28.10.2017 18:04
Development of practical work on OMZ. Grade 11
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“Practical work No. 3 “Studying the technique of applying mustard plasters, compresses, ice packs, lotions””
Practical work No. 3
Studying the technique of applying mustard plasters, compresses, ice packs, lotions
Goal: to develop practical skills in applying mustard plasters, compresses, heating pads and cold.
Equipment: medical jars, Vaseline, tweezers, cotton wool, alcohol, matches, mustard plasters, rubber heating pad, towel, bandages, gauze.
Work report:
| 1 option | |
| 1. The duration of action of a warming compress should not exceed: a) 3 hours; b) 12 hours; c) 24 hours; d)18 hours | 1. Duration of action of mustard plasters for adults: a) 5 – 15 minutes; b) 20 – 40 minutes; c) 60 min; d) 30 – 50 min. |
| 2.Describe the sequence of applying mustard plasters and a hot compress. | 2.Describe the sequence of applying a heating pad and a warm compress. |
| 3. Draw a conclusion. What mistakes should not be made when applying a heating pad and a warming compress? | 3. Draw a conclusion. What mistakes should not be made when applying mustard plasters and hot compresses? |
| 4. A patient with lung disease complains of feeling cold, trembling throughout the body, weakness, and headache. She has been sick for two days. Body temperature - 38°C. What procedure can be performed on this patient? Justify your answer. | 4. The patient complains of renal colic. What procedure can be performed on this patient? Justify |
| 5. After abdominal surgery, the patient was prescribed a procedure to avoid internal bleeding. What procedure? What are the contraindications for this procedure? | 5. The patient complains of pain in the elbow bend after inserting an IV. A hematoma formed at the site where it was placed. What procedure can be performed? Contraindications for this procedure. |
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JUSTIFICATION |
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I. Preparation for manipulation. Make sure the heating pad is intact and the plug fits. 2. Explain to the patient the course of the upcoming manipulation and obtain his consent. 3. Wash and dry your hands. Wear gloves. 4. Fill the heating pad with hot water to 2/3 of its volume, displace the air by pressing the heating pad until water appears at the neck and tighten the cap well. 5. Turn the heating pad upside down and make sure it is sealed. 6. Wipe the heating pad dry and wrap it in a diaper. II. Performing manipulation. 7. If possible, give the patient a comfortable position. 8. Apply the heating pad to the desired area of the body and leave it for 20 minutes. 9. After 5 minutes, check for signs of tissue overheating (severe hyperemia, burning sensation). III. End of manipulation. 10. After 20 minutes, remove the heating pad. 11. Examine the patient’s skin at the site of contact with the heating pad. 12. Immerse the heating pad in disinfectant. solution. 13. Remove gloves and immerse them in disinfectant. solution. 14. Wash and dry your hands. 15. Make a note of the manipulation performed (and the patient’s reaction to it in the medical documentation.) |
Efficiency of the manipulation. Patient's right to information, patient participation, ensuring patient safety. Infection safety. Effectiveness of influence (increased warming effect). Ensuring patient safety. Prevention of burns. Preventing skin burns. Ease of manipulation. Fulfilling doctor's orders. Prevention of skin burns. Onset of effect. Determination of skin sensitivity (there should be slight hyperemia). Prevention of nosocomial infections. Prevention of nosocomial infections. |
Manipulation Applying a warm compress
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JUSTIFICATION |
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I. Preparation for manipulation. 1. Prepare everything you need. 2. Examine the patient’s skin at the site of the compress. 3. Explain to the patient the course of the upcoming manipulation and obtain his consent. 4. Wash and dry your hands and put on gloves. 5. Using scissors, cut off a piece of bandage or gauze required for applying a compress (depending on the location of application) and fold it into 8 layers. 6. Cut a piece of compress paper around the perimeter 2 cm larger than the napkin. 7. Prepare 2cm of cotton wool around the perimeter. more compress paper. 8. Take equal parts of water and 96% alcohol (using a measuring container) and mix them in a container (to prepare a semi-alcohol solution). 9. Moisten a napkin prepared from a bandage or gauze (the active layer) in a semi-alcohol solution. 10. Squeeze it lightly. II. Performing manipulation. 11.Apply the prepared napkin to the intended area. 12. Place compress paper (insulating layer) on top of the napkin. 13. Take the prepared cotton wool and place it on top of the compress paper (warming layer). 14. Secure the compress with a bandage so that it fits tightly to the skin, but does not restrict movement (fixing layer). 15. Leave the compress for 6 hours. 16. Remove gloves and place them in disinfectant. rr. All subsequent stages of manipulation should be carried out with gloves. Note: To control the correct application of the compress, after 1.5 - 2 hours, carefully, without disturbing the tightness of the bandage, move your finger under its wet layer. When the manipulation is performed correctly, the skin and gauze should be warm and moist. III. End of manipulation. 17. After 6 hours (or another time prescribed by the doctor), remove the compress and place its layers in disinfectant. rr. 18. Dry the skin with a towel. 19. Apply a dry bandage. 20. Remove gloves and place them in disinfectant. rr. 21. Wash and dry your hands. 22. Make a note about the performed manipulation in the medical documentation. |
Efficiency of manipulation. Eliminate possible contraindications. The patient's right to information and his participation in the manipulation. Infection safety Efficiency of the manipulation. ________ | | ___________ ________ | | ___________ ________ | | ___________ __________ | | _________ Providing comfort. Ensuring impact effect. Ensuring impact effect. Ensuring correct application of the compress and its fixation during the entire exposure time. Prevention of nosocomial infections. Infection safety. Reliability of the effectiveness of manipulation. Prevention of nosocomial infections. After 6 hours the alcohol dries out. Ensuring comfort. Preservation of the thermal effect. Prevention of nosocomial infections. Eliminating the chemical effects of talc on the skin. Ensuring continuity in nursing care. |
Complications
If the skin is not wiped dry, maceration may occur (the skin becomes brightly hyperemic, becomes wet, and an infection may develop).
To wet the gauze, you can use 96-degree ethyl alcohol in a 1:1 ratio with water.
An alcohol compress dries faster and must be changed every 4-6 hours.
Complications after an alcohol compress – burns /due to improper dilution of alcohol/. When applying a warming compress, use only diluted alcohol.
SITUATIONAL TASKS
1. When placing standard mustard plasters on the chest area for respiratory diseases as prescribed by a doctor, the nurse moistened the mustard plasters with hot tap water.
2. The nurse on duty, when placing mustard plasters on a patient, took a pack of standard mustard plasters, lowered them into water and applied them to the patient’s chest area, excluding the shoulder blades and spine.
3. The nurse put mustard plasters on the patient’s chest area, immediately noted the time, and asked the bedmate to remove the mustard plasters in 15 minutes.
4. The patient asked the nurse to give him a heating pad, since he had
acute pain in the abdomen. The patient suffers from gastric ulcer.
The nurse placed a heating pad on the patient's stomach.
Did she do the right thing?
5. The patient has a body temperature of 38.3°C and is shivering. The patient asked the nurse for a heating pad to keep warm. The nurse gave him a heating pad.
6. A patient was admitted to the department in an unconscious state. To keep him warm, the nurse placed a heating pad wrapped in a diaper on his legs.
Did the nurse do the right thing?
7. The home nurse gave an IM injection and noticed it on the other buttock.
infiltrate from the previous injection. It is necessary to apply a warm compress, but there is not enough alcohol.
What can you use for a compress at home?
8. The nurse performs the procedure - placing a warm compress:
I soaked a napkin in a semi-alcohol solution, wrung it out well and applied it to the body. She covered the napkin with cotton wool, then with wax paper and bandaged it.
Was the procedure performed correctly?
9. The charge nurse after performing an oil injection on a 60-year-old patient
shoulder area, immediately applied a warm compress.
10. A 17-year-old boy is being treated in a hospital for a disease of the bronchopulmonary system. During an evening walk around the hospital grounds, the patient bruised his ankle joint. He turned to m/s for help. There is swelling and cyanosis in the ankle joint area. M/s applied a warm heating pad to the bruised area. 1.5 hours passed after the injury.
STANDARD ANSWERS
The nurse did the wrong thing. Hot water will wash away all the mustard, you need to take warm water below 40 - 45 0 C and not from the tap.
The nurse did the wrong thing. It is necessary to check the expiration date, which is indicated on every tenth mustard plaster, and prepare water at a temperature of 40-45 0 C.
When placing mustard plasters, the nurse must find out whether the patient “has a burning sensation” on the skin, and then note the time, and must remove the mustard plasters herself.
The nurse made a grave mistake. If you have abdominal pain, you should not use a heating pad without consulting a doctor.
The nurse did the wrong thing, because... High fever is a contraindication for using a heating pad.
The unconscious state of the patient is a contraindication for the use of a heating pad. The nurse did the wrong thing.
At home you can use: cologne, vodka.
The nurse did the wrong thing. The second layer of compress is wax paper.
The nurse did the right thing. After the introduction of oil solutions, the
more in elderly patients, infiltrates are possible, and the nurse
prevented their occurrence.
The nurse did the wrong thing. In the first hours of injury it is necessary to apply
cold /ice pack or cold compress/.
Compress- therapeutic multilayer bandage.
Action- causes dilation of blood vessels and increases blood circulation in tissues (analgesic and absorbable effect).
Indications- local inflammatory processes on the skin, in the subcutaneous fat layer, joints, middle ear, bruises (every other day).
Contraindications- fever, skin lesions, allergic or pustular rashes; Do not apply a compress to skin lubricated with iodine (a burn is possible).
Equipment- compress paper, cotton wool, bandage, ethyl alcohol 45% (salicylic or camphor), scissors.
Performance:
- wash and dry your hands;
- inspect the skin at the site where the compress was applied;
- prepare three layers of compress corresponding to the area of application: wet layer - 6-8 layers of gauze; insulating - compressed paper or polyethylene, covering the wet layer by 1.5 - 2 cm; insulating - cotton wool 2-3 cm thick, overlaps all previous layers by 1.5 - 2 cm;
- fold the layers: below - cotton wool, then - compress paper;
- dilute the alcohol with water, heat the medicinal solution by placing it in a container with water at 38-39°C;
- soak gauze in the solution, wring it out lightly and place it on top of the compress paper;
- Place all layers of the compress on the desired area of the body and secure with a bandage so that the compress fits tightly to the skin;
- record the time - 6-8 hours;
- wash and dry your hands;
- after 1.5-2 hours, check the correct application of the compress with your finger, without disturbing the tightness of the bandage (the gauze should be damp).
Using a heating pad.
Action- dry heat causes reflex relaxation of smooth muscles, increased blood supply to internal organs, and has an analgesic and absorbable effect.
Contraindications- skin damage, bleeding, infectious wounds, vague abdominal pain, acute inflammatory processes in the abdominal cavity, the first day after a bruise, malignant neoplasms of any age.
Equipment- heating pad, towel or diaper.
Performance:
- fill the heating pad with hot water (60 -- 70°C) to 1/2 or 2/3 of the volume;
- displace the air from the heating pad by pressing it with your hand at the neck, close tightly with the stopper;
- turn the heating pad upside down and make sure it is tight;
- wrap the heating pad in a towel or diaper;
- place the heating pad on the desired area of the body (if the use is long-term, then take a 15-20-minute break every 20 minutes).
Using an ice pack
Action- cold causes a narrowing of the blood vessels of the skin, reducing the sensitivity of nerve receptors.
Indications- for bleeding, acute inflammatory processes in the abdominal cavity, bruises (on the first day), high fever, in the postoperative period.
It is forbidden to freeze a bottle filled with water in the freezer, because... the surface of the resulting ice conglomerate is very large, which can lead to hypothermia of an area of the body, and sometimes frostbite. Equipment- ice pack, lump ice, diapers, wooden mallet. Performance:
- place the lump ice in the diaper and break it into small pieces (1-2 cm in size) with a wooden mallet;
- fill the bubble with ice to 1/2 of its volume and add cold (14-16°C) water to 2/3 of its volume;
- displace the air from the bubble by pressing your hand, placing it on a hard surface (free space is provided for the water formed during the melting of the ice);
- Close the bubble tightly with the lid and, turning the stopper down, check it for leaks;
- wrap the bubble in a dry diaper and pour it onto the desired area of the body for 20 minutes.
The bubble can be held for a long time, but every 20 minutes you need to take a break for 10-15 minutes (as the ice melts, the water can be drained and pieces of ice added).
Emergency measures for the development of anaphylactic shock
Signs of anaphylactic shock:
- the patient's face becomes very pale or gray;
- skin feels cool and clammy to the touch;
- the pulse becomes rapid and weak;
- the patient is frightened and restless;
- thirst, dizziness, yawning appear;
- difficulty breathing, gasping for air, suffocating;
- itching, sneezing may appear, the skin becomes bright red;
- the face may become swollen, especially around the eyes, large red spots may appear on the skin - “hives”;
- pulse is frequent and weak;
- loss of consciousness is possible.
Actions:
- stop administering the drug;
- call a doctor immediately;
- Place the patient on his back on a flat, hard surface;
- raise the foot end of the bed;
- turn your head to the side, remove dentures (if any);
- if localization allows, apply a tourniquet above the allergen injection site;
- put cold on the injection site;
- loosen tight clothing.
In the event of sudden death, begin resuscitation measures immediately!
Stopping the heart and breathing does not mean the onset of irreversible biological death. Between life and death there is a kind of transitional state, which is not yet death, but can no longer be called life (V.A. Negovsky). This condition is called clinical death, the duration of which is 4-6 minutes (5-7 minutes). Cells of different organs react differently to the lack of oxygen. First of all, irreversible changes develop in the cerebral cortex. Therefore, 5-7 minutes (the duration of clinical death) is the time that the cerebral cortex can survive in the absence of breathing and blood circulation. This is a very important point, since it is possible to restore the activity of the heart at a much later date, but in this case the function of the cells of the cerebral cortex will be completely and irreversibly lost. And this means the onset of social death (if it is possible to restore cardiac activity and breathing). A person who has been in a state of clinical death for 6-7 minutes, as a rule, dies 2-5 days after resuscitation, and the survivors develop severe neurological and mental disorders. All this leads to disability.
Attention! After cardiac arrest, the cells of the cerebral cortex are able to tolerate hypoxia at normal body temperature for 3-5 minutes.
Only during the period of clinical death is the struggle for life possible and necessary. In the short period of time during which revival can begin, the ambulance does not have time to arrive at the scene of the incident, so the fate of the victim often depends on who is next to him.
General principles of cardiopulmonary resuscitation
Make sure that the patient is unconscious: pat him on the shoulder, call out to him. Remember! Typically, loss of consciousness occurs 15 seconds after circulatory arrest.
- If there is no answer, call others for help.
- Turn the victim onto his back.
- Restore airway patency, as a person in this condition will have a tongue that will fall back, blocking the airway, using the head extension and chin lift method:
- Place your hand on the patient's forehead:
- place two fingers of the other hand on the lower jaw near the chin;
- straighten your head, pressing your forehead down and your chin up.
- Check if the patient is breathing:
- see if the chest rises;
- listen for breathing;
- feel the exhaled air with your cheek for 3-5 seconds;
- If breathing is present, continue monitoring, frequently checking carotid pulse and breathing patterns.
- Ask someone to call an ambulance (doctor).
- If there is no breathing:
- close the patient’s nostrils, open your mouth wide, take a deep breath and place your mouth tightly against his mouth;
- make two deep breaths with an interval of 5 seconds, lasting 1.5 -2 seconds each; the pause between them serves for your breath;
- make sure that the patient's chest rises and falls during inflation;
- Feel the release of air from the victim’s mouth, continue artificial ventilation for 1 minute (about 12 breaths).
Remember! Air cannot enter the respiratory tract if: you do not tightly cover the patient’s mouth with your mouth; air enters the stomach due to improper extension of the victim’s head or due to very frequent blowing. The patient's dentures are left in the mouth for closer contact with the rescuer's mouth. If the patient begins to vomit, turn him on his side, clean the mouth and continue artificial respiration.
- Check the carotid pulse for 5-10 seconds:
- hold the patient's head with one hand by the forehead, and with the middle and index fingers of the other hand, find the pulsation of the carotid artery next to the thyroid cartilage on the side that is closer to you;
- feel the pulse for 5-10 seconds;
- if there is a pulse but there is no breathing, continue artificial ventilation (each insufflation lasts 1-1.5 seconds),
- check your pulse every minute;
- if there is no pulse, ask someone to call an ambulance, and begin chest compressions yourself.
- Position your hands correctly for chest compressions:
- move the middle and index fingers of your right hand up along the costal arch and feel the xiphoid process with your middle finger;
- Place your second hand on top of the first - hold your fingers without touching your chest.
- Take the correct position for indirect massage: elbows straight, arms straight from the hands to the shoulder.
- Do 15 compressions on the sternum in 9-10 seconds (with a frequency of 80-100 compressions per minute) to a depth of 3-5 cm: count “one and, two and...”, etc. (press the sternum when you call number, and release when you say "and"). Squeeze and press your chest smoothly, keeping your hands in contact with your chest at all times.
- Give two full breaths, opening the airways with head extension and chin lift.
Remember! When performing chest compressions, artificial ventilation is always necessary.
- Do 3 large cycles, each consisting of 15 compressions and 3 blows.
- Find the carotid pulse and palpate it for 5 seconds.
- Take 2 full breaths.
- Open your airway.
- Pinch the patient's nose.
- Cover the patient's mouth with your mouth and make two blows.
- See that the patient's chest rises and falls.
- Continue the cycle: 15 compressions and 2 inflations.
- Monitor your pulse; if your pulse has returned, control your breathing.
Remember! If a pulse does not appear, continue indirect massage and artificial ventilation.
Chest compressions and artificial ventilation can be performed simultaneously by two rescuers. In this case, the ratio of chest compressions and inflations is 5:1.
Air is injected after every five compressions during a pause. Cardiopulmonary resuscitation requires a lot of physical strength, not to mention the emotional stress that the rescuer necessarily experiences.
Remember that the absence of a pulse in the carotid artery with clear signs of the effectiveness of the cardiac massage is an indication for its continuation. The rescuer should be changed every 5-7 minutes quickly, without stopping the rhythmic heart massage. Objective criteria for stopping resuscitation measures are:
Using an ice pack, heating pads, placing mustard plasters
Bannova Oksana Vasilievna,
professional module teacher
St. Petersburg State Budgetary Educational Institution "Medical College No. 2"
Lesson objectives:
Methodical:
Application of a set of teaching methods:
- reproducing, training exercises;
- problem-search methods (problem solving);
- partial search methods - independent work;
- method of problematic presentation - a combination of verbal information with problematic elements;
- individual simulation methods (simulation exercises, analysis of specific situations).
- Further development of knowledge about the simplest methods of physiotherapy.
- Working with algorithms (setting up a heating pad, ice pack, mustard plasters).
- Disclosure of the role of the nurse when performing the simplest methods of physiotherapy.
- Work with universal and standard safety measures for medical personnel when performing simple physical therapy methods.
- Formation of skills in performing the simplest methods of physiotherapy.
- Developing professional accuracy, diligence, and responsibility for the assigned work.
- Cultivating in students the most important personal and professional qualities of a medical worker:
- the ability to recognize responsibility for the patient’s life;
- the ability to analyze one’s behavior;
- developing the ability to work according to standards and algorithms.
- Formation among students:
- skills of analysis and synthesis of the studied material;
- ability to make intra-subject connections;
- ability to apply interdisciplinary connections.
- Ability to solve problematic and situational problems.
- Developing the ability to analyze errors.
Job description:
The student must know:
1. Definitions of terms used during procedures; (PC element 4.8. Participate in health education work among the population; PC element 4.4. Consult patients and their environment on issues of care and self-care)
2. Areas of the body allowed for procedures; (PC element 4.8. Participate in health education work among the population; PC element 4.4. Consult patients and their environment on issues of care and self-care)
3. Complications arising from incorrect procedure techniques; (PC element 4.8. Participate in health education work among the population; PC element 4.4. Consult patients and their environment on issues of care and self-care)
The student must be able to:
1. Clarify the patient’s understanding of the procedure; (PC 4.1. Communicate effectively with the patient and his environment in the process of professional activities)
2. Install mustard plasters; (PC 4.6. Provide medical services within the limits of their powers.)
3. Use a heating pad; (PC 4.6. Provide medical services within the limits of their powers)
4. Use an ice pack; (PC 4.6. Provide medical services within the limits of their powers)
Guidelines for the teacher on the stages of the lesson
| № |
Progress of the lesson |
Methodological justification |
| I | Organizing time: · greetings; · marking absent students, finding out the reason; · checking the appearance of students (compliance with the dress code); · checking students’ readiness for class (availability of diaries and exercise notebooks). |
· organizes and disciplines students; · fosters relevance and responsibility; · develops self-demandingness;
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| II | Motivation for the lesson:
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· creates a working environment; · activates students' attention; · creates cognitive interest in the lesson. |
| III | Updating of reference knowledge. Control of the initial level of knowledge: Frontal survey on the topic: “Methods of simple physiotherapy.” (Appendix No. 1). |
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| IY | Formation of new knowledge and skills: Plan
2. Using a heating pad. Manipulation algorithm using a heating pad. (Appendix No. 3). 3. Using an ice pack. Manipulation algorithm using an ice pack. (Appendix No. 4). 4.Use of mustard plasters. Manipulation algorithm for setting mustard plasters. (Appendix No. 5). Students are encouraged to record their plan step by step in their diaries.
2) Demonstration by the teacher of the “Use of mustard plasters” manipulation on a phantom. "Using a heating pad." "Using an ice pack." 3) Independent work of students:
4) Securing the topic:
5)Working with guidelines:
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· Students work in small groups (2-3 people): |
| Y |
Current control of knowledge to assess the assimilation of material:
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| YI | Summing up the lesson:
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Aims students to use the knowledge, skills and experience acquired in class in their future work. |
| YII | Assignment for the next lesson:
4. create an algorithm for disinfecting heating pads and ice packs |
· to expand self-education; · activates self-preparation; · forms the principle of consciousness and activity. |
Appendix No. 1 Frontal survey
1. The concept of simple physiotherapy.
2. Use of mustard plasters: indications and contraindications.
3. Use of a heating pad: indications and contraindications.
4. Using an ice pack: indications and contraindications.
Appendix No. 2
Simple methods of physiotherapy.
Even in ancient times, people healed those suffering with natural phenomena. However, only the development of natural sciences served as the basis for scientific physiotherapy. The works of outstanding domestic physiologists and clinicians were of great importance in this area: I.M. Sechenova, I.P. Pavlova, P.K. Anokhina, S.P. Botkina, G.A. Zakharyin.
Physiotherapy (Gr. physis - nature and therapeia - treatment) is the targeted effect on the human body for therapeutic purposes using various natural physical factors: water, heat, cold, light, electricity, electromagnetic field, ultrasound, etc.
It is known that when the skin is irritated, certain functional changes occur in organs and tissues - changes in vascular tone, secretory and motor activity, and cell metabolism. General reactions often occur, expressed in improved sleep, appetite, and mood. Such an effect on the skin in order to change the functional state of organs and body systems is called segmental reflex therapy.
Heat and cold procedures have a general and local effect on the human body.
Thermal impact:
· increases tissue temperature when applied topically;
· increases blood flow to the affected area, causing improved blood supply/lymph circulation to a certain area of the human body and reducing blood stagnation in internal organs;
· stimulates the intensity of metabolic processes.
T Fertility procedures can also cause adverse effects:
· locally - burns, swelling;
· systemically - presyncope, fainting (outflow of blood from the head, internal organs to the periphery).
Application of cold:
· reduces the intensity of blood circulation and slows down metabolism;
causes constriction of blood vessels;
slows down bacterial activity when there is a threat of infection;
helps relieve congestion;
· lowers body temperature;
· gives a temporary anesthetic effect.
Local application of cold changes pain sensitivity - blocks or slows down the conduction of nerve impulses, and also increases muscle spasm due to a decrease in neuromuscular conduction. Prolonged exposure to cold leads to impaired blood circulation (lymph circulation), tissue damage due to oxygen deficiency.
The use of mustard plasters, heating pads, ice packs, compresses. The effect of physiotherapeutic procedures is due to their reflex effect on skin receptors.
Appendix No. 3
Using a heating pad
A heating pad (dry heat) causes reflex relaxation of smooth muscles, increased blood flow to internal organs, and has an analgesic and absorbable effect. It should be remembered that the effect of using a heating pad depends not so much on the temperature of the heating pad, but on the duration of exposure. In hospitals, standard heating pads are used; electric ones are prohibited.
Manipulation algorithm using a heating pad
Target: therapeutic (warming, pain reduction, stimulation of resorption action in inflammatory processes).
Mechanism of action: reflex relaxation of smooth muscles, stimulation of blood supply to internal organs (local vasodilation).
Indications: local inflammatory processes of the skin, subcutaneous tissue and joints; chills; hypothermia; chronic inflammatory processes in the abdominal cavity (chronic gastritis, etc.) as prescribed by a doctor.
Contraindications: acute inflammatory processes and pain in the abdominal cavity (acute appendicitis, cholecystitis, pancreatitis, peritonitis, etc.); tumors; internal bleeding; bruises in the first hours; infected wounds; high fever; mastitis, thrombophlebitis; violation of the integrity of the skin.
Equipment:
· rubber heating pad 1.5-2 l;
water - 60-70°C,
· towel,
· two napkins for disinfecting the heating pad,
· thermometer for measuring water temperature.
Possible patient problems: the risk of burns due to reduced skin sensitivity in seriously ill patients or due to its absence; skin pigmentation due to frequent use of a heating pad on the same place; severe burning sensation in the area where the skin comes into contact with the heating pad.
I. Preparation for the procedure:
II. Performing the procedure:
3. Pour hot (60-70°C) water into the heating pad to fill 2/3 of its volume with the water prepared in the jug. Release the air by squeezing the upper third of the heating pad, screw the cap.
4. Turn the heating pad upside down and wipe the heating pad dry.
5. Wrap the heating pad in a towel.
6. Apply the heating pad to the desired area of the body for 15-20 minutes (for long-term use, as prescribed by the doctor, take 10-15 minute breaks, changing the water).
7. Remove the heating pad.
8. Examine the patient’s skin in the area of contact with the heating pad.
9. Ask the patient how he is feeling. Satisfied that he feels okay.
III. End of the procedure:
10. Pour the water out of the heating pad. Disinfect the heating pad.
11. Wash and dry your hands.
12. Make a note about the procedure and the patient’s reaction to it in the medical documentation.
Appendix No. 4
Applications of an ice pack
Dry cold is used topically on the surface of the body by applying an ice pack or a disposable cold pack. For cooling purposes, crushed ice is used when filling the bladder or a cooling pack with chemical reagents. The cooling package is exposed mechanically (impact, compression) in order to activate the components of the chemical reaction and produce a cooling effect.
Algorithm for manipulating the use of an ice pack
Target: therapeutic (cooling, reducing bleeding, reducing pain, swelling of tissues).
Mechanism of action: cold causes constriction of blood vessels in the skin and underlying organs, reducing the sensitivity of nerve receptors. Has an analgesic, hemostatic, anti-inflammatory effect.
Indications: internal bleeding; acute inflammatory processes in the abdominal cavity; bruises (first day); high fever (second period); insect bites; mastitis; postoperative period; concussion.
Contraindications: chronic inflammatory processes; skin diseases. Equipment:
· ice pack, previously checked for integrity,
ice in pieces
· water (14-16°C),
· towel (diaper),
container with disinfectant solution,
· napkins.
Possible patient problems: excessive hypothermia; risk of frostbite due to prolonged exposure to cold on the skin; cold intolerance. Mandatory condition: organization of constant monitoring of the procedure.
REMEMBER! If you use an ice pack that is frozen in the freezer, frostbite may occur on an area of your body.
I. Preparation for the procedure:
1. Clarify the patient’s understanding of the purpose and course of the upcoming procedure and obtain his consent.
2. Prepare the necessary equipment. Wash and dry your hands.
II. Performing the procedure:
3. Fill the ice bubble halfway with small pieces of ice and fill them with cold water.
4. Place the bubble on a horizontal surface and screw in the cap.
5. Wrap the bubble in a towel (diaper).
6. Apply to the desired area of the body (head area for 5 minutes (with an interval of 5 minutes), on the peritoneal area for 15-20 minutes with an interval of 30 minutes).
7. As the ice melts, drain the water and add ice pieces.
8. Record the time of application of the ice pack (total exposure time should not exceed 2 hours, including intervals).
9. At the end of the procedure, drain the water from the bladder.
10. Ask the patient how he is feeling.
III. End of the procedure:
11. Disinfect the bladder, then rinse it with water and dry it. The bottle should be stored dry with the lid open.
12. Wash and dry your hands.
13. Make a note of the procedure and the patient’s reaction to it in the medical documentation
Appendix No. 5
The use of mustard plasters.
The use of mustard powder is based on the fact that essential (allylic) oil released upon contact with water, causing irritation of skin receptors and hyperemia, leads to a reflex expansion of the blood vessels of internal organs. Due to this, an analgesic effect is achieved and the resorption of some inflammatory processes is accelerated.
The second component of mustard is phytoncides. Under the influence of water, they are released from the enzyme myrosin. Essential oil and phytoncides are the healing properties of mustard.
It is necessary to warn the patient that hyperemia and soreness of the skin where the mustard plasters were may last for several hours, even days. After frequent use of mustard plasters, skin pigmentation sometimes appears.
Indications for the use of mustard plasters are determined by the doctor. They are often used without consulting a doctor, so you need to be aware of the contraindications of a seemingly harmless procedure.
REMEMBER! Mustard plasters should not be applied to skin diseases, high temperature (above 38°C), pulmonary hemorrhage, a sharp decrease or absence of skin sensitivity, or malignant formations.
Manipulation algorithm for setting mustard plasters
Target: therapeutic (distracting, analgesic effect, stimulation of resorption action in inflammatory processes).
Mechanism of action of mustard: penetrating the patient’s skin, essential mustard oil irritates it and dilates the skin blood vessels, leading to a reflex dilation of the blood vessels of the internal organs.
Indications: for pain, acute inflammatory processes of the respiratory system: pneumonia, bronchitis, pleurisy. Diseases of muscles, nervous system, neuralgia, neuritis, osteochondrosis, hypertensive crisis, heart pain.
Places for placing mustard plasters:
1. Bronchitis, pneumonia in the resorption stage - on the chest in front and behind.
2. In case of hypertensive crisis - on the collar area and calf muscles.
3. For pain in the heart - on the heart area.
Avoid: area of nipples, mammary glands, spine and birthmarks.
Contraindications: bleeding; skin diseases; tumors of various etiologies; allergic reactions to essential oils; violation of the integrity of the skin; hyperthermia; pulmonary tuberculosis.
Equipment:
· mustard plasters (before use, you should check the quality of mustard plasters, expiration date; suitable mustard plasters have a pungent smell of mustard oil and do not crumble).
· tray with water at a temperature of 40-45°C,
· tray for waste material,
· towel,
· gauze napkins,
thermometer for measuring water temperature,
· watch.
Possible patient problems: skin burn; a strong burning sensation during the procedure.
I. Preparation for the procedure:
1 Clarify the patient’s understanding of the purpose and course of the upcoming procedure and obtain his consent.
2. Wash your hands.
3. Examine the patient’s skin at the site of mustard plasters (no damage, pustules, rash). Make sure you are not allergic to mustard.
4. Check the suitability of mustard plasters: the expiration date is set on every 10th mustard plasters, the mustard should not fall off the paper and have a specific (pungent) smell. When using mustard plasters made using other technologies (for example, packaged mustard), check the expiration date on the packaging. Prepare the necessary equipment.
II. Performing the procedure:
5. Help the patient take off his shirt and lie on his stomach (when placing mustard plasters on his back). Ask him to wrap his arms around the pillow and turn his head to the side.
6. Place a napkin on the place where the mustard plasters are placed.
7. Measure the temperature of the water for wetting the mustard plasters (40-45°C).
At a lower temperature, the essential oil is not released, and at a higher temperature, it is destroyed.
8. Soak mustard plasters in water for 5 seconds each, shake off and apply to the desired area of skin with the mustard down on a napkin; place a towel on top.
9. Cover the patient with a blanket.
10. After 2-3 minutes, clarify the patient’s sensation.
11. Keep mustard plasters for 10-15 minutes.
12. Remove mustard plasters if persistent hyperemia appears after 10-15 minutes or earlier in case of unbearable burning and place them in a tray for used materials.
13. Wipe the patient’s skin with a damp, warm gauze cloth.
14. Dry the skin with a towel. Help the patient put on a shirt, cover him with a blanket and warn him to remain in bed for at least 20-30 minutes.
15. Ask how the patient is feeling.
III. End of the procedure:
16. Throw away the mustard plasters. Wash and dry your hands.
17. Make a record of the procedure and the patient’s reaction to it in the medical records.
REMEMBER! With longer exposure to mustard plasters, skin burns with the formation of blisters are possible.
Appendix No. 6
Complete the offer
1. When blood pressure increases, mustard plaster is placed on the head in the area of ___________________ and on the area of ___________ muscles.
2. For pain in the heart, the nurse places mustard plasters on the area __________.
3. For inflammatory conditions of the upper respiratory tract, mustard plasters are placed in the chest area ___________ and on the area ____________ muscles.
4. Prolonged exposure to cold when using an ice pack can cause the body to ______________.
5. Hypertension, acute bleeding - indications for staging __________________.
6. Hypothermia, chills, renal colic - indications for use __________.
Appendix No. 7
Insert missing indicator
- The water temperature for setting mustard plasters is _____ °C.
- The heating pad is filled to _____ volume.
- The water temperature for filling the heating pad is _____°C.
- An ice pack is applied to the surface of the patient's body for _____ minutes at intervals of ____ minutes.
Terms
Anemia - anemia.
Anesthesia - anesthesia, lack of sensitivity.
Anticoagulants - drugs that prevent blood clotting.
Appendicitis - inflammation of the appendicular process.
Application - application of sources of physical influence to the surface of the body.
Bronchitis - inflammation of the bronchi.
Hemostasis - stopping blood flow.
Colic - acute, paroxysmal pain.
Metabolism - metabolism in the body.
Pneumonia - pneumonia.
Radiculitis - inflammation of the nerve roots in the lumbar region.
Angina - squeezing pain in the region of the heart...
Physiotherapy - targeted impact on the body by various natural physical factors.
Appendix No. 9
Problem-situational tasks
Task No. 1.
You are a nurse in a therapeutic department.
A patient with lung disease complains of feeling cold, trembling throughout the body, weakness, and headache. She has been sick for two days. Objectively: temperature - 38°C. Identify the patient's problem. What physiotherapeutic procedure can be performed for this patient. Justify your answer. Indications and contraindications for this procedure. Carry out the manipulation algorithm.
Task No. 2.
You are a medical doctor from the urology department.
Patient K. complains of renal colic. Determine the priority problem. What physiotherapeutic procedure can be performed for this patient. Justify your answer. Indications and contraindications for this procedure. Carry out the manipulation algorithm.
Task No. 3.
You are a nurse in a surgical department.
Patient Z., after abdominal surgery, was prescribed a physiotherapeutic procedure to avoid internal bleeding. What physiotherapeutic procedure was prescribed for this patient? Justify your answer. Indications and contraindications for this procedure. Carry out the manipulation algorithm.
Task No. 4.
You are a nurse in the cardiology department.
Patient S has an angina attack. What physiotherapeutic procedure can be performed for this patient. Identify the patient's problem. Justify your answer (place of statement). Indications and contraindications for this procedure. Carry out the manipulation algorithm.
Appendix No. 6a
Answers to the task “Complete the sentence”
1. back of the head, calf
2. heart
3. front, calf
4. hypothermia
5. ice pack
6. heating pads
Appendix No. 7a
Answers to the task “Insert the missing indicator.”
1. 40-45°C
2. 2/3
3. 60-70°C
4. 20-30 min 10-15
Appendix No. 9a
Answers to problems
Task No. 1.
Patient's problem: chills. This is the first period of fever. During this period of fever, a heating pad can be placed on the patient.
Task No. 2.
Patient's problem: pain in the lumbar region. For a patient with this problem, a heating pad can be placed on the lumbar region.
Task No. 3.
For a patient with bleeding, an ice pack may be placed on the abdomen.
Task No. 4 .
Patient's problem: pain in the heart area. The patient can have mustard plasters placed on the heart area.
Appendix No. 10
Homework "Fill in the table"
| Name | Indications | Contraindications | t˚water | Setting time | Mechanism of action |
| Warmer | |||||
| Ice pack | |||||
| Mustard plasters |
EVALUATION PAPER
| Student's name |
Appearance | Having homework
|
Frontal survey |
Independent work | Solving situational problems |
| 1. | |||||
| 2. | |||||
| 3. | |||||
| 4. | |||||
| 5. | |||||
| 6. | |||||
| 7. | |||||
| 8. | |||||
| 9. | |||||
| 10. |
Contraindications:
Purulent skin diseases,
Hyperthermia.
1. Preparation for the procedure:
1.1. Introduce yourself to the patient, explain the purpose and progress of the upcoming procedure. Make sure you are not allergic to mustard. If you have an allergy, consult a doctor.
1.2. Treat hands hygienically and dry.
1.3. Check the suitability of mustard plasters: mustard should not fall off the paper and have a specific (pungent) smell. When using mustard plasters made using other technologies (for example, packaged mustard), check the expiration date.
1.4. Prepare equipment. Pour hot (40-45°) water into the tray.
1.5. Help the patient lie on his stomach (when placing mustard plasters on his back) and take a comfortable position, the patient's head should be turned to the side.
2. Performing the procedure:
2.1. Immerse the mustard plaster in hot water and let it drain.
2.2. Press the mustard plaster firmly onto the skin with the side covered with mustard.
2.3. Repeat paragraphs 2.1.-2.2., placing the required number of mustard plasters on the skin.
2.4. Cover the patient with a diaper, then a blanket.
2.5. Clarify the patient’s sensations and the degree of hyperemia after 3-5 minutes.
2.6. Leave the mustard plasters for 10-15 minutes, taking into account the patient’s individual sensitivity to mustard.
3. Completion of the procedure:
3.1. If persistent hyperemia appears (after 10-15 minutes), remove the mustard plasters and place them in a prepared tray for used materials with their subsequent disposal.
3.2. Soak a napkin in warm water and remove any remaining mustard from the skin.
3.3. Use a diaper to blot the patient's skin dry. Help him put on his underwear, cover him with a blanket and warn him to stay in bed for at least another 20-30 minutes and not take a bath or shower that day.
3.4. Treat hands hygienically and dry.
3.5. Make an appropriate entry about the procedure performed in the medical documentation.
Additional information about the features of the technique:
It is necessary to monitor the time of the procedure, since with longer exposure to mustard plasters, a chemical burn of the skin with the formation of blisters is possible.
Grade
Skin hyperemia, burning sensation - The procedure was performed correctly
No redness, no burning sensation - The procedure was performed incorrectly, the therapeutic effect was not achieved
Signs of a chemical burn (the appearance of blisters on the skin) - The procedure was performed incorrectly due to non-compliance with the time for placing mustard plasters
14. Setting up cans.
Contraindications:
Purulent skin diseases,
Hyperthermia.
I. Preparation for the procedure.
1. Introduce yourself to the patient, explain the purpose and course of the procedure.
2. Make sure the edges of the cans are intact and place them in a box on the table at the patient’s bedside
3. Treat hands hygienically and dry.
4. Adjust the height of the bed.
5. Lower the head of the bed, help the patient lie on his stomach (when placing the cups on his back), offer to turn his head to the side, and clasp the pillow with his hands. Remove clothing from the upper body.
6. Cover the patient’s long hair with a diaper.
7. If there is hair at the place where the cups are placed, with the consent of the patient, shave it off.
II. Execution of the procedure.
8. Apply a thin layer of Vaseline to the skin.
9. Make a dense wick from cotton wool and secure it to the forceps.
10. Moisten the wick in alcohol and squeeze it out. Close the bottle with a lid and set aside. Wipe your hands.
11. Light the wick
12. Insert the wick into the jar, previously taken in the other hand.
13. Hold the wick in the cavity of the jar for 2-3 seconds, remove it and quickly apply the jar to the patient’s skin.
14. Repeat steps 12-13 as many times as necessary, according to the number of cans.
15. Extinguish the wick by immersing it in water.
16. Cover the surface of the cans with a towel or diaper, and cover the patient with a blanket on top.
17. After 3-5 minutes, check the effectiveness of the placement by the pronounced (1 or more cm) retraction of the skin into the cavity of the can and make sure that the patient does not feel pain. If the installation of one or more cans is ineffective, remove them and reinstall them.
18. Maintain exposure for 15-20 minutes.
19. After the procedure time has elapsed, remove the jars (with one hand, tilt the jar to the side, with the other, press on the skin on the opposite side at the edge of the jar, and then remove the jar).
20. Use a napkin to remove Vaseline from the patient’s skin.
III. End of the procedure.
21. Help the patient get dressed.
22. Wash the jars with warm water and put them in a box.
23. Treat hands hygienically and dry.
24. Make an appropriate entry about the results of the implementation in the medical documentation.
Additional information about the features of the technique
The typical place for cupping is the surface of the chest, excluding the heart area, the spine area and the mammary gland area in women.
In the practice of reflexology, it is permissible to place cups on other areas of the body, subject to general contraindications. In all cases, cups should be placed on areas with a pronounced subcutaneous fat and/or muscle layer.
In clinical practice, the use of alternative methods of cupping is permitted. The advantages of alternative methods are the achievement of a clinical effect without the use of flame, reduced material costs, and greater psychological comfort for the patient.
Alternative ways to place cans are to use:
1. Silicone cups, which allow, after compression and contact with the surface of the patient’s skin, to create a dosed vacuum of up to 0.5 bar. In this case, stages 10-15 of the methodology for performing a simple medical service are changed as follows:
Squeeze the body of the can, achieving a decrease in the volume of the internal cavity.
Apply the jar to the selected area, ensuring tight contact of the neck plane with the patient’s skin.
Release the can body.
2. Methods of hardware vacuum therapy, in which vacuum in the cavity of the can is achieved using a mechanical or electric pump. Vacuum therapy devices are used in accordance with the manufacturer's instructions.
^ Achieved results and their evaluation
A decrease in pressure in the skin area significantly changes the normal ratio of hydrostatic and oncotic pressure gradients in the underlying blood and lymphatic vessels, which leads to an increase in convection fluid flow and bilateral metabolism in the microcirculation zone. An increase in concentration gradients of oxygen and carbon dioxide leads to an increase in the rate of their transcapillary diffusion and increases the intensity of metabolism of the underlying tissues.
An increase in the permeability of the endothelium of the superficial choroid plexus of the dermis leads to an increase in the number of neutrophils and macrophages entering the interstitium, which utilize inflammatory products and stimulate reparative tissue regeneration.
Rupture of capillaries at the site of placement leads to the formation of a hematoma, due to the autolysis of which the biosynthesis of the body’s own proteins, including immunocompetent ones, is activated.
Irritation of the reflex zones of the skin leads, due to the arising cutaneous-visceral reflexes, to an increase in the blood supply to the internal organs segmentally associated with this area of influence.
^ Parameters for assessing and quality control of the method implementation
There are no deviations from the measurement algorithm.
- No complications during and after the procedure
- Availability of a record of the results of the prescription in the medical documentation
- Timely execution of the procedure (in accordance with the appointment time)
- Patient satisfaction with the quality of the medical service provided.
15. Applying a local warming compress.
Indications as prescribed by a doctor.
Contraindications:
Purulent skin diseases,
Hyperthermia.
PREPARE:
A napkin (linen - 4 layers or gauze - 6-8 layers),
Wax paper (no polyethylene),
Bandage (can be elastic),
kidney-shaped tray,
Solution: ethyl alcohol 40-45% or vodka, water 20-25°C.
^ PATIENT PREPARATION:
1. Psychological.
2. Explain the meaning of the manipulation and the rules of behavior for the patient.
SEQUENCING:
1. Prepare the first layer of compress (napkin) so that its dimensions are 3 cm larger than the site of the disease.
2. Each subsequent layer of compress should be 3 cm larger than the previous one.
3. Soak a napkin in the solution and wring it out well.
4. Place it on the desired area of the body (if it is the ear, cut a hole to the size of the ear).
5. Apply wax (compress) paper as a second layer (if on the ear, cut a hole).
6. Place a layer of cotton wool on top of the paper, which should completely cover the two previous layers.
7. Secure the compress with a bandage so that it fits snugly to the body, but does not restrict the patient’s movements.
8. Check with the patient about his feelings after some time.
9. Leave the compress for 8-10 hours, and the alcohol compress for 4-6 hours (it is better to leave them overnight).
10. After 2-3 hours, check that the compress is placed correctly, place your finger under the first layer of the compress, if it is wet and warm, then the compress is placed correctly, if it is dry, then the compress must be placed again.
11. After removing the compress, apply a dry, warm bandage using cotton wool and a bandage.
16. Applying a cold compress.
17. Preparing and serving a heating pad to the patient.
Indications: doctor's prescription. Contraindications:
Bleeding of various origins;
Acute inflammatory processes of any localization;
Malignant neoplasms;
Skin damage;
Bruises (first day);
Infected wounds.
PREPARE:
Water (t° 65°C);
A towel or cover for a heating pad;
Water thermometer.
^ PATIENT PREPARATION:
Psychological;
Explain to the patient how to use the heating pad and when to remove it.
SEQUENCING:
1. When using the heating pad for a long time, apply Vaseline or other greasy cream to the skin (using gloves) to avoid burns.
2. Check the heating pad for leaks.
3. Fill it 2/3 full with water, hold it by the narrow part of the neck.
4. Displace steam from the heater over the sink by bending the narrow part of the heater away from you, and in this position screw the cap.
5. Turn the heating pad upside down and check its tightness.
6. Dry with a towel, put a cover on it or wrap it in a dry towel and apply to the desired area of the body.
7. After 5 minutes, check to see if the patient has overheated skin (symptom of “marbled skin” or bright hyperemia).
8. Remove the heating pad after it has cooled down.
9. Pour out the water, screw on the cap and immerse the heating pad and towel in the disinfectant. solution for at least 60 minutes.
ADDITIONAL INFORMATION. The heating pad is stored dry with the lid open.
18. Prepare and serve an ice pack to the patient.
Indications the doctor determines:
Acute inflammatory processes;
Bleeding;
Hyperthermia;
Bruises in the first hours;
For insect bites;
After abortions;
Postoperative period.
Contraindications: hypothermia (determined by the doctor).
PREPARE:
1. Ice pack.
2. Pieces of ice.
3. Towel or diaper.
5. Wooden hammer. PATIENT PREPARATION:
Psychological;
Explain to the patient the essence of the manipulation and how he should behave when performing it."
^ SEQUENCING:
1. Take an ice pack and check its tightness.
2. Unscrew the cover.
3. Place the ice cubes in a towel and then in a tray.
4. Use a wooden mallet to crush the ice.
5. Fill the ice bubble to 2/3 of the volume with the resulting pieces of ice.
6. Add water, press the bubble against a horizontal surface and in this position screw on the lid, turn the bubble over and check its tightness.
7. Pat dry, roll the towel into 4 layers and wrap it around the bubble.
8. Sit or lay the patient in a comfortable position and apply the bladder to the desired area of the body.
9. Leave it for 10-15 minutes, if you need to use it for a long time, take a break of 30-40 minutes. and then repeat the procedure.
10. When finished using, remove the bladder, empty the water, force out the air, screw on the cap and soak it and the towel for at least 60 minutes.
ADDITIONAL INFORMATION. Store the bottle dry with the lid open.
19. Applying a tourniquet to the shoulder.
Application of tourniquet and tourniquet-twist
The method is used mainly for damage to large vessels of the extremities, primarily arteries. The absolute indications for applying a tourniquet are arterial bleeding in case of injuries to the upper extremities - from the shoulder to the elbow joint, and to the lower extremities - from the hip to the knee joint.
Before applying a tourniquet, apply finger pressure to the bleeding vessel.
^ Rules for applying a tourniquet
Before applying a tourniquet, the limb must be elevated.
A tourniquet is applied for arterial bleeding above the wound, and for venous bleeding below the wound.
When bleeding from the arteries of the upper limb - in the upper third of the shoulder;
When bleeding from the arteries of the lower limb - in the middle third of the thigh.
However, this causes large areas of tissue to bleed, which is undesirable. Therefore, it is more rational to recommend applying a tourniquet as close to the wound as possible.
A soft pad is applied to the intended application site.
The tourniquet is stretched and in this position is applied to the raised limb, and each subsequent turn lies next to the previous one and must be weaker than the previous one; the ends of the tourniquet are secured.
The tourniquet must not be covered with a bandage; the lock must be located at the front and easily accessible.
A note should be placed under the tourniquet indicating the date and time it was applied.
ATTENTION!
You should avoid applying a tourniquet in the middle third of the shoulder (due to the risk of damage to the radial nerve), in the wrist and lower third of the leg (does not always stop bleeding).
When there is bleeding from a wound located in the upper third of the shoulder and thigh, a tourniquet is applied in a figure-of-eight pattern. The application begins in 2-3 rounds on the upper third of the limb, and then the tourniquet is led along the body, where it is secured.
Signs of proper tourniquet application:
bleeding stops;
the pulse in the peripheral artery is not detected;
the skin turns pale.
applying a tourniquet without indications (bleeding can be stopped in another way);
weak tightening with a tourniquet increases bleeding;
strong tugging with a tourniquet - can cause damage to large nerve trunks (development of paralysis) or tissue necrosis;
applying a tourniquet without a soft pad and without a note.
20. Providing first aid for sudden shortness of breath.
When shortness of breath occurs, a person feels short of breath and breathes heavily and frequently. In a healthy person, shortness of breath can occur with heavy physical exertion.
As a clinical symptom in a number of diseases, shortness of breath has great diagnostic and prognostic significance.
Distinguish inspiratory dyspnea- breathing with difficulty inhaling; expiratory- breathing with difficulty exhaling; mixed- breathing with difficulty inhaling and exhaling.
Watch:
when does shortness of breath occur, how quickly does it develop;
what position does the patient take during an attack of shortness of breath;
whether shortness of breath is accompanied by cough, wheezing, chest pain;
what complexion does the patient have (the skin may take on a bluish or gray color - cyanosis);
what is the breathing rate, does shortness of breath turn into suffocation.
If a patient experiences an acute attack of shortness of breath, it is necessary to urgently call an ambulance and take urgent measures to ease breathing:
limit the physical activity of the ward;
in case of severe shortness of breath, sit the patient in a chair or on a bed;
give the patient an elevated (sitting) position by placing a headrest or several pillows under the back or raising the top of a functional bed;
reassure the patient and explain to him that after treatment begins, shortness of breath will decrease;
try to switch the attention of the ward;
free the patient from the heavy blanket and restrictive clothing;
ensure maximum flow of fresh air by opening a window or window;
use humidified oxygen inhalations at home;
monitor the frequency, depth and rhythm of breathing.
If shortness of breath is chronic and associated with chronic bronchitis or emphysema:
smokers need to quit smoking;
spend more time in the fresh air, avoid dust, smoke, strong odors;
rest more;
watch out for colds and flu;
take a course in breathing exercises and special exercises from a physical therapy doctor;
undergo a course of physiotherapy with a physiotherapist;
As prescribed by your doctor, keep broad-spectrum antibacterial drugs at home and, in case of infection, start taking them as early as possible.
it is necessary to prevent the patient’s contact with the allergen;
provide him with an inhaler containing the drug that the doctor prescribed before the attack;
If it is difficult to separate sputum, use available expectorants.
21. Collection of sputum for laboratory tests (general analysis, culture).
Indications:
Contraindications: Determined by the doctor.
Equipment:
Clean dry glass jar.
Form for referral to a clinical laboratory.
Pharmacy gum.
Gloves.
Prepare laboratory glassware.
Create a direction and attach it to the container using a rubber band.
In the morning on an empty stomach, instruct the patient to rinse his mouth and pharynx with drinking water.
Put on gloves and take the jar.
Invite the patient to breathe deeply, cough and spit the sputum into the jar without touching the edges, 3-5 ml in total.
Deliver the container containing the collected sputum to the clinical laboratory for testing.
Paste the result into your medical history.
Teaching the patient or his relatives:
Advisory type of nursing care in accordance with the sequence of actions of the nurse described above.
^
Sputum COLLECTION BACTERIOLOGICAL STUDY
Equipment:
Sterile container with a lid (jar with a lid or Petri dish).
Referral to the bacteriological laboratory.
Pharmacy gum.
Gloves.
Psychological (increased gag reflex and disgust towards this intervention).
Difficulty coughing.
Inform the patient about the upcoming procedure and its progress.
Take sterile glassware from the laboratory.
Invite the patient on an empty stomach to brush his teeth and rinse his mouth with boiled water or furacillin solution (0.02%).
Create a direction.
Wear gloves.
Carefully remove the lid from the sterile container.
Invite the patient to take 2-3 deep breaths, cough and spit 2-3 sputum into the container so that his mouth does not touch the edges of the container.
Close the lid carefully.
Attach the direction with a rubber band, remove gloves, wash your hands.
Take the collected material to the laboratory and wash your hands.
Paste the result into your medical history.
Notes:
When teaching the patient and family, ask them to demonstrate the sequence of actions to you.
Sputum must be delivered to the laboratory immediately or if stored in the refrigerator at a temperature of +4 degrees Celsius for the first 2 hours.
and pulmonary hemorrhage.
Indications: For diseases of the respiratory system.
Contraindications: Determined by the doctor.
Sequence of m/s actions to ensure environmental safety:
Inform the patient about the upcoming procedure and its progress.
The patient must be provided with complete physical rest.
It is necessary to sit the patient in bed in a semi-sitting position with an inclination to the affected side in order to avoid blood getting into the healthy lung.
An ice pack is placed on the affected side of the chest. The patient is allowed to swallow small pieces of ice, which leads to a reflex spasm and a decrease in blood supply to the blood vessels of the lungs.
Hemoptysis, and even more so pulmonary hemorrhage, is accompanied by a violent emotional reaction of fear, both from the patient himself and his loved ones, especially if it occurs for the first time. In this regard, it is necessary to try to reassure the patient and his loved ones, instilling confidence in the absence of a real danger to life.
To reduce the emotional reaction on the part of the patient and his loved ones, it is recommended to use bedding and underwear, as well as scarves and towels, not in white, but in dark colors, for example, green, on which blood is not so noticeable and looks like dark, not red spots.
If hemoptysis or pulmonary hemorrhage is accompanied by a cough, the patient must be given antitussives as prescribed by the doctor.
Exposure to high temperatures may cause increased bleeding. Therefore, the patient can only eat cold and semi-liquid foods.
The use of a hot bath or shower, cupping, mustard plasters, heating pads and hot compresses on the chest are strictly prohibited. Until examined by a doctor, the patient should not move or talk.
patient using a pocket inhaler.
Indications: Bronchial asthma (to improve bronchial patency).
Contraindications: Identified during the examination of the patient.
Equipment:
Inhaler with medicinal substance.
Inhaler without medicinal substance.
Fear of using an inhaler or medication.
Decreased intellectual capabilities, etc.
Difficulty breathing when administering a drug through the mouth.
Inform the patient about the use of the inhaler.
Inform the patient about the drug.
Check the name and expiration date of the medicinal substance.
Wash your hands.
Demonstrate the procedure to the patient using a drug-free inhalation canister.
Make the patient sit down.
Remove the protective cap from the mouthpiece of the can.
Turn the aerosol can upside down.
Shake the can
Take a deep breath.
Take the mouthpiece of the can into your mouth, wrapping your lips tightly around it.
Take a deep breath through your mouth and simultaneously press down on the bottom of the can.
Hold your breath for 5-10 seconds.
Remove the mouthpiece from your mouth.
Exhale calmly.
Disinfect the mouthpiece.
Invite the patient to perform the procedure independently with an inhaler filled with medicinal substance.
Close the inhaler with the protective cap.
Wash your hands.
Note: The number of inhalations is determined by the doctor. If the patient’s condition allows, then it is better to do this procedure while standing, since the breathing excursion is more effective.
4. Determination of the main characteristics of the arterial
pulse on the radial artery.
PULSE - jerky vibrations of the walls of blood vessels caused by the movement of blood pushed out by the heart. PULSE DETERMINATION POSITIONS:
radial artery,
temporal artery,
Carotid artery.
Artery of the dorsum of the foot.
^ SEQUENCING:
1. Using your hand, cover the patient’s WRIST joint so that the THUMB is located on the BACK of the forearm.
2. Using the remaining fingers, ON THE ANTERIOR surface of the joint, palpate the radial artery, pressing it against the radius. ADDITIONAL INFORMATION:
The pulse wave is felt as an expansion of the artery;
Pulse examination should begin on BOTH arms;
If there is no difference in pulse, then they are limited to examining it on one arm;
In healthy people, the pulse rate corresponds to the heart rate and is equal to 60-80 per minute;