BASIC MEDICAL CARE - Medicine for Mountaineering and Other Wilderness Activities - page 10

fections are the most common cause ofdeath forelderly persons confined to bed with frac-
tured hips or similar injuries.)
To eliminate the fluid, expand the lungs, and reduce the danger of infection, individuals
must be encouraged—or forced—to breathe deeply and to cough at frequent intervals.
Coughing may be difficult for someone who is very ill or very painful for someone with a
chest or abdominal injury, but such individuals are the most prone to pulmonary infections
and most in need of clearing their lungs. The practice in most hospitals is to have indi-
viduals sit up, hold their sides, and cough deeply—not just clear the throat—at least every
twohours.Asimilar routine shouldbeadopted inwilderness circumstances, particularly at
higher altitudes where any compromise in pulmonary function could be disastrous.
Elimination of fluid from the lungs can also be increased by postural drainage. If the
headandchestareslightly lowerthantherestofthebody,gravityhelpsgetridofthefluid.
In a tent, such positioning can best be achieved by elevating the abdomen, pelvis, and legs.
After the person has recovered enough to be able to walk around, forced coughing or pos-
tural drainage are usually no longer necessary.
Ambulation
Anyone confined to bed as a result of illness or injury should be encouraged to walk
several times a day. Such exercise increases the circulation in the legs and helps prevent
thrombophlebitis ( Chapter 18: Respiratory Disorders ) . The only major exceptions to this
rule are individuals with injuries that prevent walking, as well as individuals who have
already developed thrombophlebitis and should remain as immobile as possible until the
disorder has resolved.
Diet
Foodisnotasimportantduringtheacutestagesofanillnessasanadequatefluidintake.
Unless a specific disorder dictates a particular diet, the person should eat whatever is de-
sired, although bland diets are usually more acceptable. During convalescence more atten-
tion can be given to a nutritionally adequate diet, perhaps with extra protein.
Bowel Care
Difficultieswithbowelevacuationarecommonforpersonsconfinedtobedwhorepress
theurgetodefecate,havealowfoodintake,andbecomedehydrated.Ifnotcorrected,fecal
impactionoftenresults( Chapter19:GastrointestinalDisorders ) .Eventhoughstoolvolume
is reduced in the absence of solid food in the diet, bowel movements should occur every
three to four days. The best way to ensure normal elimination is to make certain fluid in-
take is adequate; roughage or fiber in the diet increases stool bulk and is helpful. Laxatives
or enemas should rarely be needed to prevent impaction in a bedridden individual.