Mother, Nurse and Infant / A Manual Especially Adapted for the Guidance of Mothers and Monthly Nurses, Comprising Full Instruction in Regard To Pregnancy, Preparation for Child-birth, and the Care of Mother and Child, and Designed to Impart so Much Knowledge of Anatomy, Physiology, Midwifery, and the Proper Use of Medicines as Will Serve Intelligently to Direct the Wife, Mother and Nurse in All Emergencies.

by S. P. Sackett

One of the signs of a FRACTURE is crepitus, the sound made by the rubbing of the ends of broken bones together. This sound cannot always be obtained, even when the bone can be moved so that the ends rub each other, and as such motion causes considerable pain the nurse should not seek for it, except as she harkens when the limb is accidentally or necessarily moved. The separation and inequalities of the ends of the fracture (when the bones are superficial), the change in the form of the limb, and the shortening of it, are circumstances communicating information in very many cases, and the diagnosis is made pretty certain if there is unnatural mobility of the limb. In other cases there is loss of motion or immobility, swelling and pain in the injured part, &c., but it will possibly require the services of the skillful surgeon to detect the existence and character of a fracture; and generally the coaptation or setting of the bone, can be deferred until he arrives. The nurse can do something in the meantime—can have the patient and fractured limb put in as easy a position as possible; perhaps have something ready for bandages and splints. A splint may be made of anything that will hold the bone securely in place; it should be longer than the bone that is broken. Sole leather is sometimes used; cut the required size, softened in hot water, moulded to fit the part and left on until dry, when it will be of the desired shape. Plaster of Paris bandages are sometimes used. These are prepared by rubbing into the ordinary muslin rollers dry plaster. They are then rolled. When they are applied, soft flannel bandages are first put on the broken limb, then the one containing plaster is (after being dipped in water, and some of the water squeezed out), applied over the flannel. It takes ten or twelve hours for this to set and become hard, and the broken limb must be kept still during the time. Dust the part over with toilet powder before the bandage is applied. The success of the surgeon depends very much on the good constant care of the nurse. If it is necessary to move the limb keep up some extension on it and do not twist it. Be very careful that the directions of the surgeon are carried out, and it will probably be necessary to keep up extension all the time, otherwise the deformity may return and the limb be shortened.

Dislocations are not so easily reduced as fractures, but after the setting and reduction of a dislocated joint the action of the muscles tends to keep it in place. There is always some laceration of the ligaments and sufficient injury to the soft parts to excite a little inflammation, but the pain is relieved as soon as the bones are replaced.

In general recent dislocations are easily reduced, but when the head of a bone has been out of its place for several days the reduction becomes exceedingly difficult, and as a rule the difficulty of reduction arising from the muscles is proportioned to the length of time that has elapsed from the period of the accident. For this reason a person who has a little general knowledge on the subject of dislocations, should sometimes make an attempt at reduction immediately after the accident.

The signs of dislocations are pain, incapacity of motion in the limb, change in the length of the limb and in the direction of its axis. Sometimes the dislocated limb is nearly incapable of any motion, and sometimes the destruction of the means of union, allows the limb to obey any extraneous influence.

The replacing of the dislocation would require very little effort or force were it not for the resistance of the muscles and tendons attached to them. In reducing a luxated bone the main point is to apply force until the head of the bone dislocated can be slipped into its place, which is generally when it is nearly to a level with its socket. This is easily effected immediately after the accident, because at that time the resistance of the muscles is not great; it may be best to attempt it, but there should be no delay in sending for a surgeon.

I recommend that an attempt be made to set a DISLOCATED THUMB or FINGER by making extension on the lower member and at the same time pressing the head of the bone towards its natural situation. If the reduction is effected, the thumb or finger should be rolled with tape and surrounded and supported with pasteboard; and the hand and forearm put in a sling. A surgeon may be necessary even in a case of dislocated thumb or finger, but bones out of joint are so much more easily set at first, that it is best to attempt to set them then, and the same may be said of some larger bones.

For instance, if there is a DISLOCATION OF THE ELBOW, the patient being settled, let one man take hold of his arm near the shoulder, to make counter extension while another makes extension at the wrist. You yourself being seated grasp the elbow with your two hands by applying your fingers to the anterior part and your thumbs to the posterior, press on the projecting point of bone downwards and forwards. You will generally be successful, but I do not advise five minutes’ delay in sending for a surgeon. I only advise that an effort be made immediately.

After thus reducing a dislocation of the forearm backwards at the elbow, apply a bandage in the form of a figure of eight; apply some lotion or liniment, and keep the arm in a sling. At the end of seven or eight days when the inflammation has subsided, the articulation can be gently moved, and the motion may be increased every day.

The figure of eight bandage is a roller applied alternately above and below a joint, the roll being carried obliquely over a central point.

The art of putting on a roller bandage is an important one for a nurse to acquire, and I may here give a few general principles though no exact directions can be given. In applying a bandage care must be taken that it is put on tight enough to fulfil the object in view, without running any risk of stopping the circulation. A bandage must lie smoothly, without wrinkles, and making an even pressure. For bandaging an arm or leg a roller from two to three inches wide may be used; a few turns may first be given on the hand or foot, and after this every circle is to be applied so as to ascend up the limb in a gradual spiral form and cover about one-third of the turn of the roller immediately below it. To accommodate it to the shape of the limb reverses are made. The bandage is doubled back by placing a finger on the lower edge to hold it firmly, and turning the bandage downward over itself, at such an angle as properly shapes its direction, and these turns can be made as often as is necessary.