Home Care of the Sick

P atients suffering from certain communicable diseases should be hospitalized. Home care facilities do not normally include the expensive and delicate medical equipment required for the complete care of these diseases.

If, however, the physician in charge of a case decides that his patient does not need hospitalization and that adequate home nursing care can be provided, the well-being of the patient can be greatly enhanced by his being cared for in the comfortable and familiar surroundings of his own home.

When the decision to treat a patient at home is made, it must be understood that the physician's orders regarding rest, exercise, diet, and medications have to be rigorously adhered to. Nursing responsibilities assigned to the patient and whoever else is tending to the patient's recovery should be carried out as conscientiously as they would be if the patient's care were entrusted to a team of medical professionals in a hospital environment.

The physician in charge of a case should, of course, be notified of any significant changes in the condition of the patient. The physician should be contacted if, for example, the patient complains of severe pain, pain of long duration, or pain that apparently is not directly related to an injury or surgical procedure. The location and characteristics of the pain should be noted, and the physician will want to know whether the pain is affected by changing the position of the patient or if it seems to be related to the intake of food or fluids.

In addition to being informed of such potentially dangerous developments, the physician should get daily or frequent reports on the patient's progress. The easiest and best way to see that this is done is to keep a written record of the following functions, symptoms, and conditions of the patient:

1. • Morning and evening body temperature, pulse rate, and respiration rate
2. • Bowel movements—frequency, consistency of stools, presence of blood
3. • Urination—amount, frequency, presence of burning sensation, color
4. • Vomiting or nausea
5. • The amount and kind of solid foods and liquids taken by the patient
6. • Hours of sleep
7. • Medications given (should be administered only on the instructions of the physician)
8. • Patient's general appearance (includes any unusual swelling, skin rash, or skin discoloration)
9. • General mental and psychological condition of the patient, such as signs of irritability or despondency