第十四章-生命体征的评估与护理课件

Chapter 9Cold and Heat TherapyChapter9ColdandHeatThera1Section IntroductionSection Cold and Heat applicationsSectionIntroduction2Section IntroductionvConcept of Cold and Heat TherapyvBodily Responses to Cold and Heat TherapyvFactors Influencing the Effect of Cold and Heat TherapySectionIntroductionConcept3Concept of Cold and Heat TherapyConcept 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.ConceptofColdandHeatThera4lcold 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 changes in the bodys environment.表皮表皮真皮真皮coldreceptors（Krause小体):-25冷刺激冷刺激冷刺激冷刺激真皮上真皮上层层 Krause小小体体热刺激热刺激热刺激热刺激真皮真皮下层下层 Ruffinis小小体体传入传入传入传入神经纤维神经纤维神经纤维神经纤维大脑皮质感觉中枢大脑皮质感觉中枢传出传出传出传出神经纤维神经纤维神经纤维神经纤维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冷刺激真皮上层Krause小体热刺激真皮下层Ruffin6Bodily Responses to Bodily Responses to Cold and Heat TherapyCold and Heat TherapyInitial,or Primary Responses Physiological Responses Thermal Receptors Adaptation Secondary ResponsesBodilyResponsestoColdand7Physiological ResponsesPhysiological ResponsesTable 9-1 physiological responses to heat and coldHeatColdVasodilationVasoconstriction Increases blood flow to the affected area;increasessupplyofnutrients,oxygen,andwastesremoval Reduces blood flow to the affected area;reducessupplyofnutrients,oxygen,andwastesremovalIncreasescapillarypermeabilityDecreasescapillarypermeabilityIncreasescellularmetabolismDecreasescellularmetabolismIncreases amount and motility ofleukocytesDecreases amount and motility ofleukocytesIncreasesinflammationandsuppurationSlowsbacterialgrowth,decreasesinflammationIncreaseslymphflowReduceslymphflowRaisesbodytemperatureLowersbodytemperatureDecreasestheviscosityofthebloodIncreasestheviscosityofthebloodDecreasesmuscletonusandrelaxesmusclesIncreasesnerveimpulseconductionDecreasesnerveimpulseconductionDecreasesviscosityofsynovialfluidsPhysiologicalResponsesTable98When the heat and cold receptors 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 thermal receptors adaptation.Thermal Receptors Adaptation1642 Whentheheatandcoldrecepto9Secondary Responses继发性效应继发性效应 When the maximum therapeutic effect of the heat or cold application is achieved,the opposite effect begins.We call these phenomenon secondary responses.SecondaryResponses继发性效应10For example 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 then constricted.Similarly,cold applications can cause blood vessel constriction,but continuation of application beyond 30 minutes to 1 hour brings vasodilation for 10-15minutes.Forexampleheatproducesmaxi11Factors Influencing the Effects of Cold and Heat TherapyTreatment methodSize of the exposed body partDuration of applicationPrior skin temperatureEnvironmental temperatureBody partIndividual toleranceFactorsInfluencingtheEffect12Treatment methodlmoist heat or cold l dry heat or cold the therapeutic effects of moist application are better than that of dry application.Treatmentmethodmoistheato13Environmental temperaturelWhen the environmental temperature is greater than or equal to the body temperature,conductive loss is inhibited.EnvironmentaltemperatureWhen14Body partvThe foot and palm of hand have 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(会会阴阴部部)are less tolerant to temperature variations.BodypartThefootandpalmof15Individual tolerancevvery old person-the sensitivity to heat or cold is decreased 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 impairmentsIndividualtoleranceveryoldp16Section Cold and Heat applicationslCold applicationlHeat applicationSectionColdandHeatappli17Cold applicationlTherapy Effects of ColdlContradictions to cold applicationslmethodsColdapplicationTherapyEffect18Therapy Effects of ColdlRelief 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.TherapyEffectsofColdRelief19减轻局部充血和出血减轻局部充血和出血使局部血管收缩使局部血管收缩,血流减少血流减少毛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而控制出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20减轻疼痛减轻疼痛抑制抑制细胞的活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.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21控制炎症扩散控制炎症扩散可使局部血管收可使局部血管收缩，血流量减少，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和细菌的活力降低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.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22降低体温降低体温l冷直接与皮肤接触，通冷直接与皮肤接触，通过传导与与蒸蒸发的物理的物理 作用，降低体温作用，降低体温;l头部用冷部用冷:可降低可降低脑细胞的代胞的代谢，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,有利于有利于脑细胞功能的恢复。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.降低体温冷直接与皮肤接触，通过传导与蒸发的物理23Contradictions to cold applicationsvImpaired Local CirculationvChronic Inflammation and Deep SuppurationvClients with Cold Hypersensitivity,Heart Diseases and very Weak ClientsvContradicted Body PartsContradictionstocoldapplica24血液循环障碍血液循环障碍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.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25慢性炎症或深部化脓病灶慢性炎症或深部化脓病灶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慢性炎症或深部化脓病灶关节炎可使局部血流减少冷疗26Contradicted Body Partsuposterior 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 artery constriction.ContradictedBodyPartsposteri27Methodsice bag,ice cap or ice collar chemical cold packmoist coldcold compresscold soaks cooling sponge bathdry coldalcohol sponge bath tepid sponge bathlocalMethodsicebag,icecapmoistc28preparation AssessmenttheclientsphysicalconditionEquipmentTheclientslevelofsensationExplanation Theclientunderstandsthepurposeofthetherapyandprecautionstakenduringtreatment.preparationAssessmenttheclie29Use of Ice BagsPurposevto reduce body temperature.vto reduce hemorrhage,swelling and pain after sprains,head injuries and dental surgeriesUseofIceBagsPurposetore30Equipmenticebagclothcovertowelbasinice,and so onEquipmenticebagclothcovertow31Procedures and key pointsFill the ice bag one half to two thirds full of crushed ice.ProceduresandkeypointsFill32第十四章-生命体征的评估与护理课件33Use of Ice caps Purposeto lower head temperature and prevent brain edema for unconscious clients.UseofIcecapsPurpose34Equipment*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 *basinEquipment*icecap*drawshe35Procedures 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(外外耳耳),),occiput(枕枕骨骨部部)and neck,and the small pillow under clients shoulders.The drainage tube is down into the bucket.ProceduresandkeypointsTake36lTake anus temperature(肛温肛温),),maintain it around 33.Below 30 ventricular fibrillation(室颤室颤)Takeanustemperature(肛温),37Cold moist Compress(冷湿敷冷湿敷冷湿敷冷湿敷)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 principles.ColdmoistCompress(冷湿敷)Them38第十四章-生命体征的评估与护理课件39Chemical cold packsa 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.十水碳酸钠十水碳酸钠和硝酸铵和硝酸铵Chemicalcoldpacksapref40Hypothermia blankets(降温毯降温毯降温毯降温毯)This appliance is made based on the 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 lowered.Hypothermiablankets(降温毯)41tepid water sponge bath（温水擦浴温水擦浴）3234 alcohol sponge bath（乙醇擦浴乙醇擦浴）2535%;30tepidwaterspongebath（温水擦浴）42Heat applicationltherapy effects of heat lcontradictions to heat applicationslmethodsHeatapplicationtherapyeffect43Therapy effects of heat vpromotes 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 ComfortTherapyeffectsofheatpromot44促进炎症的消散和局限促进炎症的消散和局限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.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45 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.临床多用于软组织细菌性感染早期、慢性感染的辅助治46减轻深部组织充血减轻深部组织充血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47减轻疼痛减轻疼痛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。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48Contradictions to heat applicationsqUnidentified acute abdomenqFacial dangerous triangle area infectionqHemorrhagic diseases qInjuries of soft tissues within 48 hoursqBacterial Conjunctivitis(细菌性结膜炎细菌性结膜炎)qNeurosensory impairment and impaired mental statusContradictionstoheatapplica49Methodshot-water bag heating lamp Chemical heating bagsmoist heat moist hot compress sitz bath(坐浴坐浴)hot soaks(浸泡)dry heat Methodshot-waterbagmoisthea50preparation AssessmenttheclientsskinareaEquipmentTheclientslevelofsensationExplanation Theclientunderstandsthepurposeofthetherapyandprecautionstakenduringtreatment.preparationAssessmenttheclie51Use of Hot-water bagsPurposevto relieve spasm and painvto provide warmth and comfortUseofHot-waterbagsPurpos52Equipmenthotwaterbagandcoverhotwater(6070)drytowelthermometerEquipmenthotwaterbagandcov53Procedures*Placethehotwaterbagflat,Fillthebagwithhotwaterabouta half to two thirds full.*turn the stopper until it is tight*PlacethehotwaterbagflatgraduallyandexpeltheremainingairProcedures*Placethehotw54Wrap the bag in a cloth cover and tighten its tiesDrythebagandholditupsidedowntocheckforitsleaksPlace the bag on the body site of the client as appropriateWrapthebaginaclothcover55key pointsvFor unconscious clients,elders,infants,and clients who havent regain consciousness after anaesthesia,the safe water temperature should 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.keypointsForunconsciousclie56Use of Hot LampsPurposevto reduce inflammationvto relieve spasm and painvto promote scar and granulation tissue formation UseofHotLampsPurposetor57Equipmentgooseneck lampEquipmentgoosenecklamp58Procedures and key pointsThe distance is usually 30 to 50cm eyes should be covered The duration of this application is 2030minutes.Observe the local exposed skin closely during treatmentProceduresandkeypointsThed59Hot moist compressPurposevto reduce inflammation and edema vto relieve spasm and pain HotmoistcompressPurposetore60Equipmenttraysteriledressingtransferforcepsdressingssterilepetrolatumsterilecottonswabsterilegauzeplasticsheetsmallrubberdrawsheetsteriledrapecottonmatelectricalstovethermometerboiler(hotwater(5060)hotwaterbag(ifnecessary)Equipmenttray61Procedures coverasterilegauzeonit.Spreadlightcoatofsterilepetrolatumoverskinsurfacetobetreated.Procedurescoverasterilegau62Putdressingsintothehotwater(Putdressingsintothehotwater(50506060)Takeoutdressingswithsteriletransferforcepsandwringexcesswater.Applythedressingontotheareatobetreated.thencoveritwithaplasticsheetandcottonmat.Putdressingsintothehotwat63key pointsvChange dressings every 3 to 5 minutes and observe skin condition.vIf continuous compresses are ordered,it can be applied 15 to 20 minutes.keypointsChangedressingseve64Hot sitz bathPurposevTo 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.HotsitzbathPurposeToreduce65Equipmenthot water bottle sitz bath solution steriled gauzes thermometer large bath blanketsterile sitz bath tub sitz bath chairEquipmenthotwaterbottle66ProceduresPlace 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 constant 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.ProceduresPlacethesitzbath67key pointsThe bath tub and medication fluid should be sterile if there is wound.It s not preferred for the female client during menses(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)havingacute inflammation in pelvic cavity.盆腔器官急性炎症盆腔器官急性炎症keypointsThebathtubandme68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。WhenYouDoYourBest,FailureIsGreat,SoDonTGiveUp,StickToTheEnd 结束语69谢谢大家荣幸这一路，与你同行ItSAnHonorToWalkWithYouAllTheWay演讲人：XXXXXX时间：XX年XX月XX日谢谢大家演讲人：XXXXXX 70