第十四章-生命体征的评估与护理课件

1、Chapter 9 Cold and Heat TherapyChapter 9 Cold and Heat TheraSection IntroductionSection Cold and Heat applicationsSection IntroductionSection IntroductionConcept of Cold and Heat TherapyBodily Responses to Cold and Heat TherapyFactors Influencing the Effect of Cold and Heat TherapySection Introducti

2、onConcept Concept of Cold and Heat Therapy The Cold and Heat Therapy is a therapy method that utilizes substances, the temperature of which are lower or higher than the skin surface temperature, acting on the skin, to attain local and systemic treating effects.Concept of Cold and Heat Theracold rece

3、ptors （Krause小体): - 真皮上层（乳头状层）,接受冷的迅息.Heat receptors （Ruffinis小体): - 真皮下层（网状层 ),接受热的迅息.25-30万个 3万个 Heat and cold receptors adapt rapidly to temperature changes in the bodys environment.表皮真皮cold receptors （Krause小体): -2冷刺激真皮上层 Krause小体热刺激真皮下层 Ruffinis小体传入神经纤维大脑皮质感觉中枢传出神经纤维机体产生相应运动 反射性地引起皮肤和内脏器官血管收缩或扩

4、张 改变机体各系统的体液循环和代谢活动 冷刺激真皮上层 Krause小体热刺激真皮下层 RuffinBodily Responses to Cold and Heat TherapyInitial, or Primary Responses Physiological Responses Thermal Receptors Adaptation Secondary ResponsesBodily Responses to Cold and Physiological ResponsesTable 9-1 physiological responses to heat and coldHeatC

5、old Vasodilation Vasoconstriction Increases blood flow to the affected area; increases supply of nutrients, oxygen, and wastes removal Reduces blood flow to the affected area; reduces supply of nutrients, oxygen, and wastes removal Increases capillary permeability Decreases capillary permeability In

6、creases cellular metabolism Decreases cellular metabolismIncreases amount and motility of leukocytesDecreases amount and motility of leukocytes Increases inflammation and suppurationSlows bacterial growth, decreases inflammation Increases lymph flow Reduces lymph flowRaises body temperature Lowers b

7、ody temperature Decreases the viscosity of the blood Increases the viscosity of the blood Decreases muscle tonus and relaxes muscles Increases nerve impulse conduction Decreases nerve impulse conduction Decreases viscosity of synovial fluidsPhysiological ResponsesTable 9When the heat and cold recept

8、ors are subjected to an abrupt change in temperature, the receptors are strongly stimulated initially. This strong stimulation declines rapidly during the first few seconds and then more slowly during the next half hour or more as the receptors adapt to the new temperature. This phenomenon is called

9、 thermal receptors adaptation. Thermal Receptors Adaptation1642 When the heat and cold receptoSecondary Responses继发性效应 When the maximum therapeutic effect of the heat or cold application is achieved, the opposite effect begins. We call these phenomenon secondary responses. Secondary Responses继发性效应 F

10、or example heat produces maximum vasodilation in 20 to 30 minutes; continuation of the application beyond 30 to 45 minutes brings tissue congestion, and the blood vessels then constricted.Similarly, cold applications can cause blood vessel constriction, but continuation of application beyond 30 minu

11、tes to 1 hour brings vasodilation for 10-15minutes. For example heat produces maxiFactors Influencing the Effects of Cold and Heat TherapyTreatment methodSize of the exposed body partDuration of applicationPrior skin temperatureEnvironmental temperatureBody partIndividual toleranceFactors Influencin

12、g the EffectTreatment method moist heat or cold dry heat or cold the therapeutic effects of moist application are better than that of dry application. Treatment method moist heat oEnvironmental temperatureWhen the environmental temperature is greater than or equal to the body temperature, conductive

13、 loss is inhibited. Environmental temperatureWhen Body partThe foot and palm of hand have thicker skin and are therefore less temperature-sensitive. certain areas where the skin is thinner, such as the inner aspect of the wrist and forearm, eyelids, the neck, and the perineal area(会阴部) are less tole

14、rant to temperature variations.Body partThe foot and palm of Individual tolerancevery old person-the sensitivity to heat or cold is decreased and therefore response to the heat and cold stimuli is retarded. Infants-have limited abilities to adapt to heat and cold because of their immature neurologic

15、al functioning. clients who have neurosensory impairmentsIndividual tolerancevery old pSection Cold and Heat applicationsCold applicationHeat applicationSection Cold and Heat appliCold applicationTherapy Effects of ColdContradictions to cold applicationsmethodsCold applicationTherapy EffectTherapy E

16、ffects of ColdRelief of congestion or hemorrhage to the affected area (减轻局部充血和出血) Relief of painControlling inflammationReducing fever, and so on.Therapy Effects of ColdRelief 减轻局部充血和出血使局部血管收缩,血流减少毛细血管的通透性降低使血流减慢血液粘稠度增加适用于: 扁桃体摘除术后; 鼻衄; 局部软组织损伤的初期,等.减轻局部充血促进血液凝固而控制出血减轻局部充血和出血使局部血管收缩,血流减少减轻局部充血促进血减轻疼

17、痛抑制细胞的活动减慢神经冲动的传导血管收缩毛细血管的通透性降低, 渗出减少适用于: 急性损伤的初期; 烫伤; 牙痛,等.使神经末稍的敏感性降低而减轻疼痛.减轻由于组织肿胀压迫神经末梢而引起的疼痛.减轻疼痛抑制细胞的活动使神经末稍的敏感性降低而减轻疼痛.减轻控制炎症扩散可使局部血管收缩，血流量减少血流速度减慢细胞代谢率和细菌的活力降低适用于: 体表部位炎症早期.如鼻部软组织发炎早期，可采用鼻部冰敷以控制炎症扩散.控制炎症扩散可使局部血管收缩，血流量减少适用于: 体表部位炎降低体温冷直接与皮肤接触，通过传导与蒸发的物理 作用，降低体温;头部用冷: 可降低脑细胞的代谢，减少脑细胞需氧量,提高脑细胞对

18、缺氧的耐受性,减少脑细胞的损害,有利于脑细胞功能的恢复。适用于:高热、中中暑患者降温; 脑外伤、脑缺氧等患者.降低体温冷直接与皮肤接触，通过传导与蒸发的物理Contradictions to cold applicationsImpaired Local Circulation Chronic Inflammation and Deep SuppurationClients with Cold Hypersensitivity, Heart Diseases and very Weak ClientsContradicted Body PartsContradictions to cold a

19、pplica血液循环障碍大面积组织受损休克微循环障碍周围血管病变动脉硬化糖尿病水肿,等进一步使血管收缩 减少局部组织的血供导致组织变性坏死冷疗血管收缩，血流减少，影响细胞间液的吸收. 血液循环障碍大面积组织受损进一步使血管收缩冷疗血管收缩，血流慢性炎症或深部化脓病灶关节炎慢性背部疼痛痔疮肛周脓肿等可使局部血流减少阻碍炎症的吸收冷疗慢性炎症或深部化脓病灶关节炎可使局部血流减少冷疗Contradicted Body Partsposterior occipital, external ear and scrotum (枕后、耳廓、阴囊); precordial region(心前区)-may re

20、sult in reflexible decreased heart rate and arrhythmia; Abdomen(腹部)-abdominal pain and diarrhea; sole of foot(足底)- can cause reflexible coronary artery constriction.Contradicted Body PartsposteriMethodsice bag, ice cap or ice collar chemical cold packmoist cold cold compresscold soaks cooling sponge

21、 bath dry coldalcohol sponge bath tepid sponge bathlocalMethodsice bag, ice capmoist cpreparation Assessmentthe clients physical condition Equipment The clients level of sensation Explanation The client understands the purpose of the therapy and precautions taken during treatment.preparation Assessm

22、entthe clieUse of Ice BagsPurposeto reduce body temperature.to reduce hemorrhage, swelling and pain after sprains, head injuries and dental surgeriesUse of Ice BagsPurposeto reEquipmentice bagcloth covertowelbasinice, and so onEquipmentice bagcloth covertowProcedures and key pointsFill the ice bag o

23、ne half to two thirds full of crushed ice .Procedures and key pointsFill 第十四章-生命体征的评估与护理课件Use of Ice caps Purpose to lower head temperature and prevent brain edema for unconscious clients.Use of Ice caps PurposeEquipment*ice cap *drawsheet (垫单) *bucket *sterile drape (无菌治疗巾) *small pillow *Sponges*r

24、ectal thermometer(肛温计)*ice *basinEquipment*ice cap *drawsheProcedures and key pointsTake away the pillow, spread the drawsheets under the clients head, place a sterile drape inside the ice cap .Place the ice cap around the clients head, apply spongy pad beneath auricles(外耳), occiput(枕骨部) and neck, a

25、nd the small pillow under clients shoulders. The drainage tube is down into the bucket.Procedures and key pointsTake Take anus temperature (肛温), maintain it around 33.Below 30 ventricular fibrillation(室颤)Take anus temperature (肛温),Cold moist Compress(冷湿敷) The moist compress is a moist gauze dressing

26、 applied to the body part. The compresses are usually immersed into the ice water and then applied to the body part. Replace compresses are necessary to maintain coolness. (35min)If a sterile compress is ordered, the nurse should follow the sterile principles.Cold moist Compress(冷湿敷) The m第十四章-生命体征的

27、评估与护理课件Chemical cold packs a prefilled plastic package with two separate compartments. strikes, kneads or squeezes the pack to mix one chemical compound with the other and provide a controlled temperature.十水碳酸钠和硝酸铵Chemical cold packs a prefHypothermia blankets(降温毯) This appliance is made based on th

28、e principle of semiconductor refrigeration. There is a circulating exchange between the cooled distilled water in the water tank and that in the hypothermia blanket via main machine. This process facilitates the heat loss of the skin in contact with the blanket, and then the body temperature is lowe

29、red.Hypothermia blankets(降温毯) tepid water sponge bath（温水擦浴） 3234 alcohol sponge bath（乙醇擦浴） 2535% ; 30tepid water sponge bath（温水擦浴） Heat applicationtherapy effects of heat contradictions to heat applicationsmethodsHeat applicationtherapy effectTherapy effects of heat promotes suppuration and phagocyt

30、es, and then promotes elimination and localization of inflammationRelief of deep congestion and swelling Relief of pain, Reduction of muscle spasms and joint stiffnessProviding warmth and ComfortTherapy effects of heat promot促进炎症的消散和局限局部血管扩张促进组织血液循环有利于组织中毒素、废 物的排出;增强新陈代谢和白细胞 的吞噬功能.炎症早期:热疗可促进炎性渗出物的吸收

31、和消散；炎症后期:可促使白细胞释放出蛋白溶解酶，溶解 坏死组织，使炎症局限.促进炎症的消散和局限局部血管扩张有利于组织中毒素、废炎症早期 临床多用于软组织细菌性感染早期、慢性感染的辅助治疗.如: 麦粒肿： 早期湿热敷可促进炎性渗出物的吸收和消散或促进硬结迅速化脓. 软组织扭伤48h后: 热湿敷可促进关节、软组织淤血的吸收和消散. 临床多用于软组织细菌性感染早期、慢性感染的辅助治减轻深部组织充血体表血管扩张,血流量增多足部热疗可减轻头部充血;软组织损伤后期.深部组织血流量减少全身循环血量 重新分布 减轻深部组织充血体表血管扩张,足部热疗可减轻头部充血;深部组减轻疼痛降低痛觉神经的兴奋性;改善血液

32、循环, 加速致痛物质的运出; 加速炎性渗出物吸收，解除对神经末梢的压迫；松弛肌肉、肌腱、韧带等组织，解除肌肉痉挛和关节强直.常用于: 腰肌劳损、关节炎的治疗; 肌肉紧张所致的疼痛; 胃肠痉挛、肾绞痛、痛经等。减轻疼痛降低痛觉神经的兴奋性;常用于: 腰肌劳损、关节炎的治Contradictions to heat applicationsUnidentified acute abdomen Facial dangerous triangle area infection Hemorrhagic diseases Injuries of soft tissues within 48 hours B

33、acterial Conjunctivitis (细菌性结膜炎)Neurosensory impairment and impaired mental status Contradictions to heat applicaMethodshot-water bag heating lamp Chemical heating bagsmoist heat moist hot compress sitz bath (坐浴) hot soaks (浸泡)dry heat Methodshot-water bag moist heapreparation Assessmentthe clients

34、skin area Equipment The clients level of sensation Explanation The client understands the purpose of the therapy and precautions taken during treatment.preparation Assessmentthe clieUse of Hot-water bagsPurposeto relieve spasm and painto provide warmth and comfortUse of Hot-water bagsPurposEquipment

35、hot water bag and coverhot water(6070 )dry towelthermometerEquipmenthot water bag and covProcedures * Place the hot water bag flat, Fill the bag with hot water about a half to two thirds full .* turn the stopper until it is tight* Place the hot water bag flat gradually and expel the remaining airPro

36、cedures * Place the hot wWrap the bag in a cloth cover and tighten its tiesDry the bag and hold it upside down to check for its leaksPlace the bag on the body site of the client as appropriateWrap the bag in a cloth cover key pointsFor unconscious clients, elders, infants, and clients who havent reg

37、ain consciousness after anaesthesia, the safe water temperature should be 50 in order to avoid burns.For the client with impaired sensation, a large towel should be put over the bag with a cloth cover or a blanket is used to wrap the bag. Remove the bag no more than 30 minutes after application if t

38、he purpose is to give treatment. key pointsFor unconscious clieUse of Hot LampsPurposeto reduce inflammationto relieve spasm and painto promote scar and granulation tissue formation Use of Hot LampsPurposeto rEquipmentgooseneck lamp Equipmentgooseneck lamp Procedures and key pointsThe distance is us

39、ually 30 to 50cm eyes should be covered The duration of this application is 2030minutes. Observe the local exposed skin closely during treatmentProcedures and key pointsThe dHot moist compressPurposeto reduce inflammation and edema to relieve spasm and pain Hot moist compressPurposeto reEquipment tr

40、ay sterile dressing transfer forceps dressings sterile petrolatum sterile cotton swab sterile gauze plastic sheet small rubber drawsheet sterile drape cotton mat electrical stove thermometer boiler (hot water (5060) hot water bag (if necessary)Equipment tray Procedures cover a sterile gauze on it.Sp

41、read light coat of sterile petrolatum over skin surface to be treated.Procedures cover a sterile gauPut dressings into the hot water(5060) Take out dressings with sterile transfer forceps and wring excess water. Apply the dressing onto the area to be treated. then cover it with a plastic sheet and cotton mat.Put dressings into the hot watkey pointsChange dressings every 3 to 5 minutes and observe skin condition.If continuous compresses are ordered, it can be applied 15 to 20 minutes.k