiling point.  Meanwhile,
         rinse the bottles to be used with cold water;
         wash with warm soap-suds,  using  a  bottle
         brush,  shot, tacks or wet  toilet  paper torn
         into small  bits with scouring soap ; rinse with
         hot water several times.  Fill each bottle with
         hot water; place in boiler with open ends in
         same direction; have sufficient water  in boiler
         to cover bottles and cover receptacle ; boil ten
         minutes, empty and plug mouth of bottle with
         non-absorbent cotton, sterilized cork or with
         oiled paper and elastic.


                    SPECIMENS

A.  Object:
      1. To aid in diagnosing diseases.
B.  General directions:
      1. Avoid outside  contamination by sterilizing all
         receptacles.
      2. Have quantity  sufficient for examination.
      3. Note  on  history chart the hour and  kind of
         specimen obtained.   Always  label the recep-
         tacle containing the specimen. Do not fail to
         send the specimen  to the  laboratory. 
SPECIMENS                 227
C. Types and method of obtaining:
     1.  Urine:
          a. A.M. specimen from all new patients.
          b. Patients going to operation.
          c. By special order of doctor.
          d. Urine may be collected by voiding and by
              catheterization.
          e. For  ordinary specimens note on label:
              Ward.          Date.         Hour.
              Patient's name and bed number.
              Kind of specimen.
              Junior  doctor's name.
          /. Twenty-four-hour specimen:
              Note the  time the specimen is  to be
                started.
              Have the patient void urine and do not
                save  this amount.
              Always begin the collection with an
                empty bladder.
              Collect all  the urine voided in twenty-
                four hours.
              Have the patient urinate at the end of
                the twenty-four hours and add it  to
                the urine collected and stopple.
              Send entire specimen to laboratory.
              Note on label:
                Ward.            Date.
                Patient's name and bed number.
                Hour of  starting and  closing the col-
                  lection.
              As:  Started 3.45 A.M., 7/2o/'i8.
                   Closed 3.45 A.M., 7/2i/'i8.
              lunior doctor's name. 
228
NURSING TECHNIC
     2.  Sputum:
         a. Save A.M. specimen.
         b. Have  patient  expectorate directly  into
              bottle and stopple.
         c. Clean outside of bottle with disinfectant.
         d. Follow general instructions.
     3.  Stomach contents:
         a. Obtain by saving vomitus or remove con-
              tents by aspirating.
         b. Use a wide mouth bottle for specimen.
         c. Clean outside of bottle with disinfectant.
         d. Follow general instructions.
     4.  Feces:
         a. Transfer defecation from bed pan to wide
              mouth bottle and cover securely.
         b. Clean outside of bottle with disinfectant.
         c. Follow general instructions.
                VAGINAL SMEARS
A. Articles necessary:
     1.  Two glass slides and cover glasses.
     2.  Applicators.
     3.  Labels.
     4.  Sponges.
B. Method:
     1.  Cleanse glass slides with alcohol and dry.
     2.  Separate vulva with thumb and index finger of
         left hand.
     3.  Insert applicator well into vagina.
     4.  Remove, rub over glass slide.
     5. Prepare two  slides; when specimen is dry,
         place the slides face to face, enclose in sponge
         and send to laboratory. 
THROAT CULTURES             229
     6. Label  with name of patient, date, number of
         ward, number  of  bed,  and state  " vaginal
         smear."

              THROAT CULTURES
A. Articles necessary:
     1. Sterile applicators.
     2. Culture tubes.
     3. Tongue depressor.
B. Method:
     1. Have  patient cleanse mouth with normal  salt
         solution.
     2. Have  patient open  mouth,  using  tongue  de-
         pressor  when necessary, and in such light as
         the throat is  readily seen.
     3. Insert applicator well up under the edge of the
         membrane.
     4. Remove the cotton  plug from  culture tube,
         being careful that it  does not become con-
         taminated.
     5. Hold the  tube in a slanting position.
     6. Insert swab, rub  it gently over the surface of
         the medium,  from the bottom of  the tube,
         upwards and do not break the surface.
     7. Place  swab and tongue  depressor in paper bag
         and  burn.
     8. Label  the tube with  number of ward, number
         of bed, name  of  patient, date  and junior
         interne's name. 
CHAPTER VIII
                 EMERGENCIES

            ARTIFICIAL RESPIRATION
 A. Object:
      I. To promote mechanical respiration when nor-
          mal respiration has  ceased, due to  certain
          causes, such as mechanical obstructions in
          esophagus,  convulsive spasms  when  cough-
          ing, after inhalation of gases, during  admin-
          istration of ether,  drowning.
 B.  General instructions:
      I. Begin artificial respiration as soon as the need
          arises.
      2. Continue the movements rhythmically, and for
          at  least two hours,  unless  respiration is
          restored before that time.
      3. Draw tongue forward  and hold  it, and if no
          assistance  is at hand, tie a handkerchief or
          string  around  it,  cross ends, pass them
          around back of neck and tie there.
     4. If patient vomits, keep head turned to one side
     5. Do not hurry movements; ten or twelve arti-
          ficial respirations per  minute are sufficient.
C. Methods:
     1. Sylvester's:
          a. Place patient on  back,  with  thick pad
             between shoulder blades.
         b.  Stand or kneel at head of patient.
         c.  Grasp forearm above the wrist, thumbs in, 
ARTIFICIAL RESPIRATION
231
        draw  arms  slowly outward  at  right
        angles and upward until the hands meet
        above the  head,   causing  the  act of
        inspiration.
    d. Hold hands and arms in this position three
        or four seconds  and  then flex  them
        slowly but  forcibly, for three seconds
        against sides of chest, causing expiration.
    e. Repeat.
2.  Schaefer's:
    a. Turn patient on  face and abdomen.
    b. In case of drowning or lungs filled with
        water, hold the patient by the hips, bring-
        ing them up to knee height of operator,
        and clinching  the  body of the patient
        between  the knees, holding it there a few
        minutes, for the gravitation of the water.
        Lower body.
    c. See that the tongue is free and the  mouth
        is  not clogged and nostrils clear.
    d. Turn head to one side and support it by
        patient's arm being flexed underneath
        the same.
    e. Kneel by side of patient.
    f. Spread palms of hands and  fingers, with
        thumbs parallel, at  base of scapulae.
    g. With a quick  forward movement of the
        body, press the side of the chest walls
        quickly,  using  the weight  from  the
        shoulder and not from the arm.   This
        expels the air from the chest.
    h. Count five, slowly and rhythmically, and
        again press forward the body, making 
232
NURSING TECHNIC
              pressure upon the side walls and back of
              the chest.
         i.  Continue until respiration becomes normal.

                     SYNCOPE
A.  Symptoms:
     i. Pale face.  Cold perspiration on forehead.
     2. Patient complains of feeling dizzy.
     3. Complete or partial unconsciousness.
     4. Pupils even and natural size.
     5. Respiration shallow and  sighing.
     6. Pulse weak and rapid.
B.  Treatment:
     1. Recumbent position or head lower than  body
         or legs elevated.
     2. Loosen clothing, especially about neck.
     3. Keep people from crowding about patient, thus
         shutting out air supply.
     4. Give simple hot or cold drinks.
     5. Keep patient quiet, after attack.

                 CONVULSIONS
A.  Symptoms:
     1. Restlessness, fretting, gritting of teeth.
     2. Twitching of muscles, jerky movements, stif-
         fening of body, head pulled backward.
     3. Eyes rolled upward.
     4. Pulse  rapid and weak.
     5. Respiration labored.
     6. Skin cold and sweaty.
     7. Pupils even and natural  size.
     8.  After  attack,  patients may seem to rest. 
HEMORRHAGE                233
B. Treatment:
     1.  Guard patient that he may not be injured, but
         do not restrain.
     2.  Prevent biting  tongue by  placing  spoon or
         tongue depressor between teeth.
     3.  Loosen clothing.
     4.  Call doctor.
     5.  Note and record duration of convulsion, char-
         acter, parts of body affected and prodromal
         symptoms.

                  HEMORRHAGE
A. Types:
     1.  Arterial: external wound, bleeding  in spurts,
         synchronous with heart beat.
     2.  Venous:  external wound, blood  wells up, no
         definite  relation between the bleeding and
         the heart beat.
     3.  Capillary: external wound, general oozing.
B. Symptoms.  External wound:
     1.  Appearance of blood.
     2.  Subjective  symptoms:  faintness,   weakness,
         restlessness, thirst.
     3.  Skin pale, cold, sweaty.
     4.  Pulse becomes rapid and weak.
     5.  Respiration becomes rapid, shallow and patient
         becomes air hungry.
C. Treatment:
     1.  Arterial: send for doctor; recumbent position
         with elevation of  part  of body from which
         there is the hemorrhage.  Control by hand 
234
NURSING TECHNIC
          pressure  or finger  pressure or  tourniquet.
          Assist with dressings.
     2. Venous: send  for  doctor;   apply  pressure;
          elevate.   Assist with dressings.
     3. Capillary:  report to  doctor;  slight pressure;
          elevation.   Assist with dressings.

              ISOLATING PATIENTS
A. To isolate a contagious suspect:
     1. Remove patient from  the general ward.
     2. Assign one or more nurses to the care of the
          patient.
     3. Separate bed utensils, basins, dishes, rubber
          sheets, blankets, etc., and care for the same
          in accordance with  the  orders  in care of
          communicable diseases.
     4. Every contagious case must be reported to the
          Health Department as soon as  fully  diag-
          nosed.

          CRAMP IN THE BACK OF LEG
     1. When  possible,  have  the patient  lie  on  the
          back, elevate  the  leg so  that it is at  right
          angles with the body.   Forcibly point toes
          toward   body.    Massage   gastrocnemius
          muscle.
     2. When  the  patient  is  unable to  assume  the
          above  position, give deep  massage to  gas-
          trocnemius  muscle.

                   SINGULTUS
     1.  Encourage  deep, rhythmical  breathing.
     2.  Cause sneezing  by tickling the nose. 
FOREIGN BODY IN EYE—SPLINTERS
235
3. Grasp tongue with clean towel and pull it for-
    ward when the sensation of hiccough is felt.
4. Cause pressure on  frontal sinuses.
5. Hot water bag or mustard  plaster to epigas-
    trium.
6. Give a teaspoonful of lemon juice, heavy with
    salt.

        FOREIGN BODY IN EYE
1. Do not allow the patient to rub the injured eye.
2. Have the patient grasp the lashes, draw the lid
    away from the eyeball and downward, over
    the  lower lid, holding  it there for  a few
    seconds.
3. Keep  the  eye  closed and  blow  the nose hard,
    on the  injured  side, closing the  opposite
    nostril.
4. When  these simple measures  fail to  dislodge
    the  object, evert the upper  lid and inspect
    it in a good light.   Never remove a  speck
    from  the eyeball  or lid, with  any soiled
    article.  An  eye-glass containing warm boric
    acid  solution, may  be used to irrigate the
    eyeball.
5. If there is no relief within a half hour, see an
    oculist.

               SPLINTERS
1. When splinters are under the nails, it may be
    necessary to  cut away a part of the nail above
    the protruding end  of the splinter,  in order
    to catch hold of it.  Hold the flesh or nail 
236
NURSING TECHNIC
         firmly and remove splinter with tweezers or
         forceps,  or by threading it in the eye of a
         needle, turning the needle so as to bind it.
         Remove  quickly and apply alcohol or tincture
         of iodine.

                  HEAT STROKE
A. Symptoms:
     i.  Giddiness  and pain in  head.
     2.  Coma.  Face flushed.  Skin, hot and dry.
     3.  Pupils  dilated.
     4.  Dyspnea or sighing respiration.
B. Treatment:
     1.  Get patient into  a cool place.   Send  for a
         doctor.
     2.  Elevate head.
     3.  Loosen clothing.
     4.  Ice or cold to head.
     5.  Hose or dash cold  water on body or give cold
         tubbing,  using constant  friction on  skin.

                  POISON CASES
     1.  Send for a doctor.
     2.  Protect patient  from  injury.
     3.  Save all articles,  marks  on clothing  or skin,
         which may lead to the identification of poison
         taken.
     4.  In case the poison taken is known,  have anti-
         dote ready by the time the doctor arrives.
     5.  Gas poison cases easily develop pressure sores
         and are readily burned by the application of
         heat. 
CARE OF THE DEAD
237
               CARE  OF THE DEAD
A.  Object:
     1. To have the body straight, clean and in proper
          condition for the morgue.
B.  General instructions:
     1. Lay  out  the body as soon as  the doctor has
          pronounced the patient dead, as the muscles
          soon become stiffened.
     2. Remove  all but  two pillows to prevent the
          blood settling in the head.
     3. Straighten the covers and cover the  face with
          the sheet.
     4. See that the body is clean, especially hair and
          nails.
     5. Do not expose the  body unnecessarily.
     6. When patient is in a dying condition, report,  in
          day service,  to head-nurse, who notifies the
          doctor, relatives, minister or priest.  In night
          service,  report to night superintendent.
C. Articles necessary:
     1. Supply basket containing:
          a. Paper bag; toilet paper.
          b. Large and small stick, for packing.
          c. Non-absorbent cotton.
          d. Bandages,  roller and four-tailed.
          e. Soap, wash cloth, towels.
          /. Scissors, comb.
          g. Two  sheets.
          h. Morgue sheet,  pins.
     2. Basin of warm carbolic  solution, 2^  per cent.,
          or formaldehyde solution, 2 per cent.
     3. Laundry bag. 
238
NURSING TECHNIC
D. Method:
      i.  Remove all covers, except sheet and gown.
      2.  Bathe body with carbolic or  formaldehyde
          solution.
      3.  Comb hair.
      4.  Close eyes by placing a very small piece of
          tissue  paper or cotton under  upper lid.
      5.  Pack mouth and nose with a small amount of
          cotton.
      6.  Fasten jaw in place with four-tailed bandage
          and a  rolled towel may be placed under the
          chin in difficult cases.
      7.  Pack the vagina well with cotton and place a
          large piece of cotton over genitals.
      8.  If  a surgical  case with open  wound,  place
          cotton pad over wound, strap in place with
          wide strip of  adhesive while the body is
          still warm.
      9.  Turn the body on side,  bathe back,  pack
          rectum well, remove under and draw sheets.
          Allow  the  rubber  sheet to  remain  over
          mattress,  adjust clean  bottom  sheet  and
          morgue sheet.  Place a large piece of cotton
          under buttocks.
     10.  Cross hands over chest  and tie wrists with
          wide bandage.
     11.  Place cotton between knees and ankles and tie
          with a wide bandage.
     12.  Bring morgue sheet down over head and pin
          with a  safety pin.
     13.  Fold morgue sheet smoothly around legs, hips
          and trunk. 
CARE OF THE DEAD
239
     14. Pin  down the front and sides, with as few
          pins as necessary to hold the sheet in place.
     15. Place clean sheet over body.
     16. Fill  out one death  notice and pin it on the
          chest, just below the head, pins pointed to
          centre.
     17. Fill  out second  death notice, to be sent to
          receiving office, in envelope.
     18. Fill  out third death notice to be attached to
          yellow slip signed by doctor.
     19. All contagious cases, including epidemic forms
          of meningitis, are wrapped in  oil sheet be-
          fore morgue sheet is wrapped about body.
          The receiving office is notified to take body
          to contagious morgue.
E. Record:
     1. Hour of death.
     2. Anything unusual connected with the death. 
CHAPTER IX
                GENERAL TOPICS

 i.  The supervisor of a department is responsible for
     the general management of the ward, in accord-
     ance with the rules of the hospital and the training
     school for nurses; and is responsible for the prac-
     tical instruction and technic of the student nurses.
 2.  Head-nurses are responsible to the supervisor of the
     department  for the management  of the  wards.
 3. Any notices sent to the wards by  the hospital ad-
     ministration are to be bulletined, carried out, and
     the  superintendent of the  training school to re-
     ceive a copy of  the  same, at once.
 4. In case a patient's  discharge has been written and
     the  patient may  need nursing care after leaving
     the hospital, the supervisor will report the same to
     the head of the social service department, prior to
     the discharge of said  patient.
 5. In case of accident to any patient, a detailed report
     of the same must be written, signed by the super-
     visor and head-nurse and sent  to the  superin-
     tendent of the training  school, at once.
6. A " serious condition"  notice  is  to be  sent  out
     through the  receiving office by the supervisor or
     head-nurse.  When a student  nurse is in charge
     of a ward, this notice must be sent out through a
     supervisor.  In all instances,  this notice  must  be
     dated, timed, made out  at  once  on back of  first
     240 
GENERAL TOPICS
241
      sheet of the doctor's record on chart and signed.
 7. Requisitions for  supplies  are  to be made  only
      through the assistant in charge of the supplies.
 8. Hospital telephone service is for the business of the
      institution only.  No member of the nursing ser-
      vice is to use the  telephone for individual  pur-
      poses or to allow the patients to use the telephone.
      Student nurses, orderlies or attendants may take
      telephone messages from the patients and report
      same to the supervisor or head-nurse, who will
      transmit the same.
 9. Requisitions for diets from the diet  kitchen must
      be ready by 9 A.M. daily  for collection.  Orders
      are to  be written  and signed  by the supervisor.
      Head-nurses  must, daily,  verify  the  corrected
      lists of special orders sent from the diet kitchen
      and must see  that this special food is not allowed
      to  collect or waste. All special orders are to  be
      promptly given out to those for whom it is in-
      tended, the diet kitchen dishes  collected, returned
      to  the diet kitchen and  never  used  in  the wards
      for any purpose  other than in the care of foods.
10. The priest should be called for the  Catholic pa-
      tients at the time when  the " serious condition "
      notice is  sent, unless  the  record shows  that he
      has already been called.
II. Every student nurse  in the ward is held responsible
          for the following duties:
      a. The  general order  of the ward.
      b. The  ventilation  of  the ward.
      c. The  immediate  attention  of  the  patient's
          necessities.
     16 
242
NURSING TECHNIC
     d. To see that all food, drink, and medicines are
         promptly and properly served and kept from
         all  contamination.
     e. To   see  that accurate  records  are  made
         promptly.
     /. To  report to the head-nurse, at once, any
         unusual  condition of a patient, any mistakes
         in  treatment or medicine or other irregu-
         larities.
12.  All nurses on  duty are responsible for the collec-
     tion of passes from visitors admitted to the wards
     at any time;  no  more than  three visitors shall be
     permitted to  visit  any one patient at one time.
     Passes issued outside of visiting  hours  are good
     for five minutes only, except when  the patient
     is in a serious condition. The visiting hours are
     as follows:
         Tuesday     2-3  P.M.    7-8 P.M.
         Thursday    2-3  P.M.    7-8 P.M.
         Saturday     .........     7-8 P.M.
         Sunday     2-4  P.M..........
13.  No women patients are permitted to  go through
     corridors  or to the X-ray  department except
     when attended by a  student nurse, attendant, or
     orderly.
14.  When patient's clothes or valuables are  taken home
     by relatives or friends, the same  must be signed
     for by them  and the nurse, in the ward clothes
     book.   In case of death or irresponsibility from
     any cause, the  nurses are responsible  for  any
     valuables retained by the patient and must follow
     the rules for the care of valuables. 
ADMISSION OF PATIENTS
243
15.  In emergencies, restraints may be used at the dis-
     cretion of the nurse.  Other than times of emer-
     gency, the  nurses may  not  apply or remove
     restraints from patients without a written order
      from the doctor.
16.  Patients are not allowed to have or to keep razors,
      knives or any sharp instruments.
17.  Patients are not allowed to loiter in the corridors
      or  to leave their  wards without a permit from
      the head-nurse.
18.  Attendants and orderlies are forbidden  to wear
      gowns  through the  main  corridors  without  a
      permit from the head-nurse.
19.  Fire: When a fire alarm is sounded in  the hos-
      pital it  also  sounds  in the nurses' home.  An
      immediate response to a  fire alarm is  required
      of  every person in the nursing  service.  Learn
      the number on the boxes in connection with each
      ward.

ADMISSION  OF  PATIENTS INTO COOK COUNTY
                    HOSPITAL
  1. Patients who  are brought into the hospital by the
      police  go  directly into  the  examining  room.
      Others  pass  into  the  waiting room,  where the
      county investigator takes  the financial history.
  2. Police cases take precedence.  When a police case
      goes to the examining room, the investigator must
      be  notified,  as  no card of admission can  go
      through the receiving office without the OK from
      the investigator.
  3. In selecting  patients from the waiting room, the 
244
NURSING TECHNIC
     one who  is apparently the sickest  is given the
     preference.
4. On entering the examining room, the temperature
     of every  patient is taken.
5. Any patient who is to have a chest or abdominal
     examination made is assigned to  a booth where
     preparation is made  for  the  examining table.
6. The nurse  is always present during the examina-
     tion.
7. When the patient has been  examined and admitted
     to  the  hospital, the  assignment  to  the  ward is
     made.  A history card is filled out by the nurse
     and signed by the doctor.  Care  must be taken
     that the name  and address are correct.  This card
     is then marked OK  by the county  investigator
     and sent to the clerk in the receiving office, where
     a smaller  card is made out designating the ward,
     and this card accompanies the patient to the ward.
8. When  the  doctor is  making a physical examina-
     tion, he may or may not order the initial bath to
     be given in this department.  This also is desig-
     nated on  the history  card, together with the pa-
     tient's temperature.   The patient is  then  taken
     to the bathroom, or allowed to walk, according
     to the condition.  The  bath depends  wholly on
     the condition  of the  patient, whether bathed in
     chair, on  cart or the  table, or whether a shower
     is given.   A head shampoo is given to  all who
     receive  the initial bath.
9. The nurse in charge of  the bathroom is responsible
     for the care of clothes,  money and other valu-
     ables.  The patient is  requested to  give all money
     and jewelry to the care of the nurse,  but if un- 
RECEIVING NEW PATIENTS
     willing, a statement is signed by the patient re-
     leasing the  nurse from further  responsibility
     of the same.  After the bath the patient is imme-
     diately taken to the assigned ward.
io.  When the doctor, in examining the case, is in doubt
     as to the diagnosis, he may place  his patient in
     the observation ward from eight  to ten hours.
     If at the end of that time symptoms have devel-
     oped  more  clearly,  the  patient is  sent into the
     hospital.  If no symptoms  have developed, and
     the patient  is  in good condition,  he is released
     from hospital.

    NURSES' RULES  FOR  RECEIVING  NEW
                    PATIENTS
A.  Follow these rules in the order given:
     i.  Call junior interne (or in emergency cases, call
         senior interne) and put patient to bed, at  once.
     2.  Write on the back of patient's admission card:
         a. Nativity.
         b. Age.
         c. Occupation.
         d. How long a resident in Cook County.
         e. Civil state.
         /. How long sick.
         g. Religion.
         h. Money.
         i.  Valuables.
         j.  Disposition of clothes arid  valuables.
         k. Temperature.
         I.  Pulse.
         m. Respiration.
         n. Signature. 
246
NURSING TECHNIC
DO NOT WRITE ADDRESS OR TELEPHONE NUMBER

 3.  Write the bed  number on  the  front  of the
     admission card.
 4.  Give liquid diet, unless contraindicated.
 5.  Put patient's  bed number on diet list, unless
     otherwise ordered.
 6.  Put patient's  bed number on  four-hour  tem-
     perature list.
 7.  Clothes:
     a. When patient  comes to ward, dressed in
          own clothes, the  clothes and valuables
          are to be listed in Clothes  Book No.  1
          and signed by  the nurse  and  patient.
          When the patient is not able to  sign,  a
          second  nurse must  inspect clothes  and
          add her signature.
     b. When patient  comes to ward in hospital
          clothing, the date, name of patient, are
          to be entered in Clothes Book No. 2, and
          a statement made that the valuables and
          clothes  have been cared  for in the re-
          ceiving  department.
 8.  Money and valuables  must be  taken from the
     patients, listed in the custodian's book  and
     signed  by the  nurse receiving the same  and
     who  is responsible for it until the custodian
     receipts for  it.  When the patient turns over
     money  or valuables  to the care of the  hos-
     pital, he must  sign a statement to that effect
     and  the hospital  then' becomes  responsible
     for the same.  When  money  or valuables 
DISCHARGING PATIENTS
247
          are known to have been cared for by the po-
          lice, a record  of the same must be made in
          the  custodian's  book.    Patients  are  not
          allowed to keep  sharp instruments of  any
          kind.
     9. Make out the chart, recording:
          a.  Time of admission of patient to hospital,
               to ward.
          b.  How the patient came to  the ward.
          c.  The general condition of the patient.
          d.  The presence of pressure-sores, abrasions,
               contusions, etc.
          e.  Bath.
          /.  Disposition of clothes and valuables.
          g.  Temperature, pulse, respiration.
          h.  Diet.
          i. Attach  police record when left with  the
               admission  card  and  record  on  chart:
               " Police  record  attached."  When  no
               police record  left,  " No police record
               attached."

NURSES' RULES FOR DISCHARGING PATIENTS

1. No patient is to be discharged from the hospital until
    the discharge is written  by the interne.
2. If the patient is to be followed up by the social ser-
    vice department, notice  is  to  be sent, at  once, to
    that department.  Workers from that department
    will arrange to transfer  the patient  from the
    hospital.
3. The  court  cases  are shown  on the ward directory 
248
NURSING TECHNIC
     with a blue slip instead of a white slip.  No court
     case shall be allowed to leave the hospital  without
     due notification to the social service department.
4. The  supervisor or head-nurse makes arrangements
     for the relatives or friends to take charge of the
     discharged  patient, or arranges for the  hospital
     ambulance.
5. After a  patient's discharge is written,  the super-
     visor or head-nurse  makes out a slip, giving the
     patient's name, dates of admission and discharge,
     and sends this to the clothes room by an attendant
     or  orderly.   The clothes  are issued upon  this slip
     and is  signed  for by the one receiving the  same.
     The patient signs for the clothes in the ward book,
     where entry was made, upon admission.   When a
     patient is able to go to the custodian's office for his
     valuables, he is given a yellow card, signed by the
     supervisor or head-nurse, on which is the patient's
     name, dates of admission and discharge and num-
     ber of ward.   The custodian then_Lssiies the valu-
     ables and the patient signs for the same.   If the
     patient is unable to go to the custodian's  office, a
     nurse takes the custodian's book, receives the valu-
     ables and the  patient signs  for the same.   Any
     other valuables that  have been left in charge of
     the nurses must be returned  to  the patient before
     he leaves the hospital
6.  After a patient has left the ward, the discharge slips
     are attached to the chart, the  chart is  rearranged,
     unused  leaves  removed  and  then sent  to  the
     librarian's office. 
    WHAT STUDENT NURSES SHOULD KNOW   249

 WHAT  STUDENT  NURSES  SHOULD  KNOW
   BEFORE GOING ON JUNIOR NIGHT DUTY
 1. General instructions.
 2. Admission of  patients into  hospital.
 3. Rules  for  receiving new  patients.
 4. Rules  for  discharging patients.
 5. Care of bed utensils.
 6. Care of bathrooms, lavatories, plumbing.
 7. Care of empty beds.
 8. Care of rubber goods.
 9. General symptoms.
10. Some things  regarding  stains.
11. Order of the  ward.
12. Charting,  recording,  and  changing  records at
    midnight.
13. Taking pulse,  temperature, and  respiration.
14. To  make  up  bed patients.
15. Cleansing  baths.
16. To place and  remove bed pan.
17. Care of mouth.
18. Care of back.
19. Care of pressure sores.
20.  Care of hair.
21.  Care of nails.
22. Enemata.
23. Application of external  heat  and cold.
24. How to make a bed patient comfortable.
25.  General liquid diets.
26. Collecting various specimens.
27.  Making solutions, 
250
NURSING TECHNIC
28.  Fomentations  and hot dressings.
29.  Handling  of sterile supplies.
30.  General disinfection and sterilization.
31.  Administration of  medicines.
32.  Catheterization.
33.  Giving of  douches.
34.  Positions  and  draping  for examinations  and
     treatment.
35.  Restraints.
36.  Care of the dead.
37.  Care of isolated cases.
38.  Emergencies:
    a. Occurring  in the ward.
    b. Brought in as new patients.
39.  Gastric lavage.
40.  Transfusion.
41.  Nasal  feeding.
  Student  nurses  going on night duty in  the medical
wards  must know the following technic, in addition to
the above:
  1. Packs: hot and cold.
  2. Sponging.
  3. Alcohol sweat.
  4. Orders in care of  communicable diseases.
  5. Tubbing.
  6. Throat cultures.
  Student nurses  going on night duty in  the surgical
wards must know the following technic in addition to
the forty-one  general points:
  1. Preparation of  patient for  operation.
  2. Preparation of operation bed.
  3. Care of patient after operation.
  4. Care of dressing-room. 
GROUPS OF INJURED PERSONS
  Student  nurses going  on  night  duty after their
second month of night duty, need to know the special
nursing technic  of the department to  which they are
assigned, the difference between the junior and senior
duties, the junior and senior internes.
   ORGANIZATION  FOR HANDLING  A LARGE
         GROUP OF INJURED PERSONS
  Notice of the possibility  of a large number of in-
jured persons being brought to the hospital should be
communicated to the superintendent of nurses, at once,
in order to provide for a temporary re-arrangement of
the nursing service.  Notice should be given the wards
likely to receive such  patients.
A.  Plan:
       i.  That one supervisor act as general manager
           of the emergency, with one assistant.
       2.  That one supervisor govern extra supplies for
           all wards to which patients are sent.
       3.  That one supervisor make the general assign-
           ments of nurses.
       4.  That one supervisor or head-nurse be assigned
           to each -ward receiving emergency patients.
       5.  That the head-nurse of the ward continue as
           head-nurse of  the ward and be responsible
           for the organization of her ward, conferring
           with the supervisors in regard to extra sup-
           plies and nurses.
       6. That  patients brought to the hospital in an
           ambulance or automobile, in an unconscious
           condition,  be met at the door by orderlies
           with stretchers,  wheel chairs, blankets and
           sheets, for covering. 
252
NURSING TECHNIC
7. That as soon as the patients are brought in, a
         special package be pinned on the cloth-
         ing.   This  package to contain:
     a. One metal tag, with tape, to tie about
         neck.
     b. One paper tag, to wire to bedstead.
     c. One paper tag, to wire on clothes bundle.
     d. One envelope, to collect money and valu-
         ables in  and seal.
     e. One muslin square, to tie clothes in. The
         three tags  and envelope to carry the
         same number.
 8. That elevator  service be reserved for these
     patients only.
 9. That two janitors be provided  for continuous
     service, in wards receiving patients.
10. That one nurse be assigned to every three or
     six patients  and  be  responsible  for the
     clothes and valuables.  The clothes, without
     being listed, put into muslin   square  and
     tagged with  numbered tag in special pack-
     age ; money,  rings or other  valuables being
     placed in numbered envelope sent in special
     package, sealed.  Both of these tags should
     also  carry the name of the  nurse who was
     responsible for this attention. These clothes
     and  valuables must be given to the nurse
     whose duty  it will be to list the same.
11. That one nurse shall be made responsible  for
     the listing of valuables  and clothes, after
     first  aid has been extended  to  the  patient.
12. That one nurse be assigned to the ward dis-
     tribution of  supplies. 
GROUPS OF INJURED PERSONS
13. That two nurses be assigned for senior duties.
14. That two nurses  be assigned  to dressing or
      examining rooms.
15. That extra nurses be assigned to  relief  and
      night duty, as required to meet  the  emer-
      gency.
16. That one or two  nurses, in each ward, be
      assigned to help friends identify patients, as
      required.
17. That one person, in each ward, be assigned to
      the telephone service  and that reports of
      death be given her immediately  and other
      reports be sent in to her once each hour.
18. That one nurse be assigned to the  reports of
      patients for each three or four wards. Two
      reports for  each  ward and two reports for
      the  hospital  information  desk   shall  be
      made.   Each  ward telephone operator  and
      information shall have a report given them
      each hour.  During the hour, between the
      reports, the report nurse  shall  see each
      patient, record his condition and exchange
      the reports at  each centre, on the even hour.
      Deaths  in the  ward shall be reported to the
      ward operator and transmitted to the hos-
      pital information desk, at once.
19. That the  operating-room service be cut down
      to surgical emergency  cases,  only, in  order
      to release the  nurses in  that  department to
      meet  the special emergency.
20. That the general visiting  hours be cancelled
      in the  wards receiving emergency cases. 
254
NURSING TECHNIC
     21. That  nurse's classes  be cancelled  and such
          notice be sent to the home to be bulletined.
     22. That, in response for a general call  for the
          nurses to report on duty, they respond  at
          once and report in their regularly assigned
          wards, until reassigned by the supervisor  in
          charge of assignments or released from duty.
     23. That the night superintendent be provided, by
          the  administration,  a  list of internes who
          may be called upon, for service during the
          night.
  In such instance as it is necessary to use the psycho-
pathic building for heat cases,  or the like, in addition
to the foregoing:
     24. That  the front hall be used  as  a  receiving
          department.
     25. That a house officer be placed at the entrance
          to keep the  police and friends from  accom-
          panying the patients to the  wards.
     26. That  one  or  more  nurses  be  placed   at
          the  entrance  to supply  the identification
          packages.
     27. That one person be transferred from the gen-
          eral receiving department to this entrance,
          to make out the admittance  cards.
     28. That  one or  two nurses be assigned  to the
          entrance, to  interview officers and  friends
          as to the patient's identification;  make out
          the card of admittance and attach it to the
          police sheet obtained from the officer.
     29. That in  such instance as  the  tubs  are used,
          they be numbered. 
IN CASE OF FIRE
255
     30.  That one interne, one nurse and two orderlies
          be assigned to each tub.
     31.  That the interne  and  orderlies  remove  the
          clothes  and that the nurse be responsible
          for the same to be wrapped and tagged;
          that valuables be sealed in envelope and
          that both  tags be signed  by her.  She must
          keep a  list of the  numbered tags she has
          used and the number of the tub.  Whenever
          possible, a  record should  be made on  the
          envelope,  whether  or not the  police have
          previously cared for  valuables.

    ORGANIZATION OF  FIRE DEPARTMENT
              COOK  COUNTY HOSPITAL
1.  Chief  of Department—Warden.
2.  Assistant Chiefs—assistant wardens, chief engineer,
    fire  guards.
3.  Stand-pipe  and hose corps—one  fireguard, one  en-
    gineer,  one fireman, from power plant.
4.  Fire pump  operator—one engineer.
5.  Chemical and hand pumps—steamfitter or plumber
    on watch  and three janitors.
6.  Pipe,  pole and ax  corps—three janitors.
7.  Stretcher  and  cart corps—doctors,  nun.es  and
    orderlies.
                IN CASE  OF FIRE
A. Nurses:
     1.  Nurses in ward where fire is discovered will
         turn in fire  alarm and get  all the patients
         who can walk or in wheel chairs to a place 
256
NURSING TECHNIC
         of safety, out of the  danger zone.   Nurses
         from the nurses'  home  and  those  not  on
         duty will divide into three squads, one squad
         to report for duty at ward where alarm was
         sounded, each of the other two to adjoining
         wards  and get patients ready  for  removal
         with the greatest possible  haste and without
         any unnecessary alarm.
B. Internes:
     1.  Internes will  report directly at scene of fire
         and place all  patients on carts and stretchers -
         and remove them to the nearest ward out of
         the danger zone.
C. Orderlies:
     1.  Orderlies will bring their carts and stretchers
         from receiving ward and  find all the other
         carts that will be  needed.
D. Elevator men:
     1.  Elevator men  in section of building where fire
         is will remain at their  posts.
E. Guards:
     1.  Door guards will remain at their posts and not
         allow any person in  the building  without
         important business.
F. Engineers and firemen:
     1.  One engineer, one  fireman from  the power
         plant and one fire guard will man the stand-
         pipe hose, two men at the nozzle  and one at
         valve;  the remaining engineer places the fire
         pump in operation.
G. Other employes:
     1.  Steamfitter or plumber on watch  and  three 
IN CASE OF FIRE
257
         janitors  will man  the  chemical and  hand
         pumps.   Three janitors  will man the axes
         and pike poles, two with axes and one with
         pike pole.   All other employes on duty  at
         the time will hasten to the scene of the fire.
         Doctors, nurses and  all employes  will act
         upon orders from the fire chief in charge.
H. Switchboard operators:
     1.  Switchboard operators will notify the receiving
         office and all wards adjoining the fire zone
         and give them location of the fire when alarm
         is sounded.
I.  Fire drills:
     1.  Employes are subject to  a fire drill at any
         time.   At such times all the foregoing rules
         will be  strictly  observed.  Attaches and em-
         ployes who  refuse to respond to a fire alarm
         call and who fail to  provide  a satisfactory
         reason  will be  subject  to such  penalties  as
         the case demands.
J.  Rules:
     1.  Keep all passageways to fire escapes, exits and
         fire apparatus  clear of obstruction.  Allow
         no door to be securely  fastened. In case it
         is absolutely necessary to fasten a door notify
         the fire  chief in charge at once. Except in
         case of  fire, employes must not remove  or
         use fire  hose or other fire equipments.
                   (Signed) J.  C. McDonnell,
         Chief Fire Prevention and  Public Safety.
      Michael  Zimmer, Warden.
     17 
 
INDEX
             A

Abdomen, examination of, 199
Acids, 22
    boric,  124,  131, 184, 190,
      217,  218
    carbolic, 20-22, 29,  30,
      100,  217
    hydrochloric, 25
    oxalic, 24, 26
    strong and weak, 22
Admission  of  patients  to
  Cook  County  Hospital,
  243-245
Albolene, 72, 124
Alcohol, 20-22, 27, 125, 128
Ammonia, 22-25
Anterior poliomyelitis,  19
Antitoxin, administration of,
  173, 174
Apomorphine,  171
Argyrol, 26
Arsenic, 170-172
Atropine sulphate, 171

              B

Back, care of, 128
Back-rest, to place, 111
Balsam  of Peru, 131
Basins,  cleaning of, 13-21
Baths, 47, 77,  !39, 162
    cleansing, 47~54
    bed-bath,  48-50
    tub-bath, 50, 51
    slab-bath,  51-53
    shower-bath, 53
    child's bath, 72-74
    infant's bath,  74-77
Baths for elimination, 61-72
    alcohol sweat, 68-70
    hot  air, 66-68
Baths, hot pack, 64-66
    hot tub, 62-64
    medicated, 69, 70
    sweat bath, 70-72
Baths  in  hyperpyrexia,  54~6*
    cold pack, 59
    tepid  pack, 58, 59
    warm pack, 57,  58
    sponge bath,  55—57
    tubbing, 59-61
Bath-rooms, care of, I3> M
Bath-tubs, cleaning of,  14
Bath-water,  disinfection  of,
  20,  21
Bed, to make an empty, 31-42
    to make an occupied, 91-
      95
    to make when linen is not
      to be changed, 97
    utensils, 11, 13,  15
Beds, 28-46
    air, 18, 42, 43
    airing, 11
    carbolizing empty, 29, 30
    cleaning empty, 28, 29
    empty, 11
    fracture, 43, 44
    in line, 12
    infected with vermin, 30
    Klondike,  45, 46
    operation, 44, 45
    water, 42,  43
 Bed-pans, 12,  14,  15, 21
    to place and remove, 90,
       91
 Beef peptonoids,  131
 Benzine,  26
 Bichloride of mercury,  19, 22,
   26, 30,  54, 170,  184,  189, 190
 Binders,  192-195
    scultetus,  192,  193
                    259 
26o
INDEX
Binders, straight,  for abdo-
      men,  192, 193
    straight, for chest, iyj,
      193
    T, for perineum,  192, 193
    triangular,  194,  195
Blood,  174
    stains, 22, 23
Brandy, 171
Rrushes, 21


              C
Caffeine sodium benzoate,  171
Camphor,  spirits of, 27
Camphorated oil,  22, 27,  171
Cantharides, 162, 167
Carbolic acid, 20,  21, 22,  29,
  30, 190, 217
Carbonate of soda, 25
Carron oil, 26
Castor  oil, 78,  129,  131,  139,
  159
Catheterization, 209-212
Charting,  79^82
Chest, examination of, 197-
  199
Children, 21
Chlorinated lime, 20
     soda solution, 15, 22,  23,
      24, 25, 26
Chloroform, 22
Coffee  stains on linen, 27
Cold, external application  of,
   133-136
Collodion,  173,  174, 223
Comfort of patient, 31, 43, 47,
  61, 91, 125,  128, 132, 133,  192
Comfortable, methods  of
  making  patient.  105-125
Communicable  diseases, care
  in, 10-21
Compresses, cold,  134
     for the eyes, 219, 220
Convulsions,  232,  233
Counter-irritants,  162-169
Cramp in  back of leg, 234
Cream of  tartar, 25
Croton  oil,  159
Croup tent, 180,  181

              D

Dakin's solution,  190
Dead, care  of, 237-23^
Decubita, 130, 131
Department of health, 19
Digitalis,  170, 171
Digitaline,  171
Discharges  from  nose and
  throat,  21
Dishes, care of,  in communi-
  cable diseases. 21
Disinfection,  chemical, 18
    of hands, 189
Dobell's solution,  124, 217
Douche, external,  205
    vaginal, 206-209
    vesical, 212, 213
Draping for dorsal and knee-
      chest position, 203
    Sim's, and  standing,  202,
      203
Dressing  room, 182-224
    duties of nurses,  182-184
Dressings, application of  hot,
      20-i, 205
    of  hot, tor eye, 219

              E
Ear,  irrigation  of, 216, 217
Emesis basins, cleaning of, 14
       containing  vomitus, 15
Emergencies, 230-236
Enemata, 98-104
    antiseptic, 98
    anthelmintic, 98
    astringent, 98, 104
    carminative,  102, 103
    colonic flushing,  99-101
    emollient, 98, 103
    milk  and molasses, 102
    nutritive, 98, 103,  104
    purgative, oil, 1-2-3, 102
    sedative, 98, 104
    stimulating,  98,  104 
INDEX
261
Enteroclysis, 98, 104
Epidemic meningitis,  19
Ergot, 170,  172
Ether, 171
Examination of abdomen, 199
    of chest,  197-199
    lower extremities, 199, 200
    of rectal,  200
    of throat,  195-197
    of vaginal, 200-202
Excretions, 19
Eyes, 146, 147
    application  of  medicine
      to, 215
    cold  compresses for, 219,
      220
    foreign body in, 235
    hot  dressings  for,  219
    irrigation of,  213-215

               F

 Faucets,  13, 14, 106
 Feces, 23, 151, 152, 226, 228
 Feeding patients,  136-138,
   139, 141,  177,  178
 Fire  department, organization
   of, 255-257
 Flaxseed poultice, 166
 Flies, 19
 Fomentations,  162, 163
 Formaldehyde solution, 16, 18,
   190
 Formalin, 20, 21, 190
 Fowler's position,  113
 Fractures,  handling  patients
   after, 121
 Fruit stains on linen, 23

               G

 Garbage, 21
 Gavage,  176
 General topics, 240-243
       accidents to  patients,
         240
       fire,  255
       patient's clothes, 242
       requisitions,  241
General  topics,  responsibili-
        ties of  students, 241,
        242
      restraints, 243
      serious  condition
        notice, 240, 241
      social  service  depart-
        ment, 240
      telephone service, 241
      ward management,  240
Gloves, rubber,  19
Glue, 24
Glycerine,  217
Gown, to change, 95-97
Grass stain, 24
Grease, 24
Green soap, 20,  191

              H

Hair, care of, 125, 139
Hands,  20, 26, 89,  123,  128,
      162, 207
     distinfection of,  189
Heat, external  application of,
       132, 133
     dry, 163
     moist, 163
     stroke, 236
Hemorrhage, handling pa-
      tients with, 121,  122
     arterial, 233, 234
     capillary, 233, 234
     venous, 233, 234
Hoppers, cleaning of, 13
Housekeeping,  11-28
Hot water-bag, 18
Hyoscine  hydrobromides,  171
Hypodermic,  140
     injections,  169-173
     syringe, to clean,  173
Hyperdermoclysis, 220-222

              I

 Ice-bags, 18, 21, 135
 Ice-caps, 18,  135
 Ice-coil, 18, 135, 136 
262                       INDEX
Inhalations, steam,  179-181
      croup tent, 180,  181
      pitcher  and towel
        method,  180
      tea kettle and cone
        method,  180
Ink, black, 24
    eradicator, 24
    indelible,  24
    red, 24
Insomnia,  145
Intravenous infusion, 223, 224
Inunctions, 160, 161
Iodine, 25, 131., 167,  206
Iron, 172
    and potassium chlorate,
      217
    rust, 25
Irrigation  of  ear, 216,  217
    of eye, 213-215
    of mouth and throat, 217,
      218
    of nose, 218
Isolating patients, 234


              J
Junior  night  duty,  what stu-
  dents  should know  before
  going on, 249-251

              K

Klondike bed, 45, 46

              L

Lubarraque's  solution,  22
Lanolin, 19,  125
Larkspur,  tincture for pedic-
  uli,  127
Lavage, 174-176
Lavatories, care  of, 13, 14
Lemon juice, 24, 25,  124
Linen,  care  of,  in  communi-
  cable  diseases, 20
Liniments, 162
Liquor  cresol compound, 14,
   15
Listerine, 124
Locke's solution, 191
Lower extremities,  examina-
  tion  of, 199,  200
Lunar  caustic,  19
Lysol,  191, 206

             M

Measles, 19
Medicinal topics, 158-181
Medicines, on linen, 25
    rules for giving,  158-160
Meningitis,  epidemic,  19
Mildew,  25
Morphine sulphate,  171
Mouth, care of,  122-125
    irrigation of. 217, 218
Mustard, 70
    plaster,  164-166

             N
Nails,  care of,  128
Nasal  feeding, 177,  178
Nitroglycerine,  171
Nose,  discharges from, 21
    irrigation of, 218
Nurse basket,  contents  of, 78

              O
Oil, camphorated, 22, 27, 171
    carron, 26
    castor,  78,  120,  131,  139,
       159
    cedar preparation, 30
    croton, 159
    on linen, 26
    on marble, 26
    olive, 22, 27, 164
    sweet, 22
Organization of  fire depart-
       ment, 255-257
    for   handling   a   large
       group of  injured  per-
       sons,  251-255
Order of the  ward, 11-13 
INDEX
263
              P
Paint,  26
Patients,  method of  making
      comfortable, 105-121
    to lift and carry,  106-108
    to lift toward  head   of
      bed, 108, 109
    to lift an injured leg  or
      arm,  109
    to undress  a  patient  in
      bed, no
    to dress a patient in bed,
       no, in
    to move patient from one
       side of bed to the other,
       113
    to turn patient without a
       draw sheet,  113, 114
    to turn  a patient  with a
       draw  sheet, 114
    to turn  patient with lift-
       ing  sheet, 114,  115
    to get patient up in chair,
       115, 116
    to move patient from one
       bed to another,  116, 117
    to change or  turn  mat-
       tress  with  patient  in
       bed, 117
    position of,  143, 144
 Pediculi on  body,  53,  54
    on hair, 125
    on head, 127
 Percentage table, 192
 Peroxide  of hydrogen,  23,
   124, 131, 217
 Phenol,  30, 190
 Phlebotomy, 222, 223
 Pillows, to change, 95
    readjust, 112,  113
 Pilocarpine  hydrochloride,
   171
 Plumbing, care of, 14, 15
 Poison cases, 236
 Positions and draping for ex-
   amination,  195-203
 Positions, dorsal, 202
    lithotomy, 202
Positions, knee-chest, 202
    Sim's, 202, 203
    standing,  203
    Trendelenburg, 203
Potassium  iodide solution,  26
    permanganate solution, 24,
      26, 131, 206, 217
Poultices,  162
    flaxseed,  166
Powders, 131
    bismuth, 131
    boric acid, 131
    lycopodium, 131
    stearate  of zinc,  131
    talcum, 131
Preparation of  surgical cases,
  I39-I4I
Pressure sores,  47,  128, 130,
  131
Pulse, 82, 84, 140, 154,  155
    to count, 89, 90

              Q
Quassia tincture for pediculi,
  127
Quinine, 170, 172

              R
Recording, 79-82
Rectal tubes, 21
Rectum, examination of,  200
Respiration,  82, 84, 85,  153
    artificial, 230-232
    to count, 90
Restraining patients, 117-121
Rigors, 157
Rubber goods, care of, 16, 18
      chemical disinfection
        of, 18
      drying and  putting
        away, 18,  19
      sheets, 16, 175
      sterilization of, 18
Rubefacients, 162
Rules,  nurses'  for  receiving
        new patients, 245-247
      for  discharging  pa-
        tients, 247, 248 
264
INDEX
Salt, 22, 24,  25
Scarlet  fever, 19
Set bowels, cleaning of,  13
Shampoo,  bed,  126,  127
    tub,  127
Shock,  55
Silver  nitrate, 26
Sinapism, 164
Singultus,  234,  235
Sinks,  cleaning  of,  13
Siphon, 61
Sleep  and  rest for  patient,
  105,  106
Slings, 194, 195
Small-pox,  vaccination
  against, 19
Smears,  vaginal, 228, 229
Solutions,  pouring of, 188
      189-192
    bichloride, 189
    boric acid, 190
    carbolic, 190
    Dakin's, 190
    formaldehyde, 190
    green soap, 191
    Locke's, 191
    lysol, 191
    potassium permanganate,
      206
    sal soda, 13,  15, 24,  25
    saline,  normal,   124, 131,
      140,  191,  206, 217, 218,
      222
      stock,  191
    soda bicarbonate, 18, 22,
      124,  217, 218
    table, 191
Specimen,  bottle, 179, 225, 230
    feces, 226, 228
    sputum,  225, 228
    stomach  contents, 225,
      228
    urine,  225,  227
    vomitus,  15
Spiritus  frumenti, 140
Splinters, 235, 236
Sprains, handling patients
  with,  122
Sputum, 151, 225, 228
    cups, 15
Stains,  22-27
Starch paste, 23-25
Steam inhalations, 170-181
Sterilizer,  bed-pan, 14
Sterilizing rubber goods, 16
Stomach contents, 225, 228
    tube, 174, 175
Stools,  disinfection of, 20, 21
Strychnia  nitrate,  171
    sulphate, 171
Stupes,  162
    turpentine, 164
Supplies, sterile, 184-189
    handling of,  186-188
    preparation of, 185, 186
Surgical cases,  care  of,  be-
  fore  and  after operation,
  130-141
Suppositories,  161, 162
Symptoms, objective, 142-155
    abdomen, 149
    appetite, 144
    bones, 150
    eyes, 146, 147
    face, 146
    feces,  151, 152
    general, 142,  143
    hands and  feet, 148
    mental condition, 144
    mouth, 147, 148
    muscles,  149
    position, 143,  144
    pulse,  154, 155
    respiration,  155
    restlessness, 144
    skin, 145,  146
    sleep and insomnia, 145
    sputum, 151
    temperature,  153,  154
    tongue, 148
    throat, 148
    urine,  152, 153
    voice,  148
    vomitus,  150,  151 
INDEX
265
Symptoms, subjective, 156,157
      chills or rigors, 157
      general, 156
      pain, 156, 157
      special senses, 157
Syncope, 232
Syphilis, when caring for, 19


              T

Table, percentage,  192
    solution,  191
Tar, 24
Tea,  stain on linen,  27
Temperature, 82, 83, 106,  140,
       141, 146
    charts, 79
    to take, 85-87
       by axilla, 88, 89
       by mouth, 87, 88
       by rectum, 88
Test  meals, 178, 179
Thermometers,  21
Throat,  195-197
    cultures,  229
    discharges  from, 21
Tinctures, benzoin compound,
       131
    iodine, 167
     larkspur, 127
     myrrh, 131
     quassia, 127
Toilets,  13
Triangular bandage,  120, 194,

   195
Tuberculosis, 19, 146, 149
 Tubbing,  59-61
 Tubes, rectal, 21
Turpentine,  140, 162, 164
Typhoid, 151, 152, 153
    carriers,  19
    vaccination against, 19

             U

Utility rooms, care of, 13, 14
Urinals,  12,  14,  15, 21
Urine, 152, 153
    disinfection of, 20
    specimens of, 162, 225, 227

              V

Vaccination against smallpox,
      19
    against typhoid,  19
Vagina,  examination of, 200-
  202
Vaginal  smears, 228,  229
Vaseline, 125, 166
Venesection, 223, 224
Ventilation,  n, 12,  106
Vermin, in beds, 30
Vesicants,  162, 167-169
Vinegar, 24
Visitors, 21
Voice, 106, 148
Vomitus, 15, 150, 151

              W
Wash basins, care of, 15
Waste  cans,  cleaning  of, 14
Water,  sterile, 206
Window shades, n,  13

              Z

Zinc oxide  ointment,  17, 131 
 
 
 
 
 
 
 
 
MJV
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