Toward the end of the afternoon the patient is probably tired, especially if she has not slept during the day. When fever is present her headache and restlessness increase as the day goes on, but it should be remembered that uncomfortable beds and too heavy covers cause much of the restlessness attributed to fever. Rubbing the back and legs with alcohol, giving a tepid sponge bath, remaking the bed or changing her position may help to soothe her.

The evening should be kept free from excitement, and every possible effort should be made to encourage sleep. It is a mistake to think that a better night results from keeping a sleepy patient awake all the evening; sick people should sleep when they can. Just before bedtime the attendant should prepare her own cot, and then make the following preparations for the patient to sleep: wash the patient's face and hands or give a sponge bath if it is desired, brush the hair, change the night gown, brush crumbs from the bed, tighten the sheets or remake the bed if necessary, rub the back and other pressure points

with alcohol, shake the pillows, give liquid nourishment, preferably hot, cleanse the mouth, and give the bedpan. See that the patient's feet are warm, the bed covers right, the room ventilated properly and in good order, and the light extinguished or arranged for the night. If the patient is inclined to be wakeful a hot foot bath may help her, or sponging the entire length of the spine for fifteen minutes, using very hot water and long downward quiet strokes. No conversation should be encouraged during preparations for the night. Patients in bed all day often lose the habit of sleeping at the regular time, and lie awake far into the night from a vague feeling that someone else is coming or something further is to be done for them. Consequently last of all ask the patient if she wants anything more; if not, say good-night, go out and stay out, at least until she has had a chance to go to sleep. She is thus helped to realize that nothing further is likely to happen, and that it is time to go to sleep.

Toward morning the patient grows weaker. More bed covers will probably be needed, and they may often be added without waking her. Night at the best is a dreary time for the sick. Pain and weariness and discouragement are less bearable in the darkness; nervous fears and morbid fancies defy control. Never is kindness more

needed or more appreciated than it is by those who lie awake and watch for the morning.

EXERCISES

  1. Name all the causes, direct and indirect, of pressure sores.
  2. Why are pressure sores generally more serious than injuries of equal extent to the skin of a well person?
  3. Where are pressure sores most likely to occur and what are their symptoms?
  4. What measures should be employed to prevent pressure sores?
  5. Describe ways to support a person lying down in bed.
  6. Describe ways to support a person sitting up in bed.
  7. How may the weight of the bedclothes be removed from any particular part of the body?
  8. How should a bedpan be cared for?
  9. Describe in detail a day's routine either of yourself the last time you were ill in bed, or of another patient personally known to you. Could the plan of the day have been improved, and if so, in what ways?

CHAPTER IX
FEEDING THE SICK

Substances used for food are generally grouped into three classes, called the three nutrients. The nutrients are: first, the proteids or nitrogenous substances, which are found in meat, fish, eggs, milk, cheese, peas, beans, etc.; second, the carbohydrates, which include sugars and starch; and third, the fats, which are found in butter, oil, the fat of meat, etc. In addition to the nutrients, water and certain mineral salts are essential to life, while some indigestible material like the fibre of vegetables is needed to give bulk and to stimulate the action of the intestines.