The methodical instruction
for practical lesson
for 2nd year medical students
Lesson 4 (practical 7 h)
Theme: Using of main types of medicines. Physical treatment. (7 h)
Aim: To be able the procedures, influencing on circulatory system.
The professional orientation
The patients with serious disease require help in activity of daily living. They need also special skin care for bedsore prevention. The appropriate practical skills will be useful for students for providing home care in their families.
The simple techniques of physical therapy is very helpful for patient and can be used at home.
1. Self-preparation program
1. Using of mustard in medicine. Using of mustard-poultice.
2. Applying leeches. Sites for this procedure, care.
3. Compresses. Medicines, using with compresses.
4. Using of heater and ice-bag.
5. Preparation of bath.
2. The examples of test questions and case studies.
1. The doctor is doing the heart massage in patient F. How long is it necessary to do this, if positive changes are absent?
2. What is ratio between chest compressions and breathings during CPR?
3. The patient R. need applying the compress on the infiltration after injection. What solutions can be used?
4. The patient with myositis is administered with mustard-poultice. During this procedure the pain became more severe. What should the nurse do?
5. During taking bath the patient feels dizzy. What should the nurse do?
3. Answers.
1. 30 min.
2. 15 compressions : 1 breathing.
3. Hypertonic NaCl solution, 40º alcohol, 25 % dimexid.
4. Stop the procedure.
5. Help patient go out bath and lye on the couch.
4. LITERATURE
1. Wilson S., Giddens J. Health assessment for nursing practice. Second edition. Mosby.–2001.–P.857.
1. Practical work – 900-1200 (4 hours)
Task 1. Applying Cold Treatment
Cold therapy is used to decrease blood flow to an area by promoting vasoconstriction and increased blood viscosity. These changes facilitate clotting and control bleeding. Cold decreases tissue metabolism, reduces oxygen consumption, and decreases inflammation and edema formation. Cold therapy has a local anesthetic effect by raising the threshold of pain receptors. It causes a decrease in muscle tension. Cold is used to reduce fever. Sources of cold include ice packs, ice bags, cold collars, or commercial cold packs. If the client’s systemic temperature is elevated, cooling blankets or cooling tepid sponge baths can be used. Moist cold compresses or immersion of a body part can be used for large areas of acute inflammation or swelling. Cooling the extremity decreases blood flow and may also decrease pain and suppress inflammation.
EQUIPMENT NEEDED:
(Select equipment depending on the treatment chosen
and supplies available.)
• Pan for cold soak
• Ice or ice bag
• Gauze or towel
• Water bottles or reusable containers if used for one client only
• Compresses (if moist cold) consisting of gauze dressing, iced or chilled solution, and a container of the appropriate size for the body part
• Commercially prepared ice pack
ACTION
1. Wash hands.
2. Assess the client’s sensation and skin color at the site of planned application.Determine if any tissue damage is present. Assess for bleeding
or wound drainage
3. Determine the diagnosis. Identify whether the client has a history of circulatory impairment or neuropathy.
4. Check the physician’s or qualified practitioner’s order and the reason for the application of cold.
5. If using an ice bag with moist gauze or towels, fill the bag three-fourths full with ice and remove the remaining air from the bag. Close the bag. Check for leaks.Wrap the bag in a towel or protective cover and place it on the affected area. If cold soaks are being applied, use the appropriate-size basin for the body part to be soaked.
6. If an ice collar is used, fill the collar threefourths full with ice and remove the remaining air from the collar before closing the collar. Check for leaks. Place the collar in a protective cover and around the client’s neck.
7. If a disposable cold pack is used, activate the pack according to the manufacturer’s directions, wrap the pack in a towel, and place it on the affected area. Some packs come with covers. Secure pack in place with tape, elastic wrap, or bandage. Dispose of the pack after the treatment.
8. Assess the client’s skin periodically for signs of cold intolerance or tissue damage.
9. If the client can tolerate the cold, leave the cold application in place for
approximately 20–30 minutes at approximately
10. Reassess the condition of the client’s skin or exposed tissue.
11. Wash hands.
Task 2. Applying Moist Heat
Heat application is used to promote vasodilatation, increase capillary permeability, decrease blood viscosity, increase tissue metabolism, and reduce muscle tension. Moist heat can be in the form of immersion of a body part in a warmed solution or water. It can also be accomplished by wrapping body parts in dressings that are saturated with warmed solution.
EQUIPMENT NEEDED :
• Aqua heat pad
• Commercial heat pack
• Solution for heat treatment
• 434 Gauze and waterproof pads
• Examination gloves
• Sterile glove if open wounds
• Towel
ACTION
1. Assess the client’s skin for areas of redness, breakdown, or scar tissue. If open wounds are involved, carefully assess the open wounds.
2. Determine the client’s condition, medical diagnosis, and any history of diabetes mellitus or impairments in sensation.
3. Check the physician’s order and the reason for the warm compress.The reason for the compress should be explained to the client.
4. Wash hands.
5. Warm the container of sterile saline or tap water by placing it in a bath basin filled with hot tap water. Sterile saline should be warmed to 105°–113°F. If you are using a commercial compress, follow the manufacturer’s directions for heating the compress.
6. Place a waterproof pad under the body area that needs the warm compress
8. Pour the sterile saline into the sterile basin. Soak an appropriate-size piece of gauze or a towel, wring out the excess saline, and place it on the affected area .Wear gloves if there is any drainage of the client’s body fluids.Wear sterile gloves if there is an open wound.
9. Wrap the area with a waterproof pad or apply a disposable heat or aquathermia pad
10. Check the client’s skin periodically for signs of heat intolerance.Tell the client to report any signs of discomfort immediately.
11. If it is tolerated, leave the compress in place for approximately 30 minutes and then remove it.
12. Dry the affected area with sterile towels if there is an open wound and with clean towels if there is no open wound.
13. Properly dispose of all single-use equipment according to hospital protocol.
14. Clean the bath basin and thermometer. Return the sterile basin to the appropriate place for resterilization.
15. Remove gloves if they were worn and wash your hands.
16. Reassess the condition of the client’s skin.
17. Record the procedure. Note the condition of the client’s skin and the length of the application. Report any abnormal findings to the physician.
Task 3. Applying Dry Heat
Dry heat can be used to enhance circulation, promote healing, reduce swelling and inflammation, reduce pain, reduce muscle spasms, and increase systemic temperature. Different types of equipment are used to apply dry heat to body surfaces, specific areas, and the entire body.
These can be divided into the following categories:
1. Body surfaces. Equipment used to apply heat to any body surface includes disposable instant hot packs, gel-filled hot packs, aquathermia pads, electric heating pads, and hot water bags or bottles. Aquathermia pads are waterflow rubber heating pads with tubing and a reservoir control unit, sometimes called aqua pads, k-pads, t-pump, or hydrocalculator. Hot water bags or bottles should be used only by clients at home because bags and bottles cannot be cleaned properly to meet universal standards.
2. Specific areas. Equipment used to apply heat to specific areas includes heat lamps or infrared lamps (generally for the abdomen, perineum, or the chest), heat cradles (generally for the lower extremities), and diathermy (generally for deep heat treatment, which utilizes electrical energy that is changed to heat).
3. Entire body. Equipment used to heat the entire body to treat cases such as hypothermia includes thermal blankets and infant radiant warmers, which are discussed in Skill 3-8. The principles and precautions are similar in most types of heat application.
EQUIPMENT NEEDED:
• Equipment determined by type of heat treatment:
disposable gel-filled packs , aquathermia pad, heating pad, hot water bottle (generally
used only in home setting if at all), heat lamp or heat cradle, hot blankets, or hot air patient warming system
• Protective cover to be used between heat source and patient
• Electrical source for pads
• Timer or clock
ACTION
1. Check the physician’s or qualified practitioner’s order and the purpose of the heat treatment.
2. Determine if there are any underlying problems that may affect the use of heat treatment such as decreased sensation; decreased mentation; or a history of diabetes mellitus, bleeding disorders, peripheral vascular disease, or peripheral neuropathy.
Heat should not be used over areas of scarring.
3. Wash hands.
4. Check the skin for lotions or ointments and remove if present.
5. Explain the reasons for heat treatment, the expected outcomes, any potential complications, and the necessity to alert the nurse of heat intolerance.
6. Gather equipment and complete as follows:
For a disposable heat pack:
• Activate the pack according to the manufacturer’s directions. Some packs must be
heated in boiling water, others can be heated by microwave, and some require
bending and chemical activation.
• Wrap the pack in a towel or protective covering (some manufacturers include cover). Do not use pins.Use tape if needed to secure the towel.
Discard after use.
For a heating pad:
• Note: Heating pads are generally not used in hospital facilities.
• Place a formed cover, usually a flannel, over the pad.Towels should not be used. Pins should never be used. If it is necessary to secure the cover, use tape.
• Instruct the client not to lie on the heating pad.
• Turn on the switch to low and place the heating pad on the affected area.The nurse
may increase heat after the client adjusts to the heat. Instruct the client not to adjust the heat level.
Generally the highest setting is not used and is blocked from use by taping the control
in place.
• Set a timer and remove the pad after 20 minutes.
• Clean appropriately after use.
For a hot water bottle:
• Hot water bottles are usually used only in home care settings.
• Fill the bottle with tap water, tighten the cap, turn the bottle upside down, then open
the cap and empty.
• Fill the bottle or bag with hot water (40.5°–46°C or 105°–115°F). Fill bag only
two/thirds full, expel any air from top, and secure cap. Wipe off excess moisture.
• Cover with protective cover or towel. Never use pins.Tape may be used.
• Keep the bottle in place for 20–30 minutes.
7. Wash hands.
6. Seminar Discussion of pracrical work – 1230-1445 (2 hours)
7. Test control of students’ knowledges – 1415-1500 (1 hour).
Basic level:
Student must know:
· Using of mustard in medicine.
· Using of mustard-poultice.
· Applying leeches. Sites for this procedure, care.
· Compresses. Medicines, using with compresses.
· Using of heater and ice-bag.
· Preparation of bath.
Student must have the skills:
· Using of mustard in medicine.
· Compresses.
· Using of heater
· Using of ice-bag.
· Preparation of bath.
Prepared by
Adopted at the Chair Sitting N .2008
