A Manual 
of 
Nursing Procedures 
By 
E. Priscilla Reid, R. N. 
Formerly Educational Director for the Schools of Nursing of the General, 
Highland, and Homeopathic Hospitals, Rochester, N. Y. 
Instructor in the General Hospital School of Nursing, Rochester, N. Y. 
Mabel E. Hoffman, R. N. 
Hazel L. Jennings, R. N. 
Instructor in the General Hospital School of Nursing, Rochester, N. Y. 
Lillian A. Read, R. N. 
Instructor in the Homeopathic Hospital School of Nursing, Rochester, N. Y. 
ILLUSTRATED 
Philadelphia and London 
W. B. Saunders Company 
1923 Copyright, 1923, by W. B. Saunders Company 
MADE IN U. S. A. 
PRESS OF 
W. B. SAUNDERS COMPANY 
PHILADELPHIA PREFACE 
This manual of nursing procedures is intended to be used 
with a standard text-book on nursing. Text-books combining 
both the theory and the procedures have, for the younger 
students especially, often led to confusion and consequent 
difficulty in systematizing the procedures. 
The methods given here are those that have been followed 
for several years in the General, Homeopathic, and Highland 
Hospitals of Rochester, N. Y., and that are also being used 
in the Central School of Nursing, Utica, N. Y. Each procedure 
has been given considerable practical trial, and is the result 
of several revisions. While there are various efficient ways of 
accomplishing the same end, it was not considered wise to 
give many of these in one small manual. A multiplicity of 
methods easily leads to confusion, especially for the younger 
student. 
The text has been made as concise as possible. The arrange- 
ment in outline form, giving purposes, required equipment, 
method of procedure, and precautions, is intended to give a 
clear, logical picture that will save confusion, time, and energy. 
A few well-tried rules for solutions and dosages have been added. 
Too much stress cannot be placed upon good technic. The 
nurse who can systematize her work saves not only her own 
time and energy but also saves her patient nerve irritation 
and the resulting fatigue.. There should be no confusion in 
3 4 
PREFACE 
connection with nursing either in the ward or in the home. 
After all, it is the type of work that the nurse does that counts. 
All the education which a nurse receives—and she cannot re- 
ceive too much—should contribute toward her efficiency as a 
nurse and her helpfulness in the home. 
The excellent photographs from which the illustrations were 
made are the work of Mr. Charles G. Hooper, of Rochester, 
N. Y. 
E. P. R. 
December, 1923. CONTENTS 
PAGE 
Cleaning Utensils and Utility Room 15 
Cleaning a Bed 17 
Making an Empty Bed 19 
To Open a Bed for a Patient 24 
To Strip the Bed After the Patient Has Left 25 
Convalescent Bed 25 
Morning Care of a Bed Patient, Including Making the Bed .... 26 
Evening Care of the Patient 28 
Ether Bed 29 
Tonsil Bed 32 
Bed Bath 33 
To Place a Patient on a Back-rest 36 
To Assist a Patient Out of Bed... 39 
Preparation of Bed for Fracture Case 40 
Care of the Patient in Fracture Bed 41 
Care to Be Observed if the Patient is in a Body Cast 42 
To Move a Patient from One Bed to Another 44 
When Patient is to B-e Changed to Different Bed Frame Only 45 
Turning the Mattress Without Moving the Patient from the Bed 45 
Pulse, Temperature, and Respiration 48 
Enemata 52 
Cleansing Enema 52 
Carminative Enema 53 
Nutritive Enema 55 
Medicated Enemas 57 
Formulas for Medicated Enemas 58 
Proctoclysis 58 
Local Antiseptic Baths or Soaks 62 
Vaginal Douche 64 
Aural Douche 66 
Nasal Douche 68 
Pharyngeal Douche 70 
Care and Use of Hot-water Bag 71 
To Fill Ice-bags 73 
Rubber Rings 75 
Ice Coil 76 
Drainage Pads 77 
5 6 
CONTENTS 
PAGE 
Care of Rubber Goods 78 
Application of a Larkspur Cap 79 
Giving a Shampoo to a Patient in Bed 81 
Poultices 83 
Flaxseed 83 
Digitalis 85 
Yeast. 86 
Starch 86 
Soap 86 
Antiphlogistin 87 
Counterirritants 88 
Iodin 88 
Mustard Foot-bath 89 
Mustard Paste 91 
Turpentine Stupes 92 
Dry Cupping 94 
Application of Various Treatments to the Eye 96 
Douching the Eye 96 
Application of Drops to the Eye 98 
Application of Powder to the Eye 99 
Application of Ointment to the Eye 99 
Application of Ice Compresses to the Eye 100 
Application of Heat to the Eye 101 
Application of Cold Compresses to the Head 103 
Inhalations 104 
Inhalations for General or Systemic Action 105 
Some of the Drugs Which May Be Used in Inhalations 105 
Special Care of the Patient’s Mouth 106 
Cold Sponge 108 
Alcohol Sponge 110 
Cold Towel Pack 112 
Cold Sheet Pack 115 
Cold Chest Pack 116 
Hot Fomentations 117 
Hot Pack 119 
To Take Patient Out of Pack 121 
Gastric Lavage 123 
Gavage 126 
Nasal Feeding 127 
Colon Irrigation (Enteroclysis) 128 
Catheterization 130 
To Obtain a Sterile Specimen 132 
Bladder Irrigation 134 
Instillation of Medicine Into the Bladder 135 
Preparations for Surgical Operations 137 
Before Taking the Patient to the Operating-room 138 CONTENTS 
PAGE 
Surgical Dressings 140 
Feeding a Helpless Patient 143 
Method of Serving Cracked Ice 145 
Giving Medication by Hypodermic 146 
Bathing a Baby—Tub Bath 150 
Preparation for Administration of Salvarsan 152 
Lumbar Puncture 153 
Intravenous Medication 155 
Paracentesis 157 
Blood-count 159 
Hypodermoclysis 160 
Transfusion 162 
Intubation 164 
Restraint of Restless or Delirious Patients 165 
Care of the Body After Death 168 
Tables of Weights and Measures 170 
Rules Used in Making Solutions and Giving Medicines 172 
Tray Equipments , 174 
Index 177 LIST OF ILLUSTRATIONS 
FtG- PAGE 
1. Practice Period in the Class Demonstration Room 11 
2. Linen and Supply Closet in Class Room 12 
3. Medicine Closet in Class Room 13 
4. Arrangement of Utensils in Utility Room 14 
5. Mattress Cover Partly in Place : 16 
6. Folding a Draw-sheet (First Step) 20 
7. Folding a Draw-sheet (Second Step) 20 
8. Adjusting Draw-sheet 21 
9. Second Side of Bed Partly Completed 21 
10. Making Square Corner on First Blanket 22 
11. Making Square Corner on Second Blanket 22 
12. Completed Bed 23 
13. An Open Bed 24 
14. Mattress Airing 25 
15. Bed Ready for an Ether Patient 31 
16. Adjusting Bath Blanket 34 
17. Beginning the Bath 34 
18. Making Bed After Bath 35 
19. Ready to Lift the Patient Before Placing the Back-rest 37 
20. Patient on Back-rest, Slings Adjusted 37 
21. Gatch Bed in Use 38 
22. Arrangement of Fractured Limb 40 
23. Completed Fracture Bed ! 42 
24. Moving a Patient from One Bed to Another 45 
25. Turning a Mattress with the Patient in Bed 46 
26. Taking Pulse, Temperature, and Respiration 49 
27. Showing Position of Fingers in Taking the Pulse 50 
28. Enema Tray 53 
29. Giving a Proctoclysis 60 
30. Giving an Aural Douche 67 
31. Filling Hot-water Bag 72 
32. Application of a Larkspur Cap 80 
33. Preparation of a Flaxseed Poultice 84 
34. Flaxseed Poultice Ready to Apply 84 
35. Patient Having a Mustard Foot-bath. A Heavy Blanket Covers 
the Tub and the Bedding Has Been Brought Down Over This 
Blanket 90 
9 LIST OF ILLUSTRATIONS 
FIG. PAGE 
36. Method of Adding Hot Water During Mustard Foot-bath 90 
37. Applying Turpentine Stupes 93 
38. Trays for Douching the Eyes, and for Application of Medication 
to the Eyes 96 
39. Douching the Eye 97 
40. Application of Medication to the Eye 98 
41. Tray for Applying Ice Compresses to Head 103 
42. Care of the Patient’s Mouth 107 
43. Cold Towel Pack 113 
44. Preparing a Patient for a Hot Pack 120 
45. Patient in a Hot Pack 120 
46. Gastric Lavage 124 
47. Patient Prepared for Catheterization 131 
48. Tray and Preparation of Patient for Abdominal Dressing 141 
49. Feeding a Patient 144 
50. Cracked Ice Ready to Serve 145 
51. Hypodermic Tray with Equipment 146 
52. Expelling Air from the Hypodermic Syringe 147 
53. Method of Inserting the Hypodermic Needle 148 
54. Method of Injecting the Medication 148 
55. Use of a Bed-board 165 
56. Restraining Sheet 166 
57. Equipment for Surgical Dressing of the Eye 174 A Manual of Nursing Procedures 
Fig. 1.—Practice period in the class demonstration room. 12 
A MANUAL OF NURSING PROCEDURES 
Fig. 2.—Linen and supply closet in class room. A MANUAL OF NURSING PROCEDURES 
Fig. 3.—Medicine closet in class room. 14 
A MANUAL OF NURSING PROCEDURES 
Fig. 4.—Arrangement of utensils in utility room. CLEANING UTENSILS AND UTILITY ROOM 
Purpose: 
To insure clean, sanitary, and therefore safe equipment and 
supplies for use in nursing procedures. 
Equipment: 
Warm soap and water. 
Cleaning cloths. 
Cleaning brushes. 
Antiseptic solutions. 
Procedure: 
Remove articles from shelves. 
Wash shelves and racks with soap and water. 
Clean all articles before replacing. 
Basins, pitchers, irrigating cans, etc., to be cleaned with soap, 
scouring soap, and antiseptic solutions as required. 
Where utensils are kept in solutions, these solutions should 
be emptied and fresh ones made. 
Urinals and bed-pans may be placed in a deep sink or tub, 
soaked in an antiseptic solution, then scoured, and rinsed with 
scalding water (sterilize by steam or boiling if possible). 
Line dressing cans with paper. 
Clean sink and hopper, and flush with hot water. 
See that utility rooms are well ventilated, and as free from 
odor as it is possible to make them. 16 
A MANUAL OF NURSING PROCEDURES 
Fig. 5.—Mattress cover partly in place. CLEANING A BED 
Purpose: 
To provide clean, attractive, hygienic surroundings for the 
patient. 
Equipment: 
Dust basin containing warm soapy water (0.5 per cent, 
lysol may be used). 
Two cleaning cloths. 
Small brush (tooth-brush is good). 
Brush broom. 
Cleaning soap. 
Newspapers. 
Clean sheet. 
Procedure: 
Strip the bed, placing the soiled linen in a pillow-case. 
Brush the mattress and pillows with a brush moistened in 
lysol and soap solution. (If the mattress is not covered, be 
careful to brush well into all the seams.) 
Remove mattress, blankets, and pillows to sun porch. 
Change mattress cover* if necessary. 
Clean the bed frame with soapy water, using cleaning soap 
only where necessary (do not scratch the enamel). 
Use the small brush for corners. 
Clean the table and chair. 
Place papers on the bed springs. 
Place rubber sheet on papers, and clean, washing every por- 
tion with lysol and soap solution. 
Place rubber sheet over the head of the bed. 
Make a fresh 0.5 per cent, lysol solution and brush the springs. 
* This is a close-fitting cover of unbleached muslin, the open end of which 
is basted up, or tied with tapes, after being fitted to the mattress (Fig. 5). 
17 18 
A MANUAL OF NURSING PROCEDURES 
Replace rubber sheet on the springs, cover with a clean sheet, 
and leave until ready to make up the bed. 
Table drawers, bureau drawers, etc., should be thoroughly 
cleaned. 
Note: If it is suspected that the bed is vermin infested, the 
following procedure may be adopted, and additional equip- 
ment will be required. 
Additional Equipment: 
Wood alcohol. 
Lighter. 
Damp cloth. 
Old rubber sheet. 
Procedure: 
Remove all soiled clothes except one sheet. 
After the mattress, pillows, and blankets have been removed, 
spread the soiled sheet under the bed. 
Tap the springs, going over them thoroughly. 
Remove the sheet, and if any vermin have fallen into it, fold 
carefully, and place in an antiseptic solution. 
Place old rubber sheet under the foot and the head of the bed. 
Put wood alcohol into all cracks, and light (one part at a 
time). 
Have a damp cloth ready, in case burning alcohol falls to the 
floor. 
Clean the bed as in the preceding demonstration. 
Note: Keep at a little distance from the flame of the al- 
cohol, and, if in the ward, screen the bed. MAKING AN EMPTY BED 
Purpose: 
Comfort and neatness. 
Equipment: 
2 sheets. 
1 draw-sheet. 
1 rubber sheet. 
2 pillow-cases. 
2 blankets. 
1 spread. 
2 pillows. 
1 towel. 
1 face cloth. 
Procedure: 
Move the table away from the bed. 
Move the chair away from the bed, placing squarely. 
Stand at the foot of the bed, and turn the mattress. 
Place mattress pad (if one is used). 
Place the bottom sheet, having the middle of the sheet at 
the middle of the bed, and allowing plenty to tuck in at the 
top. (Have the foot of the mattress well covered.) 
Make square corners at the foot and head of the bed. 
Tuck in at the side. 
Place rubber sheet at the middle of the mattress, and 12 to 
14 inches from the top. 
Tuck in at the side. 
TO FOLD A DRAW-SHEET WHEN A LARGE SHEET IS USED 
Fold hemmed ends down, one end being about 2\ feet lower 
than the other. Hold the sheet with the wrong side toward 
you, and fold edges together right side in, then fold back same 
edges to center fold in form of W (Figs. 6 and 7). 
Cover the rubber with the draw-sheet, and tuck in (Figs. 
8 and 9). 
Place the top sheet hem side up a little above the end of the 
mattress. 
Make square corner at the foot of the bed. 
19 20 
A MANUAL OF NURSING PROCEDURES 
Fig. 6.—Folding a draw-sheet: Step 1. 
Fig. 7.—Folding a draw-sheet: Step 2. MAKING AN EMPTY BED 
21 
Fig. 8.—Adjusting draw-sheet. 
Fig. 9.—Second side of bed partly completed. 22 
A MANUAL OF NURSING PROCEDURES 
Fig. 10.—Making square corner on first blanket. 
Fig. 11.—Making square corner on second blanket. MAKING AN EMPTY BED 
23 
Place first blanket 2 inches from the top of the mattress 
and tuck in at the foot with a square corner (Fig. 10). 
Place second blanket well down at the foot. 
Tuck in at the side, and make a square corner at the foot of 
the bed (Fig. 11). 
Fold the sheet over the top of the blankets, and tuck in. 
Go to the other side of the bed. 
Fold the clothes back along the side of the bed. 
Beginning with the bottom sheet, pull the clothes very tight, 
and make as the other side. 
Fig. 12.—Completed bed. 
Place the bed spread, being sure to have it straight. 
Make envelope corners. 
Put cases on the pillows, placing the lower one with the 
closed end toward the table, the second pillow the opposite way. 
Place table squarely at the side of the bed. 
Place chair with back to foot of bed (if in the ward). 
If in the ward, see that the bed, table, and chair are in line 
with the others. 
See that the bed is tightly made, and that everything is clean 
and in order (Fig. 12). TO OPEN BED 
Place table at one side. 
Remove the pillows. 
Loosen bedding to draw-sheet on one side. 
Fold top of spread under the blanket, and the sheet over 
spread. 
Arrange other side of bed the same. 
Turn bedding down to edge of mattress, and fold back to 
make a box-plait (Fig. 13). 
Fig. 13.—An open bed. 
See that draw-sheet is tight and smooth. 
Replace the pillows. 
Put stand in place. TO STRIP A BED 
Place table at one side. 
Move chair away from the bed and place squarely. 
Place the pillows on chair and remove soiled cases. 
Keep case for soiled bedding on back of chair. 
Loosen bedding down to mattress around entire bed. 
Fold spread, blankets, and sheets, and place on the chair. 
Put soiled bedding in pillow-case, or fold and place on chair 
Fig. 14.—Mattress airing. 
Turn mattress end to end, and leave to air (Fig. 14) 
Replace table and chair, remove soiled bedding. 
CONVALESCENT BED 
When making a bed for a patient who is up all day, and 
there is no danger of drainage, etc., soiling the bed, the rubber 
sheet may be placed under the bottom sheet, and the draw-sheet 
omitted. 
25 MORNING CARE OF A BED PATIENT INCLUDING 
MAKING THE BED 
Purpose: 
Comfort, cleanliness, neatness. 
Equipment: 
Wash-basin with warm water. 
Towel. 
Soap. 
Face cloth. 
Nail file or orange-wood stick. 
Comb. 
Bathing alcohol. 
Powder. 
Pillow-case. 
Sheet. 
Gown. 
Procedure: 
Remove the pillows. 
Change case and put soiled case on back of the chair. 
Loosen bedding to the mattress all around the bed. 
Fold spread and top blanket and place on the chair. 
Change the top sheet, by putting the clean sheet in place 
and slipping the blanket and soiled top sheet out. 
Replace blanket. 
Fold top sheet if it is to be used as draw-sheet. 
Change the gown. 
Turn patient on her side. 
Turn top bedding back, along the side, over the patient. 
Wash the back, rub with bathing lotion, then powder. 
Fold the soiled draw-sheet up against the patient. 
Fold rubber sheet out of the way. 
Brush all crumbs from the bottom sheet, and tuck in. 
26 MORNING CARE OF A BED PATIENT 
27 
Place the rubber sheet and tuck under the mattress. 
Be sure that no crumbs are left on rubber or sheet. 
Place clean draw-sheet, tuck under the mattress, and fold 
against soiled draw-sheet. 
Turn patient back and remove soiled sheet, at the same 
time drawing the clean sheet under the patient. 
Go to other side of the bed. 
Place soiled sheet in pillow-case. 
Make up the bed, beginning with the lower sheet, making 
all tight, smooth, and free from crumbs. 
Adjust upper bedding, replacing blanket and spread. 
Replace the pillows. 
Comb the patient’s hair, protecting the clean bed by placing 
a towel under the hair. 
Clean the finger-nails, also using a towel to protect the bed. 
To Change the Lower Sheet: 
When changing the lower sheet, arrange it in folds under 
the patient, as when changing the draw-sheet. 
Place clean sheet with center at center of bed. 
Proceed as when changing the draw-sheet. 
Note: Be sure that the bedside table, the room, and every- 
thing in it is clean, and in perfect order. 
Place the call bell within the patient’s reach. 
While working, be most careful to insure privacy for the 
patient. This is particularly necessary when the patient is in 
the ward. EVENING CARE OF THE PATIENT 
Purpose: 
To refresh and rest the patient, and make him comfortable 
for the night. 
Equipment : 
Basin with warm water. 
Soap. 
Face cloth. 
Towel. 
Alcohol or bathing lotion. 
Powder. 
Procedure: 
Remove the pillows. 
Turn the patient on his side. 
Wash the back, dry, rub with alcohol, and powder. 
Loosen draw-sheet and rubber. 
Brush all crumbs from the bed. 
Tighten draw-sheet and rubber and tuck in. 
Turn the patient back and make the other side of the bed. 
Shake up the pillows and replace. 
Adjust upper bedding. 
Ascertain the patient’s requirements or wishes as to hot- 
water bottle, extra bedding, drink of water, bed-pan, etc. 
Note: In the wards the patients are given water for the face 
and hands previous to the evening toilet, usually before supper. 
The patient must be given an opportunity to brush the teeth 
when most convenient or desirable. 
As far as it is possible to do so, follow the patient’s wishes as 
to time and order of giving the care outlined above. Make your 
patient feel that he is the one being considered, rather than the 
nurse. In other words, “do as you would have done for you,” 
whenever it is possible to do so. 
28 ETHER BED 
Purpose: 
Warmth for the patient. 
Protection for the bed. 
Convenience in caring for the patient. 
Equipment: 
Equipment as for a closed bed and, in addition, 
2 small rubbers. 
2 draw-sheets (or ether sheets). 
2 bath'blankets. 
Hot-water bottles with covers. 
Two pieces of bandage. 
2 towels. 
2 vomitus basins. 
Pad and pencils. 
Paper bag. 
Safety-pin. 
Small pieces of gauze or paper napkins. 
2 small bowls for ice. 
Shock blocks. 
Rubber pillow-case. 
Procedure: 
Make up as a closed bed, including the draw-sheet. 
Place one rubber under the region of the operation. 
Cover with a draw-sheet (or ether sheet). 
Protect the head of the mattress with a rubber and draw- 
sheet. 
Place bath blanket on the bed, bringing the top 6 inches from 
the top of the mattress. 
Fold sides of blanket until they almost meet in the center. 
Fold back the top corners to form a triangle. 
Place covered hot-water bags in the fold of this blanket. 
29 30 
A MANUAL OF NURSING PROCEDURES 
Put on the top sheet and both blankets, without tucking in. 
Place the spread. 
Turn the spread under the blankets at the top, and the 
sheet over the spread. 
Protect the top of the sheet and spread by folding a towel 
over them. 
Make a cuff at the foot of the bed, as at the top. 
Tuck in bedding on the side opposite the stand. 
Fold back the bedding on the side next the stand in a neat 
fold, having the edge of the fold come to the edge of the mattress. 
Have one pillow protected by a rubber case ready to place 
under the patient’s knees (this may be left on the chair). 
Protect the second pillow with a rubber case, and tie upright 
against the head of the bed (bandages may be used for this). 
Place the stand by the bed, with towels, basins, gauze, pad 
and pencil, and bowls of ice, neatly arranged. 
Fasten the paper bag to the side of the table or to the mat- 
tress. 
When the Patient Returns: 
Stand on opposite side of the bed, turn clothes back and 
remove heaters. Cover the patient with the bath blanket, 
adjust upper bedding, and tuck in at the foot. If so ordered, 
the heaters may be refilled and placed around the patient, out- 
side the hath blanket. The extra blanket may be used to cover 
the patient’s chest and shoulders. Great care must be taken 
that the patient is not chilled or exposed to a draft. Do not 
leave an ether patient alone one moment. 
Note: In many hospitals surgical patients are kept in the 
recovery room until at least partly recovered from the effects 
of the ether. In this case they are awake when returning to 
their own bed, and part of the equipment listed in the preceding 
demonstration will not be required. 
Equipment: 
In addition to the regular bed equipment, 
2 bath blankets. ETHER BED 
Small rubber sheet and surgical pad or draw-sheet. 
Hot-water bottles with covers. 
2 rubber pillow-cases. 
2 towels. 
2 vomitus basins. 
Procedure: 
Make up as a closed bed, including the draw-sheet. 
Place the small rubber, covered with a surgical pad (or ether 
sheet), under region of operation. 
Fig. 15.—Bed ready for an ether patient. 
Place bath blanket, upper hem 6 inches from top of mattress. 
Place sheet, blankets, and spread, but do not tuck in. 
Fold spread under blankets at the top, and sheet over 
spread. 
Make similar cuff at foot of the bed, making fold even with 
the foot of the mattress. 
Open the side nearest the door by turning back the upper 
bedding in two longitudinal folds, bringing to the edge of the 
mattress (Fig. 15). 32 
A MANUAL OF NURSING PROCEDURES 
Place pillow, covered with rubber and linen case, open end 
away from the stand. 
Place hot-water bottles, covered, in the bed. 
The extra blanket, basins, and towels are left on the table. 
The second pillow, protected with a rubber case, is placed 
on the chair at the foot of the bed. 
When the patient returns remove the hot-water bottles, 
cover the patient comfortably, and tuck in the bedding. 
TONSIL BED 
If the child is to be in the hospital just a few hours or a day, 
the bed may be made without a draw-sheet, placing the rubber 
sheet under the bottom sheet. Place a second rubber com- 
pletely covering the mattress at the head of the bed, and cover 
this with a surgical pad or ether sheet. Otherwise make up as 
for an ordinary surgical bed. BED BATH 
Purpose: 
Cleanliness and comfort of the patient. 
Equipment: 
Face towel. 
Bath towel. 
Clean sheet. 
Pillow-case. 
Gown. 
2 bath blankets. 
Face cloth. 
Powder and comb. 
Soap. 
Scissors, orange-wood stick, and nail file. 
Alcohol or other bathing lotion. 
Tub with water about 110° F. 
Small rubber to protect the table. 
Procedure: 
Remove the pillows. 
Remove spread and upper blankets, fold and place on the 
back of the chair. 
Place bath blanket, as when changing upper sheet (Fig. 16). 
Cover the patient with one warm blanket if it is cold. 
Turn the patient on his side, and place the second bath 
blanket under him. 
Remove the gown. 
Wash the face with clear water (Fig. 17). 
Wash neck and ears with soapy water, being careful not to 
get soap in the ear canal. 
Bathe arms, axillae, and chest. 
Bathe abdomen. Dry each part thoroughly. 
Bathe the back, dry, and rub with alcohol and powder. 
33 34 
A MANUAL OF NURSING PROCEDURES 
Fig. 16.—Adjusting bath blanket. 
Fig. 17.—Beginning the bath. BED BATH 
35 
Bathe each thigh and leg, uncovering only a portion at one 
time, and dry carefully. 
Place the tub at the foot of the bed, and the feet in the tub. 
Bathe well, especially between the toes. 
Place feet on bath towel, remove tub, and dry the feet. 
Unless the patient is very ill, he may himself bathe the 
perineal region, the nurse seeing that cloth, water, and towel are 
within easy reach. 
Fig. 18.—Making bed after bath. 
Finger- and toe-nails must be kept clean and properly cut 
(toe-nails may be cut straight across). 
Put on the patient’s gown, remove bath blankets, and make 
up the bed (Fig. 18). 
Comb the patient’s hair, protecting the bed with a towel. 
Be sure that the patient is left warm and comfortable. 
Avoid any unnecessary exposure, and use screens as required. TO PLACE A PATIENT ON A BACK-REST 
Purpose: 
As a support when convalescents are up in bed. 
For goiter cases, who must be in the semi-upright position 
constantly. 
For asthma patients. 
For cardiac patients. 
Surgical and obstetric patients who must be kept in the 
Fowler position to facilitate drainage. 
Equipment: 
Back-rest. 
Cover for the back-rest. 
5 large pillows. 
1 or 2 small pillows. 
Bath blanket. 
Safety-pins. 
Rubber pillow-case. 
2 sheets (for slings). 
Procedure: 
Cover the back-rest (for neatness and cleanliness). 
Make a sling by placing the large pillow protected by the 
rubber case diagonally in the sheet and twisting the ends. 
Make a second sling, using the small pillow. 
Have equipment ready at the bedside. 
One nurse may support the patient while an assistant ad- 
justs the back-rest and pillows (Fig. 19). 
Arrange first pillow lengthwise, then one under each arm, 
closed end out, and one under the patient’s head. 
A small pillow may be needed also under the head. 
Place the bath blanket around the patient’s shoulders and pin 
as a nightingale. 
36 TO PLACE A PATIENT ON A BACK-REST 
37 
b ig. 19.—Ready to lift the patient before placing the back-rest. 
Fig. 20.—Patient on back-rest, slings adjusted. A MANUAL OF NURSING PROCEDURES 
Place the large sling under the knees, and tie it to the side 
of the head-rest. 
Place the small sling at the patient’s feet. Tie to rail of the 
bed frame. 
Shock blocks, elevating the foot of the bed, may be used to 
keep the patient from sliding down in bed. 
Be sure that the patient is comfortable, and that he does not 
slip down in an uncomfortable position (Fig. 20). 
Fig. 21.—Gatch bed in use. 
Note: If the patient is a convalescent, and up for a short 
time only, the slings will not be necessary. 
If a Gatch bed is used, fewer pillows will be required, as the 
bed is adjusted to the desired position (Fig. 21). TO ASSIST A PATIENT OUT OF BED 
Purpose: 
To aid the patient in gaining strength. 
Equipment: 
Comfortable chair. 
2 blankets. 
Pillows. 
Safety-pins. 
Patient’s underclothing, stockings, bath robe, and slippers. 
Foot-rest. 
Procedure: 
Dress the patient while he is lying down. (If this is the 
first time the patient is getting up, strength must be conserved.) 
Arrange the chair with blankets and pillows, and place near 
the bed. 
With one arm under the patient’s shoulders and one under 
his knees help him to the edge of the bed, and into the chair. 
(If the patient is heavy, two nurses will be needed.) 
Arrange blankets comfortably around the patient, and, if 
cold, pin one around shoulders in form of a nightingale. 
Place a small stool for the patient’s feet, and see that the 
ankles and feet are well covered with the blankets. 
Watch the patient carefully and do not leave him up until 
exhausted; never more than twenty minutes the first time. 
Place the stand and call bell within easy reach. 
Be sure that the patient is warm and comfortable. 
39 PREPARATION OF BED FOR FRACTURE CASE 
Purpose: 
To give the usual nursing care to a patient, and at the same 
time avoid injury to a fracture, or pain and discomfort to the 
patient. 
Equipment: 
To prepare a bed for a patient with a fracture of the leg or 
thigh the following equipment will be required: 
Fig. 22.—Arrangement of fractured limb. 
Equipment for a Fracture Bed: 
Cradle. 
Extra pillow and pillow-case. 
Rubber pillow-case. 
Sand-bags. 
Fracture boards. 
Bath blanket (if cold). 
40 PREPARATION OF BED FOR FRACTURE CASE 
Safety-pins. 
Bandage. 
Arrangement of Bed: 
Place fracture board under the mattress to prevent any 
sagging under the fractured limb. 
The patient is placed in the bed with the fractured limb rest- 
ing on the rubber-protected pillow (Fig. 22). 
The end of the case may be pinned around the foot, and a 
bandage tied around the pillow to keep the part in a fixed 
position. 
Sand-bags are placed on either side of the pillow. 
If cold, a bath blanket is placed loosely over the limb. 
Avoid weight on the toes. 
Place a cradle over the foot and leg, to prevent the weight 
of the bedding causing discomfort. 
The bed must be firm, and give perfect and even support to 
the broken limb. 
TO GIVE MORNING CARE TO THE PATIENT IN THE BED 
DESCRIBED ABOVE 
Equipment: 
Same as that required for the care of the average patient. 
Procedure: 
Remove the pillows, spread, top blankets, and such fracture 
equipment as possible. 
Put on top clean sheet, and replace one blanket. 
Change the gown. 
Wash the back, rub with bathing lotion, and powder. (The 
patient may sit up to have the back washed, or it may be done 
by first rubbing the shoulders, then the hips. Do not turn the 
patient on his side.) 
Have the patient move to one side of the bed, first giving 
support both above and below the point of fracture, and allowing 
the patient to move his body. 
Make one side of the bed. 42 
A MANUAL OF NURSING PROCEDURES 
Move the patient back in the same manner, and make the 
other side of the bed. 
Replace the pillow and the fracture equipment. 
See that the limb is straight, comfortable, and well sup- 
ported, also that no weight is over the toes. 
Adjust top bedding. 
It may be found difficult to adjust the spread neatly over the 
cradle. It may be brought down over the foot of the bed, folded 
squarely, and pinned. Sometimes it is easier and gives a better 
Fig. 23.—Completed fracture bed. 
appearance to tuck in the spread and fold the corners as neatly 
as possible (Fig. 23). 
IF THE PATIENT IS IN A BODY CAST 
A patient in a cast requires expert nursing care. 
Protect the cast in every possible way from being soiled. 
Care must be taken to prevent cracking or breaking the cast. 
A broken cast is of no use, neither is a soiled one, as the soiling 
softens the plaster. PREPARATION OF BED FOR FRACTURE CASE 
43 
The effects of the cast upon circulation must be noted: pain, 
numbness, and blueness of the extremities are adverse symptoms. 
Care must also be taken to prevent chafing of the skin and 
development of sores just under or at the edge of the plaster. 
Pressure may be relieved by the proper placing of small pads, 
the use of which will help to relax muscular tension, and so 
relieve pressure. 
Whether in a cast or not, all possible care should be taken 
to move the injured part as little as possible, and at the same time 
to ensure the comfort of the patient. 
Bed-sores, both of the back and the heels, must be con- 
stantly guarded against. 
Good nursing care will include rubbing of the upper part of 
the back to insure good circulation in the lungs, and instruction 
of the patient in breathing exercises, also to prevent congestion 
in the lungs. 
Whenever possible, nursing care should be used to relieve 
discomfort and pain. P. R. N. orders for opiates used only when 
these fail. TO MOVE A PATIENT FROM ONE BED TO ANOTHER 
Purpose: 
When a patient is confined to bed for some time it is very 
desirable to move him frequently to another bed, so that the 
mattress may be turned, aired, and made up fresh. 
FIRST METHOD 
Equipment: 
An extra bed and mattress, or a surgical cart. 
Sheet. 
Rubber draw-sheet. 
Procedure: 
Have the extra bed made up as far as the rubber sheet. 
Remove pillows from under the patient’s head. 
Loosen bedding as far as the rubber sheet, all around the 
bed, and fold over the patient. 
Place the beds together, having an assistant hold them to 
prevent slipping apart. 
Reach across the empty bed, and, grasping the draw-sheet, 
move the patient to the new bed. 
Make up bed as usual. 
SECOND METHOD 
Three nurses can easily lift the average patient from one bed 
to another. The following method may also be used when 
moving a patient from the surgical cart to the bed. 
Procedure: 
Have fresh bed made up. 
Fold upper bedding back to the foot of the bed, or fold 
lengthwise, as in an ether bed. 
44 TO MOVE A PATIENT FROM ONE BED TO ANOTHER 
45 
Place the head of the fresh bed at the foot of the bed that 
the patient is in, having the beds at a slight angle. 
Wrap the patient in the top sheet, or in a light blanket. 
Support the patient under the head and shoulders, under the 
hips, and at the feet. 
Fig. 24.—Moving a patient from one bed to another. 
Lift the patient carefully and place in the fresh bed. If the 
bed is on wheels, be careful not to push it from you. 
Cover the patient, and remove the extra blanket (Fig. 24). 
WHEN PATIENT IS TO BE CHANGED TO DIFFERENT BED FRAME 
ONLY 
Procedure: 
Remove the pillows. 
Loosen bedding all around, and fold back over the patient. 
Place beds together, having an assistant hold them. 
Reach across empty bed, and, grasping the mattress, pull to 
the empty bed. 
Make up bed as usual. 46 
A MANUAL OF NURSING PROCEDURES 
TO TURN THE MATTRESS WITHOUT MOVING THE PATIENT 
FROM THE BED 
Equipment: 
One extra pillow. 
Small table about the height of the bed or a stool. 
Procedure : 
Remove pillows. 
Loosen all bedding, and remove spread and one blanket. 
Fold upper bedding over the patient. 
Fig. 25.—Turning a mattress with the patient in bed. 
Roll under bedding with rubber sheet in two longitudinal 
rolls close to the patient. 
Bring the patient to the edge of the bed nearest to you. 
The mattress may now be moved to the opposite side, half 
off the bed, and resting on the table or stool. An assistant 
stands at this side of the bed. 
Place the three pillows lengthwise on the springs. TO MOVE A PATIENT FROM ONE BED TO ANOTHER 
47 
Move the patient on to the pillows, using improvised 
stretcher made of the bedding, which has been rolled close to 
the patient. 
Turn mattress from top to bottom (Fig. 25). 
Move the patient on to the mattress. 
Remove pillows, move mattress back into place. 
Make up the bed as usual. 
Precautions: 
If one or both beds are on wheels, great care is necessary to 
keep them from slipping apart. ■ 
Have plenty of assistance to prevent any possibility of 
accident, or fear on the part of the patient. PULSE, TEMPERATURE, AND RESPIRATION 
Purpose: 
As an aid in determining the condition of the patient. 
Equipment: 
Weak green soap solution. 
Antiseptic solution (bichlorid, 1 : 5000, or carbolic 1 : 20). 
Fresh water. 
Clean cotton dossils. 
Thermometers. 
Pad and pencil. 
(Hospitals are using, more and more, the individual ther- 
mometer racks, which are most desirable.) 
Method: Mouth Temperature: 
Cleanse the thermometer carefully, wipe clean, and dry. 
Shake mercury down to 94° F. 
Place thermometer under the patient’s tongue, and ask 
him to keep his lips closed (Fig. 26). 
Leave in place at least three minutes, read carefully, and 
record. 
Wash thermometer in soapy water, then in antiseptic, and 
last in clear water. Leave in antiseptic until ready to use for 
next patient. 
Axillary Temperature: 
Wipe axilla with a dry towel. 
Place bulb of thermometer in the axilla. 
Hold the arm close to the body, with the hand resting on the 
opposite shoulder. 
At least five minutes will be required to register correctly. 
The temperature will register at least one-half degree lower 
than if taken by mouth. 
48 PULSE, TEMPERATURE, AND RESPIRATION 
49 
Rectal Temperature: 
A special thermometer, easily distinguished from the mouth 
thermometer, is used. There is usually a colored bulb, red or 
blue, that is larger than that of the mouth thermometer. 
Lubricate the bulb, and insert carefully, never using force. 
Have patient on his side if possible. 
Hold the thermometer, as the patient may turn and so 
break it. 
Fig. 26.—Taking pulse, temperature, and respiration, 
Leave it in place at least jive minutes. 
Read and record accurately, and cleanse carefully. 
Temperature will register about one degree higher than if 
taken by mouth. 
Pulse: 
While taking the temperature (by mouth) the pulse may be 
counted (see Fig. 26). 
Let the patient’s hand rest lightly on the chest. 50 
A MANUAL OF NURSING PROCEDURES 
Place fingers over radial artery, and count for one minute 
(Fig. 27). 
Note rate, regularity, force, and tension. 
(The pulse may be taken at the radial artery, at the tem- 
poral just in front of the ear, or at the facial artery, where it 
passes over the angle of the jaw.) 
Fig. 27.—Showing position of fingers in taking the pulse. 
Respirations: 
With hand in same position, count the respirations. 
In this way the respirations may be counted without the 
knowledge of the patient. 
Record correctly. 
Precautions: 
Careful attention to cleanliness, fresh solutions, and clean 
dossils. 
Care not to forget and leave the thermometer in the patient’s 
mouth longer than is necessary. 
Temperature will not be accurate if taken immediately after 
the patient has had something hot or cold in the mouth. PULSE, TEMPERATURE, AND RESPIRATION 
A rectal temperature is taken when the patient is a child, a 
delirious patient, a very sick patient, when there is difficulty in 
breathing, or when there is disease or injury about the mouth 
or nose. 
Thermometers should be tested frequently, and compared 
with one of known accuracy. 
Be sure that the mercury is shaken down before using. 
Take the pulse with the fingers, not the thumb. 
Have patient as quiet and comfortable as possible, never 
standing. 
It is necessary, for accuracy, to count the respirations with- 
out the patient’s knowledge, or they will, unconsciously, be 
altered to a certain extent. 
Much dependence is placed upon the pulse, temperature, and 
respirations in determining the patient’s condition, and the 
necessary care and treatment. It is, therefore, highly desirable 
to be strictly accurate, both as to the conditions observed, and 
also in recording the hours when the observations were made. ENEMATA 
CLEANSING ENEMATA 
Purpose: 
To relieve constipation, to relieve flatulence, to cleanse. It 
is also given to further or hasten the effects of a cathartic. 
Equipment : 
Small rubber sheet and cover. 
2 bath blankets. 
Bed-pan with cover. 
Toilet paper. 
Irrigating can with rubber tubing and enema tip. 
Lubricant. 
Thermometer. 
2 quarts solution,* 110° to 115° F. 
Basin of warm soapy water and dossils (Fig. 28). 
Procedure: 
Remove the pillows. 
Protect the bed. 
Place patient in comf ortable position (on side if possible). 
Cover shoulders with bath blanket. 
With second bath blanket (folded) turn clothes back to foot 
of bed. 
Have the two blankets overlap at the patient’s hips. 
Lubricate enema tip. 
Expel air from tube, letting fluid run until warm. 
Clamp the tube, and inset enema tip very gently. 
Allow the fluid to flow slowly into the rectum, holding the 
can not more than 2 feet above the patient. 
When finished, clamp the tube, and withdraw tip carefully. 
* 1. Use mild white soap, as strong soap is particularly irritating to the 
mucous membrane. 
2. Unless soap solution is ordered, plain hot water or normal saline 
solution may be used, and will usually give as good results as the soap solu- 
tion, with none of its irritating effects. 
52 ENEMATA 
53 
Place patient on the pan, and remove other equipment. 
When pan is removed, see that the patient is left very clean, 
dry, and comfortable, and that the bed is dry and clean. 
Carefully note the contents of the bed-pan, and record. 
Precautions: 
Care should be taken that the temperature is correct, and 
that the patient’s rectum is not irritated. 
Have the bed amply protected. 
Fig. 28.—Enema tray. 
Have the patient as comfortable as possible, and watch for 
signs of faintness. 
After finishing see that the room is thoroughly aired, and 
that toilet paper, etc., are not left carelessly in sight. 
Observe and report results accurately. 
CARMINATIVE ENEMATA 
Purpose: 
To relieve flatulence. 54 
A MANUAL OF NURSING PROCEDURES 
Equipment: 
Small rubber sheet and cover. 
2 bath blankets. 
Irrigating can and rubber tubing. 
Glass connecting tube. 
Rectal tube. 
Lubricant. 
Solution* (110° to 115° F.). 
Bed-pan. 
Toilet paper. 
(Funnel may be used instead of an irrigating can if pre- 
ferred.) 
Procedure: 
Mix the solution thoroughly before putting it in the can. 
Protect the bed and prepare the patient in the same way as 
for a purgative or cleansing enema. 
* Formulas for Carminative Enemata: 
1. Turpentine 0.5 ounce 
Asafetida 1 dram 
Soap solution 1 quart 
Egg 1 
Mix turpentine and asafetida with the egg, then add to the soap solution. 
2. Magnesium sulphate 2 ounces 
Glycerin 2 “ 
Water 1 quart 
3. Magnesium sulphate 2 ounces 
Glycerin 2 “ 
Water 4 “ 
4. Milk .- 1 pint 
Molasses 1 “ 
5. Magnesium sulphate 2 ounces 
Sweet oil 4 “ 
Water, to make 1 quart 
6. Turpentine 1 dram 
Soap solution 1 pint 
7. Peppermint 1 dram 
Water 1 pint ENEMATA 
55 
Lubricate the rectal tube and insert it from 4 to 6 inches, 
after having expelled the air from the tube. 
Give in the same manner as a purgative enema. 
Precautions: 
Turpentine is inflammable, and must be handled with care 
if solution is heated over an open flame. 
Turpentine burns mucous membranes, therefore must be 
thoroughly mixed, and given in an emulsion. It may also be 
absorbed, and cause kidney irritation. 
Never use turpentine unless you have an order to do so. 
Great care is necessary in mixing the milk and molasses 
enema, as molasses retains the heat, and, being heavy, is liable 
to sink to the bottom of the can, and so pass first into the rectum. 
A patient may be seriously burned through carelessness in 
mixing and in ascertaining the temperature of this type of enema. 
NUTRITIVE ENEMATA 
Purpose: 
To supply the body with food, when for some reason food 
cannot be taken by mouth, as in such cases as the following: 
Cancer of the mouth or throat. 
Stricture of esophagus. 
Gastric ulcer. 
Pernicious vomiting, etc. 
Equipment: 
Small rubber sheet and cover. 
Bath blanket. 
Pitcher containing solution at 105° F. 
Thermometer, glass graduate, teaspoon, bowl. 
Small funnel with tube, and glass connecting tip. 
Catheter. 
Clamp. 
Lubricant. 
Basin. 
Pitcher of very hot water. A MANUAL OF NURSING PROCEDURES 
Procedure: 
Put equipment on tray, and take to the bedside. 
Protect the bed and drape patient as for an ordinary enema. 
(If necessary to give with the patient on her back, place a pillow 
under the hips and drape as for a douche.) 
Lubricate the catheter, expel the air, being careful not to 
waste any solution; fasten clamp so that the solution just drips. 
Insert catheter carefully, about 6 inches. 
Keep solution at correct temperature by changing the water 
in the basin in which is kept the pitcher of solution. 
Give slowly, taking from twenty to thirty minutes for the 
entire amount. 
When finished, clamp the catheter, disconnect at glass con- 
necting tube, and remove other equipment. 
Leave protection for the bed under the patient. 
Encourage the patient to remain very quiet for at least half 
an hour. 
At the end of a half hour the catheter may be gently with- 
drawn. 
Formulas for Nutritive Enemata: 
1. Peptonized milk* 3 ounces 
Beef juice 2 drams 
Egg 1 
Salt 0.5 dram 
2. Glucose 6 per cent, solution 
(Amount ordered usually 6 ounces.) 
3. Glucose 
Soda bicarbonate J ' 
da 6 per cent, solution 
4. Glucose 3 drams 
Beef peptonoid 0.5 ounce 
Water, to make 6 ounces 
* do peptonize milk: One powder, dissolved in 3 ounces tepid water. Add 
1 pint fresh milk, and let stand in pan of water at 115° F. for two hours. 
To prepare egg: Cut with a spoon, never beat, or in any way incor- 
porate air. Stir milk into the egg slowly, add beef juice and salt. Heat in 
a double boiler to 105° F. ENEMATA 
57 
Precautions: 
When giving nutritive enemata for any length of time great 
care is necessary to prevent irritation of the rectum. Care in 
inserting and withdrawing the tube, and the regular application 
of vaselin or some other lubricant is necessary. 
A cleansing enema should be given once a day, at least one 
hour before giving the nutritive enema. It is usually best to 
give this in the morning. 
Nutritive enemata may be given every six or eight hours. 
If given too frequently they may not be retained well. Six 
ounces is about as much as the average patient can retain at one 
time. To give more than this will often mean losing all. 
MEDICATED ENEMATA 
Purpose: 
This is one method by which medicines may be given when 
either a local or a general effect is desired. The particular pur- 
pose of each enema will depend upon the solution used, and is 
usually designated by the name of the enema. 
Equipment: 
Small rubber sheet and cover. 
Bath blanket. 
Pitcher containing solution at 105° F. 
Small funnel. 
Rubber tube, glass connecting tip. 
Catheter. 
Clamp. 
Lubricant. 
Basin in which to carry equipment, and cover. 
Procedure: 
Put equipment on a tray or in the basin, and take to the 
bedside. 
Protect the bed. 
Turn down bedding to waist line with bath blanket. 
Lubricate catheter, expel the air (do not waste solution). 58 
A MANUAL OF NURSING PROCEDURES 
Insert about 6 inches into the rectum. 
Give very slowly. 
Clamp the tube and remove catheter carefully. 
Leave protection under the patient for at least a half-hour. 
Patient should remain quiet, as solution is to be retained. 
FORMULAS FOR MEDICATED ENEMATA 
Stimulating Enemata: 
(Stimulating enemata are usually given hot—115° to 118° F.) 
Physiologic salt solution (0.9 per cent.) or strong black 
coffee, about 6 ounces. 
Sedative Enema: 
Bromid or chloral (amount ordered by physician) dissolved 
in about 4 ounces of water, 105° F. 
Emollient Enema : 
Starch solution, made as ordinary laundry starch, about the 
consistency of cream. 
(This is sometimes given to relieve local irritation, to check 
diarrhea, or may be used as a vehicle for the introduction into 
the rectum of irritating drugs.) 
PROCTOCLYSIS 
Purpose: 
To supply fluid to the tissues in case of hemorrhage. 
To stimulate in case of shock. 
To relieve thirst. 
To dilute toxic substances. 
Equipment: 
Protection for the bed. 
Irrigating can with rubber tube.* 
Glass connecting tube. 
Rubber catheter. 
* There is a special apparatus, called the “Murphy drip apparatus,” 
which may be used, and which simplifies the matter of regulating the tem- 
perature, and also of regulating the flow. It is supplied with an extra tube, 
through which gas expelled through the rectum passes up into the can. ENEMATA 
59 
Lubricant. 
Solution (normal salt solution), 118° F. 
Extension light.* 
Hot-water bottle with cover. 
Small basin. 
Clamp for rubber tubing. 
Glass apparatus for regulating flow of solution. 
Standard. 
Procedure: 
Protect the bed. 
Place the irrigating can on the table a little above the level 
of the bed, or hang on the standard. 
Lubricate the tip. 
Regulate the flow until it runs about 40 drops a minute. 
Coil the tube under the hot-water bag which is placed in a 
bath blanket on the side of the bed near the patient. 
Pass the tube under the patient’s thigh, and insert the 
catheter gently, about 6 inches. 
Adjust electric light carefully, placing it in the solution, but 
being sure not to immerse the bulb, as the fuse may be burned 
out (Fig. 29). 
Cover the can. 
Allow the fluid to run for two hours, then stop for two hours.f 
At the end of the first hour of rest, pass a rectal tube (lubri- 
cated) , one end of which is in a urinal. 
Leave rectal tube one-half hour, remove, and measure 
amount of fluid expelled into the urinal. 
Allow the patient to rest one-half hour (completing the two 
hours), then start solution again, as at the beginning. This 
procedure is continued as long as ordered. 
* If an extension light cannot be used, a small bottle containing very hot 
water may be suspended into the solution. The water in this bottle must be 
changed frequently enough to keep it very hot. 
| The solution may be ordered given continuously, for several hours, 
or it may be given for two hours, with only one hour of rest before giving 
again. Be sure of the particular method required in each case. A MANUAL OF NURSING PROCEDURES 
Measure solution left in the can when discontinuing the treat- 
ment, add to that expelled into the urinal, and subtract from 
amount which was in the can at the beginning. This will give 
the amount absorbed by the patient. This amount should al- 
ways be ascertained and recorded. 
Fig. 29.—Giving a proctoclysis 
Precautions: 
It is important to keep the solution at the correct tem- 
perature. As the solution runs very slowly through the tube, it 
will be about body temperature when it reaches the rectum. A 
lowering of the temperature in the can will mean cold solution 
in the rectum. Regulate the flow carefully, and observe often 
if the flow is maintained, as feces may clog the tube, or the 
catheter may slip out of the rectum. ENEMATA 
61 
Be very sure that the patient is comfortable, and that the 
solution is not flowing into the bed. 
Dr. Murphy is quoted as saying that “When a nurse complains 
that the solution is not being retained by the patient it is cer- 
tain that it is not being properly given.” LOCAL ANTISEPTIC BATHS OR SOAKS 
Purpose: 
As a means of relieving pain, inflammation, and congestion 
in an infected and congested area, and also to check infection. 
Equipment: 
2 small rubber sheets. 
Cover for rubber. 
Face towel. 
Bath towel. 
Tub containing solution, 100° to 118° F. 
Solutions may be: 
Bichlorid solution, 1 : 5000 to 1 : 10,000. 
Lysol, 0.5 per cent. 
Salt, 0.9 per cent. 
Dakin’s solution, or other antiseptics as ordered. 
Bath blanket. 
Safety-pins. 
Pitcher. 
Procedure: 
(Procedure will differ very slightly according to the part to 
which the bath is to be applied.) 
If the forearm is affected, proceed as follows: 
Protect the stand with a small rubber sheet. 
Arrange pillows at head of bed so that the patient can lean 
comfortably against them in a sitting posture. (Place the 
patient on a back-rest if necessary.) 
Have patient close to side of the bed. 
Arrange bath blanket about the shoulders. 
Place stand near the bed. 
Place the tub so that the patient can comfortably let the 
forearm rest in the solution, being well immersed in it. 
Protect the arm from resting against the edge of tub. 
62 LOCAL ANTISEPTIC BATHS OR SOAKS 
63 
Cover the tub with a small rubber and a heavy blanket 
(placing towel in such a way that the rubber will not rest against 
the patient’s arm.) 
As the solution in the tub cools, add more, being careful to 
lift the arm and hand out of the solution while doing so. 
Leave for half an hour, or as long as is ordered. 
Remove arm from the tub, and dry with towel, or cover with 
dressing, as may be required. 
If the patient cannot sit up, the tub must be arranged 
accordingly, and the bed protected with rubber and covers. 
Precautions: 
It may be necessary to start with a low temperature, increas- 
ing as the patient becomes accustomed to it. 
Whatever temperature is to be used must be maintained, 
the solution not allowed to become cool. 
Great care is necessary in order not to burn the patient when 
adding hot water. 
See that the patient is in a comfortable position, one that 
can easily be maintained for the required length of time. VAGINAL DOUCHE 
Purpose: 
To cleanse, to reduce inflammation, or to arrest hemorrhage. 
Equipment : 
Tray. 
2 bath blankets. 
Small rubber and cover. 
Irrigating can and rubber tubing. 
Sterile douche tip in clean basin (wrapped in cloth and boiled 
five minutes). 
Solution 110° to 115° F. (higher temperature may be ordered). 
Salt, 0.9 per cent. 
Lysol, 0.5 per cent. 
Bichlorid, 1 : 5000. 
Boric acid, saturated solution. 
Sterile water. 
Other solutions and strengths as ordered. 
Douche pan or bed-pan with cover. 
Pitcher. 
Thermometer. 
Small basin. 
Basin with dossils. 
Procedure: 
Screen bed. 
Remove the pillows. 
Protect bed with rubber and cover. 
Fold one bath blanket in the form of a W. Ask the patient 
to hold the top edge of the bath blanket, and with the border 
of the blanket even with the fold of the bedding bring them 
even with the foot of the bed. 
Fold the second blanket lengthwise, and cover one thigh, 
wrapping the blanket securely around the patient’s foot. 
64 VAGINAL DOUCHE 
65 
Fold the first blanket back to cover the other thigh in the 
same manner. 
Place the patient on the pan, and dossil the parts with soapy 
water or antiseptic solution. 
Attach the douch tip to rubber tubing, taking care to keep 
the tip sterile. 
Expel all air from the tube, letting solution flow until it 
runs warm. 
Insert the tip carefully into the vagina while the solution is 
flowing. 
Hold the can about 12 inches above the patient. 
When all the solution has been used, remove the tip and 
wrap in the cloth in which it was previously boiled, not touching 
with the hands. 
Remove the pan, and leave the patient dry and comfortable. 
Note carefully, and record the character of the return flow. 
Boil the douch tip five minutes before putting away. 
Leave all equipment clean and in their proper places. 
Precautions: 
Great care to have the solution the correct strength and cor- 
rect temperature. 
Keep douche tip sterile. If contaminated, boil again. 
See that the surface parts are cleansed before beginning the 
douche, to avoid carrying contaminating material into the 
vagina. 
Be sure that the glass tip is not cracked. 
The nurse should avoid contaminating her fingers, and she 
should scrub before and after giving the treatment. 
Carefully observe and report the character of the return flow. AURAL DOUCHE 
Purpose: 
To cleanse, relieve inflammation and pain, remove accumula- 
tion of wax, or to apply medication. 
Equipment: 
Tray. 
Draw-sheet or large towel. 
Small rubber. 
Safety-pins. 
Sterile irrigating can, with solution 105° F. 
Boric acid, 2 to 4 per cent. 
Saline, 0.6 to 0.9 per cent., or other solution as ordered. 
Rubber tubing and sterile irrigating tip. 
Large kidney-shaped basin. 
Pitcher. 
Thermometer. 
Glass graduate. 
Procedure: 
Put small rubber inside the sheet or towel and pin com- 
fortably around the patient’s neck. 
Let the patient hold the kidney-shaped basin under the 
ear if he is able; otherwise have someone assist (Fig. 30). 
Hold the ear in such a way that the canal will be straightened. 
Wipe off any discharge. 
Attach tip to the tubing, being careful to keep it sterile. 
Expel the air, and let the solution run until warm. 
Insert the tip gently. 
Allow the solution to run slowly, without much force, direct- 
ing the stream against the wall of the canal, not against the 
drum. Have the patient hold the head slightly toward the af- 
fected side. 
66 AURAL DOUCHE 
67 
The can should be held not more than 8 or 10 inches above 
the patient’s head. 
When finished, remove the tip and dry the ear channel with 
small pledgets of cotton previously prepared. 
Boil the tip, remove, and put away equipment. 
Fig. 30.—Giving an aural douche. 
Precautions: 
Care must be taken to guard against too great pressure or 
uneven pressure, as either may injure the tympanic membrane 
and will also cause the patient distress. NASAL DOUCHE 
Purpose: 
To cleanse, to relieve inflammation or to arrest hemorrhage, 
or to remove foreign substances. 
Equipment: 
Tray. 
Small rubber. 
Small sheet or large towel. 
Safety-pins. 
Irrigating can (sterile) with solution 105° F. 
Boric acid, 2 to 4 per cent. 
Saline, 0.6 to 0.9 per cent. 
Rubber tubing. 
Nasal irrigating tip (sterile). 
Large kidney-shaped basin. 
Small basin. 
Sterile cotton. 
Pitcher. 
Thermometer. 
Glass graduate. 
Procedure: 
Place the small rubber inside the sheet or towel and pin 
comfortably around the patient’s neck. 
Let the patient hold the basin under his nose. 
Instruct the patient to breathe through his mouth, to pre- 
vent the solution from going down his throat. 
Expel air from the tube, and allow solution to run until it 
is warm. 
Instruct the patient to hold the head forward and down, 
and slightly inclined to the opposite side. 
Insert the tip and allow the solution to run slowly without 
much force. 
Solution should return through the opposite nostril. 
68 NASAL DOUCHE 
69 
Precautions: 
Irrigate from the unaffected side. 
If there is a small foreign substance in one nostril, irrigate 
from the opposite side. If the object is not dislodged at once, 
leave it, and have a doctor remove it. 
Avoid force. PHARYNGEAL DOUCHE 
Purpose: 
To cleanse, relieve inflammation, or to reduce swelling. 
Equipment: 
Small rubber. 
Small sheet or large towel. 
Safety-pins. 
Irrigating can with solution 105° F. 
Saline solution, 0.9 per cent. 
Boric acid, 2 to 4 per cent. 
Sodium bicarbonate or any antiseptic mouth or throat wash 
may be used. 
Irrigating tip (sterile). 
Large basin. 
Mouth-gag and tongue depressors. 
Towel. 
Thermometer. 
Glass graduate. 
Procedure: 
Place the rubber and cover so that it will protect the pillow 
and side of the bed. 
Instruct the patient to breathe through the mouth, and not 
to swallow during the treatment. 
Expel air from the tube and let solution run until it is warm. 
Turn the patient’s head to one side and place the basin under 
his jaw, so that drainage can run into the basin. 
Irrigate the throat, not allowing the solution to run with too 
much force. 
Precautions: 
Guard against the patient swallowing any of the solution. 
Watch the patient’s expression, and if he seems distressed, 
discontinue the treatment for a moment, as it may be difficult 
for him to refrain from swallowing. 
Do not use much force, and be sure that the temperature is 
correct. Purpose: 
Hot-water bags afford a convenient method of applying dry 
heat to relieve pain, congestion, to relax muscles, to act as a 
counterirritant, or may be used as a means of keeping moist 
compresses hot. 
Equipment: 
Hot-water bag and cover. 
Pitcher. 
Thermometer. 
Procedure: 
Test the temperature of the water in the pitcher, then pour 
into the hot-water bag, filling it about one-third full. The 
amount depends upon the purpose. 
Flatten the bag (without twisting) until all air is expelled and 
then screw in the cork firmly (Fig. 31). 
Remove all moisture from the surface of the bag and place 
in the cover. 
Apply to the area; see that it is kept hot by frequently chang- 
ing the water. 
The temperature which is usually used is about 118° or 120° F. 
Precautions: 
The careless use of the hot-water bottle has resulted in 
serious burns to the patients. A leaking bottle may cause a 
scald even when the water is not intensely hot. This is par- 
ticularly true of babies, old people, or paralytics. 
If a temperature higher than 120° F. is required, great care 
must be taken that no burn results. Watch for undue redness 
of the skin. A cover should always be used. 
Care of Rubber Bags: 
Never pour boiling or extremely hot water in a rubber bag. 
Do not twist the neck of the bottle when expelling the air. 
CARE AND USE OF HOT-WATER BAG 72 
A MANUAL OF NURSING PROCEDURES 
Be careful, when screwing in the cork, not to spoil the thread, 
but screw in straight. 
Fig. 31.—Filling hot-water bag. 
When putting away, empty the bag, leave some air to keep 
the inner surfaces from adhering, screw in the cork, and hang up 
the bag. 
Do not leave near extreme heat, as a radiator or register. TO FILL ICE-BAGS 
Purpose: 
To apply continuous cold to an area in order to reduce in- 
flammation, relieve pain, lessen swelling, to check the growth 
of bacteria, or to arrest hemorrhage. 
Equipment: 
Basin. 
Strong canvas bag. 
Mallet. 
Piece of ice. 
Ice-cap. 
Cover. 
Towel. 
Procedure: 
Place the ice in the canvas bag, using the mallet to break it 
into small pieces. 
Place ice in the basin, and allow a little cold water to run 
over it, to remove sharp edges which would cut the rubber. 
Fill the ice-cap, letting it rest flat upon the table, so that air 
will be expelled. 
Screw in the cap, remove moisture from surface of bag, and 
place in the cover. 
Apply where required. 
Precautions: 
Always watch for leakage. The rubber in ice-bags is very 
thin, therefore easily cut by sharp pieces of ice and careless 
handling. 
Never apply an ice-bag without a cover unless ordered to 
do so. The intense cold next the skin for any length of time 
is destructive to the tissues. 
If the bag is to be applied to some tender part, or to the 
chest, do not fill very full, as weight is undesirable. 
73 74 
A MANUAL OF NURSING PROCEDURES 
By the use of a towel, binder, or bandage secure the bag so 
that it will stay in place and not annoy the patient. 
Do not allow the hag to become warm. Ice is to be applied, 
not a warm compress. 
Be sure that the rubber washer is in place. Otherwise the 
bag will leak. 
Care of Ice-bags: 
These require the same care as hot-water bottles. In addi- 
tion, dry inside carefully and powder. This keeps the rubber 
from sticking together. Screw in the cap carefully. Do not 
leave near heat. RUBBER RINGS 
Purpose: 
To form an air-cushion which may be used to relieve pressure 
on some irritated or tender part of the body. 
Equipment: 
Rubber ring of the desired size. 
Cover for rubber ring. 
Procedure : 
Open the valve and blow up the ring until it is about one- 
third to one-half full. 
Close the valve quickly and test for leakage. 
Place in the cover, and adjust to the position required by 
the patient, being sure that the valve is so placed that the 
patient will not lie on it. 
Precautions: 
Be sure that the ring is so placed that no pressure whatever 
comes on the injured or tender area. 
Care of Rings: 
As for other rubber goods. Leave a small amount of air in 
the ring, and do not fold at a sharp angle, as rubber tends to 
crack where it is folded. 
75 ICE COIL 
Purpose: 
A convenient method of applying cold. 
Equipment: 
Standard. 
Ice coil. 
Irrigating can with water and ice wrapped in gauze. 
Glass connecting tip. 
Clamp. 
Pitcher. 
Towel. 
Large jar. 
Rubber sheet or paper to place under the jar. 
Procedure: 
Connect one end of the coiled tubing with the tubing of the 
irrigating can. 
The other end of the coiled tubing is to drain into the jar, 
which is placed on the floor convenient to the bed. 
Protect the area to which the coil is to be applied by a towel 
or compress. 
Adjust the coil comfortably, and allow the water to flow 
through slowly. 
See that the supply of water and ice in the can is kept up, 
and that the jar is emptied as required. 
Precautions: 
See that the patient is warm and comfortable, that the bed 
does not get damp, and that the area to which the cold is applied 
does not become cyanosed from too prolonged an application of 
cold. 
76 DRAINAGE PADS 
Purpose: 
To absorb drainage. 
To absorb excretions from the rectum and bladder when 
they are discharged involuntarily. 
Equipment: 
Piece of wrapping paper a little larger than the size of finished 
pad desired. 
Piece of old muslin same size as paper. 
Cotton substitute or oakum. 
Needle and thread. 
Procedure: 
Fold paper in about 2 inches all around. 
Fill with the cotton substitute and oakum. 
Cover with the muslin and sew the muslin to the paper. 
Place pad where it is required. 
Note: If there is a disagreeable odor from the discharge, it is 
better to use oakum, as it absorbs odor. 
Always have extra pads ready to replace soiled ones. 
77 CARE OF RUBBER GOODS 
All rubber goods should be cleaned and dried before putting 
away. 
Oil ruins rubber. Never bring in contact unless absolutely 
necessary. In this case, wash off as soon as possible with warm 
soapy water. Do not use scouring soap, as it, too, ruins rubber. 
Heat destroys rubber. Do not place on or near a hot radiator 
to dry. Do not put boiling water in rubber. 
Powder the inside of ice-bags, or put a piece of cotton inside 
after drying. This keeps the surfaces from adhering. 
Clean, dry, and powder both inside and outside of rubber 
gloves. Muslin pockets, which allow the gloves to lie full length 
and keep them separate, are best. 
Rubber rings, hot-water bags, etc., should have air left in 
them to keep the surfaces separate. 
Do not boil hard rubber. 
Stomach-tubes should be rinsed first in cool water, then in 
warm soapy water. If used for more than one patient, it should 
be boiled three minutes. Hang the tube up to dry, but do not 
allow it to bend at a sharp angle. 
Do not fold rubber sheets, etc., as they will crack along the 
line of the fold. 
Do not allow tubing to remain bent, as the rubber will soften 
and be useless at this point. The same thing happens if clamps 
are left on rubber tubing. 
78 APPLICATION OF A LARKSPUR CAP 
Purpose: 
Used in the treatment of pediculosis capitis. 
E quipment: 
Protection for the table. 
Basin of bichlorid, 1 : 1000. 
Comb. 
Fine comb. 
Tincture of larkspur. 
Large piece of old muslin (large enough to make a turban). 
Safety-pins. 
Towel. 
Procedure: 
Protect the table. 
Place large towel or small sheet under the patient’s head. 
Comb hair first with the large comb, then with the fine comb. 
Notice the comb carefully for presence of pediculi, dipping 
the comb in the bichlorid solution to confine and destroy the 
pediculi. 
Part the hair, and apply the tincture of larkspur with a piece 
of old linen, being careful to get it over all the scalp. 
Cover the hair with the piece of muslin, applying it as you 
would a triangular head bandage. Be sure that the hair is com- 
pletely and securely confined within the cap (Fig. 32). 
Leave from eight to twelve hours, then wash and fine comb 
the hair. 
Precautions: 
Guard against scattering pediculi, or getting them on your- 
self. 
Do not get any of the solution in the patient’s eyes. 
Note: Nits are very difficult to destroy and to remove from 
the hair. Hot vinegar and soap or kerosene are very useful. 
79 A MANUAL OF NURSING PROCEDURES 
Where there are nits the hair must be watched and fine 
combed almost daily, as the nits or eggs hatch. 
Fig. 32.—Application of a larkspur cap. 
When for any reason it is not desirable to use larkspur, grease 
may be used, or kerosene, although kerosene is apt to be irritating 
to the scalp unless rinsed with oil. METHOD OF GIVING A SHAMPOO TO A PATIENT IN 
BED 
Purpose: 
In preparation for certain operations, as those of the eye 
or ear. 
For ordinary cleanliness and comfort. 
To assist in removing pediculi. 
Equipment: 
Rubber pillow-case. 
Rubber to be used as a cape or apron. 
Rubber to protect stand. 
Face cloth. 
Face towel. 
Bath towel. 
Safety-pins. 
Liquid soap. 
Bath-tub. 
Pitcher of water, 110° F. 
Brush and comb. 
Protection for the floor. 
Bath blinket. 
Procedure: 
Turn bedding to waist line with bath blanket. 
Place rubber case and muslin case on one pillow, and place 
under the patient’s head. 
Make a cape of the small sheet and rubber and pin around 
the patient’s neck, rubber side out, and arranged to form a trough, 
the free end falling into a tub placed on the floor. 
Wet the hair thoroughly with warm water, and apply soap. 
Brush the scalp, using plenty of soap, or rub with the face 
cloth. 82 
A MANUAL OF NURSING PROCEDURES 
After washing the scalp bring the patient close to the edge 
of the bed, and pour water over the hair, washing thoroughly. 
Rinse the hair well. Use cold water the last time unless the 
patient desires otherwise. 
Squeeze as much water as possible out of the hair. 
Place warm bath towel on the pillow, remove the rubber 
cape, and bring the patient back on the pillow. 
Rub the scalp and the hair, and spread the hair over the pil- 
low so that it will dry. 
Dry the hair thoroughly. See that the patient does not get 
chilled during the process. 
Precautions: 
Have the patient as comfortable as possible while you are 
working. 
See that the room is warm before you start, and that the 
patient does not get chilled. 
Rinse all soap out of the hair, and dry the hair thoroughly. POULTICES 
FLAXSEED POULTICES 
Purpose: 
To promote suppuration, to localize infection, and to relieve 
local congestion. 
Equipment: 
Poultice board. 
Piece of old muslin. 
Saucepan. 
Large spoon. 
Flaxseed. 
Oil. 
Teaspoon. 
Tray. 
Sodium bicarbonate. 
Lubricant for the skin. 
Old towel. 
Oiled muslin. 
Bandage. 
Hot plate or hot-water bottle. 
Procedure: 
Stir slowly into boiling water enough flaxseed to make a 
paste. Boil until thick, or until it drops from the spoon. 
Add about a dram of oil, and a pinch of sodium bicarbonate. 
Have the tray ready, and the piece of old muslin, the desired 
size, spread on the plaster board. 
Beat poultice until very light. Spread on the cloth about 
\ inch thick, depending upon the area to which it is to be applied 
(Fig. 33). 
Cover quickly, and place on the hot plate or water bottle 
(Fig. 34). 84 
A MANUAL OF NURSING PROCEDURES 
Fig. 33.—Preparation of a flaxseed poultice. 
Fig. 34.—Flaxseed poultice ready to apply. POULTICES 
85 
Oil the surface of the skin, and apply slowly, being sure not 
to burn the patient. It is well to test the temperature of the 
poultice on your own wrist before applying. 
Cover with a flannel or a piece of rubber between the folds 
of an old towel. 
Make secure by applying a binder, or pinning an old towel 
over the part. 
Change every half-hour for as long as ordered, or apply as 
ordered. Large poultices will not need change as frequently as 
small ones, but must be kept very warm to be effective. 
Precautions: 
Work quickly. 
Leave poultice on only until desired results are obtained. 
Protect the skin by using a lubricant, and watch carefully to 
avoid burns. 
Change the poultice before it becomes cool. 
DIGITALIS POULTICE 
Purpose: 
May be ordered in cases of nephritis to stimulate the 
kidneys. 
Equipment: 
Digitalis leaves, and equipment as for other poultices with 
exception of flaxseed, oil, and sodium bicarbonate. 
Procedure: 
Add hot water to just cover the leaves, and allow to simmer 
until soft. 
Break into a pulp. 
Spread the pulp between the folds of muslin. 
Apply over the region of the kidneys. 
Note: Flaxseed poultice may be made with the water from 
steeping the leaves, and the leaves added to the poultice. 86 
A MANUAL OF NURSING PROCEDURES 
YEAST POULTICE 
Purpose: 
To stimulate granulations in old, infected wounds, difficult 
to heal. 
Equipment: 
Old piece of muslin. 
Poultice board. 
Brewer’s yeast. 
Binder and safety-pins. 
Procedure: 
Spread the yeast on the poultice cloth about \ to | inch thick. 
Apply to area to be covered, and make secure with binder. 
STARCH POULTICE 
Purpose: 
Sometimes ordered in skin affections to allay irritation. 
Equipment: 
Muslin. 
Poultice board. 
Ordinary cooked laundry starch, thick enough to drop from 
a spoon. 
Procedure: 
Spread warm starch paste on muslin and apply. 
SOAP POULTICE 
Purpose: 
May be ordered to cleanse the skin before an operation, or 
to cleanse a part not possible to cleanse otherwise, such as ex- 
tremely dirty feet, that resist ordinary methods of cleansing. 
Equipment: 
Gauze large enough to cover the area. 
Warm green soap solution. 
Binder and safety-pins. 
Procedure: 
Wet the compress in the soap solution and apply. 
Cover with the binder and secure with safety-pins. POULTICES 
87 
ANTIPHLOGISTIN 
Purpose: 
Same as a flaxseed poultice, to which it is sometimes pre- 
ferred. 
Equipment: 
Antiphlogistin may be spread on muslin or old linen and 
applied. 
Binder and safety-pins. 
(A piece of flannel or a hot-water bag, or both, may be used 
to retain the heat longer.) 
Procedure: 
Place the can of antiphlogistin in a pan of boiling water, and 
make very hot. Stir to insure even heat. 
Spread on a piece of muslin about \ inch thick. 
Apply to the part, the antiphlogistin next the skin. 
Cover and secure with a binder. 
The paste is usually left on until it dries (twelve to fourteen 
hours). COUNTERIRRITANTS 
Purpose: 
Irritation of some part of the skin, by means of which deep- 
seated irritation, inflammation, and pain are relieved. 
For explanation of the action of counterirritants, and the 
degree of action, see “Action of Counterirritants” in text-book. 
Materials Used: 
Iodin, turpentine, mustard, and ammonia are among the 
most common drugs used. Dry cupping, application of simple 
heat, as the hot-water bag, and use of the thermocautery are 
physical methods of producing counterirritation. 
IODIN 
Equipment: 
Small tray. 
Bottle of iodin (strength ordered either 4 or 7 per cent.). 
Absorbent cotton. 
Basin for waste. 
Forceps or sponge stick. 
Procedure: 
Make small cotton swabs by winding firmly around end of 
sponge stick, or held in forceps. 
Either pour iodin over the sponge, or put small amount of 
iodin in an ounce glass, and dip sponge into it. 
Outline the area to be painted. 
Paint the area, painting in one direction only, not allowing 
the strokes to overlap. 
When first coat is dry, more may be applied if desired, paint- 
ing in an opposite direction. 
Precautions: 
Iodin is an alcoholic preparation, and an old solution, from 
which alcohol has evaporated, may be very strong and cause 
burns. 
88 COUNTERIRRITANTS 
89 
Never apply iodin to a wet surface, or allow wet cloths, 
water, etc., to come in contact with the painted surface. 
Do not cover the painted area closely; if evaporation is pre- 
vented, it is liable to blister. 
Note: If too much iodin has been applied, or it is desired to 
remove it, use alcohol, which will quickly dissolve the iodin. 
MUSTARD FOOT-BATH 
Purpose : 
To relieve congestion and pain in some other part of the 
body, as in colds, headaches, painful menstruation. 
To induce sleep. 
Equipment: 
2 small rubber sheets and one cover. 
Large blanket. 
Bath towel. 
Foot-tub with water at 110° to 112° F. 
Mustard (1 to 1| tablespoons to 1 gallon of water). 
Piece of old muslin. 
Tablespoon. 
Pitcher. 
Hot-water bag. 
Ice-bag (not always necessary). 
Procedure: 
Use about 1| gallons of water. 
Tie mustard in piece of old muslin (or dissolve thoroughly in 
warm water). 
Dissolve mustard in water. 
Protect table with rubber sheet. 
Turn bedding back at foot of bed to above the patient’s knees, 
replacing with a bath blanket. 
Protect the bed with a small rubber and cover. 
Move the patient’s feet to one side of the bed. 
Place the tub of water about the center of foot of bed. 
Lift the patient’s feet and place slowly into the water. 90 
A MANUAL OF NURSING PROCEDURES 
Fig. 35.—Patient having a mustard foot-bath. A heavy blanket covers the 
tub and the bedding has been brought down over this blanket. 
Fig. 36.—Method of adding hot water during mustard foot-bath. COUNTERIRRITANTS 
Cover the tub with the blanket, tucking slightly under the 
tub, to prevent sagging into the water (Fig. 35). 
Bring the bedding down over the blanket. 
As the water in the tub cools, add more, at about 130° F., 
raising the patient’s feet before putting the water in (Fig. 36). 
The bath should last about twenty minutes. 
Put the bath towel at the side of the tub, and place the 
patient’s feet on the towel, covering immediately. 
Remove the tub. 
Dry the patient’s feet thoroughly. 
Bring the bedding down with the blanket, and arrange. 
Leave a hot-water bag at the patient’s feet. 
Precautions : 
Remember that there is danger of burning the patient. 
Keep the patient well covered, and avoid drafts. 
Watch the patient’s condition, and if there is any tendency 
to faintness, discontinue the bath at once. 
An ice-cap may be used to counteract any such tendency. 
Undissolved mustard may burn the skin. 
Be sure that the bed is dry, and that the patient is comfort- 
able when you leave him. 
MUSTARD PASTE 
Purpose: 
Mustard is often used as a counterirritant in congestion, 
pain, and inflammation of the chest. 
Equipment: 
Plaster board. 
Piece of old linen or muslin. 
Bowl or basin for mixing. 
Mustard. 
Flour. 
Cotton. 
Piece of flannel. 
Binder. 
Tablespoon. 
Knife or spatula. 
Small tray with hot plate or 
hot-water bottle. 
Small dish of oil or other 
lubricant. 92 
A MANUAL OF NURSING PROCEDURES 
Procedure: 
Use 1 part of mustard to 3 or 4 parts of flour. 
Make a paste with warm water that will spread easily, but 
not thin enough to run. 
Spread on a piece of muslin twice the desired size of the paste. 
Turn in generous edges all around, and fold over to thor- 
oughly confine the mustard. 
Oil the surface to which it is to be applied. 
Warm the paste on a hot plate or over a hot-water bag. 
Cover with a protector, which may be a towel or a piece of 
flannel. 
Leave on until the skin is reddened to the desired degree. 
After removing the paste, oil the skin and cover with a towel. 
Precautions: 
Be sure that the paste is not strong enough, or left on long 
enough, to blister the skin. Burns caused by mustard are pain- 
ful and difficult to heal. 
Note: If the skin is very tender, use 1 part of mustard to 
5 or 6 parts of flour. If for a child, use 10 to 12 parts of flour. 
If the mustard is mixed with the white of an egg it is not so apt 
to blister tender skin. 
When mustard is mixed with hot water the volatile oil is 
evaporated, and thus the valuable constituent of mustard is 
lost. Tepid water only should be used. 
TURPENTINE STUPES 
Purpose: 
To relieve pain and reduce tympanites. 
Equipment: 
Tray. 
Bath blanket. 
Abdominal binder. 
Oiled muslin. 
Three pieces of flannel. 
Stupe wringer. COUNTERIRRITANTS 
93 
Pitcher of scalding water. 
Small dish containing turpentine and oil (1 part of tur- 
pentine to 2 or 4 parts of oil, or equal parts, as ordered). 
Cotton. 
Procedure: 
Turn bedclothes back to waist line with bath blanket. 
Place abdominal binder under the patient. 
Fig. 37.—Applying turpentine stupes. 
Have oiled muslin or rubber tissue and flannel conveniently 
near the patient. 
Apply the turpentine and oil mixture to the abdomen with 
cotton swabs. 
Place one piece of flannel in the stupe wringer and pour 
scalding water over it. 
Wring very dry. 
Shake out and apply carefully to the abdomen (Fig. 37). 94 
A MANUAL OF NURSING PROCEDURES 
Cover with second piece of flannel, with rubber tissue, and 
secure by pinning binder in place. 
These may be applied fifteen minutes out of every hour, 
being changed every five minutes. 
Solution of turpentine and oil to be applied every third hour. 
If continuous stupes are ordered, apply solution every hour, 
and change flannels every fifteen minutes. 
When changing stupes always have the fresh hot stupe ready 
before removing the one from the abdomen. 
When stupes are removed, leave warm flannel over the part. 
Precautions: 
Avoid exposing the patient or uncovering the abdomen even 
for a moment. 
Wring cloths so dry that there will be no danger of scalding 
the patient, or of getting the patient or the bedding wet. 
Be sure that the turpentine and oil are in the correct pro- 
portions, and thoroughly mixed. 
DRY CUPPING 
Purpose: 
Counterirritation to relieve congestion in pneumonia, acute 
nephritis, edema of the lungs, etc. 
Equipment: 
Tray. 
Glass cups with very thick, smooth edges. 
Jar with cotton. 
Alcohol lamp. 
Applicators. 
Small basin for waste. 
Small dish of water. 
Towel. 
Matches. 
Bottle of alcohol. 
Wool blanket. 
Lubricant. COUNTERIRRITANTS 
95 
Procedure: 
Place the patient in a comfortable position. 
Protect the bedding, the patient’s gown, and hair by draping 
with towels and the woolen blanket. 
Oil the surface of the skin. 
Dip the swabs in alcohol, ignite, and hold while burning 
inside the inverted cup to create a vacuum. 
Apply quickly to the skin, not allowing time for loss of 
vacuum. 
Leave until the skin is as red as desired (never a dusky red). 
Remove by pressing the skin down carefully with the ball of 
the finger, allowing the air to enter, and releasing the cup. 
Precautions : 
Protect all cotton and linen from possible contact with 
flame, as there is great danger of fire. Keep the bottle of alcohol 
at some distance from the flame. Avoid allowing the edges of 
the cups to become hot, and so burning the patient. Do not 
apply cups twice in the same place. Apply cups so that you 
will obtain a uniform counterirritant action over the region. APPLICATION OF VARIOUS TREATMENTS TO THE EYES 
Purpose: 
To cleanse, to relieve inflammation, or to check infection. 
Equipment: 
Small sterile basin containing the solution at 100° F. (usually 
boric acid 2 per cent.) (Fig. 38). 
DOUCHING THE EYE 
Fig. 38.—Trays for douching the eyes and for application of medication to 
the eyes. 
Sterile medicine-dropper. 
Sterile cotton. 
Towel. 
Paper bag. 
Procedure: 
Have the patient seated with his head held very slightly 
backward. 
Remove any discharge from around the eye. 
Fill medicine-dropper with solution, not allowing it to run 
back into the rubber cap. 
96 APPLICATION OF VARIOUS TREATMENTS TO THE EYES 
97 
Hold eyelids apart and place cotton in such a way that it 
will absorb all overflow (Fig. 39). 
Hold under lid out and flush toward outer angle of the eye. 
Hold the dropper parallel with the cornea, not pointed at it, 
supporting in such a way that even though the patient moves it 
cannot touch the eye. 
Use cotton sponge once only, then discard into the paper bag 
or a small basin. 
Fig. 39.—Douching the eye. 
Precautions: 
Avoid making any pressure on the eyeball. 
Be careful not to hold the patient’s head at an uncomfortable 
angle, or to point the medicine-dropper toward the eyeball. 
If one eye only is affected, protect the other with a dressing 
of non-absorbent cotton held in place by adhesive. A watch- 
crystal makes a good protection. 
Scrub hands thoroughly before and after caring for the eyes, 
and avoid touching your own face or eyes. 98 
A manual of nursing procedures 
APPLICATION OF DROPS TO THE EYE 
Purpose: 
To apply medication to the eye for local effects: to dilate 
the pupil and paralyze the ciliary muscles, to contract the 
pupil, to relieve inflammatory conditions, or to produce local 
anesthesia prior to operation. 
Equipment: 
Solution as ordered. 
Clean medicine-dropper (usually a special dropper which 
also serves as a cork to the bottle of solution (Fig. 3S). 
Clean cotton. 
Fig. 40.—Application of medication to the eye. 
Procedure: 
Stand at the side of the patient. 
Pull the lower lid down, thus forming a “pocket” (Fig. 40). 
Have the patient look up, and gently place 1 drop on the APPLICATION OF VARIOUS TREATMENTS TO THE EYES 
99 
inside or mucous surface of the lower lid, near the outer corner 
of the eye. 
Release the lid, and place a small piece of cotton over the 
entrance to the nasal duct, holding it firmly for two or three 
minutes (this is to prevent the drug from passing into the nasal 
chamber where it would be absorbed, causing, in the case of 
certain drugs, serious systemic symptoms). 
Precautions: 
Do not allow the dropper to touch the eye; hold it in such 
a way that, even though the patient moves, this cannot happen. 
Be very sure that the solution is correct, both as to kind 
and strength. Patients have lost their sight through mistakes of 
this kind. 
Be careful that none of the solution passes to the mucous 
membrane of the nose. 
Cleanliness, both in materials used and in the care of the 
hands, is essential. 
APPLICATION OF POWDER TO THE EYE 
Equipment: 
Wooden applicator or toothpick. 
Cotton. 
Powder. 
Procedure: 
Wind cotton around the applicator, making it fluffy. 
Dip it in the powder, separate the eyelids, and dust the 
powder over the affected area by gently tapping the applicator 
with the middle finger of the right hand. 
Lower upper eyelid gently over the eyeball, and keep the 
eye closed for a short time. 
APPLICATION OF OINTMENT TO THE EYE 
Equipment: 
Tube of ointment. 
Toothpick and cotton, if ointment is not in a tube. A MANUAL OF NURSING PROCEDURES 
Procedure: 
Pull down the lower eyelid, and press the ointment from 
the tube, laying it gently on the mucous membrane of the 
lower lid. 
Close the eye, and instruct the patient to roll the eye so that 
the eyeball may be well covered. 
Light massage may sometimes be applied to distribute the 
ointment. 
If ointment is not in a tube: 
Wind cotton tightly on a toothpick, having the end well 
covered. 
Put ointment on the applicator, pull the lower eyelid down, 
and place the ointment just inside, on the mucous membrane. 
APPLICATION OF ICE COMPRESSES TO THE EYE 
Purpose: 
To relieve pain, to prevent and relieve inflammation, to check 
suppurative changes. 
Equipment: 
Pledgets of absorbent cotton, or of old soft linen or gauze, 
about 2 inches square, or large enough to nicely cover the 
eye. 
Large piece of ice in a basin, or placed on wire mesh or gauze 
tied over a bowl. 
Paper bag to hold discarded compresses. 
Procedure: 
Place several pledgets of moist cotton or compress on the 
ice, allowing them to remain until well chilled. 
Apply one (or two if both eyes are affected) over the closed 
lids. 
Change about every one or two minutes. 
If the eyes are not infected, the compresses may be used over 
again. 
Have plenty of compresses on the ice, so that the cold may 
be kept constantly on the eye. APPLICATION OF VARIOUS TREATMENTS TO THE EYES 
If eye is infected, discard compresses, using a fresh one each 
time. 
Scrub hands thoroughly before and after caring for eyes. 
APPLICATION OF HEAT TO THE EYE 
Purpose: 
To prevent inflammation, relieve pain, to promote the 
absorption of inflammatory products, or to hasten suppuration 
in the later stages of inflammation. 
Equipment: 
Several pledgets of absorbent cotton or other light com- 
press material a little larger than the eye. 
Bowl of hot solution (sterile water or boric acid solution, 
115° to 120° F.). 
Electric stove or alcohol lamp to keep the solution at the 
desired temperature, or place the bowl of solution in a larger 
bowl of very hot water. 
Paper bag. 
Tube of vaselin. 
Towel. 
Procedure: 
The patient should be lying down, and, for convenience, 
near the side of the bed. 
Apply vaselin over the lids and around the area to be covered. 
Wring or press compresses fairly dry, as surplus water may 
scald. 
Apply over the area firmly yet without pressure. Change 
every one or, at most, two minutes, as they cool rapidly. This 
should be kept up from fifteen to thirty minutes as ordered. 
After removing the last compresses dry the area carefully. 
Do not use soiled compresses the second time. 
Consider all discharges as contagious, and treat accordingly. 
Precautions: 
Hot compresses should be kept hot, as the effect of warm or 
cool compresses is totally different, and much harm may be done 102 
A MANUAL OF NURSING PROCEDURES 
by applying a temperature to the eyes that the condition does 
not indicate. 
Avoid leaving the eyelids damp after removing the com- 
press, as moisture evaporates, chilling the part. 
Avoid any transfer of infection. Be scrupulously clean when 
caring for the eyes. APPLICATION OF COLD COMPRESSES TO THE HEAD 
Purpose: 
To relieve pain or to reduce inflammation. 
Equipment: 
Large piece of ice in a basin, or placed on wire mesh over the 
basin (Fig. 41). 
Fig. 41.—Tray for applying ice compresses to head. 
Compress material or gauze several thicknesses, large enough 
to well cover the area. 
Rubber case to protect the pillow. 
Towel. 
Procedure: 
Wring out compresses fairly dry, place on ice until chilled. 
Place one compress on the patient’s forehead, leaving one on 
the ice. Change frequently, keeping one always on the ice. 
Precautions: 
Avoid allowing the water to drip from the compresses. 
Do not allow the patient to become chilled. INHALATIONS 
Purpose: 
Used for local action on some part of the respiratory tract. 
To stimulate respirations. 
To stimulate heart action. 
To relieve distressed cardiac conditions (angina pectoris). 
Equipment and Procedure: 
According to method employed, as follows: 
To give a steam or medicated inhalation for local action on 
the respiratory tract. 
No. 1: Make a canopy over the head of the bed, using a 
screen as a frame, covered with blankets to shut out in part the 
escape of steam. Leave an opening at either the side or the 
back, through which the steam may be directed. 
A croup kettle with a long spout may be used, the solution 
kept boiling by an electric stove or alcohol lamp on the bedside 
table. 
Great care must be taken that the steam does not come too 
near and so scald the patient, also care must be taken to guard 
against fire if an alcohol lamp is used. 
Medication may be added to the boiling water; usually 
tincture of benzoin is ordered (1 dram to 1 pint). 
Note: There are several methods by which the “canopy” 
may be improvised. The idea to be kept in mind is that the 
arrangement used will allow the patient to breathe the steam 
without danger of scalding, and that ventilation without drafts 
is allowed, avoiding giving the patient a “steam bath.” 
No. 2: An ordinary tea-kettle may be used, with a funnel 
attached to the spout. Cotton soaked in the drug may be 
placed in the spout of the kettle. 
No. 3: If the patient is not in bed a pitcher of boiling water 
may be placed on a stand or chair, at a comfortable height for 
104 INHALATIONS 
105 
the patient, and a bath towel or bath blanket placed over the 
pitcher and the patient’s head. This will soon cool, and will 
need to be renewed. 
INHALATIONS FOR GENERAL OR SYSTEMIC ACTION 
No. 1: Stramonium may be ordered for asthma patients. 
The stramonium may be burned in a small dish, and the patient 
inhale the fumes. 
No. 2: The fumes of ammonia or smelling salts may be used 
to stimulate a patient in case of fainting or to relieve some forms 
of headache. 
The patient may inhale the fumes from the bottle, or a 
small amount may be placed on a clean handkerchief or piece 
of gauze, and held near the patient’s nose. 
No. 3: Amyl nitrite may be used to relieve the distress 
caused by angina pectoris. The pearl may be broken in a hand- 
kerchief or fold of gauze, and held to the patient’s nose. 
SOME OF THE DRUGS WHICH MAY BE USED IN INHALATIONS 
Tincture of benzoin compound, 1 dram in 1 pint of water 
(or 1 quart). 
Peppermint, 10 drops to 1 quart of water. 
Eucalyptus, 1 dram in each quart of water. 
Turpentine, 10 drops in each quart of water. 
(Turpentine must be used cautiously, as it burns easily.) 
Note: Benzoin stains are difficult to remove from both 
linen and utensils, therefore care must be taken in its use. It is 
better to use an old pitcher for such a solution. 
Stains may be removed by ether or denatured alcohol. SPECIAL CARE OF THE PATIENT’S MOUTH 
Purpose: 
The mouth requires careful attention at all times, but in 
some diseases there is a particularly great tendency to dryness 
and cracking of the mucous membrane of the tongue and lips, 
of infection, collection of sordes, foul breath, etc. 
The following treatments are intended to offset these ten- 
dencies, to keep the patient’s mouth clean, moist, free from in- 
fection, and cracking of mucous membrane. It is both for com- 
fort and for prevention of disease. 
Equipment: 
Small tray. 
Glass of fresh water. 
Glass of mouth-wash. 
Applicators wound with cotton, and tongue depressors (in 
corked test-tubes). 
Ointment for the lips. 
Paper bag for waste. 
Small kidney-shaped basin. 
Towel. 
Procedure: 
Place towel about the patient’s neck. 
Have patient’s head turned toward you, and place basin so 
that he may expectorate into it without effort (Fig. 42). 
Dip applicators into the mouth-wash and clean the teeth 
thoroughly. (A number of applicators will be necessary.) 
Cleanse thoroughly between the gums and the cheeks. 
Clean the tongue and the roof of the mouth. 
Allow the patient to rinse the mouth with antiseptic solu- 
tion, and, if desired, with clear fresh water. 
If the patient’s lips are dry or cracked, apply a thin coating 
of cold cream, vaselin, or lemon juice and glycerin. SPECIAL CARE OF THE PATIENT’s MOUTH 
107 
If the patient has a high temperature the mouth should be 
cleansed before and after each feeding. 
If the patient is unconscious it will be necessary to hold the 
mouth open with a tongue depressor or mouth-gag. 
Fig. 42.—Care of the patient’s mouth. 
Work with great care and gentleness. 
Keep all equipment perfectly clean, and boil utensils after use. 
Precautions: 
If the patient has a communicable disease, the tray and all 
equipment must be kept isolated and used only for this patient. 
If possible, it is better to have separate equipment in all cases. COLD SPONGE 
Purpose: 
To reduce the temperature, to quiet the nervous system. 
To act as a tonic to the heart and circulation. 
Equipment: 
One large rubber sheet. 
One small rubber and one rubber pillow-case. 
Two bath blankets. 
Five face cloths. 
Face towel. 
Bath towel (large). 
Bath-tub with water 70° to 80° F. (or 10 to 20 degrees below 
body temperature, as ordered). 
Bathing alcohol in a basin of hot water. 
Powder. 
Ice-bag with cover. 
Hot-water bottle with cover. 
Procedure: 
Take the patient’s temperature, pulse, and respiration. 
Remove pillows, replace one, with rubber protection. 
Bring bedding down, covering the patient with a bath blanket. 
Place the second bath blanket and the rubber sheet under 
the patient. 
Place ice-bag to the head and hot-water bottle to the feet. 
Wring the bath towel out of cold water, and drape over the 
patient’s chest, abdomen, and groin. 
Remove the upper bath blanket from the part being sponged. 
Wring four wash cloths out of cold water, and place one in 
each groin (leave fairly wet); these should be changed fre- 
quently. 
Have face cloth almost dripping wet, and sponge each part 
with long quiet strokes. COLD SPONGE 
109 
After sponging, each part should be well rubbed. 
Work quickly to prevent chilling the patient. 
Repeat the alternate sponging and rubbing two or three 
times on each part. 
Cover with the blanket and remove the drape. 
When thoroughly dry, turn the patient on his side, and 
sponge the back, rub with alcohol until dry, then powder. 
Remove the lower blanket and rubber. 
Replace the patient’s gown, adjust upper bedding, remove 
the blanket. 
Refill the hot-water bag and leave the patient comfortable. 
Take the temperature, pulse, and respirations one-half hour 
after the bath. 
The bath should take from twenty to thirty minutes. 
Precautions: 
Avoid chilling the patient either by exposure, slow working, 
or leaving him damp. 
Avoid all unnecessary exposure, using screens if necessary. 
Be considerate of your patient’s mental as well as his physical 
comfort. 
Note: Special attention should be given to sponging on 
the inner surfaces of the thighs and arms. The large blood- 
vessels are just underneath, and the skin is thinner in these areas, 
therefore results will be attained more quickly. In some cases 
it is desirable to add to the equipment a basin containing pieces 
of ice, which are used to gradually cool the water in the tub. ALCOHOL SPONGE 
Purpose: 
See Cold Temperature Sponge. 
Equipment: 
Two bath blankets. 
Towel. 
Face cloth. 
Rubber sheet and rubber pillow-case. 
Small rubber to protect stand. 
Hot-water bag with cover. 
Ice-bag with over. 
Basin of water 70° to 80° F., containing 4 to 6 ounces of 
alcohol. 
Procedure: 
Take the temperature, pulse, and respiration. 
Remove the pillows, replacing one with rubber protection. 
Fold bedding down with bath blanket, in same manner as 
for a bed-bath. 
Turn the patient on her side, and place bath blanket and 
rubber under her. 
Remove the gown, place hot-water bag and ice-cap. 
With a fairly wet wash cloth (not dripping) bathe the body 
in sections, with long soothing strokes, followed by rubbing, 
also with long soothing strokes. 
The patient’s face and hands should be bathed first, then 
the neck, chest, arms, abdomen (do not rub the abdomen), 
thighs, and legs. 
Particular attention should be given the axillary spaces, the 
groin, inner surfaces of arms and thighs, and spaces under the 
knees. 
Turn the patient on her side, and bathe and rub the back. 
Remove bath blankets, replace gown, arrange upper bedding, 
refill hot-water bag, and leave the patient comfortable. ALCOHOL SPONGE 
Take temperature, pulse, and respiration one-half hour after 
the sponge. 
Precautions: 
Be sure that the room is warm before beginning the sponge. 
Watch the pulse carefully. 
If the patient has typhoid, she should be moved as little 
as possible, and all effort on her part should be avoided. 
Leave the patient dry, warm, and comfortable. 
Avoid all unnecessary exposure; use screens whenever neces- 
sary. Purpose: 
See Temperature Sponge. 
Equipment: 
Rubber sheet and rubber pillow-case. 
Small rubber- to protect stand. 
3 bath blankets. 
8 bath towels. 
Tub of water, 70° to 80° F. 
Hot-water bag with cover. 
Ice-bag with cover. 
Bathing alcohol in a basin of hot water. 
Procedure: 
Take the pulse, temperature, and respiration. 
Remove the pillows, replacing one with rubber protection. 
Turn bedding back with a bath blanket. 
Remove the patient’s gown, and place it where it will be 
kept warm. 
Turn the patient on her side, and place the rubber sheet and 
bath blanket under her. 
Place the ice-cap to the head and the hot-water bottle to 
the feet. 
Have one towel in the tub, ready to wring out. 
While the patient is still on her side apply friction to the 
back, making the skin glow. 
Wring out the towel, and apply quickly to the back, leaving 
it there during entire procedure. 
Turn the patient on her back. 
Apply friction, followed quickly by application of the wet 
towels, to the arms, chest, abdomen (do not rub the abdomen), 
and lower limbs (Fig. 43). 
COLD TOWEL PACK 
112 COLD TOWEL PACK 
When the whole body is covered, remove the bath blanket. 
Change the towels in the order of their application (except 
the back), applying brisk friction, as in the beginning. 
Repeat two or three times on the anterior part of the body. 
Cover with a warm bath blanket, and remove the towels. 
Rub with warm alcohol. 
Turn the patient on her side, and remove the wet towel. 
Rub the back with warm alcohol. 
Fig. 43.—Cold towel pack. 
Remove rubber and bath blanket from under the patient. 
Turn the patient on her back. 
Bring up bedding with bath blanket. 
Replace gown. 
Refill hot-water bottle. 
Leave patient comfortable and remove equipment. 
Take temperature, pulse, and respiration one-half hour after 
the pack. 114 
A MANUAL OF NURSING PROCEDURES 
Precautions: 
Be sure that the room is warm, and avoid drafts. 
Give brisk friction that will bring the blood to the surface. 
Work quickly and avoid chilling the patient. 
If the patient shivers or shows real signs of chilliness, cover 
warmly and give brisk friction, discontinuing the pack. 
Do not forget to screen your patient while you are working. COLD SHEET PACK 
Purpose: 
See Temperature Sponge. 
Equipment: 
Same as for Towel Pack, substituting two sheets for the 
eight bath towels. 
Procedure: 
Take the pulse, temperature, and respiration. 
Remove the pillows, and replace one with rubber protection. 
Turn down bedding with a bath blanket. 
Place rubber sheet, covered with two bath blankets, under 
the patient. 
Remove the patient’s gown. 
Place the ice-bag at the head and the hot-water bag at the 
feet. 
Place two sheets in the tub of water. 
Wring out one sheet, and wrap around the patient, tucking 
in well around the arms and at the sides. 
Cover with the second wet sheet, removing the top bath 
blanket at the same time. 
Tuck in well at the neck, under the axilla, close to the body 
of the patient, and between the thighs. 
Bring the right side of the first blanket across the patient, 
and tuck in on the left side, doing the same with the left side of 
the blanket, and with the second blanket. Place the third 
blanket over the patient. 
In this way none of the wet sheet is uncovered. 
Cover with a sheet or a bed spread. 
Leave in the pack twenty to thirty minutes. 
Give the patient a drink of water frequently. 
When removing from the pack rub well with warm alcohol, 
and avoid any exposure or opportunity for chilling. 
Take the temperature one-half hour after the pack. 
Precautions: 
As for Towel Pack. COLD CHEST PACK 
Purpose: 
As for other cold packs. May be used especially in pneu- 
monia, and in some heart conditions, as a tonic to the circulation. 
Equipment: 
Rubber sheet. 
Bath blanket. 
Woolen blanket. 
Two bath towels. 
Ice-bag with cover. 
Hot-water bag with cover. 
Tub of ice-water. 
Procedure: 
Protect the bed in the region of the chest with rubber sheet 
covered with the bath blanket. 
Remove the patient’s gown. 
Place ice-bag to the head and hot-water bag to the feet. 
Wring bath towels out of ice-water and wrap around the 
chest and back to the waist, leaving the arms out. 
Cover the towels with the woolen blanket. 
Keep in the pack from twenty minutes to one-half hour. 
Take the temperature before the pack and one-half hour 
after. Towels may be changed two or three times. 
Note the effect upon the quality and rate of the pulse. HOT FOMENTATIONS 
Purpose: 
To reduce inflammation. 
To soften fibrous tissue. 
To cause muscular relaxation. 
Equipment: 
Rubber sheet (size to cover area treated). 
2 small bath blankets. 
Compress material (flannel, small bath blanket, or bath 
towel). 
Wringer. 
Basin or tub (according to size of compress). 
Hot-water bags. 
Vaselin. 
Procedure: 
Place rubber between the two bath blankets, and place under 
the part affected. 
Lubricate area to be covered. 
Place compress material in wringer. 
Pour boiling water over compress. 
Wring them out, shake quickly, and test heat on your fore- 
arm. 
Place carefully, being careful not to burn the patient. 
Cover with the first dry bath blanket. 
Place hot-water bags outside this first blanket. 
Bring up rubber sheet and second bath blanket. 
Safety-pins may be used to hold blanket in place. 
Note: When, as is often the case, the treatment is to be con- 
tinued for an hour or more, an extra piece of flannel will be 
needed, as the compress in use is not to be removed until the 
fresh one is ready. 
Refill hot-water bags if necessary. 118 
A MANUAL OF NURSING PROCEDURES 
Precautions: 
Care must be taken not to burn the patient, also to avoid 
exposure of the part when compresses are changed. 
The part should be left warmly covered when the final com- 
press is removed. Purpose: 
To increase circulation, to relieve kidney congestion. 
To increase the activity of both the kidneys and the skin, 
thereby increasing elimination. 
To relieve muscular tension and spasm, to quiet the patient. 
Equipment: 
5 bath blankets. 
3 large blankets. 
2 towels. 
Hot pack rubber (large size). 
Rubber pillow-case. 
Rubber to protect stand. 
Ice-cap with cover. 
Hot-water bottle with cover. 
Hot pack wringer (an ordinary clothes-wringer may be 
attached to the tub). 
Bath-tub with scalding water. 
Bathing alcohol in basin of warm water (may be brought 
later). 
Procedure: 
Remove the pillows, and replace one protected with the 
rubber case. 
Place one bath blanket on the radiator to warm. 
Turn bedding down with a bath blanket (as when giving 
bath). 
Place two heavy blankets (with the rubber sheet between) 
under the patient (Fig. 44). 
Place one bath blanket under the patient (this may be done 
at same time heavy blankets are placed). 
Remove the patient’s gown. 
HOT PACK 120 
A MANUAL OF NURSING PROCEDURES 
Fig. 44.—Preparing a patient for a hot pack. 
Fig. 45.—Patient in a hot pack. HOT PACK 
121 
Tuck the bath blankets all around the patient, between the 
arms and the body, and between the thighs. 
Have ice-cap ready to place on the head. 
Place two light bath blankets in the tub of hot water. 
Wring out very dry. (If no wringer is available, place in a 
strong sheet and twist dry.) 
Empty the tub quickly, and take blankets to the bedside in 
the dry tub. 
Turn the patient on her side. 
Place one blanket under the patient, and one over her, work- 
ing very rapidly. 
Bring first heavy blanket, then rubber, then second blanket 
up over the patient separately, tucking in snugly and neatly. 
Place the third heavy blanket over the patient, tucking in 
around the patient. 
Place a clean towel over the top of the blankets to protect 
the patient’s face.. 
Apply the ice-cap to the head. 
Place the hot-water bags at the feet (outside the blankets). 
Bring bedding up over the patient, arranging neatly (Fig. 45). 
Watch the pulse very carefully, taking frequently. 
Give hot drinks if the patient is able to take them. 
Leave patient in the pack about twenty to thirty minutes if 
no ill effects are shown. 
TO TAKE THE PATIENT OUT OF THE PACK 
Turn bedding down, and remove the first heavy blanket, 
and place warm bath blanket over the patient. 
Loosen blankets and remove wet ones. 
Turn patient on her side and remove all but the blanket which 
is under the rubber sheet. 
Fold dry blankets loosely over the patient, and bring bedding 
up again. 
Refill hot-water bag and replace at the feet. 
Remove equipment. 122 
A MANUAL OF NURSING PROCEDURES 
Leave patient in this way for at least half an hour, during 
which time she should perspire. 
Watch closely, as when in the pack. Warm drinks may be 
given. 
At the end of this period, turn the bedding down, and give 
the patient a good rub with warm alcohol. 
Arrange bedding, remove blankets, refill hot-water bottles. 
Precautions: 
Work must be done very rapidly, and in warm surroundings. 
Great care must be taken to avoid exposure to the cooler 
air, especially when taking the patient out of the pack, when the 
greatest harm can result from carelessness. 
If undesirable effects result, place warm blankets over the 
patient and remove the wet ones, avoiding any exposure. 
In case of convulsions, loosen the blankets, but do not remove 
until after the convulsion has ceased. Purpose: 
To empty the stomach in case of poisoning. 
To remove the contents of the stomach for diagnostic pur- 
poses. 
To relieve extreme nausea, distress from gas, overdistention, 
etc. 
Equipment: 
Tray. 
Large pitcher with 2 to 6 quarts of solution,* 100° to 106° F. 
Small pitcher for pouring. 
Basin containing ice or ice-water and stomach-tube. 
Kidney basin. 
Mouth-gag (may or may not be required). 
Dressing rubber and draw-sheet to protect patient and bed. 
Rubber apron. 
Protection for floor. 
Gauze handkerchiefs for the patient. 
Paper bag for soiled handkerchiefs. 
Jar or pail for the return flow. 
Procedure: 
Place the stomach-tube on ice or in ice-water. 
Have all equipment at the bedside. 
Place jar on the floor near the bed (protect the floor). 
Protect the patient and bed with the dressing rubber and 
sheet. 
GASTRIC LAVAGE 
* Solutions which may be used: 
Soda bicarbonate, 5 per cent. 
Normal salt solution. 
Plain warm water. 
Solutions containing chemicals, as permanganate of potassium or other 
antidotes for poisons. 
123 124 
A MANUAL OF NURSING PROCEDURES 
Pass the tube carefully 16 to 18 inches, asking the patient 
to swallow constantly. Patient’s head should be slightly for- 
ward (Fig. 46). 
Do not force the tube; wait for any muscular spasm of the 
esophagus to cease, asking the patient to swallow. 
Fig. 46.—Gastric lavage. 
After the tube is in place, fill the funnel, and keep full, until 
about 1 pint has been given (never any more than this at one 
time). 
Pinch the tube below the funnel, invert over the jar, and 
siphon fluid back. 
Refill the funnel and wash stomach again. GASTRIC LAVAGE 
125 
Repeat until fluid returns clear, or until the amount ordered 
has been used. 
Pinch the tube firmly, and withdraw quickly, placing it in 
the basin. 
Cleanse the patient’s mouth and face with gauze hand- 
kerchief. 
See that patient is comfortable. 
Remove and clean equipment. 
Note carefully the nature of return flow, and report. (If 
in doubt, save contents of jar for inspection.) 
Precautions: 
Any appearance of blood in the return flow is an indication 
to stop the treatment at once, and withdraw the tube. 
When inserting the tube avoid touching the back of the 
pharynx, as this causes gagging. 
Avoid introducing tube into the larynx (watch patient’s 
color, breathing, and notice if air escapes from the funnel, indi- 
cating that the tube is in the larynx. 
Do not hurry or startle the patient, but make her as com- 
fortable as is possible under the circumstances. GAVAGE 
Purpose: 
To provide nourishment for the patient when for some 
reason she cannot or will not take food in the usual manner. 
Equipment: 
Tray: 
Small pitcher in basin of hot water. 
Basin with ice for stomach-tube. 
Kidney basin. 
Protection for the patient. 
Gauze handkerchiefs. 
Liquid food (milk, eggs in milk, beef juice, or any concen- 
trated liquid nourishment). 
Procedure: 
Proceed as for stomach lavage. 
When tube has been inserted, pour in the warm (105° F.) 
liquid food (slowly). 
When all the solution has been given, withdraw the tube 
carefully (first pinching the tube to avoid any dripping into the 
larynx). 
Precautions: 
As when giving lavage. 
In both cases the tubes should be carefully washed in cool 
water, both inside and out, then in soapy water. If the tubes 
are to be used for other patients, they should be boiled from 
one to three minutes. The boiling will not be necessary if the 
tube is kept for one patient. 
126 NASAL FEEDING 
Purpose: 
This method may be used for forced feeding when the use of 
the stomach-tube is not practical, as in diseases and operations 
of the jaw, and in cases of insanity. This method is always 
used for infants and children. 
Equipment: 
Large catheter and funnel. 
Lubricant. 
Liquid food in a small pitcher in basin of hot water. 
Protection for the patient. 
Procedure: 
Lubricate catheter, and pass carefully through the nostril, 
through the throat, and into the esophagus. 
Attach the funnel, and hold to the cheek to test if any air is 
passing out. (Air passing out, or a whistling sound, indicates 
that the tube is in the trachea.) 
When tube has been properly inserted, pour the liquid food 
in slowly. 
Keep the tube as still as possible to avoid irritation and 
vomiting. 
When finished, pinch the tube and withdraw quickly. 
Precautions: 
Great care must be taken that the tube is in the esophagus, 
not in the trachea. 
Be careful to pinch the tube before removing it, to avoid the 
dripping of liquid into the trachea. 
127 Purpose: 
To relieve the lower intestine of irritating substances. 
To relieve flatulence and to check diarrhea. 
To reduce temperature. 
To relieve dysentery. 
To destroy worms. 
Equipment: 
Two bath blankets. 
Small rubber and cover. 
Protection for the floor. 
Large jar or pail for return flow. 
2 rectal tubes (medium or small size). 
Irrigating can and rubber tubing. 
Clamp for tubing. 
2 connecting tips. 
Lubricant. 
Basin. 
Solution. (Both the nature of the solution and its tempera- 
ture will depend upon the purpose for which it is given, and will 
be ordered.) 
Procedure: 
Turn the patient on her side, and bring well to the edge of 
the bed, with the upper leg flexed. 
Drape patient with two bath blankets, as when giving a 
cleansing enema. 
Place protecting rubber and cover under the patient’s hips, 
allowing part of it to hang over the edge of the bed, to protect 
the mattress. 
Place the jar or pail beside the bed (protect floor). 
Lubricate the two rectal tubes, and insert both at the same 
time, inserting one tube (which is to be connected with the irri- 
COLON IRRIGATION (ENTEROCLYSIS) 
128 COLON IRRIGATION (ENTEROCLYSIS) 
129 
gating can) about 6 inches, the second tube (which is to drain 
into the jar) inserted about 4 inches. If tubes are marked before 
insertion, one 6 and the other 4 inches from the tip, there will be 
no difficulty or confusion. 
When tubes are properly inserted and attached, allow the 
fluid to flow in very slowly. 
When the solution returns clear, or amount ordered has been 
given, remove the tubes. 
Apply vaselin or ointment to the rectum to prevent irritation. 
Note the character of return flow. 
Remove and clean equipment. 
If the irrigation was given to reduce temperature, take the 
temperature one-half hour after the treatment. 
Note: The temperature of the irrigation when given for 
dysentery, colitis, diarrhea, or flatulence may be from 110° to 
118° F. 
If to reduce temperature, it may be ordered 10 to 20 degrees 
below that of the body. 
Normal saline, plain water, or medicated solutions may 
be used. 
Some hospitals provide special tubes for irrigations, making 
it unnecessary to insert two rectal tubes. CATHETERIZATION 
Purpose .• 
To empty the bladder when the patient cannot void. 
To obtain a sterile specimen. 
Following certain operations, when it is not desirable to 
have the patient void, or when much urine in the bladder would 
be harmful. 
To empty the bladder immediately preceding some operations. 
Equipment: 
Tray. 
Rubber protection and cover. 
2 bath blankets. 
2 catheter basins. 
3 or 4 sterile catheters (glass, silver, or rubber). 
Basin for urine. 
Extension light. 
Cotton dossils. 
Dressing towel. 
Sterile lubricant (not always used). 
Procedure: 
Place catheters with dossils in basin with plenty of water. 
Cover with the second basin, and boil five minutes. 
Drape the patient as for a douche. 
Place rubber protection and cover between thighs and where 
basins will be placed. 
Screen the bed, and arrange extension light. 
Place the equipment convenient to the bed, and allow the 
catheters to cool. 
Scrub hands thoroughly, using clean brush, orange-wood 
stick, soap, and running water. 
Each hand should be scrubbed at least three minutes, giving 
careful attention to each part—the nails and between the fingers, 
etc., also scrubbing the wrists and forearms. 
130 CATHETERIZATION 
131 
Have an assistant place the basins—the specimen basin be- 
tween the thighs, close to the vulva; the empty basin covering 
the sterile catheters, next, to receive the used dossils and cath- 
eters; last, the basin containing the catheters and dossils 
(Fig. 47). 
Do not touch anything unsterile with the right hand. 
Wrap sterile pledget of cotton around the first finger and 
thumb of left hand (or use sterile finger-cots). 
Fig. 47.—Patient prepared for catheterization. 
With this thumb and finger separate the labia, exposing the 
meatus. 
With the right hand take a dossil from the basin, drain 
excess water into the empty basin, and cleanse the vulva, dossil- 
ing down, and discard dossil (use once only). 
Repeat until the external parts are clean, leaving the last 
dossil over the orifice of the vagina. 
Pick up a catheter {never touching the end to he inserted) and A MANUAL OF NURSING PROCEDURES 
insert gently into the urethra; 1| or 2 inches is all that is neces- 
sary as a rule. 
After the urine has ceased to flow, pinch the catheter (if 
rubber) or place finger-tip over end if glass, and withdraw 
gently. 
Dossil the patient again, and leave dry and comfortable. 
Remove equipment, measure urine, and chart results. 
Precautions: 
Great care must be taken that nothing unsterile comes in 
contact with the catheter. 
If a glass catheter is used, observe whether the glass is 
cracked. 
A glass catheter that has boiled dry should never be used, 
as the glass will be brittle, and may break. 
A glass catheter should never be used for children, for 
delirious or restless patients, in pregnancy, or following certain 
operations. 
No force must be used in inserting the catheter. 
Avoid any unnecessary exposure, and keep the patient warm. 
Chilliness and nervousness will contract muscles and make the 
procedure more difficult, as well as more uncomfortable for the 
patient. 
TO OBTAIN A STERILE SPECIMEN 
Equipment and Procedure: 
Same as for ordinary catheterization, except that a sterile 
receptacle must be provided, and the urine must be kept sterile. 
Such a specimen should go immediately to the laboratory. 
Note: In some hospitals argyrol, 20 per cent., is always used. 
In this case the argyrol should be in a wide-mouthed bottle, and 
the first 2 inches of the catheter dipped into the solution just 
before inserting into the bladder. 
When a lubricant is used, it should be in a wide-mouthed 
jar into which the tip of the catheter can easily be dipped, or in 
a collapsible tube, when a small amount can be squeezed on the 
eye of the catheter. CATHETERIZATION 
A very good method of handling the catheter is to have a 
pair of sterile forceps (boiled with the catheters), using these to 
pick up the catheter (if rubber) near the end to be inserted, and 
therefore not touching the catheter with the fingers until after 
it has been inserted in the urethra. 
A glass catheter should be inserted with the curved end 
pointing upward, and allow it to gently follow the curve of the 
urethra. Never insert farther than just enough to allow the 
urine to flow. BLADDER IRRIGATION 
Purpose: 
To reduce inflammation and infection of the bladder (cys- 
titis) . 
Equipment: 
Equipment as for catheterization, with addition of: 
Sterile basin. 
Sterile pitcher with sterile solution* (usually boric acid 4 
per cent.) at 100° to 110° F. (covered). 
Sterile funnel, rubber tubing, and glass connecting tip. 
Sterile towel for cover, and sterile clrapings. 
Douche pan (or large basin for return flow). 
Procedure: 
Proceed as for catheterization, using rubber catheter, receiving 
the urine into a separate receptacle if it is desired to save a 
specimen or to measure amount. 
Do not remove the catheter. 
Attach the sterile tubing and funnel by means of the sterile 
connecting glass to the catheter, after allowing a small quantity 
of fluid to run through, expelling the air. 
Fill the funnel with solution, and allow it to flow gently into 
the bladder. 
Do not allow the funnel to become empty. 
From 1 to 4 ounces (rarely larger amounts) may be allowed 
to enter the bladder at one time. 
Siphon back into the basin or douche pan, and while the 
solution is still flowing from the funnel fill again. 
Repeat until the solution returns clear. 
* Solutions: 
Boric acid, 2 to 4 per cent. 
Normal salt solution. 
Bichlorid of mercury 1 : 20,000. 
Potassium permanganate. 
Argyrol. 
134 BLADDER IRRIGATION 
135 
Finish as for a catheterization. 
Observe and record character of return flow and amount of 
solution used. 
Note: A silver two-way catheter is sometimes used, provid- 
ing for a continual inflow and outflow of the solution. 
Instead of a pitcher and funnel a douche bag or irrigating 
can is used in some hospitals. In this case the tubing is de- 
tached from the catheter to allow return flow. 
Precautions: 
Observe great care to keep all sterile articles sterile. 
Handle the funnel in such a way that it will not become con- 
taminated. Never allow enough fluid to enter the bladder to 
cause the patient great distress. The lining of the bladder is 
extremely sensitive when diseased or inflamed, and even small 
quantities cause distress. 
Avoid introducing air into the bladder. 
BLADDER INSTILLATIONS 
Purpose: 
Method of introducing medication in the treatment of cys- 
titis, inflammation, etc. 
This treatment often follows a bladder irrigation. 
Equipment: 
Preparation as for catheterization or bladder irrigation, 
adding: 
Sterile funnel, tubing, and glass connecting tip. 
Sterile medicine-glass. 
Medication as ordered. 
Procedure: 
Cleanse the mouth of the bottle containing the solution 
with alcohol, and do not touch bottle or anything else to the 
sterile medicine-glass. 
If treatment is following an irrigation, pour the medication 
(amount and strength ordered) into the funnel, and allow to flow 
slowly into the bladder. 136 
A MANUAL OF NURSING PROCEDURES 
Finish as for catheterization. 
If no irrigation is given, first catheterize the patient, and 
without removing the catheter, attach the funnel, and pour 
medication slowly into the bladder. 
Precautions: 
Note and report if the patient complains of pain, as the 
solution may be too strong. PREPARATIONS FOR SURGICAL OPERATIONS 
Purpose : 
To thoroughly cleanse the area of operation, making it as 
nearly surgically clean as possible without unnecessary irritation 
of the skin. 
Equipment: 
Tray. 
Razor (safety or straight). 
Basin for dossils. 
Basin for waste. 
Sterile cotton. 
Tincture of green soap. 
Ether. 
Alcohol. 
Iodin (if ordered) may be 4, 5, or 7 per cent. 
Small jar for iodin. 
Electric-light extension. 
Sterile towels. 
Abdominal binder. 
Safety-pins. 
Paper squares. 
Hemostat. 
Procedure: 
Before beginning the preparation the patient should have 
had a cleansing bath, particular attention having been given to 
the field of operation. Before an abdominal operation the 
abdomen should be carefully cleansed and the umbilicus made 
perfectly clean. If the patient is very dirty, it may be neces- 
sary to apply a soap poultice, leaving this on for some time be- 
fore proceeding with the usual preparation. 
Most hospitals have their routine orders for preparations, 
some surgeons preferring one method, and some another. These 
orders should be followed carefully. In each method the under- 138 
A MANUAL OF NURSING PROCEDURES 
lying principle will be the same: to make the area clean and 
safe for operation, with as little irritation to the skin as possible. 
Screen the bed. 
Drape the patient, the method depending upon the part to 
be prepared for operation, and the necessity of keeping the 
patient warm. 
Shave the part, using dossils wet with green soap solution 
(if for a wet preparation). 
Cleanse the skin with whatever solution is ordered (alcohol, 
ether, gasoline, iodin, etc.). 
If iodin is applied, it should never be put on a moist skin, 
as it will cause a blister. (See directions for application of iodin 
on page 88.) 
After the skin dries, cover with a sterile towel, and apply the 
abdominal binder to hold it securely in place. 
Note: Sometimes the iodin or other solutions are not 
applied until the patient is in the operating-room, the only 
preparation being to thoroughly cleanse the skin, and shave the 
part carefully. 
Precautions: 
It is a disgrace for a nurse to send a patient to the operating- 
room who is not clean, or who is carelessly prepared. See that 
the parts are shaved thoroughly, and that the skin is not cut 
while doing so. 
Be most careful not to burn or blister the patient by the 
careless application of iodin. Do not stain linen with iodin. 
Avoid any unnecessary exposure of the patient, and do not 
allow her to become cold or chilly. Make all preparations as 
quietly, carefully, and as quickly as possible. Have everything 
ready before beginning to work. 
BEFORE TAKING THE PATIENT TO THE OPERATING-ROOM 
Comb or brush the hair, braiding in two braids. 
Remove any false teeth, plates, etc., from the mouth. (See 
that these are placed in water, in a safe and clean place.) PREPARATIONS EOR SURGICAL OPERATIONS 
139 
Put on the patient’s stockings, slippers, kimona, and, if cold, 
underclothing. 
See that any jewelry, money, etc., that the patient may have 
is either taken care of by the patient’s family, or placed in safe 
keeping. 
Take the patient to the operating-room in a wheel chair, or 
on a stretcher, as the case requires. In some cases the patient 
may walk. Usually this last is not wise, as the patient may be 
faint and tired from lack of food, worry, etc. 
Bring back the patient’s clothing from the operating-room 
and put away properly. 
Do not leave your patient alone in the anesthetic or the 
waiting room. If the routine work does not allow you to stay, 
see that another nurse takes charge of your patient before you 
leave her. Consider your patient first, last, and always. SURGICAL DRESSINGS 
Purpose: 
For cleanliness and comfort. 
To prevent infection. 
To protect from injury. 
Equipment : 
Dressing carrier or tray. 
Set of sterile instruments: probe, forceps, scissors, and other 
instruments as required. 
Basin with antiseptic solution and dossils. 
Package of sterile towels. 
Sterile supplies: gauze, cotton, bandage, etc. 
Adhesive stick. 
Bandage scissors. 
Tube of iodoform gauze. 
Sterile safety-pins. 
Sterile vaselin. 
Extra supplies for individual cases, as aristol, silver nitrate, 
Dakin’s solution, etc. 
Rubber gloves (for some cases). 
Procedure: 
As in the case of preparation for surgical operations, each 
hospital will have its own routine methods. However, the un- 
derlying principles will be the same, even though methods may 
differ. 
Abdominal Cases: 
Turn the bedding back, to just below the dressing. 
Cover the fold of bedding with a sterile towel, folded under 
the sheet, and next to the patient. 
Another sterile towel, folded over the patient’s gown just 
above the dressing, is desirable (Fig. 48). 
140 SURGICAL DRESSINGS 
141 
Breast Cases: 
Drape one sterile towel across the shoulder, one across the 
opposite side, and one below the incision, making a triangular 
opening. 
Foot or Hand: 
Raise the limb and put a sterile towel beneath it, directly 
under the wound. 
Place basins for soiled dossils on the foot of the bed, or 
within convenient reach of the one doing the dressing. 
Fig. 48.—Tray and preparation of patient for abdominal dressing. 
Have dossils ready in solution ordered (bichlorid of mercury, 
1 : 5000, is commonly used). 
Unpin bandages and remove outer dressing. 
Cleanse the wound and surrounding area with dossils, always 
working away from the wound. 
Have dressings ready, and handle sterile gauze with sterile 
instruments. 
Place sterile dressings carefully over the wound, and secure 
with bandages or adhesive straps. A MANUAL OF NURSING PROCEDURES 
Drainage cases may require fresh sterile tubes, and irrigation 
may also be required. 
If the doctor is to do the dressing, the nurse should remove 
the outer dressings, open the instruments, and leave them within 
easy reach on a sterile towel or container. 
Have everything in readiness, and anticipate the require- 
ments of the doctor who is doing the dressing. 
After the fresh sterile dressing has been applied, make secure 
with adhesive straps or bandage. 
Precautions : 
When it is necessary to remove adhesive from the skin, use 
benzine, alcohol, or ether. Cleanse carefully and completely, 
and apply vaselin or powder to prevent irritation. 
If in the ward, always screen the bed before beginning the 
dressing. 
Avoid allowing the patient to become chilled (pneumonia 
develops easily in postoperative cases). 
Keep everything that may come in contact with the wound 
absolutely sterile. 
When doing several dressings, do the clean cases first and the 
infected cases last. 
Handle dossils, instruments, etc., with care, disturbing the 
wound as little as possible. 
If there is an irritating discharge, sterile vaselin or the like 
may be applied to the skin close to the wound to prevent skin 
irritation. 
If there is much drainage or irrigation is to be done, extra 
rubber protection may be required. 
Wounds that are draining freely should be reinforced fre- 
quently, as a saturated dressing is not impervious to bacteria. 
Never do a dressing when the air is dusty from sweeping, bed 
making, etc. 
Try to avoid having the patient see the open wound, as it is 
very upsetting to some patients. FEEDING A HELPLESS PATIENT 
Purpose: 
Your aim should be to have the patient get the required 
nourishment with the least possible fatigue and discomfort, and 
with as much enjoyment as possible. 
Equipment: 
Extra pillows for the patient. 
Tray with dishes and food arranged as attractively as 
possible. 
Glass drinking tubes or invalid cup. 
Procedure: 
Arrange the patient as comfortably as possible, with the 
head and shoulders slightly elevated if this is allowed. 
See that the surroundings are clean (do not allow basins, soiled 
dishes, soiled towels, etc., on any part of the stand). 
Arrange the tray conveniently on the stand. 
Have a clean napkin or a clean towel to protect the bed. 
When everything is ready, sit down, and take whatever time 
is necessary. 
Never hurry your patient. 
When feeding with the spoon, give small amounts only, and 
give your patient time to finish before offering more (Fig. 49). 
Give the patient the food in the order in which she will most 
enjoy it, and do not forget to give her a drink. 
When giving tea, coffee, soup, or other hot liquids, be very 
careful not to burn the patient. This is more apt to happen when 
giving hot liquids through a tube, as the food is taken in quickly, 
and without opportunity to test the temperature with the lips. 
See that food which is intended to be hot, is hot, and that 
food intended to be served cold, is cold. 
Have the food seasoned to the patient’s taste, unless seasoning 
is to be eliminated from her diet. 
143 144 
A MANUAL OF NURSING PROCEDURES 
Fig. 49.—Feeding a patient. 
Try to make the meal hour as pleasant and restful to your 
patient as possible. METHOD OF SERVING CRACKED ICE 
Purpose: 
When the mouth is dry and parched, and the patients can- 
not take the amount of water desired, they will frequently 
derive great comfort from allowing small pieces of ice to melt 
in the mouth. 
In fevers and after surgical operations it may be particularly 
desirable, though it is apt to increase thirst. 
Equipment: 
Tray with a tray cloth, or a plate. 
Tumbler or small bowl with gauze over the top, tied, or 
secured by a rubber band. 
Small pieces of ice placed on the gauze (Fig. 50). 
Fig. 50.—Cracked ice ready to serve. 
Teaspoon. 
Place conveniently for the patient. GIVING MEDICATION BY HYPODERMIC 
Purpose: 
To obtain rapid action of the drug given. 
To give medication when it is not possible or wise to give 
it by mouth. 
Equipment: 
Hypodermic tray, with the following articles: 
Alcohol lamp may be attached to a solid base (Fig. 51b 
Fig. 51.:—Hypodermic tray with equipment. 
One or two spoons. 
Hypodermic syringe and needles. 
Bottle of alcohol. 
Sterile pledgets of cotton. 
Sterile hypodermic tablets. 
Small box of matches. 
Procedure: 
Clean the syringe. If glass, it may be boiled one minute; 
if metal, with a rubber washer, clean with alcohol, alternately 
drawing it into the syringe and expelling. 
146 GIVING MEDICATION BY HYPODERMIC 
147 
Boil the needle in the spoon. 
Boil water (distilled is best) in a spoon, and drop the hypo- 
dermic tablet into it. (Be sure to have just the correct amount 
of water; 15 minims is usually plenty.) 
Fig. 52.—Expelling air from the hypodermic syringe. 
When the tablet is dissolved, draw the solution into the 
syringe. 
Pick up the needle by the screw end, being careful not to 
contaminate the part that will pierce the skin, and screw it 
carefully into place. 
Cover the needle with a sterile pledget of cotton wet in al- 
cohol, and carry to the bedside. 148 
A MANUAL OF NURSING PROCEDURES 
Fig. 53.—Method of inserting the hypodermic needle. 
Fig. 54.—Method of injecting the medication. 
With a second pledget of cotton wet with alcohol cleanse a 
small area of the skin, rubbing rather briskly to bring the blood 
to the part (upper and outer part of the arm or thigh). GIVING MEDICATION BY HYPODERMIC 
149 
Remove the cotton from the needle, hold syringe straight, 
press the piston gently until all air is expelled (Fig. 52), 1 or 2 
drops of fluid have been expelled (not more). 
Grasp a portion of the skin and underlying tissue between 
the thumb and finger, holding in such a way that the skin will 
be perfectly smooth and tight (Fig. 53). 
Quickly insert the needle at a slight angle, putting it in its 
full length (Fig. 54). 
Withdraw needle very slightly and press the piston, forcing 
the fluid slowly and gently into the tissues. 
Withdraw the needle and cover the part quickly with a cotton 
pledget wet with alcohol; massage very gently in order to hasten 
distribution and absorption. 
Sterilize the syringe and needle before putting away, being 
careful that the needle is dry, and that the wire is in the needle. 
Leave hypodermic tray completely ready for instant use. 
Precautions : 
Have everything sterile. Remember the danger of abscesses 
from carelessly prepared and carelessly given hypodermics. 
Be careful to expel all air. The injection of air into the tissues 
will cause pain, and may be a source of danger. Take every 
precaution against breaking the needle in the tissues. Breaking 
may be caused by the sudden movement of the patient or the 
contraction of a muscle. 
When a needle is put in straight, especially into a large 
muscle, as in the hip, the needle is liable to break. 
Do not give more solution than necessary, as the pressure 
causes pain and destruction of tissue. 
When giving solutions of irritating drugs they should be 
given deep into the muscle. 
When giving drugs that are already in solution, be sure that 
these are sterile, and kept so. Bottles of such solutions may 
have rubber tops, and if so, these can be cleansed by wiping with 
alcohol, then the needle passed through the rubber top into the 
solution, the amount required being drawn up into the syringe. Purpose: 
Cleanliness and comfort. 
Equipment: 
Small tub (preferably rubber). 
Bath thermometer. 
Castile soap. 
Wash cloth (light material, gauze or cheese-cloth). 
Boric acid solution. 
Soft bath towel. 
Olive oil or some good baby talcum powder, unscented. 
Rubber apron. 
White apron to cover rubber apron. 
Clean clothing for the baby. 
Small screen to protect the baby from drafts. 
Soft hair-brush. 
Safety-pins or needle and thread. 
Procedure: 
Fill bath-tub three quarters full of water (98° F. when giving 
first tub bath, reducing to 85° F. by the time the baby is one 
year old). 
Adjust screen to protect the baby from drafts. 
Remove clothing. 
Wash the face with clear water and dry gently without 
rubbing (patting dry). 
Make a soapy lather on wash cloth and soap the baby’s 
head and body. 
Immerse the baby in the tub of water, first placing the left 
hand under the left axilla, allowing the forearm to serve as a 
support for the head and shoulders. 
Sponge the scalp with the wash cloth. 
Sponge entire body, giving special care to the creases, also 
reaching under and sponging the back. 
Lift the baby from the tub with the left arm in the same 
position, and the right supporting the feet. 
BATHING A BABY—TUB BATH BATHING A BABY—TUB BATH 
Lay the baby on your lap and dry gently with the towel, 
being careful that all creases are dry. 
Either olive oil or powder may be applied, oil preferred. 
If powder is used, brush off all surplus powder, being careful 
not to leave any, especially between folds of the skin. 
Make small pledgets of cotton, dip in olive oil, and clean 
the nostrils by rotating the pledgets in them. 
Clean navel with cotton dipped in boric acid solution. 
Clean nails with toothpick or orange-wood stick, cutting 
when necessary. 
If eyes are secreting, wipe lids gently with cotton dipped in 
boric acid solution, wiping outward, away from the nose. 
If tongue is coated, sponge gently with cotton dipped in boric 
acid solution, otherwise leave alone. 
Give the genitals special care: 
If a male child, retract the foreskin gently with the thumb 
and forefinger, clean the glans with boric acid and cotton, bring- 
ing the foreskin forward again. 
If a female child, clean labia with cotton and boric acid, 
wiping toward the rectum. Finish by applying olive oil. 
Dress the baby, putting the clothes on over the feet, and 
arranging the clothing so that the dress and petticoats may be 
put on at the same time. 
Precautions: 
Handle the baby as little as possible. 
Keep the baby’s head clean or a crust will form, and the 
baby’s head is apt to become sore. 
A baby is not usually given a tub bath until after the navel 
is dry and healed, which is usually at the end of the third week. 
Keep the baby comfortably warm, and protect from drafts. 
Avoid hot water and direct heat from fireplace or heater, 
as the baby’s skin is very easily burned. 
A burn or scald may be fatal to a baby. 
Note: Boric acid solution is made up by adding 2 ounces of 
boric acid to 1 pint of boiled water. PREPARATION FOR ADMINISTRATION OF SALVARSAN 
Purpose: 
Salvarsan is used in the treatment of syphilis, sleeping sick- 
ness, relapsing fever, malaria, anemia, and other diseases. 
Equipment: 
Same equipment as that used for Intravenous Medication 
and Transfusion (see p. 155), with addition of: 
Salvarsan. 
Sterile saline solution. 
Procedure: 
The patient is prepared and the treatment carried out with 
the same apparatus and the same aseptic precautions as when 
giving transfusions or intravenous medication. 
Precautions: 
The same as for intravenous medications. 
Stomach and bowels should be empty. 
Have the patient rest quietly following the treatment. 
Watch carefully for symptoms of reaction. 
Note all urine passed, as suppression frequently occurs. 
152 Purpose: 
To remove cerebrospinal fluid for diagnostic purposes or to 
relieve pressure. 
To introduce medication directly into the spinal canal. 
Equipment: 
Tray, containing the following: 
Alcohol. 
Iodin. 
Local anesthetic. 
Sterile gauze. 
Sterile towels. 
2 sterile lumbar puncture needles. 
Sterile glass syringe (10 to 30 c.c.). 
Sterile specimen basin. 
3 or 4 sterile test-tubes for fluid. 
(If the patient is to have a local preparation, added equip- 
ment will be required.) 
Procedure: 
The patient is turned on his side, with his back to the edge 
of the bed. 
Have the patient flex his knees, and bend shoulders forward. 
Draw up the gown (unless open at the back) and arrange 
bedclothing so that the lumbar region will be exposed, and 
clothing out of the way. 
Place a bath blanket over the shoulders. 
Cleanse the area with antiseptics. 
Drape the exposed part with sterile towels. 
Place the tray with required articles in a convenient place. 
Assist if required, and observe carefully the patient’s con- 
dition. 
LUMBAR PUNCTURE 
153 154 
A MANUAL or NURSING PROCEDURES 
Note: The puncture is usually made between the fourth 
and fifth lumbar vertebrae, as the liquid and bacteria tend to 
gravitate at this portion of the neural sac. This also brings the 
puncture below the spinal cord, and the anatomy of the lumbar 
vertebrae makes it easier to introduce the needle at this point. 
Precautions: 
Keep articles sterile. 
Have the patient in a comfortable position. 
If in the ward, screen the bed. INTRAVENOUS MEDICATION 
Purpose: 
To supply the body with fluid after hemorrhage or shock. 
To slow and strengthen the heart action. 
To obtain the full and immediate action of drugs. 
Equipment: 
Tray, with the following: 
Torniquet. 
2 hemostats. 
2 pieces rubber tubing. 
2 glass connecting tips. 
Tube carrier. 
Hypodermic with cocain, 2 per cent. 
Rubber sheet. 
Surgical pad or ether sheet. 
Sterile towels. 
Sterile sponges. 
Alcohol. 
Iodin. 
Collodion. 
Sterile aspirating needle. 
Flask of sterile solution (as ordered). 
Sterile instruments: thumb forceps, probe, scissors, scalpel, 
skin needles. 
Catgut. 
Procedure: 
Place the patient in a comfortable position (the arm and 
forearm only need be exposed), as the solution is injected either 
into the median cephalic or the median basilic vein at the bend 
of the elbow. 
Place rubber-covered dressing with sterile towel under the 
patient’s arm. 156 
A MANUAL OE NURSING PROCEDURES 
Place tourniquet around arm well above the elbow. 
Cleanse the skin at the point where the needle is to be 
inserted. 
Place the flask containing the solution (at 120° F.) in the 
proper position and connect the end of the tubing to the needle. 
Expel all air before inserting the needle into the vein. (This 
procedure is usually done by the physician, the nurse assisting 
when needed.) 
Allow the solution to run slowly until the required amount 
has been given. 
If the patient’s condition becomes worse, a stimulant may 
be ordered. 
Note: If an incision is made into the vein (rarely necessary), 
the instruments and catgut will be required. 
Precautions: 
Have all articles sterile. 
Have solution at correct temperature. 
Watch the patient’s condition, taking the pulse frequently. PARACENTESIS 
Purpose: 
To remove fluid from a cavity or a tumor in conditions 
where free opening is not desirable. The peritoneal cavity, 
thoracic cavity, and the pericardium are regions frequently 
tapped. 
Equipment: 
Tray with the following: 
Bath blanket. 
Rubber sheet. 
Surgical pad or ether sheet. 
Sterile sponges. 
Sterile towels. 
Rubber tubing. 
Iodin. 
Alcohol. 
Collodion. 
Specimen basin. 
Large jar. 
Hypodermic with 2 per cent, cocain. 
Trocar and cannula. 
Procedure: 
Place the patient in a comfortable position, a blanket around 
her shoulders, and feet resting upon a stool. 
Arrange rubber sheet and cover to protect the clothing. 
Cleanse the area where puncture is to be made. 
Cocain is sometimes injected in the area. 
Drape sterile towels around the area to be operated upon. 
Direct the end of the rubber tubing into the jar, which has 
been placed conveniently near to catch the fluid. 
The trocar and cannula are next introduced, and the trocar 
withdrawn. 158 
A MANUAL OF NURSING PROCEDURES 
When sufficient fluid has escaped, the cannula is withdrawn, 
and the opening covered with a sterile dressing. 
The patient must be kept comfortably warm and her con- 
dition watched closely. 
Precautions: 
Everything must be kept sterile. 
The patient’s condition watched closely, as the change in 
pressure from the loss of a large quantity of fluid may disturb 
the general circulation. Purpose: 
To compare the number, comparative percentage, and 
varieties of blood-corpuscles with that of the normal, thereby 
aiding in diagnosis. 
Equipment: 
Small pipet. 
Cleaning solution. 
Alcohol. 
Diluting fluid (depending upon whether a red or a white 
blood-count is to be made). 
Procedure: 
A small area of the skin surface (the tip of the finger or lobe 
of the ear) is cleansed with soap and water, then sponged with 
alcohol. 
(Antiseptics are not used, as they coagulate the albumin in 
the blood.) 
Make a small prick in the skin with a sterile needle, and 
draw a drop of blood into the pipet. 
The drop of blood is next sucked up to a mark on the tube, 
the point of the tube wiped clean, and a certain quantity of the 
diluting fluid drawn into the pipet. 
The blood and the diluting substance are thoroughly mixed. 
A smear is made on a special glass slide, and the blood ex- 
amined under the microscope. 
BLOOD-COUNT HYPODERMOCLYSIS 
Purpose: 
To supply the body with fluid in case of hemorrhage or 
shock. For stimulation. 
Equipment: 
Tray with the following articles: 
Rubber sheet. 
Surgical pad or ether sheet. 
Sterile rubber tubing. 
Sterile glass connecting tip. 
2 needles about 3 inches long. 
Sterile gauze sponges. 
Sterile towels. 
Iodin. 
Alcohol. 
Flask of sterile solution (120° F.). 
Procedure: 
Place the patient in a comfortable position, the position 
depending upon the site to be used for the injection of the fluid. 
Cleanse the skin. 
Drape area with sterile towels. 
Attach the needle to the rubber tubing. 
Allow the fluid to run until it is warm and the air all expelled 
from the tube. 
Insert the needle. (This procedure usually carried out by 
the doctor.) 
Allow the solution to run until the desired amount has been 
given. 
Withdraw the needle while some fluid still remains in the 
flask. 
Clamp the tube before the needle is withdrawn to avoid 
spilling the contents. HYPODERMOCLYSIS 
Have pledget of sterile cotton ready, and press gently for a 
moment over the area where needle was withdrawn. 
Precautions: 
Do not introduce too much solution in one area, as the 
pressure will cause pain and discomfort. 
Allow the solution to flow slowly. 
Be very sure that the solution is the correct temperature. 
Keep needles, etc., sterile. 
Watch the patient’s condition carefully. 
ii TRANSFUSION 
Purpose: 
To supply the body with blood after a hemorrhage, in 
hemophilia with lessened coagulability of the blood, in serious 
anemias, malnutrition, in septicemia, and for patients suffering 
from malignant growths. 
Equipment: 
Tray with the following: 
Large flask containing sodium citrate solution (strength 
ordered). 
Sterile glass rod. 
Flask of sterile normal saline solution. 
Sterile glass graduate (to measure citrate). 
Sterile towels. 
Sterile sponges. 
Sterile dressing. 
Rubber tubing. 
Syringe (20 to 30 c.c.). 
Rubber pad and cover. 
Disinfectant to cleanse skin. 
Basin with warm water (to keep citrate warm). 
Note: Three methods may be used: 
1. The “Unger,” or direct method. 
2. Lindeman method. 
3. The citrate method. 
The direct method is not used so much as the indirect, except 
in emergency. 
The Lindeman method is accomplished by means of several 
20-c.c. syringes, with a special set of cannulas. 
The citrate method is used extensively, and results are 
satisfactory. 
162 TRANSFUSION 
163 
Procedure for Citrate Method: 
Blood is withdrawn from the donor directly into a flask con- 
taining sodium citrate solution. It is then stirred gently with the 
sterile glass rod to mix with the citrate and avoid clotting of the 
blood. 
The method of injecting the blood into the vein of the re- 
cipient is the same as that for a saline infusion. 
The amount of blood given is noted and recorded on the 
chart. 
Precautions: 
Keep the patient warm, and watch for any adverse symp- 
toms, noticing the color and the pulse. 
Preparation of the Donor: 
Have donor in comfortable position. 
Cleanse the skin, and drape the area with sterile towels. 
Two methods are used for withdrawing the blood: 
1. With cannula and trocar. 
2. Needle, with rubber tubing attached, inserted into the 
vein. 
A tourniquet is applied above the vein, and when the needle 
has been inserted the tourniquet is loosened. 
The amount of blood given is noted, and recorded on the 
chart. INTUBATION 
Purpose: 
To keep the respiratory channel sufficiently open to allow 
the patient to breathe until the obstruction is removed. 
Equipment: 
Mouth-gag. 
Intubator or introducer. 
Extubator or remover. 
Set of hard-rubber tubes (different sizes). 
Silk thread. 
Obturator. 
Blankets for draping. 
Procedure: 
The patient (depending upon size) should be wrapped 
closely, and confined in a sheet or blanket. 
The head held upward and backward, with the chin in a 
straight line with the trachea. 
Adjust the mouth-gag. 
The tube is inserted by the physician, and should take not 
more than two or three seconds, as the breathing is obstructed 
during this process. 
The tube may be left in two to seven days, depending upon 
the condition. 
164 RESTRAINT OF PATIENTS 
Purpose: 
To prevent irresponsible patients from doing themselves 
injury. 
Equipment : 
Depending upon method of restraint. 
Procedure: 
1. A board the length of the bed, and about 14 inches high, 
covered with a sheet and padding, tied to the bed frame, is all 
that is necessary in most cases to keep the patient in bed (Fig. 55). 
Fig. 55.—Use of a bed-board. 
Old people, or those affected by mild delirium, may continually 
try to get out of bed. A slight barrier is all that is usually 
necessary. 
2. Another method that serves very well for mild cases is a 
sheet folded lengthwise and placed across the patient, the ends A MANUAL OF NURSING PROCEDURES 
being tucked in under the mattress. This must not be drawn 
too tightly over the patient. 
3. Fold two sheets diagonally. Place the center of the first 
folded sheet under the patient’s pillow. Bring the ends over 
his shoulders, under the arms, and tie the ends to the bar at the 
head of the bed. Place the second folded sheet under the 
patient’s ankles, making a loop around each ankle, and tying 
the ends together around the bar at the foot of the bed. 
Fig. 56.—Restraining sheet. 
If the hands must be restrained, fold two draw-sheets diag- 
onally. Loop one sheet around each wrist, and tie to the side of 
the bed frame, out of reach of the patient’s hands. Or, use a 
strip of strong muslin 1| yards by 27 inches; fold, and place a 
pad of cotton in the center between the folds. 
4. For violent patients the restraining sheet or jacket may 
be required (Fig. 56). This is heavy, uncomfortable, and very 
fatiguing. It should never be used unless absolutely neces- 
sary, and never without an order from the doctor in charge of RESTRAINT OE PATIENTS 
167 
the case. Help will always be required to put a patient in such 
a restraint, and also to take him out. Never attempt it alone. 
Have the patient well covered with one or two bath blankets 
before applying the restraint. Place the arms in the sleeves of 
the sheet. If there is an underpiece, pass this beneath the 
bed and fasten securely. Fasten all buckles and straps in such 
a way that the patient cannot get at them. Avoid pressure and 
weight over the chest. 
Precautions: 
Restraint in any form may be a serious danger to the pa- 
tient, and should never be used unless ordered. It is seldom 
necessary if a competent nurse is in charge. If used, be most 
careful that the restraint does not interfere with the circulation 
or the respiration, and that it does not hold any part of the 
body in an uncomfortable position. CARE OF THE BODY AFTER DEATH 
Equipment: 
Clean sheet. 
Gown. 
Stockings. 
Cotton waste. 
Old linen. 
Pins. 
Tags. 
Comb. 
Bandage. 
Rubber gloves (for infected cases). 
Equipment for a bath. 
Procedure: 
Never begin the preparation of the body until the doctor 
has pronounced the patient dead, and notice of this, with exact 
time, etc., has been sent to the office. 
First straighten the body, and place in the dorsal recumbent 
position, so that it will look as natural as possible (this can be 
done without waiting for orders). 
Remove rubber rings, hot-water bags, back-rests, and extra 
pillows. 
Remove spread and blankets, leaving a sheet over the body. 
Care for all valuables, rings, jewelry, money, etc.; make an 
accurate, detailed list, and. take these, with the list, to the 
office. 
If the patient has any false teeth, these should be placed in 
the mouth at once, as the jaw sets, and it is impossible to do 
this later. 
Leave the head and shoulders on one pillow to prevent con- 
gestion of the vessels of the face. 
168 CARE or THE BODY AFTER DEATH 
169 
Bathe the body as you would bathe a patient. 
If a surgical case, apply clean dressings, using plenty of 
cotton if there is any drainage (use unsterile dressings). 
A diaper of old muslin reinforced with cotton waste or oakum 
is put on to guard against the escape of feces from the relaxed 
rectum. 
If there should be any difficulty in keeping the eyes closed, 
a few fibers of cotton may be placed over the cornea. 
Put on the gown and stockings, and, if in the hospital, pin a 
tag, containing the name, date, and ward, securely to the gown. 
Wrap the body in a sheet, pin securely, and pin a tag, cor- 
responding to the first one, on the outside of the sheet. (Use 
sheet and gown reserved for this purpose.) 
All clothing should be carefully wrapped, marked with the 
patient’s name, and sent with the body. 
Place the body on a stretcher, cover completely, and remove 
to the morgue. 
All work should be done quietly, quickly, and respectfully, 
keeping the knowledge of or the idea of death from the patients 
as much as possible. 
Precautions: 
Consider the wishes and feelings of the patient’s family, 
whether or not they are present, and work accordingly. 
Do as little talking as possible, and that only business. 
Be most careful of all the patient’s belongings; see that none 
are mislaid or lost. 
Undertakers, as a rule, do not like to have bandages used, as 
they are apt to cause congestion, the marks of which are difficult 
or impossible to remove. TABLES OF WEIGHTS AND MEASURES 
Apothecaries’ System: 
Dry Measure 
20 grains (gr.) = 1 scruple 
3 scruples = 1 dram 
8 drams = 1 ounce 
12 ounces = 1 pound 
Liquid Measure 
60 minims = 1 fluidram (f5) 
8 fluidrams = 1 fluidounce (fg) 
16 fluidounces = 1 pint (O) 
2 pints = 1 quart (qt.) 
4 quarts = 1 gallon (gal.) 
Metric System: 
The unit of volume is 1 cubic meter. 
1000 cubic decimeters = 1 cu. meter 
1000 cubic centimeters = 1 cu. decimeter 
1000 cubic millimeters = 1 cu. centimeter 
The unit of capacity is the liter, which is equal to the amount of water at 
4° C. contained in 1 cubic decimeter. The millimeter (tsW liter) is equivalent 
to the cubic centimeter, and is written 1 c.c., or 1 mil. (the abbreviation of 
millimeter). 
1000 c.c. or 1000 mils. = 1 liter. 
The unit of weight is the gram, which is the weight of 1 cubic centimeter 
of water at 4° C. 
1.0 =1 gram 
0.1 =1 decigram 
0.01 =1 centigram 
0.001 = 1 milligram 
10.0 gm. = 1 dekagram 
100.0 gm. = 1 hectogram 
1000.0 gm. = 1 kilogram 
Equivalents: 
5j or 4 gm. = 1 level teaspoonful 
3ij or 8 gm. = 1 dessertspoonful 
5iv or 16 gm. = 1 tablespoonful (§ oz.) 
5viij = 2 tablespoonfuls (1 oz.) 
§vj =1 teacupful 
3 viij or 256 c.c. = 1 drinking glassful 
170 TABLES OF WEIGHTS AND MEASURES 
171 
In average non-poisonous solutions 5viij or 1 oz. is usually considered to 
equal 30 grams (in round numbers). This would give 180 c.c. in 6 oz., and 
240 c.c. in 8 oz. 
1 milligram = 0.001 gm. = grain (gr.) 
1 centigram = 0.01 gm. = | gr. 
1 decigram =0.1 gm. = 1J gr. 
1 gram =1.0 gm. = gr. (usually taken as 15 gr.) 
1 cubic centimeter (1 c.c.) = 15 grains 
1 liter, 1000 c.c. = 1 quart (approximately) 
1 grain (gr.) = 0.065 gram or 65 milligrams 
1 dram (dr.) = 4.0 grams 
1 ounce (oz.) = 30.0 grams (approximately) 
1 minim = 0.065 c.c. 
1 dram = 4.0 c.c. 
1 ounce = 30.0 c.c. 
1 pint = 500.0 c.c. 
1 quart = 1000.0 c.c. RULES USED IN MAKING SOLUTIONS AND IN GIVING 
MEDICINES 
1. To reduce per cent, to ratio, divide 100 by the per cent. 
2. To reduce ratio to per cent., divide 100 by the second term 
of the ratio. 
3. To find the amount of drug in a solution of a known 
strength when the strength is expressed in per cent.: 
The amount of the drug : amount of solution :: per cent. : 100. 
4. The above rule is also used to find the per cent, strength 
of a solution when the amount of drug in the solution is known. 
5. To find the amount of drug in a solution of known strength 
when the strength is expressed in ratio: 
The amount of drug : amount of solution : : 1 : second 
term of ratio. 
6. To make a weaker solution from a stronger one when the 
strength of each solution is expressed in per cent.: 
Per cent, strengths are to each other as the amount of the 
stronger solution needed is to the whole amount to be made. 
Example: Make 5 oz. of a 10 per cent, solution from a 25 
per cent, solution. 
10 : 25 : : x : 5 oz. 
25 x — 50 
x — 2 oz. (amount of stronger solution needed). 
7. To make a weaker solution from a stronger when the 
strength of each solution is expressed in ratio: 
Second term of ratio : second term of ratio : : x : the whole 
amount to be made. 
Example: Make 10 oz. of a 1 : 1000 solution from a 1 : 100 
solution. 
100 : 1000 : : x : 10 oz. 
1000 x — 1000 
x — 1 oz. (amount of stronger solution required). 
172 RULES IN MAKING SOLUTIONS 
173 
8. A convenient rule to remember: There are approximately 
4.5 grains of drug in 1 oz. of a 1 per cent, solution. 
9. Every bichlorid of mercury tablet contains 7.5 grains, and 
will make 1 pint of a 1 : 1000 solution. 
10. To give fractional doses: 
Divide the amount ordered by what you have on hand, and 
give that fraction of the dose on hand. If in tablets, dissolve in 
amount of water easily divisible by your fraction. 
Example: The ordered dose is fo grain of strychnin. The 
tablets on hand are grain to. 
ft — f (fraction of tablet on hand required to give dose 
ordered). Dissolve the tablet in 20 minims of water, and give 
15 minims. 
11. Computing children’s doses: 
(1) For a child from one to thirteen years old. 
age 
— X adult dose. 
age + 12 
(2) For a child one month to twelve months old. 
age in months 
X adult dose. 
150 TRAY EQUIPMENTS 
MOUTH TRAY 
Covered cups 3 
Glass tubes 3 
Toothpicks. 
Tongue depressors. 
Applicators. 
Lubricant: 
Cold cream. 
Zinc oxid. 
Vaselin. 
Mouth-wash cup. 
Expectorant basin. 
Surgical towels 2 
Gauze. 
EYE TRAY (Fig. 57) 
White enamel basin. 
Instrument basin, with following: 
Sterile scissors. 
Sterile probe. 
Sterile forceps. 
Sterile hemostat. 
Glass jar with sterile dossils. 
Candle-holder with candle. 
Box of matches. 
Adhesive—\ inch wide. 
Tube with safety-pins. 
Eye-shields. 
Sterile gauze—6 and 9 inch. 
Fig. 57.—Equipment for surgical dressing of the eye. 
SOLUTIONS USED FOR MOUTH- 
WASH 
Sterile cotton eye-pads. 
Bandages. 
Ointments. 
Solutions: 
Boric acid—saturated. 
Bichlorid—1 : 10,000. 
Eserin. 
Boric acid. 
Seiler’s solution. 
Dobell’s solution. 
Glycerin and lemon juice. 
Castor oil and lemon juice. 
174 TRAY EQUIPMENTS 
175 
Cocain—1 per cent. 
Silver nitrate—1 per cent. 
Atropin—1 per cent. 
HYPODERMIC TRAY 
Alcohol lamp 1 
(with spoons) 
Hypodermic syringe 1 
Needles and wires. 
Container for cotton. 
Cup for waste. 
Surgical alcohol. 
Bottle of water. 
Matches. 
Enamel tray with bottles of drugs 
used. 
DRESSING TRAY 
Small instrument tray 1 
Probe, forceps, and scissors. 
Bandage scissors. 
Hemostat. 
Gray basin 1 
Dressing basins 2 
Sterile safety-pins Tube 
Iodoform gauze Tube 
Sterile goods, including: 
Gauze. 
Cotton. 
Bandages. 
Surgical towels 2 
Unsterile goods, as pads, etc. 
Special equipment as needed. 
PREPARATION TRAY 
Gray basin 1 
White enamel cup 1 
Razor 1 
Extension light 1 
Bath blankets 2 
Surgical towels 2 
Paper squares. 
Extra equipment: 
Iodin. 
Ether. 
Gasoline. 
Alcohol. 
Sterile towels and binders. 
TRANSFUSION AND BLOOD- 
CULTURE TRAY 
Tourniquet 1 
Hemostat 1 
Tr. iodin Bottle 
Surgical alcohol Bottle 
Collodion Bottle 
Surgical towels 1 
Small rubber 1 
Sterile cotton. 
Small basin for waste. 
Extra equipment. 
Wassermann tubes. 
Blood chemistry tube. 
EYE-COMPRESS TRAY 
Gray basins 2 
White enamel cup 1 
Glass jar with cover. 
Gauze compresses. 
Eye pads. 
Alcohol lamp 1 
Matches Box 
Bichlorid of mercury. 
Sterile water. 
PHYSICAL EXAMINATION 
TRAY 
Gray basin 1 
White enamel cup 1 
Dossils in cup. 
Sterile gloves Pr. 
Sterile vaselin. 
Bath blankets 2 
Surgical towels 2 
Extension light 1 
Extra equipment. 
Speculum. 
Tenaculum forceps. 
Uterine dressing forceps. 176 
A MANUAL OF NURSING PROCEDURES 
CATHETERIZATION TRAY 
Gray basin 1 
Kidney basin 1 
Catheter basin 1 
(For boiling) 
Catheter basin 1 
(Covered) 
Catheters 4 
(Glass and rubber) 
Bottle of argyrol 1 
Sterile vaselin. 
Extension light. 
Bath blankets 2 
Surgical towels 2 
EXTRA EQUIPMENT FOR BLAD- 
DER IRRIGATION 
Sterile funnel 1 
Sterile rubber tubing. 
Connecting tip. 
Pitcher 1 
Solutions: 
Boric acid. 
Sterile water. 
Potassium permanganate. 
Argyrol (as ordered). 
LAVAGE TRAY 
Stomach-tube 1 
Large jar 1 
Pitcher (for solution) 1 
Gray basin 2 
Vomitus basin 1 
Mouth-gag 1 
Rubber apron 1 
Small rubbers 2 
Bath blanket. . . . 1 
Surgical pad 1 
Surgical towel 1 
Solutions used: 
Sodium bicarbonate. 
Tap-water. 
Salt solution. 
EXTRA EQUIPMENT FOR 
GAVAGE 
Pitcher or enamel cup for solution. 
Gray basin containing hot water to 
keep solution warm. 
TRAY FOR TREATMENT OF 
BURNS 
Gray basin 1 
White enamel cup 1 
Brush basin. 
Brushes 2 
Spatula 1 
Jar of wax 1 
Electric dryer 1 
Sterile gauze. INDEX 
Abdominal dressing, 140 
Airing mattress, 25 
Alcohol sponge, 110 
Antiphlogistin poultice, 87 
Antiseptic baths, local, 62 
soaks, local, 62 
Apothecaries’ system, table of, 170 
Assisting patient out of bed, 39 
Aural douche, 66 
Axillary temperature, method of tak 
ing, 48 
Baby, tub bath for, 150 
Back-rest, placing patient on, 36 
Bag, hot-water, care and use, 71 
filling of, 72 
ice-, care of, 74 
filling of, 73 
rubber, care of, 71 
Bath, antiseptic, local, 62 
bed, 33 
foot-, mustard, 89 
tub, for baby, 150 
Bed, assisting patient out of, 39 
bath, 33 
cleaning of, 17 
completed, 23 
convalescent, 25 
empty, making of, 19 
ether, 29 
fracture, arrangement of, 41 
completed, 42 
equipment of, 40 
morning care to patient in, 41 
Gatch, in use, 38 
opening of, 24 
patient in, shampoo to, 81 
Bed, patient in, morning care, includ- 
ing making the bed, 26 
preparation of, for fracture case, 40 
stripping of, 25 
to bed, moving patient from, 44 
tonsil, 32 
turning mattress without moving 
patient from, 45 
vermin-infested, cleaning of, 18 
Bed-board, use of, 165 
Bladder instillations, 135 
irrigation, 134 
extra equipment for, 176 
Blood transfusion, 162 
citrate method, 163 
preparation of donor, 163 
tray, equipment for, 175 
Blood-count, 159 
Blood-culture tray, equipment for, 175 
Body, care of, after death, 168 
cast, patient in, care of, 42 
Breast cases, dressing of, 141 
Burns, tray for treatment of, equip- 
ment for, 176 
Cap, larkspur, application of, 79 
Care of body after death, 168 
Carminative enema, 53 
formulas for, 54 
Cast, body, patient in, care of, 42 
Catheterization, 130 
obtaining sterile specimen of urine 
by, 132 
tray, equipment for, 176 
Chest pack, cold, 116 
Children, doses for, method of com- 
puting, 173 
177 178 
INDEX 
Citrate method of blood transfusion, 
163 
Cleaning a bed, 17 
utensils, 15 
utility room, 15 
Cleansing enema, 52 
Coil, ice, 76 
Cold chest pack, 116 
compresses, application of, to head, 
103 
sheet pack, 115 
sponge, 108 
towel pack, 112 
Colon irrigation, 128 
Compresses, cold, application of, to 
head, 103 
ice, application of, to eye, 100 
Convalescent bed, 25 
Counterirritants, 88 
dry cupping, 94 
l'odin, 88 
mustard foot-bath, 89 
paste, 91 
turpentine stupes, 92 
Cracked ice, method of serving, 145 
Cupping, dry, 94 
Death, care of body after, 168 
Delirious patients, restraint of, 165 
Digitalis poultice, 85 
Donor, preparation of, for blood trans- 
fusion, 163 
Doses for children, method of com- 
puting, 173 
Douche, aural, 66 
nasal, 68 
pharyngeal, 70 
vaginal, 64 
Douching eye, 96 
Drainage pads, 77 
Draw-sheet, folding of, 19 
Dressing tray, equipment for, 175 
Dressings, surgical, 140 
abdominal, 140 
breast cases, 141 
Dressings, surgical, foot, 141 
hand,142 
Drip apparatus of Murphy, 58 
Drops, application of, to eye, 98 
Drugs used in inhalations, 105 
Dry cupping, 94 
Ear douche, 66 
Emollient enema, 58 
Empty bed, making of, 19 
Enema, 52 
carminative, 53 
formulas for, 54 
cleansing, 52 
emollient, 58 
medicated, 57 
formula for, 58 
nutritive, 55 
formulas for, 56 
sedative, 58 
stimulating, 58 
tray, 53 
Enteroclysis, 128 
Ether bed, 29 
Evening care of patient, 28 
Eye, application of drops to, 98 
of heat to, 101 
of ice compresses to, 100 
of ointment to, 99 
of powder to, 99 
of various treatments to, 96 
douching of, 96 
tray, equipment for, 174 
Eye-compress tray, equipment for, 175 
Feeding helpless patient, 143 
nasal, 127 
Filling hot-water bag, 72 
ice-bags, 73 
Fingers, position of, in taking pulse, 50 
Flaxseed poultices, 83 
Folding draw-sheet, 19 
Fomentations, hot, 117 
Foot dressings, 141 
Foot-bath, mustard, 89 INDEX 
Fracture bed, arrangement of, 41 
completed, 42 
equipment of, 40 
morning care to patient in, 41 
case, preparation of bed for, 40 
Fractured limb, arrangement of, 40 
Gastric lavage, 123 
Gatch bed in use, 38 
Gavage, 126 
extra equipment for, 176 
Hand dressing, 141 
Head, application of cold compresses 
to, 103 
Heat, application of, to eye, 101 
Helpless patient, feeding, 143 
Hot fomentations, 117 
pack, 119 
method of removing patient from, 
121 
Hot-water bag, care and use, 71 
filling, 72 
Hypodermic medication, 146 
needle, method of inserting, 148 
syringe, expelling air from, 147 
tray, 146 
equipment for, 175 
Hypodermoclysis, 160 
Ice coil, 76 
compresses, application of, to eye, 
100 
to head, 103 
cracked, method of serving, 145 
Ice-bag, care of, 74 
filling of, 73 
Inhalations, 104 
drugs used in, 105 
for general or systemic action, 105 
steam, 104 
Instillations, bladder, 135 
Intravenous medication, 155 
Intubation, 164 
Iodin as counterirritant, 88 
Irrigation, bladder, 134 
extra equipment for, 176 
colon, 128 
Larkspur cap, application of, 79 
Lavage, gastric, 123 
tray, equipment for, 176 
Linen and supply closet in class room, 
12 
Lumbar puncture, 153 
Making empty bed, 19 
Mattress airing, 25 
turning of, without moving patient 
from bed, 45 
Medicated enemas, 57 
formulas for, 58 
Medicine closet in class room, 13 
Medicines, rules used in giving, 172 
Metric system, table of, 170 
Milk, peptonized, for enema, 56 
Morning care of bed patient including 
making the bed, 26 
to patient in fracture bed, 41 
Mouth, special care, 106 
temperature, method of taking, 48 
tray, equipment for, 174 
wash, solutions used for, 174 
Moving patient from one bed to an- 
other, 44 
Murphy drip apparatus, 58 
Mustard foot-bath, 89 
paste, 91 
Nasal douche, 68 
feeding, 127 
Needle, hypodermic, method of in- 
serting, 148 
Nose douche, 68 
Nutritive enema, 55 
formulas for, 56 
Ointment, application of, to eye, 99 
Opening bed, 24 180 
INDEX 
Operating-room, preparation of pa- 
tient before taking to, 138 
Operations, surgical, preparations for, 
137 
Pack, cold chest, 116 
sheet, 115 
towel, 112 
hot, 119 
method of removing patient from, 
121 
Pads, drainage, 77 
Paracentesis, 157 
Paste, mustard, 91 
Patient, assisting of, to get out of bed, 
39 
bed, morning care, including mak- 
ing the bed, 26 
changing of, to different bed frame 
only, 45 
evening care of, 28 
in bed, shampoo to, 81 
in body cast, care of, 42 
in fracture bed, morning care, 41 
moving of, from one bed to another, 
44 
placing of, on back-rest, 36 
restraint of, 165 
Peptonized milk for enema, 56 
Pharyngeal douche, 70 
Physical examination tray, equip- 
ment for, 175 
Poultices, 83 
antiphlogistin, 87 
digitalis, 85 
flaxseed, 83 
soap, 86 
starch, 86 
yeast, 86 
Powder, application of, to eye, 99 
Practice period in class demonstration 
room, 11 
Preparation tray, equipment for, 175 
Proctoclysis, 58 
Pulse, 48 
Pulse, method of taking, 49 
Puncture, lumbar, 153 
Rectal temperature, method of tak- 
ing, 49 
Respiration, 48 
method of taking, 50 
Restless patients, restraint of, 165 
Restraining sheet, 166 
Restraint of patients, 165 
Rings, rubber, 74 
care of, 75 
Room, utility, cleaning of, 15 
Rubber bags, care of, 71 
goods, care of, 78 
rings, 75 
care of, 75 
Rules used in making solutions and 
in giving medicines, 172 
Saline solution as enema, 52 
Salt solution by proctoclysis, 58 
Salvarsan, preparation for administra- 
tion, 152 
Sedative enema, 58 
Shampoo to patient in bed, 81 
Sheet, lower, method of changing, 27 
pack, cold, 115 
restraining, 166 
Soaks, antiseptic, local, 62 
Soap poultice, 86 
solution as enema, 52 
Solutions, rules used in making, 172 
used for mouth wash, 174 
Sponge, alcohol, 110 
cold, 108 
Starch poultice, 86 
Steam inhalations, 104 
Stimulating enemas, 58 
Stomach, lavage of, 123 
Stripping bed, 25 
Stupes, turpentine, 92 
Surgical dressings, 140 
abdominal, 140 
breast cases, 141 INDEX 
181 
Surgical dressings, foot, 141 
hand, 141 
operations, preparations for, 137 
Syringe, hypodermic, expelling air 
from, 147 
Tables of weights and measures, 170 
Temperature, 48 
axillary, method of taking, 48 
mouth, method of taking, 48 
rectal, method of taking, 49 
Tonsil bed, 32 
Towel pack, cold, 112 
Transfusion, blood, 162 
citrate method, 163 
preparation of donor, 163 
tray for, equipment of, 175 
Tray equipments, 174 
Tub bath for baby, 150 
Turning mattress without moving pa- 
tient from bed, 45 
Turpentine stupes, 92 
Urine, method of obtaining sterile 
specimen, 132 
Utensils, arrangement of, in utility 
room, 14 
cleaning of, 15 
Utility room, cleaning of, 15 
Vaginal douche, 64 
Vermin-infected bed, cleaning of, 18 
Yeast poultice, 86