Medical Paper

Kai Tiaki : the journal of the nurses of New Zealand, Volume XXII, Issue 3, 1 July 1929, Page 119

Medical Paper

1. — Describe the composition and the functions of the blood. What are the essential alterations m the blood m a case of pernicious anaemia? — 1. Blood Consists of: Red corpuscles, white corpuscles, blood platelets, plasma. The whole being on an average of 1 13 th of the body weight. Red Corpuscles arc bi-concave discs of uniform size, and there from 4\ million tt) 5 million per cubic millimeter. Contain the colouring matter haemaglobin (which consists of pigment haemetin and the protein globin) which gives the corpuscles their red colour. Red corpuscles have no nucleus, arc formed m the mar-

row of the long bones, live about three weeks, and the spleen is concerned m the destruction of them. White Corpuscles are (1) Various shapes and sizes ; (2) Have a nucleus ; (3) Have the power to pass out through the walls of the blood vessels, and back again; (4) Are m the proportion of 1-500 red corpuscles, and average normally from 71 thousand to 10 thousand per cubic millimeter. In disease they are enormously increased. Several kinds of white corpuscles: — Leucocyles, lymphocytes, polymorphs, mast cells, eosinphiles ; are formed m lymphatics.

Blood Platelets are small bodies of more- or .Lesa-tobscu-re function, but are concerned m clotting* of the blood when a vessel is severed. Plasm?:" 1* the colourless liquid m whreh the corpuscles are f suspended. Functions : 1. Red Corpuscles: Carry oxygen from the lungs to all tissues of the body. 2. Carry the carbon dioxide from tissues to lungs, where it isigiven up for oxygen. •- •*' >- 3. White Corpuscles: Assist m fight-ing-of bacteria that have gained access to body aTid provide body resistance to disease. ' 4. Bleed- Platelets: To assist m the clotting of blood when vessels are .severed. Question 1. — General: 5. To can*}' nutrition, heat energy to all parts of body. 6. To carry waste products to kidneys for elimination. ■ Pernicious Anaemia: White corpuscles are markedly increased, and ma}' be up to 40,000 per cubic millimeter. Red corpuscles diminished slightly, but m the effort for the marrow to produce them m proportion to the white they are pushed into blood stream before completion, and are badly shaped and distorted sizes. Haemoglobin is diminished but the colour - index is more or less normal as .there are less corpuscles to get the index percentage on. Question : 2. — What steps woud you take m the immediate treatment of pulmonary haemorrhage occurring m a patient suffering from pethisis? — Place the patient m the most comfortable position .he can assume, preferably recumbent o"e pilrow. 1. Give hypodermic injection of morphine gr. i to quieten the nerve centres, and arrest -trie haemorrhage. fr £. jPI&Qe ah ice bag , over the heart to contract bloodvessels and assist m the arrest of haemorrhage.

3. Ice m small quantities may be given to suck. 4. Absolute rest and quietness arc essential. 5. Keep patient calm and re-assured by being tactful, quiet and confident during treatment. 6. Remove traces of haemorrhage from bed without disturbing patient. Question : 3. — Write a specimen report such as a nurse on night duty would write for the information of the doctor attending a case of lobar pneumonia. Assume the report to cover the first night subsequent to the occurrence of this crisis and the patient to be making good progress. John Brown, lobar's pneumonia, 8 p.m.: Patient tired and ready for lobar pneumonia. Sleep : Feeling very comfortable. 10 p.m.: T. 98; pulse 88; respiration 24. Sleeping, breathing deep an eleven. Pulse good volume and tension. Colour, slightly flushed, skin moist, but no sweating. 12 midnight: Still sleeping. Breathing remains quiet and even, pulse good. 2 a.m.: Awake for short time. Sponged and made comfortable. Hot drink given. Patient feeling comfortable and drowsy. Sleeping again. 2.30 a.m.: Pulse and colour have improved. Breathing deep. No pain. T. 98. P. 80, R. 22. 4 a.m.: Still sleeping quietly, no distress at all. 6 a.m. : Patient awake. Colour good, slight flush on waking, pulse steady and good, natural breathing, deep and easy. Temperature normal. 8 a.m. : Had a good breakfast — lightly poached egg, toast and coffee. Condition maintained. 8 p.m.: T. 99. Resp. 24, Pulse 92. Good colour, skin moist, but no sweating. Pulse good volume. Breathing quiet and even. Ready for sleep. 10 p.m.: Sleeping. Breathing deep and even. Pulse good volume. No restlessness. 12 midnight: Still sleeping. improvement maintained. 2 a.m. : Awake for short time, sponged and made comfortable, passed urine 15 ounces. Pulse

has steadily improved and breathing is deep and even. T. 98, Pulse 84, R. 22. 4 a.m. : Sleeping still. General condition improving, colour slightly flushed, pulse good volume, respirations quiet. No difficulty m breathing. 6 a.m.: Patient awake. Feeling well. Pulse remaining steady and even. Breathing free and easy. 8 a.m.: Had a good breakfast of lightly poached egg, toast and coffee. T. 98, P. 80, R. 22. Improvement maintained. Question: 4. — Describe the general nursing of a child suffering from acute nephritis : 4. Place child m warm bed, nursing between blankets and having a flannel nightgown on. Sponge eight-hourly to assist skin to act. Strict attention to cleanliness of mouth and teeth. Urfne: Carefully measured, tested and amount charted daily. Bowels: A purge of pulso. jalap gr. xv to xx would be given, followed by magnesium sulphate 3 ii each morning to draw fluid from tissues into bowel for evacuation. Diet: The object is to obtain rest for the kidneys, so a diet of light or nonprotein and salt free would be given. Fluids restricted to one pint daily during the acute stage, and while aedema is marked. Strict fluid chart kept so that the intake of fluid may be compared to the output as urine daily. Fluids increased when aedema is diminished and blood and albumen is vaine rapidly disappearing. Local Treatment: Hot packs twohourly or four-hourly to loins, hot air baths or hot packs to assist skin to act. Pilocarpine gr. 1-20 may be ordered by doctor to assist perspiration. Dry cupping over loins or counter irritants such as mustard plasters may be applied to assist kidneys to secrete waste products. General: Temperature, pulse and respiration are taken, and recorded fourhourly. Question : 5. — How is the injection of insulin of benefit to certain cases of diabetes? What dangers attend its use? —

5. Diabetes Mellitus results from imperfect metabolism of carbahydrates owing* to decrease or lack of insulin brought about by the imperfect functioning of Islets of Langerhans m the pancreas which secrete insulin, and pour it directly into bloodstream. Benefits of insulin given hypodermically are that a man suffering from diabetes mellitus can live a more or less ordinary life. Carbohydrates are necessary m the diet for the complete oxidisation of the fats, so they are given m restricted quantities, and insulin given accordingly, dosage from 10 to 20 units daily. Insulin cannot be given m large enough quantities to netabolise the whole of carbohydrates m an ordinary diet, but by giving usual quantity of protein (1 grain daily for every kilogram of body weight) increasing fats and decreasing carbohydrates, a diet of sufficient caloric value can be given so that patient's normal weight and strength can be maintained. Dangers : Overdose: Lowered blood sugar (usual .12 per cent, lowered anything down .07 per cent.) which produces the following symptoms. First, just a sense of some danger impending indefinite, patient vaguely uneasy. Breaks out m cold perspiration. especially about forehead. Breathing uneasy, becoming laboured. Patient passes into noisy delirium and if untreated into a quiet coma resembling a sound sleep. Urine sugar free. Underdose: Symptoms of glycosuria appear. Blood sugar increases, and if untreated severe asidosis, due to formation of acetone bodies m blood, comes on. Breath has sw r eet odour, urine contains sugar, and acetone. Breathing stertorus passing into coma. General Dangers m Giving Dose: Meal must be given within 20 minutes or halfhour after the injection is given to act as a buffer. Question : 6. — Pending the arrival of a doctor what would you do for a case of Lysol poisoning? —

Lysol Poisoning: 1. Treat Shock Immediately. Put into warm bed, surrounded by well-protqcted hot water bottles, foot of bed raised on blocks. Stimulants such as strong black coffee, 10 ounces of brandy, 2 ounces given per rectum. 2. If Patient Conscious: Do not give emetic as lysol is corrosive poisoning, but give alkalis such as magnesium sulphate one ounce to 10 ounces water to drink. Demulcent drinks such as gruels, then arrowroot. White of egg may be given. 3. If unconscious get the following things ready for the doctor, who will pass a stomach tube if mucous membrane is not too badly damaged :—Tray containing stomach tube and funnel, lubricant, jug of magnesium, sulphate solution two ounces to one pint of water 100 deg. F. Bucket to receive stomach contents, macintoshes to protect patient and bed. Stimulants as under should be m readiness for doctor :—Hyp. m strychnine gr. 1-30; Hyp. m Digitalis gr. 1-100.

***** EXAMINER'S COMMENTS At the head of the examination paper there is a line which reads as follows : — " Candidates should answer briefly and concisely only what is asked." A consideration of the papers put in by the candidates in the " Medical Nursing " paper makes it quite clear that some seventyfive per cent of the candidates either omitted to read this instruction or deliberately ignored it. If I were a Matron I think I should get together the nurses who were going to sit for examination and say something like this to them : — ' Your object in answering questions that are set should be to make it as easy as possible for the examiner to find out whether you know the essential points in the question set or not. Examiners are human, and are just as easily irritated as anyone else, and there is nothing more irritating to an examiner than to have to wade through three or four pages of padding to find one sentence that is of

any account. You will not get any extra marks for giving even a perfect description of the symptoms of an illness, or the medical treatment of it when you are asked for the nursing treatment, and you might even give th examiner the impression that you are attempting to hide your ignorance on one subject by displaying your profound knowledge of another. Also read over your answers after you have written them. It is surprising how many silly slips get into them. For instance, the nurse who wrote " All urine passed must be voided " was not making a particularly impressive statement. And there appeared to be something deep m the working of the mind of the nurse who wrote, " Patient complained of feeling much better this a.m." One nurse, m her answer to the question re lysol poisoning made her opinion of the usefulness of a doctor very clear by her carefully tabulated list of measures to be taken, drawn up as follows : — 1. Send for the relatives. 2. Wash out the stomach. 3. Give an emetic. 4. Send for the doctor. If you are asked to give a specimen report of one night's night duty don't write out reports of seven night's duty as did some twenty nurses m the last paper, and if the examiner has specially mentioned that m the case to be reported on the crisis was over and the patient making good progress, it really will not impress him however graphically you describe the occurrence of a crisis on the night m question. And do not say m answer to a question on the " general nursing " of acute nephritis that yon would give a vaccine! The nurse, who, to show her knowledge, says she will give treatments which she knows quite well she would never dream of giving unless instructed to do so by the doctor, runs just a risk of giving an examiner the impression that she might be a rather dangerous person to be m charge of a case. Don't assume that the examiner knows what you meant. Say it.

While excessive verbosity m an examination is a fault and a bad one, do not go to the opposite extreme. A paper that is full of remarks such as " hot packs useful." ' Mist. pot. cit. str. given," does not read prettily, and it does not take much more time to make a short sentence of what you want to say.

And the extraordinary common habit of nurses making such statements as " Mist. pot. cit. half an ounce should be given " is extremely foolish. The examiner does not know what your particular hospital " Mist. pot. cit. is, if there is such a thing, and you will not always be nursing m hospital, and actually you probably will not give Mist. pot. cit. or any other Mist, unless the doctor orders it." ORAL AND PRACTICAL EXAM. EXAMINERS' COMMENTS. Question 10: Give the three general principles of bandaging and apply : — (a) Triangular bandage for the arm. (b) Eour-tailed bandage for jaw.

(c) Bandage for fractured clavicle or collar bone. Comment: The question on bandaging was very weak, only two out of six candidates examined by me knew anything about it. Question 1: Make a mustard and linseed poultice for a child six years old suffering from acute bronchitis. Comment: Question 1 was poorly carried out by all canddates but one. Queston 5: In preparing a patient for a gynaecological examination, what are the most important points to remember and why? Comments: (a) Candidates showed a poor knowledge of gynaecology, and the preparation of such cases, and even of the organs concerned. (b) Few of the candidates answered the question dealing with the preparation of a patient for a gynaecological examination m a satisfactory manner, particularly m regard to the preparation of the patient. Comment: The general standard was not brilliant.