mcga-shs_capt_guide_chap3.pdf

CHAPTER 3

Introduction

This section of the Guide is concerned with the care and

treatment of bed patients until they recover or are sent to

hospital for professional attention.

Good nursing is vital to the ease and speed of recovery

from any condition. Attention to detail and comfort may

make the lot of the sick or injured person much more

tolerable. Cheerful, helpful and intelligent nursing can

greatly influence the person’s attitude in a positive direction

towards his illness or injury.

Introduction

The nurses

Sick quarters

Arrival of the patient

Visitors

Check list

Body temperature

Pulse rate

Respiration rate

Bed baths

Mouth care

Feeding patients in bed

The bed

Bed sores

Incontinence

Bodily functions of bed

patients

Bowel movement

Examination of faeces

Testing the urine

Examination of vomited

matter

Examination of sputum

Breathing difficulties

Fluid balance

Mental illness

Unconsciousness (and

insertion of airways)

Injections

The nurses

A sick person needs to have confidence in his attendants who

should understand his requirements. A nurse should be

selected with care and the master or a senior officer should

check on the performance of the person chosen.

Sick quarters

Wherever possible a patient sufficiently ill to require nursing

should be in the ship’s hospital or in a cabin away from others.

In this way the patient will benefit from quietness and the

risk of spreading any unknown infection will be minimised.

The sick quarters should be comfortable and easily cleaned.

The room fittings and floors should be cleaned daily.

Adequate ventilation of the sick quarters is of great

importance and it is equally important that changes of

temperature should be avoided. The ideal temperature for

the sick room is between 15.5 º C and 18.5 º C. If possible, direct

sunlight should be admitted to the cabin. If the weather is

warm and the portholes will open they should be left open.

Arrival of the patient

It may be necessary to assist the patient to undress and get

into bed. A patient with a reduced level of consciousness will

have to be undressed. Take off boots or shoes first, then

socks, trousers, jacket and shirt in that order.

In the case of severe leg injuries, you may have to remove

the trousers by cutting down the seams. In the case of arm

injuries, remove the arm from the shirt sleeve on the sound

side first, then slip the shirt over the head and lastly withdraw

the arm carefully from the sleeve on the injured side.

In cold climates the patient should always wear suitable

night wear. In the tropics cotton nightwear is preferable.

Blankets are unnecessary in the tropics but the patient

should have some covering, a sheet spread over him.

If your patient has a chest condition accompanied by

cough and spitting he should be provided with a receptacle,

either a sputum pot or an improvised jar or tin. The

receptacle provided should be fitted with a cover. If the

sputum pot is not of the disposable variety add a little

disinfectant. It should be thoroughly cleaned out twice daily

with boiling water and a disinfectant.

THE SHIP CAPTAIN’S MEDICAL GUIDE

Your other duties may make it impossible for you to give uninterrupted attention to your

patient and a urine bottle should therefore be left within reach of the patient on a chair, stool

or locker, and covered with a cloth.

Food, plates, cups, knives, forks and spoons should be removed from the sick quarters

immediately after a meal and in no circumstances should they be left there except in infectious

cases. In such cases they should be washed up in the cabin and then be stacked neatly away and

covered with a cloth.

Visitors

The patient should be protected from long and tiring visits from well-meaning shipmates. Visits

to patients who are ill and running a temperature should be restricted to 15 minutes.

Check list

Ensure that the person is comfortable in bed.

Check temperature, pulse and respiration twice daily (morning and evening) or more often

if not in the normal range (a four-hourly check is usual in any serious illness). Document

observations.

In appropriate cases test a specimen of urine and document.

Keep a written record of the illness.

Arrange that soft drinks are easily available unless fluids are to be restricted. No alcohol.

Specify normal diet or any dietary restrictions.

Ensure that the person knows to ask for a bottle or a bedpan as needed – some do not

unless told.

Check and record if bowels have moved or not.

Check fluid-in and fluid-out by asking the person questions about drinking and passing

urine. In certain illnesses a fluid chart must be kept.

Check that the person is eating.

Re-make the bed at least twice a day or more often if required to keep the person

comfortable. Look out for crumbs and creases, both of which can be uncomfortable.

Try to avoid boredom by suitable reading and hobby material. A radio and/or TV will also

help to provide interest for the patient.

A means of summoning other people, such as a bell, telephone or intercom should be

available if the person cannot call out and be heard, or if the person is not so seriously ill as

to require somebody to be with him at all times.

Ensure patient safety.

The body temperature

The body temperature, pulse rate and respiration should be recorded. You should make use of

your temperature charts, or if no more charts are available, then your findings should be written

down, together with the hour at which they were noted. These readings should be taken twice

a day and always at the same hours, and more frequently if the patient is seriously ill.

It will rarely be necessary to record the temperature at more frequent intervals than four-

hourly. The only exceptions to this rule are in cases of severe head injury, acute abdominal

conditions and hyperpyrexia when more frequent temperature recordings are required.

Chapter 3 GENERAL NURSING

The body temperature is measured by using a clinical thermometer, except in hypothermia

when a low reading thermometer must be used. To take the temperature, first shake down

the mercury in a clinical thermometer to about 35 º C. Then place the thermometer in the

person’s mouth, under the tongue. The thermometer should remain in the mouth with the lips

closed – no speaking – for at least 1 minute. After 1 minute, read the thermometer, then replace

it in the patient’s mouth for a further minute. Check the reading and if it reads the same,

record the temperature on the chart. Repeat the process if it is different. Then disinfect the

thermometer.

Sometimes it will be necessary to take the temperature per rectum, e.g. hypothermia. In that

case, first lubricate the thermometer with Vaseline. Then, with the patient lying on his side,

push the thermometer gently into the rectum for a distance of 5 cm and leave for 2 minutes

before reading it. Do not use the same thermometer as is used in the mouth.

People who are unconscious, restless or possibly drunk should not have their mouth

temperatures taken in case they chew the thermometer. These people should have their

temperature taken by placing the thermometer in the armpit and holding the arm into the side

for 2 minutes before the thermometer is read.

The normal body temperature is 36.9 º Celsius (centigrade) and lies in the range 36.3 to

37.2 º C. Temperature taken in the armpit is 1 / 2 º C lower, and in the rectum 1 / 2 º C higher. In good

health, variations in temperature are slight.

Body temperature is raised, and fever is said to be present, in infectious conditions and in a

few disorders which affect the heat regulating mechanism in the brain.

Centigrade (Celsius)

Fatal (as a rule)

43.3

42.8

42.2

Dangerous Fever

41.7

41.1

High Fever

40.6

40.0

39.4

38.9

Moderate Fever

38.3

37.8

Healthy Temperature

37.2

36.7

36.1

35.6

Hypothermia

35.0 and below

In feverish illnesses the body temperature rises and then falls to normal. At first the person may

feel cold and shivery. Then he looks and feels hot, the skin is flushed, dry and warm and the

patient becomes thirsty. He may suffer from headache and may be very restless. The

temperature may still continue to rise. Finally the temperature falls and the person may sweat

profusely, becoming wet through. As this happens, he may need a change of clothing and

bedding.

During the cold stage, the person should have one or two warm blankets put around him to

keep him warm but too many blankets may help to increase his temperature. As he reaches the

hot stage, he should be given cool drinks, not alcohol.

If the temperature rises above 40 º C sponging or even a cool bath may be required to prevent

further rise of temperature or reduce it. In the sweating stage the clothing and bedding should

be changed.

THE SHIP CAPTAIN’S MEDICAL GUIDE

The pulse rate

The pulse rate is the number of heart beats per minute. The pulse is felt at the wrist, or the heart

rate is counted by listening to the heartbeat over the nipple on the left side of the chest. The

pulse rate varies with age, sex and activity. The pulse rate is increased normally by exercise and

excitement; it is decreased by sleep and to a lesser extent by relaxation and some drugs.

Pulse rates of 120 and above can be counted more easily by listening over the heart.

Normal resting pulse rate (number of heartbeats per minute)

Age 2 to 5

About 100

Age 5 to 10

About 90

Adults, male

65 to 80

Adults, female

75 to 85

The pulse rate will usually rise about 10 beats per minute for every 0.5 º C over 38 º C. In heart

disease and shock, a high pulse rate may be found with a normal temperature.

Note and record also whether the pulse beat is regular or irregular, i.e. whether there are the

same number of beats in each 15 seconds and whether the strength of each beat is about the

same.

If the rhythm is very irregular, count the pulse at the wrist and also count the pulse by

listening over the heart. The rates may be different because weak heartbeats will be heard, but

the resulting pulse wave may not be strong enough to be felt. Count for a full minute in each

case.

The respiration rate

The respiration rate will often give you a clue to the diagnosis of the case.

The rate is the number of times per minute that the patient breathes in. It is counted by

watching the number of inspirations per minute. This count should be made without the

patient’s knowledge by continuing to hold the wrist as if taking the pulse. If the patient is

conscious of what you are doing, the rate is liable to be irregular. A good plan is to take the

respiration rate immediately after taking the pulse.

The respiration rate varies with age, sex and activity. It is increased normally by exercise,

excitement and emotion; it is decreased by sleep and rest.

Normal resting respiration rate (number of breaths per minute)

Age 2 to 5

28 – 24

5 to Adult

24 – 18

Adult, male

18 – 16

Adult, female

20 – 18

Always count respirations for a full minute, noting any discomfort in breathing in or out.

The pulse rate will usually rise about 4 beats per minute for every rise of 1 respiration per

minute. This 4:1 ratio will be altered in chest diseases such as pneumonia or asthma which can

cause a great rise in respiration rate.

Chapter 3 GENERAL NURSING

A Temperature, Pulse and Respiration Chart

Patient's Name 3rd OFFICER M.Y.X. Age 24 years

CABIN

MONTH

DAY

DAY OF

DISEASE

TIME

2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10 2 6 10

NOVEMBER

6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th

1 2 3 4 5 6 7 8 9 10 11 12

MEMEME ME M EMEMEMEMEMEME ME MEME

MONTH

DAY

DAY OF

DISEASE

TIME

107

106

105

104

103

102

101

100

state your diagnosis

180

170

160

150

140

130

120

110

100

180

170

160

150

140

130

120

110

100

Weight

Faeces

Urine

Proteins

Sugar

Ketones

70.5

68.5

Weight

Faeces

Urine

Proteins

Sugar

Ketones

–

– –

–

– –

–

See

Note

2500

3000

4000

3000

2750

2500

POS

NEG

+ +

+ + +

NEG

Note

Weight - in kgs : Faeces - number of movements am/pm : Urine - amount in mls

If urine tested record as appropriate , for Protein ; Neg or Pos ( not present / present ) ; &

for Sugar and for Ketones ; Neg / + / + + / + + +

The remaining rows can be used for other factors significant to the patient's condition

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