第十四章 生命體征的評(píng).ppt

1、Chapter 9 Cold and Heat Therapy,Section Introduction Section Cold and Heat applications,Section Introduction,Concept of Cold and Heat Therapy Bodily Responses to Cold and Heat Therapy Factors Influencing the Effect of Cold and Heat Therapy,Concept of Cold and Heat Therapy,The Cold and Heat Therapy i

2、s 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.,cold receptors （Krause小體): - 真皮上層（乳頭狀層）,接受冷的迅息. Heat receptors （Ruffinis小體): - 真皮下層（網(wǎng)狀層 ),接受熱的迅息.,25-30萬(wàn)個(gè),3萬(wàn)

3、個(gè),Heat and cold receptors adapt rapidly to temperature changes in the bodys environment.,表皮,真皮,冷刺激,真皮上層 Krause小體,熱刺激,真皮下層 Ruffinis小體,傳入神經(jīng)纖維,大腦皮質(zhì)感覺(jué)中樞,傳出神經(jīng)纖維,機(jī)體產(chǎn)生相應(yīng)運(yùn)動(dòng),反射性地引起皮膚和內(nèi)臟器官血管收縮或擴(kuò)張,改變機(jī)體各系統(tǒng)的體液循環(huán)和代謝活動(dòng),Bodily Responses to Cold and Heat Therapy,Initial, or Primary Responses Physiological Responses

4、Thermal Receptors Adaptation Secondary Responses,Physiological Responses,Table 9-1 physiological responses to heat and cold,When the heat and cold receptors are subjected to an abrupt change in temperature, the receptors are strongly stimulated initially. This strong stimulation declines rapidly dur

5、ing 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.,Thermal Receptors Adaptation,1642 ,Secondary Responses繼發(fā)性效應(yīng),When the maximum therapeutic effect of the heat or cold

6、application is achieved, the opposite effect begins. We call these phenomenon secondary responses.,For 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,

7、cold applications can cause blood vessel constriction, but continuation of application beyond 30 minutes to 1 hour brings vasodilation for 10-15minutes.,Factors Influencing the Effects of Cold and Heat Therapy,Treatment method Size of the exposed body part Duration of application Prior skin temperat

8、ure Environmental temperature Body part Individual tolerance,Treatment method,moist heat or cold dry heat or cold,the therapeutic effects of moist application are better than that of dry application.,Environmental temperature,When the environmental temperature is greater than or equal to the body te

9、mperature, conductive loss is inhibited.,Body part,The 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(會(huì)陰部) are less tolerant to

10、temperature variations.,Individual tolerance,very 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 neurological functioning. clients who have neu

11、rosensory impairments,Section Cold and Heat applications,Cold application Heat application,Cold application,Therapy Effects of Cold Contradictions to cold applications methods,Therapy Effects of Cold,Relief of congestion or hemorrhage to the affected area (減輕局部充血和出血) Relief of pain Controlling infla

12、mmation Reducing fever, and so on.,減輕局部充血和出血,使局部血管收縮,血流減少 毛細(xì)血管的通透性降低 使血流減慢 血液粘稠度增加 適用于: 扁桃體摘除術(shù)后; 鼻衄; 局部軟組織損傷的初期,等.,減輕局部充血,促進(jìn)血液凝固而控制出血,減輕疼痛,抑制細(xì)胞的活動(dòng) 減慢神經(jīng)沖動(dòng)的傳導(dǎo) 血管收縮 毛細(xì)血管的通透性降低, 滲出減少 適用于: 急性損傷的初期; 燙傷; 牙痛,等.,使神經(jīng)末稍的敏感性降低而減輕疼痛.,減輕由于組織腫脹壓迫神經(jīng)末梢而引起的疼痛.,控制炎癥擴(kuò)散,可使局部血管收縮，血流量減少 血流速度減慢 細(xì)胞代謝率和細(xì)菌的活力降低,適用于: 體表部位炎癥早期.

13、如鼻部軟組織發(fā)炎 早期，可采用鼻部冰敷以控制炎癥擴(kuò)散.,降低體溫,冷直接與皮膚接觸，通過(guò)傳導(dǎo)與蒸發(fā)的物理 作用，降低體溫; 頭部用冷: 可降低腦細(xì)胞的代謝，減少腦細(xì)胞需氧量,提高腦細(xì)胞對(duì)缺氧的耐受性,減少腦細(xì)胞的損害,有利于腦細(xì)胞功能的恢復(fù)。 適用于:高熱、中中暑患者降溫; 腦外傷、腦缺氧等患者.,Contradictions to cold applications,Impaired Local Circulation Chronic Inflammation and Deep Suppuration Clients with Cold Hypersensitivity, Heart Dis

14、eases and very Weak Clients Contradicted Body Parts,血液循環(huán)障礙,大面積組織受損 休克 微循環(huán)障礙 周?chē)懿∽?動(dòng)脈硬化 糖尿病 水腫,等,進(jìn)一步使血管收縮 減少局部組織的血供 導(dǎo)致組織變性壞死,冷,療,血管收縮，血流減少，影響細(xì)胞間液的吸收.,慢性炎癥或深部化膿病灶,關(guān)節(jié)炎 慢性背部疼痛 痔瘡 肛周膿腫等,可使局部血流減少 阻礙炎癥的吸收,冷,療,Contradicted Body Parts,posterior occipital, external ear and scrotum (枕后、耳廓、陰囊); precordial regi

15、on(心前區(qū))-may result 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.,Methods,ice bag, ice cap or ice collar chemical cold pack,moist cold,cold compress cold soaks cooling sponge bath,dry co

16、ld,alcohol sponge bath tepid sponge bath,local,preparation,Assessment,the clients physical condition,Equipment,The clients level of sensation,Explanation,The client understands the purpose of the therapy and precautions taken during treatment.,Use of Ice Bags,Purpose,to reduce body temperature. to r

17、educe hemorrhage, swelling and pain after sprains, head injuries and dental surgeries,Equipment,ice bag,cloth cover,towel,basin,ice, and so on,Procedures and key points,Fill the ice bag one half to two thirds full of crushed ice .,Use of Ice caps,Purpose to lower head temperature and prevent brain e

18、dema for unconscious clients.,Equipment,*ice cap *drawsheet (墊單) *bucket *sterile drape (無(wú)菌治療巾) *small pillow *Sponges *rectal thermometer(肛溫計(jì)) *ice *basin,Procedures and key points,Take away the pillow, spread the drawsheets under the clients head, place a sterile drape inside the ice cap .,Place t

19、he ice cap around the clients head, apply spongy pad beneath auricles(外耳), occiput(枕骨部) and neck, and the small pillow under clients shoulders. The drainage tube is down into the bucket.,Take anus temperature (肛溫), maintain it around 33. Below 30 ventricular fibrillation(室顫),Cold moist Compress(冷濕敷)

20、,The moist compress is a moist 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 princ

21、iples.,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.,十水碳酸鈉和硝酸銨,Hypothermia blankets(降溫毯),This appliance is made based on the principle of semicondu

22、ctor 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 lowered.,tepid water sponge

23、bath（溫水擦?。?3234 alcohol sponge bath（乙醇擦?。?2535% ; 30,Heat application,therapy effects of heat contradictions to heat applications methods,Therapy effects of heat,promotes suppuration and phagocytes, and then promotes elimination and localization of inflammation Relief of deep congestion and swelling

24、 Relief of pain, Reduction of muscle spasms and joint stiffness Providing warmth and Comfort,促進(jìn)炎癥的消散和局限,局部血管擴(kuò)張 促進(jìn)組織血液循環(huán),有利于組織中毒素、廢 物的排出; 增強(qiáng)新陳代謝和白細(xì)胞 的吞噬功能.,炎癥早期:熱療可促進(jìn)炎性滲出物的吸收和消散； 炎癥后期:可促使白細(xì)胞釋放出蛋白溶解酶，溶解 壞死組織，使炎癥局限.,臨床多用于軟組織細(xì)菌性感染早期、慢性感染的輔助治療.如:,麥粒腫： 早期濕熱敷可促進(jìn) 炎性滲出物的吸收和消散或促進(jìn)硬結(jié)迅速化膿.,軟組織扭傷48h后: 熱濕敷可促進(jìn)關(guān)節(jié)、軟組

25、織淤血的吸收和消散.,減輕深部組織充血,體表血管擴(kuò)張, 血流量增多,足部熱療可減輕頭部充血; 軟組織損傷后期.,深部組織血流量減少,全身循環(huán)血量 重新分布,減輕疼痛,降低痛覺(jué)神經(jīng)的興奮性; 改善血液循環(huán), 加速致痛物質(zhì)的運(yùn)出; 加速炎性滲出物吸收，解除對(duì)神經(jīng)末梢的壓迫； 松弛肌肉、肌腱、韌帶等組織，解除肌肉痙攣和關(guān)節(jié)強(qiáng)直.,常用于: 腰肌勞損、關(guān)節(jié)炎的治療; 肌肉緊張所 致的疼痛; 胃腸痙攣、腎絞痛、痛經(jīng)等。,Contradictions to heat applications,Unidentified acute abdomen Facial dangerous triangle area

26、 infection Hemorrhagic diseases Injuries of soft tissues within 48 hours Bacterial Conjunctivitis (細(xì)菌性結(jié)膜炎) Neurosensory impairment and impaired mental status,Methods,hot-water bag heating lamp Chemical heating bags,moist heat,moist hot compress sitz bath (坐浴) hot soaks (浸泡),dry heat,preparation,Asse

27、ssment,the clients skin area,Equipment,The clients level of sensation,Explanation,The client understands the purpose of the therapy and precautions taken during treatment.,Use of Hot-water bags,Purpose,to relieve spasm and pain to provide warmth and comfort,Equipment,hot water bag and cover,hot wate

28、r (6070 ),dry towel,thermometer,Procedures,* 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 air,Wrap the bag in a cloth cover and tighten its ties,Dry th

29、e bag and hold it upside down to check for its leaks,Place the bag on the body site of the client as appropriate,key points,For unconscious clients, elders, infants, and clients who havent regain consciousness after anaesthesia, the safe water temperature should be 50 in order to avoid burns. For th

30、e 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 the purpose is to give treatment.,Use of Hot Lamps,Purpose,to reduce inflammation to relieve spasm and pain

31、to promote scar and granulation tissue formation,Equipment,gooseneck lamp,Procedures and key points,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 treatment,Hot moist compress,Purpose,to reduce

32、inflammation and edema to relieve spasm and pain,Equipment, tray 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 nece

33、ssary),Procedures,cover a sterile gauze on it.,Spread light coat of sterile petrolatum over skin surface to be treated.,Put 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.,key points,Change dressings every 3 to 5 minutes and observe skin condition. If continuous compresses