CARE OF UNDER FIVE’S – Under Five’s Clinic, Aims of Under Five Clinics, Objectives of Under Five Clinics, Role of a Nurse in Under Five’s Clinic and Physical Facilities for a Children’s Clinic (CHILD HEALTH NURSING)

UPDATED 2024

THE RIGHTS OF THE CHILD

To meet the special need of the child, the general assembly of the United Nations adopted on 20^th November 1959, and the declaration of the Rights of the child. India was a signatory to this declaration

• Right to develop in an atmosphere of affection and security and whenever possible in the care and under the responsibility of his/her parents
• Right to enjoy the benefits of social security including nutrition, housing and medical care
• Right to free education
• Right to full opportunity for play and recreation
• Right to a name and nationality
• Right to special care if handicapped
• Right to be among the first to receive protection and relief in times of disaster
• Right to learn to be a useful member of society and to develop in a healthy and normal manner and in conditions of freedom and dignity
• Right to bring up in a spirit of understanding of brotherhood
• Right to enjoy these rights, regardless of race, color, sex, religion, social and national origin

UNDER FIVE’S CLINIC

The under five’s clinic or well baby clinic’s combines the concepts of prevention, treatment, health supervision, nutritional surveillance, and education into a system of comprehensive health care within the resources available in the country, making use of nonprofessional auxiliaries, thus making the service not only economical but also available to a larger proportion of children in the community. Under five clinics must provide for courteous reception of mother and children, with enthusiasm and zeal on the part of each member of the team

AIMS OF UNDER FIVE CLINICS

Care in illness: the basic philosophy of the under five’s clinic to give nurses effective training and responsibility for handling the child healthcare service. The illness care for children will comprise of diagnosis and treatment, X-ray and laboratory services and referral services

Preventive care: the preventive care given on the basis of immunization, nutritional surveillance, health checkups, oral rehydration, family planning and health education

Growth monitoring: for under five clinic to weigh the child periodically at monthly intervals during the first year, every 2 months during the second year and every 3 months thereafter up to a age of 5 to 6 years. The growth curve will help the health worker to detect early onset of growth failure

OBJECTIVES OF UNDER FIVE CLINICS’

• The prevention of malnutrition, pertussis, tuberculosis, poliomyelitis, diphtheria, tetanus and measles
• The supervision of the health of all children upon the age of five
• The education of parents to promote health and family planning
• The provision of simple treatment for diarrhea, with or without dehydration, pneumonia, skin conditions and other common disorders

ROLE OF A NURSE IN UNDER FIVE’S CLINIC

• Treating minor illness
• Referring the more seriously-ill children
• Instructing about feeding, nutrition and hygiene
• Encouraging child spacing and family planning
• Maintaining the children’s weight cards, e.g. road to good health cards
• Being alert in every conditions so that the effectiveness of the service can be improved

PHYSICAL FACILITIES FOR A CHILDREN’S CLINIC

• Outside compound: playground for children waiting to be served including swings slides and sand box are needed. These facilities may be provided by the community volunteer group or by the health committee
• Waiting room should include a reception table and the record. The area should include child health posters, display exhibits and play are for the children
• Weighing and measuring should be provided in a separate area if possible or it may be part of the waiting room
• Isolation area for children with signs and symptoms of illness is essential for every child health clinic

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KEY POINTS

Here are some key points regarding the care of children under the age of five:

1. Nutrition: Proper nutrition is crucial for the healthy development of children under five. Breastfeeding is recommended as the best source of nutrition for infants up to six months of age, followed by the introduction of complementary foods while continuing breastfeeding up to two years or beyond. Adequate intake of nutrients such as protein, vitamins, and minerals is essential for growth and development.
2. Immunization: Following the recommended immunization schedule is essential to protect children under five from vaccine-preventable diseases. Vaccines help build immunity and prevent the spread of infectious diseases, reducing the risk of illness, disability, and death.
3. Hygiene and Sanitation: Good hygiene practices, including handwashing with soap and water, safe food handling, and sanitation measures, are critical for preventing the spread of infections and diseases among young children. Access to clean water and sanitation facilities is essential for maintaining health and preventing waterborne illnesses.
4. Healthcare: Regular health check-ups and access to healthcare services are vital for monitoring the growth and development of children under five, detecting and managing health issues early, and providing appropriate treatment and preventive care. Maternal and child health services, including antenatal care, postnatal care, and well-child visits, play a crucial role in promoting child health and well-being.
5. Safety and Childproofing: Creating a safe environment for young children is essential to prevent accidents and injuries. Childproofing the home, including installing safety gates, securing furniture and electrical outlets, and keeping hazardous substances out of reach, helps minimize the risk of accidents and promote child safety.
6. Stimulation and Play: Providing opportunities for play, exploration, and stimulation is vital for the cognitive, emotional, and social development of children under five. Engaging in age-appropriate activities and spending quality time with children supports their learning and overall well-being.
7. Parental and Caregiver Support: Supporting parents and caregivers in providing responsive and nurturing care is crucial for the healthy development of children under five. Providing information, education, and support on child-rearing practices, positive discipline, and early childhood development can empower parents and caregivers to create a nurturing environment for their children.

UPDATED 2024

CARE OF HAIR

Care of hair is part of the personal hygiene. It is another way of helping the patient feel good about him and maintain a good mental attitude. A patient’s hair should be combed daily. In addition, other care is necessary to enhance morale, stimulate circulation of the scalp and prevent tangled, matted hair

Purposes of Hair Care

• Hair care improves the morale of the patient
• It stimulates the circulation of the scalp
• Shampooing removes bacteria, microorganisms, oils, and dirt that cling to the hair

Objectives

• To maintain cleanliness of the scalp and hair
• To prevent matting of hair
• To promote comfort and to stimulate circulation of the scalp
• It gives an opportunity of observation of the scalp and hair
• It maintains a glossy and healthy appearance of hair and gives satisfaction to the patient

Scientific Principles

• Well-combed and attend hair provide comfort to the patient and make appearance more attractive
• Neglected hair and scalp contain dirt and microorganism and also produce infection of the scalp
• Unbroken skin acts as a barrier to infection

Types of Hair Care

• Daily care: the hair should be thoroughly combed and brushed daily. A woman usually needs more attention to the hair due to its length
• Hair shampoo: shampooing the hair in order to maintain its cleanliness
• Treatment of hair: pediculosis treatment – it is the treatment given with DDT 5% of carbolic lotion 1:40 applied thoroughly on the scalp and it is left for overnight, and the next day a thorough bath is given and the linen is change

MAINTAINING HAIR CARE

Care of hair means maintaining cleanliness of hair, i.e. free from dandruff, dirt, nits, lice, flakes, dryness and irritation

Purpose

• To keep hair clean and healthy
• To promote growth of hair
• To have a neat and tidy appearance
• To prevent itching, infection, dandruff, lice, flakes, dryness and irritation
• To prevent loss of hair
• To prevent accumulation of dirt
• To stimulate circulation
• To prevent tangles
• To promote comfort
• To have a sense of well-being

Three Aspects of Hair Care

1. Daily care by brushing and combing
2. Head bath in order to maintain to cleanliness
3. Treatment of hair for lice infestation

Factors Influence on Hair

• General health of a person
• A well-balanced diet
• Light and fresh air
• Daily practices (hair wash and combing)
• Hair brushing and massage
• Endocrine disorder

Factors Affecting Hair

• Altered level of consciousness
• Physical weakness or disease condition
• Immobility and aging
• Insect bite and infestations
• Accumulated secretions
• Hormonal changes
• Physical and emotional stress
• Poor health practices
• Effects on drug

Common Hair Scalp Problems

• Dandruff – sealing of scalp accompanied by itching
• Pediculosis – lice infestation
• Alopecia – hair loss
• Tangled and matted hair
• Dryness
• Flakes
• Irritation

HAIR COMBING

The hair can be combed and washed in the morning so that the patient can feel refreshed and appear well-groomed before starting daily activities

General Instructions

• Hair needs to be brushed daily in order to be healthy
• Long air should be combed at least once a day to prevent it from matting
• Teeth of the comb should be dull to prevent scratching of the scalp
• Hair must be kept free from snarls, combed and brushed without hurting the patient

Preliminary Assessment

Check

• Doctors order for specific precautions
• General condition and self-care ability
• Condition of the scalp and hair
• Mental status to follow directions
• Articles available in the unit

Preparation of the Patient and Environment

• Explain the procedure
• Arrange the article at the bedside
• Provide privacy and adequate light
• Make the patient to sit on a bedside chair or stool
• Protect the bottom sheet and pillow case with a towel
• Protect the nurse’s uniform by wearing aprons

Equipment

• Clean comb
• Mackintosh and towel
• Coconut oil in a container
• Kidney tray and paper bag
• Kidney tray with carbolic lotion 1:20 to destroy the lice and to disinfect the comb

Procedure

• Wash hands and take required articles at bedside
• If possible as patient to sit on a stool otherwise side lying or fowler’s position
• Place the Mackintosh under the head of the patient
• Each half of the hair is treated separately without causing strain on the patient
• Separate the hair in small strands. To prevent pulling hold strands above the part being combed, so that there will be no pain to the patient
• Comb the tangle out from the ends first and then go up gradually. Use oil to remove tangles
• After combing the hair thoroughly, use ribbon to tie the hair
• Discard loose hair into the paper bag

After Care

• Place the patient comfortable and tidy
• Replace the articles to the utility room
• Wash hands thoroughly
• Record and report the procedure in nurse’s record sheet

Problems of Neglected Hair Care

Neglected hair care cause sticky and heavy and acquires a sour, unpleasant odor, which may be quite distressing the patient. Pediculosis is associated with poor hygiene, crowded living condition and exposure to other individuals.

The people with pediculosis have complaints of severe itching of the scalp and scratch the head continuously giving rise to abscess formation. The lice are blood suckers and cause anemia. They also spread disease, e.g. typhus fever, relapsing fever, trench fever.

HAIR WASH/BED SHAMPOO

The patient confined to bed will require a cleansing shampoo at least every two weeks. With the approval of the medical officer, plan the shampoo for a time when the patient feels rested and has no conflicting treatments or appointments. If the patient can be moved to a stretcher, do so and take him to a convenient sink. If this is not possible, do the shampoo in bed

Definition

Hair wash/bed shampoo is a special care of the hair may be required for patients who are in bed for a prolonged period of time

Shampooing the hair should be performed whenever the hair and scalp are dirty

Principles of Shampooing the Bed Patient’s Hair

• The supine position is preferred for weaker patients
• Patients with significant heart or lung disease will not tolerate being supine; they must be in a sitting position
• Hair care should be given regularly during illness, just as it would be normally

Purpose

• To keep hair and scalp clean and healthy
• To promotes sense of comfort and self-esteem
• To complete the treatment of pediculi

General Instructions

• The patients are given hair wash at least once a week for bedridden patients
• Avoid hair wash for patients who have just taken meals at least for an hour
• Avoid exposure and chilling by keeping the patient covered with top clothes
• If the patients are very sick, note pulse before and after the hair wash
• Do not let the patient exert and try to avoid exertion to the patient as far as possible

Preliminary Assessment

Check

• Doctors order for specific precautions
• General condition for the patient
• Self-care ability
• Patients preference for soap, shampoo, oil, etc
• Patients mental state to follow instructions
• Availabilities of ward article

Preparation of the Patient and Environment

• Explain the procedure
• Arrange the articles at the bedside
• Provide privacy
• Position the patient (flat) comfortably to the edge of the bed (if condition permits)
• Remove the extra pillows and back rest
• Make an improvised through (Kelly’s pad) and place it under the hand to facilitate the drainage of water in to receptacle
• Place the bucket on the low stool close to the side of the bed. The distal end of the Mackintosh (trough) is received in to it
• Plug the ear with cotton balls

Equipment

• A tray contains bath towels – 2
• Face towel – 1
• Long Mackintosh – 1
• Cotton swabs – 2
• Liquid soap  or shampoo
• Hair comb
• Kidney tray
• Paper bag and news paper
• Bucket – 1
• Mug – 1
• Jugs – 2 (hot and cold water)
• Safety pins

Procedure

Following is the procedure for administering a shampoo to a patient in bed

• Place a newspaper on the chair and the bucket on the newspaper. Place the patient of water, shampoo, comb, brush, and one of the two bath towels on the bedside cabinet
• Move the patient to the near side of the bed. Lower the bed to a level position
• Pull the pillow down under the patient’s shoulders to assisting extending the neck. Fold one bath towel around the neck
• Place the narrow side of the rubber sheet under his head and over the edge of the pillow. Roll the sides of the sheet to improvise a trough, and place the free end in the bucket
• Give the patient a washcloth for his eyes and face
• Check provisions for water drainage before pouring any water
• Wet his hair and apply shampoo. Lather and rinse it
• Reapply shampoo and rinse the hair again repeatedly until his hair is “squeaky clean”. (a woman will require more rinse water than a man, but otherwise the procedure is unchanged)
• Slip a dry towel under the patient’s bed. Then roll and remove the rubber sheet. Pull the pillow up into its normal place
• Dry the hair by gently rubbing it with a clean towel
• Remove the equipment and wipe up any water spilled on the floor
• Assist the patient to comb and brush his hair with a clean comb and brush

After Care

• Place the patient in comfortable position
• Dry the hair, comb and arrange hair when completely dry
• Change linen if wet
• Replace the articles into utility room
• Wash hands thoroughly
• Record and reporting the procedure in nurses record street

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TIPS TO MAINTAIN HEALTHY AND BEAUTIFUL HAIR

Here are some general hair care tips to help maintain healthy and beautiful hair:

1. Regular Washing:
   • Wash your hair regularly to keep it clean and free from excess oil and product buildup. The frequency may vary depending on your hair type.
2. Use a Mild Shampoo and Conditioner:
   • Choose a shampoo and conditioner that suits your hair type and is free from harsh chemicals. Avoid excessive use of styling products with strong chemicals.
3. Avoid Hot Water:
   • Wash your hair with lukewarm or cool water. Hot water can strip the hair of natural oils, leading to dryness and damage.
4. Proper Conditioning:
   • Use a good-quality conditioner to keep your hair moisturized and manageable. Focus on the tips and mid-lengths of your hair while applying conditioner.
5. Protect Your Hair from Heat:
   • Limit the use of heat-styling tools such as flat irons, curling irons, and blow dryers. When using them, apply a heat protectant spray to minimize damage.
6. Regular Trims:
   • Schedule regular haircuts to prevent split ends and keep your hair looking healthy. Trimming every 6-8 weeks is a good rule of thumb.
7. Gentle Towel Drying:
   • Pat your hair dry with a soft towel instead of rubbing vigorously, which can cause breakage. Avoid using a towel on wet hair, as it is more prone to damage.
8. Protect Your Hair from the Sun:
   • UV rays can damage your hair. If spending extended periods in the sun, consider wearing a hat or using hair products with UV protection.
9. Balanced Diet:
   • A nutritious diet rich in vitamins and minerals contributes to healthy hair. Include foods high in protein, iron, and omega-3 fatty acids.
10. Avoid Tight Hairstyles:
    • Avoid hairstyles that pull on the hair, such as tight ponytails or braids, as they can cause breakage and damage the hair shaft.
11. Use a Wide-Toothed Comb:
    • Detangle your hair gently using a wide-toothed comb, especially when it’s wet to prevent breakage.
12. Hydrate:
    • Stay hydrated as it also contributes to the health of your hair. Dehydration can make your hair dry and brittle.
13. Limit Chemical Treatments:
    • Minimize the use of chemical treatments like coloring, perming, or straightening, as they can weaken the hair structure.
14. Choose Silk Pillowcases:
    • Silk pillowcases can reduce friction, helping to prevent tangles and breakage.
15. Manage Stress:
    • High stress levels can contribute to hair problems. Practice stress management techniques like meditation or yoga.

UNDER FIVE ASSESSMENTS – Purposes, Symbol of Under Five Clinics, Equipment Needed and Procedure (COMMUNITY HEALTH NURSING)

Updated 2024

Under five clinic is also called the well-baby clinic that offers preventive and promotive services for the benefit of the under-five or preschool children

PURPOSES

• To provide carafe during illness
• To provide adequate nutrition
• To immunize the child at right time
• To plan and prepare for family planning
• To provide health teaching or education to promote health
• To assess the growth and development of children

SYMBOL OF UNDER FIVE CLINICS

• Care in illness
• Adequate nutrition
• Immunization
• Family planning
• Health teaching/education

EQUIPMENT NEEDED

• Weighing machine
• Inch tape, Snellen’s eye chart
• Shakir tape to measure midarm circumference
• Nutrition cups, infantometer to measure the length of infant
• Flash cards or posters and records or health chart

PROCEDURE

• Wash hands and warm
• Keep ready with the articles such as inch tape, shakir tape, nutrition cups
• Explain the procedure to the parent or the group
• Weight the infant using weight balance or Bar scale weighing machine or path weighing machine
• Check the height by using inch tape, use infantometer, if the child’s age is below 2 years
• Record the height and weight in the chart inform to their parents
• Measure the chest and head circumference and record
• Anthropometry should be entered in health record
• General physical examination can be done by the nurse to rule out any abnormalities
• Rule out any refracting errors among children by using Snellen’s chart

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“Under Five Assessments” typically refers to a set of key evaluations used in public health to assess the health status of children under the age of five years. Here are some key points related to these assessments:

1. Nutritional Status: This assessment evaluates the nutritional status of children under five, focusing on parameters such as weight, height, and mid-upper arm circumference (MUAC). Malnutrition, including undernutrition and overnutrition, can significantly impact a child’s health and development.
2. Immunization Status: It’s crucial to assess whether children under five have received all recommended vaccinations according to the immunization schedule. Immunizations protect against a range of infectious diseases, preventing illness and potentially life-threatening complications.
3. Growth and Development: Monitoring growth and development milestones is essential for early detection of developmental delays or health issues. Assessments may include motor skills, language development, cognitive abilities, and social-emotional development.
4. Health Status: This involves assessing the overall health of children under five, including identifying any acute or chronic illnesses, infections, or conditions that may require medical attention. Regular health check-ups can help in early detection and management of health issues.
5. Access to Healthcare: Assessing access to healthcare services is crucial to ensure that children under five have access to essential healthcare services, including preventive care, treatment for illnesses, and maternal and child health services. Barriers to access, such as distance, cost, and availability of healthcare facilities, need to be identified and addressed.

These assessments play a vital role in monitoring the health and well-being of children under five, guiding interventions and policies aimed at improving child health outcomes and reducing child mortality rates.

TYPES OF COMFORT DEVICES (Role of Nurse in Comfort Measures)

Updated 2024

Comfort is concerned with rest, with exercise, with the relation of one part of the body to another, with the bed and the whole environment. Comfort is a phase of every procedure as it is an aspect of the total care of the patient.

Comfort devices are invented articles which would add to comfort of patient when used in appropriate manner.

These devices relieve the discomfort and help in maintaining correct posture. Various comfort devices are used for giving comfort to the patient, such as: pillows, back rest, foot rest, bed block, bed cradles, sand bags, air cushion, rubber and cotton rings, air and water mattresses and knee rest.

Here are some common types of comfort devices:

1. Heating Pads:
   • These devices generate warmth and are often used to soothe muscle aches, cramps, or provide general comfort during colder weather.
2. Cooling Fans:
   • Fans help circulate air and can provide relief during hot weather. Some are portable, while others are built into air conditioning units.
3. Massage Chairs/Devices:
   • Designed to provide relaxation and relieve muscle tension, these devices come in various forms, including massage chairs, handheld massagers, and massage cushions.
4. Electric Blankets:
   • These blankets have integrated heating elements to provide warmth during colder nights, offering a cozy and comfortable sleep environment.
5. Orthopedic Pillows and Mattresses:
   • These are designed to support proper body alignment and reduce pressure points, offering comfort and relief for individuals with specific sleep or posture needs.
6. Humidifiers:
   • Humidifiers add moisture to the air, which can be beneficial in dry environments. They can help relieve respiratory issues, dry skin, and enhance overall comfort.
7. Aromatherapy Diffusers:
   • These devices disperse essential oils into the air, creating a pleasant and calming atmosphere. Certain scents are believed to have relaxation and stress-relief properties.
8. Foot Massagers:
   • These devices are designed to provide relief to tired and achy feet, often using massage techniques to improve circulation and reduce tension.
9. Weighted Blankets:
   • These blankets have added weight, which is believed to provide a calming effect and help alleviate anxiety or stress by providing a sense of security.
10. Eye Masks:
    • These masks are often used for relaxation or sleep aid, blocking out light and promoting a more restful environment.
11. Electric Foot Warmers:
    • Devices designed to keep feet warm and cozy, especially in cold weather. They often come in the form of heated slippers or foot warmer pads.
12. Therapeutic Cushions:
    • Cushions designed for specific purposes, such as lumbar support cushions for chairs or seat cushions with cooling gel for improved comfort.

PILLOWS

Pillows are used to give comfortable position to the patient. These are most commonly used to support various body parts.

Purpose

• To maintain proper body alignment
• To support body part in good alignment
• Help to reduce pressure
• It can be folded, rolled or tucked firmly against the body to maintain position
• It is used to support head, neck, arms, legs and part of the back adds to the physical comfort

BACK REST

Back rest is a mechanical device which provides a suitable support and rest for the back of the patient in sitting position

Purpose

• To support back
• To facilitate easy breathing
• It is given especially for heart patients and asthma patients
• Used in postoperative period

ROLLS

• Hand rolls are made of cloth that rolled into a cylinder’ about 4-5 inches long and 2-3 inches in diameter and stuffed firmly

Purpose

These used to keep the fingers from being held in a tight fist leading to flexion contracture in patients who are unable to move hands due to paralysis, injury or disease. Thigh rolls are made by folding a sheet to the desired length of 2-3 feet and then rolled into a tight cylinder.

Thigh rolls are used to support hips and thighs preventing them from outward rotation and keeping the feet in good alignment in case of paralysis, fracture of femur of hip surgery.

FOOT RESTS

Foot rests are the mechanical device used to give rest to feet. Sands bags or foot board may be substituted.

Purpose

• It helps to maintain the normal position of feet
• It is used for the comfort
• To prevent foot drop

SAND BAGS

Sand bags are canvas, rubber or plastic bags filled with sand and are 1, 5 and 10 lbs in weight. Sand bags are used to immobilize a part.

Purpose

• To relieve discomfort
• Used to support the body part
• Used to immobilize the body part
• Used to support as in fractures bones
• To prevent foot drop or wrist drop

AIR AND WATER MATTRESSES

Air and water mattresses are used for very thin or obese patients and for those who are prone to get pressure sores. The principles is that pressure exerted by the body, will be distributed equally in all directions.

Air and water mattresses are plastic mattresses with two sets of chambers. To use them place the mattress on the bed and fill air or water in the compartment. Cover the mattress with light bottom clothes.

Purpose

• To improve circulation
• To provide comfort
• To prevent pressure sores
• Used in very thin or very obese patients
• Used in chronic bed ridden patients

Caution

Avoid punctures in the mattress with needles, pins or other sharp objects

RINGS

Air rings are made of rubber. The air rings is inflated about half full tested for leakage, covered and the placed under the patient’s hip in such a way that the value is on side and not in contact with body.

Cotton rings are made wrapped with bandage. These are placed under the bony prominences such as heels and fastened in place if necessary.

Purpose

• Used to lift the hip from bed to prevent bed sores
• It helps to prevent direct pressure on bony prominence
• It improves the circulation

BED CRADLES

Bed cradles vary widely in size and in material. Bed cradles are of wooden, metal or electronic. The bed cradles support and take off the weight of the bedding.

Bed cradle are semi-circular in shape made of wood or metal or entirely made of metal tubing or slats.

Purpose

• Used to prevent the top cloth is coming in contact with the patients especially in burns patients
• To apply heat in case of dying plaster casts
• Electronic bed cradles are used to supply the desired warm to the case of shock

BED BLOCKS

Bed blocks are made up of wood size; it may be high or low. These are placed under the foot of bed for various reasons.

Purpose

• To prevent shock
• To arrest hemorrhage
• To retain enema
• After spinal anesthesia
• After tonsillectomy
• To provide traction
• To position in postural drainage

AIR CUSHION

Air cushions are round in shape and made up of rubber. These can be inflated with air. These are used to take off the weight of the body.

Air cushion should not be applied directly in contact with skin. They should have a cover.

Purpose

• To relieve pressure on certain parts of the body
• It provides relaxation as it yields to shift off body weight and it relieves pressure on certain parts of the body

Uses: air cushion vehicles work by creating a large force of those points to the ground. This lifts the vehicle off the ground letting it ride on a cushion of air.

CARDIAC TABLE

 A table is in the hospital for patient’s use during hospitalization. It is used to maximize safety of both patients and staff. Improve patient’s surrounding by modifying the current cardiac table to one that can be kept and folded.

• Bed table placed in front with a pillow on it, patient can lean forward and take rest
• Table without pillow is used for writing and meals
• Used for patients with cardiac conditions and asthma
• Position should be changed to relieve fatigue

Purpose

• Patient can rest over the table with the help of pillow
• Helps to take meals and in writing

TRAPEZE BAR

An overhead trapeze is a triangle-shaped metal bar. It hangs from a metal frame, which is attached to the headboard and footboard of the bed. A trianglular metal apparatus above a bed, used to help the patient move and support weight during transfer or position change.

Trapeze bar is suspended from an overhead frame that extends from the foot to head of bed. Patient can grasp the bar to raise the trunk off the bed surface or to move up in bed.

ROLE OF NURSE IN COMFORT MEASURES

• Nurse identify comfort needs of patients and family members
• Nurses design interventions to meet identified needs
• Intervening variables are considered when designing interventions
• When interventions are delivered in a caring manner and are effective, and when enhanced comfort is attained, interventions are called “comfort measures”
• Patients and nurse agree on desirable and realistic health seeking behaviors
• If enhanced comfort is achieved, patients and family members are more likely to engage in health-seeking behaviors these further enhance comfort
• When patients and family members are given comfort care and engage in health-seeking behaviors, they are more satisfied with health care and have better health-related outcomes.
• When patients, families, and nurses are satisfied with health care in an institution, public acknowledgement about that institution’s contributions to health care will help the institution remain viable and flourish. 

TYPES OF COMFORT DEVICES – VIDEO

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COMFORT DEVICES USED IN HOSPITAL (Definition, Purpose, Principles, Preparation, Factors influencing Comfort and Types)

Updated 2024

Comfort is a sense of mental and physical well being. Physical comfort gets affected due to a dirty and wet bed and lack of body alignment. High temperature and humidity, poor ventilation too much noise, unpleasant odors and glaring lighting make the patient uncomfortable. To promote comfort for the patients, certain mechanical devices can be used.

Pillows can be used for giving support for the various part of the body. Sometimes – patient feels comfortable in a propped up position. In a hospital, a backrest is provided for the patient to keep him in a sitting position. For relaxation of abdominal muscles, when patients are in pain or after an abdominal operation, knees can be kept flexed by means of a knee rest. Comfort devices are mechanical devices which are used to provide comfort to the patient

DEFINITION

• Comfort is a state of free from pain and discomfort tension and anxiety
• Comfort is defined as the contented enjoyment in physical or mental well being freedom from pain or trouble
• Discomfort is defined as want of comfort or ease due to pain or annoyance
• Comfort devices are the mechanical devices to promote comfort to the patient
• Comfort devices are invented articles which would add to the comfort of the patient when used in the appropriate manner, by relieving the discomfort and helping to maintain correct posture

PURPOSE

• To promote comfort
• To prevent discomfort
• To alleviate discomfort
• To ensure that the patient has rest
• To assist the patient to obtain an adequate sleep to meet his requirement
• To maintain correct posture

PRINCIPLES OF COMFORT

• Definite periods of sleep are a essential component of the circadian rhythm in human being
• Adequate amounts of sleep are needed for optimal physical and psycho-social functioning of the individual
• Individual needs for sleep vary with age, growth patterns, health status and individual differences
• Lack of sufficient sleep impairs a person’s physical functioning, his mental alertness and his social relationship
• Individual habits vary with regard to bed time rituals
• Sleep pattern may be disturbed by changes in person’s normal daily living patterns by social and emotional problems by physical problems and by minor irritation or discomforts
• Sleeps at terms are almost invariable disturbed by illness

PREPARATION OF AIDS

The use of aids for positioning helps to keep the patient in the desired position so as to avoid pressure ulcers developing as well as facilitate the moving of the patient.

• Aids that help to keep the patient in the desired position, or prevent pressure ulcers developing
• Decubitus pad or mattress
• Small or large cushions
• Feet or elbow pads (or foam rings) for reducing pressure on the skin
• Trochander roll or other aids to prevent external rotation of the hip
• A roll (e.g. inflatable) placed under knee
• Block (box) of foam or inflatable

FACTORS INFLUENCING COMFORT

• Pain
• Restriction of movements due to weakness
• Wrinkled soiled and wet sheets
• Delayed or inadequate attention to meet the personal needs
• Lack of exercise
• Temperature extremes
• Too bright lights and glares
• Fear and anxiety due to illness
• Insecurity feeling
• Lack of sleep
• Uncomfortable position
• Indigestion and irregular bowel movements

The ‘English word ‘hospital’ originates from the Latin word “HOSPILE” and also some viewed that it comes from the French word “hospitale.”

Types of Comfort

• Relief – the state of having a specific comfort need met
• Ease – the state of calm or contentment
• Transcendence – the state in which one can rise above problems of pain

Context in which Comfort Occurs

Physical – pertaining to bodily sensations, homeostatic mechanisms, immune function, etc

Psychospiritual – pertaining to internal awareness of self, including esteem, identity, sexuality, meaning in one’s life, and one’s understood relationship to a higher order or being

Environmental – pertaining to the external background of human experience (temperature, light, sound, odor, color, furniture, landscape, etc)

Sociocultural – pertaining to interpersonal, family, and societal relationships (finances, teaching, healthcare personnel, etc). Also to family traditions, rituals, and religious practices

COMFORT DEVICES/MECHANICAL DEVICES

• PILLOW – used for support to maintain correct body alignment. Used under head, arms, legs and along spine or abdomen. Correct positioning reduces strain on muscles and joints back rest. Support patients back at an angle, so that he may maintain a sitting position. Can be adjusted to desired angle. Extra pillows are needed. Arms of patient are well supported. Used for patients suffering with cardiac and pulmonary distress

Purposes:

1. To relieve dyspnea
2. To promote drainage from abdominal cavity
3. To provide a comfortable change of position

• Backrest – it is a mechanical device which provides support for the patient in sitting position

• Cardiac cradle – it is a frame used to hold the bed linen from touching the patient. It is used to prevent pressure from the weight of linen. It is used to allow air to circulate around lower limbs. Cradle is often a semicircular frame of metal. Maybe made of wood or bamboo. It may be made into a rectangular shape

• Cardiac table – usually for patients who are propped up in a sitting position for change of position. Bed table placed in front with a pillow on it, patient can lean forward and take rest. Table without pillow is used for writing and meals. It is used for patients with cardiac conditions and asthma. Make it possible to use accessory muscles of respiration. Position should be changed to relieve fatigue and prevent embolism

• Bed boards – boards are usually made of wood and are placed under the mattress to provide support chairs bed. Beds can be placed into the position of chair for patients who cannot move from the bed but require a sitting position

• Knee rest – knee rest may be substituted by a pillow, gives relaxation and thus relieves pain on abdominal muscles and tendons beneath the knees

• Foot rest/board – foot board is the device that is placed towards the foot of patient’s bed to serve as support for his feet. Some fit onto the sides of bed frame and rest on the mattress at any point along the bed. Usually made up of wood/plastic/heavy canvas 

• Trapeze bar – trapeze bar is suspended from an overhead frame that extends from the foot to head of bed. Patient can grasp the bar to raise the trunk off the bed surface, or to move up in bed

• Fracture board – fracture board is a support that is placed under patient’s mattress to give added rigidity to the mattress. Usually made of wood/canvas and is constructed to fit the standard hospital bed

• Balkan frame – Balkan frame is made of wood or metal that extends lengthwise above the bed and is supported at either ends by a pole. Trapeze may be attached to the frame just above patient’s head as an aid to the pt in lifting himself up in bed fracture board

• Bradford frame – it is a canvas stretcher like device that is supported by blocks on the foundation of bed. It used to immobilize patients who have injured spines. Canvas is divided into 3 parts so that small center portion can be removed to insert a bedpan

• Trochanter board – trochanter rolls prevents external rotation of legs when patient is in supine position. A cotton bath blanket/sheet is folded lengthwise to width extending from greater trochanter of femur to lower border of popliteal space blanket is placed under the patient until thigh is in neutral position with patella facing upward Bradford frame

• Sand bags – it provides support and shape to body contours. Immobilize extremities and maintain specific body alignment. They are filled plastic bags that can be shaped to body contours. It can be used in place of or in addition to trochanter rolls

• Hand rolls – hand rolls maintain thumb in slightly adducted and in opposition to fingers. Maintain fingers in slightly flexed position. It can be made by folding a washcloth in half, rolling in lengthwise and securing roll with rape. Roll is placed against palmar surface of hand sand bags

• Hand-wrist splints – individually molded for the patient to maintain proper alignment of the thumb in slight adduction and wrist in slight dorsiflexion. These splints should be used for the patient whom the splint was made.

• Side rails – side-rails are bars positioned along the sides of the length of the bed. Ensure patient’s safety and are useful for increasing mobility. Provide assistance in rolling from side-to-side or sitting up in bed

• Air and water mattress – these are used for very thin, obese and those who are prone to bed sores. The principle exerted on the bony prominences will be equally distributed in all directions, thus pressure against bony prominences or areas subject to develop pressure sores will be reduced

• Rubber and cotton rings – it is used to relieve pressure on certain parts of the body like elbows and heels

• Air cushions – it is used to take off the weight of the body and to relieve pressure on certain parts of the body. Air cushion should not be used directly in contact with the skin. They should have covers

• Bed blocks – these are made of wood, may be high or low. These are placed under the foot of the bed for various reasons, e.g. surgical shock, traction and postural drainage. This may be placed under the head of bed to promote drainage and improve cerebral circulation. It is used to prevent shock, to arrest hemorrhage, to retain enema and after giving spinal anesthesia

• Thigh rolls – these are made by folding a sheet to a desired length of 23 feet and then rolled into a tight cylinder. These are used to support the hips and thighs, preventing them outward rotation and keeping the feet in good alignment, in case of paralysis, fracture of the femur or hip surgery. To use the roll, place the lose end (flap) under the patients hips and thighs with the role under the flap end and then tucking snugly along the hip and thigh

TYPES OF COMFORT DEVICES

COLD APPLICATION

HOT APPLICATION

COMFORT DEVICES USED IN HOSPITAL VIDEO

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CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAM (CSSM) (CHILD HEALTH NURSING)

Updated 2024

INTRODUCTION

• CSSM program launched on 20^th August 1992
• CSSM program is directed at achieving 9 of the 17 goals of National Health Policy (1983) which are related to maternal and child health

OBJECTIVES OF CSSM

• Giving strength to universal immunization program
• Giving continual ORT to children below 5 years of age against respiratory infections
• Protect children below 3 years of age against blindness caused by deficiency of vitamin A
• Providing iron and folic acid tablets to pregnant mothers, lactating mothers and children below 5 years of age to protect them against malnutritional anemia
• To bring improvement in the care of infants and mothers at community level

ACTIVITIES OF CSSM

Children

• Essential newborn care
• Immunization
• Appropriate management of diarrhea
• Appropriate management for acute respiratory infections
• Vitamin “A” prophylaxis

Mother

• Immunization
• Prevention and treatment of anemia
• Antenatal care and early identification of maternal complications
• Deliveries by trained personnel
• Promotional of institutional deliveries
• Management of obstetric emergencies
• Birth spacing

GOALS OF CSSM

• To decrease IMR, MMR and under five mortality rate
• Polio eradication by 2000 AD
• Neonatal tetanus elimination by 1995
• Measles prevention
• Diarrhea – prevention of 70% deaths and 25% cases by 2000 AD
• Acute respiratory infections (ARI), prevention of 40% deaths by 2000 AD

COMPONENTS OF CSSM – 3E’S

• Essential maternal care
• Early identification of complications
• Emergency obstetric care

STRATEGIES OF CSSM

• To improve maternal care and promote birth spacing
• To train medical and other health personnel in essential newborn care
• To use of low cost effective and locally available equipment for newborn
• To provide basic facilities for care for low birth weight and sick newborns in first referral units and district hospitals
• Create awareness about essential newborn care among healthcare providers, pregnant women and mother of the newborns

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PATIENT POSITIONING – Purpose, Principles, Factors Involved, Types, General Instructions, Preliminary Assessment, Equipment and Procedure

Updated 2024

Positioning defined as placing the person in such a way to perform therapeutic interventions to promote the health of an individual.

Positioning defined as placing the person in a proper body alignment for the purpose of preventive, promotive, curative, and rehabilitative aspects of health.

PURPOSE

• To provide comfort to the patient
• To relieve pressure on various parts
• To improve circulation
• To prevent formation of deformity
• To carry out investigations
• To perform surgical and medical investigations
• To prevent pressure sores
• To provide proper body alignment
• To conduct delivery/labor
• To carryout nursing interventions

PRINCIPLES OF POSITIONING

• Systemic and orderly way of doing
• Cooperation between two
• Follow safety measure to prevent accidents
• Active participation
• Using a right technique at right time

FACTORS INVOLVED INN POSITIONING

• Need of an individual
• Self care ability
• Extend of disability
• Nature of disease condition
• Level of consciousness
• Protocol of the hospital

TYPES OF POSITION

• Dorsal position
• Dorsal recumbent position
• Lithotomy position
• Lateral position
• Prone position
• Slim’s position
• Knee-chest position
• Trendelenburg’s position
• Fowler’s position

SUPINE POSITION

Supine position, the patient lies on his back with his head and shoulders are slightly elevated. One pillow is given under the head. His legs should be slightly flexed. A small pillow is placed under his knees.

LATERAL POSITION

Patient lies on left side with legs flexed at thighs. The upper leg is flexed more than the lower. A pillow is kept in front of the abdomen and at the back and one under the upper leg.

PRONE POSITION

A patient lies flat on abdomen. Head turned to sideways. One soft pillow is given under head. An extra pillow is given under the ankles to keep toes from touching the bed.

DORSAL RECOMBENT POSITION

Patient lies on back, knees fully flexed, thighs flexed and externally rotated feet flat on the bed

SEMI-FOWLER’S POSITION

The semi-fowler’s position is the position of a patient who is lying in bed in a supine position with the head of the bed at approximately 30 to 45 degrees.

FOWLER’S POSITION

Fowler’s position is a sitting position in which the head is elevated, at least, a 45 degree angle. Back rest and two pillows are used for the back and head. Fowler’s position the main weight bearing areas of the patient are the heels, sacrum and the posterior aspects of the ileum.

LITHOTOMY POSITION

The patient lies on her back. The legs are separated and thighs are flexed on the abdomen and the legs are on the thighs. The patient’s buttocks are kept the edge of the table and legs are supported by stirrups.

ASSISTING THE PATIENT IN KNEE-CHEST POSITION

A prone position in which the individual rests on the knees and upper part of the chest, assumed for gynecologic or rectal examination. It is also called genupectoral position.

KNEE CHEST POSITION

Patient rests on the knees and the chest. The head is turned to one side with one check on a pillow. A pillow is placed under the chest. The weight is on the chest and knees.

CARDIAC POSITION

The client is propped-up in a sitting position by means of back rest and pillows. Place an over bed table in front with a pillow on it. The client has an aircushion to sit and a small pillow under the knees.

TRENDELENBURG’S POSITION

The patient lies on his back. The patient’s head is low. The foot of the bed is elevated at 45 degree angle. The body is on an inclined place and the legs hang downward over the end of the table.

TYPES OF PATIENTS NEED SPECIAL CARE

• Unconscious patient
• Infant and children
• Hemiplegic and paraplegic position
• Immediate postoperative patients
• Orthopedic patients
• Cardiac patients

GENERAL INSTRUCTIONS

• Maintain good body alignment of the patient at all times
• Support body parts in good alignment by using supportive devices to promote comfort and prevent undue muscle strain
• Avoid prolonged flexion of any one body segment by changing the position at least every two hours
• Reduce the pressure caused by body weight of his or her body or object by changing the position and using protective devices

PRELIMINARY ASSESSSMENT

• Check the patient’s general condition
• Check the physician’s order for any limited movements
• Assess the self-care ability of an individual
• Arrange the comfort devices near the bedside
• Identify the deformed extremity
• Support the immobilize area during positioning
• Identify the rationale before positioning

EQUIPMENT

• Extra man power if needed
• Extra pillows
• Sheets and sheet rolls
• Comfort devices such as back rest, cardiac table, sand bag, etc

PROCEDURE

• Explain the procedure to the patient
• Provide privacy
• Arrange the articles and manpower (if needed)
• Untie the bed sheets
• Turn/lift/ambulate gently
• Place and support with extra pillows under pressure points
• Special care taken at pressure areas
• Cover the patient with top sheet
• Hand wash
• Record the time, position and condition of the skin
• Positioning a patient in bed is important for maintaining alignment and for preventing bed sores (pressure ulcers), foot drop, and contractures. Proper positioning is also vital for providing comfort for patients who are bedridden or have decreased mobility related to a medical condition or treatment. When positioning a patient in bed, supportive devices such as pillows, rolls, and blankets, along with repositioning, can aid in providing comfort and safety.

Good body alignment can be achieved in any of the bed rest positions. The following points should be checked.

• Head should be in midline with the trunk
• Back should be straight, with normal body curves (cervical, thoracic, and lumbar) maintained
• Ribs should be elevated to prevent constriction of the chest
• Arms and legs should be in a position of function (the position for maximum usefulness of the joints, feet and hands)

Position of function of leg and feet. This position favors standing upright and walking. In general, if the toes point to the ceiling when in a back-lying position and point to the floor when in a front-lying position, the feet, legs, and hips are in good alignment.

Position of function of arms and hands. This position favors raising arms and grasping things with the fingers. The hand should not droop at the wrist, be clenched in a fist, or be flat. The position of function for the hand is dorsiflexion (at a slight upward angle) at the wrist, with the fingers and thumb in position to write with a pencil.

SUPINE & DORMANT  RECUMBENT

LITHOTOMY & PRONE

LATERAL & SIM’S

KNEE-CHEST/GENUPECTORAL & TRENDELENBURG’S

FOWLER’S & C-SHAPED

ROSE & RECOVERY

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COLD COMPRESS (Cold Application) – Definition, Purpose, General Instructions, Preliminary Assessment Check, Effects, Physiologic Effects, Indications, Preparation of the Patient and Environment, Equipment, Procedure, After Care and Contraindications

Updated 2024

Cold compress is a local moist cold moist application made out of folded layers of gauze, lint piece or old soften linen, wring out of cold or ice water or in some evaporating lotion.

DEFINITION

A cloth wrung from cold or ice water which may be applied to any part of the body.

PURPOSE

• To provide comfort
• To reduce body temperature
• To reduce inflammation and edema
• To relieve pain, burning sensation and irritation
• To anesthetize for short time
• To control hemorrhage
• To inhibit bacterial growth and thus prevent suppuration

GENERAL INSTRUCTIONS

• Application of cold compress over the skin helps in conduction of heat
• Cold application beyond 20 minutes leads to secondary effects
• Check the temperature every 15 minutes, it helps in detection of any variations in the body temperature

PRELIMINARY ASSESSMENT CHECK

• The doctor order for any specific instruction
• General condition and diagnosis of the patient
• Self-care ability of the patient
• Assess for the need of cold applications
• Frequency and duration of application
• For any contraindication of cold application
• Articles available in the unit

EFFECTS

To prevent the depression that often occurs following heating treatments. The most effective form of cold compress is a small towel wrapped around the head like a turban during the treatment. The same receptors, or special nerve endings, which serve to convey stimuli to the blood vessels and nerve endings, hence to all the organs reflex connected with them, are affected as much by cold applications as by hot. The more intense is the stimulation, the greater the reaction.

PHYSIOLOGIC EFFECTS

• To decrease blood  flow locally and distally
• To prevent and relieve congestion
• For relief of pain due to edema and/or trauma
• If applied over the heart: will slow the heart rate, increase the force and raise the arterial blood pressure
• To increase the reflect effect of thermal applications by increasing the difference between hot and cold; an example is using the cold compress following a fomentation.

INDICATIONS

• Throbbing pain due to edema or trauma, such as sprains
• Fevers
• Congestion in the face and head-sinusitis and head-ache (use with a hot foot bath)
• As a precordial compress in tachycardia-fast heartbeat (more than 100 beats/min)
• May be applied as a turban to the head or cravat to the neck with general applications of heat
• Headache-apply cold compress to head while using a hot foot bath
• Passive chest congestion in lung problems, together with fomentations

PREPARATION OF THE PATIENT AND ENVIRONMENT

• Explain the procedure to the patients
• Arrange the articles at the bedside
• Provide privacy
• Place the patient in a comfortable position
• Bring the patient to the edge of the bed
• Place the Mackintosh and towel under the patient to protect the bed

EQUIPMENT

A clean tray containing:

• Bowel with ice water
• Folded gauze pieces in a bowl
• Mackintosh and towel
• Small cotton balls in a bowl
• Thermometer tray

PROCEDURE

• Wash hands
• Pack the ear with cotton balls if compress is to be applied to forehead
• Take the gauze pieces immerse it in the water wring it
• Make sure that there is not dripping of water and apply it to the part ordered
• Change it as soon as it becomes warm
• Check the temperature every 15 minutes
• Keep a constant watch on the color of the skin. Test the skin for numbness

AFTER CARE

• When the time is over, remove the compress
• Wipe the part and make the patient comfortable
• Take out the cotton balls from the ears
• Inspect the part for discoloration or numbness
• Place the patient in a comfortable position
• Check the vital signs end of the treatment
• Replace the articles after cleaning
• Wash hands
• Record the procedure in nurse’s record sheet
• Record the vital signs in TPR sheet

CONTRAINDICATIONS

• Diabetes use with caution
• Local skin inflammation
• Patients who cannot tolerate cold
• Patient who is chilled – wait until the entire body is warm

COLD APPLICATION

COLD PACK

ICE CAP / ICE COLLAR

TEPID SPONGE / COLD SPONGE

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Updated 2024

NURSING PROCEDURE – HOT APPLICATION (Definition, Purpose, Classification, Physiological Effects, Principles, Complications and General Instructions

Thermotherapy is the use of heat to treat symptoms of acute or chronic pain, especially those related to muscle tension or spasm. It is also a common treatment for arthritis, bursitis, tendonitis, back pain, shoulder pain and other kinds of joint pain. Hot applications result in an increase in molecular vibration and cellular metabolic rate. This form of treatment is divided into two categories, namely, superficial and deep heating modalities. These are further divided into chemical, electric or magnetic. Temperatures range from 105 to 170 degrees Fahrenheit (41 to 77 Degree celcius). Superficial modalities include infrared lamps, moist heat packs, paraffin baths, and warm whirlpools. Deep heating modalities include microwave diathermy, shortwave diathermy, and ultrasound. The body reacts with a series of local and systemic effects.

DEFINITION

Hot application means the application of an agent warmer than the skin. Heat is applied in either a moist or dry form.

PURPOSE

• Heat decreases pain
• To provide comfort
• To promote circulation
• To promote suppuration
• To relax the muscles
• To promote healing
• To relieve deep congestion
• To soften the exudates
• To stimulate peristalsis
• To counteract sudden drop in temperature
• To decrease joint stiffness
• To relieve bladder distention

CLASSIFICATIONS

Hot Applications – Local and General

Local – Dry Heat and Moist Heat

LOCAL

Dry Heat – hot water bottles, chemical heating bottles, infrared rays, shot wave diathermy, heating lamps, electric cradles, and electric heating pads

Moist Heat – warm soaks (local baths), hot fomentations (compresses), poultices (cataplasm), stupes (medical fomentations), paraffin baths, sitz bath and aquathermia pad

GENERAL

Dry Heat – sun bath, electric cradles, and blanket bed

Moist Heat – steam baths, hot packs and whirlpool bath (full immersion bath)

Physiological Effects

Primary Effects

• Peripheral vasodilatations
• Increased capillary permeability
• Increased local metabolism
• Increased oxygen consumption
• Blood-flow is increased
• Blood viscosity is decreased
• Lymph flow is increased
• Motility of leukocytes is increased
• Muscle tone is decreased

Secondary Effect

The primary effect of hot application may last only for 20 to 40 minutes. After this time, the heat application must be discontinued and recovery time of one hour allowed, otherwise secondary effects (vasoconstriction) will take place.

Contraindications

• Heat is not used because heat increases the metabolism
• Heat is not used for the patients with impaired kidney, heart and lung functions
• Heat should not be applied to acutely inflamed areas e.g. acute appendicitis and tooth abscess
• Heat should not be applied on patient with paralysis weak and debilitated patients
• Heat should not be applied when there is open wounds and bleeding
• Heat should not be applied when there is edema associated with venous or lymphatic diseases
• Heat should not be applied on patients with metabolic disorder. E.g. patients with diabetes, arteriosclerosis
• Heat should not be applied on patients with high temperature

Principles

• Heat causes dilation of blood vessels and increases the blood supply to the area
• Heat stimulates metabolism and the growth of the new cells and tissues
• The end organs of the sensory nerves in the skin convey the sensation of heat; the sensations are interpreted in the brain
• Water is a good conductor of heat
• The flow of heat is from the hotter area to the less hot area
• Presence of stream increases the temperature of the hot applications
• The temperature tolerance varies with individuals and according to the site and area covered
• Friction produces heat

Complications

• Pain
• Burns
• Maceration (with moist heat)
• Redness of the skin
• Edema
• Hyperthermia
• Pallor (secondary effect)

General Instructions

• Protect damaged skin layers exposed layers of skin are more sensitive to temperature variations than skin layer
• Check a patient frequently during hot application, the condition of the skin indicates whether tissue injury is occurring
• Do not allow a patient to adjust temperature settings
• Never position a patient in such a way that he cannot move away from the temperature source. This avoids the risk of injuries from temperature exposure
• Never ignore the complaints of a patient however small they appear to be

COUNTERIRRANTS

HOT FOMENTATION

HOT WATER BAG

INFRARED THERAPY

SITZ BATH

SOAK OR LOCAL BATH

STEAM INHALATION

COLD APPLICATION

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KEY POINTS ABOUT HOT APPLICATION NURSING PROCEDURE

Hot applications, also known as thermal therapy, involve the application of heat to a specific area of the body for therapeutic purposes. Here are some key points for the hot application nursing procedure:

1. Indications:
   • Hot applications are typically used to promote vasodilation, increase blood flow, and relax muscles.
   • Commonly used for conditions such as muscle spasms, joint stiffness, and localized pain.
2. Types of Hot Applications:
   • Hot packs, warm compresses, electric heating pads, and warm baths are common forms of hot applications.
   • Each type may be chosen based on the specific needs of the patient and the area of the body being treated.
3. Assessment:
   • Assess the patient’s skin condition, sensitivity, and ability to perceive heat accurately.
   • Identify the specific area of the body that requires the hot application.
4. Contraindications:
   • Avoid hot applications in cases of acute inflammation, open wounds, or impaired circulation.
   • Be cautious with patients who have sensory deficits or conditions that affect the ability to perceive temperature.
5. Patient Education:
   • Explain the purpose of the hot application and the expected therapeutic effects.
   • Educate the patient about the importance of reporting any discomfort or changes in sensation during the procedure.
6. Application Technique:
   • Follow the healthcare facility’s protocols for the specific type of hot application being used.
   • Ensure that the temperature is safe and comfortable for the patient, avoiding extremes that could cause burns.
7. Monitoring:
   • Regularly check the patient’s skin for signs of redness, blistering, or any adverse reactions.
   • Monitor the patient’s response to the hot application, including pain relief and increased comfort.
8. Duration:
   • Follow the recommended duration for the hot application as per the healthcare provider’s orders.
   • Prolonged exposure may lead to complications such as burns.
9. Documentation:
   • Record the type of hot application used, duration, patient’s response, and any observations in the patient’s medical record.
10. Follow-up:

• Evaluate the effectiveness of the hot application in alleviating symptoms.
• Adjust the treatment plan as needed based on the patient’s response.

HOME VISIT – COMMUNITY HEALTH NURSING (Concept of Home Visiting, Purposes, Principles, Steps and Advantages)

Updated 2024

HOME VISIT

Home visits are an integral part of community health nursing, allowing healthcare professionals to provide personalized care and support to individuals and families within their homes.

The community health nurse work with families is in different settings including clinics, schools, support groups, office and the family home. Home visits give a more accurate assessment of the family structure and behavior in the natural environment

Home visits also provide opportunities to observe the home environment and to identify barriers and support for reaching family health promotion goods. Health services in the home requires technical skills, knowledge of preventive and therapeutic measures, teaching ability, judgment and a full understanding of human relations

Home visit refers to meeting the health needs of people at their doorsteps. Health services given at home for patient, family and the community in general for nursing service and health counseling

CONCEPTS OF HOME VISITING

• Home visiting provides opportunity to make direct observation on home environment, family structure, familial roles and relationships, life style, cultural practices, group dynamics, etc. and make family health assessment.
• In home visiting the members are relaxed, have more time and privacy and feel free to raise questions, seek clarifications and sort out their problems
• It provides opportunities to make direct observation of care given by family members in planning and implementing family health care services
• It provides opportunities to contact and interact with most of the family members and establish report with the family as a whole
• It also make possible to have active participation of family members in planning and implementing family health care
• It makes feasible to plan and provide comprehensive family health care with major emphasis on promotive and preventive care

PURPOSES OF HOME VISITING

• It is a routine part of a planned visiting program by community health personnel
• It helps to investigate the source of infectious diseases
• To do follow up on some problems identified in the health center, school, industry or hospital
• To assess the nutritional and immunization status, environmental hazards
• To give health education to the individual, family and community
• To supervise and guide other health workers

PRINCIPLES OF HOME VISITING

• Need Based: home visiting should be planned and conducted based on the identified needs of the people
• Priority based: the home visit should give to the existing problem in the family. It may be maternal and child health services or antenatal checkup
• Regularity: plan for regular home visiting programs based on family needs. It should be conducted at regular intervals
• Flexibility: the community health nurse should adopt a flexible approach based on prevailing circumstances at home
• Scientific based: be sure of the scientific soundness of the subjects used for discussion. Use of technical skills includes hand washing an inspection
• Analysis based: collect facts about the home, the patient and the environment and make an objective analysis of the facts as an initial step in visiting the home
• Developing relationship: work with the person and family plan jointly. Home visiting helps to establish good working relationship in the family
• Sensitivity: the community health nurse should be sensitive to the persons feeling and needs at the time of the visit. Listen to the family and understand the other person’s point of view
• Educative: evaluate your own work remember the quality of care is more important than the number of home visits. It is essential to evaluate home visits from time to time

STEPS IN HOME VISITING

1. Initial phase: the community health nurse should collect information from clinical and other records before planning for a visit. During home visit, she has to assess or observe and make a note in initial visit

The community health nurse should introduce and establish a friendly relationship by using simple language. Assess physical and environmental status, family’s cultural background, occupation and income of family members, age, educational factors and psychological factors influences

• Action phase: the interpersonal relationship starts when nurse enters into the house. The nurse should use their effective communication skills to implement the nursing process. During home visit, nurse practice a variety of roles when interviewing in patient care. The community health nurse has to take a role as collaborator, consultant, co-coordinator, preventor of disease, promoter of health, health educator and an epidemiologist, and takes steps to implement nursing process

During action phase the community health nurse provides nursing care, e.g. taking temperature, physical examination and dressing, etc. demonstrating and teaching, e.g. teaching insulin self-administration. She makes diagnosis and tentative nursing care plan based on establishing priorities

• Termination phase: nurse-patient goals are reached, health is restored and the patient can function without actions. The nurse records the important events in the family and reports the problems of the family. Evaluation of home visit is a continuous process

ADVANTAGES OF HOME VISIT

• The nurse can directly observe home and family atmosphere
• The nurse can directly observe the care given to patient by the family members
• It is possible to discover new health problems
• The family members will be more relaxed in their own surroundings
• The family gains confidence and feels to clear their doubts
• This helps to apply the gained knowledge and skills in the homes assisting and solving individuals and families health problems

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KEY COMPONENTS IN HOME VISITS

1. Assessment:

• Conduct a thorough assessment of the home environment, including living conditions, safety hazards, and available support systems.

2. Purpose of the Visit:

• Clearly define the purpose of the home visit, whether it is for routine check-ups, health education, medication management, post-discharge follow-up, or addressing specific health concerns.

3. Appointment and Consent:

• Schedule home visits at convenient times for the client and obtain consent for the visit. Respect the client’s privacy and autonomy.

4. Communication:

• Establish effective communication with the client and their family. Listen actively, address concerns, and encourage open dialogue to better understand their needs.

5. Cultural Competence:

• Be culturally competent and respectful of the client’s cultural practices, beliefs, and values. Consider cultural factors when planning and delivering care.

6. Safety Precautions:

• Assess and address safety concerns in the home, including fall risks, fire hazards, and other environmental factors. Provide education on maintaining a safe living space.

7. Medication Management:

• Review medications with the client, ensuring proper administration and understanding. Address any concerns or questions regarding medications.

8. Health Education:

• Provide individualized health education on topics such as chronic disease management, nutrition, hygiene, and preventive care. Use visual aids and written materials as needed.

9. Family Involvement:

• Involve family members or caregivers in the care plan, as appropriate. Consider their support and collaboration in maintaining the client’s health.

10. Health Promotion: – Encourage and facilitate healthy lifestyle choices. Discuss strategies for maintaining or improving health and preventing illness.

11. Assessment of Activities of Daily Living (ADLs): – Evaluate the client’s ability to perform daily activities, such as bathing, dressing, and eating. Provide assistance or make recommendations for improvement as needed.

12. Monitoring and Follow-up: – Establish a plan for ongoing monitoring and follow-up. Determine the frequency of home visits based on the client’s needs and the nature of the healthcare issue.

13. Documentation: – Document the home visit thoroughly, including assessments, interventions, education provided, and any changes in the client’s health status. Maintain accurate and up-to-date records.

14. Collaboration with Other Healthcare Providers: – Collaborate with other healthcare professionals involved in the client’s care, such as physicians, therapists, and social workers. Ensure a coordinated and holistic approach.

15. Respect for Autonomy: – Respect the client’s autonomy and involve them in decision-making regarding their care. Encourage them to express their preferences and goals for health and well-being.