The Nursing Care of Pneumonia

Author(s): Lena Steuer

Source: The American Journal of Nursing, Vol. 11, No. 7 (Apr., 1911), pp. 515-519
Published by: Lippincott Williams & Wilkins
Stable URL: http://www.jstor.org/stable/3404929
Accessed: 01-02-2017 03:04 UTC

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 Nursing Care of Pneumonia.-Steuer 515

their
theirlives
livesfrom
from infantile
infantile
paralysis,
paralysis,
contracted
contracted
while in
while
attendance
in attendance
upon upon
cases
cases suffering
suffering from
from thethe
disease,
disease,
makesmakes
it imperative
it imperative
that allthat
that all
is that is
known
knownrelative
relativetotothese
these
matters
mattersbe known
be known
to you.
toAtyou.
theAt
present
the present
time time
poliomyelitis
poliomyelitisis isconsidered
considered infectious.
infectious.
All state
All state
boardsboards
have assumed
have assumed
the
the attitude
attitudethat
thatit it
should
should
be reported
be reportedand quarantined
and quarantined
by cardsbystating
cards stating
that
that aacase
caseexists
existsin in
thethe
house.
house.
It isIt
known
is known
that the
thatinfectious
the infectious
organism organism
responsible
responsiblefor forthethemalady
maladygainsgains
access
access
to thetospinal
the spinal
centrescentres
throughthrough
the
the nasal
nasaland
andbuccal
buccal mucous
mucousmembranes.
membranes.It is thought
It is thought
that thethat
organ-
the organ-
isms
isms find
findtheir
their exits
exits
through
through the the
samesame
channels,
channels,
consequently
consequently
care care
must
must be beexercised
exercised to to
prevent
preventinfection
infection
fromfrom
handling
handling
the discharges
the discharges
from
fromthese
theseparts.
parts.Dr.Dr.
Richardson,
Richardson,
of Boston,
of Boston,
believes
believes
that thethat
twothe two
fatal
fatal cases
casesininhis
his
own
ownhome
home
werewere
acquired
acquired
by hisby
children
his children
kissing kissing
a a
neighbor's sick child. I will not have to caution nurses about
this danger. When infantile paralysis is treated as infectiows
as diphtheria there will be fewer nurses infected; and the sooner
all who come in contact with the disease assume the infectious char-
acter of it, the better it will be. The nurse with abrasions on the
lips, in the nose, or having even the slightest inflammations of the
throat, has no business whatever in proximity to the infection. Finally,
the more one sees of the disasters in the wake of infantile paralysis, the
paralytic curvatures of the spine, the withered and blighted legs and
arms, and the well-nigh useless humanity that sometimes remains of
the disease-toSsed wreckage, the more fear and respect one will have for
this most fearful of adolescent infections.

THE NURSING CARE OF PNEUMOINIA

BY LENA STEUER,
Lakeside Hospital, Cleveland, Ohio

THE nurse in assuming her duties should have in mind at least a

general synopsis of the nursing care of the case at hand. One that
would quite thoroughly cover a case of pneumonia is: Preparations:
the patient, sick-room, daily care, hydrotherapy measures. Care:
nourishment, medications, emergency treatments. Crisis. Convalescence.
Relapse. Complications: pleurisy, endocarditis, myocarditis, pericar-
ditis.
PREPARATIONS.-The Patient.--The two principal things in the
treatment of pneumonia are the saving of the patients strength to
combat the disease, and avoiding all unnecessary exertion, especially
any sudden movement which might cause acute dilatation of the heart.

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516 The American Journal of Nursing

Therefore, the patient should at once be made as quiet and comfortable

as possible. Before starting to prepare the sick-room, the things used
for and on the patient should be gathered and kept in easy reach, such
as gowns, linen, and all utensils.
Sick-room.-It is very important in preparing the sick-room that
the nurse use tact and discretion, for it is not well to upset the home
nor have the patient disturbed by too much rearrangement. She must
bear in mind the things which will help to establish a rapid convales-
cence and give the most comfort with the least exertion. The room
should be quiet, light, and well ventilated; and the air must be pure
and moist if possible. The bed should be hard and cool, with a good
spring, and coverings that are light and warm. The pillows should
number according to the patient's comfort and the doctor's judgment,
for much depends on the condition of the heart. A small pillow for
the knees and one under the head will give comfort. As the patient
generally lies on the affected side, causing the hip to become numb as
well as painful, a pillow at his back will support and give comfort.
The nightgown should be made of flannel, as the temperature of the
room should be 60? to 70?, and the coverings light.
Pneumonia being an infection of the air-passages moist air is most
beneficial. This may be had by either attaching a rubber tube to the
spout of a tea-kettle, filled with boiling water, and bringing it to the
bedside, or by having a small alcohol lamp burning underneath a dish,
containing creosote or some medicated solution as pine-Aeedle oil.
Inhalations are also soothing to the irritated mucous membrane of the
throat. For this an old pitcher and a cone made of newspaper will
reach to the patient's mouth and nose and save exertion. The windows
in the room may be covered with towels or cheese-cloth, thus not only
sifting out the dirt, but protecting the patient from draughts. Screens
may be used to good advantage for this same purpose. A sputum cup
with a solution of 1-20 carbolic is a good preventive for spreading dis-
eases. A few flowers are very cheering, and growing plants are very
beneficial to the patient. An orderly room is not only restful to the
patient but to the doctor and the nurse.
CARE.-Bedside Notes.-From the first, the nurse should keep an
accurate account of temperature, pulse, respirations, of all medicines
given, nourishment and water intake, number and character of stools,
the color and amount of each urination, and also the total for the twenty-
four hours, any distention of the bladder or abdomen, where and how
often pains occur, duration of chills, number of baths given and if well
taken, character of the cough, the color and appearance as well as the

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 Nursing Care of Pneumonia.-Steuer s51

amount of sputum, amount of sleep and rest the patient has had, and
all the treatments given.
Daily Care.-When the patient awakens in the morning the hands
and face should be washed and the hair brushed back. If it is long,
it is best to wait until after the cleansing bath to comb it. Cleanse
mouth and teeth with a 1-4 H ,02 solution, or a 1-8 Listerine solution,
It is very important that special care be given to the mouth and gums,
cleansing them after each feeding. Straighten the bedclothes and serve
nourishment.
All orders for medicine and treatment must be carried out as the
doctor instructs, and in a uniform way best suited to the individuality
of the patient. An hour after nourishment, a cleansing bath is given at
a temperature of about 85? or 90?, whichever is more comfortable for
the patient. At this time attention must be given to the changing of
the bed linen and gown. The turning of the patient must be as little
as possible. It should not be necessary to mention that the nurse should
have everything in readiness before starting to give the bath, not only
the necessary articles for the bath, but hot water bag filled, the ice cap
refilled with very finely cracked ice, or, if a mustard plaster is ordered,
this should be ready and when administered care must be taken not to
blister. Cold applications for old age and children are often distressing.
Heat is best used in these cases.
The paroxysms of coughing are usually painful. During these spells
the patient's head should be held, turned, or lifted so as to help to raise
the rusty colored sputum. Medicine should be measured and if it is
a hypodermic the needle should be sterilized and wrapped in cotton
saturated with alcohol. There should be at hand cold cream for herpes,
alboline for the nose, alcohol and powder for a general rub which should
be given after each bath. An alcohol rub, while soothing, is also a
preventive of bed-sores. It is well to offer a bed-pan at this time as,
on account of the illness, the patient may not feel the need of it. After
the bath is finished, the hair should be combed and the nails cleaned.
If the patient is quiet, the room should be put in order without raising
dust or making any noise.
The nurse must be ever watchful to give all the little attentions
that gain the patient's perfect confidence and rest of mind, which is so
conducive to an early convalescence. All through the illness the patient
will exercise many peculiarities and these must not be overlooked; an
endeavor should be made to relieve all worry or excitement, to induce
sleep and rest. Visitors must be limited, explaining to family and
friends that absolute quiet is essential. This must be done without
alarming or offending the family, thus avoiding much trouble.

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518 The American Journal of Nursing

Hydrotherapy Measures.-The bath is very essential for the elimina-

tion of poisons through the skin and affords considerable comfort to
the patient. The drinking of water also helps this elimination of poisons
and increases the urine which, on account of increased acidity, is high
in color and scanty.
CAuE.-Nourishments.-Water and nourishments should be urged.
Nourishment is best given in liquid form and at fixed intervals. Great
care must be taken in their preparation and in the serving to make them
appeal to the patient.
Medications.-The nurse must know the effects of the different medi-
cines ordered and should be ever watchful for the toxic symptoms of
an over-dose of the two drugs most frequently used. When too much
Spiritus Frumenti has been given, the breath will smell of alcohol, the
face will be flushed, and if not watched may put a patient in a semi-
conscious condition. Strychnine, given in large doses, may cause the
patient to become toxic, to complain of vertigo, the pupils will contract,
and the muscles twitch. These symptoms, of course, must be reported
at once to the attending physician.
Emergency Treatments.-Oxygen may be at hand, while in many
instances the doctor may be deterred from ordering it early in the case
on account of its cost. However, the nurse must be quick to see the
patient's need of it and have everything in readiness for its prompt
administration by funnel or mask. She must watch for any cyanosis or
more marked dyspncea. To have saline solution in readiness is very
important and the nurse must not be caught unawares, as its proper
preparation takes three days.
CRIsIs.-The crisis may come at any time between the third and
tenth day and is determined by a decided change in the patient's con-
dition. There will be a decided drop in the temperature and the patient
undoubtedly will be in a warm perspiration. So it is well to have a
change of clothing in readiness.
I recall a case of a young girl of eighteen years who, on the ninth
day, seemed more uncomfortable than at any time during her illness. A
sponge bath seemed a disagreeable thought on account of the intense
pain in her side and head, and was therefore omitted. An alcohol rub
proved very soothing. After rubbing the whole body, the patient was
turned on her left side and her back was rubbed for ten minutes, and
after many attentions to make her comfortable in about one-half hour
she fell asleep. This particular evening the urine record was much
higher. Her temperature at 8 P.M. was 103.6?, pulse 110, respiration 32.
After sleeping two hours she awakened feeling much better and in a
warm perspiration. A warm sponge was rapidly given and the damp

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 Administration of Small Hospital 519

clothes changed. Her appearance had changed decidedly, and she seem
more comfortable. At midnight her temperature had dropped to 99.6
pulse, 92, respiration 26. She was very hungry and ate a bowl of mil
toast.

CONVALESCENcE.-Convalescence is generally very rapid, but the

patient must be kept quiet so as to build up strength and avoid com
plications. In the above-mentioned case, the patient was kept very qui
for ten days. At the end of fourteen days she was allowed to have
back rest and a full tray. During this convalescence there was n
irregular fever or rise in temperature nor at any time a feeble pul
or dyspnoea. About the second week she complained of pain in t
shoulder and left arm. However, these left soon after hot stupes h
been applied. There were no signs of delayed resolution. Convalescenc
was complete in three weeks.
RELAPSE.-A relapse may come at any time after the crisis, as lat
as the eighth or ninth day. The symptoms would be chills and feve
as in pneumonia, and the care would be the same.
COMPLICATIONS.-As complications may come at any time, a ver
close watch of pulse and temperature should be kept during the disea
being taken every four hours at least. Baths may be changed, if th
doctor permits, from q. 4 h. to b.i.d.

THE ADMINISTRATION OF A SMALL HOSPITAL

BY A. E. B.

ITS TRIALS AND TRIBULATIONS

IN the administration of a small hospital, much depends on

it is located. Having had charge of a hospital in a town o
thousand, in a large city, and in a small town, with poor railroa
ties, poor trolley service, I would say that the smaller the hosp
town, the greater the trials and tribulations, and especially is t
if it is a new hospital, among people who know little or nothin
hospitals. The task of educating a community to the needs and
ties of the hospital, of combating its indifference, and of con
it that it is not a source of revenue, is far from an easy one.
In the large hospital, the public is considered; in the sm
pital, in the small town, the individual must be considered. Th
intendent must not only be nice to the patients, but exceeding
their friends. One disgruntled person can make a world of trou

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