NURSING CARE OF THE SICK AND INJURED

[Music] [Applause] medical self-help is an emergency measure to be used only in cases of sudden or extraordinary misfortune if people require medical care in the course of normal everyday living they should always be treated by a doctor however when disaster strikes you may not be able to obtain trained medical aid in time there are many forms of disaster they can happen to you and your family at any moment this film is one of a series on medical self-help its purpose is to teach you what to do in an emergency situation when there is no doctor [Music] during the first week or two following a major disaster which disrupts most civilian services and causes many casualties one of the most urgent problems to be faced by the survivors is the nursing care of the sick and injured among these will be people suffering from burns fractures and lacerations who will require nursing care for the prevention or control of shock there will be persons seriously ill with infections caused by wounds who must be nursed against the ravages of fever there will be victims suffering from acute nausea and vomiting or perhaps from prolonged diarrhea caused by a drastic change in diet who must be nursed against extreme body fluid loss and exhaustion there will be those with chronic diseases such as diabetes or heart disease whose illness will be aggravated by the stress of living in a shelter and who must be supported by basic nursing care until professional medical and nursing services are again available there will be a shortage of nursing supplies by normal standards however in all public shelters that are federally stocked there are sufficient medical kits to provide for the basic medical needs of the occupants before anything in such a kit is used the instructions must be read carefully the contents of the kit should be under the control of the shelter manager at all times in addition to the basic medical and first aid supplies three special medicines are included they are penicillin g sulfadiazine and phenobarbital these of course are prescription drugs ordinarily dispensed only by a physician the purposes of these medicines are to save life to prevent the spread of disease to prevent and control emotional problems recognizing that a physician will not be available the instructions list other people who have training in the health professions if one of them is among the shelter occupants the special medicines are entrusted to him if there is no occupant so qualified the special medicines should not be dispensed at all because their use can be dangerous the other supplies in the kit are similar to those you might have in your home medical cabinet in addition to the instruction booklet the kit contains the family guide emergency health care which describes the use of the supplies in specific instances among the contents are such familiar items for nursing care as clinical thermometers bandages cotton aspirin surgical soap baking soda and so on remember that the shelter manager must control these austere supplies strictly for they should be used sparingly and only when absolutely needed improvisation will be the rule when sick and injured are crowded into shelters at such a time there is ever-present danger of the outbreak and spread of communicable diseases the control or prevention of this is the highest nursing priority the second priority is to treat the acute symptoms of disease you cannot diagnose disease that is a physician's responsibility but you can recognize the symptoms of disease such as fever and pain and take steps to relieve the patient of these symptoms a third necessity is to protect yourself from becoming ill and disabled or of becoming emotionally disturbed by close contacts with the sick and injured these are multiple responsibilities but they need not be overwhelming by knowing the priorities that require attention and by carrying out nursing care in a calm and optimistic manner anyone can provide helpful nursing care in such emergency conditions remember the first priority is to prevent or control the spread of communicable diseases one way to do this is to set up an area of isolation where persons with suspected infectious diseases can be kept apart from others in the shelter although most persons in this country today have been immunized against many infectious diseases there are others that may break out under crowded and perhaps unsanitary conditions these include typhoid dysentery and influenza as well as measles mumps chickenpox scarlet fever and the common cold you are not expected to diagnose each of these diseases but you should recognize the various symptoms that suggest the presence of any communicable disease one of the most common symptoms of an infectious disease is fever if this is associated with coughing and pain in the chest it may be any one of several serious respiratory infections since germs are spread by coughing and sneezing instruct the patient to cover her mouth and nose during such attacks and to dispose of soil tissues in a container in many disease conditions fever is obvious the skin feels warm or hot and may be dry and tight feeling there may also be skin rashes on the face neck shoulders chest or arms such rashes together with fever and a feeling of sickness strongly indicate an infectious disease which requires isolation even though it cannot positively be diagnosed if there is no difficulty in breathing or any acute pain all you can do for the patient is to keep her comfortable provide liquids and light nourishment and try to prevent the spread of her disease to the others one way to help prevent the spread of infection is to wash your hands thoroughly after caring for one patient and before going to the next diarrhea or frequent loose watery stools contributes to dehydration and further weakness it is essential to combat dehydration by insisting the patient drink nourishing liquids or water under emergency conditions there may be no convenient way to dispose of contaminated paper products or linens temporarily however they may be kept in tightly covered metal containers wash your hands again after handling contaminated objects hand washing frequent hand washing is the best possible method of controlling the spread of germs before leaving the isolation area make sure there is nothing more you can do for any of the patients at this time although persons with communicable diseases should be isolated from others in the shelter it is important that families be kept together in order for parents to help their children and for those who may have lost relatives to help overcome that loss by giving aid to anyone in need whether you are giving nursing care to a relative or a stranger however you must not mistake sentimentality for practicality for example a person with high fever and pain is in more urgent need of cold compresses or soaks than one who wants only a comforting bed bath if water is scarce the water used to bathe a feverish patient can be used for him again for the same reason pain relieving drugs such as aspirin should be reserved for those who really need them rather than be dispensed for the relief of minor headache or insomnia remember your own time must also be dispensed to those who are most seriously ill or are threatened with complications how can you recognize the symptoms of serious illness or the beginning of complication one of the most common symptoms is fever in many cases you cannot determine the presence of fever by feeling the patient's skin you must take the patient's temperature with a clinical thermometer there are two types of clinical thermometers and you should know how to use each this is an oral thermometer which is placed in the mouth under the tongue the characteristic feature of an oral thermometer is the long slender tip that contains mercury the temperature is read by noting how high the mercury climbs as seen against the scale a reading of 98.6 degrees is normal in practice you may have to rotate the thermometer in order to see the column of mercury clearly through the magnifying ridge this ridge extends along the scale of the thermometer and magnifies the scale and the mercury column for easier reading before using a thermometer shake it down several times so that the mercury will drop toward the tip end and give a reading no higher than 95 degrees be careful you don't strike it against any furniture and break it now check to be certain the column of mercury has dropped to 95 degrees or below unless this is done you may get a false high reading always clean the thermometer and shake down the mercury before using when using the oral thermometer carefully place the tip or bulb end under the patient's tongue instruct the patient to keep his mouth closed and to breathe through his nose he must avoid biting on the thermometer leave the thermometer in place for three minutes observing the patient to make sure it remains under her tongue when you remove the thermometer wipe the tip with a piece of tissue or cotton and hold the instrument up to eye level in a good light to read the results rotate the thermometer slowly until the magnifying ridge focuses on the column of mercury this reading is 101.6 indicating a slight fever each time you take a sick person's temperature make a record of it and indicate the time and day it was taken the record will enable you to know if a sick person's temperature is rising dropping or remaining steady accurate record keeping is essential to good nursing care clean the thermometer after each use do this by holding the instrument by the top and wiping it down with wads of cloth or cotton soaked in cool soapy water replace the clean thermometer in its container bulb end first always handle a thermometer carefully to prevent breakage in a shelter it cannot be replaced the rectal thermometer is used for taking temperatures by rectum never confuse it with an oral thermometer the characteristic feature of a rectal thermometer is the short stubby tip that contains the mercury in comparison with an oral thermometer with its long slender tip a rectal thermometer is thicker at the tip end and usually throughout its length it is much sturdier than an oral thermometer to minimize the risk of breaking within the rectum before using a rectal thermometer shake it down and lubricate its bulb end with petroleum jelly or mineral oil rectal thermometers should always be used to take the temperatures of unconscious persons infants and young children and persons with injuries of the face or mouth if in doubt as to a person's ability to hold an oral thermometer under the tongue take the temperature by rectum the infant should be placed on his stomach remember only a thermometer with the short stubby bulb should be inserted into the rectum pass the lubricated bulb end of the thermometer into the rectum about an inch and hold in position for three minutes the patient must remain quiet as possible during this time after three minutes remove the thermometer wipe it clean and read the result rotate the thermometer slowly until the column of mercury is seen under the magnifying ridge this reads 99.5 degrees it does not mean the patient has a fever since the rectal temperature is normally about one degree higher than oral temperature clean the rectal thermometer as you do an oral thermometer if you do not have a rectal thermometer an ordinary thin stemmed oral thermometer can be used to take a person's temperature without putting it into his mouth this is done by taking the temperature of the body under the armpit both the thermometer and the armpit must be dry place the tip of the thermometer under the arm and hold the arm firmly against the body for three minutes make sure the patient lies quietly to prevent the thermometer from being broken or dislodged the armpit method can be used to take the temperatures of babies and young children or of older persons who cannot hold a thermometer under the tongue and when you do not have a rectal thermometer armpit temperature averages about one degree lower than mouth temperature or about two degrees lower than rectal temperature an armpit reading of 97.6 degrees is about normal in addition to a person's temperature the pulse and respiration frequently show signs of illness or a critical change in a sick person's condition like the temperature they should be taken every few hours and recorded on a chart the pulse indicates the rate of the heartbeat during illness the heart frequently beats faster than normal the pulse is usually felt in an artery at the base of the thumb in some individuals you can actually see the pulsation of this artery however it is always much easier to feel the pulsation by placing your first and second finger lightly on the outer edge of the wrist directly below the thumb do not press your fingers too forcefully against the wrist or you will block the pulse and be unable to feel it use your first and second fingers only and hold them lightly over this portion of the wrist until you feel a definite pulsation when you feel the pulse count the number of times it beats in one complete minute the average rate for women is 75 to 80 times a minute for men the average is lower from 65 to 70. since the pulse indicates the vitality of the heartbeat make sure you take it correctly check yourself by taking it at least twice remember the normal pulse rate is different for adult men and women for women the normal pulse is 75 to 80 times per minute and for men it is 65 to 70 times per minute another vital sign is a person's rate of breathing or respiration to determine a person's respiration observe the number of times the chest rises and falls during a minute the average rate is 16 to 20 a minute for both men and women in sickness and injury respiration is often faster than normal indicating oxygen hunger on the other hand it may be slower than normal indicating extreme weakness and failure of vital processes it is good nursing practice to take the respiration immediately after counting the pulse while the patient is relaxed and unaware of your observation among the signs of illness or injury none is more important to the patient than pain pain may be general in one part of the body or it may be localized to one area it may be dull or sharp it may be continuous or it may come and go pain in the abdomen may be caused by simple indigestion or it may be due to a serious condition such as appendicitis stomach ulcers poisoning or diseases of the gallbladder or other abdominal organs since you should never try to diagnose the condition suspect it may be serious do not give a laxative and withhold solid food for a few days on the other hand if a patient with abdominal pain has vomited excessively there is danger of dehydration combat this by helping him to sip as much water as can be tolerated pain in the chest accompanied by pain in the arms or shoulders and difficulty in breathing may indicate some type of heart attack keep the patient in bed but elevate the head and shoulders to make breathing easier it is especially important to reassure a patient with suspected heart disease that he will be all right if he lies quietly and tries to keep his mind off his own condition a person fearing he has a heart attack will benefit more from your calm reassurance than any other available form of treatment another common result of illness is eruptions or rashes of the skin this may be due to simple irritation or it may indicate a nutritional deficiency or some other systemic condition frequently these eruptions occur about the mouth and other body openings a mixture of three tablespoons of baking soda in a glass of water will help to dry and soothe open skin sores another type of sore frequently seen in bed ridden persons is a bed sore caused by the constant chafing of the skin against rough blankets or wrinkled sheets bed sores are likely to develop on the body's pressure points such as at the heels the elbows and the shoulders it is easier to prevent bed sores than to treat them do this by inspecting bed ridden persons for signs of chafing and soothe the chafed areas with an ointment such as cold cream or petroleum jelly better still prevent skin chafing in bed-ridden patients by placing supports under the neck back knees and feet this will not only help to avoid bed sores but will enable the patient to rest more comfortably for longer periods of time this is a carbuncle or boil or abscess it is an infection of the skin and may also be a sign of an infectious disease since carbuncles boils and abscesses contain pus which is highly infectious do not open them or attempt to reduce them by squeezing leave them alone if they are draining cover them with a sterile or clean dressing to prevent infectious material from being carried to other parts of the patient's body or to other persons in emergency nursing as in any type of nursing the prevention of disease or complication is the highest priority it is most important to prevent the spread of a communicable disease one way to do this is by isolating persons with suspected communicable diseases another way is to see that contaminated materials such as tissues bandages and linens are handled carefully and disposed of safely [Music] another is to wash your hands each time you leave one patient and before going to the next by applying these rules of isolation and sanitation for the protection of all and providing nursing care to relieve the symptoms of the individual you will be doing your best for everyone dependent upon your care under these emergency conditions [Music] me so you