American Red Cross Text-Book on Home Hygiene and Care of the Sick by Isabel McIsaac (best large ereader TXT) 📖
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Strength or weakness is indicated to some extent by the way the patient moves, and by his ability to walk, stand, sit, hold up his head, feed himself, or turn in bed without assistance. The position he habitually takes is sometimes significant; in heart affections, for instance, he may be unable to lie down, in pleurisy he ordinarily lies on the affected side, and during abdominal pain he generally draws the knees up.
—The special senses are frequently disturbed in sickness. The eyes may be blood-shot; the patient may be over-sensitive to light, or see spots floating before the eyes, or he may be unable to see at all. The pupils of the eyes may be unusually large or small, or one may be large while the other is small. Swelling, redness, or discharge from the eyes should be noticed. Hearing and touch and smell may be impaired; or they may be abnormally acute, and cause real suffering. Taste may be impaired, especially when the nose is affected or when the mouth is not clean. Discharge from the nose or ears should be reported. Not only discharge, but also trouble of any kind, such as pain, tenderness, or swelling, is important if situated in or near the ears.
is often much altered in sickness. It may be weak, hoarse, or whispered. Speech may be clear or thick, or the ability to speak may be entirely lost; in extreme weakness speaking is generally difficult, and may be impossible. Moaning, groaning, and other unusual sounds should be noted. A loud, sharp cry at night with or without waking, if a repeated occurrence, may be an early symptom of some diseases of children.
in health is red and moist; when extended it is somewhat pointed and can be held steadily. In sickness it may be cracked, dry and parched, or if the patient is not properly cared for, it may be covered with white, yellow, or brown coating; in many exhausting illnesses it is flabby and trembling. In scarlet fever the tongue is often a vivid red color, and is then called strawberry tongue. The odor of the breath may be foul from decay or neglect of the teeth, from indigestion, constipation, nasal catarrh, or special diseases.
and tonsils are sometimes red and swollen as in simple sore throat; or they may be covered by white patches.
may be swollen, tender, or bleeding. A collection of sticky brownish material may appear on the teeth and gums of neglected patients.
when present may be: dry, or accompanied by expectoration; painful, frequent, loud, or whooping; and worse by day or by night. The sputum may be yellow, white, gray, rusty, blood-streaked, dark, or frothy. The amount of sputum should be noticed as well as its appearance.
or absence of appetite should be noted, and also the amount of food actually eaten by a patient; the amount eaten is frequently not the same as the amount carried to him on a tray.
If
vomitingoccurs, the color, consistency, amount, and general appearance of the vomitus should be noted; if its appearance is unusual the vomitus should be saved for the doctor's inspection.
—The number of bowel movements is important, and also their character. The consistency of the feces may be hard, soft or fluid; their color may be any shade of brown, yellow or green, from black to clay color. They should be saved for the doctor to see if appearance or odor is unusual.
in health is clear, amber colored, and slightly acid. From 30 to 50 ounces should be excreted in 24 hours; the amount varies, however, especially according to the amount of fluid taken. It is important to notice whether the urine is scanty or greatly increased in amount, dark or pale, clear or cloudy, and whether sediment is deposited after standing. It is essential that urine should be voided in sufficient amount; the necessity for watching its quantity is frequently overlooked in the home care of the sick. Frequency of urination should also be noted. Inability to urinate, particularly where the urine has previously been scanty, is serious if continued; it should be reported to the doctor without delay. Inability to control the bladder and bowels are also symptoms to be reported.
is significant in both adults and children, and failure of babies and children to gain in weight is a danger signal.
—The number of hours a patient sleeps should be noticed and recorded as accurately as possible. The word of the patient on this subject is not sufficient evidence. Character of sleep should also be noted, whether it is quiet or restless, and whether the patient sleeps lightly or is difficult to arouse.
—It is important to watch carefully the mental condition of a patient; whether, for example, he is normal, or depressed, irritable, restless, apathetic, dull, excited, wandering, delirious, or unconscious. Hasty judgment of mental conditions should be avoided, but close attention to them is necessary.
SUBJECTIVE SYMPTOMSis the most important subjective symptom and should never be disregarded. Bodily pain does not occur in persons who are in all regards physically and mentally well; hence pain is a sign that something, small or great, is out of order.
"Of all symptoms pain is the one which interests patients the most. We here emphasize the truth, too little understood, that pain is an unpleasant sensation, nothing more, and is never imagined. Imagination may be its cause, but the pain thus produced hurts just as truly as pain produced by a real disease. Pain is only a phenomenon of consciousness; it is always real, even that felt in a dream. If the patient is too unconscious to feel it, there simply is no pain, no matter how badly the person's body is injured." (Emerson: Essentials of Medicine, p. 356.)
One should remember that no possible method exists to measure the intensity of pain exactly, or to describe its quality accurately. Therefore in describing pain, it is best to use the patient's own language. Four points should especially be observed, (1) its location; (2) its character, which may be dull or sharp, stabbing, throbbing or continuous, slight or severe; (3) the time at which it is worst; certain diseases, for instance, are characterized by more severe pain at night; (4) it should be noticed whether the pain is relieved or increased by change of position, eating or drinking, heat or cold, or the like. Pain may be felt in a part far from the place where the trouble really lies; thus a dislocated shoulder causes pain in the elbow.
Pain is always a danger signal, although the significance is not always so great as the sufferer thinks. The more attention a patient gives to his pain, the more severe it always becomes, therefore his attention should not be called to it unnecessarily. A good observer, however, can get much information by noticing the patient's expression, position, motions, etc., without constantly asking him how he feels. Although many persons overestimate pain, others persistently disregard it, either because they are unwilling to take the necessary measures to remedy it, or because they wish to appear heroic. Both courses of action are mistaken; everyone should realize the folly and danger of bearing pain if it is possible to remove the cause.
Nausea, fatigue and malaise are other subjective symptoms; malaise is the name given to a general feeling of physical discomfort not restricted to any one part of the body. All three are abnormal when there is not apparent or sufficient cause.
—An accurate record should be kept of the patient's symptoms, medicine, diet, treatment, etc., so that the doctor may have a continuous record, and so that another person taking charge temporarily may know just what has been done for the patient. The record must be written; otherwise details cannot be remembered exactly. It should be as simple and concise as possible; it is the place for facts, not for opinions, and if inaccurate it is worse than none. It is better not to keep the record in the patient's room, for the patient should not see his own record, nor hear its contents discussed. The doctor usually writes his orders on the record sheet itself, or on a separate sheet to be attached to the record for reference. Blank record forms can be purchased, but a form that is made at home is entirely satisfactory. An example of a daily record sheet follows.
Record Date Hour Tem. Pulse Resp. Diet and medicine B.M. Urine Remarks 1916 Jan. 1 4 p.m. 100° 76 24 Medicine 5 p.m. 1 ℥ vii 6 p.m. Supper:Baked potato, toast, fruit, tea. 8 p.m. Medicine Sponge bath. 9:30 p.m. Asleep. Jan. 2 3 a.m. ℥ ix 8 a.m. 99° 74 22 Medicine Patient slept most of the night. 8:30 a.m. Breakfast:
Cereal, orange, toast, coffee. 9:30 a.m. Bath. 11:30 a.m. Sat up 1 hour.
—As we have seen, early symptoms of sickness are always important; yet it seems worth while to mention particularly the early symptoms of tuberculosis, cancer, and mental disorders, because each of these diseases, though curable in many cases when taken in the early stages, is serious and often fatal if neglected. Certain facts relating to their cause and prevention should be known to everyone. Tuberculosis, long our greatest cause of death, is gradually growing less; but cancer and mental disease are now on the increase.
—Every year tuberculosis causes the death of about 150,000 people in the United States. It is caused by the bacillus tuberculosis, a germ which may attack any tissue of the body, although it most frequently affects the lungs of grown people, and the bones and glands of children. The disease is not inherited, but susceptibility to it appears to be; it is readily communicated from person to person. The germ of tuberculosis is so widely distributed that probably few persons over 30 years of age have not been infected with it at some time, although the infection may have been too slight to be noticed. Indeed, most people have probably been infected many times, though without serious results.
Tuberculosis is spread chiefly in two ways: (1) through any bodily discharges from infected persons, especially through the nose and mouth discharges; (2) through milk from infected cows. The ways by which the disease is spread indicate methods of prevention. Milk, especially for children, should either be pasteurized or should come from cows that have been tested and proved to be free from the disease. Other methods of prevention include avoiding any and all bodily discharges of infected persons, and increasing bodily resistance as far as possible. Good food, sufficient rest and fresh air are not only important preventives, but also the most efficacious means of cure. Persons who suffer from insufficient food, exposure, bad housing, long hours, and bad conditions of work are especially susceptible to tuberculosis, and thus it is rightly called a disease of poverty.
Early symptoms of tuberculosis include cough, hoarseness, loss of appetite,
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