General Rules

In the treatment of disease there are few questions which have to be considered so often in the daily routine of practice as those which concern the proper support and nourishment of the patient.

A good nurse will never exceed or depart from the physician's instructions; but there are occasions when her possession of accurate, even if limited, knowledge on the subject of chemical and physiological action of food will enable a physician to give more definite directions, greatly assisting him in the performance of his duties, and adding to the comfort and well-being of the patient.

Physician's Directions

The nurse's directions in reference to feeding her patient should be written, stating how much food may be given, its form, preparation and time of serving. In pneumonia, typhoid and all acute serious conditions, a record of all these details should be kept, also a record of the quantity of fluid and medicine taken.

The nurse has a far better opportunity than the physician to judge of all the conditions of the patient's digestion, and his likes and dislikes for different foods, and she should not fail to report them to the physician in charge and understand very definitely to what extent she is to be permitted to humor her patient, and substitute one form of food or drink for another.

It may happen from lack of care or indefinite instruction, that the food served will neutralize the effect of the medicine, either by overfeeding, or by irregularities in feeding,which disturb digestion and interfere with the beneficial effect of the medicine.

Those who are ill are often allowed to drift into critical conditions through not being properly supplied with such nutritive material as their enfeebled powers can digest. Many have perished because those around them did not know how to feed them, and either withheld food altogether, or gave that which was unsuitable, through ignorance. Even when the patient is confined to bed and prevented from taking any kind of voluntary exercise, he still requires heat and energy for the involuntary action of heart, lungs, and the other processes of living, and healthy nutrition must be provided for by a supply of suitable food.

Often the nurse may conscientiously serve one form of food ordered, offering it in spite of the patient's dislike and nausea with the result of half starving him. When her in-structions have not been specific, or have not provided for emergencies, she should make it a point to have them clearly understood at the next visit of the physician.

To be able to carry out these instructions and offer nourishment intelligently, a thorough practical knowledge of dietetics is necessary, and should be the foundation of every nurse's training. If we wish to succeed in avoiding nausea, vomiting, loss of strength, and even loss of life, we must learn to offer food to the patient in a suitable form, in the quantity and at the times suited to his digestive power, and so adapt his food to his capabilities.

This subject has been so ably treated by Dr. Thompson (Practical Dietetics, 2d ed. ) in his chapter, "Administration of Food for the Sick," that permission has been asked, and kindly granted, to use extracts from that chapter; also, by the kindness of Mrs. Ellen H. Richards, quotations have been made from the article, "Nourishment in Acute Disease," from the "Rumford Kitchen Leaflets".