State Examinations of Nurses and Midwives
The State Examinations of nurses and midwives took place on 6th and 7th of December. The centres for the Examinations m general nursing were Wellington, Auckland. Christchurch, Dunedin, Wanganui, New Plymouth, Napier, Greymouth. The questions for the medical paper were as follows : — 1. Describe the symptoms, complications, and treatment of erysipelas. With what diseases might it be mistaken ? 2. How would you distinguish hsematemesis from haemoptysis ? What are the causes of melena ? Describe the symptoms of duodenal ulcer. 3. In what diseases or conditions do the following occur :■ — (a.) Convulsions — (i) partial, (ii) general, (b.) Vertigo. (c.) Unconsciousness. (d.) Delirium. (c.) (Edema— (i) local, (ii) general. 4. Describe the symptoms of the morphia habit, and its treatment. 5. How would you diet a patient suffering from any of the following diseases or conditions : — (a.) Obesity. (b.) Consumption. (c.) Diabetes. (d.) The bilious temperament. (c.) Chronic constipation. (f.) Nephritis, acute or chronic. 6. Describe fully the causes and symptoms of simple aneemia (chlorosis). The comments of the examiner, published below, are of special interest, inasmuch as a letter from one training school was sent to the Registrar of Nurses protesting against the questions as being beyond the scope which should be expected of nurses. The protestors, we think, lost sight of the fact that questions set for such an examination may be answered from two standpoints; that of the medical student and that of the nurse, and m the latter case the answer appropriate for the former would not be expected by any sane examiner.
The examiner writes : — ■ "I have an excellent report to forward this year oji the nurses' papers m the medical examination. The paper was evidently right into the nurses' hands -the answers given were of a particularly high standard, and showed thorough knowledge and careful training. Five nurses obtained over ninety per cent., and forty-two over seventyfive per cent. There were also very few nurses who lost marks through carelessness m the arrangement of their answers and papers , but when an examiner thinks he has finished marking question ] , and then comes on to the second part of it, a week later, among the leaves of question G, he naturally notes that paper as a careless one and off comes a mark. I noted with surprise that quite a number left a blank opposite the question re diet for obesity; could it be that they did not understand the term, for surely it is only a matter of common sense to a nurse to advise at least the avoidance of fats, butter and cream. Such outstanding points are usually the ones that give the most marks, and it is foolish to leave blanks where a very short answer gives full marks. Question I.— re erysipelas was very well answered, the majority obtaining well over 75 per cent, on it. I publish the answer of number seventy-four, but many others were equally good. Only one answer was really poor, number eighty-two. Question 2. — Distinguish hsematemesis from hsemoptysis. Causes of melena. Symptoms of duodenal ulcer. This was also well answered. Number twent}'-three obtained full marks ; her answer is published. The poorest was number sixty-four. Question 3. — In what diseases or conditions do the following occur :• — (a.) Convulsions (partial or general) ; (b.) Vertigo ; (c.) Unconsciousness ; (d.) Delirium ; (c.) (Edema (local and general). This was not answered so well as some of the others, the two best answers being from number sixty and number nine. The weak points were convulsions, and vertigo, also localized cedema ; some made the mistake of calling a collection of fluid within a
cavity, such as ascites, hydrocephalus, etc., oedema. The poorest answers were from numbers eighty-two, ... eighty-four, eightyfive. . Question 4.- -The symptoms and treatment of the morphia habit. This question was practically well answered, quite a large number getting full marks. I have difficulty m choosing the best answer for publication, but perhaps number seven was the most descriptive and the best arranged. A fair number made the mistake of describing only the symptoms of an overdose of morphia. Except for number ninety-seven, whose answer was a blank ? number eighteen was the poorest. Question 5. — Diet for the following diseases or conditions : (a.) Obesity ; (b.) Consumption ; (c.) Diabetes ; (d.) Bilious temperament ; (c. ) chronic constipation ; (f.) Nephritis. This question was intelligently answered, most of the nurses showing a very thorough knowledge of the dieting of patients The one chosen as best from many good ones, is number thirty-eight. It would be unfair to mention the poorest, because even it was a very good answer. Question 6. — Anaemia. I am particularly pleased to be able to report that this was the best answered question m the whole paper. The reason for my pleasure, of course, is obvious, many of the conditions causing this disease are preventible, and depend on the sanitary arrangement of schools, homes, factories and places of amusement, where the youth of our girls is spent, also upon the work to which they are put m their early days, and as the whole future health and stamina of the nation depends largely on the health of its mothers, I was pleased to recognise that our nurses would go out into the world equipped with this knowledge, and able to advise mothers as to the care of their young daughters m avoiding this disease. Even m the best answered papers there was a little confusion as between cause and effect, e.g., disorders of menstruation were put down as cause instead of result, and constipation as result rather than cause. Number sixty is published as the best, but there were many equally good. Unfortunately two nurses did not answer the question, and if they have gone through
a course of four years training without knowing anything at all about the causes or symptoms of anwmia, I should say that their own brains and nervous system must be suffering from that self-same disease. Otherwise the poorest answer was number seventy-seven, but even so she obtained more than half marks, and the answer was distinctly good. Question 2. by No. 23 Haemoptysis : (a.) ... -; By history of lung trouble. Blood coughed up. Usually bright red May be mixed Avith sputum Feeling of distress m the chest Haemoptysis is rarely followed by inalena Blood from the lungs is alkaline m reaction. (b.) Hsematemesis : By history of abdominal trouble, especially gastric Blood is vomited May be bright, but is usually dark (coffeegrounds) May be mixed with food Feeling of heaviness m epigastium and nausea Hsematemesis often followed by malena Blood from stomach is a,cid m reaction (c) The causes of Helena are: 1 — 1. Duodenal ulcer 2. Action of certain poison :* — (a.) Phosphorus; (c.) Arsenic 3. May get melena m gastric ulcer 4. Cancer of bowel 5. Typhoid fever 6. Hsemorrhagic type of scarlet fever 7. Haemorrhagic type of small pox 8. Scurvy 9. Haemophitta 10. Purpura 11. Yellow atroph of liver 12. After operative interference 13. Rupture of Haemorrhoids The symptoms of duodenal ulcer : 1. Pain m right hypochrondriac region, which is relieved by the taking of food, the pain being due to the presence of gastric juice. Pain of duodenal ulcer is known as the- " hunger pain." Patient often wakes m early morning
complaining of pain. Pain comes on about three hours after food. 2. Melena 3. May be vomiting if ulcer is high up m duodenum 4. Tenderness m right hypochrondriac region 5. If haemorrhage profuse patient may show signs of internal haemorrhage. 1 . Increasing pallor of skin and mucus membrane 2. Respirations rapid, gasping (airhunger) 3. Pulse rapid, weak, wiry 4. Subnormal temperature 5. Patient is bathed m a cold, clammy perspiration 6*. Pupils semi-dilated 7. Plashes of light before eyes 8. Restlessness 9. Vomiting 6. — Perforation This may be indicated by its occurance after a meal, after heavy exercise or vomit ing. Symptoms 1. Sudden severe pain 2. Abdominal distention and tenderness o. Rigidity of abdomen, especially right rectus 4. Vomiting 5, Face livid, anxious, nose pinched, eyes sunken 7. Pulse rapid weak 8. Respiration rapid shallow thoracic 9. Skin cold and clammy 10. Collapse If not relieved general peritonitis will follow with fatal results. Question 1 Erysipelas. Symptoms : — Erysipelas being an acute infectious disease caused by a germ which enters the body through an abrasion m some mucous surface, the patient suffering from the above will probably be able to give a history of a cut at the point of infection. The onset of the disease is sudden. The local symptoms are : — The area becomes inflamed, swollen, painful and dusky red m appearance. A rash appears, browny m character and spreads rapidly with a well-defined edge. Blobs may appear later on the surface. The temperature rapidly
rises to 101 or 102° F., and remains at a high level reaching 105° F. often, until the disease has run its course. The pulse is accelarated, full ; later becomes weaker and irregular. The respiration may become rapid and laboured if the disease infects the throat. The disease is generally ushered m by a rigor, and the patient may complain of headache, nausea and malaise for a few days. Constipation is a usual symptom ; diarrhoea generally m children. The urine is scanty, high coloured, and may contain albumin. The tongue is furred, dry, and brown ; later cracked. If complicating a wound the stitches become tight and the area painful. Complications : — Embolism ; thrombus ; septicaemia ; pysemia ; peritonitis, hsemorrhage ; recurrence of attack ; pneumonia ; pleurisy ; ulceration of larynx with respiratory failure ; iritis ; conjunctivitis ; middle ear disease ; delirium ; coma. Treatment :— Put the patient at once to bed m a well-ventilated room, free from draughts, and keep at an even temperature, 05° F. (about). Put on a four-hourly chart, record pulse, temperature and respirations. Measure and record and test urine. If an open wound is the source of iufection, open it up, put m drainage tubes and apply hot fomentations, four-hourly or oftener. Aim at strict pesepsis. Paint the outside margin of the rash with tincture and liniment of iodine, equal parts, to prevent spreading. Then a wide area of Ichthyol and glycerine, 5 % about, and a half -inch margin of 20 % of Ichthyol and glycerine. Do not allow this near enough to enter the wound. If occurring on the face or head, shave hair and apply same treatment. The ears should be carefully swabbed and plugged with cotton wool, watching for discharge. The nose, if affected, is treated with douches boracic solution. The eyes are a very important item. They are bathed frequently with boracic lotion and if any infection, argyrol is instilled. When bathing, the eye, not being treated, mustbe covered with a swab of sterile wool or gauze. A mask is usually worn by the patient, who is strictly isolated. AIJ dishes, brooms, mops, etc., kept for his use only. The nurse must wear a gown anil mask and gargle her throat and scrub her hands frequently after touching patient.
The general condition of the patient is treated with daily saline purgatives of mag., sulph., etc., and his bowels opened with a simple enema, if necessary. The urine is tested frequently for albumin, and report made to physician. The throat, if infected, is treated with gargles and foments, if necessary. The tongue is cleaned with glycerine and borax or lemon, and tJbe moutn most carefully washed after drinks, as it is through this orifice that infection travels to the throat. Stimulants are generally ordered, such as whisky half ounce, four-hourly; strychnine 1-30 — 1 *60 grain, four-hourly ; and cardiac failure Avatchcd for. The diet m the acut e stage is mostly milk, water m plenty, albumen- water, barleywater, beaten egg, the object being to give plenty of fluid to eliminate the tocsins from the body. Fluid is given two hourly. Salines are given if the patient is unable to take food by mouth. Later the diet is increased and should be nourishing with plenty of eggs (if no albumin m urine), custards, fish, and later the patient is put on a full diet. For hyperpyrexia the patient is given a hot or warm soapy sponge four-hourly, the back and the bony prominences being carefully treated with spirits and* powders, to prevent bedsores occurring. Antiseptics may be ordered— aspirin, 10 grs. to 20 grs. or quinine, 5 grs. to 10 grs. For pain morphia may be given. Phenacitin is often ordered. For insomnia sponging will usually suffice, but the physician may order a hypnotic. The patient must have fresh-air m plenty, and during convalescence great care taken to prevent a relapse occurring. Erysipelas may be mistaken for cellulitis, septicaemia, orchitis (m testicle). Question 3 by No. 60. (a) 2. — ln children convulsions may occur as follows : — Teething Phimosis Rickets When tonsils (enlarged) and adenoids are causing disorder In ear trouble — earache At the onset of infectious fevers As a preliminary symptom of nervous irritation, i.e., infantile paralysis
Indigestion and any gastric or intestinal disorder Worms Also m :— strychnine poisoning Later stages of other poisonings Epilepsy (major) Jacksonian epilepsy Hysteria Tetanus Cerebro-spinal meningitis In later stages of shock and collapse Concussion Compression Tubercular meningitis Any injury to central nervous system Uraemia Toxaemia (b.) Extreme debility or exhaustion caused by illness Shock or excitement Over- strain, especially under unhygienic conditions Haemorrhage Nervousness or worry ex. before an impending operation Injury A prodromal symptom of most illnesses Local anaesthesia Vomit ing, especially ansesthet ie sickness In heart disease (c.) Under an anaesthetic Apoplexy Concussion Compression In advanced stages of shock and collapse Hysteria Asphyxia (may be caused by drowning, the inhalation of gases, foreign body, etc) Alcoholic and other poisoning — opium Diabetic coma Uraemia Epilepsy Injury to central nervous system Also may occur as a result of extreme worry 3 fright, haemorrhage causing syncope, also anaemia (d.) Delirium tremens In pneumonia There may be delirium at night m scarlet fever and other fevers or illness where there is high temperature
Pneumonia Typhoid Post operative delirium Delirium cordis m heart cases at night In mental disease, i.e., insanity (c [i]) In heart disease oedema may be local, and confined to the feet or legs or hands, oedema of the brain ; this may also occur after cerebral operations In kidney disease oedema may be local, and confined to face and eyes Malignant oedema oedema of the larynx Centre of area of part affected by erysipelas In varicose condition of the legs oedema of the various organs, such as the lungs Burns and scalds Cellulitis Local injury may cause oedema m part below injury. In cardiac disease Kidney disease Malignant oedema may become general Disease of the liver In advanced tuberculosis Any interference with the natural return of blood to the heart In paralytic conditions
Question 4, by No. 7. The symptoms of the morphia habit are : Sallow complexion. Emaciation of body. Thin hands with tapering finger nails. Loss of appetite. Dryness of the mouthy Thirst. Constipation. Irritability of temper. Great weakness of mind. Excitability and suspicion of others. Intense desire for the drug at frequent intervals, when the patient passes, after a short interval of drowsiness, into a deep sleep, and the following are noticed : Contraction of the pupils of the eye. Slow, regular pulse. Slow, irregular breathing ; may be stertorous. Retention of urine. On awakening there is calmness of mind, the patient is apt to indulge m reminisences and imaginations. Renewed vigor of body
and exhilaration is experienced, but this lasts but a short time, and the craving for the drug soon manifests itself again. Treatment : If habit is of short duration, Stop the drug. Isolate the patient. Give nourishing food. Watch carefully. Keep bowels regular. Injections of sterile water. If habit is of long duration : Gradually decrease the drug without the patient's knowledge, making up the deficiency with sterile water. Isolate. Watch carefully day and night, as morphia patients are very cunning and will do anything to procure the drug. Keep as quiet as possible. Occupy their minds by various methods, such as reading. Allow no friends near. Give nourishing food, and anything fancied . Toon and mix vomica are usually ordered.
Question 4, by No. 18 Patients suffering from morphia habit have a craving, irritable mental state. After having had a dose of morphia they are at once calm, even before perhaps the hypodermic needle has been removed from the skin, before it has had the possible time to act. In treating such patients they are kept interested m things apart from their illness. Question 5, by No. 38. (a.) Obesity. Food cut down m quantity and quality. Avoid : Pure starches, fats, alcohol. No fluids taken with meals. Breakfast : Little toast, boiled or poached egg, fruit. Dinner : Lean meat, green vegetables, very small amount of potato. Cheese and dry biscuit. Tea: Dry toast or stale bread, small amount of steamed fish ; salad or fruit. Drinks : Weak tea, lemon drinks, plain water, toast and water. Very little fluids.
(c.) Constipation. Drink of water first thing m the morning ; fruit eaten first thing m the morning. Breakfast : Coarse porridge with cream ; fat bacon, fresh fruit brown bread, coffee. Dinner : Clear soup, little meat, plenty of green vegetables, little potato ; stewed fruit with cream. Tea. Brown bread and butter, salads, fruits, weak tea, plenty of water to drink.
By No. 38. (b.) Consumption. Feed patient as well as their digestive powers will allow. Small meals and frequent . Diet, if possible, of a fatty nature. If diarrhoea present will need milk diet . Allowed . Thick soup, fat bacon, red meat, fresh cream, butter, green vegetables, milk pudding, plenty of milk to drink, eggs (of all kinds). Not too much carbohydrates, heavy wines, porter, etc. Breakfast. Porridge and cream ; fish or bacon, eggs ; plenty of milk to drink. Dinner . Thick soup, fish or meat, any vegetables, milk pudding with cream. Tea. Poached egg on toast, or omelette, if fancied ; tea or milk, bread and butter ; preserves with cream. Extra meals. Gruels, bread and milk, cocoa, glass porter. (c.) Diabetes. Food should be weighed before serving and also any that remains after meal. Allowed. Eggs, fish, meat, bacon, clear soup, bovril, green vegetables, especially spinach, lettuce, salads made oil, cream, some fruits, lemons, apples, custards, jellies, sweetened with saccatrine ; tea, coffee with cream and saccatrine ; gluten bread, almond biscuits, cheese. Avoid. Ordinary bread, pure starches, cereals, too much milk, thick soups. Allowed. — plenty of water to drink.
Breakfast. Bacon and egg, gluten bread, tea sweetened with saccharine and with cream. Dinner . Cup clear soup, chop, green vegetables (small potato), jelly with cream, or cheese with biscuit. Tea. Gluten bread or toast, fish, lettuce, tea or coffee. Doctor visually orders a fast day once a fortnight, m which only water is drunk, and bovril or whisky is ordered if any signs of collapse. Urine should be tested for sugar and acetones. Try and reduce sugar by cutting down cardohydrates. If any acetones present diet must not be too rigid. (d.) Bilious Temperament. Plenty of water to drink. Juice of a lemon drank m early morning. Avoid : Twice cooked meats, curries, spiced food, liver, brain, etc.; pastry, new bread, excessive fats and sugar, alcohol. Allowed : Stale bread, green vegetables, milk pudding, lean meats, bacon, lightly cooked egg, boiled or steamed fish. (f.) Nephritis (Acute). Fluid Diet. Milk and water, milk, barley water, soda water, chicken or mutton broth, lemon drinks, imperial drinks, oatmeal drinks, plenty of water to drink. Avoid Coffee, beef tea, stimulating soups, all nitrogenous food. Later. Bread and milk, bread and butter, boiled fish, milk pudding, white meat. Nephritis (Chronic). Allowed. Fish, white meat, milk pudding, bread and butter, broths, plenty of water to drink. Avoid. Red meats, curries, liver, eggs, all stimulating and nitrogenous foods. Question 6, by No. 60. Unhygienic surroundings, i.e., badly ventilated rooms with very little sunlight, etc..
accompanied by sedentary habits and poor food are the chief causes of anaemia ; especially so if the patient has to spend many hours a day at work under conditions such as described above. Under the best of conditions, however, overstudy or overwork may cause anaemia, especially if the patient is not of robust strength. Anaemia may follow an exhausting illness or operation. Disorders m menstruation, such as dysmen orrheea, menorrhagia, very frequently a cause of anaemia. Irregular habits, such as late hours at night, depriving the patient of plenty of sleep ; insufficient clothing, not taking regular meals of nourishing, simple food, may also lead to an anaemic condition ; decayed teeth. Increasing debility, loss of weight, pallor of the skin and mucous membranes, the face has a greeny tinge ; indigestion, anorexia. Fainting fits may occur frequently. Brcathlessness, especially after slight exercise. There is generally constipation, general malaise, headache, nausea, vomiting, etc., may occur. There i ■ generally headache present, at times severe. The pulse is easily accelerated, especially after slight excitement or exercise.
The questions m the surgical paper were as follows : — 1. Give fully the nursing details for the first twenty-four hours of the treatment of a patient just returning from the operating-theatre after undergoing an abdominal operation. What complications may occur, and how would you combat them ? 2. A patient enters the hospital suffering from a compound fracture of the tibia. Describe how you would arrange the bed and undress and clean the patient. What splints, dressings, etc., would you have ready for the surgeon ? 3. Describe the main signs and symptoms of a patient suffering from a ruptured ectopic gestation. What would you have ready for an intravenous injection of saline, and what strength would you prepare the saline ? 4. If a patient were brought into hospital unconscious, how would you tell
whether he was suffering from apoplexy or a fracture of the base of the skull through the middle fossa ? Enumerate the chief symptoms of each. 5. A patient is suffering from a fracture dislocation of the spine m the region of the first lumbar vertebra. What would be the local and general symptoms of such an injury ? How would you treat such a patient, and what complications would you guard against ? 6. Describe the formation of an ulcer. What are the chief causes of ulceration of the leg, and the different methods of treatment of a varicose ulcer ? The comments of the examiner are printed below and also the paper of No. 75, selected as generally the best. On the whole the questions have been answered very satisfactorily, particularly the part of the paper relating to treatment I have given greatest attention and the most credit to the " treatment " part of the paper. Several points struck me which I think it would be as well for the nurses to try and remedy. (1.) These two sentences explain themselves : ' The patient may be unable to pass urine, m that case would have to be catherised." (2.) The other sentence : "If complaining of severe pain, a hyperdermic injection of morphia may be given." In the first sentence the nurse does not describe an attempt to make a patient pass water as a good nurse should, nor m the second sentence does the nurse describe how to ease a patient's pain. Of course, no credit would be given for such sentences, m fact the examiner would be inclined to deduct marks from the rest of the answer. (2.) Another point is that some nurses put m unnecessary padding, and describe mattersunasked for. The result is only irritating and confusing to the examiner. (3.) Some have been slipshod m their method of expression. For instance, it is not quite correct to say " for hiccoughs, pull out the tongue." It would be better to say "pull forward." Again, "the patient must be lifted all m one piece " could be better expressed. (4.) Many nurses are very careless about stops and the commencement of sentences. They run one fact into another without t he slightest regardtothe elementary
rules of composition. It often makes a decided difference m marks if the composition is bad and the facts are all jumbled up together. Surgical Paper by No. 75 Question I. (a.) Patient brought back from the theatre and placed m a previously warmed bed. Blankets placed next skin . and if suffering severely from shock, hotwater bags may be placed m the bed outside the first blanket, to guard against the risk of burns. Blocks may be placed under foot of bed. He must not be left until fully conscious, tongue forceps must be handy, also a bowl m case he vomits. Careful watch must be kept on the pulse. Head turned on one side. Saline may be ordered to be given either continuous or interrupted per rectum ; if general condition low, may be given subcutaneously or intravenously. A binder must be placed over the dressings and applied firmly for support. Quiet essential for patient. Temperature, pulse, and respiration to be taken and recorded four -hourly, pulse hourly if necessary. Careful watch must be kept for either external (evidenced by blood on the dressings) or internal haemorrhage. Mouth may be frequently washed out after patient is conscious, and drinks of water may be given when vomiting ceases. When patient out of the anaesthetic he may be placed m the position he is to be nursed m; this is usually " Fowler's.' 1 Patient sits up m bed, well supported by pillows, knees flexed over suitable pillow and sandbag placed at his feet to prevent him slipping down. If urine is not passed within twelve hours after, other means failing, preparations must be made for catheterisation. A specimen of the urine to be saved and tested. Before patient settles down for the night he may be given a hot, soapy sponge bath ; it will make him comfortable and help to induce sleep. If much pain surgeon will probably allow some sedative or hypnotic to be given. Rectal Saline will be given six ounces four-hourly, unless otherwise ordered. At the end of the first twenty-four hours, if the patient complains of much abdominal discomfort, a turpentine enema may be given unless contra-indicated. If vomiting ceased or there has not been any, give hourly
drinks barley water, albumen water, lemon drink, etc., but do not give pure milk at first, as not easily digested after an anaesthetic. (b.) Complications which might arise : Tympanites. — Pass a rectse tube, if after twenty-four hours alum or turpentine or glycerine enema may be given. Shock. — Keep patient thoroughly warm, bandage limbs tightly towards trunk. Stimulants given if no f err of haemorrhage either hypodermic or by mouth. Free administration of salines. Thirst. — Salines per rectum. Sips of hot water. Plenty of drinks if no vomiting. Vomiting. — Usually occurs within the first twenty-four hours ; no special means taken to stop it unless persistent. Mustard leaf may be applied to epigastrum. Iced champagne half-ounce may be given ; iodine tinct. m.t. m water, four or twohourly. Haemorrhage. — lf external send for surgeon, apply more dressing ; treat for shock. No stimulants. Keep patient quiet . Retention of Urine .— Apply hot bag or hot fomentations over bladder and phineum ; place warm bed-pan containing warm water under patient. If this fails, catheterise. 2 (a.) Preparation of bed. On the wire mattress place fracture boards to keep mattress firm. Get fracture mattress made m three parts, divided transversely to facilitate nursing of patient . Place on mattress blanket, sheet, mackintosh, and draw sheet Over this have dark blanket ready for patient to be placed on, also several hotwater bags. (b) Treatment of Patient. — Now get patient on to bed, one nurse supporting the injured limb. When on the bed, if temporary splints on, that is all right, but if not, place limb between sandbags. Take patient's temperature, pulse and respiration, at the same time ascertain if patient suffering much from shock. Keep warm. If condition will allow, start to undress him, and while doing so enquire how long since bowels have moved and urine been passed, as preparation may have to be made for catheterisation. Remove the garments from sound limb first, if necessary cut up the seams of the clothes. ' One nurse must support the injured limb all the time; a
clean dressing (aseptic dressing) placed over the wound. Watch for haemorrhage. Now the patient may be sponged over with hot water, not attempting to clean the injured limb until arrival of surgeon. Do not give any nourishment by mouth. Get patient's particulars according to rules of hospital. Remove dark blanket from under patient by drawing from the top to the bottom of the bed. Place a wire cradle over injured limb and put on usual top bed clothes. If suffering severely from shock, salines may be given. (c.) Preparations for surgeon : Dressing Tray. — All articles, except scissors, sterilised by boiling ;bowls containing sterile, swabs, gauze, and wool ; dressing, forceps, scissors, probe, methylated spirits, hydrogen, peroxide, etc. Shaving Tray. — Razor, scissors, hot water, ethereal soap, cotton wool, and paper. An anaesthetic will probably be given for the dressing and application of splints. Patient may require an enema. The anaesthetist will bring all he requires. Have a table ready with the following articles on it ; — Back splint, with or without foot piece, may be used, splint padded ; two pieces of plain board and draw sheet to make a boxsplint ; bandages for ties for splint ; gooching for local splinting m case needed ; safety pins ; strapping or adhesive plaster ; cotton wool ; tape measure ; bandages ; methylated spirits, and some dusting powder, bran bags, small, and sandbags. 3. Signs and symptoms of a patient suffering from a ruptured ectopic gestation. (a) Patient would give history which would aid diagnosis, as cessation of menstruation for some weeks , changes m br east s , etc., history of acute abdominal pain, also shoots down leg on side affected. There would be a discharge, either slight or more profuse, of blood from vagina. Face pale. Skin cold and clammy, and covered with sweat. Dimness of vision. Subnormal temperature. Sighing respirations, thoracic breathing. Pulse rapid and feeble. Abdomen may be distended and rigid. Paleness of mucous membranes. Great thirst. Restlessness. Preparation for an intravenous injection of saline.
Hypodermic syringe charged with cocaine or other drug ordered for deadening pain m arm. Place a mackintosh and draw a dressing sheet under the arm. Have a bandage ready, drawn up or remove the nightgown sleeve and paint area m front of elbow with iodine. Have beside bed hypodermic syringe, strychnine and pituitrin, also whisky. Prepare, by sterilising, the following : — + Glass funnel ; rubber tubing, glass connection ; metal or glass cannula ; aneurysm needle ; artery forceps, three, dissecting one pair ; three pint jugs with graduated scale ; silk worm gut and silk ; bowls ; dressing tray. These may be boiled for ten minutes, or longer if not wanted urgently. Place m pure carbolic or lysol for ten minutes one scalpel ; one pair small scissors ; one cutting needle. Rinse m cold sterile water. Place these articles on the sterile tray. Have one jug of saline double strength, cold. Another jug boiling water and one jug empty to mix saline to correct strength and heat. Cold sterile water must be ready, also bowl of hot water to stand jug of saline m. Bath theimometer wanted to be kept m jug. lodine, cotton wool swabs ; gauze and wool for dressing arm or collodion. Saline should flow into vein temperature cf 100°-105° F. Strength of Saline. — Normal salt solution, sodium chloride, 1 drachm to sterile water, 1 pint used. (b) Symptoms of Apoplexy. Unconsciousness, m severe case. Pulse full, usually slow. Breathing sterterous. may be cheyne-stokes m character. Pupils may react to light, may or may not be equal, sometimes contracted. Paralysis of one side of body or portion of body. Retention or incontinence of urine and faeces. Reflexes may be absent. May be twitching of muscles. Temperature may be raised or sub-normal. May get previous history of nephrites. ■ Symptoms of fracture of base of skull. Unconsciousness may be complete — coma. Symptoms of compression present. May be bleeding or discharge of cerebro- spinal fluid from nose and ears . . Ret ent ion of urine. Constipation. May be incontinence.
Temperature usually elevated. Breathing very slow and stertorous. Pulse slow and full. May be signs of an external wound. Portion of bone may be depressed. Pupils usually unequal and do not react to light L May be erepitus. If a patient were brought into hospital unconscious suffering from apoplexy there would not be any signs of external bleeding or discharge from nose and ears as there might be m the case of fracture of the skull. In a case of apoplexy there would probably be a history of it occcurring suddenly and without any obvious reason. In a case of fracture of the skull there would be history of an accident or injury. Local symptoms fracture of spine m region first lumbar vertebra. — Inequality of spine. Crepitus. Unnatural mobility at seat of fracture. General Symptoms. — Paralysis of body below seat of fracture. Retention of urine, afterwards incontinence of urine and fseces. Anaesthesia of skin below seat of fracture. Treatment of Patient. — Careful nursing required. Patient nursed on fracture bed consisting of fracture mattress divided transversely m three pieces, and flat long boards under mattress. If possible nurse on an air or water bed. Patient must h a ve daily sponge bath . Temperat ure, pulse, and respiration taken and recorded four-hourly for first few days after injury, then twice daily. Bowels kept well open, by purge or better, m case like this, by enemata. Catheterise at regular intervals using strict asepsis, this most necessary ; patients bladder very easily gets septic. Urine tested regularly, especially for albumin and pus. Care of Back. — With regard to bedsores, which so easily form m these cases, great care is needed. Patient turned on to side for this treatment. Must have assistance n moving him and roll over, holding shoulders and hips. Wash back carefully, using warm water and good soap ; massage hips and buttocks gently, dry, rub with alcohol and use a good dusting powder as zinc and starch. This treatment may be given fourhourly. If air or water bed cannot be procured, an air cushion or water pillow may be placed under buttocks, with surgeon's permission. Change draw sheet as
soon as soiled, and keep free from crumbs and wrinkles. Diet. — 'Fluid, if pyrexia, gradually assuming a light, easily digested diet. Give hourly drinks, water, barley water, to assist m maintaining healthy condition of kidneys. Never place hot-water bag near patient's skin ; is easily burnt. Complications to be guarded against : 1. Urinary sepsis, cystitis, pus tracking up ulcer to kidney, forming surgical kidney. 2. Bedsores. 3. Lung complications— Hypostatic pneumonia. Pleurisy. 4. Shock. 5. Exhaustion, physical. 6. An ulcer is formed by the molecular death of tissue on a free surface, either skin or mucous membrane. (b) Chief causes of ulceration of the leg. 1. Imperfect nerve supply. 2. Imperfect blood supply. 3. Pressure from badly padded splints. 4. Varicose veins. 5. Constitutional diseases, as tubercle or syphilis. 6. Chemical action. 7. Burns or scalds. 8. Traumatism or injury. (c) Different methods of treatment of a varicose ulcer. Constitutional Treatment. ■ — Improvement of general health. Diaphoretics and purgatives. Rest m bed. Fresh-air. Tonics. Good food. Local Treatment. — Elevation of the limb. Biers congestive treatment. Application of stimulants. Saline irrigation ; redlotion. Main object to get to a healthy healing sore. Rub up with nitrate of silver or sulphate of copper. Dress with strips of green protective tissue over wound, and outside this dry gauze or lint soaked m boracic lotion, when ulcer has reached the stage of healing.
There were 99 candidates for the Examination and the following is the result published, only four having completely failed ; — -
name. training school. Passed First — Pearce, Olive L. M. . . Auckland The following Nurses obtained 75 per cent, or over — Godfrey, CM. . . Wellington Lancaster, W. E. . . „ Law, Jessie R. . . „ Mence, Effie . . Taylor, Gertrude M. . . MacWhinney, Margaret . . Greytown McNab, Mary . . Christchurch Goulstone, Lucy B. . . Gorman, Catherine . . Jull, Annie M. . . Cookson, Althea A. . . Allen, Elizabeth S. . . Dunedin Patersen, Catherine A. Haggart, Annie J. . . „ Anderson, Mary . . „ Alexander, Lilian M. . . Brown, Emma T. M. . . Oamaru Cussen, Alice V. M. . . Auckland Whitehouse, Daisy I. Hilditch, Ethel M. . . Waikato Lewis, Edith H. '. . Waihi Cronin, Rubi P. . . Napier Smale, Violet C. . . „ Taylor, Emily M. . . Wanganui Tame, Elaine . . Timaru The remaining Nurses were also successful— Gilliver, Margaret . . Wellington Lampp, Gertrude S. . . MacNicol, S. C. Punter, Rosamund . . Williams, Beatrice F. . . Neilson, Nettie . . Wairau Knyvett, Edith . . Nelson Mettam, Lavinia . . New Plymouth Patchell, Annie . . Kennedy, Hilda Alice Barleyman, E. M. . . Hawera ODea, Bridget . . Ongley, Monica . . Traynor, Eleanor . . Christchurch Chapmab, Pansy . . Manson, Alice . . Stanford, Gerti*ude O. Tait, Helen Francis . . Binnie, Caroline . . Smith, Katherin^ . . »
NAME. TRAINING SCHOOL. Withell, Ada S. . . Ashburton Copeland, Margaret . . Dunedin Saunders, Florence Ada . . „ Gray, Isabel Portecus, Jessie M. . . Riverton Davis, Lilian P. . . Auckland Brown, Frances A. . . „ Clark, Florence . . Gardener, Gloretta . . „ Bidwell, Laura . . Webb, Mathar . . „ Vos, Mabel W. Montgomery, Vivienne . . „ Bannister, Mary . . „ Stronach, Gwendoline E. Kerr, Marjorie Forbes . . Small, Elspeth Primrose . . „ Wallace, Caroline M. . . Gisborne McFadgen, Ellen . . Waikato Scherer, Freda G. . . Thames Gubb, Maud K. . . Hokianga Brabant, Amy L. . . Waihi Philpot, Lilan . . Whangarei Jewiss, Amy . . Denholm, Mrs. Esther . . Napier Bbwe, Elizabeth . . Murphy, Elizabeth . . Wanganui Gillin, Veronica . . „ Peterson, Hilda B. . . Palmerston North Smale. Myrtle Ruahine . . „ Dolph, Mary . . Greymouth Luff, Lilian V. . . Westport Murray, Isabel A. . . „ Hamilton, Annie . . Westland Chittenden, Delia . . Palmerston North Trask, Henrietta C. Marsh, Alice May . . Hawera Gedney, Ethel I. . . Southland Avery, Emily . . Wairau Arnold, Harriet . . Timaru Flanagan, Elsie M. . . Masterton The following Nurses obtained a Partial Pass — Pope, Elizabeth . . Masterton Passed Oral Franklin. Amelia 0. .. Christchurch „ Oral and Medical King, Nora Brindley Dunedin Medical Muir, Agnes . . Riverton Medical and Surgical MeCaw. Isabel T. .. Southland „ Medical and Surgical Hughan, Pearl ..Wellington „ Oral
Permanent link to this item
https://paperspast.natlib.govt.nz/periodicals/KT19170101.2.37
Bibliographic details
Kai Tiaki : the journal of the nurses of New Zealand, Volume X, Issue 1, 1 January 1917, Page 36
Word Count
6,258State Examinations of Nurses and Midwives Kai Tiaki : the journal of the nurses of New Zealand, Volume X, Issue 1, 1 January 1917, Page 36
Using This Item
The New Zealand Nurses Organisation is the copyright owner for Kai Tiaki: the journal of the nurses of New Zealand. You will need to get their consent to reproduce in-copyright material from this journal. For advice on reproduction of out-of-copyright material from this journal, please refer to the Copyright guide.