~Nephritis~ is one of the complications apt to develop when the kidneys are not sufficiently strong to carry on their own work and that generally done by the lungs. ~The Heart.~--Cardiac symptoms are also likely to develop during attacks of pneumonia and make the disease one to be dreaded and guarded against. ~The Diet.~--The dietetic treatment in pneumonia is like that used in acute infectious diseases, fevers in general, fluids constituting the form of diet and milk the chief food, as long as there is an elevation of temperature. TONSILLITIS ~The Heart.~--As in pneumonia, the development of cardiac symptoms must be guarded against. These symptoms may not develop at once but show later during or after convalescence. ~The Kidneys.~--Nephritis also develops in some patients and the treatment is directed as far as possible to prevent its developing into a chronic form. ~Dietetic Treatment~ is the same as used in acute infectious conditions, fevers of short duration, taking care to institute the diet for acute nephritis should the patient show evidences of this disease. PROBLEM Write a diet order for a tuberculous patient weighing 135 pounds, allowing 3000 calories and fifty per cent. of the protein to be derived from animal sources. FOOTNOTES: [104] The addition of cream to coffee produces acute indigestion in certain individuals, hence the nurse must be governed by this point in formulating the diet. [105] See "High Calorie Diet for Typhoid Fever," Chapter XIV. CHAPTER XVI DIETETIC TREATMENT BEFORE AND AFTER OPERATION PREOPERATIVE FEEDING The dietetic treatment which is essential before and after operations is deserving of attention here, since it constitutes one of the points so frequently overlooked or slighted. As a rule the treatment depends (1) upon the character of the disease for which surgical intervention is necessary, and (2) upon the general health and physical condition of the patient in question. ~Preparatory Treatment.~--In many cases it is found to be advisable to build up the patient before subjecting her to the shock of an operation, and the more serious the operation the more necessary this "building-up" process. The character of the disease also has much to do with the preliminary diet. In certain pathological conditions involving the gastro-intestinal tract, for example, the patient comes to the surgeon after medical treatment has failed to give relief and surgical intervention is necessary to save life. The body is found to be in a condition bordering on starvation, anemic and exhausted from insufficient nourishment. The functions of the blood-making organs have become out of gear, as it were, and the blood consequently is deficient in one or more of its essential elements. For such patients it is wise to attempt to reenforce and strengthen their bodies before operation, that they may have more endurance to withstand the shock which is more or less unavoidable.