BAG TECHNIQUE

BAG TECHNIQUE

OBJECTIVES:

After 8 hours of varied classroom activities, the Level 11 students will be able to:

1. define the following terms:

a. bag technique
b. plan of visit
c. home visit
d. family- nurse contact
e. public health bag
f. case load

2. give the purpose of the following:

a. bag technique
b. CHN bag
c. Home visiting

3. identify the following:

a. different types of family- nurse contact
b. case loads

4. formulate a sample plan visit

5. list the guidelines in using CHN bag

6. demonstrate beginning skills in:

a. performing bag technique
b. arranging contents of CHN












DEFINITON OF TERMS:

a. BAG TECHNIQUE
- a tool use of a public health bag through which the public health nurse, during his/ her home visit can perform nursing procedures with ease; knowing he/ she has with them their materials, it saves time & energy with the end view of rendering effective nursing care

b. PLAN OF VISIT
- an essential tool in achieving the best results in home visiting

c. HOME VISIT
- a professional face to face contact made by a public health nurse to the patient or the family to provide health care activities

d. FAMILY-NURSE CONTACT
- the within or behalf of the particular family & the nurse in achieving an important goal for the success of delivering nursing care
e. PUBLIC HEALTH BAG
- an essential & indispensible equipment for the public health nurse which he/she has to carry along he/ she goes home visiting
- contains basic medications which are needed for giving care

f. CASE LOAD
- number & kind of families a caregiver will handle at a given time


Purpose:

a. CHN Bag

 Serves as a first aid kit
 To work efficiently and swiftly during nursing procedures
 To conserve time and energy
 To minimize or prevent the spread of infection
 To render effective nursing care to clients and/ or members of the family during home visit

b. Bag Technique

 To minimize if not to prevent the spread of infection
 To work efficiently and rapidly during techniques
 For organization purposes


c. Home Visiting

 It provides necessary health care activities
 Impart health teachings to the family for maintenance of health
 To evaluate results of the outcomes of the nursing care given
 To know the health status of an individual or a family



DIFFERENT TYPE OF FAMILY- NURSE CONTACT:

Home Visit
- health caregiver visits a home in the community

Clinic Visit
- clients visit the health clinics to inquire or to seek health center consultation, check-ups or treatments of health problem visit

Industrial Clinic Visit
- nurses are hired by agencies or companies to do a medical assessment on their employees for pre- employment check-up and treatment on health problems

School Clinic Visit
- it’s where students seek health care services from their school
- most schools have clinic wherein the nurse is always in contact with the students who are prone to accidents


CONTENTS OF CHN BAG:

a. FRONT OF THE BAG (left to right)
- oral thermometer (facing down)
- rectal thermometer
- syringes & needles in a metal container

b. on the RIGHT SIDE OF THE BAG
- test tube & test tube holder
- medicine dropper
- match
- alcohol lamp & denatured alcohol

c. on the LEFT SIDE OF THE BAG (near to the front)
- medicine glass w/ suction inside
- baby weighing scale

d. BACK of the bag (left to right)
- betadine
- 70% alcohol
- hydrogen peroxide
- Lysol solution
- spirit of ammonia
- Benedict’s solution

e. on the CENTER OF THE BAG
- kidney basin
- cloth bag:
Kelly curve & Kelly straight
Umbilical scissors
Bandages
- cloth bag w/ sterile OS, cotton balls, cotton applicators
- hand towel
- soapdish & soap
- apron

f. on the TOP POCKET
- sterile gloves
- French 12 catheter
- French 8 catheter
- cord clamp
- paper waste bags
- plastic bags

g. TOP OF THE INNER COVER
- 5’- 8” paper soapdish lining
- 12 ½’ – 18 ½” paper lining
- 13 ½’– 19 ½” plastic lining
- 14’ – 20” paper lining- for the bottom
TYPES OF CASE LOAD:

1. morbid
- for the diagnosed/ undiagnosed diseases (eg. Tuberculosis)
2. antepartum
- for the pregnants
3. postpartum
-after the mother’s delivery, 6 mos. after
4. health supervision
- used for children under 6 years old & below
5. case finding
- this is without the diagnosis by doctors or physicians
6. geriatric
- for the olds, 65 years of age & above






SAMPLE PLAN OF VISIT
Name of Student: Dionne M. Perez Type of Case: Case Finding
Age: 17 Visit no.: 3
Address: Banilad, Mandaue City Date of Visit: June 30, 2009

General Objectives:
After 2 weeks of home visiting, the family will be able to acquire adequate knowledge, skills, and attitudes in the promotion of health, prevention of illness and management of common diseases.

Specific Objective:
After 45 minutes of nurse-client orientation, the nurse will be able to:

1. establish rapport with the student nurse
2. explain the purpose and importance of home visit
3. observe family’s behavior and surrounding
4. identify health related problems
5. plan appropriate nursing intervention from identified health problems
6. set another contact of visit



GUIDELINES IN USING THE CHN BAG

1. Perform handwashing as frequently as possible or if the situation calls for the help to minimize or avoid contamination of bag & its contents.

2. The CHN bag should contain all the necessary articles & equipment which may be used to answer emergency needs.


3. Contents of the bags should be protected from contact of different unsterilized object.

4. The arrangement of the contents of the bag should be the most convenient to the users to facilitate efficiency & so as to avoid confusion.

5. Bag technique should be performed in different ways depending upon the policies.

6. Bag should be placed in a clean & warm temperature.

7. Avoid shaking or swaying the bag when carrying it.

8. The bag should be thoroughly cleaned & disinfected after using esp. if there is a communicable case in the area.






GENERAL PRINCIPLES:

1. MICROBIOLOGY
- CHN bag and its content should be well protected from contact with any article in the home. Do medical handwashing as frequently as the situation calls
- Utensils & other materials should be sterilized

2. TIME & ENERGY
- time & effort should be budgeted wisely so that efficient plan of procedure can be achieved

3. PHARMACOLOGY
- CHN bag contains disinfectants, such as betadine which is used in cleaning wounds

4. PSYCHOLOGY
- bag technique shouldn’t overshadow but rather should show the effectiveness of the total care given to an individual or family

5. SOCIOLOGY
- nurse & family interaction should occur always during the procedure

6. PHYSICS
- avoid swinging the bag to prevent breaking of contents

URINE TESTING

URINE TESTING

OBJECTIVES:

1. define the following terms:

a urine
b urine testing
c hematuria
d pyuria
e dysuria
f anuria
g ketone bodies
h uric acid
i gestational diabetes

2. give the importance and purpose of urine testing

3. list the indications and contraindications

4. enumerate factors affecting urination

5. tabulate characteristics of normal and abnormal urine in their corresponding significance

6. state the different methods of urine collection

7. identify guideline principles involved in urine testing

8. explain guidelines in urine testing

9. demonstrate beginning skills in performing urine testing














I. Definition of Terms:

URINE
 waste product excreted by the kidney

URINE TESTING
 used to determine any abnormalities in the urine

HEMATURIA
 discharge of urine containing blood

PYURIA
 abnormal presence of pus in the urine

DYSURIA
 painful or difficulty in voiding

ANURIA
 voiding less than 100ml a day

KETONE BODIES
 are products of fat metabolism and appear in the urine

DIURETICS
 medicine which stimulates flow of urine

URIC ACID
 end product of purine metabolism
 acid in the urine

GESTATIONAL DIABETES
 a disorder characterized by an impaired ability to metabolize carbohydrate usually caused by a deficiency of insulin occurring in pregnancy


IMPORTANCE AND PURPOSE OF URINE TESTING

1. to determine any abnormalities in the urine
2. to monitor proper functioning of liver and kidney
3. to determine the presence
4. helps determine patient’s hydration status
5. to determine disorders of glucose metabolism
6. to determine the acidity and alkalinity if urine



INDICATIONS:
 urine testing is utilized for physical exam
 used for any suspected Urinary Tract Infection
 for pregnancy evaluation; to know whether the female is pregnant or not
 for felt pain during urination


CONTRAINDICATIONS:
 for patient who does not feel the urge to void
 those who has renal failure
 females who has an on-going menstruation
 patients who just had an operation in the genitals
 panuresis/ shy bladder patients-person who finds it difficult or impossible to urinate
when other people are around



FACTORS AFFECTING URINATION

1. Growth & Development
- a child is unable to control micturation, until the age of 18-24 mos.

2. Socio- Cultural
- the habits of micturation are no exception. North Americans expect toilet facilities to be private, where as Europeans accept less private communal facilities, as a way of life

3. Personal Habits
- some people follow complex routines before defecation. Usually fewer rituals precede urination. Privacy is the most essential condition for most people.

4. Muscle Tone
- weakness of abdominal & pelvic floor muscles impair bladder contraction & control of the external sphincter

5. Medication
- various medications influence the volume of urine. Diuretics prevent the reabsorption of water & certain electrolytes in the kidney tubules, resulting in urine.
- Examples:
Levadope & Pyridium- causes urine discoloration
Chlorothiazide & Hydrochlothiazide- causes the kidneys to get rid of unneeded water & salts from the body into the urine
Other diuretics:
furosemide- is a potent diuretic (water pill), in the kidneys, salt (composed
of sodium and chloride), water, and other small molecules
normally are filtered out of the blood and into the tubules of the
kidney. The filtered fluid ultimately becomes urine
triamterene- helps make more urine and to lose the extra water from your
body. This medicine is used to treat high blood pressure and
edema or swelling from excess water.

6. Fluid Intake
- increase in fluid intake, increase urination
- Example
Increased intake of water can be a factor for the frequency of urination


METHODS OF URINE COLLECTION
a. URINALYSIS
- analysis of the urine
- consist of screening for urinary infection, renal disease & diabetes Mellitus
- measures urine color, Ph, & specific gravity
- determines presence of glucose & blood in the urine
- performed by collecting a urine sample from the patient in a specimen cup. Usually only small amounts (10-15 ml's) may be required

b. MIDSTREAN SPECIMEN
- this is ideal for adults, and for children who are continent and can void their bladder on request

c. CLEAN- CATCH SPECIMEN
- this is collected by having the sterile container with lid removed easily available, so that the sample can be easily collected if the person voids

d. SPECIMENS FROM ABSORBENT PADS
- the pads are placed inside a clean nappy(diapers)and then checked every 10 minutes until wet (but not soiled). The urine is then aspirated with a
syringe


GUIDELINES IN URINE TESTING

 Nurse is responsible for instructing client abut urine collection or for obtaining a
sample urine from the client.
 know the voiding status of the patient
 provide fluids to drink 30 minutes before the collection
 Explanation to the short & careful documentation of the type of specimen, collection
site, date & time are the vital nursing interventions.
 the containers used for the urine collection must be clean.




PRINCIPLES INVOLVED IN URINE TESTING

1. ANATOMY
- the urinary is hallow, muscular & distensible organ that sits on the pelvic

2. MICROBIOLOGY
- the nurse must do the special precautions which are neede in the care of the incontinent patients to keep the skin dry & avoid infection

3. CHEMISTRY
- the use of Benedict’s solution to determine the volume of sugar present in the urine Ph of the urine which indicates the acid-based organic waste

4. PHARMACOLOGY
- diuretics are drugs that are used to increase urine output

5. PHYSICS
- specific gravity of urine is the relation it bears to the weight of water

6. PSYCHOLOGY
- frequent urination may be caused by excitement, anxiety or fear. The client must be relaxed

HOT & COLD APPLICATION

HEAT & COLD APPLICATION

Objectives:

After 4 hours of varied classroom activities the level II students will be able to:

1. define the following terms:

1.1 Hot Application 1.11 Aquathermia Pads

1.2 Cold Application 1.12 Electrical treating Pads

1.3 Aquathermia 1.13 Radiation

1.4 Cold chemical packs 1.14 Connection

1.5 Heat cradle 1.15 Conduction

1.6 Heat lamp

1.7 Ice bag

1.8 Ice collar

1.9 Counterirritants

1.10 Ice Gloves

2. state the importance of heat and cold application

3. give the indications and the contraindications of heat and cold application

4. identify the three (3) processes of heat transfer

5. cite factors affecting heat and cold application

6. enumerate the different methods of heat and cold transfer

7. discuss the physiological effects of heat and cold applications

8. list guidelines in heat and cold application

9. explain the scientific principles involved of heat and cold application

10. enumerate nursing responsibilities before during and after of heat and cold

application

1. Definition of terms

1.1 Heat application - applying of heat to the painful area of the body part to reduce pain.

1.2 Cold application - applying of cold to the painful area of the body part to reduce pain.

1.3 Aquathermia - water flow to treat with warm water.

1.4 Cold chemical packs - contain chemicals that released by stricking, kneading, or squeezing the packs which are used for the therapeutic program.

1.5 Heat cradle - is made of metal bands which have been soldered and shaped in the form of a “half moon”. It is used to apply dry heat to the extremities and affords a good way to help circulation in an extremity

1.6 Heat lamp - is an incandescent light bulb that is used for the principal purpose of creating heat rather than visible light.

1.7 Ice bag - is usually made of rubber or plastic and often has a cloth covering.

1.8 Ice collar - is a specialized type of ice bag, smaller than most ice bags and is used for the neck or the small areas of the body.

1.9 Counterirritants - are drugs which produce vasodilation in l ocal cutaneous tissues.

- an agent that induces local information in underlying or adjacent tissues.

1.10 Ice gloves - is used to protect the hands from extreme cold.

1.11 Aquathermic Pads - also known as aquamatic pad (K- Pad), is a rubber pad constructed with tubes containing water which is heated and maintained at a constant preset temperature by an electric control unit.

1.12 Electrical treating pads - is a method for application of dry heat locally. It is easy to use provides a constant and even heat, and is relatively safe if proper used.

1.13 Radiation - is the transfer of heat form the surface of one object to the surface of another without contact between the two objects, mostly in the form of infrared rays.

1.14 Convection - is the dispersion of heat by movement of liquid or gas

- transfer of heat by movement of liquid of gas

1.15 Conduction - is the transfer of heat from one molecule to a molecule of lower temperature with contact between molecules.

Importance of Heat and Cold Application

ü To relieve spasm

ü To soften exudates

ü To hasten healing

ü To warm a part of the body

ü To increase peristalsis

ü For comfort and relieve

Indications and Contraindications of Heat and Cold Application

INDICATIONS OF HEAT APPLICATION

• For the relief of swelling
• For the healing of wounds and removal of toxin
• Improves elimination of waste
• For increase body temperature
• For warmth, comfort and relief fatigue.

INDICATIONS OF COLD APPLICATION

• Relief of pain
• Controlling hemorrhage
• Reducing fever
• For comfort

CONTRAINDICATIONS OF HEAT APPLICATION

• Non-inflammatory edema
• Acutely inflamed areas
• Localized malignant tumor
• Skin Disorder causing redness of blisters
• Cutaneous injuries

CONTRAINDICATIONS OF COLD APPLICATION

• Open wounds
• Impaired circulation
• Allergy of hypersensitivity
• Lowered body temperature, shivering
• Presence of neuropathy

Precautions for the Uses of Heat and Cold Application

Ø Sensory Impairment

§ Persons with sensory impairments are unable to perceive that heat is damaging the tissues and are at risk for burns or they are unable to perceive discomfort from cold and are unable to prevent tissue injury.

Ø Impaired Mental Status

§ Confused persons and persons with an altered level of consciousness lack full awareness and are unable to cooperate during the application, making such a therapy unsafe for them.

Ø Impaired Circulation

§ Persons with peripheral vascular disease, diabetes, congestive heart failure lack the normal ability to dissipate heat via the blood circulation, which put them at risk for tissue damage.

Ø Low Heat Tolerance

§ Infants, children, and older clients tolerate temperature changed poorly. Precautions are needed to prevent burning.

Ø Open Wounds

• Tissues and an open wound are more sensitive to heat and cold.

The (3) Processes of Heat Transfer

1. Conductive Heat

§ Provided by direct application of heat or immersion in heated bath water

· Ex. Hot water bag, disposable hot and cold pack, aquathermic pad, and warm compress.

§ Heat is transferred directly to the skin and then to the underlying tissues

§ Relatively superficial

2. Conversive or Radiant Heat

§ Provided by a heat lamp

· Ex. Standard lamp, heat lamp, and heat cradle

3. Convective Heat

§ Easily applied by heating the surrounding air

§ Transfer of heat by conduction in a moving medium, such as fluid.

Factors Affecting Heat and Cold Application

1. The intensity of the temperature

2. Prior skin temperature

3. Rapidity of temperature

4. Duration of the application

5. Environmental temperature

6. Differences in temperature toleration level

7. Traumatic damage

8. Amount of body surface area

9. Generalized systematic responses

10. Age of patient

Methods of Heat Application and Cold Application

Heat Application

Ø Use of Hot Water Bag (bottle) 40° - 46° C/37 – 40°

Ø The Disposable Hot Pack 101° - 114° F

Ø The Aquamatic Pad (K-Pad) 40.5° C

Ø The Electric Heating Pad

Ø The Heat Cradle

Ø The Hip or Sitz Bath 40 – 43 °

Ø Warm Soak

Ø Heat Lamp

Cold Application

Ø The Ice Bag (Ice Collar) below 15° C

Ø Disposable Cold Pack

Ø Cold Compress

Ø Cold Soaks

Ø Alcohol or cold sponge bath

Physiological Effects of Heat Application and Cold Application

Ø Heat Application

1. Heat raises the temperature of the skin and underlying tissues, causing vasodilation.

2. Heat and vasodilation increase local cellular metabolism

3. Heat increases capillary permeability

4. Heat accelerates the inflammatory process by increasing both the action of phagocytic

cells that ingest microorganisms and other foreign material and the removal of the

waste products of infection.

5. Heat promotes muscle relaxation

6. Heat also makes the connective tissue more flexible

7. Heat to the abdomen decreases peristalsis

8. Heat relieves pain

Ø Cold Application

1. Cold decreases capillary permeability

2. Cold, like heat can reduced muscle spasm

3. Cold alters tissue sensitivity

4. Cold relieves pain, particularly which associated with muscle spasm

5. Prolonged exposure to cold results in impaired circulation

Guidelines in Heat and Cold Application

• Determine the client’s ability to tolerate the therapy

• Identify conditions that might constrain treatment.

(e.g., bleeding, circulatory impairment)

• Explain the application to the client

• Assess the skin area to which the heat or cold will be applied

• Ask the client to report any discomfort

• Examine the area to which the heat or cold was applied.

The Scientific Principles Involved of Heat and Cold Application

1. Anatomy and Physiology

v our blood vessels react to the application of Heat and Cold. Heat applications improves blood flow to an injured part.

2. Physics

v conduction, convention and radiation may transfer heat from one place to another.

3. Chemistry

v commercially prepared hot packs are activated by striking, kneading or squeezing the pack wherein chemicals are mixed and released heat.

4. Microbiology

v hand hygiene should be observed.

5. Sociology

v people differ on their degree of heat and cold toleration.

6. Psychology

v application of heat or cold on the skin gives therapeutic effects to the patient.

7. Safety and Security

v nurse must know the recommended temperatures in applying the heat and cold application to the client

Nursing Responsibilities

BEFORE:

• Refer the physician’s order
• Perform medical handwashing
• Ensure proper operation of equipment
• Explain steps of procedure and purpose to client

DURING:

• Ensure privacy
• Assist client in assuming comfortable position

AFTER:

• After the application, gather the materials used, dispose these appropriately and do after care.
• Perform medical handwashing
• Record the application compress, observations, solutions used, appearance of wound and any exudates, any statement of discomfort from the patient.