24. The nurse should know the ordinary doses of medicines and the symptoms of overdosing. Every unusual and inordinate action of a drug may be a good reason for omitting a dose or two till the physician is seen and new directions are given, otherwise be always regular and prompt in the administration of medicines.
25. But in general the nurse can best display her knowledge and exercise her skill by faithfully carrying out the instructions she has received from the physician. If the directions are not what she would expect, it may be an exceptional case; the doctor and not the nurse is the judge as to what is exceptional; she must obey his orders. Do not receive orders from the physician in silence, and when he is gone refuse to obey them. The nurse should never hide anything from the doctor, even if she has done wrong; it is a serious thing to think that life should be risked in order to conceal wrong doing. Never be afraid of troubling the doctor; he will always be glad to hear anything that will help in the diagnosis or treatment of the case. The nurse has much to do with an art whose end is the saving of human life; any neglect to act openly and intelligently becomes a crime.
26. Remember that kindness and tenderness as well as faithfulness are needful to successful nursing.
BEDSORES.
Every precaution should be taken by the nurse to avoid bedsores on her patient. These appear most frequently upon the hips, but may develop elsewhere in parts subjected to pressure. To harden the parts they must be frequently washed with soap and water and thoroughly dried. A draw sheet should be placed under the patient that can be changed as often as it becomes wet and damp. Be careful to keep the sheet free from wrinkles and inequalities, and the patient’s clothes must be kept smooth under her. Occasionally rub on the skin oil or vaseline, and then dust on some fine powder such as oxide of zinc, fine starch, or toilet powder.
Plasters that are entirely unirritating may be applied either before or after there is an evident sore, and if change of position is not possible, it may be necessary to obtain air cushions or a water bed.
An air mattrass or air cushions may be put on any bed, but a water bed must be put in a trough or wooden frame made of just the right size. The water in a bed of this kind should be of a temperature of 70° and renewed every two weeks. To prevent a water bed from sticking to the boards some old cloths must be interposed.
Reddening and roughening of the skin, and pain on pressure indicate an approaching bedsore before there is an abrasion of the skin. Those washes that cause smarting must be discontinued, and sulphate of zinc ointment, and unirritating plasters used.
If a part is dead and likely to slough off, apply charcoal or yeast or chlorinated poultices until the gangrenous parts can be removed. After the separation of the slough you can apply lint smeared over with carbolated cosmoline or whatever application the surgeon or doctor may direct. The sore must be washed and applications renewed each day, and at each time it may be covered with a piece of oiled silk or muslin, or rubber tissue confined in place by adhesive straps.