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Moist Cold • Cold compress • A cloth (padded gauze) is immersed in cold water and applied in area where we get large superficial vessels E buy cheap apcalis sx 20mg erectile dysfunction due to diabetes icd 9. Dry Cold (Ice Bag) • Ice kept in a bag • Covered with cloth and applied on an area • Temperature <15 C Application of Heat Purpose Basic Nursing Art 86 • To relieve stasis of blood • To increase absorption of inflammatory products • To relieve stiffness of muscle and muscle pain • To relieve pain and swelling of a localized inflammation boil or carbuncle – sometimes increases edema cheap apcalis sx 20 mg amex erectile dysfunction medicine from dabur, increases capillary permeability • To increase blood circulation • To promote suppuration • To relieve distention and congestion • To provide warmth to the body Methods 1 purchase apcalis sx 20mg mastercard erectile dysfunction australian doctor. Dry Heat • Using hot water bottle (bags) • After contact of the body with moisture of water vapors o temperature >46 C o • 52 C for normal adults o • 40. Hot compress: a wash cloth immersed in hot water of temperature o 40-46 c and change the site of washcloth frequently Complication Basic Nursing Art 87 • Paralysis • Numbness • Loss of sensation – fear of burn 2. I Gastric Lavage Definition- This is the irrigation or washing out of the stomach. Explain procedure to the pt and ask him/her to remove artificial dentures, If any. But if unconscious, place in prone position with head over the edge of the bed or head lower than the body. Measure the tube from the tip of the nose up to the ear lobe and from the bridge of the nose to the end of the sternum. Gently pass the tube over the tongue, slightly to one side of the midline towards the pharynx. Ask patient to swallow while inserting the tube and allow to breath in between swallowing. If air bubbles, cough and cyanosis are noticed the tube is with drawn and procedure commenced again. After inserting, place funnel end in a basin of water to check if the tube is in the air passage. Fill the small pint measure and power gently until the funnel is empty, then invert over the pail. If required, and continue the process until the returned fluid becomes clear and the prescribed solution has been used. Before solution stops running, turn up funnel and add another quantity of solution 7. In case of gastrointestinal obstruction, to remove the stomach or gastric contents Basic Nursing Art 93 3. To aspirate the stomach contents for diagnostic purposes There are two type of gastric Aspiration 1. Intermittent method: - In this case, Aspiration is done as condition requires and as ordered. Continues method: - Attached to a drainage bag There are 2 ways of supplying suction a. An electric suction machine The continues method is indicated when it is absolutely necessary and desirable to keep the stomach and duodenum empty and at rest. Explain procedure to patient, in order to gain her/his co-operation Basic Nursing Art 94 2. Insert the tube as directed in nasal feeding and ask the patient to swallow as the tube goes down. Instruct patient to open her or his mouth to make sure the tube is in the stomach 7. Always measure the amount withdrawn accurately noting color, contents and small 3. Enema Enema: is the introduction of fluid into rectum and sigmoid colon for cleansing, therapeutic or diagnostic purposes. Purpose: • For emptying – soap solution enema the cloth • For diagnostic purpose Barium enema Basic Nursing Art 95 • For introducing drug/substance (retention enema) Mechanisms of some solutions used in enema 1. Soap solution: increases peristalsis due to irritating effect of soap to the lumenal mucosa of the colon. Classified into: Cleansing (evacuation) Retention Carminative Return flow enema Cleansing enema is of two kinds: 1. High enema Is given to clean as much of the colon as possible The solution container should be 30-45 cm about the rectum 2. Low enema Is administered to clean the rectum and sigmoid colon only Guidelines o o Enema for adults are usually given at 40-43 c and for children at 37. Colonoscopy To remove feces prior to a surgical procedure or a delivery For incontinent patients to keep the colon empty For diagnostic test E. Epsum salt 15 gm – 120 gm in 1,000 ml of H2O Cleansing Enema Procedure Inform the patient about the procedure Put bed side screen for privacy Attach rubber tube with enema can with nozzle and stop cock or clamp Place the patient in the lateral position with the Rt. Procedure Similar with the cleansing enema but the enema should be administered very slowly and always be preceded by passing a flatus tube Note 1. Kinds of solution used to supply body with fluid are plain H2O, normal saline, glucose 5% sodabicarbonate 2-5% 6. Olive oil 100-200 cc to be retained for 6-8 hrs is given for server constipation Retention Enema Are enemas meant for various purpose in which the fluid usually medicine is retained in rectum for short or long period – for local or general effects E. Principles: • Is given slowly by means of a rectal tube • The amount of fluid is usually 150-200 cc • Cleansing enema is given after the retention time is over • Temperature of enema fluid is 37. Asafetida in 1:1000 to relieve distention Amount of solution • 5-6 liters or until the wash out rectum fluid becomes clear Procedure • Insert the tube like the cleansing enema • The client lies on the bed with hips close to the side of the bed (client assumes a right side lying position for siphoning) • Open the clamp and allow to run about 1,000 cc of fluid in the bowel, then siphon back into the bucket • Carry on the procedure until the fluid return is clear Note: • The procedure should not take > 2 hrs • Should be finished 1 hr before exam or x-ray – to give time for the large intestine to absorb the rest of the fluid • Give cleansing enema ½ hr before the rectal wash out • Allow the fluid to pass slowly Passing a Flatus Tube Purpose • To decrease flatulence (sever abdominal distention) • Before giving a retention enema Procedure • Place the patient in lt. Lateral position Basic Nursing Art 101 • Lubricate the tube about 15 cm • Separate the rectum and insert 12-15 cm in to the rectum and tape it • Connect the free end to extra tubing by the glass connector • The end of the tube should reach the (tape H2O) solution in the bowel • The amount of air passed can be seen bubbling through the solution (a funnel may be connected to free end of tube and placed in an antiseptic solution in bowel) • Teach client to avoid substances that cause flatulent • Leave the rectal tube in place for a period or no longer than 20 – can affect the ability to voluntarily control the sphincter if placement is prolonged • Reinsert the rectal tube Q 2-3 hrs if the distention has been unrelieved or reaccumulates – allows gas to move in the direction of the rectum. Urinary Catheterization Definition of catheterization: Is the introduction of a tube (catheter) through the urethra into the urinary bladder • Is performed only when absolutely necessary • Fear of infection and trauma Note. Select the type of material in accordance with the estimated length of the catheterization period: - Are sized by diameters of the lumen Basic Nursing Art 103 - Graded on French scale or numbers 2. Determine appropriate catheter size • Catheter size depends on the size of the urethral canal ⇐ # 8-10 Fr – children ⇐ # 14-16 Fr – female adults ⇐ # 18 Fr – adult male 3. Determine appropriate catheter length by the clients gender • For adult male – 40 cm catheter • For adult females – 22 cm catheter 4. Select appropriate balloon size • 5 ml – for adults • 3 ml – for children Types of Catheter 1. Retention (Foleys, indwelling) Catheterization Using a straight catheter Purpose • To relieve discomfort due to bladder distention • To assess the anti of residual urine • To obtain a urine specimen • To empty the bladder prior to surgery Procedure • Prepare the client and equipment for perennial wash • Position the patient – dorsal recumbent (pillows can be used to elevate the buttocks in females). Dorsal Recumbent Female - for a better view of the urinary meatus and reduce the risk of catheter contaminate. Male- allows greater relaxation of the abdominal and perennial muscles and permits easier insertion of the tube. Ask the client to take deep breaths - relaxes the external sphincter (slight resistance is normal) Inserting a Retention (Indwelling) Catheter Purpose • To manage incontinence • To provide for intermittent or continuous bladder drainage and irrigation • To prevent urine from contacting an incision after perineal surgery (prevent information) • To measure urine out put needs to be monitored hourly Procedure • Explain the procedure to the patient • Prepare the equipment like the straight catheterization and retention catheter ⇐ Syringe ⇐ Sterile water ⇐ Tape ⇐ Urine collection bag and tubing Retention (Foley) Catheter • Contains a second, smaller tube through out its length on the inside – this tube is connected to a balloon near the insertion tip. Basic Nursing Art 106 • The balloons are sized by the volume of fluid or air used to inflate them 5 ml – 30 ml (15 commonly) indicated with the catheter size 18 Fr – 5 ml.
Many drugs are similar to or have similar chemical groups to the naturally occurring chemical and have the ability to bind onto a receptor where one of two things can happen- either the receptor will respond or it will be blocked buy generic apcalis sx 20mg erectile dysfunction options. A drug generic apcalis sx 20 mg free shipping erectile dysfunction home remedies, which is able to fit onto a receptor purchase apcalis sx 20mg line erectile dysfunction doctor in bangalore, is said to have affinity for that receptor. An agonist has both an affinity and efficacy whereas antagonist has affinity but not efficacy or intrinsic activity. When a drug is able to stimulate a receptor, it is known as an agonist and therefore mimics the endogenous transmitter. When the drug blocks a receptor, it is known as antagonist and therefore blocks the action of the endogenous transmitter (i. However, as most drug binding is reversible, there will be competition between the drug and the natural stimulus to the receptor. The forces that attract the drug to its receptor are termed chemical bonds and they are (a) hydrogen bond (b) ionic bond (c) covalent bond (d) Vander waals force. Covalent bond is the strongest bond and the drug-receptor complex is usually irreversible. Dose Response relationship The exact relationship between the dose and the response depends on the biological object under observation and the drug employed. When a logarithm of dose as abscissa and responses as ordinate are constructed graphically, the “S” shaped or sigmoid type curve is obtained. The lowest concentration of a drug that elicits a response is minimal dose, and the largest concentration after which further increase in concentration will not change the response is the maximal dose. Graded dose effect: As the dose administered to a single subject or tissue increases, the pharmacological response also increases in graded fashion up to ceiling effect. Quantal dose effect: It is all or none response, the sensitive objects give response to small doses of a drug while some will be resistant and need very large doses. The quantal dose- effect curve is often characterized by stating the median effective dose and the median lethal dose. Penicillin has a very high therapeutic index, while it is much smaller for the digitalis preparation. Structural activity relationship The activity of a drug is intimately related to its chemical structure. Knowledge about the chemical structure of a drug is useful for: (i) Synthesis of new compounds with more specific actions and fewer adverse reactions (ii) Synthesis of competitive antagonist and (iii) Understanding the mechanism of drug action. Slight modification of structure of the compound can change the effect completely. Pharmacokinetics Pharmacokinetics deals with the absorption, distribution, metabolism and excretion drugs in the body. Biotransport of drug: It is translocation of a solute from one side of the biological barrier to the other. Structure of biological membrane: The outer surface of the cell covered by a very thin structure known as plasma membrane. The 5 membrane proteins have many functions like (a) contributing structure to the membrane (b) acting as enzyme (c) acting as carrier for transport of substances (d) acting as receptors. The plasma membrane is a semipermeable membrane allowing certain chemical substances to pass freely e. Drug absorption: Absorption is the process by which the drug enters in to the systemic circulation from the site of administration through biological barrier. In case of intravenous or intra-arterial administration the drug bypasses absorption processes and it enters into the circulation directly. Routes of drug administration: a) From the alimentary tract: (i) Buccal cavity: e. Disadvantages of oral route: Onset of drug action is slow, irritant drugs cannot be administered and it is not useful in vomiting and severe diarrhea, gastric acid and digestive enzymes may destroy some drugs, and water soluble drugs are absorbed poorly. Disadvantages: Pain at local site of injection, the volume of injection should not exceed 10 ml. Advantages: It can be given in large volumes, production of desired blood concentration can be obtained with a well designed dose. Disadvantages: Drug effect cannot be halted if once the drug is injected, expertise is needed to give injection. Bioavailability: It is the rate and amount of drug that is absorbed from a given dosage form and reaches the systemic circulation following non-vascular administration. The route of administration largely determines the latent period between administration and onset of action. Drugs given by mouth may be inactive for the following reasons: a) Enzymatic degradation of polypeptides within the lumen of the gastrointestinal tract e. Factors affecting drug absorption and bioavailability: a) Physico-chemical properties of drug b) Nature of the dosage form c) Physiological factors d) Pharmacogenetic factors e) Disease states. However at the cell surface, the lipid soluble drugs penetrate into the cell more rapidly than the water soluble drugs. Unlike inorganic compounds, the organic drugs are not completely ionized in the fluid. Unionized component is predominantly lipid soluble and is absorbed rapidly and an ionized is often water soluble component which is absorbed poorly. T is impermeable to the ionized form of a weak organic acid or a weak organic base. Disintegration time: The rate of break up of the tablet or capsule into the drug granules. Fillers may not be totally inert but may affect the absorption as well as stability of the medicament. Thus a faulty formulation can render a useful drug totally useless therapeutically. However certain irritant drugs like salicylates and iron preparations are deliberately administred after food to minimize the gastrointestinal irritation. Calcium present in milk and in antacids forms insoluble complexes with the tetracycline antibiotics and reduces their absorption. Thus a drug though absorbed well when given orally may not be effective because of its extensive first pass metabolism. Bioavailability curves Single dose bioavailability test involves an analysis of plasma or serum concentration of the drug at various time intervals after its oral administration and plotting a serum concentration time curve. Formation B = Effect would last much longer and nontoxic Formulation C = gives inadequate plasma level so therapeutically ineffective. Definition: Penetration of a drug to the sites of action through the walls of blood vessels from the administered site after absorption is called drug distribution. Drugs distribute through various body fluid compartments such as (a) plasma (b) interstitial fluid compartment (c) trans-cellular compartment. Protein binding of drug: A variable and other significant portion of absorbed drug may become reversibly bound to plasma proteins. The active concentration of the drug is that part which is not bound, because it is only this fraction which is free to leave the plasma and site of action. It is the free form of drug that is distributed to the tissues and fluids and takes part in producing pharmacological effects. The concentration of free drug in plasma does not always remain in the same level e.
Oatmeal (Aveeino) and cornstarch can also be used Tub Bath Typically order apcalis sx 20 mg without a prescription erectile dysfunction treatment in india, bathtubs are low in height to ease the process of getting in and out of the tub purchase apcalis sx 20 mg mastercard impotence vitamins. Equipment • Bath blanket • Bath mat • Bath towel • Soap • Clean gown or pajama 132 Basic Clinical Nursing Skills • Clean bed linen • Bath thermometer if available • Disinfectant for cleansing the tub Procedure Check the bath room temperature buy cheap apcalis sx 20 mg line erectile dysfunction causes wiki, which should be warmer than the normal room temperature. After dressing assist the client back to the room Inform the cleaner to carefully clean the tub after the bath Dispose of the glove and wash your hands Document the procedure, describing any unusual client reactions Back Care (massage): includes the area from the back and shoulder to the lower buttocks Purpose • To relieve muscle tension • To promote physical and mental relaxation • To improve muscle and skin functioning • To relieve insomnia • To relax patient • To provide a relieve from pain • To prevent pressure sores (decubitus) • To enhance circulation Equipment Basin of warm water Washcloth Towel Soap 134 Basic Clinical Nursing Skills Skin care lotion Procedure 1. Massaging the back • Pour small amount of lotion (oil) on your palm and rub your palms together to warm the lotion (oil) before massaging. Petrissape: kneading and making large quick pinches of the skin, tissue, and muscle • Clean the back first • Warm the massage lotion or oil before use by pouring over your hands: cold lotion may startle the client and increase discomfort 1. Effleurage the entire back: has a relaxing sedative effect if slow movement and light pressure are used 2. Petrissape first up the vertebral column and them over the entire back: is stimulating if done quickly with firm p 137 Basic Clinical Nursing Skills • Assess: signs of relaxation and /or decreased pain (relaxed breathing, decreased muscles tension, drowsiness, and peaceful affect) ⇒ Verbalizations of freedom from pain and tension ⇒ Areas or redness, broken skin, bruises, or other sings of skin breakdown Note • The duration of a massage ranges from 5-20 minutes • Remember the location of bony prominence to avoid direct pressure over this areas • Frequent positioning is preferable to back massage as massaging the back could possibly lead to subcutaneous tissue degeneration. Backrub requires special skills as it might cause subcutaneous tissue degeneration; mainly in elderly. Offering and Removing Bed Pan • If the individual is weak or helpless, two peoples are needed to place and remove bed pans • If a person needs the bed pan for a longer time periodically remove and replace the pan to ease pressure and prevent tissue damage • Metal bed pans should be warmed before use by: o Running warm water inside the rim of the pan or over the pan o Covering with cloth 138 Basic Clinical Nursing Skills • Semi-Fowler’s position relieves strain on the client’s back and permits a more normal position for elimination Improper placement of the bedpan can cause skin abrasion to the sacral area and spillage o Place a regular bed pan under the buttocks with the narrow end towards the foot of the bed and the buttocks resting on the smooth, rounded rim o Place a slipper (fracture) pan with the flat, low end under the client’s buttocks o Covering the bed pan after use reduces offensive odors and the clients embarrassment If the client is unable to achieve regular defecation help by attending to: 1. Timing – do not ignore the urge to defecate • A patient should be encouraged to defecate when the urge to defecate is recognized • The patient and the nurse can discuss when mass peristalsis normally occurs and provide time for defecation (the same time each day) 3. Nutrition and fluids For a constipated client: increase daily fluid intake, drink hot liquids and fruit juices etc For the client with diarrhea – encourage oral intake of foods and fluids 139 Basic Clinical Nursing Skills For the client who has flatulence: limit carbonated beverages; avoid gas-forming foods 4. Positioning • Sitting position is preferred Measures to assist the person to void include: • Running water in the sink so that the client can hear it • Warming the bed pan before use • Pouring warm water over the perineum slowly • Having the person assume a comfortable position by raising the head of the bed (men often prefer to stand) • Providing sufficient analgesia for pain • Having the person blow through a straw into a glass of water – relaxes the urinary sphincter Perineal Care (Perineal – Genital Care) Perineal Area: • Is located between the thighs and extends from the symphysis pubis of the pelvic bone (anterior) to the anus (posterior). Perineal Care (Hygiene) • Is cleaning of the external genitalia and surrounding area • Always done in conjunction with general bathing Patients in special needs of perineal care • Post partum and surgical patients (surgery of the perineal area) • Non surgical patients who unable to care for themselves • Patients with catheter (particularly indwelling catheter) Other indications for perineal care are: 1. Excessive secretions or concentrated urine, causing skin irritation or excoriation Purpose • To remove normal perineal secretions and odors • To prevent infection (e. Patient preparation • Give adequate explanation • Provide privacy • Fold the top bedding and pajamas (given to expose perineal area and drape using the top linen. Cleaning the genital area • Put on gloves 142 Basic Clinical Nursing Skills For Female • Remove dressing or pad used • Inspect the perineal area for inflammation excoriation, swelling or any discharge. In case of post partum or surgical patient • Clean by cotton swabs, first the labia majora then the skin folds between the majora and minora by retracting the majora using gauze squares, clean from anterior to posterior direction using separate swab for each stroke. In case of non-surgical patients • Wash or clean the genital area with soapy water using the different quarters of the washcloth in the same manner. Female Perineum • Is made up of the vulva (external genitalia), including the mons pubis, prepuce, clitoris, urethral and vaginal orifices, and labia majora and minora • The skin of the vaginal orifice is normally moist • The secretion has a slight odor due to the cells and normal vaginal florae • The clitoris consists of erectile tissues and many nerves fibers. Sterile cotton balls • The operative site and perineal area may be washed with an antiseptic solution – apply by squirting them on the perineum from a squeeze bottle Male Perineum • The penis contains pathways for urination and ejaculation through the urethral orifice (meatus) • At the end of the penis is the glans covered by a skin flap (fore skin or prepuce) • The urethral orifice is located in the center of the penis and opens at the tip 144 Basic Clinical Nursing Skills • The shaft of the penis consists of erectile tissue bound by the foreskin’s dense fibrous tissue Care • Hold the shaft of the penis firmly with one hand and the wash cloth with the other – to prevent erection – embarrassment • Use a circular motion, cleaning from the center to the periphery • Use a separate section of the wash cloth Position • Lying in bed with knee flexed to clean the perineal part and side lying cleaning the perineal area N. Equipments • Comb (which is large with open and long toothed) • Hand mirror • Towel • Lubricant/oils (if required) Procedure 1. Comb the hair by dividing the hair 146 Basic Clinical Nursing Skills • Hold a section of hair 2-3 inches from the end and comb the end until it is free from tangles. Shampooing/Washing the Hair of Patient Confined to Bed Purpose • Stimulate blood circulation to the scalp through massaging • Clean the patients hair so it increase a sense of well-being to the pt • To treat hair disorders like dandruft Equipments • Comb and brush • Shampoo/soap in a dish 147 Basic Clinical Nursing Skills • Shampoo basin • Plastic sheet • Two wash towels • Cotton balls • Water in basin and pitcher • Receptacle (bucket) to receive the used water • Lubricants/oil as required Procedure 1. Prepare the patient • Assist patient to move to the working side of the bed • Remove any hair accessories (e. Documentation and reporting Pediculosis Treatment Definition Pediculosis: infestation with lice Purpose • To prevent transmission of some arthropod born diseases • To make patient comfortable Equipment Lindane 1% permethrine cream rinse Clean linen Fine-tooth “nit” comb Disinfectant for comb Clean gloves Towel Lice: • Are small, grayish white, parasitic insects that infest mammals • Are of three common kinds: 150 Basic Clinical Nursing Skills ¾ Pediculose capitis: is found on the scalp and tends to stay hidden in the hairs ¾ Pediculose pubis: stay in pubic hair ¾ Pediculose corporis: tends to cling to clothing, suck blood from the person and lay their eggs the clothing suspect their presence in the cloth and the body: a. There are hemorrhagic spots in the skin where the lice have sucked blood Head and body lice lay their eggs on the hairs then eggs look like oval particles, similar to dandruff, clinging to the hair. Kerosene Oil mixed with equal parts of sweet oil • Destroys both adult lice and eggs of nits • From aesthetic point of view, kerosene causes foul smell and create discomfort to patient and the attendant 151 Basic Clinical Nursing Skills Guidelines for Applying Pediculicides Hair: • Apply pediculicide shampoo to dry hair until hair is thoroughly saturated and work shampoo in to a lather • Allow product to remain on hair for stated period (varies with products) • Pin hair and allow to dry • Use a fine toothed comb to remove death lice and nits (comb should not be shared by other family members) • Repeat it in 8-10 days to remove any hatched nits • Apply pediculious lotion (or cream) to affected areas • Bath after 12 hrs and put on clean clothes 7. Oil of Sassafras • Is a kind of scented bark oil • Only destroy lice not nits • For complete elimination, the oil should be massaged again after 10 days when the nits hatch • Is used daily for a week with equal parts of Luke warm H2O then it should be repeated after a week 8. Gammaxine (Gamma Bengenhexa Chloride) • Emphasize the need for treatment of sexual partner • After complete bathing wash linen available as a cream, lotion, and a shampoo 152 Basic Clinical Nursing Skills • 1. Feeding a Helpless Patient During illness, trauma or wound healing, the body needs more nutrients than usual. However, many peoples, because of weakness, immobility and/or one or both upper extremities are unable to feed themselves all or parts of the meal. Therefore, the nurse must be knowledgeable, sensitive and skillful in carrying out feeding procedures. Prepare pt units 153 Basic Clinical Nursing Skills • Remove all unsightly equipments; remove solid linens and arranging bedside tables. Lab, radiologic examination or surgery) • Assess any cultural or religious limitations, specific likes or dislikes. Comfort patient • Assist hand washing and oral care • Offer bedpan and commodes, of indicated • Comfort patient, provide quite environment so that the pt may relax after meal, which also promote good digestion. Morning, Afternoon, and Evening Care • Morning, afternoon, and evening care are used to describe the type of hygienic care given at different times of the day Early Morning Care • Is provided to clients as they awaken in the morning • In a hospital it is provided by nurses on the night shift • Helps clients ready themselves for breakfast or for early diagnostic tests 155 Basic Clinical Nursing Skills Consists of: • Providing a urinal or bed pan if client is confined to bed • Washing the face and hands and • Giving oral care Late Morning Care • Is provided after clients have breakfast Includes: • The provision of a urinal or bed pan • A bath or shower • Perineal care • Back massage and • Oral, nail and hair care • Making clients bed Afternoon Care • When clients return from physiotherapy or diagnostic tests • Includes: ¾ Providing bed pan or urinal ¾ Washing the hands and face ¾ Assisting with oral care refresh clients Evening Care • Is provided to clients before they retire for the night 156 Basic Clinical Nursing Skills • Involves: ¾ Providing for elimination needs ¾ Washing hands ¾ Giving oral care ¾ Back massage care as required Study questions: 1. To relieve swelling (facilitate wound healing) - To relieve inflammation and congestion Heat • Increases the action of phagocytic cells that ingest moisture and other foreign material • Increases the removal of waste products or infection metabolic process 3. Dry Purpose: (Indication) • To reduce body to during high fever and hyper pyrexia or sun stroke • To relieve local pain • To reduce subcutaneous bleeding e. Moist Cold • Cold compress • A cloth (padded gauze) is immersed in cold water and applied in area where we get large superficial vessels E. Dry Cold (Ice Bag) • Ice kept in a bag • Covered with cloth and applied on an area 0 • Temperature <15 C Application of Heat Purpose • To relieve stasis of blood • To increase absorption of inflammatory products • To relieve stiffness of muscle and muscle pain • To relieve pain and swelling of a localized inflammation boil or carbuncle – sometimes increases edema, increases capillary permeability • To increase blood circulation • To promote suppuration • To relieve distention and congestion • To provide warmth to the body Methods 1. Dry Heat • Using hot water bottle (bags) • After contact of the body with moisture of water vapors o temperature >46 C o • 52 C for normal adults 163 Basic Clinical Nursing Skills o • 40. Hot compress: a wash cloth immersed in hot water of o temperature 40-46 c and change the site of washcloth frequently Complication • Paralysis • Numbness • Loss of sensation – fear of burn 2. Great care has to be taken to prevent heat/cold burns when applying heat or cold especially to elderly. Proper Body Mechanics Use of safest and most efficient methods of moving and lifting is called body mechanics. Basic Principles of Body Mechanics 168 Basic Clinical Nursing Skills The laws of physics govern all movements. The nurse rocks backward or forward on the feet and with his or her body as a force for pulling or pushing. Principles under lying proper body mechanics involve three major factors: center of gravity, base of support, and line of gravity. This means that approximately half the body weight is distributed above this 169 Basic Clinical Nursing Skills area, half below it, when thinking of the body divided horizontally. Line of Gravity Draw an imaginary vertical (up and down) line through the top of the head, the center of gravity, and the base of support. For highest efficiency, this line should be straight from the top of the head to the base of support, with equal weight on each side. Therefore, if a person stands with the back straight and the head erect, the line of gravity will be approximately through the center of the body, and proper body mechanics will be in place. Body Alignment 170 Basic Clinical Nursing Skills When lifting, walking, or per forming any activity, proper body alignment is essential to maintain balance.