State Examinations

Kai Tiaki : the journal of the nurses of New Zealand, Volume XII, Issue 3, 1 July 1919, Page 129

State Examinations

Tho State Examination of Midwifes was held on the 11th and 12th of June. The result, which is just to hand, is as follows : — ■ There were 43 candidates, 39 of whom passed. One passed oral only, and 3 failed. Passed First. St. Helens Hospital, Auckland. — Almena I. R. White. Obtained 75 Per Cent. And Over. !St. Helens Hospital, Christchurch. — Bertha Eliza Hight, Gwynneth S. Field, Winifred M. Bowron (R.N".). St. Helens Hospital, Invercargill. — Grace Ballantyne, Ellen Duff, Nettie Neilson (R.N.) Townley St. Helens, Gtisborne. — Gertrude Cato, Mrs. Julia Fahey, Clarice M. Emerson. McHardy Maternity Home, Napier. — Blanche E. Wright (R.N.), Rhoda W. T. Walker (R.N.), Edith Harrison (R.N.). Salvation Army Maternity Home, Napier.— . Grace B. Stevens. St. Helens Hospital, Auckland. — Lucy B. Goulstone (R.N.), Ellen F. McKay, Mrs. Nan Massicks, Eliz. j. Armour. Hospital, Whangahei. — Hilda B. Hogwood (R.N), Dora Alice Roberts (R.N.). St. Helens Hospital, Wellington. — Violet A. Kelly (R.N.). Hilda Wright, Louisa C. Tyrrell, Mary Rowe, Nell M. McClea (R.N.), Lottie M. Earp (R.N.), Ruth H. Leach. St. Helens Hospital, Dunedin. — Beatrice H. Kendall, Ruby Lodge, Eliz. Campbell. Batchelor Maternity Hospital, Dunedin — Anna Coppin (R.N.), Georgina Milne. Alexandra Home, Wellington. — Sarah G. McMillan, Agnes S. Davidson, Mabel Little (R.N.). The following were also successful : — Essex Maternity Home, Christchurch. — -Annie Nelson. St. Helens Hospital, Wellington. — Lilian M. Young. St. Helens Hospital, Dunedin. — Catherine Me Alpine, Agnes J. Baird. The following obtained a partial pass : — St. Helens Hospital, Wellington. — Hoi on Flower (written). Tho questions m the written paper were :• — 1 . How would you prepare : — (a.) A saline injection ? (b.) Nutrient enemata ? 2. Describe the signs and symptoms of phlegmasia alba dolens, and give the treatment. 3. Name and differentiate between the different kinds of haemorrhage met with m pregnancy. 4. What are the duties of a maternity nurse when called to a confinement ? 5. How would you prepare artificial food for an infant from birth until the third month ? (5. What is ophthalmia ? Describe the different kinds, and give their treatment. Tho comments of the examiner, Dr. Owen Jones, of Auckland, which are most valuable for future candidates, run : — ■ It was a pleasure to examine candidates' answers to the questions m the written paper

set at the recent state examination for midwives. One felt more convinced than ever of the high standard of training given at the various St. Helens Hospitals. [Editor's Note. — These remarks apply also to the candidates from other maternity training schools of which the examiner may not have been aware.] Nearly all the candidates did very well ; their answers were methodically and neatly written, and showed a thorough grasp of the matter m hand. I would like, however, to point out a few hints to future candidates. They should read over the directions and the questions carefully before commencing their answers. "Answers must be brief and to the point.'* Some answers were not brief, and were far from V being to the point." For instance, — ■ several nurses m describing the preparation of nutrient enemata, made use of soap and water as the ingredients. Then again, an examiner does not like to have the patient referred to as " pt." As to the different kinds of haemorrhage met with m pregnancy, one candidate gave a very elaborate description of post partum haemorrhage, and omitted to refer to abortion, cctopic pregnancy, etc. The question, " How would you prepare artificial food for an infant from birth until the third month, was well answered by a 11. Nurses at St. Helens evidently learn all about humanised milk. A few nusres forgot to give directions as to quantities and strength at the various ages. They were satisfied with just writing : Humanised milk No. 1 ; humanised milk No. 2 ; and then giving m full, directions for making up. No mention as to kind of feeding bottle, care of bottle and teat, etc. May I quote m full three answers, which I consider were very good :■ — ■ Question 0. — What is ophthalmia ? Describe the different kinds, and give their treatment : — ■ Ophthalmia is inflammation of the conjunctiva of the eye. Simple ophthalmia, m which tho eye is inflamed and swollen, and there is a watery discharge. 1. Nurse must thoroughly scrub her hands. 2. Carefully bathe affected eye with a warm lotion, e.g., a weak solution of biniodide followed by boracic lotion. 3. Instil one drop of sol. silver nitrate, I per cent., m eye. 4. Bathe 4-hourly, or more often, if necessary.

Ophthalmia neonatorum 1. Symptoms usually appear soon after birth. 2. Eye is inflamed and swollen. 3. There is a copious purulent discharge, which wells up between the closed lids. 4. There may be constitutional symptoms, such as rise of temperature and increased pulse rate. Fretfulness. Treatment. 1. Isolation. 2. Nurse must wear gown, and sterile rubber gloves. 3. All swabs, etc., must be burned. 4. If only one eye is infected, first treat the good eye and cover. 5. Place child on knees, holding it with its face towards you, head hanging down a little ; and have a dish on the floor to catch lotion. 6. Carefully clean away all discharge with cotton wool swabs and warm boracic lotion. 7. Gently pour lotion into eye m a continuous stream. 8. Dry well, and instil 1 drop solution silver nitrate, 1 per cent. 1). Keep eye lightly covered. 10. Treat every hour (using silver nitrato only twice daily) until eye improves. Then 2 hourly, 4 hourly, etc. 11. Keep child warm and well nourished. Question 1.- — How would you prepare: — (a) A saline injection ? (b) Nutrient enemata ? (a) Preparation of a saline injection. To prepare the saline : — 1 drachm of common salt to one pint of water. Boil for 10 minutes, and strain. Articles required. — -Small enamel jug containing the saline. Funnel with rubber tubing attached. The tubing connected with rubber catheter No. 12 by a glass connexion. These arbicles to bo boiled, placed m a basin, carried with the jug of saline on a dressing tray to the bedside. A little vaseline or olive oil will be required to lubricate the end of the catheter. The saline should be at a temperature of 105 degrees F. Test with bath thermometer. (b) Preparation of a nutrient enema : — Must be m a liquid form and never exceed 6 ozs. The following ingredients should be mixed togther :— 4 ozs. of peptonised milk ; . 1 oz. of beef tea ; 1 egg ; J oz. of brandy may bo added if ordered.

The mixture should be strained, and heated to a temperature of 100 degrees F.

The same articles aro required for the giving of a nutrient enema as for a rectal injection of saline, and should be prepared m the same way. if patient not able to retain the enema well, tincture of opium (10 minims) may bo added to the prepared mixture.

Question 2. — Describe the signs and symptoms of phlegmasia alba dolens, and

give the treatment. Signs and^Symptoms of phlegmasia albadolens: —

Local. — Painful swelling of one or more veins of the leg ; usually commences from above downwards. There is increasing swelling, leg becomes white and shining. At first may pit on pressure, later becomes too tense for pitting to take place. Leg is exceedingly tender to the touch.

General Symptoms. — Usually some form of sepsis present, with febrile symptoms. Rise of temperature and pulse rate. Headache, furred tongue, sleeplessness. Nursing Treatment. — Absolute rest necessary. Patient to be kept m bed, lying on her back, one pillow only allowed. She should be kept perfectly still, the only movement being for evacuation of bowels. Plenty of fresh air should be admitted to tlie room.

Temperature and pulse should be taken, and recorded 4 hourly. Attention paid to passing of urine. Bowels should be kept free by the use of saline purgatives. Thc patient should be given a sponge bath daily. Attention paid to the care of her hair, teeth and tongue. In such a case bed sores are liable to form nnless especial care is taken, and at the first appearance of a bed sore, the doctor

must be iuformed The bed linen must be kept clean, and free from wrinkles and crumbs. An air cushion may be used for patients' comfort.

Local Treatment. — The limb must be gently handled, avoiding friction of any kind on account of detaching a clot. Treatment ordered by doctor must be faithfully carried out. Hot fomentations may be ordered, or applications of lead and opium. The limb must be kept warm ; may be wrapped m cotton wool. When the acute stage is over the limb should be bandaged from below upwards to hasten absorption. Sedatives may be needed for pain and sleeplessness. When patient is being moved, someone must support the affected limb.

The State examination of Nurses was held on June llth. The questions and best answers of the medical paper are as follows: Six out of eight questions were to be answered. The examiner's comments are attached, and we commend them to the attention of future, candidates. : —

The examination paper on medical nursing was answered exceedingly well, and shows that the nurses have been very well trained, and that they have taken an intelligent interest m their studies. The first question on the digestion of foods was not selected by many ; the candidates had the option of selecting six questions for answering out of eight set. The information on typhoid fever was remarkably voluminous, and the third question on summer diarrhoea brought forth m every instance an accurate account of the main principles m the nursing management of what is really an acute milk infection. Generally, the answers to the question on nursing a case of tracheotomy were too discursive. One would have imagined that a report on septic pneumonic influenza would have proved acceptable to nearly all the candidates, but this question was m point of fact generally avoided ; when attempted, a general review of the disease was written, and not what could be called a report by any stretch of the imagination. Definitions of lysis, uraemic coma, and the rest were uniformly good, and the answers to the question on the general principles of nursing the unconscious were good when set out systematically. The last question was avoided by the great majority of candidates. It related to the various way?* a patient's breathing may be affected and their significance. The advice printed at the top of the examination paper — " Candidates are expected to answer briefly, and only exactly what is asked" — should metaphorically bo printed m letters of gold, because it is so apt to be overlooked or neglected. Answers tend to become discursive. For instance, a dissertation on the Widal reaction has nothing to do with the nursing management of typhoid. Discursiveness and exaggeration of detail or a want of perspective can be avoided by the candidate; first of all, considering what the question exactly means, and planning out the answer m a systematic way. Some questions can be tabulated, and it is a good plan to index m the mar-

gin both for the benefit of the candidate and the examiner, and paragraphing is like: wise twice blessed. It is sad when a candidate writes so voluminously on the first four questions that there is little time to finish the last two except m a hurried and scrappy style ; this is a fault of the foolish virgins who, lighting their lamps at noonday, had to be content with the moonlight at night. All the candidate*? but two could spell, and this pair provided the following :- — "Cronic," "venterlated," "gard" for guard, "liquarist" powder, "bowle" for bowel, and "epletic" fit is enough to cause the genuine article. Herewith are some of the best answers :■ — Question 1. — How arc foods digested ? Answer by No. 14. How are Foods Digested ? : — Foods are digested by the action of the various juices secreted by the different parts of the alimentary canal, and also by others poured into the canal from the pancreas and liver. Ptyalin. — Secreted by salivary glands, and poured into the mouth, where, being mixed with the foods, converts insoluble starches into soluble sugars. No further action, except that it renders the mass of food alkaline. Rennia and Pepsin.- — Secreted by walls of stomach, and are poured out, together with a little hydrochloric acid, when foods enter stomach. Rennin. — Coagulates milk. Pepsin. — Converts insoluble proteids into soluble peptones. Hydrochloric Acid. — Helps to soften tough fibres, as m meat, and also renders contents of stomach acid. In the duodenum the pancreatic ferments are poured from the pancreas. Trypsin. — Alkaline ferment ; continues the conversion of proteids into peptone 3. Amylopsin. — Alkaline reaction ; converts starches into soluble sugars. Continues work of Ptyalin. Steapsin. — Alkaline reaction ; splits up fatty substances, and emulsifies them. The bile is poured into the duodenum from the liver, its action being to further emulsify fats, and to stimulate peristaltic action. A ferment, the Succus Entericus, is secreted by the walls of the intestine, its action being to finish the digestion of any particles not acted on by other ferments. Question 2. — -What is the general nuraing management of typhoid fever ? What complications of the disease, may occur ? Answer by No. 14. General Nursing Management of Typhoid Fever ; — Absolute rest m bed, lying almost flat, with low pillows under head, water pillow under buttocks, and light but warm coverings.

Attend well to all pressure points, especially back, heels, and elbows, to prevent pressureBorea ; washing parts well with soap and water, dry and rub with methylated spirits, and powder. Sponge patient at least twice daily, and if temperature above 102 deg. Fahrenheit, sponge fourhourly with tepid or cold water to reduce temperature. Also helps to lessen delirium, if present, and keeps skin active, and assisis m the elimination of the toxins from the body. Clean mouth and tongue four -hourly, and after each feed, if very dirty. Put vaseline on lips to prevent sores forming round mouth. Measure all urine passed, and see that a sufficient quantity is passed m the twenty-four hours. Retention often occurs, m which case patient may have to be catheterised. Incontinence of urine common symptom, and patient must be kept dry and comfortable, especial attention being given to back when necessary. Test urine for albumen. Attend to bowels and see that they are kept well open. If constipated, give an enema of soap and water every other day. If diarrhoea and bowels open more than five or six times daily, an enema of starch four ounces, and opium 15 to 30 minims, may be ordered to check it. Take temperature, pulse, and respiration, and record four-hourly. Diet. — Fluid diet is given until the temperature has been normal for ten days, when light farinaceous diet, increasing gradually io white meat, mid then full diet as patient improves. While fluid diet is given it must be made as nourishing and as varied as possible, and be given at regular intervals half a pint every two hours, all fluids being strained well before giving to patient. Water may be given freely, m addition to the regular feeds. Complications which may occur. — Haemorrhage into bowel from ulcers ; perforation of bowel wall ; tympanites, or over-distention of bowels with gases ; delirium ; pneumonia ; phlebitis. Question 3. — Discuss the feeding and management of a case of acute summer diarrhoea and vomiting m a child nine months of age. Answer ey No. 14. Acute Summer Diarrhoea and Vomiting m a Child of Nine Months : — Treatment. — Give nothing to drink except^ sterile water for twenty-four hours. Give an aperient, castor oil, one to two drams, and have bowels well irrigated with a mild lotion, boric or saline, at least twice daily. After twenty-four hours give small quantities of albumen water, or food, as Benger's, made with water instead of milk, about two ounces, twohourly. If vomiting returns, reduce again to sterile water and albumen water. Keep on this diet till vomiting and diarrhoea cease, then gradually increase by giving a little whey instead of Benger's food or other food made with water. Gradually increase whey, and add a little milk each day, and if no recurrence of vomiting , increase to half milk and half water, or to humanised milk.

Groat care and cleanliness must bo used m the preparation and storing of all foods, especially milk, and food should be quite fresh, and all utensils sterilised, and feeding bottles and teats boiled daily, and kept m cold water when not m use. Question 4. — Describe the nursing and precautions necessary m a case of diphtheria m which tracheotomy has been performed. Answer by No. 14. Nursing and Precautions Necessary m Case of Diphtheria, m which Tracheotomy has been Performed. Treatment. — After operation performed, put patient to bed with only a low pillow under the head, and a sandbag or firm pillow beneath the nock to extend trachea as much as passible and allow free breathing through tube. Bed must be placed m a steam tent, or m a email room m which a kettle of water is kept boiling, the steam being allowed to escape into the tent or room to keep the air moist and warm. Tincture of benzoin or eucalyptus may bo added to tho water, and, being carried out by the steam, helps to allay tho irritation of the air passages. Piece of moist gauze kept over tube. The patient must not be left alone, especially if a child, as the tube may become blocked with mucus or membrane, and breathing through tho tube impossible. The inner tube should be removed, cleansed, dried, and replaced every twenty minutes, and oftener if necessary. If outer tube is blocked, a well boiled feather may be passed down it, twisted round, and removed, but if this does not remove the obstruction, nurse must notify the surgeon m charge of case immediately. The tube is generally removed on the third day if condition of larynx sufficiently improved, and after removal patient must be watched carefully for any sign of difficult breathing. The tube must be sterilised, and everything be m readiness for the re-insertiOn of the tubeWhile tube is m the trachea, fluid diet is given, slightly thickened foods, as arrowroot, being given if any difficulty m swallowing. When tube removed increase gradually to light farinaceous, and gradually to white meat diet. The wound m the neck is dressed daily and kept clean, and when tube removed should soon close m. Stimulants, as brandy or strychnine, may be ordered by the physician, and the pulse must be watched carefully for any sign of heart-failure, which is a very serious complication m diphtheria. The oxygen apparatus should be constant ly m readiness, and also brandy, strychnine and hypodermic needle. The tracheal dilators should always be kept m covered basin, sterilised, m case of accidental removal of the tube. The trachea may be held open till surgeon arrives to replace tube. Question 5. — -Write a report on a case of septic pneumonic influenza m reference only to your own observa-

tion of the patient and the nursing of the patient. Answer by No. 71. Acute Pneumonic Influenza. Patient brought into hospital m the acute atage, temperature 103 deg., pulse 100, weak and irregular ; respirations 40. Patient cyanosed, breathing most embarrassed, sputum copious, tenacious, and streaked with blood. Bowel very relaxed; epistaxis ; speaks with difficulty. Tongue dry, cracked sores on lips. Patient put into warm bed. Fowler position to relieve embarrassed breathing. Inhalation of oxygen given, starch and opium enema given ; fluids per mouth as thirst is intense ; bowel washout given. Starch and opium enema repeated eight-hourly as diarrhoea becomes more acuto. Temperature rises to 105 deg. F., patient is quite delirious, restless, and noisy. Sponged with icod water to reduce temperature. No improvement m condition as the- days go on. Breathing becomes more distressed, diarrhoea is uncontrollable. Pulse weak, running intermittent. Putiont dies practically of asphyxia. Question <>. — What do yon understand by the following : — (a) Lysis ; (b) uraemic coma ; (c) hypostatic pneumonia ; (d) rigor ; (c) cyanosis ? Answer by No. 14. Lysis. — The gradual fall of tempera! ure, with steady inprovement of general condition, m a fever. Uraemic Coma. — Condition of unconsciousness which may occur m nephritis, caused by poisoning of the nervous system with the toxins, circulating m the blood, which should be removed from the blood by the kidneys, and excreted through the bladder. Hypostatic Pneumonia. — Form of pneumonia which generally occurs m elderly patients when long confined to bed m a recumbent position, as m fracture of the femur. Condition caused by the insufficient circulation of the blood through the lungs. Rigor.—Condition m which the blood becomes congested m the internal organs, the surface of the body, from want of circulation, becoming cold and blanched, and patient shivers violently with cold perspiration, s\nd blue pinched face, and cold extremities. Generally occurs at onset of fevers, or during any debilitating or septic diseases. Cyanosis. — Blueness of face and skin, caused by insufficient oxygen being supplied to the blood, as m disease of lungs, trachea, or heart. Question 7. — What are the general principles of nursing the unconscious ? Answer by No. 97. 1. Put patient m recumbent position. 2. Turn head on one side to prevent him swallowing his tongue, or to prevent him choking if he vomits. 3. Clean mouth, tongue, and teeth frequently. 4. Bathe eyes frequently with boracic lotion if open. 5. Keep warm, light woollen clothing preferably.

0. See patient has plenty of air. 7. Keep bowels well open by enemata. 8. See that patient passes sufficient urine, and test same. 9. Treat back frequently, changing posit ion from side to side regularly. 10. See that under-linen is free from cr.umbs, creases, etc. 11. Sponge over once daily, and more ofton if necessary. 12. Take temperature, pulse, and respirations regularly, and chart same ; watch carefully. 13. Give nourishment per rectum. This would consist of any of the following : — Egg and milk, four ounces four-hourly. Peptonised milk, four ounces four-hourly. Glucose and water, eight ounces four-hourly. Saline, eight ounces four-hourly. Strong coffee, four ounces four-hourly. 14. Tf any paralysis, protect feet and limbs from pressure so that there may not be foot-drop or wrist-drop. 15. At all times watch patient carefully for any fresh symptoms that may arise, and report same. 10. Report any lapses into consciousness. 17. Report any twitchings, convulsions, etci 18. Never leave patient while unconscious. 19. Watch for any cyanosis or heart failure. 20. Watch for hypostatic pneumonia. Question 8. — In what ways may a patient's breathing be affected, and what is their significance ? Answer by No. 21. 1 . The breathing may become quickened, due to some inflammatory condition of the pulmonary organs. 2. It may become stertorous, due to paralysis of the soft palate. 3. It may become laboured, due to some constriction of the trachea or bronchi, 4. It may become shallow, due to weakness, or to the fact that using the abdominal muscles causes pain. 5. It may become sighing, due to shock. 6. It may become Cheyne-Stokes, due to a very low condition of the patient though occasionally seen m normal healthy children. 7. In asthma the patient may become quite cyanosed owing to the spasmodic constriction of the bronchi. 8. It may be of a crowing naturo, due to constriction of the larynx. 9. It may also become sonorous, due to imflamed condition of bronchi, and later of a rattling nature (Rates), due to exudation of inflammatory lymph into bronchi.

A recent birth of four sons at Nurse Margett's private hospital at Ngaruawahia is interesting. The parents, are poor people and already have five children. The Health Department nurse is collecting some clothes for the four babies, who, it is hoped, will live, as they were all healthy and so far doing well. (Ed. — We hear that two of the babies have since died).