A milk diet is the means of reducing the nitrogen intake; or in some cases even that small amount of proteid is deemed too much, and only water is given until 24 to 48 hours after the convulsive seizures have ceased. From three to five litres of these fluids should be given in the course of twenty-four hours, in order to increase elimination by way of both kidneys and skin, and it usually taxes the nurse’s patience and ingenuity to give this amount, for the patient will seldom take large quantities of fluids willingly, even when quite conscious. A surprising amount of water may be given to the sleeping or unconscious patient by dropping it into her mouth from the point of a teaspoon, taking care to give it only at those moments when she is lying quite still. If the nurse attempts to hold the restless patient’s head, or so much as places her hand upon the chin to steady it in order to give water, the irritation, though slight, may be enough to cause a return of the tossing and struggling.
Lithia water and cream-of-tartar lemonade (a teaspoonful of cream of tartar to a pint of water), are frequently given because of their diuretic and diaphoretic action; but whatever the fluid, it must be given persistently, with greatest gentleness and with care that the patient does not choke nor aspirate it into her lungs and thus possibly cause pneumonia. Food even in liquid form is not given while the patient is unconscious, because of this danger of aspiration and subsequent pneumonia.
The bowels are stimulated to greater activity by powerful purges, such as croton oil, in olive oil, dropped on the back of the tongue, or salts or castor oil given by stomach tube.
Copious colonic irrigations, alternating with hot packs so that one or the other is given every six, eight or twelve hours, according to the seriousness of the case, are frequently given and with excellent results. A colonic irrigation may be given by means of the Murphy drip method or through a rectal tube so contrived that a two-way flow of fluid is possible. Water, normal saline (2 drams of salt to a quart of water), or a weak solution of sodium bicarbonate (an ounce of soda to a quart of water), are all used for colonic irrigations, which are given at a temperature of 110° F., very slowly, with the receptacle for the solution placed so low that the flow is under very slight pressure. The patient should lie on her left side, in a comfortable position and be warmly covered. The tube should be introduced from 12 to 18 inches, and the stop cock arranged so that it will take from twenty to thirty minutes for each gallon of fluid to run in and out. About two gallons are usually used for the first irrigation, the amount being increased until five gallons are used each time. The beneficial effects of the colonic irrigations are two-fold, for in addition to removing the toxic material that may be in the colon and rectum, a good deal of fluid is absorbed through the intestinal wall.
The function of the lungs may be promoted by using oxygen and by keeping the air in the patient’s room fresh and constantly moving, but moving so gently that there is no perceptible draft. The nurse must remember that the skin also is an excretory organ whose function is being stimulated, and this necessitates its being kept warm.
Some obstetricians feel that it is as important to increase the excretions of the skin as of the kidneys, and that inability to induce perspiration is an unfavorable sign. Others, who disagree on this point, believe that the skin is of minor importance but that the bowels are of equal consequence with the kidneys. However, the nurse will do no harm, and will err on the safe side if she takes care to keep her patient warm and constantly protects her from being chilled, that is from exposure or changes in the temperature of her surroundings. A flannel nightgown or dressing gown will help to this end, or if neither is available, at least the patient’s chest and arms may be protected by warm bed jacket, or sweater, put on backwards and fastened at the back of the neck. This protection, together with a number of blankets, with or without hot water bags between them, will often induce a slight but constant perspiration, particularly if fluids by mouth are being forced at the same time. This may be all of the stimulation that the skin needs, and has the advantage of not greatly disturbing the patient, a point that cannot be too constantly borne in mind.
Fig. 48.—Patient in hot pack given with dry blankets and hot-water bags. The blankets are turned back in this picture to show their arrangement. (From photograph taken at Johns Hopkins Hospital.)
If something more is needed, the hot dry pack is a widely used and usually efficacious method of producing a sweat and can be given easily in the patient’s home with no more equipment than the average family possesses or can obtain. The articles needed are two rubber sheets or two heavy quilts; four blankets; three, four or five hot water bags; an ice cap or a basin with ice and two cloths for the patient’s head; a pitcher of the fluid that she is taking, and a feeding cup, drinking tube, small pitcher or a spoon with which to give it. One rubber sheet (or one of the quilts), and two blankets should be slipped under the patient, after the regular bedclothes have been loosened at the foot. If the patient is having convulsions it is better to leave on her a warm garment with sleeves to insure against her arms and chest being uncovered, otherwise the nightgown may be removed.
The patient is covered with one blanket which is tucked between her legs and around her body with her arms out, so that no two surfaces of the skin come in contact. The blanket on which she lies is brought up about her; another blanket should be laid over this and tucked in well about the neck, shoulders and entire body, while the fourth blanket is next wrapped around her from below. One long or two short hot water bottles should be placed on each side of the patient and one at her feet, all being placed outside the four blankets. The second rubber sheet, or quilt, is thrown over the whole and the ice cap, or cold compresses (changed every four or five minutes) placed on her forehead. (Fig. [48].)