Providing emergency care for an injury or other medical issue is important. In normal times, it’s the most that’s expected of the average citizen. More than that, and you’re expected to pass the sick or injured along to modern medicial facilities.

In survival settings, however, there is no hospital. rehab center, nor nursing home which can take in those who require convalescent care. Therefore, it’s the medic’s responsibility to learn proper nursing care for the sick and injured members of the group. In normal times, most of the care a patient receives is from the nurses on the ward. If the medic can acquire some of their skills, they’ll have surpassed the accomplishments of many a doctor in terms of helping a patient recover.

Here are a list of nursing care duties that will give a sick loved one a better chance at survival in good times or bad:

Vital Signs & Charting

-Take the patient’s temperature, blood pressure, heart rate and respirations (vital signs) three times a daily until recovered. Check more frequently if any result is out of the normal range. Maintain a chart to document their progress.

-Listen to lung sounds comparing one side to the other (see physical exam section for more details) once per day. In their record, chart “lungs clear on both side” or specify any issues found.

-A pulse finger oximeter will help check the status of the respiratory system. Although this is a device that requires batteries it is very useful to have in your medical supplies. This shows you how much oxygen is getting from the lungs into the blood as well as the heart rate. Document results in the chart.

-Perform capillary refill checks on both hands and feet to assure good blood flow to the extremities. While you are evaluating each hand and foot, also check skin color, pulses, and strength. Chart these results daily; If a body part involves the injured area, then the medic should check these signs during each dressing change.

-Ask the patient about their pain level while performing vital signs and dressing changes. Give appropriate over the counter medication to help with their comfort. Document the pain level (1-10), and any treatment in the chart, plus if improvement occurred.

Safety & Shelter

-Provide a safe shelter with a comfortable temperature and some fresh air.

-Encourage bed rest until fully recovered.

-Note any disabilities the patient has, such as trouble hearing, seeing, mental status and with mobility. Make sure all caregivers are aware if special care is needed.

-Check on the patient frequently and provide visiting time for loved ones to sit quietly by their side (except for contagious diseases). Feeling cared for speeds recovery.

-Assess the patient’s mental status with every encounter. Does the patient know who they are, where they are, and what day it is? Their moods, speech patterns, responses to questions or commands (“will you lift you right arm please”), as well as their posture and ability to walk should all be considered. You don’t need to directly ask these questions every five minutes but keep a note of any changes or sudden confusion. Chart “awake, alert, and aware” once per day or record any deficits.

-Keep a close eye on any confused or disoriented patient; they should have someone at their bedside at all times for their safety. Protect them from falls and further injuries.

-Assess their emotional status and look for signs of anxiety, depression and PTSD (all discussed in that chapter of the same name). Support and listen to the patient’s feelings. Allow them to verbalize as much as they want. Seek special counseling for the patient, if available, from a capable individual.

-Teach patients how to use any ambulation or movement equipment, like a wheelchair, (commercial or homemade) properly. Encourage mobility as tolerated by the patient.

Hygiene & Sanitation

-Wash your hands before providing any care or preparing your loved one’s food or fluids

-Protect yourself, the patient, and visitors from infections and contagious diseases with PPE (personal protection equipment) as needed. This includes hand washing and glove changes while providing wound care.

-Provide a comfortable sleeping cot or bed with a pillow and blankets. Change all linens daily (if possible) to avoid moisture and soil buildup (immediately if wet or soiled).

-Keep the patient clean. Bathe daily; even a sponge bath is helpful. Use a gentle soap and soft washcloth. Keep the patient warm and covered in areas not being bathed. Change linens immediately afterward. Provide or apply a skin moisturizer.

-On a daily basis, ask the patient to brush their teeth or assist if needed. Oral hygiene is often overlooked and causes problems down the road.

-For contagious patients, try to maintain the sickroom and a bathroom space for the patient separate from the other family members.

-Dispose of human waste safely.

Nutrition & Hydration

-Give plenty of fluids. Fluids help loosen secretions so that the patient can bring up phlegm and help maintain adequate hydration. Examples include water, sports drinks, ginger ale, and diluted fruit juices.

-Document how many ounces or cups of fluids the patient is able to drink and the volume of urination (or an approximation). In hospitals this is known as “I & Os” or “input and output”.

-Chart any bowel movements, including how the patient describes it (color, amount, and consistency). Listen for gurgling bowel sounds in all four quadrants during a daily exam until bowel movements are noted. Patients on bed rest tend to get constipated. Treat as needed with extra fluids, fiber and/or over the counter medications. Chart bowel sounds, problems, and treatments provided.

-Provide frequent small, easy-to-digest, nutritious meals and snacks. Add vitamin supplements to help boost the immune system. Chart type and amount of foods eaten plus any supplement type and dosage.

-Meals and snacks can include soups, applesauce, plain chicken, sandwiches, crackers, cottage cheese, mashed potatoes, rice, gelatin, pudding, bananas, etc.

Preventing Bedridden Patient Issues

-Allow the patient to sit in a comfortable chair or prop the patient up in bed to help with breathing and prevent pneumonia.

-A short walk as tolerated will help decrease the chance of blood clots. Keep a patient record and chart mobility out of bed, time, and location.

-If the patient is on bed rest, perform ROM (range of motion) gently every day to prevent stiffness. This means helping the patient move every joint slowly and comfortably. As the patient gains mobility, add exercises that use small weights to increase strength. The injured area should receive special attention. Chart ROM performed, include the time and date.

-Change the bedridden patient’s position during waking hours at least every two hours to avoid skin irritation and bedsores.

Here are some different positions to place the patient in:

• Side lying with the upper leg bent and forwards (if possible) while supported with pillows, is one position utilized (both sides are used).
• Moving the upper hip backwards and bringing the upper leg parallel to the lower leg can modify this as another position.
• The back is supported with pillows and pillows are used to pad between the upper and lower leg.
• Keep both knees bent slightly.
• Further rotating the back and bringing the upper leg to its natural side is another position.
• Support the tilted back, tilted upper hip and upper leg with pillows.
• A back lying position is best performed while the patient is sitting up (it does not need to be fully sitting).
• Provide pillows behind the back and under both knees and lower legs to relieve strain on the hips and back.
• Chart each position change in the patient’s record.

-Provide some activities for the patient as tolerated. A deck of cards, some crossword puzzles, a few books and will keep them occupied and connected to the outside world.

Wound Care

-Wound care should be performed at least daily. Twice daily is ideal. Infections may need three or more dressing changes depending on the drainage of pus. Chart the look of the wound, including any signs of infection, and amount, odor and color of any discharge. We’ll discuss wound care in much more detail in a future article.

If you can perform all of the above duties regularly, you’ll have given your patient the best chance of a full recovery (and you’ll never have to prove your fortitude in any other way).

Amy Alton ARNP

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