BEST ANSWERS.

Kai Tiaki : the journal of the nurses of New Zealand, Volume II, Issue 2, 1 April 1909, Page 50

BEST ANSWERS.

No. 1.

Coma is caused by : (1) Drugs; as alcohol, opium, and other poisons ; (2) Fits ; apoplexy, epilepsy, also hysteria (similates) fainting: (3) Head injuries or diseases ; compression, concussion, tumour, etc.: (4) Sunstroke : (5) Suffocation ; by water, gas or smoke : (6) Shock ; electric, etc. ; (7) Anaesthetics : (8) Diabetes : (9) Uraemia. Apoplexy : The patient, usually past middle life, falls suddenly, the face becomes congested! and flushed, the eyes are unequally dilated, one only reacting to light. Temperature will be raised, pulse full and bounding. Respiration : Slow, stertorous. Breath may possibly smell of alcoho], the patient having previously taken some, and very often it has been administered by the first person who saw him. One side of the patient 's body will be paralysed, also one side of the face, and should the haemorrhage be on the left side of the brain, the power of speech will be lost. Put patient in bed in a warm room, give him plenty of fresh air. Raise the head slightly, turning it on one side to prevent suffocation and to relieve stertor. Protect from falling out of bed. Administer croton oil, m.i, or m.ii if so ordered. Remove false teeth and examine for and treat any injuries sustained by the fall. Make and keep patient thoroughly clean, as urine and faeces will probably be passed unconsciously, necessitating extreme care of the back, and perhaps constant changing of the bed, which must be well protected by long macintosh. Draw macintosh and sheet while patient is unconscious, avoid giving nourishment by mouth, and later, when he can swallow, restrict him for some time to liquids. Take and record temperature, pulse, and respiration regularly, four -hourly at first, and keep bowels well opened each day. Attend to general health and comfort of patient, guarding carefully against bed-sores, especially in affected parts. Later, massage

and other treatment may be resorted to to restore the affected muscles. Heat must be applied with extreme care (hot tins to feet, etc.), as there is extreme danger of burning. Avoid stimulants. ~$ 0t 2. — Typhoid Fever. Symptoms : First the patient complains of listlessness, drowsiness (especially during the day), headache, anorexia, and general malaise. The temperature and pulse may be slightly above normal. As the attack comes on the temperature is noticed to go up two degrees at night, falling one degree in the morning. Pulse anel respiration also become accelerated. Position : Flat on back. Epistaxis, bronchitis, indigestion, constipation, and possibly retention of urine, are often present. Later, constipation gives place to diarrhoea, stools being the typical " pea-soup ' ' consistency. Delirium comes on. Spots appear in successive crops on the abdomen or back. The tongue becomes dry and brown, sores form on the teeth and lips, and unless improvement sets in, the patient falls into the " typhoid " state : when he picks at the bedclothes, sinks down in bed, passes urine and faeces under him, pulse becomes rapid and weak, and respiration may be " CheyneStokes." Nursing treatment : Keep patient at perfect rest in bed, forbidding any movement, all of which must be done for him extremely carefully. Atmosphere warm, fresh air but not draughts. Windows and doors must be guarded if patient delirious. The bed should be narrow and accessible, the mattress fairly firm, and it is desirable to have a second bed or couch in the room. Patient's clothes (light and warm) are best opened right down the back. Diet : This is a point about which there is a great difference of opinion ; but a nurse's duty consists in carrying out, conscientiously and exactly the doctor's orders. Probably liquid diet — milk (z5), diluted with barley, soda, or plain boiled water (z3), strained beef tea — will be given two-hourly during the acute stage. Chicken broth, custard, beaten eggs, arrowroot, leading gradually on to hght diet, according to state of patient. General treatment comprises attention to the general health and cleanliness of patient ; guarding against bed-sores by thorough cleanliness of back and bed, and constant slight alteration of position, which decreases tendency to hypostatic pneumonia.

Extreme care in handling patient, especially abdomen. Care of mouth and tongue — glycerine and borax, etc. Thorough disinfection of everything connected with patient : urine, faeces, soiled linen, etc.; also nurse's hands, for which purpose a basin of disinfectant should be kept by the bed. Take and record temperature, pulse, and respiration four-hourly, reporting any suspicious changes at once. Sponging fourhourly, or even cold packs or cold baths may be ordered to reduce temperature, allay delirium, and promote sleep, or remove perspiration. Alcohol is administered only under doctor's orders ; usually given towards the end of the illness. Watch for, and withhold if symptoms of internal haemorrhage appear. Drugs, too, are given as ordered, for relief of symptoms, or perhaps to act as disinfectants of the alimentary track. Watch for undigested curd in stools, or blood. Complications : (1) haemorrhage, (2) relapse, (3) retention, (4) perforation anel peritonitis, (5) hypostatic pneumonia, (6) thrombosis. No. 4 — Pneumonia. Symptoms : Rigor, or feeling of chilliness, followed by sudden rise in temperature (103 deg. 105 deg.). Rapid increase in pulse, which may go up to 120 deg. per minute. Very rapid respiration (40-60 per minute) is one of the most marked symptoms. Anorexia, malaise, hstlessness, flushed face, bright eyes, working nostrils, dry brown tongue, and excessive thirst, scanty concentrated urine, constipation, perhaps sickness, sordes on lips and teeth, cough dry and hard at first, then followed by rusty-coloured — or prune-juice — blood-stained expectoration. Nursing Treatment : Keep at rest in bed, head and shoulders raised, in a very wellventilated room, protecting from actual draughts. Flannel nightdress and singlet, open down back. Fresh air and oxygen, the last obtained naturally or artificially, are of the greatest importance in treating pneumonia. Prevent movement, especially sitting or rising up suddenly, on part of patient, as there is great danger of heart failure. Pay attention to general cleanliness and health of patient. Back to be well washed and rubbed to prevent bed-sores. Teeth and tongue to be swabbed with glycerine and borax, lemon, etc. Constantly keep bowels well open, and watch state and quantity of urine. Take

and record temperature, pulse, anel respiration four-hourly till temp, normal at least a week. Sponge four-hourly if temperature over 102 deg. (as ordered). This also promotes sleep and lessens delirium. Alcoho], administered by doctor's orders when the state of the pulse indicates its use, is used more freely during this illness on account of its short duration. Drugs may be ordered to relieve symptoms, when it will be the nurse's duty to see that they are administered exactly when, and as, ordered. Watch patient carefully if delirious ; also watch for symptoms of overdose alcohol, heart failure, cyanosis, etc.; also false and true crisis, night sweats. Diet : Liquid during acute stage. About 3pts. milk and Ipt. beef tea in the 24 hours. Administer milk 5oz., water 3oz., two-hourly ; beef tea half -pint , twice daily. Give plenty of water to relieve thirst, lemon water, etc. Increase gradually, with doctor's orders, to light diet, as temperature remains normal. Complications : Heart failure, pleurisy and empyaema, bronchitis, tympanitis, jaundice, gangrene of lung.