Cebu Doctors University Staff Nurse Requirements

Nurse's Notes

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NCM 101
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*RLE

1) SCRUBBING, GOWNING, GLOVING AND ARRANGING SURGICAL EQUIPMENT:


http://suikoden18.blogspot.com/2009/08/scrubbing-gowning-gloving-and-arranging.html




2)Hot Sitz Bath and Perilite Exposure:


http://suikoden18.blogspot.com/2009/08/hot-sitz-bath-and-perilite-exposure.html




3)HOT & COLD APPLICATION:


http://suikoden18.blogspot.com/2009/07/hot-cold-application.html




4) Admission, Labor Watch, Enema:


http://suikoden18.blogspot.com/2009/06/admission-labor-watch-enema.html





*THEORY

1) Responsible Parenthood:


http://suikoden18.blogspot.com/2009/06/responsible-parenthood-theory.html



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CHN/ Community Health Nursing
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*RLE

1) FIRST AID:


http://suikoden18.blogspot.com/2009/08/first-aid.html



2) CARDIOPULMONARY RESUSCITATION:


http://suikoden18.blogspot.com/2009/08/cardiopulmonary-resuscitation.html



3)BAG TECHNIQUE:


http://suikoden18.blogspot.com/2009/07/bag-technique.html




4)URINE TESTING:

http://suikoden18.blogspot.com/2009/07/urine-testing.html





*THEORY

1)N/A

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Hot Sitz Bath and Perilite Exposure

Hot Sitz Bath and Perilite Exposure

OBJECTIVES:

After 4 hours of varied teaching learning activities, the level II students will be able to:

1. Define the following terms:
hot sitz bath radiation
perilite exposure convection
heat application conduction
dry heat episiotomy
moist heat perineorrhaphy

2. State the importance of:
hot sitz bath
perilite exposure

3. Discuss the process of heat transfer

4. Cite the physiological responses to heat

5. List variables that influences the effectiveness of heat

6. Discuss the therapeutic effect of administering the following:
hot sitz bath
perilite exposure

7. Enumerate the disadvantages/advantages of:
moist heat
dry heat

8. Identify the indications and contraindications of:
hot sitz bath
perilite exposure

9. Give the principles involved in:
hot sitz bath
perilite exposure

10. State the nursing responsibilities in:
hot sitz bath
perilite exposure

11. Explain the guidelines in:
hot sitz bath
perilite exposure

12. Demonstrate beginning skills in:
hot sitz bath
perilite exposure
Definition of Terms:

 Hot Sitz bath
– is a procedure whereby patient’s perineal area is submerged to water with solutions depending on the needs of the client.
- a bath in which only the pelvic area is immersed in warm fluid.

 Perilite Exposure
– application of dry heat to perineal area in order to provide comfort and increase blood circulation and hasten wound healing by means of perineal lamp.
- 20-50 centimeters or 18-24 inches away from the body to be exposed.

 Heat application
– is a process of applying heat through radiation and convection

 Dry heat
– requires a higher temperature and a longer period of heating

 Moist heat
- utilizes hot air that is heavily laden with water vapor

 Radiation
- is the transfer of heat through electromagnetic radiation. For any body the reflectivity depends on the wavelength distribution of incoming electromagnetic radiation and therefore the temperature of the source of the radiation.

 Convection
- is a combination of conduction and the transfer of thermal energy by fluid circulation or movement of the hot particles in bulk to cooler areas in a material medium.

 Conduction
- is the transfer of thermal energy from a region of higher temperature to a region of lower temperature through direct molecular communication within a medium or between mediums in direct physical contact without a flow of the material medium

 Episiotomy
– refers to an incision through the perineum that allows for less pressure on the fetal head during delivery and prevents lacerations of the perineum.

 Episiorraphy
-operation for repairing the episiotomy

 Perineorrhaphy
– Operation for repairing laceration of perineum usually following delivery






IMPORTANCE OF PERILITE EXPOSURE

1. Relief of pain and muscular spasm
2. -provides comfort by relief pain
3. -it relaxes muscles and capillaries making pain tolerable
4. Increases blood circulation
5. Hastens wound healing following an episiotomy repair
6. -increases circulation of blood
7. -increases supply of oxygen and nutrient which promotes wound healing
8. Reduces edema and soreness
9. -it releases dry heat and thus help reduce edema and soreness
10. -alleviated by relax muscles and capillaries


IMPORTANCE OF HOT SITZ
1. Reduces soreness
2. Relieves swelling and pain
3. brought about vasodilatations, increases circulation, increases capillary permeability, venous congestion of injured tissues
4. Hastens healing
5. increases blood circulation and with all its nutrients
6. Promotes comfort and relaxation
7. Cleanses and reduces inflammation of perineal, and areas of client
8. the presence of moist softens exudates and other hardened substances
9. Stimulates voiding
10. it stimulates voiding and elimination by peristaltic activity


Process of Heat transfer

 CONDUCTION
-the transfer of heat from a warm object to cooler object or vice versa by contact
-is the transfer of thermal energy from a region of higher temperature to a region of lower temperature through direct molecular communication within a medium or between mediums in direct physical contact without a flow of the material medium.

 CONVECTION
-heat transfer by means of movement of liquid or gas
-is a combination of conduction and the transfer of thermal energy by fluid circulation or movement of the hot particles in bulk to cooler areas in a material medium.
-this transfer occurs in sitz bath.

 RADIATION
- is the transfer of heat through electromagnetic radiation. For any body the reflectivity depends on the wavelength distribution of incoming electromagnetic radiation and therefore the temperature of the source of the radiation.






Physiological responses to heat

• Vasodilation or increase in capillary surfaces
- Heat causes vasodilation and increases blood flow to the affected area bringing oxygen nutrients, antibodies and leukocytes.
• Increase in capillary permeability
- heat increases capillary permeability which allows extra cellular fluid and substances such as plasma proteins to pass through the capillary walls and may result in edema or an increase in pre-existing edema.
• Increase blood flow
• Increase cell metabolism
• Increase supply of nutrients
• Increase removal of wastes
• Relaxation of muscles
• Softening of exudates
• Increase peristalsis
• Increase body temperature


Variables that influences the effectiveness of heat

• Individual tolerance
– tolerance is influenced to some degree by age, condition of skin, the
condition of nervous and circulatory system. Young children, elderly clients, diabetic clients and individuals with circulatory or sensory alterations have low tolerance for heat.
- The very young and the very old generally have the lowest tolerance. Persons
- who have neurosensory impairments may have a high tolerance, but the risk of injury is greater.

• General conditions of patient
– shock or metabolic disorders such as diabetes increase the hazard of tissue
damage. Impaired perception because of individual’s level of
consciousness, medications and mental impairment may make it difficult
to determine patient’s response to end potential damage from application
of heat.

• Intactness of the skin
- Injured skin areas are more sensitive to temperature variations

• Whether the heat is moist or dry
– moist heat penetrates more deeply than dry heat because water is a good
conductor of heat. Application of moist heat should be at a lower
temperature than applications of dry heat.

• Size of skin area to be treated
– the greater the body area to be treated, the lower the temperature should be.

• Environmental temperature
– in warm or in humid environment, heat can’t be dissipated through
evaporation to some degrees that it can dry or cool circumstances.

• Length of Exposure
- People feel hot applications most while the temperature is changing. After a period of time, tolerance increases.

• Location of area to be covered
– individual tolerance to heat depends on the number of heat receptors in body
parts. In general, the inner aspects of thighs and arms, the axillae, the chest
and the abdomen are more sensitive to heat than the other parts of the body.

- The back of the hand and foot are not very temperature sensitive. In contrast the inner aspect of the wrist and forearm, the neck, and the perineal area are temperature sensitive.


Therapeutic uses of heat

SEDATIVE EFFECT
- Heat is generally considered to produce a relaxation effect and increase the contractility of muscles.

RELIEVES PAIN
- Heat relieves pain by promoting muscle relaxation, increasing circulation, and promoting psychological
relaxation and a feeling of comfort.

REDUCES CONTRACTURE AND INCREASES RANGE OF MOTION
- This effect is achieved by allowing greater distention of muscles and connective tissue.

REDUCES JOINT STIFFNESS
- Heat reduces joint stiffness by decreasing viscosity of synovial fluid and increasing tissue distensibility.

PROVIDES WARMTH AND COMFORT


Dry Heat
ADVANTAGES:
Less risks of burns to skin than moist application
Retains temperature longer since not influenced by evaporation
Doesn’t cause maceration

DISADVANTAGES:
increases body fluid loss through sweating
Doesn’t penetrate deep into tissues
Increase drying of skin

Moist Heat
ADVANTAGES:
Moist application reduces drying of skin and softens wound exudates
Warm moist doesn’t promote sweating and insensible fluid loss
Moist heat penetrates deeply into tissue layers
Moist compresses comfort well to area of body being treated


DISADVANTAGES:
Moist heat creates a greater risk for burns to skin since moisture conducts heat
Prolonged exposure can cause maceration of skin
Moist heat will cool rapidly because of moist evaporation

-invisible heat rays readily seen in use of infrared; ultraviolet rays or electromagnetic waves






Hot Sitz Bath
INDICATIONS:
• Post partum mother with episiotomy wound
• With rectal or vaginal surgery


CONTRAINDICATIONS:
• Patients with hemorrhage
• Mother who had undergone CS delivery
• Multiparity with wound
• Before 24 hours of postpartum


Perilite Exposure
INDICATIONS:
• Patients who have undergone rectal or perineal surgery
• Post-partum patients with episiotomy wounds
• Patients having vaginal inflammation or bladder spasm
• Patients with painful or local irritation from hemorrhoids

CONTRAINDICATIONS:
• Patients with cardiovascular condition
• Presence of cyst or malignancy in the area
• Patients with open wounds with hemorrhage
• Patients with burns or fracture at the lower limbs
• Heat lamps are contraindicated in pressure ulcer care

Principles involved in Hot Sitz Bath

• HUMAN ANATOMY AND PHYSIOLOGY
- client who has episiotomy has painful hemorrhoids or vaginal inflammation may benefit from immersing pelvic area in warm water.
- -sitz bath requires special attention to body posture ad limb position to avoid cramping and constriction of circulation from pressure against edge of tub.

• MICROBIOLOGY
- application of heat to open wounds that may rupture may demand a sterile technique instruments should be sterile.

- application is for thermal effect and there’s no wound, materials should be kept cleaned to reduce transfer of bacteria.

• PSYCHOLOGY
• nurse should explain first the procedure to patient to gain cooperation
• nurse should know if patient is sensitive to warmness.

• CHEMISTRY
• heat generally is the speed of chemical reaction since metabolism is largely caused by chemical reactions, the application of heat speeds metabolism either locally or generally
• the solvent action of water maybe increased by adding other substances like soap.
• Magnesium Sulfate is used for preterm labor or commonly used for treatment of preeclampsia to slow uterine contractions.

• PHYSICS

• heat is most valuable and most versatile physical for treatment.
• water has also great capacity, it undergoes change more slowly than other substances. It also gives off more heat.
• heat maybe transferred from 1 place to another by conduction, convection and radiation.
• application of heat & cold employs physical agents; heat, light & electricity.










Principles involved in Perilite Exposure

• HUMAN ANATOMY AND PHYSIOLOGY
• through blood vessels and nerves, skin and connections they make with nerves and blood vessels of body, practically all parts of body maybe influenced by application of heat to skin.

• MICROBIOLOGY
• the application of heat to open wounds of lesions may rapture demands a sterile technique.

• BODY MECHANICS
• position of mother is dorsal recumbent with legs and knees flexed to allow proper exposure of area to be treated

• PHYSICS
• application of heat employs physical agents: heat, water and light. Heat maybe transferred from one place to another by radiation (perilite exposure) and convection (hot sitz) bath.

• PSYCHOLOGY
• nurse explains purpose of treatment in order to gain cooperation.

• SOCIOLOGY
• the patient needs to cooperate with nurse in order for treatment to be effective and to add patients early recovery.




Nursing Responsibilities in Hot Sitz Bath
BEFORE:
• Check doctors order for desired solution and body part to be soaked at a desired temperature.
• Assess the condition of skin of the body to be immersed
• Explain procedure to the patient.
• Nurse must have adequate knowledge about the procedure.

DURING:
• Check the temperature of water in a sitz bath before the patient enters into the tub (40.5-43.5 degrees Celsius)
• Assist the patient into the tub and position her properly
• Wrap a blanket around patients shoulder
• Don’t leave the patient alone unless certain that its safe to do so

AFTER:
• Assist the patient in going out of the tub after the procedure is complete
• Assist patient to her bed, its best for her to be down, avoid draft until normal condition and circulation returns
• Monitor patients general response to therapy and properly document significant data
• Do after care



Nursing Responsibilities in Perilite Exposure
BEFORE:
• Check the client’s condition before applying the procedure.
• Check all electrical equipment for defects or try to switch it on and off.
• Always handle equipment with dry hands
• Check physicians order for each area to be treated and duration of therapy
• Do perineal flushing

DURING:
• Position client comfortably with only area where heat is to be applied
• Position lamp at a safe distance from where it is to be applied
• Inspect skin and see to it that its clean and dry before applying heat
• Place bed cover over lamp but not allowing bed sheet to touch the light bulb
• Check skin every 5 minutes interval throughout duration of procedure
• Monitor any untoward response
• Perilite exposure should be given 24 hours after delivery
• Place bed cover after pulling lamp and provide privacy
• Position lamp at 18-24 inches away from the body part to be exposed.

AFTER:
• Assist the client
• Do after care
• Monitor clients response
• Do recording; record on patients chart
- time when it started
- patients reaction
- condition of perineum
- inspect sutures and episiotomy after procedure
• Inspect condition of part being treated



Guidelines for Hot Sitz Bath
• Check physicians order
• Nurse should explain the procedure
• Nurse should observe privacy
• Place towel at the patients back
• Adequate support during birth is essential
• She should make sure the perineal region is immersed
• Check temperature of water for hotness
• Observe patient closely for 15-20 minutes
• If client feels like fainting, discontinue procedure
• Monitor vital signs before and after



Guidelines for Perilite Exposure
• Explain procedure
• Instruct patient to do perineal flushing before perilite exposure
• Check the equipment for any defects
• Handle equipment with dry hands especially when your about to plug it.
• Provide privacy during procedure
• During exposure, keep lamp 20-50 cm away from perineum.
• Heat lamp should be left in place for 15 minutes then removed
• Perilite exposure process should be repeated 3-4 times a day
• Washable parts of lamp should be wiped with antiseptic solutions before its returned to storage area or used with another patient.

CARDIOPULMONARY RESUSCITATION

CARDIOPULMONARY RESUSCITATION
Objectives:
After 5 hours of classroom discussion, the level II students will be able to:

1. define the following terms:
1.1 airway
1.2 artificial respiration
1.3 basic life support
1.4 breathing
1.5 circulation
1.6 cardiopulmonary resuscitation
1.7 crackles
1.8 external cardiac compression
1.9 rales
1.10 respiratory arrest
1.11 cardiac arrest
1.12 rhonchi
1.13 ventilation
1.14 wheezing

2. explain the principles related to CPR
2.1 basic principles of breathing and circulation

2. identify the ABC of basic life support

3. discuss the following according to its causes and signs and symptoms
3.1 cardiac arrest
3.2 respiratory arrest

4. cite the importance of performing cardiopulmonary resuscitation

5. enumerate the different methods of artificial resuscitation

6. explain the following:
6.1 indications of cardiopulmonary resuscitation
6.2 contraindications of cardiopulmonary resuscitation
6.3 techniques for external chest compression

7. show table of comparison for adult, child and infant

8. determine ways to check for effectiveness in doing cardiopulmonary
resuscitation


9. list guidelines in performing cardiopulmonary resuscitation

11. demonstrate beginning skills in performing the following
11.1 one man rescue
11.2 two man rescue
11.3 artificial resuscitation
11.4 Heimlich maneuver
11.5 back blows
11.6 jaw thrust maneuver






























Definition of Terms
1. AIRWAY- protection and maintenance of patient airway including the use of airway adjuncts such as an oral or nasal airway.

2. ARTIFICIAL RESPIRATORY- a procedure used to restore or maintain respiration in
a person who has stopped breathing

3. BASIC LIFE SUPPORT- refers to first aid given if victim’s breathing or heart stops

4. BREATHING- actual flow of air through respiration, natural or artificial
respiration often assisted by emergency oxygen

5. CIRCULATION- the movement of blood through beating of the heart or the
emergency measure of CPR

6. CARDIOPULMONARY RESUSCITATION- is a combination of oral resuscitation
which supplies oxygen to the lungs and external cardiac massage, which is
intended to reestablish cardiac function and blood circulation

7. CRACKLES- fine, short, interrupted crackling sounds

8. EXTERNAL CARDIAC COMPRESSION- is delivered on the midline of the lower half
of the sternum.

9. RALES- abnormal or pathological respiratory sounds heard on auscultation

10.RESPIRATORY ARREST- sudden cessation of breathing

11.CARDIAC ARREST- the absence of pulse and respiration

12.RHONCHI- coarse rattling sounds that are produced by secretions on the
bronchial tubes

13.VENTILATION- is also used to refer to the movement of air in and out of the
lungs

14.WHEEZING- continuous, high-pitched, musical squeak or whistling sound
occurring on expiration and sometimes on inspiration when air moves through a
narrowed or partially obstructed airway




Basic Principles of Breathing and Circulation

1. Air that enters the lungs contains 21% of oxygen and the trace carbon dioxide. Air that is exhaled from the lungs contains 16% oxygen and 4% carbon dioxide.
2. The right side of the heart pumps blood to the lungs when blood picks up oxygen and releases carbon dioxide.
3. The oxygenated blood then returns to the left side of the heart, where it will be pumped to the different tissue of the body.
4. In the body tissues, the blood releases oxygen and takes up carbon dioxide after which it flows back to the right side of the heart.
5. All body tissues require oxygen, but brain requires more than any other tissue.
6. When breathing and circulation stops, this is called Clinical Death ; 0-4 min.(brain damage is most not likely) , 4-6 min. (brain damage is probable)
7. When the brain has been deprived of oxygenated blood for a period of 6 min. or more, an irreversible damage will probably occur. This is called Biological Death: over 10 min. (brain damage is certain).
8. Both respiration and circulation is/are required to maintain life.
9. When respiratory breathing stops, the pulse and circulation may continue for sometime, this condition is known as Respiratory Arrest.
10. When circulation stops, the pulse disappears and breathing stops at the same time or soon thereafter. This is called Cardiac Arrest


The ABC’s of Basic Life Support

Airway

The protection and maintenance of patient airway includes the use of airway adjuncts such as an oral or nasal airway

If the airway is not obstructed by food or vomitus, turn the person on his or her back, remove pillows, and then open the airway by one of the following methods:

Head tilt-chin lift
1. Position yourself at the person’s head.
2. Place your fingers behind the angle of the jaw and lift upward and forward.
3. Place the other hand on the person’s forehead and press downward to tilt the head backward and help lift the chin.

Head tilt-neck lift method
1.Tilt the head back by lifting behind the neck with one hand while
pushing down on the forehead with the other.

Jaw thrust method
1.Place your fingers (both hands) behind the angle of the jaw.
2.Lift the jaw forward.

Breathing

It is the actual flow of air through respiration, natural or artificial respiration, often assisted by emergency oxygen.

To check for breathing:
1. Look for the person's chest to rise and fall.
2. Listen for the sounds of inhaled or exhaled air.
3. Feel for exhaled air by putting your cheek near the person's mouth.

Circulation

It is the movement of blood through the beating of the heart or the emergency measure of CPR

To assess for circulation:
1. Feel for a pulse, by gently pressing two fingers (do not use the thumb) on the person's neck between the Adam's apple, or voice box, and the muscle on the side of the neck. This is the carotid pulse.
2. To feel for an infant's pulse, press two fingers (do not use the thumb) on the inside of a baby's arm between the armpit and elbow.

If the pulse is absent is absent or questionable, start external heart compression.


Cardiac arrest

Cardiac arrest is the sudden, abrupt loss of heart function. The victim may or may not have diagnosed heart disease. It's also called sudden cardiac arrest or unexpected cardiac arrest. Sudden death (also called sudden cardiac death) occurs within minutes after symptoms appear.


Causes:
 Coronary heart disease.
 Ventricular tachycardia
Sudden death occur when the electrical impulses in the diseased heart
become rapid
 Ventricular fibrillation
Sudden death occur when the electrical impulses in the diseased heart
become chaotic.
 Arrhythmia
Irregular heart rhythm (arrhythmia) causes the heart to suddenly stop beating.
 Bradycardia
Some cardiac arrests are due to extreme slowing of the heart.

Signs and symptoms:

 victim loses consciousness
 victim stops normal breathing
 victim loses pulse
 victim loses blood pressure

Respiratory arrest

A premorbid condition in which there is insufficient transfer of oxygen and/or inadequate elimination of carbon dioxide resulting in the patient’s inability to respire.

Causes:
 airway obstruction
 drowning
 stroke
 smoke inhalation
 drug overdose
 trauma
 infection
 allergy
 Decreased respiratory effort due to CNS impairment may result from drug overdose, carbon monoxide or cyanide poisoning, CNS infection, brain stem infarct or hemorrhage, and intracranial hypertension (due to mass lesions, hydrocephalus, or brain injury).

Signs and symptoms:
 patient is unable to breathe spontaneously
 the patient is unconscious, or about to become so
 cyanotic (unless markedly anemic)
 Before complete respiratory arrest, patients with intact neurologic function may be agitated, confused, and struggling to breathe.
 Tachycardia and diaphoresis are present; there may be intercostal or sternoclavicular retractions.
 Patients with CNS impairment or respiratory muscle weakness exhibit feeble, gasping, or irregular respirations and paradoxical breathing movements.
 Patients with a foreign body in the airway may choke and point to their necks.
 Infants, especially if less than 3 months old, may develop acute apnea without warning, secondary to overwhelming infection, metabolic disorders, or respiratory fatigue.

Importance of Performing Cardiopulmonary Resuscitation

 The earlier CPR is given to a person in cardiopulmonary arrest (no breathing, no heartbeat), the greater the chance of a successful resuscitation
 Keep the blood oxygenated flowing to the heart and brain
 Gives the victim a chance for survival
 It restores minimal breathing until EMS units arrive
 It maintains blood circulation
 It is highly recommended in emergency situations regarding cardiopulmonary arrest
 To provide artificial breathing and circulation until patients recovers or brought to the hospitals

The Different Methods of Artificial Respiration
A. Mouth to Mouth
 Artificial ventilation with the mouth to mouth technique is a quick, effective way to provide oxygen to the patient.
 The exhaled air contains enough oxygen to supply the patient’s needs.
 To perform the mouth to mouth ventilation, the air way must be open. To open the airway, perform the head tilt-chin lift or jaw thrust maneuver.
 If there is no spontaneous breathing, start artificial ventilation
1. Pinch the nose closed with your thumb and index.
2. Take a deep breath and seat your lips around the patient’s mouth (creating an airtight seal) and give two ventilations (1 ½ to 2 seconds per breath).
3. If the patient still does not respond, continue mouth to mouth ventilations at the rate of 10-12 ventilations per minute or one breathe every 5 seconds.
4. Periodically, check the pupils for reaction to light: constriction is a sign of adequate oxygenation.








B. Mouth to Nose
 Mouth to nose ventilation is effective when the patient’s mouth cannot be opened (lockjaw), extensive facial or dental injuries occur, or an airtight seal of the mouth cannot be achieved.
 To administer this technique:
1. Tilt the head back with one hand on the patient’s forehead and use the other hand to lift the jaw (as in the head tilt chin lift maneuver).
2. Close the victim’s mouth. Take a deep breath, seal your lips around the patient’s nose and give to ventilations.
3. Allow the victim’s lungs to deflate passively after each ventilation
4. If the victim does not respond, then you must fully inflate the lungs at the rate 10-12 ventilations per minute or one breath every 5 seconds until the victim can breathe spontaneously.






C. Mouth to Stoma
 Breathing is done when the person has had a laryngectomy
 A stoma is a permanent opening in the neck through which the person breathes following removal of the larynx.
 To perform this technique:
1. Cover the casualty’s mouth with your hand, take a deep breath, and seal your mouth over the stoma.
2. Breathe slowly, using the procedures for mouth-to-mouth breathing.
3. Do not tilt the head back. (In some situations, a person may breathe through the stoma as well as his nose and mouth. If the casualty’s chest does not rise, cover his mouth and nose, and continue breathing through the stoma)

D. Mouth to Mask

 The mouth-to-mask breathing device includes a transparent mask with a one-way valve mouth piece.
 The one-way valve directs the rescuers breathe into the patient’s airway while diverting the patient’s exhaled air away from the rescuer.
 Some devices have an oxygen adaptor that permits the administration of supplemental oxygen.









A. Mouth to Mouth and Nose

 It is usually done for infants and children whose mouths are very small for effective mouth-to-mouth resuscitation. Artificial respiration is inflated and maintained in essentially the same manner.
 Used on infants (usually up to around 1 year old), as this forms the most effective seal

D. Bag Valve Mask

 This is a simple device manually operated by the rescuer, which involves squeezing a bag in order to expel air into the patient.














Indications of Cardiopulmonary Resuscitation

 Unconsciousness
 Breathing is absent
 No pulse detected
 Patients who have cardiopulmonary arrest
 Death-like appearance and pallor
 Dilated fixed pupils
 Children choking

Contraindications of Cardiopulmonary Resuscitation

 Person with massive facial injuries
 An adult who is definitely known to have no effective circulation
 Broken ribs
 Patient known to be in terminal state of fatal disease
 Should never be performed on a healthy person

Techniques for External Chest Compression

 Lay down the casualty’s flat and kneel beside him. Locate the point where the ribcage meets in the middle. Position your middle finger here and your index finger on the bone above. Place the heel of your other hand on the breastbone just above your fingers.

 Cover the hand with the heels of your other hand and then lock your fingers together.

 Kneel up right so that your shoulders one directly over the casualty’s breastbone and your arms are straight. Press down about 4.5 cm (11/2 – 2 in.) then release the pressure but do not remove your hand. Complete is compressions at a rest of about 80 per minute


 When you reach 30, move back to the casualty’s head, tilt the chin back and give him two breaths of mouth-to-mouth resuscitation.

 Continue giving 30 heart compressions followed by two breaths of mouth-to-mouth if there is any sigh that the circulation is returning, check organ for a carotid pulse.

 If you can feel pulse again, stop pumping immediately. Continue mouth-to-mouth until natural breathing is restored.


Table for Comparison for Adult, Child and Infant

Infant
0-1 yr. old Child
1-8 yrs. old Adult
Older than 8 yrs. old
Compression
Landmarking
Method Just below the nipple line at the center of the chest Center
of the chest or at the sternum Center
of the chest or at the sternum
Compression with… 2 to 3 fingers Heel of 1 hand 2 hands
Depth of compression ½ to 1 inch 1 to1½ inches 1½ inches
Compression
Rate About 100/minute
About 100/minute About 100/minute

Chest Compression
to Ventilation Ratio
30:2
30:2
30:2


Rescue Breaths
1 breath/3 seconds
20 breaths per minute 1 breath/2seconds
15 breaths per minute

1 breath/5 seconds
12 breaths per minute


Ways to Check for Effectiveness in Doing Cardiopulmonary Resuscitation

 Bilateral chest movement is visible
 Bilateral breath sounds are heard on auscultation
 The heart rate increases to a regular 100 beats per minute or more
 There is an improvement in skin color and peripheral pulses
 A comparative change from dilated, fixed pupils to smaller or reactive pupils
 Movement of extremities

Termination of Basic Life Support

Cardiopulmonary resuscitation is stopped as a result of a number of circumstances:
 Restoration of spontaneous respiration and/or circulation.
Signs of restored ventilation or circulation include:
a. struggling movements (although these may not necessarily
mean the person has recovered)
b. decreased pupil size
c. improved color
d. return of or stronger pulse
e. return of systemic blood pressure
 Complete rescuer exhaustion
When a rescuer is entirely alone (seldom the case in health care
facilities), he/she may not be able to continue because of exhaustion.
When this occurs, people often feel very guilty. These people may need support to deal with their feelings and to realize that they did the best they could.
 Medical decision to stop CPR
On occasion, a medical decision is made to stop CPR without going
on to advanced life support techniques, owing to the nature of the
person’s underlying disease or condition. Sometimes these decisions are
made “in advance” by the person and significant others in consultation
with the physician.

Guidelines in Performing CPR

 When finding a person that appears to be unconscious, the most important thing to do is to establish if person is unconscious or sleeping.
This prevents injury of person who has not suffered cardiac or
respiratory arrest.
 The person must be flat on his/her back on a hard surface for external compression to be effective
If the person sinks into a soft mattress instead of a hard surface,
It is difficult to evaluate the amount of sternal depression obtained
during each compression, and thus the amount of intrathoracic pressure
generated. The person must be horizontal because blood pressure
generated by external compression is not adequate to pump blood up to
the head when the person is seated.
 Correct hand placement
Compression landmarking: center of the chest for adult/children and just below the nipple line at the center of the chest for infants. If it is too low, the xiphoid process may be fractured and driven into the upper abdomen, damaging the liver, spleen, or stomach. If it is too high, compressions are not effective because the upper sternum is rigid and very difficult to depress.
 In chest compressions use a 30:2 compression to ventilation ratio for all ages
Frequent interruption of chest compressions significantly decreases blood flow in the circulatory system. A higher number of consecutive compressions will improve blood flow to the brain and other internal organs.
Additionally, a universal compression to ventilation ratio of 30:2 will be easier to remember for the lay provider.
 If normal breathing is not present take a normal breath and deliver two ventilations. Ventilations should be 1 second in length for all ages.
Taking a normal before ventilations will prevent a rescuer from becoming light-headed. It will also help prevent complications of air getting in the stomach during ventilations. Current evidence gives greater importance on the need for quality compressions during CPR. Shortening ventilation time will result in a shorter interruption between compressions.
 In opening an Airway, use a head tilt-chin lift in all situations
The head tilt-chin lift is more effective. In the unlikely event that a neck injury is present, an open airway is still a higher priority of care.
 Never interrupt CPR for more than five seconds.
Do not wait for special equipments, such as oxygen, self-inflating resuscitation bags, endotracheal tubes, defribrillators, or suction equipment. Continue CPR technique until special treatment arrives and is ready to be used by trained personnel. Failure to perform legal this vital function may be for the victim
 Push hard, push fast, allow full chest recoil, and minimize interruptions in chest compressions.
This coordinated effort provides better maintenance of blood flow than the interrupted pattern if cardiac compression necessary when there is only one rescuer.

Beginning Skills

Cardiopulmonary Resuscitation on an Adult (One Rescuer)

Procedure Rationale
1. Assume rescuer’s position. Allows performance of rescue breathing and chest compressions without moving knees.
2. Determine the patient’s level of consciousness: Tap or gently shake patient while shouting, “Hey, hey are you okay?” Prevents injury of person who has not suffered cardiac or respiratory arrest.
3. Call for help or activate EMS
(Emergency Medical System) Activated mechanism for additional personnel.
4. Place patient in a supine position on a firm surface. Kneel at the level of the patient’s shoulder. Firm surface provides maximum compression and proper positioning It facilitates external compression of heart. Heart is compressed between sternum and a hard surface.
5. Open the airway.
a. Head tilt and chin lift maneuver.
Place one hand on the patient’s forehead and apply firm back pressure to tilt the head back. Then place the fingers of the other hand on the underside of the chin an lift it up to bring the jaw forward and the teeth almost to occlusion. Maneuver is more effective in opening airway than previously recommended head-tilt/neck-lift.

Removes tongue or epiglottis as airway obstruction.
Breathing
Determine presence or absence of spontaneous breathing.
1. Place cheek over patient’s mouth and nose while observing the rise and fall of the chest. Listen for air escaping during exhalation, and feel for the flow. Determines return of respiratory and need to continue CPR.
2. Perform rescue breathing (mouth to mouth). While keeping the airway open, pinch the nostrils with the thumb and index finger of the hand that is placed on the forehead. Take a deep breath and open mouth wide and give two full breaths (1-1½ seconds each breath). Take a breath after each ventilation. Pinching of nose shut allows maximum ventilation with no escape of air through nostrils.

In most adults, volume is 800 ml and is sufficient to make chest rise. Excess of air volume and fast inspiratory rates can cause pharyngeal pressures that exceed esophageal opening pressures, allowing air to enter stomach and resulting in gastric distention, thereby increasing risk of vomiting.
3. If the initial ventilation is successful, reposition the patient’s head and repeat the mouth to mouth breathing. Ensures that artificial respiration enters lungs.
Circulation
Determine pulselessness
1. While maintaining head tilt with one hand on the forehead, palpate the carotid pulse with the other hand. In the absence of the carotid pulse, start external chest compressions. Carotid artery is large, centrally located, and ordinarily readily accessible. A 5 to 10 second pulse is needed to adequately assess for pulselessness. Performing external cardiac compressions on victims who has pulse may result in serious medical complications.
External Chest Compressions
Consist of serial, rhythmic application of pressure over the lower half of the sternum.
1. Kneel as close to side of patient’s head as possible. Trace ribcage with the left finger towards the xiphoid process. Kneeling facilitates proper position.

Results in maximal compression of heart between sternum and vertebrae. If compression over xiphoid process, liver can be lacerated.
2. Place the heel of the left hand on the sternum just above two fingers from the xiphoid process. The heel of the right hand is placed on top of the left keeping fingers of both hands raised. Reduces risk of rib fracture during compression.

Interlocking the fingers helps keep them off the victim’s ribs, where pressure may cause fractures of the ribs.
3. While keeping your arms straight elbows locked and shoulders positioned directly over your hands, quickly and forcefully depress the lower half of the patient’s sternum straight down 1½-2 inches. Thrust of each compression is straight down on the sternum.

Faster rate increases blood flow with increased blood for to brain and heart.
4. Release the external chest compression completely and allow chest to return to its normal position after each compression. The time allowed for release must be equal the time required for compression. Do not lift hands off the chest or change position. Frequent interruption of chest compression significantly decreases blood flow in the circulatory systems.
5. For one rescuer, do 30 compressions at a rate of 80-100/min and then perform 2 ventilations. A higher number of consecutive compressions will improve blood flow ti the brain and other internal organs.
6. For CPR performed by 2 rescuers, the compression rate is 20-100/min. The compression-ventilation ration is 5:1 Promotes adequate cardiac output.

Faster rate allows pause for ventilation.
7. While resuscitation proceeds, simultaneous efforts are made to obtain and use resuscitation equipment for better management of situation and to provide definitive care. Resuscitation equipments increase survival rates.

Continuation of compression/ventilation rate is necessary to sustain life


Cardiopulmonary Resuscitation of an Adult (Two Rescuers)

Procedure Rationale
1. Rescuer who will ventilate initiates airway assessments. Sequence continues as for one rescuer. Assessment determines need for CPR
2. After pulselessness is determined, first rescuer states, “No pulse.” This indicates clearly to second rescuer to initiate compression sequence.
3. Compressor gets into position, locates anatomic landmarks and begins chest compressions. Correct ratio of compressions to ventilations is 5:1 with a compression rate of 80 to 100 per minute. Stop compressing for each ventilation. Continue for a minimum of 5 cycles The rate of 10 to 15 regularly spaced breaths per minute is considered necessary to supply the victim with sufficient oxygen to maintain cell integrity.
4. Compressor calls for switch when fatigued and gives clear signal. Compressor completes fifth compression, and ventilator completes ventilation after fifth compression. Rescuers switch simultaneously. The person who becomes ventilator does a 5-second pulse check, “No pulse” (if absent) and ventilates once. Person who becomes compressor then begins compressions at 5:1 ratio. It is important to carry out CPR without interruption and adequate flow of oxygenated blood to maintain cell integrity.

Heimlich Maneuver

Procedure Rationale
1. Assess victim. Ask, “Are you choking?” Determine if victim can speak or cough. Inability to speak or cough indicates that airway is obstructed.
2. If victim is obstructed, initiate abdominal thrust (Heimlich maneuver):
a. Stand behind victim.
b. Wrap arms around victim’s chest
c. Make a fist with one hand with thumb outside of fist. Place thumb side of fist against victim’s abdomen above navel and well below the xiphoid process.
d. Grasp fist with the other hand, and press inward and upward with quick, firm thrusts.
e. Continue distinct thrusts until foreign object is expelled or victim becomes unconscious. Firm abdominal thrusts force exhalation of air through the victim’s airway and aid in dislodging obstruction.


Chest thrust

Chest thrusts are to be administered only to women in advanced stages of pregnancy and markedly obese persons who cannot receive the Heimlich maneuver.
Procedure Rationale
1. Determine if the person can speak or cough
2. Call for help
3. Stand behind the person’s with your arms
under the person’s armpits and circling the
person’s chest.
4. Place the thumb side of the fist on the middle
of the breast bone, not on the xiphoid
process.
5. Grab the fist with the other hand and deliver a
quick backward thrust.
6. Exert four quick backward thrusts.
Inability to speak or cough indicates that airway is obstructed.

Chest thrusts force exhalation of air through the victim’s airway and aid in dislodging obstruction.

Back Blows

Procedure Rationale
1. Put the baby facedown on your forearm so the baby's head is lower than his or her chest.
2. Support the baby's head in your palm, against your thigh. Don't cover the baby's mouth or twist his or her neck.
3. Use the heel of one hand to give up to 5 back slaps between the baby's shoulder blades. When back blows are delivered to an infant placed in the head down position, gravity facilitates the moment of the foreign object from the airway toward the mouth.

Jaw Thrust Maneuver

Procedure Rationale
1. Kneel near the top of the patient’s head.
2. Grasp the angles of the patient’s lower jaw
3. Lift the patient’s lower jaw with both hands, one on each side.


This will displace the mandible (jawbone) forward while tilting the head backward.

The jaw-trust technique without head tilt is considered the safest approach to opening the airway of patients with suspected neck injuries because it usually can be done without extending the neck.










One-rescuer CPR














Heimlich Maneuver




Back Blows




















Chest Thrust





Jaw thrust maneuver

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.