For local inflammatory processes, warming and hot compresses . The purpose of the procedure is to achieve an analgesic and absorbable effect. A warm compress and a hot compress are applied as prescribed by a doctor.
Indications for the use of hot and warming compresses are:
- local inflammatory processes in the skin and subcutaneous tissue, in joints;
- inflammation of the middle ear (otitis);
- bruises one day after injury;
- myositis;
- post-injection infiltrates.
Sequencing
After preparing the equipment:
- We wash our hands and put on gloves.
- We free the required area of the patient’s skin for applying a compress.
- Prepare a napkin of the required size: it should be 3 cm larger than the area on which the compress is applied.
- Wet the napkin in 45% alcohol or hot water (water temperature 40-45 °).
- Place the napkin on the prepared area of the body and press it firmly against the skin.
- We put compress (waxed) paper on top of the napkin so that it overlaps the size of the wet napkin by 2-3 cm.
- Apply the next layer of cotton wool so that it covers the size of the compression paper.
- We secure the compress with a bandage so that it fits tightly to the skin, but does not cause compression of the underlying tissues and does not restrict the patient’s movements.
- After 2-3 hours, we check that the compress has been applied correctly: place your finger under the 1st layer of the compress; if the compress is wet and warm, it is applied correctly. If the compress is dry, remove it and redo it again.
- Leave the semi-alcohol compress for 4-6 hours, the water compress for 8-10 hours.
- After removing the compress, apply a dry, warm bandage to the skin area.
- After completing the procedure, remove the gloves, immerse them in a tray with a disinfectant solution and wash your hands.
Possible complications of warm compresses:
- skin irritation;
- skin burns.
When reapplying the compress, first wipe the skin with 45% ethyl alcohol and wipe dry. Between compresses we take a break of 2-3 hours.
Applying a warm compress is one of the necessary skills for a nurse. You should remember the basic rules when applying compresses:
Warming compress layers:
- a napkin moistened with water or a semi-alcohol solution;
- compress paper;
- cotton wool
Each subsequent layer should overlap the previous one by 2-3 cm.
Ethyl alcohol must be diluted to a concentration of 45%. Using undiluted or insufficiently diluted alcohol can cause burns.
Applying a warm compress
1. Establish contact with the patient (say hello, introduce yourself, indicate your role), identify the patient (ask the patient to introduce himself, check with medical documentation).
2. Explain the process and purpose of the procedure, position the patient comfortably
3. Make sure the patient has voluntary informed consent
4. Prepare: a piece of gauze folded 6-8 times, compress paper, compress paper (oilcloth or compress paper 2 cm larger than the gauze layer), a piece of cotton wool of sufficient thickness, 2 cm larger than the compression paper, water at room temperature or 45% alcohol, bandage.
5. Treat your hands hygienically, wear non-sterile gloves
6. Moisten a gauze pad and squeeze it out so that the liquid does not drain, apply to the desired area.
7. Place compress paper or oilcloth on top of the gauze cloth, then cotton wool, completely covering the previous two layers.
8. Fix the applied compress firmly with a bandage (if on a limb, then bandage starting from a narrower area)
9. The correct application of the compress must be checked after 2 hours (insert 1-2 fingers under the napkin, you should feel moisture and warmth). The compress lasts for 6-8 hours.
10. Check with the patient about his well-being
11. Remove gloves and apron and place them in a bag for class B waste
12. Treat your hands with antiseptic
13. Make a record of the results of the manipulation in the medical documentation.
25.Using an ice pack
1. Establish contact with the patient (say hello, introduce yourself, indicate your role), identify the patient (ask the patient to introduce himself, check with medical documentation).
2. Explain the process and purpose of the procedure, position the patient comfortably
3. Make sure the patient has voluntary informed consent
4. Prepare: ice pack, water thermometer, clock, container with cold water 12-14 degrees, crushed ice, towel, diaper, paper towels
5. Offer or help the patient to find a comfortable position.
6. Treat hands hygienically and dry
7.Fill the bubble with pieces of ice and fill them with cold water (12-14ºС)
8. Place the bubble on a horizontal surface, displace the air and screw the cap tightly.
9. Wrap the bubble in a towel or diaper folded in several layers.
Apply an ice pack to the designated area of the body for 20 minutes
10. Remove the ice pack and inspect the surface of the skin.
If necessary, reapply after 10-15 minutes.
As the ice melts, the water is drained and pieces of ice are added. The total cooling time should not exceed 2 hours.
11. Help the patient take a comfortable position. Check with the patient how he is feeling
12. Open the lid of the bubble and pour out the water.
13. Treat the bubble with a disinfectant solution 2 times with an interval of 15 minutes.
Dry the bladder and store in a dry, clean condition.
14. Treat hands hygienically and dry
15. Make a record of the manipulation in the medical documentation.
26. Using a heating pad
1. Establish contact with the patient (say hello, introduce yourself, indicate your role), identify the patient (ask the patient to introduce himself, check with medical documentation).
2. Explain the process and purpose of the procedure
3. Make sure the patient has voluntary informed consent
4. Prepare: a heating pad, a container with water at a temperature of 60-65 degrees, a water thermometer, a diaper - 2 pcs.
5. Treat your hands hygienically
6. Fill the heating pad with water to 2/3 of its volume, carefully displace the air from it, and screw the valve tightly.
7. Wipe the heating pad dry, make sure the heating pad is sealed by turning the cap down and squeezing it with your hands on both sides.
8.Help the patient find a comfortable position
9. Wrap the heating pad in a diaper
10 Apply a heating pad to the designated area for a certain time (place of application and time are prescribed by the doctor)
11. After 5 minutes, check for signs of tissue overheating (severe hyperemia, burning sensation).
12. After the prescribed time, the doctor remove the heating pad, examine the patient’s skin at the site of contact with the heating pad. Help the patient take a comfortable position in bed, cover him with a blanket and warn him to remain in bed for at least 1 hour.
13. Open the cap of the heating pad and pour out the water.
14. Using a napkin moistened with disinfectant, treat the heating pad twice with an interval of 15 minutes, throw a disposable rag into a bag for class B waste
15. Remove gloves, treat hands hygienically
16. Make a note of the results of the manipulation
27. Blood pressure measurement
1. Establish contact with the patient (say hello, introduce yourself, indicate your role), identify the patient (ask the patient to introduce himself, check with medical documentation).
2. Explain the process and purpose of the procedure. Ensure that the patient has voluntary informed consent
3. Invite the patient to take the necessary position for the procedure, ask to bare his arm and clarify that the patient is comfortable, with relaxed and uncrossed legs, feet on the floor, back resting on the back of the chair, hand lying on the surface at heart level, palm surface up , breathing calmly, maintaining silence.
4. Prepare: a device for measuring blood pressure, a stethophonendoscope (for auscultatory determination of Korotkoff sounds), an antiseptic or disinfectant for treating the stethophonendoscope membrane.
5. Check the serviceability of the device for measuring blood pressure in accordance with the instructions for its use.
6. Treat hands hygienically and dry
7.Expose the patient’s hand, placing it palm up, at the level of the heart.
8. Place the blood pressure cuff on the patient’s shoulder. Two fingers should be placed between the cuff and the surface of the shoulder (for children and adults with small arms - one finger), and its lower edge should be located 2.5 cm above the ulnar fossa.
9. Place two fingers of your left hand on your forearm where you can feel the pulse.
10. Close the bulb valve of the blood pressure measuring device with your other hand. Gradually inject air with the bulb of the device for measuring blood pressure until the pulse disappears. This pressure level, recorded on the tonometer scale, corresponds to systolic pressure.
11. Deflate the blood pressure cuff and prepare the device for re-inflation.
12. Place the stethophonendoscope membrane at the lower edge of the cuff above the projection of the brachial artery in the area of the ulnar cavity, lightly pressing it against the skin, but without making any effort.
13. Re-inflate the cuff of the device for measuring blood pressure to a level exceeding the result obtained with a finger pulse measurement by 30 mm Hg.
14. Maintaining the position of the stethophonendoscope, begin deflating the air from the cuff at a speed of 2-3 mm Hg. in a second. When the pressure is more than 200 mmHg. it is allowed to increase this indicator to 4-5 mm Hg. in a second.
15. Remember on the scale on the device for measuring blood pressure the appearance of the first Korotkoff sound - this is systolic pressure, the value of which should coincide with the estimated pressure obtained by palpation from the pulse
16. Mark on the scale on the blood pressure device the cessation of the loud last Korotkoff sound - this is diastolic pressure. To control the complete disappearance of sounds, continue auscultation until the pressure in the cuff decreases by 15-20 mm Hg. relative to the last tone.
17. Remove the blood pressure cuff from the patient’s arm.
18. Inform the patient the result of blood pressure measurement.
19. Treat the membrane of the blood pressure measurement device with an aseptic or disinfectant.
20. Treat hands hygienically and dry.
21. Record the results in the appropriate medical records.
1. Conditions for measuring blood pressure. The measurement should be carried out in a calm, comfortable environment at room temperature, after the patient has adapted to the office conditions for at least 5–10 minutes. An hour before the measurement, avoid eating, smoking, taking tonic drinks, alcohol, and using sympathomimetics, including nasal and eye drops.
2. Patient position. Blood pressure can be determined in the “sitting” (most common), “lying”, and “standing” positions, but in all cases it is necessary to ensure that the arm is positioned in such a way that the middle of the cuff is at the level of the heart. Every 5 cm of displacement of the middle of the cuff relative to the level of the heart leads to an overestimation or underestimation of blood pressure by 4 mmHg. Art.
In the “sitting” position, the measurement is carried out with the patient seated in a comfortable chair or chair, supported on the back, with the exception of crossing the legs. It must be taken into account that deep breathing leads to increased variability in blood pressure, so it is necessary to inform the patient about this before starting the measurement. The patient's hand should be comfortably located on the table next to the chair, and lie motionless with support at the elbow until the end of the measurement. If the table height is not sufficient, you must use a special hand rest. The position of the hand “in weight” is not allowed. To measure blood pressure in a standing position, it is necessary to use special supports to support the arm, or support the patient’s arm at the elbow during measurement.
3. Frequency of measurement. Repeated measurements are carried out at intervals of at least 2 minutes. During the patient's first visit, blood pressure should be measured in both arms. In the future, it is advisable to perform this procedure only on one hand, always noting which one. If persistent significant asymmetry is detected (more than 10 mm Hg for systolic and 5 mm Hg for diastolic blood pressure), all subsequent measurements are carried out on the arm with higher numbers. Otherwise, measurements are carried out, as a rule, on the “non-working” hand. If there is a difference of more than 5 mm Hg. Art., a third measurement is carried out, which is compared according to the above rules with the second, and then (if necessary) the fourth measurement. If a progressive decrease in blood pressure is detected during this cycle, additional time should be allowed for the patient to relax. If multidirectional fluctuations in blood pressure are observed, then further measurements are stopped and the average of the last three measurements is determined (the maximum and minimum values of blood pressure are excluded).
28. Respiratory rate measurement
1. Establish contact with the patient (say hello, introduce yourself, indicate your role), identify the patient (ask the patient to introduce himself, check with medical documentation).
2. Explain the process and purpose of the procedure (say that you will assess the pulse), position the patient comfortably (lay him down)
3. Make sure the patient has voluntary informed consent
4. Prepare: watch with stopwatch. Check the serviceability and accuracy of the watch with a stopwatch.
5. Treat hands hygienically and dry.
6. Take the patient’s hand, place your hands (yours and the patient’s) on the chest (in women) or the epigastric region (in men).
7. Take a watch with a stopwatch and count the frequency of breathing movements in 1 minute. Respiratory movements should be counted in a calm environment. If breathing is rhythmic, it is possible to count respiratory movements in 30 seconds, and the result should be doubled.
The number of respiratory movements per minute in a healthy person ranges from 16 to 20.
8. Tell the patient the measurement result.
9. Treat hands hygienically and dry.
10. Record the results in the appropriate medical records.
29. Pulse assessment
1. Establish contact with the patient (say hello, introduce yourself, indicate your role), identify the patient (ask the patient to introduce himself, check with medical documentation).
2. Explain the process and purpose of the procedure, position the patient comfortably (seat or lie down)
3. Make sure the patient has voluntary informed consent
4. Prepare: watch with stopwatch. Check the serviceability and accuracy of the watch with a stopwatch.
5. Treat hands hygienically and dry
6. Assess the pulse in the following sequence: 1. Symmetry and rhythm. 2. Frequency.
7. Place the first finger of the hand on the back side above the patient’s hand, and the second, third and fourth along the radial artery, starting from the base of the patient’s first finger.
8. Lightly press the arteries to the radius on both arms, feel their pulsation, evaluate the symmetry and rhythm of the pulse.
9. Take a watch with a stopwatch.
10. Count pulse waves in the artery for 1 minute.
11.Determine the intervals between pulse waves (pulse rhythm)
12. Inform the patient the result of the pulse measurement.
13. Treat hands hygienically and dry.
14. Record the results in the appropriate medical records.
1. Pulse studies can be carried out not only on the radial artery, but also on the carotid, temporal, femoral arteries, as well as arteries of the foot, etc. Pulse studies should be carried out on both limbs, comparing its properties.
If the pulse is rhythmic, it is possible to count pulse waves in 30 seconds, and the result should be doubled.
If the patient has an infectious skin disease, it is recommended to perform the manipulation with gloves.
The results are assessed by comparing the data obtained with established age standards:
rhythmicity of the pulse - assessed by the regularity of pulse waves following one another. If pulse waves follow at regular intervals, then they speak of a rhythmic pulse.
pulse rate in adults – 60-80 oscillations/min.;
30. General thermometry
How to apply a warm compress to a child's ear
For a child, ear pain is almost unbearable. Parents, in turn, try in every possible way to help the baby. As you know, without a doctor’s examination you should not put any medication into a child’s ear, as this can cause unpleasant consequences. For this reason, many parents use good old folk remedies.
Compress is one of the most effective remedies. For ear inflammation, you can only use a warm compress, and not in all cases. Before using a warming procedure for a baby, every mother should know in what cases it is possible to warm the ear and in what cases it is not. In our article we will talk about applying a warm compress to a child’s ear.
In what cases can you warm a child’s ear?
Warming compress on a child's ear
Warm compresses are very useful for ear pain. Thanks to the effect of heat, blood circulation accelerates and blood vessels dilate, as a result of which pain is reduced and the child feels much better.
Parents are often tormented by the question, in what cases can a sore ear be warmed? The opinion of experts on this matter is as follows: Warming the ear is rather an additional therapy that becomes effective at the recovery stage.
For example, a warm compress can be applied for pain in the ears that is not associated with an inflammatory process, or if we are talking about otitis media that arose due to a concomitant disease, for example, against the background of a cold. During the first two days, you should not warm your child’s ear.
If after two days the child does not have a fever and there is no discharge from the ear, the ear can be thoroughly warmed up.
It is important! In no case are warm compresses an independent treatment. You can warm your ear only if there are no contraindications.
Contraindications
Despite this factor, doctors strongly recommend caution when warming the ear. Applying a compress has some serious contraindications for use:
- You cannot warm your ear if there is discharge from the ear canal;
- Under no circumstances should you create a “greenhouse” effect for the ear. In other words, moist heat is a contraindication. In this case, small drops of water settle inside the ear, which contribute to the spread of infection and an increase in the number of pathogenic microorganisms;
- It is forbidden to warm the baby’s ear if the body temperature exceeds the norm;
- You should not warm your ear if you suspect a perforated eardrum.
How to apply a compress to a child's ear
A warm compress on a child’s ear is a traditional method of treating ear pain associated with inflammation of the middle ear, hypothermia, or inflammation of the auditory nerve. If you apply an ear compress to your child correctly, you can reduce pain and speed up recovery.
This occurs by accelerating blood circulation in the diseased area. Thanks to this, metabolism, immune processes and the removal of toxic products are activated.
The so-called distraction effect also plays a role - warming the ear and insulating it reduces the sensation of pain and discomfort associated with congestion.
How to apply a compress to a child’s ear correctly? We will talk about the different types of compresses, their advantages and disadvantages. The technique of placing a warm compress on the child’s ear will also be described in detail.
Indications for use
A compress is placed on a child’s ear for pain in the ear. The main indication for the use of this remedy is acute catarrhal otitis media. What kind of disease is this?
Otitis is an inflammation of the middle ear. The adjective “catarrhal” indicates that the main role in the pathogenesis of the disease is played by inflammation of the mucous membrane - catarrh.
Inflammation of the mucous membrane of the middle ear is accompanied by swelling, accumulation of exudate (fluid produced by the glands of the mucous membrane), increased sensitivity to various irritants - temperature changes, sharp sounds, etc.
Most of the symptoms of otitis media are associated with swelling and accumulation of exudate:
- feeling of ear fullness;
- popping, crackling, tinnitus;
- headache (due to increased pressure in the middle ear cavity);
- severe ear pain.
Why does otitis media develop? The main cause of this disease is infection, most often bacterial.
Inflammation of the mucous membrane is caused by opportunistic human microflora, primarily staphylococci and streptococci. Their reproduction in the ear cavity causes a number of changes in the functioning of the body.
Thus, in children with otitis media, body temperature often rises, nausea, and lack of appetite bother them.
In case of acute catarrhal otitis, complex treatment is necessary - antibiotics, vasoconstrictor nasal drops (they relieve congestion in the Eustachian tube and facilitate the outflow of fluid from the ear).
Warm compresses can be an effective aid, but they have no effect on the infection.
Contraindications
Warming the ear does not always have a positive effect on the course of the disease. For example, with purulent otitis media, heating is fraught with increased production of pus and its flow into the cranial cavity associated with the middle ear canals.
For purulent otitis media, any thermal effects, including heating with compresses, are strictly contraindicated.
How to understand that you have purulent otitis media? This is indicated by the following symptoms:
- severe throbbing ear pain;
- sometimes pus leaks from the ear canal - check this with a napkin or cotton swab;
- body temperature reaches 38.5-39 C;
- a feeling of increasing pressure in the sore ear;
- dullness of hearing.
Warming should not be performed on patients with elevated body temperature.
Contraindications also include age under 1 year, the presence of skin diseases in the ear area (psoriasis, eczema, furunculosis, etc.) and perforation of the eardrum.
Types of Warming Compresses
Warming compresses are a three-layer bandage applied to the disturbing area of the body in order to preserve internal heat and deeply warm the tissues. They consist of the following layers:
- The first layer applied directly to the skin is wet. This is a gauze napkin folded 6-8 times. Its size should be slightly larger than the area of the child’s ear (approximately 10x10 cm). A longitudinal cut is made in the center of the napkin, corresponding to the length of the auricle. This layer is impregnated with various liquids - alcohol, vodka, oil, etc.
- The second layer serves to insulate the wet layer. It prevents the evaporation of liquid, its drainage, and also retains the heat generated by the body. As an insulating layer, special paper for compresses is used, which can be purchased at the pharmacy. At home, it can be replaced with cling film or parchment paper. An incision for the auricle is also made in the center of the insulating layer.
- The outer layer is called insulation. It is made from a dense layer of cotton wool several centimeters larger than the underlying layers (approximately 14x14 cm).
Depending on the liquid with which the wet layer is soaked, the following types of warming compresses are distinguished: