The symptoms of physical illness described below are not presented in the order of their frequency or of their importance because people react differently to illness. Nor is the severity of a symptom a true guide to its importance, for a mild symptom may precede a serious illness.

General Appearance

The total process by which the home nurse evaluates the condition of the patient includes the impressions that she has of changes in the patient as they contrast with his pre-illness appearance. Perhaps the simplest explanation is to say that the nurse decides how the patient is by his general appearance, by those things one can see as well as those things on senses. The relationship of the home nurse to the patient is a face-to-face relationship. It follows therefore that judgments about illness are based on what can be seen in the patient’s face, his expression, his movements, and what he says as well as how he says it.

The Face

The appearance of the patient’s face often gives a clue to the nature of his illness and to how much he is actually suffering. The facial expression may be drawn and haggard, alert and anxious, or dull and listless. The may seem swollen or puffy about the eves or it may be flushed or pale.

The eyes may seem heavy or unusually bright, and the sclera or whites of the eyes may be yellow or show a yellowish tinge. The eyes may be inflamed, bloodshot, or unusually sensitive to light. Because some diseases are characterized by disturbance of vision, the doctor should be told whether the patient complains of spots before the eyes, of halos around lights, of seeing double, or of not being able to see clearly.

The Nose and Throat

A running nose, sneezing, coughing, hoarseness, difficulty in breathing, and sore throat are all symptoms of the common cold. They may also mean the onset of influenza, poliomyelitis, pneumonia, sinusitis, and, in fact, any disease of the respiratory tract. When these symptoms are accompanied by fever and if they persist they are a matter of concern, and the patient should be given medical attention. A chronic cough, hoarseness, and continued difficulty in breathing are especially serious.

A sore throat accompanies many disease conditions, including most colds, coughs, and sinus infections. The most common type of sore throat is that caused by an infection characterized by an inflamed, raw throat with or without whitish patches. Abscessed or infected tonsils usually cause pain and difficulty in swallowing. A sore throat is an important symptom in the diagnosis of several communicable diseases. Severely sore and swollen throats, painful throat conditions that persist and are accompanied by fever, throats that show yellow or grayish patches and throats that are raw and bleeding should be reported to the doctor immediately.

Any person with a sore throat should keep away fro others. To bed if he has a fever or any patches in the throat, drink plenty of fluids, eat a light or soft diet, and get plenty of rest. The toilet articles and dishes he used should be kept separate from those of others until communicable disease is ruled out.

So many of the early signs of illness include a sore throat that it is wise to know how to inspect the throat easily, quickly, and skillfully. It is good practice for parents to accustom their children to throat inspection when they are well so that they will be less likely to object to having their throats inspected when they are ill.

The Mouth

Healthy gums are pink and firm, while unhealthy gums may be swollen, bleedings; and sensitive. Disease of the gums, the lining of the mouth, and the boney sockets of the teeth is called periodontal disease. One of the earliest indications of this disease may be “pink toothbrush,” which is caused from bleeding of the sensitive gums. This condition should be treated by a dentist before it leads to serious infection.

In illness the tongue may be dry and cracked, have a heavy white or yellow coating, be vivid red and have a raw appearance, or when extended, treble noticeably. The sense of taste is nearly always disturbed, especially when the patient has a high fever or any difficulty in breathing through the nose.

The Voice

The voice is often changed in sickness; it may weak, hoarse, or reduced to a whisper. In extreme weakness, speech may be difficult. Any unusual moaning, groaning, and crying should be noted as an indication so some disturbance.

The Skin

The entire surface to the body should be observed for discoloration, selling, itching, rash or eruptions of any kin, or breaks in the skin. Sometimes there is a puffiness of the skin under the eyes or swelling around the wrist or ankles. Any of these symptoms should be reported to the doctor. The skin acts as a protective covering for the body and as a barrier against disease, and any break in it may serve to permit the entrance of bacteria.

In the skin there are two kinds of glands, the sebaceous or oil glands and the seat glands. The oil secreted on the skin makes it soft and pliable, Very dry skin is subject to abrasions and breaks in the surface through which infection can enter. The seat glands normally produce about a quart of perspiration a day. They are part of the excretory system of the body and help in the removal of water and waste products. They also aid in maintaining the water balance of the body and normal body temperature. Heat noticeably increases the activity of the sweat glands, as do tension, nervousness, and extreme emotional upset. Excessive perspiration usual occurs in the hands and the alxillae or arm pits and on the face and the feet.

Appetite and Hunger

Appetite is an emotional reaction to the stimulus of empty stomach, and hunger is the physical response. When the stomach is empty, it is shrunken, and the contracted muscles of its walls irritate the nerve endings, causing the sensation of hunger. After eating, the walls of the stomach are stretched and its nerves are soothed so that one is no longer hungry. Any food that is ingested will suffice to destroy huger because of its mechanical action, but appetite makes some foods more appealing than others. Appetite is also a sensory response to the desire to repeat a previously enjoyed experience. The sight, taste, smell, and even the texture of foods in the mouth are all part of remembered pleasurable experience and sometimes are the stimuli that cause one to eat after hunger is appeased.

Loss of appetite usually accompanies illness. Therefore, the amount and kind of food eaten as well as the amount of water and other liquids taken by the patient should be recorded for the doctor. Occasionally, sick people have strong cravings for certain foods or will develop enormous appetites.

Children may have the desire to eat unusual things such as dirt, plaster, paint, hair, or grass. This condition is called Pica. This craving may be a physical response to supply some body deficiency or it may be an emotional reaction to deep-seated problems. In any event, it is a fairly serious abnormality and should always be called to the attention to the doctor.

Weight

Continued los of weight in either adults or children in the absence of dieting is usually a sign that something is wrong. It may be caused by disease, disordered functions of the internal organs, emotional tension, or and insufficient amount or the wrong kind of food. A definite gain in weight may also indicate a change in the physical condition. Because nearly everyone loses weight in a severe illness, it is of special importance that nourishing foods be provided the ill person to protect the body from too great a weight loss.

Sleep

A person in bed all the time may not need as much sleep as when he is up and about, but sleep is nature’s way of resting the mind and the body and is essential in both sickness and health. Some of the body changes that occur during sleep are not entirely understood, but sleep comes primarily as a result of lessened activity of the nervous system. Breathing slow down and may be irregular; heart action is decrease, sometimes as much as 20 beats a minute, and is accompanied by a lowering of the blood pressure; muscles relax; and the energy requirements of the body are lessened. The amount of sleep needed varies with age. An infant will sleep from 18 to 20 hours a day, children from 12 to 14 hours, and adults from 7 to 9 hours. Old people sometimes sleep no more than 5 hours at night because they take cat naps during the day.

Because of the restorative nature of sleep, the number of hours a sick person sleeps should be recorded as accurately as possible. Too little sleep may be a result of discomfort or tension and should be noted. Information from the patient about his sleeping is not always reliable. When one is ill, a short period of wakefulness may seem much longer than it really is, especially at night when other in the household are asleep. The character of the seep should be observed: whether the patient is quiet or restless, sleeps for short periods of time and wakes often, or sleeps unbrokenly for several hours. Naps also should be noted, because the person who naps during the day may not sleep as long at night as he ordinarily would.

General Malaise

A feeling of vague general discomfort, weakness, and fatigue is known as malaise. It may be present at the beginning of an illness and usually accompanies convalescence following a serious illness. At the start of an illness, malaise may be accompanied by such symptoms as headache, sore throat, and fever. Infection will often increase the feeling of exhaustion, which may be the result of toxins produced in the body by the infectious microorganisms, for these poisons are more powerful than the body wastes accumulated during normal activity. Bed rest is essential when infection is present because fatigue lowers resistance to disease.

Another kind of physical fatigue occurs in the patient who is confined to bed for some time. Lack of exercise causes loss of muscle tone and strength, and it may take several days of activity before the feeling of weakness and fatigue disappears.

Children may show illness in much the same way as an adult or the onset of their illnesses may be entirely different. However, irritability, unwillingness to play, refusal of food, crying, and whining may be the child’s way of showing malaise. The wise mother learns to know her children, for each child will be different in the way he behaves when he is ill. Children are sensitive to suggestion, and the mother who is apprehensive and alarmed creates similar feelings in the child. Asking a child if he has a pain in his ear, for example, may give him the idea that he is supposed to answer yes, and the attention he receives may be so gratifying that he feigns earache. Here again, common sense and judgment are invaluable assets for parents as well as for the home nurse.

Fever

Feeling chilly alternating with feeling hot may mean that fever is present. The skin may be hot and dry. Usually some loss of appetite, considerable thirst, and general discomfort accompany fever.

Fever is a sing that something is out of order in the body, although sometimes a person may be ill but still be with out an elevation of temperature. A change from the normal body temperature has been used by doctors for years as a basis for judging whether a person is sick, for diagnosing and treating illness, and for noting the progress of the patient’s recovery from illness. Frequently, one of the first questions asked when illness occurs every family to own a clinical thermometer and to know how to use and care for it.

Usually the temperature is taken by mouth, although it may be taken in the rectum or in the axilla. For infants and very young children, for the unconscious, for very sick patients, and for those unable to keep the lips closed, either the rectal or the axillary method should be used.

Temperature should be taken:

Whenever a person complains of feeling ill or shows signs of illness.
During illness, once or twice a day, at the same time each day, usually in the morning and evening or whenever the doctor orders (Temperature may be taken as often as every 4 hours or only once a week, depending on the condition and age of the patient.)
Whenever there is a sudden change in the patient’s condition, such as a chill, restlessness, or pain.
Whenever there is headache, pain in the chest or the abdomen, sore throat, chill, vomiting, diarrhea, or skin rash.

Fever, in combination with the symptoms mentioned above, may mean the presence of serious illness or of conditions needing immediate attention. A person with a head cold or with a cough and who has a mouth temperature of more than 99.6 Fahrenheit should not go to work or to school but should remain a home away from others, preferably in bed. A person with an away from others, preferably in bed. A person with a fever, together with other symptoms of illness, needs medical care.

Unless the doctor has requested it, the patient should not be awakened to have his temperature taken. For accuracy, there must be a wait of not less that 15 minutes between the time a temperature is taken and the time the patient has had a hot or a cold bath, has taken hot or cold food or drink, or has been smoking, because temperature in the mouth under these conditions will not be the same as the actual body temperature. After at least another 15 minutes the temperature should be taken again to verify the accuracy of the first thermometer reading. A rectal temperature is not to be taken immediately after an enema or when the rectum is full of fecal matter.

Pulse and Respiration

The pulse rate, even of persons in good health, varies with the individual. Age and sex account for some of the wide variation. A child’s pulse rate, for example, is faster than that of an adult. The average rate for a man is about 70 beats per minute, while for a woman it may be as much as 90. The rate may increase for many reasons, such as fever,
exercise, eating, fright, emotional tension, and extreme heat or cold. It decreases when a person is resting or asleep or is emotionally depressed.

The pulse may be felt most easily where a large artery is near the surface; this may be at the wrist, at the ankle, at the throat, or at the temple. The inner side of the wrist above the thumb is the place most often used to count the pulse because it is usually the most convenient. The pulse should be counted after the patient has been resting quietly, or if the patient is a child, when he is asleep. A watch or a clock with a second hand is needed to count the pulse.

Respiration is usually faster if the patient has a fever. Because the rate of breathing can be voluntarily controlled, the patient should not know that his respirations are being counted. In addition to the rate or number of times the patient breathes each minute, the doctor will want to know anything unusual about the respiration, such as difficult or painful breathing.

Pain

Pain is an important symptom in illness and should never be disregarded. It is a warning that something is wrong. Because pain cannot be measured, the home nurse or the doctor must rely entirely on the patient’s description of its intensity. Some patients overemphasize minor pains, while others disregard severe ones. Some people have high pain thresholds and others have low ones, which mean that different people can tolerate different degrees of pain. The aged, for example, are much less sensitive to pain than younger people; therefore, when they complain of pain, the complaint has great significance. Older people quite often have some degree of discomfort at all times and are inclined to minimize pain. The doctor must draw hi own conclusions about its significance after considering other symptoms and using his personal knowledge of the patient’s behavior pattern. Frequently the alert home nurse has come to know the patient’s habitual responses to pain and is well able to judge their significance. The report to the doctor should include the location, onset, and duration of the pain; when the pain is most severe; whether it is relieved or increased by physical acts, such as eating or changing position, or by a new interest; and the patient’s description of the pain as dill or sharp, stabbing or throbbing, intermittent or continuous, slight or sever.

Pain in the abdomen or the stomach may be caused by improper eating or by food poisoning or it may be from appendicitis or some other acute and serious condition in the abdomen. Abdominal pain caused by poisoning from spoiled or contaminated food is commonly accompanied by nausea and vomiting and by diarrhea. If abdominal pain is not relieved promptly be rest and by withholding food, the patient should be seen by a doctor. Don’t give a laxative or enema. Do not apply heat. Abdominal pain accompanies so many serious conditions that it should always be reported to the doctor and the patient observed carefully.

Nausea and Vomiting

If nausea and vomiting are accompanied by severe cramps or abdominal pain, the doctor should be notified because the patient may have appendicitis, a bowel obstruction, or another serious illness. Vomiting, if caused by indigestion, tension, or mild food poisoning, usually brings its own relief. The color, general appearance, and amount of material vomited should be observed. If vomiting is continuous, severe, and accompanied by blood, either bright or dark red, or if the material has an offensive odor, a report should be made at once to the doctor and the vomitus saved for him to see.

Bowel Movements

In sickness the number and frequency of bowel movements and their color and consistency should be noted. The normal color of feces is brown or yellow and the consistency is somewhat soft. Changes in the consistency or in the color of the stool if continued for several movements or if accompanied by other symptoms should be noted and reported to the doctor. The stool should be saved for him to see. The doctor may order a laboratory examination of the stool to determine the cause of the illness. If the stool is found to be infectious it must be carefully disposed of to prevent the spread of the disease to other members of the family. The doctor will give instructions for its disposal.

Diarrhea, which is characterized by frequent watery or slimy stools, may be caused by an infection, by poisonous or undigested food, or by emotional strain. It is sometimes caused by a disease process in which there is irritation of the mucous membrane, as for example, colitis and cancer. In babies and small children, diarrhea is usually the result of improper feeding or of consuming unclean water, milk, or other food. Diarrhea is nature’s effort to remove the substances that do not agree with a person after they have passed from the stomach into the intestines. It may have serious results because it exhausts the patient and dehydrates his body tissues. Severe or persistent diarrhea should be reported to the doctor. Widespread epidemics of this illness have been prevented by prompt diagnosis of individual cases.

First relief measures for both children and adults in severe cases of diarrhea are to withhold food and to give only boiled water until a diagnosis can be made and treatment instituted. After the diarrhea has stopped, a liquid or a soft diet should be given until bowel movements are again normal. The patient should be kept quietly in bed until all symptoms have subsided.

Urinary Disturbances

The inability to urinate, pain or burning sensation when voiding, incontinence, the presence of blood in the urine, and too frequent urination are all critical symptoms and as such should be considered danger signals. The amount of urine, whether more or less than usual as well as any change from the usual amber color and any deposit of sediment after the urine stands should be carefully noted.