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Nourishment for the

food, nurse, patient, physician, appetite, hand, knowledge and invalid

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NOURISHMENT FOR THE SICK.—The great importance of diet as a factor in the treatment of the sick cannot be doubted. In some cases it is one which is difficult to control, and every physician can give a number of personal experiences of a most annoying, and at times even tragic, nature to illustrate what disaster may be wrought by the well-meant blunders of devoted friends or the capricious desires of the invalid himself. It cannot be too frequently or too strongly emphasised that the patient's food, no less than his medicine, should be dictated by the physician in charge of the case, and that the latter's orders in this respect are no more to be disobeyed than those in regard to drugs. It is quite impossible that a person not equipped with the special knowledge of the physician, and uninformed by the study which he gives to each individual case, should successfully select food especially adapted to the particular conditions existing in that case. On the other hand, appetite and preference, which form a reasonably safe guide under normal conditions, may he so distorted by disease as to demand food which the digestive apparatus is totally unable to cope with.

The attractive serving of food is of great importance ; and in this respect the tact and good taste of the nurse come most potently into play in cases where it is difficult to get the patient to take nourishment. Even in the appetite and the digestion are both influenced to a perfectly appreciable degree by the appearance and serving of the food, and in illness this factor becomes a much more important one. A carelessly prepared tray, a soiled or rumpled napkin, a cup which has " slopped over " into the saucer, or any one of a hundred other possible defects or accidents, even merely a hap hazard arrangement of dishes, may cause the invalid to turn away in disgust and miss the much-needed nourishment. The trained nurse has been taught, and the amateur nurse should learn that such refusals on the part of the patient are not to be regarded as " notions " which are to be ridiculed or chided. but arc to be met by more care and thought in providing a really appetising and dainty repast. No amount of pains is too great to lavish upon this point. If a glass of milk is brought, set it upon a pretty plate with a dainty bit of linen, instead of bringing it in the hand. If a fruit-juice drink is offered, attractive in colour, serve it in a clear, thin glass, so that it may delight the eye as well as the palate. On the other hand, if the article

of food is a clingy gruel, put it in the prettiest china bowl that can be found, where its unpleasant appearance may be rendered least conspicuous, and something else agreeable to look at be at hand. All linen must be fresh and crisp, all silver polished. Dishes should never be crowded on a tray, and the quantity of food should never be so much as to discourage a weak appetite. A fresh flower or two brought in with a meal actually stimulates the appetite in many patients ; and any little " surprise " or novelty will often prove marvellously efficacious in the childish state to which illness reduces most people. Occasionally a patient is revolted by the mere sight of food, and in such case liquid foods may be conveniently taken through a bent tube.

The details of the patient's diet, although to be indicated by the physician, must naturally be left largely to the nurse ; and it is therefore extremely important that the latter should have a sufficient fund of general knowledge of the subject to apply correctly the physician's directions. Some know ledge of the chemistry of foods is essential no less than an understanding of the chemical and mechanical processes of digeston. If the nurse has this knowledge, she will understand that cooking does not render meats more digestible, but merely more palatable ; and that the steak served to an invalid had best be underdone, whereas starchy vegetables must be cooked for a long time, since otherwise the starch-grains will offer effective resistance to the digestive processes. She will know that the albumen of an egg is rendered most available by slight boiling or by thorough beating, and that the seasoning of food for the sick should be most delicately done in order to secure the desirable degree of stimulation. In case of fevers she will understand that the time for the most important meal of the day should coincide with that of lowest temperature, that food should not be given when the patient is likely to be disturbed or excited or tired in any way, and that only under explicit instructions from the physician should the patient be wakened from sleep to take nourishment. Such a nurse will not need an explanation of the reason for combating a suppurative or tuberculous process with forced feeding, for treatment by starvation in other cases, or for favouring a diseased stomach with food to be digested in the intestine.

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