BEST ANSWERS

Kai Tiaki : the journal of the nurses of New Zealand, Volume II, Issue 2, 1 April 1909, Page 52

BEST ANSWERS

No. 1. The patient should have daily hot baths for some days previous to the operation, if he is able, if not daily spongings in bed. Especial attention be given to the lower part of abdomen. The bladder should be syphoned out with boracic lotion two or three times a day, for some days previous to operation. Bowels should be regulated, and given a light, generous diet, and put under as good hygienic conditions as possible. On the afternoon before the day of operation, the patient should have an aperient. The lower part of abdomen, pubes, and perinaeum should be shaved.

The part is now prepared for operation. Have ready on tray beside patient : hot sterile water, biniodide of mercury lotion, aseptic dabs, lint, gutta-percha tissue, ethereal soap, turpentine and bandage, sterile guards. Sterilise your own hands. Get someone to turn down blankets, and to expose operation area. Surround with guards. Wash well with ethereal r.oap and sterile water. Wash off soap with sterile water. Rub quickly with turpentine, taking care not to burn the skin. Wash off with sterile water and soap. Re-sterilise your own hands. Rub well with ethereal soap. Wash off with sterile water. Wash with 1-500 biniodide of mercury solution. Wash with sterile water. Cover prepared parts with sterile lint wrung out of 1-2,000 biniodide of mercury. Cover with the gutta percha tissue and bandage on. The skin of abdomen perinaeum, and all surrounding parts, must be cleansed for this operation. After this preparation put clean nightshirt on patient and leave for the night. Try to secure him a good night's rest if possible. About four hours before operation an enema of soap and water should be given, and not less than three hours before, a cup of beef tea or other easily digested fluid should be given. No solid food should be taken if the operation takes place in the morning ; if operation later in the day, a ligh-: breakfast might be given, bread and milk, etc. A good plan to give a nutrient enema half hour before operation to keep up strength. About three hours before operation the preparation of parts is repeated. Some surgeons prefer the moist aseptic pad to be now replaced by a dry sterile towel. Before going to the theatre the patient is warmly clad. The nurse sees that the clothing is loose, and that any false teeth are removed. After treatment.— The patient should be brought back carefully from theatre, avoid jolting. Watch breathing and pulse. Have bed warmed with hot bottles. Lift him carefully into bed. If any vomiting, turn head to one side. Do not leave him until he is out of anaesthetic. If breathing should stop, pull out tongue and apply artificial respiration. Send for the doctor. If the patient suffers from shock, saline enemata will be given. If vomiting is very severe-, drinks of hot water (about half a pint at a time) may be given, or soda bi-carb. gr. 15

given with it. Essence of peppermint, 20 elrops on a lump of sugar, slowly sucked, gives relief sometimes. Strong coffee, or lumps of ice swalloweel whole, sometimes given. If none of these arrest the vomiting the doctor may order the stomach to be washed out by means of a stomach tube ; or mustard leaf may be applied to the epigastorum. The patient must be kept dry. Dressings changed frequently as required. The bladder will probably be drained by glass and indiarubber tubing into a basin by bedside. Bladder may be syphoned out once or twice daily, more often if tubing becomes blocked. Towards end of week tube may be removed. Recorel of temperature, pulse, and respiration must be kept. Fluid diet for first few days ; light food, as milk puddings, etc. later. Doctor's orders carefully carried out. Complications, as cellulitis and uraemia, looked for. No. 2. " Instruments required for operation for appendicitis " — ■ Two scapels, one pair angular scissors, one pair curved scissors, one nee die -holder, six needles of various sizes, two retractors, two blunt hooks, one probe, one director, three aneurism needles, one blunt dissector, twelve Spencer- Wells artery forceps, one sinus, one pair toothed dissecting forceps, one pair plain dissecting forceps, four sponge holders, bladder sound and catheter, pedicle needle, intestinal clamps, intestinal needles, two pairs large haemostatic forceps, eye curette, hernia needle often useful. No. 3. Have bed ready, with fracture board and fracture mattress. Put patient on to bed, moving the injured limbs as little as possible. Remove clothes from broken leg : first by splitting the trousers along the seam, and slipping them from under the leg ; cut off the boot and sock if not able to remove them easily. Arrest haemorrhage, if any present, by pressure ; ligature, etc. Sterilise wound and surroundings by washing round wound with ethereal soap. The doctor would probably flush out the wound with some strong antiseptic — 1-1000 perchloride of mercury, or 1-2000 biniodide of mercury — then dressing would be applied to wound. Some sutures might be required, or drainage tube inserted if wound large.

While this was being done the leg must be held in position by assistant, to prevent the ends of the bone doing further damage. The doctor would now set the fracture, probably using back and side splints with foot piece ; or box splint might be used. The leg would then be supported by a pillow, and steadied by sandbags on either side. Care must be taken to see that the splints are properly padded, and that there is no pressure on the heel or mallioh, or splint sores will result. The splints and bandages are so arranged that the wound can be easily inspected. If the wound can be made aseptic, it will heal about as quickly as a simple fracture. The bandages must be watched for the first few days to see that they are not too tight, afterwards to see that they are not too loose. Care must be exercised when examining the leg, during bed-making and use of bedpan, that leg is not disturbed by too much movement. Bed-sores must be watched for and avoided, also splint sores. In about three weeks to a month, if the bone has united satisfactorily, the leg may be put up in plaster of Paris, and the patient allowed to get about on crutches. Usually well united by end of two months ; but patient must take care of it for some time. Wasting of muscle treated • by electricity massage and stimulating liniments. If the wound becomes septic boracic fomentations will be applied frequently ; doctor may order wound to be syringed with some antiseptic : as peroxide of hydrogen. Symptoms of sepsis : Rise of temperature about second or third day, with pain and throbbing in wound. Inflamed appearance of edges on wound itself. No. 4. Shock is a severe depression, or lowering of the vital powers, due to excessive nerve energy, and is more severe when the sympathetic nerve system is affected. The depression is chiefly caused by exhaustion of the vaso motor nerves centre. Symptoms of Shock : Increasing pallor of face, cold perspiration, extremities cold, pupils dilated, pulse and respirations rapid and feeble. The senses are dulled, or there may be unconsciousness. Nursing anel Treatment : Place in warm bed. Hot bottles. Foot of bed raised on blocke, no pillow under head. Saline enemata ldr. to a pint of sterile water at a tem-

perature of 103 deg. Fah. to 105 deg. Fah. 4oz. given half-hourly. Brandy or strong coffee may be combined with these. Surgeon sometimes injects saline solution at temp, of 105 deg. Fah., either into vein or intercellular tissues. Digit alin, 1 -100 th gr., and strychnine sulph. l- r oth gr. may be given. If the pain is very severe and prolonging the shock, morphia may be ordered and combined with atrophine 1100 th - 100 th gr. Stimulants may be given by mouth if the patient can take them ; but care must be taken not to carry stimulation too far, as more harm may be done than good when reaction sets m. If patient can take nourishment, give fluids ; otherwise nutrient enemata must be resorted to if shock is prolonged. Sometimes the legs are elevated, or bandaged spirally upwards, from foot to thigh.