A patient may usually be left in such a pack as this from half an hour to an hour, but since any sweat bath is more or less depressing, she must be watched constantly for evidence of exhaustion, such as a weak, rapid, irregular pulse and increased weakness, or the sudden relaxation of an active eclamptic patient.
In some instances the hot-water bags may be inadvisable, because of supplying more heat than the condition of the patient warrants; but if they are used, the nurse must remember how easily an unconscious or ill person is burned. She must watch the bags, move them frequently and take care that one of them does not slip under the patient. And while the pack is in progress, an even greater effort than ever should be made to force the fluids.
If the blankets are wrapped snugly about the patient, alternately from below and above as described, they will frequently provide all of the restraint that is necessary should she have a convulsion while in the pack. The importance of protecting her against exposure and chilling while in the pack cannot be too insistently stressed.
If I have seemed to dwell at surprising length upon rudimentary nursing details, in this connection, it is because the patient’s life literally depends upon the nurse’s conscientious and painstaking attention to these same details. The doctor may study the case ever so earnestly and order the treatment ever so wisely, but if every detail of that treatment is not thoughtfully and skilfully carried out, it may do the patient more harm than good. And on the other hand, I can think of no circumstance that gives the nurse deeper gratification than the almost miraculous improvement in an eclamptic patient, sometimes only overnight, after she has taxed to the utmost all of her ingenuity to make her ministrations effective.
Appliances for giving hot packs and hot-air baths are usually found in all hospitals, and the nurse will use them as directed, which obviates any necessity for describing them here. But in addition to correctly adjusting and using the appliance itself, she must watch her patient for evidence of exhaustion or shock; protect her from burns; keep cold applications on her head and give her as much fluid as possible. And when the hot pack is over, the patient must be taken from it gradually; one blanket at a time, or the heat slowly reduced, and then the greatest care taken that she is not chilled while being put into dry clothing, for she must be kept warm and perspire slightly even after the sweat is finished.
Restraint during convulsions should be as mild as possible, for resistance only increases the patient’s excitement, and sustained effort should be made to reduce it instead. To this end there are innumerable details to be considered. Every act must be performed as quietly as possible. The nurse must walk lightly and if her tread will be made softer by wearing bedroom slippers, she should wear them. She should consciously guard against kicking or striking the bed. All talking should be in low tones; doors opened and closed quietly; papers should not be rustled nor furniture scraped on the floor. The room should be as dark as is feasible and the source of light screened from the patient’s eyes.
She should be saved from biting her tongue by having placed between her teeth something that will serve as a mouth gag and still not cut nor bruise the mucous membranes. In a private home, one will find that a cork answers admirably; or the handle of a wooden spoon well wrapped with gauze or a clean handkerchief; or a small roll of bandage or clean cloth tightly rolled. Another method is to take a fresh handkerchief, or napkin, in the fingers by opposite corners, twist it slightly into a roll and force it between the teeth and tie the two corners firmly together at the back of the neck.
Venesection. The large intake of fluids tends to dilute and eliminate the toxins which are giving so much trouble, but another very prompt and efficacious measure is to withdraw from 500 cubic centimetres to 1000 cubic centimetres of blood by venesection, according to the condition of the pulse. In preparing for a venesection the nurse will slip a small rubber, covered with a towel, under the arm that is to be opened, and scrub the inner surface of the elbow with soap and solutions according to the wishes of the doctor in charge, and cover the cleaned area with a dry sterile towel or one wet with a disinfecting solution. A sterile towel should be slipped under the patient’s arm, one laid over the arm above and one below the cleaned area so that the entire surrounding field is protected by sterile towels.
For the puncture there will be needed a sterile canula, or infusion needle, with a piece of rubber tubing attached; a sterile receptacle for the blood, usually a 1000 cubic centimetre, graduated measuring-glass; both dry and alcohol sponges or cotton pledgets; adhesive plaster, or a bandage to hold in place the small dressing which is applied after the needle is withdrawn; and a tourniquet for tight application to the upper arm to impede the return of the venous blood and thus distend the large vein to be seen near the surface of the inner curve of the arm. This vein usually may be easily pierced, without incising the skin, the canula pointed toward the hand to meet the blood stream, after which the tourniquet is removed. Sometimes it is necessary to incise the skin in order that the vein may be exposed and the needle inserted into it directly. In this case the doctor will need, in addition to the articles already mentioned, a scalpel, a pair of tissue forceps, three or four artery clamps, a needle holder, skin needles and sutures.
A venesection is practically always followed by a drop in the blood pressure and a marked improvement in the general condition.