2/23/14

Transport Mechanism of Electrolyte

1. Osmosis
2. Diffusion
3. Active transport (Na and K pumb)
4. Filtration
5. Phagocytosis
6. Pincytosis

Substances are transported between cellular and extracellular fluids between biological membranes. These transport mechanisms are mentioned above.

Osmolarity – refers to the concentration of active particles per unit of solution. Two opposing forces exist with in the vascular compartment. These are:

1. Hydrostatic pressure of the blood which forces fluid out through semi permeable membrane
2. Osmotic pressure of the blood protein (colloid osmotic pressure) – which is pulling or holding force opposing the flow of fluid across the vascular membrane

When blood enter the arteriol and the capillaries hydrostatic pressure is greater than osmotic pressure and fluid filters out of the vessels. The movement of fluid out of the vessel is facilitated also by negative hydrostatic pressure – sucking fluid from plasma and the osmotic pressure in the interistissual space.

The result of the force that promotes the movement of fluid through the capillary is the sum of positive out ward pressure from within the capillaries and the negative hydrostatic pressure and the osmotic pressure in the interstissual spaces. E.g. Intracapillary hydrostatic pressure (ICHP), plasma osmotic pressure (POP). Negative
interstissual hydrostatic pressure (Int.-H.P) Interstissual Osmotic Pressure (Int.O.P)

At arterial end of capillaries, there is outward force =
CHP – POP + Int.H.P – Int.O.P
30 - 28 + 6 – (-5.3) = 13.3

At the venous end: POP – CHP + Int.H.P – Int.O.P
28 – 10 + 6 – (-5.3)
= 6.7

In extracellular fluid the principal osmotic forces are exerted by sodium and chlorine ions. Potasium, magnesium and phosphorous are mainly responsible for osmotic pressure within the cells.

Effect of osmosis as applied to different extracellular solute concentration will give isotonic, hyper tonic and hypotonic solution.

When all contributions to osmolality are summed the total serum osmolality ranges from 275 mosm/kg to 290 mOsm/kg.

Solutions can be categorized according to how their osmolality compared with that of extracellular fluids. When the osmolality is the same as extracellular fluid, a solution is lebelled isoltonic. Such a solution remains within extracellular compartment. One third is distributed to the vascular space and two thirds to the interstissual space.

A fluid with a lower or higher osmolality is lebelled hypotonic or hypertonic respectively. Hypotonic fluids are distributed in proportion of 1/3 to the extracellular compartment and ⅔ of intracellular compartment. They are associated with cell swelling. When hypertonic fluids are added to the vascular space, the extracellular
osmolality becomes greater than that of intracellular fluid. As a result water moves from the intracellular to extracellular compartment and cells shrink.
Read More

Electrolyte Composition of the Fluid

Electrically charged particles act as a conductor of electrical current in the solution. E.g. NaCl > Na+ + Cl-

Intracellular fluid and extra cellular fluid are separated by cell membrane, which is semi permeable. Body fluid composed of water, electrolyte, and non-electrolyte. The difference is maintained by the cells, which actively reject certain electrolytes, and retain others. E.g. Na+ is reach higher in concentration in extra cellular fluid. The difference is maintained by cellular action referred as sodium pump, which reject sodium from the cells. The major ions of cellular fluid in order of their quantity are:

ICF   ECF
K+ 141 M Eg/L 4 M. Eg/L
Mg++ 58 M Eg/L 2 M. Eg/L
Po4++ 75 M Eg/L 10 M. Eg/L
Na+ 10 M Eg/L 142 M. Eg/L
Cl+ 4 M Eg/L 103 M. Eg/L

Read More

Distribution of Body Water in Adult

Body water is contained with in two major physiological reservoirs (compartments).

1. Intracellular fluid % about 40% of body weight (25 liter)

2. Extra cellular fluid 􀀅 about 20% of body weight (20 liters) in which:
a) 5 liter in intra vassal
b) 15 liter interstissual – tissue space the space between blood and the cells. A part from this the extra cellular fluid contains other fluids, which are usually negligible, considering their concentration in the body. These are CSF, ocular fluid, cynovial fluid, pleural fluid, and pericardial fluid, peritoneal fluid.

Water Balance
Normal body water is in a dynamic state. There is constant loss and constant replacement. i.e., intake is equal to output.


Read More

Fluid, electrolyte and Acid base balance

Fluid & Electrolyte Balance - Normal body function depends on a relatively constant volume of water and definite concentration of chemical compounds (electrolyte).

Water – is the most essential nutrient of life. 60-65% of the body weight is water and no physiology can function without it.

Electrolyte – is a compound that dissociate in a solution to break up in to separate electrically charged particles (ions) – cation, anions

Read More

Helping the client into Wheelchair or Chair Procedure

Supplies and Equipment
- Wheelchair
- Slippers or shoes (non-skid soles)
- Robe
- Transfer self (optional)

Procedure
1. Wash your hands
2. Explain the procedure to the patient
3. Position the wheelchair next to the bed or at 450 angles to the bed. Lock the wheel brakes and remove the food rests or move them to the “up” position.

4. Prepare to move the client:
a. Assist the client with patting on robe and slippers.
b. Obtain help from another person if the client is immobile, heavy, or connected to multiple pieces of equipment.

5. Raise the head of the bed so that the client is in the sitting position.
6. Assist the client to sit on the side of the bed
a. Support the head and neck with one arm.
b. Use your other arm to move the client’s leg over the side of the bed.
c. Allow the client’s feet to rest on the floor.
d. Maintain the client in this position for a short-time

7. Prepare to raise the client to a standing position
a. Apply a transfer belt if necessary.
b. Spread the client’s feet and brace your knees against client’s knees.
c. Place your arms around client’s waist.

8. Use the rocking motion of your legs to assist the client to stand. The client may use his or her hands to help push upward from bed.
9. Pivot the client in to position immediately in front of the wheelchair. Encourage the client to use armrests for support while you lower him or her in to chair.
10. Reposition foot rests; secure the client in a chair with a reminder device if needed. Cover the client with a blanket. Provide the nurse call button.
11. Wash your hands.
12. Check on the client frequently. Document the transfer and the client’s response.

Study questions
• State the principle underlying proper body mechanics and relate a nursing consideration.
• State the purposes of range of motion exercise.
• Identify principles related to safe movement of clients in and out of bed.
• Demonstrate the ability to move a partially mobile client safely from bed to chair and back.
• Demonstrate the ability to teach each of the crutch walking gaits to a client.
• Mention different positions used for various examination and treatment.
Read More

Teaching up stairs and down stairs ambulation with crutches procedure

Equipment
- Properly fitted crutches
- Regular, hard soled streed shoes
- Safety belt, if needed

Procedure
1. Explain the rational of the procedure to the client.
2. Apply safety belt if client is unsteady or requires support.
3. Demonstrate the procedure using a three-point gait.

Going Down Stairs
a. Start with weight on uninjured leg and crutches on the same level.
b. Put crutches on the first step
c. Put weight on the crutch handles and transfers unaffected extremity to the step where crutches are placed.
d. Repeat until the client understands the procedure

Going Upstairs
a. Start with the crutches and unaffected extremity on the same level.
b. Put weight on the crutch handles and lift the unaffected extremity on the first step of the stairs.
c. Put weight on the unaffected extremity and lift other extremity and the crutches to the step.
d. Repeat until client understands the procedure.

4. Help the client practice
5. Make sure that the client has adequate balance. Be ready to assist if necessary.
6. Assess the client’s progress, and correct any mistakes as they occur.
7. Document the following points:
- Time and distance of ambulation on crutches
- Balance
- Problems noted with technique
- Remedial teaching
- Client’s perception on the procedure
Read More

Teaching Swing To Gait and Swing through Gait Procedure

Equipment
1. Properly fitted crutches
2. Regular, hard soled street shoes

Procedure
1. Explain the rationale for the procedure the client.
a. These gaits are usually performed when the client’s lower extremities are paralyzed.
b. The client may use braces.

2. Demonstrate the crutch-foot sequences to the client
a. Move both crutches forward
b. Swing to gait: left and swing the body to the crutches
c. Swing through gait: left and swing the body past the crutches
d. Bring crutches informed of the body and repeat.

3. Help client practice the gait

4. Assess the client’s progress and correct any mistakes as they occur.

Read More

Two Point Gait Teaching

Two Point Gait
Procedure
1. Explain the procedure to the client.
a. This procedure is a rapid version of the four point gait
b. This gait requires more balance than the four gait

2. Demonstrate the crutch-foot sequence to the client.
a. Advance the right foot and left crutch simultaneously
b. Advance the left foot and the right crutch simultaneously

3. Help the client practice the gait.

4. Assess the client’s progress, and correct any mistakes as they occur.

Read More

Three Point Gait Teaching

Three Point Gait
The Equipment is Similar with Four Gait

Procedure
1. Explain the rationale of the procedure
a. The gait can be performed when the client can bear little or no weight on one leg or when the client has only one leg.
b. This gait is fairly rapid and requires strong appear extremities and good balance.

2. Demonstrate the crutch-foot sequence to the client.
a. Two crutches support the weaker extremities
b. Balance weight on the crutches
c. Move both crutches and affected leg forward
d. Move unaffected leg forward

3. Assess the client’s progress, and correct any mistakes as they occur.

4. Remain with client until cutch safety is ensured.
Read More

Four Point Gait Teaching

Four Point Gait Walking
Equipment
- Properly fitted crutches
- Regular, hard soled street shoes
- Safety belt, if needed

Procedure
1. Explain the rationale for the procedure to the client
a. The gait is rather slow but very stable
b. The gait can be performed when the client can move and bear weight on each leg.

2. Demonstrate the crutch foot sequence to the client.
a. Move the right crutch
b. Move the left foot
c. Move the left crutch
d. Move the right foot

3. Help the client practice the gait. Be ready to help with balance if necessary.

4. Assess client’s progress, and correct mistakes as they occur.
Read More

Crutch Walking Assesment

Crutches: - are walking aids made of wood or metal in the form of a shaft. They reach from the ground to the client’s axillae.

Application of Nursing Process

Assessment
- Assess physical ability to use crutches and strength of the client’s arm back, and leg muscle.
- Observe client’s ability to balance self.
- Note any unilateral or unusual weakness or dizziness.
- Assess which gait is appropriate for client.
- Assess client’s understanding of crutch-waking technique.

Planning/Objective
- To improve client’s ability to ambulate when he/she has lower extremity injury.
- To increase muscle strength, especially in arms and legs.
- To increase feeling of well-being when client can ambulate.
- To promote joint mobility.

Implementation/Procedure
- Teaching muscle- strengthening exercises
- Measuring client for crutches
- Teaching crutch walking: Four-point gait, Three-point gait, two-point gait.
- Teaching Swing-To-Gait and Swing-Through Gait
- Teaching upstairs and downstairs ambulation with crutches.

Evaluation/Expected Outcomes
- Client’s ability to ambulate is improved.
- Muscle strength of client’s arms and legs is improved
- Client experiences a feeling of well-being.
Teaching Techniques of Crutch Walking
Read More

Client Positioning for Examination and Treatment

Horizontal Recumbent Position
1. Horizontal Recumbent Position
This position is required for most of the physical examinations. The client lies on the back with the legs extended. The arms are placed, folded on the chest, or along side the body. One small pillow may be used. Cover the client with bath blanket for privacy. Caution: This position may be uncomfortable for a person with a back problem

Dorsal recumbent position
2. Dorsal recumbent position
used for variety of examinations and procedures. The client lies on the back, with the knees flexed and the soles of the feet flat on the bed. Cover the client with a sheet or a bath blanket folded once across the chest. The second sheet should be cross wise over the client thighs and legs. Wrap the lower ends of this sheet around the client’s legs and feet. Fold the sheet so the genital area is easily exposed. Keep the client covered as much as possible

Prone Position
3. Prone Position
is used to examine the spine and back. The client lies on the abdomen with head turned to the side for comfort. The arms are held above the head or along side the body. Cover the client with a bath blanket for privacy. Caution: Unconscious clients, pregnant women, clients with abdominal incisions, and clients with breathing difficulties cannot lie in this position.

Sims’ Position
4. Sims’ Position:
This position is used for rectal examination. The client rests on the left side, usually with a small pillow under the head. The right knee is flexed against the abdomen, the left knee is flexed slightly, the left arm is behind the body, and the right arm is in a comfortable position. Cover the client with a bath blanket.
Caution: The client with leg injuries or arthritis often cannot assume this position

Fowler’s Position
5. Fowler’s Position:
this position is used to promote drainage or to make breathing easier. Adjust the head rest to the desired height, and raise the bed section (Gatch bed) under the client’s knees. Place a rolled pillow between the client’s feet and use the foot of the bed as a brace, if desired. Caution: Observe for signs of dizziness or faintness when you raise the head of the bed.

Knee-chest Position
6. Knee-chest Position:
is used for rectal and vaginal examinations and as treatment to bring the uterus into normal position. The client is on the knees with the chest resting on the bed and the elbow rested on the bed, or with the arms above the head, the client’s head is turned to the side. The thighs are straight up and down, and the lower legs are flat on the bed. Caution: The client may become dizzy or faint and fall. Do not leave the client alone.

Dorsal Lithotomy Position
7. Dorsal Lithotomy Position:
is used for examination of pelvic organs. It is similar to dorsal recumbent position, except that the client’s legs are well separated and the knees are a cutely flexed. The nurse will usually place the client’s feet in stirrups. Keep the client covered as much as possible for privacy.
Read More

Body Positioning

Positioning client in various positions is done for diagnostic and therapeutic purposes. Some of the reasons include promoting comfort, restoring body function, preventing deformities, relieving pressure, preventing muscle strain, restoring proper respiration and circulation and giving nursing treatment.

Guideline for Positioning the Client

Positioning the Client for Comfort
♦ Maintain functional client body alignment. (Alignment is similar whether the client is standing or in bed.)
♦ Maintain client safety.
♦ Reassure the client to promote comfort and cooperation.
♦ Properly handle the client’s body to prevent pain or injury.
♦ Follow proper body mechanics.
♦ Obtain assistance, if needed to move heavy or immobile clients.
♦ Follow specific orders.
♦ Do not use special devices (e.g. Splints, traction) unless ordered client positioning for examination and treatment.

Read More

Controlling Postural Hypotension

• Sleep with the head of the bed elevated (8-12 inches).
This makes the person’s position change on rising less
severe.
• Avoid sudden changes of position. Arise from bed in
three steps:
♦ Sit on the side of the bed with legs dangling for 1 minute
♦ Stand with core holding on to the edge or the bed or another non mobile object for 1 minute
♦ Sit up in the bed for one minute

Gradual change in position stimulates renin, kidney enzyme that has a role in regulating BP and which prevents a dramatic drop in BP

• Balance is maintained with minimal effort when the base
•f support is enlarged in the direction in which the movement will occur
• Contracting muscles before moving an object lessens the energy required to move it
• The synchronized use of as many large muscles groups as possible during an activity increases overall strength and prevents muscle fatigue and injury
• The closer the line of gravity to the center of the base of support, the greater the stability
• The greater the friction against the surface beneath an object the greater the force required moving the object. (Pulling creates less friction than pushing)
• The heavier the object, the greater the force needed to move the object
• Moving an object along a level surface required less energy than moving an object up an inclined surface or lifting it against gravity
• Continuous muscle exertion can result in muscle stretch and injury
Read More

Performing Passive ROM Exercises/Steps

1. Wash hands

2. Explain the procedure to the client

3. Adjust the bed to a comfortable height. Select one side of the bed to begin PROM exercises.

4. Uncover only the limb to be exercised.

5. Support all joints during exercise activity.

6. Use slow, gentle movements when performing exercises. Repeat each exercise three times. Stop if the client complains of pain or discomfort.

7. Begin exercise with the client’s neck and work down ward.

8. Flex, extend and rotate the client’s neck. Support his or her head with your hands.

9. Exercise the client’s shoulder and elbow
a. Support the client’s elbow with one hand and grasp the client’s wrist with your other hand.
b. Raise the client’s arm from the side to above the head.
c. Perform internal rotation by moving the client’s arm across his or her chest.
d. Externally rotate the client’s shoulder by moving the arm away from the client.
e. Flex and extend the client’s elbow.

10. Perform all exercises on the client’s wrist and fingers
a. Flex and extend the wrist.
b. Abduct and adduct the wrist.
c. Rotate and pronate the wrist.
d. Flex and extend the client’s fingers.
e. Abduct and aduct the fingers.
f. Rotate the thumb.

11. Exercise the client’s hip and leg.
a. Flex and extend the hip and knee while supporting the leg.
b. Abduct and adduct the hip by moving the client’s straightened leg toward you and then back to median position.
c. Perform internal and external rotation of the hip joint by turning the leg inward and then outward.

12. Perform exercises on ankle and foot
a. Dorsiflex and plantar flex the foot
b. Abduct and adduct the toes
c. Evert and invert the foot

13. Move to the other side of the bed and repeat exercise.

14. Position and cover the client. Return the bed to low position.

15. Wash your hands.

16. Document completion of PROM exercise.
Read More

Joint Mobility and Range of Motion

Every body joint has a specific but limited opening and closing motion that is called its range of motion (ROM). The limit of the joint’s range is between the points of resistance at which the joint will neither open nor close any further. Generally all people have a similar ROM for their major joints.

Passive Range of Motion
If a client is unable to move, the nurse helps by performing passive range of motion (PROM) exercise.
Read More

Turning the Patient to a Side lying Position

Supplies and Equipment
- Pillows
- Side rails
- Cotton blanket or towels, rolled for support

Procedure/Steps
1. Wash your hands
2. Explain the procedure to the client
3. Adjust the bed to a comfortable height
4. Lower the client’s head to as flat a position as he or she can tolerate, and lower the side rail.
5. Move the client to the far side of the bed. Raise the side rail.
6. Ask the client to reach for the side rail
7. Assume a broad stance, tensing your abdominal and gluteal muscles. Roll the client toward you.
8. Position the client’s legs comfortably.
(a) Flex his or her lower knee and hip slightly.
(b) Bring his or her upper leg for ward and place a pillow between legs.

9. Adjust the client’s arms
(a) Shift his or her lower shoulder to ward you slightly
(b) Support his or her upper arm on a pillow

10. Wedge a pillow behind the client’s back. Use rolled blankets or towels as needed for support.
11. Lower the bed, elevate the head of the bed as the client can tolerate, and raise the side rail.
12. Wash your hands.

Read More

Moving and Positioning Clients

Moving and positioning promote comfort, restore body function, prevent deformities, relieving pressure, prevent muscle strain, and stimulate proper respiration and circulation.

Purpose:
• To increase muscle strength and social mobility
• To prevent some potential problems of immobility
• To stimulate circulation
• To increase the patient sense of independence and selfesteem
• To assist a patient who is unable to move by himself
• To prevent fatigue and injury
• To maintain good body alignment

Practice Guideline
- Maintain functional client body alignment. (Alignment is similar whether client is standing or in bed.)
- Maintain client safety.
- Reassure the client to promote comfort and cooperation.
- Properly handle the client’s body to prevent pain or injury.
- Follow proper body mechanics.
- Obtain assistance, if needed, to move heavy or immobile clients.
- Follow specific physician orders.
- Do not use special devices (e.g. splints, traction unless ordered)
Read More

Body Alignment

When lifting, walking, or per forming any activity, proper body alignment is essential to maintain balance. When a person’s body is in correct alignment, all the muscles work together for the safest and most efficient movement, without muscle strain. Stretching the body as tall as possible produces proper alignment. This can be accomplished through proper posture. When standing, the weight is slightly forward and is supported on the out side part of the feet. Again the head is erect, the back is straight, and the abdomen is in (remember that the client in bed should be in approximately the same position as if he/she were standing).

Positioning the client:
Encouraging clients to move in bed, get out of bed, or walk serves several positive purposes. Prolonged immobility can cause a number of disorders, among which are pressure ulcer, constipation, and muscle weakness, pneumonia and joint deformities. By assisting clients to maintain or regain mobility, you promote self-care practices and help to prevent deformities.
Read More

Line of Gravity

Draw an imaginary vertical (up and down) line through the top of the head, the center of gravity, and the base of support. This becomes the line of gravity, or the gravity plane. This is the direction of gravitational pull (from the top of the head to the feet).

For highest efficiency, this line should be straight from the top of the head to the base of support, with equal weight on each side. Therefore, if a person stands with the back straight and the head erect, the line of gravity will be approximately through the center of the body, and proper body mechanics will be in place.
Read More

Base of Support

A person’s feet provide the base of support. The wider the base of support, the more stable the object with in limits. The feet are spread side wise when lifting, to give side-to side stability.

One foot is placed slightly in front of the other for back-to-front stability. The weight is distributed evenly between both feet. The knees are flexed slightly to absorb jolts. The feet are moved to turn the object being moved.
Read More

Center of Gravity

The person’s center of gravity located in the pelvic area. This means that approximately half the body weight is distributed above this area, half below it, when thinking of the body divided horizontally.

In addition, half the body weight is to each side, when thinking the body divided vertically. When lifting an object, bend at knees and hips, and keep the back straight. By doing so, the center of gravity remains over the feet, giving extra stability. It is thus easier to maintain balance.
Read More

Basic Principles of body mechanism

1. It is easier to pull, push, or roll an object than to lift it. The movement should be smooth and continuous, rather than jerky.

2. Often less energy or force is required to keep an object moving than it is to start and stop it.

3. It takes less effort to lift an object if the nurse works as close to it as possible. Use the strong leg and arm muscles as much as possible. Use back muscles, which are not as strong, as little as possible. Avoid reaching.

4. The nurse rocks backward or forward on the feet and with his or her body as a force for pulling or pushing. Principles under lying proper body mechanics involve three major factors: center of gravity, base of support, and line of gravity.

Read More

Body Mechanics and Mobility

Learning Objectives:
At the end of this chapter the learner will be able to:
• State the principle underlying proper body mechanics and relate a nursing consideration.
• State the purposes of range of motion exercise.
• Identify principles related to safe movement of clients in and out of bed.
• Demonstrate the ability to move a partially mobile client safely from bed to chair and back.
• Demonstrate the ability to teach each of the crutch walking gaits to a client.
• Mention different positions used for various examination and treatment.

Key Terminology
Body alignment        Dorsal lithotomy
Prone
Base of support       Foot drop
Protective device
Body mechanics        Fowler’s position
Recumbent
Center of gravity     Gait
Rotation
Contracture           Gaitbelt
Transfer belt
Centrolateral         Line of gravity
Sim’s position
Dangling              Paralysis
Supnation

Acronyms
AROM
PROM
ROM

Body Mechanics:
is the effort; coordinated, and safe use of the body to produce motion and maintain balance during activity.

Proper Body Mechanics
Use of safest and most efficient methods of moving and lifting is called body mechanics. This means applying mechanical principles of movements to the human body.

Basic Principles of Body Mechanics
The laws of physics govern all movements. From these laws we derive the general principles of body mechanics.
Read More

Local Application of Cold and Heat

Application of Cold
• Has systemic and local effect
• Can be applied to the body in two ways
1. Moist
2. Dry

Purpose: (Indication)
• To reduce body to during high fever and hyper pyrexia or sun stroke
• To relieve local pain
• To reduce subcutaneous bleeding e.g. in sprain and contusion
• To control bleeding e.g. epistaxis
• To relieve headache
• To provide comfort to a patient in extreme hot weather if desired

1. Moist Cold
• Cold compress
• A cloth (padded gauze) is immersed in cold water and applied in area where we get large superficial vessels E.g. axilla and groin
• Change the cloth when it becomes warm
• Applied for 15-20 min

2. Dry Cold (Ice Bag)
• Ice kept in a bag
• Covered with cloth and applied on an area
• Temperature <150 C

Application of Heat
Purpose
• To relieve stasis of blood
• To increase absorption of inflammatory products
• To relieve stiffness of muscle and muscle pain
• To relieve pain and swelling of a localized inflammation boil or carbuncle – sometimes increases edema, increases capillary permeability
• To increase blood circulation
• To promote suppuration
• To relieve distention and congestion
• To provide warmth to the body

Methods
1. Dry Heat
• Using hot water bottle (bags)
• After contact of the body with moisture of water vapors temperature >46 oC
• 52 oC for normal adults
• 40.5 – 46oC for debilitated or unconscious patient’s and child < 2 yrs
• 2/3 of the bag should be filled with water
• Expel the remaining air and secure the top
• Dry the bag and hold it upside down to test for leakage
• Wrap it in a towel or cover and place it on the body part
• Maximum effect occurs in 20-30 min
• Remove after 30-45 minutes

2. Moist Heat
1. Hot compress: a wash cloth immersed in hot water of temperature 40-46oc and change the site of washcloth frequently
Complication
• Paralysis
• Numbness
• Loss of sensation – fear of burn

2. Sitz bath
Sitz Bath (hit bath)
It is used to sock the client's pelvic area
• A clients sits in a special tub or a bowel
• The area from the mid things to the iliac crests or umbilicus - increases circulation to the perineum (when the legs are also immersed blood circulation to the perineum or pelvic area decrease)
• Temperature of water – 40-43 oc (105-110 o F) – unless the patient is unable to tolerate the temperature

Purpose:
• To relieve pain in post operative rectal condition
• Smoothen irritated skin (perineum)
• Facilitates wound healing (after episiotomy)
• To release the bladder in case of urinary retention

If it is going to be given in the tub – fill ½ the tube with water and add the ordered medication In a bowel – fill 2/3 of it with water – add the ordered medication and dilute The medication to Rx the perineum in KMNO4 sol. 250 mg KMNO4 in 500 ml of water The duration of the bath is generally 15-20 minutes (20-25)
depending on the client’s health. Help the client to dry. NB. Great care has to be taken to prevent heat/cold burns when applying heat or cold especially to elderly.

Study questions:
1. Mention the two purposes of the heat application.
2. Describe the mechanism of action of heat application to effect its purposes.
3. What is tepid sponge?
4. What is the common medicine used in sitiz bath?
5. What is the average duration of time the patient is soaked in sitiz bath?
Read More

Tepid Sponging

Definition: sponging of the skin with alcohol or cool water.

Purpose: to lower body temperature (fever)
Tepid (Lukewarm) water + alcohol
3 parts water: 1 part alcohol

The temperature of the water is 32 c (below body temperature) 27- 37 – alcohol evaporates at a low temperature and therefore removes body heat rapidly
• Less frequently used – because alcohol causes skin drying
• Heat loss is by conduction and vaporization
• Determine the patients’ temperature, PR and RR frequently every (Q) 15 min
• Sponge each area (part) for 2-3 min changing the wash cloth
• The sponge bath should take about 30 minutes
• Reassess v/s at the end
• Discontinue the bath if the clients becomes pale or cyanotic or shivers, or if the PR becomes rapid or irregular

Temperature of hot water bottle (bag) 52 o
c for normal adults,40.5 –
46 oc– for debilitated (unconscious patients).
40.5-46 oc for children < 2 yrs;
Fill the bag about 2/3 full;
Expel the remaining air and secure the top;
Maximum effect occurs in 20-30 min;
The application is repeated Q2 – 3 hrs to relieve swelling compress
– a moist gauze or cloth immersed in (hot or cold) water and applied
over an area.
Read More

Care of Patient with Fever

This includes sponging of the skin with alcohol or cool water for reducing temperature

Solution: Tepid (luck – warm) water

Alcohol
• Part of alcohol to 3 parts of Luke warm H2O remove patient’s gown
• Take the patient temperature, sponge the body using the wash cloth alternately, sponge each part 2-3 min. changing the was cloth
• Heat loss is by conduction or vaporization
• Check pulse frequently and report any change

Local Application of Heat and Cold
Heat and cold are applied to the body for local and systemic effects

Heat Application
Purpose
1. To relieve pain and muscles spasm – by relaxing muscles
- Increase blood flow to the area
2. To relieve swelling (facilitate wound healing)
- To relieve inflammation and congestion

Heat
• Increases the action of phagocytic cells that ingest
  moisture and other foreign material
• Increases the removal of waste products or infection
  metabolic process

3. To relieve chilling and give comfort Heat can be applied in both dry and moist forms

Dry Heat :- is applied locally, for heat conduction
• By means of a hot water bottle
Moist heat – can be provided, through conduction
• By compression or sitz bath

Cold Application
Purpose
• To relieve pain: cold decrease prostaglandin's, which intensify the sensitivity of pain receptors, and other substances at the site of injury by inhibiting the inflammatory processes

• To reduce swelling and inflammation: by decreasing the blood flow to the area (vasoconstriction effect)

• Reduce raised body temperature due to fever Cold can be applied in moist (cold compress 18-27 c) and dry form (ice pack (bag) <15 oc)
Systemic effects of cold – extensive cold application can increase blood pressure
Systemic effects of Hot – produce a drop in blood pressure – excessive peripheral vasodilatation
Read More
Subscribe to: Posts (Atom)