第十四章-生命体征的评估与护理课件.pptx

1、Section IntroductionSection Cold and Heat applicationsvConcept of Cold and Heat TherapyvBodily Responses to Cold and Heat TherapyvFactors Influencing the Effect of Cold and Heat Therapy The Cold and Heat Therapy is a therapy method that utilizes substances,the temperature of which are lower or highe

2、r than the skin surface temperature,acting on the skin,to attain local and systemic treating effects.lcold receptors（Krause小小体体):):-真皮上真皮上层层（乳头状层乳头状层）,接受冷的接受冷的迅迅息息.lHeat receptors（Ruffinis小小体体):):-真皮下真皮下层层（网状层网状层),接受接受热热的的迅迅息息.25-30万个万个 3万个万个 Heat and cold receptors adapt rapidly to temperature chan

3、ges in the bodys environment.表皮表皮真皮真皮真皮上真皮上层层 Krause小小体体真皮真皮下层下层 Ruffinis小小体体大脑皮质感觉中枢大脑皮质感觉中枢机体产生相应运动机体产生相应运动 反射性地引起皮肤和内反射性地引起皮肤和内脏器官血管收缩或扩张脏器官血管收缩或扩张 改变机体各系统的体液循环和代谢活动改变机体各系统的体液循环和代谢活动 Initial,or Primary Responses Physiological Responses Thermal Receptors Adaptation Secondary ResponsesHeatCold Vaso

4、dilation 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 Increases cellul

5、ar 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 body temperature

6、 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 fluids When the heat and cold receptors are subjected to an abrupt change in tem

7、perature,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 thermal receptors adaptation.1642 When the max

8、imum therapeutic effect of the heat or cold application is achieved,the opposite effect begins.We call these phenomenon secondary responses.lheat produces maximum vasodilation in 20 to 30 minutes;continuation of the application beyond 30 to 45 minutes brings tissue congestion,and the blood vessels t

9、hen constricted.Similarly,cold applications can cause blood vessel constriction,but continuation of application beyond 30 minutes to 1 hour brings vasodilation for 10-15minutes.Treatment methodSize of the exposed body partDuration of applicationPrior skin temperatureEnvironmental temperatureBody par

10、tIndividual tolerancel moist heat or cold l dry heat or cold the therapeutic effects of moist application are better than that of dry application.lWhen the environmental temperature is greater than o r e q u a l t o t h e b o d y temperature,conductive loss is inhibited.vThe foot and palm of hand ha

11、ve thicker skin and are therefore less temperature-sensitive.vcertain areas where the skin is thinner,such as the inner aspect of the wrist and forearm,eyelids,the neck,and the perineal area(会阴部会阴部)are less tolerant to temperature variations.vvery old person-the sensitivity to heat or cold is decrea

12、sed and therefore response to the heat and cold stimuli is retarded.vInfants-have limited abilities to adapt to heat and cold because of their immature neurological functioning.vclients who have neurosensory impairmentslCold applicationlHeat applicationlTherapy Effects of ColdlContradictions to cold

13、 applicationslmethodslRelief of congestion or hemorrhage to the affected area (减轻局部充血和出血减轻局部充血和出血)lRelief of painlControlling inflammationlReducing fever,and so on.使局部血管收缩使局部血管收缩,血流减少血流减少毛细毛细血管的通透性降低血管的通透性降低使血流减慢使血流减慢血液粘稠度增加血液粘稠度增加适用于适用于:扁桃体摘除术后扁桃体摘除术后;鼻衄鼻衄;局部软组织损伤的初期局部软组织损伤的初期,等等.减轻局部充血减轻局部充血促进血液凝固

14、而控制出血促进血液凝固而控制出血抑制细胞的活动抑制细胞的活动减慢神经冲动的传导减慢神经冲动的传导血血管收缩管收缩毛细毛细血管的通透性降低血管的通透性降低,渗出减少渗出减少适用于适用于:急性损伤的初期急性损伤的初期;烫伤烫伤;牙痛牙痛,等等.使神经末稍的敏感使神经末稍的敏感性降低而减轻疼痛性降低而减轻疼痛.减轻由于组织肿减轻由于组织肿胀压迫神经末梢胀压迫神经末梢而引起的疼痛而引起的疼痛.可使局部血管收缩，血流量减少可使局部血管收缩，血流量减少血流速度减慢血流速度减慢细胞代谢率细胞代谢率和细菌的活力降低和细菌的活力降低适用于适用于:体表部位炎症早期体表部位炎症早期.如鼻部软组织发炎如鼻部软组织发炎

15、早期，可采用鼻部冰敷以控制炎症扩散早期，可采用鼻部冰敷以控制炎症扩散.l冷直接与皮肤接触，通过冷直接与皮肤接触，通过传导传导与与蒸发蒸发的物理的物理 作用，降低体温作用，降低体温;l头部用冷头部用冷:可降低脑细胞的代谢，可降低脑细胞的代谢，减少脑细胞减少脑细胞需氧量需氧量,提高脑细胞对缺氧的耐受性提高脑细胞对缺氧的耐受性,减少脑细减少脑细胞的损害胞的损害,有利于脑细胞功能的恢复。有利于脑细胞功能的恢复。适用于适用于:高热、中中暑患者降温高热、中中暑患者降温;脑外伤、脑缺氧等患者脑外伤、脑缺氧等患者.vImpaired Local Circulation vChronic Inflammatio

16、n and Deep SuppurationvClients with Cold Hypersensitivity,Heart Diseases and very Weak ClientsvContradicted Body Parts大面积组织受损大面积组织受损休克休克微循环障碍微循环障碍周围血管病变周围血管病变动脉硬化动脉硬化糖尿病糖尿病水肿水肿,等等进一步使血管收缩进一步使血管收缩 减少局部组织的血供减少局部组织的血供导致组织变性坏死导致组织变性坏死冷冷疗疗血管收缩，血流减少，血管收缩，血流减少，影响细胞间液的吸收影响细胞间液的吸收.关节炎关节炎慢性背部疼痛慢性背部疼痛痔疮痔疮肛周脓肿等

17、肛周脓肿等l可使局部血流减少可使局部血流减少l阻碍炎症的吸收阻碍炎症的吸收冷冷疗疗uposterior occipital,external ear and scrotum (枕后、耳廓、阴囊枕后、耳廓、阴囊););u precordial region(心前区心前区)-)-may result in reflexible decreased heart rate and arrhythmia;uAbdomen(腹部腹部)-)-abdominal pain and diarrhea;usole of foot(足底足底)-)-can cause reflexible coronary arte

18、ry constriction.ice bag,ice cap or ice collar chemical cold packmoist cold cold compresscold soaks cooling sponge bath dry coldalcohol sponge bath tepid sponge bathlocalAssessmentthe clients physical condition Equipment The clients level of sensation Explanation The client understands the purpose of

19、 the therapy and precautions taken during treatment.Purposevto reduce body temperature.vto reduce hemorrhage,swelling and pain after sprains,head injuries and dental surgeriesice bagcloth covertowelbasinice,and so onFill the ice bag one half to two thirds full of crushed ice.Purpose to lower head te

20、mperature and prevent brain edema for unconscious clients.*ice cap *drawsheet(垫单垫单)*bucket *sterile drape(无菌治疗巾无菌治疗巾)*small pillow*Sponges*rectal thermometer(肛温计肛温计)*ice *basinTake away the pillow,spread the drawsheets under the clients head,place a sterile drape inside the ice cap.Place the ice cap

21、 around the clients head,apply spongy pad beneath auricles(外耳外耳),),occiput(枕骨部枕骨部)and neck,and the small pillow under clients shoulders.The drainage tube is down into the bucket.lTake anus temperature(肛温肛温),),maintain it around 33.Below 30 ventricular fibrillation(室颤室颤)The moist compress is a moist

22、gauze dressing 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.a prefilled plastic package wi

23、th two separate compartments.strikes,kneads or squeezes the pack to mix one chemical compound with the other and provide a controlled temperature.十水碳酸钠十水碳酸钠和硝酸铵和硝酸铵 This appliance is made based on the principle of semiconductor refrigeration.There is a circulating exchange between the cooled distill

24、ed 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 lowered.tepid water sponge bath（温水擦浴温水擦浴）3234 alcohol sponge bath（乙醇擦浴乙醇擦浴）2535%;30ltherapy effects of heat

25、lcontradictions to heat applicationslmethodsvpromotes suppuration and phagocytes,and then promotes elimination and localization of inflammationvRelief of deep congestion and swelling vRelief of pain,Reduction of muscle spasms and joint stiffnessvProviding warmth and Comfort局部血管扩张局部血管扩张促进组织血液循环促进组织血液

26、循环有利于组织中毒素、废有利于组织中毒素、废 物的排出物的排出;增强新陈代谢和白细胞增强新陈代谢和白细胞 的吞噬功能的吞噬功能.炎症早期炎症早期:热疗可促进炎性渗出物的吸收和消散；热疗可促进炎性渗出物的吸收和消散；炎症后期炎症后期:可促使白细胞释放出蛋白溶解酶，溶解可促使白细胞释放出蛋白溶解酶，溶解 坏死组织，使炎症局限坏死组织，使炎症局限.临床多用于软组织细菌性感染早期、慢性临床多用于软组织细菌性感染早期、慢性感染的辅助治疗感染的辅助治疗.如如:麦粒肿：麦粒肿：早期湿热敷可促进早期湿热敷可促进炎性渗出物的吸收和消炎性渗出物的吸收和消散散或促进硬结迅速化脓或促进硬结迅速化脓.软组织扭伤软组织扭

27、伤48h48h后后:热湿敷可促进关节、热湿敷可促进关节、软组织淤血的吸收和消软组织淤血的吸收和消散散.体表体表血管扩张血管扩张,血流量增多血流量增多足部热疗可减轻头部充血足部热疗可减轻头部充血;软组织损伤后期软组织损伤后期.深部组织血深部组织血流量减少流量减少全身循环血量全身循环血量 重新分布重新分布 降低痛觉神经的兴奋性降低痛觉神经的兴奋性;改善血液循环改善血液循环,加速致痛物质的运出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；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，解除肌肉痉挛和松弛肌肉、肌腱、韧带等组织，解除肌肉痉挛和关节强直关节强直.常用

28、于常用于:腰肌劳损、关节炎的治疗腰肌劳损、关节炎的治疗;肌肉紧张所肌肉紧张所致的疼痛致的疼痛;胃肠痉挛、肾绞痛、痛经等。胃肠痉挛、肾绞痛、痛经等。qUnidentified acute abdomen qFacial dangerous triangle area infection qHemorrhagic diseases qInjuries of soft tissues within 48 hours qBacterial Conjunctivitis(细菌性结膜炎细菌性结膜炎)qNeurosensory impairment and impaired mental status ho

29、t-water bag heating lamp Chemical heating bagsmoist heat moist hot compress sitz bath(坐浴坐浴)hot soaks(浸泡)dry heat Assessmentthe clients skin area Equipment The clients level of sensation Explanation The client understands the purpose of the therapy and precautions taken during treatment.Purposevto re

30、lieve spasm and painvto provide warmth and comforthot water bag and coverhot water(6070)dry towelthermometer *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 ai

31、rWrap 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 appropriatevFor unconscious clients,elders,infants,and clients who havent regain consciousness after anaesthesia,the safe water temperature sho

32、uld be 50 in order to avoid burns.vFor 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.vRemove the bag no more than 30 minutes after application if the purpose is to give treatment.Purposevto reduce inflammationvto r

33、elieve spasm and painvto promote scar and granulation tissue formation gooseneck lamp The distance is usually 30 to 50cm eyes should be covered The duration of this application is 2030minutes.Observe the local exposed skin closely during treatmentPurposevto reduce inflammation and edema vto relieve

34、spasm and pain tray sterile dressing transfer forceps dressings sterile petrolatum sterile cotton swab sterile gauze plastic sheet small rubber drawsheet sterile drape c o t t o n m a t e l e c t r i c a l stove thermometer boiler(hot water(5060)hot water bag(if necessary)cover a sterile gauze on it

35、.Spread light coat of sterile petrolatum over skin surface to be treated.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.vChange dressings every 3 to 5 minutes and observe skin co

36、ndition.vIf continuous compresses are ordered,it can be applied 15 to 20 minutes.PurposevTo reduce edema in rectum and organs in pelvic cavity(盆腔盆腔).vto relieve edema,inflammation and pain in the area of anus and perineum(会阴会阴).).vto clean the local area and provide comfort.hot water bottle sitz bat

37、h solution steriled gauzes thermometer large bath blanketsterile sitz bath tub sitz bath chairPlace the sitz bath tub in a special chair.Pour the hot water(40404545)into the tub until a half full.Then make prescribed solution.Allow the client to have sitz bath for 15 to 20 minutes and maintain a con

38、stant temperature by adding warm water.Observe the client for pulse,respiration and facial color.(light-headed or nauseated)After the sitz bath,assist the client out of the tub.The bath tub and medication fluid should be sterile if there is wound.It s not preferred for the female client during mense

39、s(月经月经)in the latter period of pregnancy(妊娠后期妊娠后期)less than 2 weeks after delivery(产后产后2 2周内周内)having vaginal bleeding (阴道出血阴道出血)having acute inflammation in pelvic cavity.盆腔器官急性炎症盆腔器官急性炎症 结束语当你尽了自己的最大努力时，失败也是伟大的，所以不要放弃，坚持就是正确的。When You Do Your Best,Failure Is Great,So DonT Give Up,Stick To The End谢谢大家荣幸这一路，与你同行ItS An Honor To Walk With You All The Way演讲人：XXXXXX 时 间：XX年XX月XX日