As per the New Syllabus of Indian Nursing Council for GNM

Second Edition

Harindarjeet Goyal PhD, MPhil, MSc (MSN), BSc (Hons.), RN, RM

Former Principal
Rajkumari Amrit Kaur College of Nursing
New Delhi

CBS Publishers & Distributors Pvt Ltd

• New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Lucknow
• Mumbai • Hyderabad • Nagpur • Patna • Pune • Vijayawada
 Preface

Keeping in mind the challenge that today’s nurses confront with, it becomes imperative to provide them necessary skills of
compassionate nursing care in a variety of health care settings, which they could apply for patients in the various stages of
illness. At the same time, there are ample opportunities for health promotion activities for individuals and groups; this is an
integral part of providing nursing care.
It gives me immense pleasure and satisfaction to introduce and present new edition of title of Textbook of Nursing
Foundations. The book is specifically designed for the nursing education in Asia to prepare nurses to think critically and
practice collaboratively within today’s challenging and complex health care delivery system.
Health care is an exciting and challenging field with opportunities and advancements. The entire health care system
reverberates with change. The role of nurses in this system is expanding and extending, hence the process of embracing
change inevitably requires adaptation and a constant demand for literary excellence. This textbook has been developed
comprehensively with an incredible outlook to help nurses develop their clinical skills which are fundamental aspect of
nursing care.
The book is organized into 15 Units having 64 chapters. The content has been designed for the GNM Nursing students
and is based on prescribed curriculum and requirements, which is conforming to Indian Nursing Council.
Training is an integral part of the nursing profession. A nurse must possess a strong theoretical base and practical skills.
This book will act as a standard prescription for educators and mentors to teach and demonstrate the clinical nursing
procedures to budding and practicing nurses. The text has been developed keeping in mind the clinical requirements of a
student nurse at all levels of nursing education.
I hope you will enjoy reading the book as much as I enjoyed writing it. Constructive criticism from the readers is always
welcome to improve upon in further edition. Happy Reading!

Harindarjeet Goyal
 Special Features of the Book

Important Learning Objectives of every chapter are highlighted in the beginning.

Learning Objectives
After completing this chapter, you will be able to:
• Define health and its changing concepts • E xplain the causation of disease with the help of model
• Describe the health-illness continuum • Discuss the impact of illness on patient and family
• Enumerate the various factors influencing health

Important Key Terms used in the chapter are presented to familiarize the readers with
the important terminologies.
Key Terms
• Health • Holistic concept
• Biomedical concept • Agent
• Ecological concept • Host
• Psychosocial concept • Environment

Chapter Outline is given in the beginning of every chapter to make the reader go
through the topics covered in a particular chapter.
Chapter Outline
• Introduction • Health-illness Continuum
• Concept of Health and Disease • Factors Influencing Health
• Changing Concepts of Health • Illness and Illness Behavior

Numerous Tables are used to clarify the concept

and make the reading enjoyable and informative.
TABLE 1: Clinical observations for nutritional assessment

Parameters/body Signs of good nutritional status Signs of poor nutritional status

area
Appearance Alert, responsive Listless, apathetic
Vitality Energetic, vigorous, sleeps well Lacking energy, tired, apathetic
Weight Normal as per height, age and body build Overweight or underweight
Hair Shiny, lustrous, healthy scalp Dull, dry, brittle, thin
Skin Smooth, good color, slightly moist, no rashes or swelling Rough, dry, swollen, pale, pigmented, bruises, petechia
Nails Pink, firm Spoon-shaped, pale, brittle
 Textbook of Nursing Foundations

Fig. 1: Health-illness continuum

Studded with 200 + fully colored Images and Illustrations for easy grasp of the relevant topic.

At the end of every chapter, Bibliography has been Added information Boxes have been supplemented
added for further reference to enhance knowledge. throughout the book.

Box 1
B ibliography Change of Shift Report
• Bed no. 104- M2X
1. Park K. Park’s Textbook of Preventive and Social • Admitted last night with head injury
Medicine, 25th edition: Banarsidas Bhanot. • Allergic to penicillin
Jabalpur, MP: 2017. • I/V Dextrose 5% infusing 100 mL/hour in (L) forearm
• Needs urgent CT scan
2. Lewis LW. Fundamental Skills in Patient Care, • Temp. 102°F Pulse 98/minute, RR 24/minute
2nd edition: Lippincott Williams and Wilkins. • Blood pressure 110/70 mm of Hg.
3. Christensen K. Fundamentals of Nursing, 8th • GCS-11
edition: Mosby Publishing. Maryland Heights
Missouri: 2010.
4. Sharma S. Potter and Perry’s Fundamentals of
Nursing. A South Asian edition: India. Gurugram:
Elsevier 2013.

xiv
 Syllabus
Syllabus
NURSING FOUNDATIONS
 Time: 210 hours
Placement: First Year Fundamentals of Nursing: 190 hours
Course description: This course is designed to help students develop an ability to meet the basic health need of the patients with regard
to nursing care and develop skill in the competencies required for rendering effective patient care.

Unit Learning Objectives Content Hours Method of Teaching Assessment

Methods
I • Define nursing and explain Introduction to Nursing 25 Lecture cum • Short answer
its nature, meaning, scope, • Nursing—concept, meaning, discussions • Objective type
ethics and principles in definitions, scope and functions • Essay type
nursing. • History of nursing in India
• Identify the qualities of a • Nursing as a profession
professional nurse health • Nursing professional—qualities and
care agencies and its preparation
functions. • Ethics in nursing—roles and
• Describe the holistic responsibilities of a nurse
approach to nursing and • Health care agencies—hospital and
the determinants of health community service—types and
and the effects of illness. function of hospitals health team.
• Modern approaches to nursing care
including holistic nursing care
• Health and disease:
ƒ Definition of health, determinants
of health status.
ƒ Basic human needs
ƒ Illness and its effects on individual

II • Describe nursing care Nursing Care of the Patient 6 • Lecture cum • Short answer
of the patient/client in • Patient environment in the hospital: discussions • Objective type
hospital using nursing Patients unit • Demonstration • Essay type
process. • Therapeutic environment: of maintaining • Return
• Demonstrate skill in the ƒ Physical factors—lighting the records and demonstration
admission and discharge temperature, ventilation, humidity, reports
process, maintenance noise, pestilence. • Role play
of safe environment and ƒ Safety needs prevention of
records and reports. environmental hazard
ƒ Psychosocial and aesthetic factors.
• Patient’s adjustment to the hospital:
ƒ Understanding the patient as a
person socioeconomic and cultural
background, health status, etc.
ƒ Effect of hospitalization on patient
and family.
ƒ Admission, transfer, discharge
procedures
Contd…

xv
 Textbook of Nursing Foundations

Unit Learning Objectives Content Hours Method of Teaching Assessment

Methods
• Basic nursing skills:
ƒ Communication
ƒ Nursing interview
ƒ Recording and reporting
• Nursing process:
ƒ Meaning and importance
ƒ Assessment, planning,
implementation and evaluation
ƒ Nursing care plan

III • Describe basic needs of the Meeting the Basic Needs of a Patient 65 • Lecture cum • Short answer
patient • Physical needs: discussion • Objective type
• Demonstrate skill in ƒ Comfort, rest, Sleep and exercise— • Demonstration • Essay type
meeting basic care of the importance and its promotion • Return
patient ƒ Body mechanics—moving, lifting, demonstration
transferring • Assessment
ƒ Position and posture maintenance
using checklist
ƒ comfort devices
ƒ Beds and bed making—principles of
bed making, types and care of bed
linen
ƒ Safety devices, restraints and splints
ƒ Exercises—active and passive
• Hygienic needs:
ƒ Personal and environmental hygiene
ƒ Nurses role in maintaining personal
and environmental hygiene
ƒ Care of eyes, nose, ears, hands and
feet
ƒ Care of mouth, skin, hair and
genitalia
ƒ Care of pressure areas, bed sores
• Elimination needs:
ƒ Health and sickness
ƒ Problems—constipation
and diarrhea, retention and
incontinence of urine
ƒ Nurse’s role in meeting elimination
needs
ƒ Offering bedpan and urinal
ƒ Observing and recording
abnormalities
ƒ Preparation and giving of laxative,
suppositories, enemas, bowel wash,
flatus tube
ƒ Perineal care, care of patient with
urinary catheter, diapers
ƒ Maintenance of intake and output
record
• Nutritional needs:
ƒ Diet in health and disease
ƒ Factors affecting nutrition in illness
ƒ Nurse’s role in meeting patient’s
nutritional needs
ƒ Modification of diet in illness
ƒ Diet planning and serving
ƒ Feeding helpless patients including
artificial methods of feeding
Contd…
xvi
 Syllabus
Unit Learning Objectives Content Hours Method of Teaching Assessment
Methods
• Psychological and spiritual needs:
ƒ Importance
ƒ Nurse’s role—diversional and
recreational therapy
• Care of terminally ill and dying patient:
ƒ Dying patient’s signs and symptoms
of approaching death, needs of
dying patient and family
ƒ Nursing care of dying—special
considerations; advance directives,
euthanasia, will, dying declaration,
organ donation, etc.
ƒ Medico legal issues
ƒ Care of the dead body
ƒ Care of unit
ƒ Autopsy
ƒ Embalming

IV Describe the principles of Assessment of Patient/Client 14 • Lecture cum • Short answer

assessment demonstrate • Physical assessment: discussions • Objective type
skills in assessing the patient ƒ Importance, principles, methods of • Demonstration • Essay type
assessment • Return
ƒ Height, weight, posture demonstration
ƒ Head to toe examination
• Assessment
• Physiological assessment: using checklist
ƒ Vital signs, normal, abnormal
characteristics, factors influencing
the variations
ƒ Observation and collection of
specimens-urine, stool, vomitus and
sputum
• Psychological assessment:
ƒ Mood, intelligence, emotions
normal and abnormal behavior
V • Describe the infection Infection Control 20 • Lecture cum • Short answers
control, methods in the • Infection control: discussion • Essay type
clinical setting. ƒ Nature of infection • Demonstration • Objective type
• Demonstrate infection ƒ Chain of infection transmission • Explain using
control practices. ƒ Defence against infection: Natural manual of
and acquired biomedical
ƒ Hospital acquired infection waste
(nosocomial infection) management of
• Concept of asepsis: Government of
ƒ Medical and surgical asepsis India
ƒ Isolation precautions, barrier • Demonstration
nursing • Videos
ƒ Hand washing: Simple, hand • Simulation
asepsis, surgical asepsis (scrub) exercises
ƒ Isolation—source and protection
ƒ Personal protective equipments—
types, uses and techniques of
wearing and removing
ƒ Decontamination of unit and
equipment
ƒ Transportation of infected patient
ƒ Standard safety precaution
ƒ Transmission-based precautions

Contd…

xvii
 Textbook of Nursing Foundations

Unit Learning Objectives Content Hours Method of Teaching Assessment

Methods
• Biomedical waste management:
ƒ Importance
ƒ Types of hospital wastes
ƒ Hazards associated with hospital
waste
ƒ Decontamination of hospital waste
ƒ Segregation and transportation
ƒ Disposal

VI Describe therapeutic nursing Therapeutic Nursing Care 30 • Lecture cum • Short answer
care • Care of patients with respiratory discussions • Objective type
problems/dyspnea • Demonstration • Essay type
ƒ Deep breathing and coughing • Return
exercises demonstration
ƒ O2 inhalation
• Assessment
ƒ Dry and moist inhalation
using checklist
ƒ Oronasal suctioning
• Care of patient with altered body
temperature—Hot and cold
applications
• Care of patients with fluid and
electrolyte imbalance
• Care of unconscious patient
• Care of the bedridden patient
(traction, fractures, etc.)
• Care of patient with pain
• Care of patients with body elimination
deviation
VII Explain the principles, routes, Introduction to Clinical Pharmacology 30 • Lecture cum • Short answer
effects of administration of Administration of medication: discussions • Objective type
medications • General principles/considerations: • Demonstration • Essay type
ƒ Purposes of medication • Return
ƒ Principles: Rights, special demonstration
considerations, prescriptions, safety • Assessment
in administering medications and using checklist
medication errors
ƒ Drugs forms
ƒ Routes of administration
ƒ Storage and maintenance of drugs
and nurses responsibility
ƒ Broad classification of drugs
ƒ Therapeutic effect, side effect,
toxic effect, allergic reaction, drug
tolerance, drug interactions
ƒ Factors influencing drug actions
ƒ Systems of drug measurement:
metric system, household
measurements
ƒ Converting measurements units:
Conversion within one system,
between systems, dosage
calculations
ƒ Terminologies and abbreviations
used in prescription of medications
Contd…

xviii
 Syllabus
Unit Learning Objectives Content Hours Method of Teaching Assessment
Methods
• Oral drug administration: Oral,
sublingual, buccal : equipment and
procedure
• Parentral:
ƒ General principles
ƒ Types of parentral therapies
ƒ Types of syringes, needles, canulas
and infusion sets
ƒ Protection from needle stick
injuries, giving medications with a
safety syringe
ƒ Routes of parentral therapies:
Purposes, site equipment,
procedure and special
considerations in giving intradermal,
subcutaneous, intramuscular and
intravenous medications.
ƒ Advanced techniques: Epidural,
intrathecal, intraosseous,
intraperitoneal, intrapleural,
intra-arterial
ƒ Role of nurse
• Topical administration: Purposes,
site, equipment, procedure, special
considerations for applications to skin
and mucous membrane.
• Direct application:
ƒ Gargle, throat swab
ƒ Insertion of drug into body
cavities: Nasal pack, suppositories/
medicated packing into rectum/
vagina
ƒ Instillations: Ear, eye, nasal, bladder
and rectal.
ƒ Irrigations: Eye, ear, bladder, vaginal
and rectal.
ƒ Spray: Nose and throat
• Inhalations: nasal, oral, endotracheal,
tracheal (steam, oxygen and
medications)—purposes, types,
equipment, procedure and special
considerations
• Recording and reporting of
medications administered

xix
 FIRST AID
Textbook of Nursing Foundations

 Time: 20 hours
Course description: This course is designed to help students develop and understanding of community emergencies and be able to
render first aid services as and when need arises.
General objectives: Upon completion of this course, the students shall be able to:
1. Describe the rules of first aid.
2. Demonstrate skills in rendering first aid in case of emergencies.

Unit Learning Objectives Content Hours Method of Teaching Assessment

Methods
I Describe the importance Introduction 2 Lecture cum • Short answer
and principle of first aid • Definition, Aims and Importance of first aid discussions • Objective type
• Rules/ General principles of First Aid
• Concept of emergency
II Demonstrate skill in first aid Procedures and Techniques in First Aid 8 • Lecture • Short answer
techniques • Preparation of First Aid kit. • Discussions • Objective type
• Dressing, bandaging and splinting(spiral, • Demonstration • Return
reverse spiral, figure of 8 spica, shoulder, • Videos demonstration
hip, ankle, thumb, finger, stump, single and simulation
double eye, single and double ear, breast, exercises
jaw, capelin), triangle bandages uses,
abdominal binder and bandage, breast
binder, T and many tail bandage, knots reef,
clove.
• Transportation of the injured
• CPR: Mouth to mouth, Sylvester, Schafer,
External cardiac massage
III Describe first aid in common First Aid in Emergencies 6 • Lecture cum • Short answer
emergencies • Asphyxia, drowning, shock discussions • Objective type
• Wounds and Bleeding • Videos • Return
• Injuries to the Bones, Joints and Muscle- Demonstration demonstration
fractures, sprains, strains, hanging, falls
• Burns and scalds
• Poisoning – ingestion, inhalation, bites and
stings
• Foreign body in eye, ear nose and throat.
IV List various community Community Emergencies and Community 4 • Lecture cum • Short answer
emergencies and Resources discussions • Objective type
community resources. • Fire, explosion, floods, earth-quakes, • Videos mock • Essay type
famines etc drill
• Role of nurses in disaster management • Simulation
• Rehabilitation exercise
• Community Resources • Videos field visit
ƒ Police, Ambulance services to voluntary
ƒ Voluntary agencies-local, state national agencies
and international

xx
 Contents
Reviewers’ List ........................................................................................................................................... iii
Preface ...................................................................................................................................................... vii
Acknowledgments ..................................................................................................................................... viii
Special Features of the Book ...................................................................................................................... xiii
Syllabus ................................................................................................................................................... xv

UNIT I: INTRODUCTION
Chapter 1 Concept of Health .......................................................................................................... 3–8
Chapter 2 Body Defenses, Immunity and Immunization ................................................................. 9–12
Chapter 3 Health Care Services—Health Promotion and Levels of Disease Prevention ................... 13–17
Chapter 4 Health Care Agencies ................................................................................................. 18–24

UNIT II: NURSING AS A PROFESSION

Chapter 5 Nursing: A Sacred Profession ....................................................................................... 27–36
Chapter 6 Values and Ethics ........................................................................................................ 37–44
Chapter 7 History of Nursing in India ........................................................................................... 45–47
Chapter 8 Legal Implications in Nursing ...................................................................................... 48–52

UNIT III: CONCEPTUAL AND THEORETICAL MODELS IN NURSING PRACTICE

Chapter 9 Conceptual and Theoretical Models in Nursing Practice ............................................... 55–65

UNIT IV: COMMUNICATION AND NURSE PATIENT RELATIONSHIP

Chapter 10 Communication .......................................................................................................... 69–72
Chapter 11 Factors and Barriers Influencing Communication ......................................................... 73–77
Chapter 12 Patient Teaching .......................................................................................................... 78–80
Chapter 13 Communication among Health Professionals and Specific Clients ................................. 81–83

UNIT V: HEALTH ASSESSMENT

Chapter 14 Critical Thinking and Nursing Judgment ...................................................................... 87–89
Chapter 15 Assessment of Each Body System .............................................................................. 90–113
Chapter 16 General Health Assessment ..................................................................................... 114–120
Chapter 17 Nursing Process ...................................................................................................... 121–123
Chapter 18 Assessment ............................................................................................................. 124–126
 Textbook of Nursing Foundations

Chapter 19 Nursing Diagnosis ................................................................................................... 127–133

Chapter 20 Planning ................................................................................................................. 134–137
Chapter 21 Implementation ....................................................................................................... 138–139
Chapter 22 Evaluation ............................................................................................................... 140–144

UNIT VI: DOCUMENTATION AND REPORTING

Chapter 23 Documentation ....................................................................................................... 147–154

UNIT VII: HOSPITAL ADMISSION, TRANSFER AND DISCHARGE

Chapter 24 Hospital Admission, Transfer and Discharge ............................................................. 157–161

UNIT VIII: INFECTION CONTROL AND WASTE MANAGEMENT

Chapter 25 Infection Control ..................................................................................................... 165–181
Chapter 26 Biomedical Waste Management ............................................................................... 182–197

UNIT IX: VITAL SIGNS

Chapter 27 Temperature ........................................................................................................... 201–209
Chapter 28 Pulse ....................................................................................................................... 210–214
Chapter 29 Respiration .............................................................................................................. 215–217
Chapter 30 Blood Pressure ........................................................................................................ 218–223

UNIT X: MEETING NEEDS OF PATIENTS

Chapter 31 Providing Safe and Clean Environment .................................................................... 227–241
Chapter 32 Providing Comfort ................................................................................................... 242–250
Chapter 33 Hygiene .................................................................................................................. 251–273
Chapter 34 Rest and Sleep ........................................................................................................ 274–281
Chapter 35 Nutrition ................................................................................................................. 282–293
Chapter 36 Fluid and Electrolyte Imbalance ............................................................................... 294–318
Chapter 37 Urinary Elimination ................................................................................................. 319–337
Chapter 38 Bowel Elimination .................................................................................................... 338–356
Chapter 39 Observation and Collection of Urine, Stool, Vomitus and Sputum ............................. 357–363
Chapter 40 Maintenance of Normal Body Alignment and Mobility .............................................. 364–387
Chapter 41 Oxygenation ........................................................................................................... 388–412
Chapter 42 Cardiopulmonary Resuscitation ............................................................................... 413–420
Chapter 43 Psychosocial Needs ................................................................................................. 421–438

xxii
 Contents
Chapter 44 Sexuality ................................................................................................................. 439–444
Chapter 45 Recreational and Diversional Therapies ................................................................... 445–450
Chapter 46 Care of Patient having Alterations in Temperature .................................................... 451–455
Chapter 47 Care of Patient having Alterations in Respiration ...................................................... 456–460
Chapter 48 Care of Patient having Alterations in Sensorium ....................................................... 461–466
Chapter 49 Assessment of Self-care Ability ................................................................................ 467–472
Chapter 50 Meeting Needs of Perioperative Patients .................................................................. 473–496
Chapter 51 Bandaging .............................................................................................................. 497–501
Chapter 52 Pain ........................................................................................................................ 502–515

UNIT XI: THERAPEUTIC USE OF HEAT AND COLD APPLICATIONS

Chapter 53 Hot Application ....................................................................................................... 519–533
Chapter 54 Cold Application ..................................................................................................... 534–540

UNIT XII: ADMINISTRATION OF MEDICATIONS

Chapter 55 Administration of Medications and Oral Administration ............................................ 543–557
Chapter 56 Parenteral Therapies ............................................................................................... 558–570
Chapter 57 Administering Intravenous Solutions and Medications .............................................. 571–586
Chapter 58 Advance Techniques ................................................................................................ 587–602
Chapter 59 Topical Applications: On Skin and Mucous Membranes ............................................ 603–606
Chapter 60 Treatments Related to Eye (Eye Care, Eye Irrigation, Instillation of Eye Drops) ........... 607–618
Chapter 61 Treatments Related to ENT ....................................................................................... 619–628

UNIT XIII: REHABILITATION

Chapter 62 Rehabilitation .......................................................................................................... 631–635

UNIT XIV: CARE OF TERMINALLY ILL PATIENT

Chapter 63 Care of Terminally Ill Patient .................................................................................... 639–649

UNIT XV: FIRST AID NURSING

Chapter 64 First Aid Nursing ..................................................................................................... 653–674

Appendices ..................................................................................................................................... 675–682

Index ............................................................................................................................................... 683–692

xxiii
 UNIT XI

THERAPEUTIC USE OF HEAT

AND COLD APPLICATIONS
Unit Outline
Chapter 53 Hot Application
Chapter 54 Cold Application
 Chapter

53
Hot Application

Learning Objectives
After completing this chapter, you will be able to:
Š Define key terms in hot applications Š List down various types of hot applications
Š Explain the physiological changes taking place due to application Š List the indications and contraindications of hot applications
of heat Š Demonstrate procedures skillfully
Š Explain the effects of hot applications

Key Terms
Š Medical fomentation Š Moist hot pack
Š Surgical fomentation Š Counter-irritants
Š Stupes Š Rubefacients
Š Poultices Š Vesicants
Š Sitz bath Š Postulants

Chapter Outline
Š Introduction Š Contraindications
Š Related Anatomy of the Skin Š Local Dry Heat Application
Š Effects of Heat Application Š Local Moist Heat Application
Š Principles of Application of Hot Therapy Š General Application of Dry Heat
Š General Instructions Š General Moist Heat Applications

INTRODUCTION temperature regulation and sensation. Skin consists of three

layers: epidermis, dermis and subcutaneous layer.
Hot application is the application of hot agent, warmer than The epidermis is the outer layer and is composed of several
skin either in a moist or dry form on the surface of the body. layers of cells undergoing different stages of maturation. The
Application of heat is commonly used in the hospital and innermost layer of epidermis generates new cells that migrate
home as therapeutic measure. Hot application also serves as slowly toward the epidermal surface, that is stratum corneum.
comfort measure. The nurse, therefore, needs knowledge of The epidermis also contains melanocytes which produce
the physiological reactions resulting from this measure and melanin, or dark pigment of the skin.
also to any untoward reaction, which may occur. The dermis is the thicker layer containing collagen and
elastic fibers to support the epidermis. It contains the nerve
fibers, blood vessels, sweat glands, sebaceous glands and
RELATED ANATOMY OF THE SKIN
hair follicles. Sebum from sebaceous glands lubricate the
Skin is one of the sensory and excretory organs. It has skin and hair. There are two types of sweat glands: Eccrine
important functions like protection, secretion, excretion, glands (present throughout the skin, but more in forehead,
 palms and soles) and apocrine glands (found in axillary and
Textbook of Nursing Foundations for KUHS

genital area). The subcutaneous tissue contains blood vessels,

lymph and loose connective tissue filled with fat. The fatty
tissue serves as a heat insulator.

Appendages
Hairs nails and sebaceous glands are the appendages of skin.

EFFECTS OF HEAT APPLICATION

Local Effect of Heat Fig. 1: Systemic effects of heat application

Š Vasodilatation and increase of blood flow to the affected

area. Š To promote tissue relaxation
Š Increases inflammation bringing oxygen, nutrients, anti- Š To relieve pain
bodies, and leukocytes. Š To soften exudates
Š Promotes soft tissue healing and reduces tissue swelling. Š To provide warmth and comfort
When applied, blood vessels dilate, causing increased
Š To stimulate peristalsis
blood flow, increasing oxygen and nutrition to area and
removing excess fluid from tissues.
Š Decreases joint stiffness, relieves pain and relaxes muscles. Classification
Š Sedative effect. Classification of hot application is shown as in Figure 2.

Systemic Effects of Heat Therapeutic Effect of Heat Application

The effect of heat application depends on a number of factors Vasodilatation (by Relieves pain caused
(Fig. 1). increased blood supply) by ischemia and local
Heat and cold are relative degrees of temperature congestion
dependent, to some extent, on the perception of the individual. Reduces blood viscosity Improves the supply of
The temperature at the surface of the skin of the torso is leukocytes, antibodies and
generally 33.9°C (93°F). Local tolerance is thought to range nutrients to the injured area of
between 41.4°C (105ºF) and 43.3°C (110°F). Hot applications the body.
that are 11.1°C (20°F) below or 8.3°C (15°F) above this level Reduces muscle tension Heat relieves the stiffness
excite cutaneous nerve fibers. or spasm of the muscles by
relaxing the muscles and
stimulating blood circulation
Purposes
and relieves fatigue.
Š To promote circulation Increased capillary It provides local warmth and
Š To relieve congestion, reduce edema or inflammation permeability and tissue promotes movement of waste
Š To increase suppuration metabolism products and nutrients.

Fig. 2: Classification of hot applications

520
PRINCIPLES OF APPLICATION OF Š Be extremely careful when patient is unconscious,

Chapter 53 Hot Application

anesthetized or unable to respond to pain.
HOT THERAPY Š Any signs of complication should be early recognized,
Š Heat is a form of energy resulting from the internal stop the procedure, and report immediately.
vibration of the molecules of which the body is composed. Š After the procedure, dry the part gently by patting
Š Heat is always passed from a hotter body to a cooler one. and not by rubbing to remove the moisture thereby
Š Heat causes expansion and change of state. Any chemical preventing maceration of the skin and further cooling by
action capable of being accelerated is increased by rise of evaporation.
temperature. Š During the procedure protect the patient from chills.
Š Heat is distributed throughout the body by the circulating Shivering can raise the temperature. It also allows patient
blood and by direct conduction throughout the tissue. to catch a cold.
Š Heat is lost from the body through conduction,
convection, radiation and evaporation.
Š The amount of heat loss from the body is directly CONTRAINDICATIONS
proportional to the amount of blood circulating close to Š In malignancy, heat increases metabolism of both normal
the skin’s surface. This is influenced by the dilatation and and abnormal cells.
constriction of the peripheral arterioles. Š When heat involves a large body area, blood supply of vital
Š Moisture conducts heat better than air. organs gets reduced. This may pose a serious problem to
Š People vary in their ability to tolerate heat or cold. People patients of renal impairment, heart and lung diseases.
at both extremes of age spectrum (very old and very Š Edema associated with venous and lymphatic disease
young) are particularly more sensitive to heat and cold. e.g., arteriosclerosis, atherosclerosis which is common in
Š People become less sensitive to repeated application of diabetes mellitus patients.
heat and cold. Š Cutaneous injuries (e.g., stomas or scar tissues).
Š The length and time of exposure to extremes in temperature Š Patients with paralysis.
affects the body’s tolerance to the temperature. Š Heat is not applied in areas where diffusibility of heat is
limited e.g., in abscess of tooth or in an inflamed appendix
GENERAL INSTRUCTIONS as heat might cause these areas to rupture, spreading
infection in the blood stream.
Š Assess the patient’s condition prior to, during and after Š It should not be applied to very young or very old or
the therapy. debilitated patients.
Š Maintain correct temperatures for the entire duration of
application.
Š Never use any equipment unless you know its operation PROCEDURES RELATED TO HEAT
completely. APPLICATION
Š There must be a recovery period between application of
heat because it is detrimental to health and tissues. LOCAL DRY HEAT APPLICATION
Š Expose patient only to a safe temperature.
Š Don’t allow patients to adjust temperatures of appliances The application of dry heat means the use of an agent warmer
such as short-wave diathermy, electric heating pads, etc. than the skin, which is applied in dry form to produce local
Š Never ignore even small complaints of patients. effect.
Š Ensure that patient is in a position to remove application
or to remove devise, if it is causing a discomfort Hot Water Bottle
Š The patient must have a calling signal within his reach. Š Hot Water Bottle is the commonest and inexpensive
Š Since water is a good conductor of heat, squeeze off water method of applying dry heat locally to the body as a
from moist heat application to prevent scalding. therapeutic and comfort measure
Š Apply a thin layer of oil to the skin prior to moist heat Š Objective: To supply heat to the area, to provide comfort, a
application. This protective layer reduces soaking of the feeling of general warmth and to promote healing
skin and therefore prevents maceration. Š Indications: To relieve pain (rheumatoid arthritis
Š Do not use electrical appliance close to open oxygen or backache, dysentery and dysmenorrhea), to relieve
near water and other fluids. Badly maintained equipment muscle spasm, to reduce inflammation and congestion,
with signs of deterioration should never be used. and to relieve retention of urine.

521
 Textbook of Nursing Foundations for KUHS

SKILL: HOT WATER BOTTLE APPLICATION

Preparation of Articles Š Inspect the body part that is to receive treatment for any
lesion or injury
Articles Rationale
Š Check the general condition of the patient and ability to
A hot water bag with To provide treatment follow commands
cover/towel-1
Š Determine the duration and frequency of treatment as
Jugs-2 One to keep hot water and the
instructed
other to keep cold water
Duster-1 To wipe outside of the bottle
Preparation of the Patient (Planning)
Lotion thermometer To check the temperature
Vaseline/oil To apply on the skin Š Explain the purpose of the procedure to build rapport
Š Maintain privacy of the patient, drape the patient if
A kidney tray and paper bag To receive waste
needed
Preliminary Assessment Š Provide a comfortable position to the patient
Š Prevent chills by covering patient with blanket or bed
Š Check for the diagnosis and physician’s instructions cover
Steps of Procedure
Action/steps Rationale
1. Wash hands To prevent cross-infection, pathogens can transfer from the
source to the new host
2. Screen the patient To maintain privacy. It helps in giving relaxation and comfort to
the patient
3. Collect supplies from the equipment room To economize time, energy and material. Organization
facilitates performance of task
4. Mix hot and cold water and check the temperature (120–149°F To prepare application within the acceptable range
or 49–65°C) or keep boiling water till steam disappears
5. Pour some water into the hot water bottle and empty it To warm the hot water bottle and minimize heat lost through
conduction and convection
6. Pour water to fill the half or two-third of the capacity of hot To avoid unnecessary weight on body parts, especially if applied
water bottle on abdomen and allows to mould over the area to provide even
heat
7. Expel the air by placing the bag over a flat surface. Cork it tightly Air in the bag will interfere with the conduction of heat and it
(Fig. 3). will not mould easily to the patient’s body

Fig. 3: Expelling air from hot water bag

Contd...

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 Chapter 53 Hot Application
Action/steps Rationale
8. Dry the outside of the bottle and hold it upside down for To prevent scalding of the patient
checking leakage To ensure that the bottle is not leaking
9. Cover the bag with a bottle cover or other protector and apply to Protects the skin from direct contact with hot rubber
the prescribed area
10. Keep bottle in place for 20–30 minutes, change position if Maximum therapeutic effects from application of heat occur
needed and inspect area for redness, pain and swelling within 20–30 minutes. Extended use of heat causes tissue
congestion and vasoconstriction. Inspection and changing
position prevent burns

After Care of Patient and Articles Š Wash the cover of the bag, dry it and put it in a proper place.
Š Wash hands.
Š Remove the bag when treatment is over.
Š Inspect area for redness. If present, apply vaseline or oil. Documentation
Š Note the patient’s response and make him comfortable.
Š Take all articles to utility room and remove the bag Š Record the procedure with date, time, the area to which it
cover. Empty the bag and wash its outside with soap and is applied, the purpose and reaction, if any.
water.
Š Dry the bag by hanging upside down. When dried, fill
Evaluation
with some air, cork it and store in a proper place. Š Observe for its therapeutic effectiveness.

Heating Lamp The recommended distances are:

Š 25 watt bulb: 35 cms away from the body part
Flexible necked lamps are used to supply dry heat to the body
Š 40 watt bulb: 45 cms away from the body part
part and are placed 18–30 inches from the area to be treated.
Š 60 watt bulb: 60 cms away from the body part
The distance between the exposed part and the lamps depends
on the voltage of the light bulb, the pigmentation of the skin
Objectives/indications
and heat tolerance by the patient. The duration of treatment
is 20–30 minutes. Š To provide dry heat to increase circulation to a small area
such as in decubitus ulcer
Š To reduce inflammation

Š To dry casts and moist wounds

Š To promote healing
SKILL: HEATING LAMP APPLICATION

Articles Required Preliminary Assessment

Articles Rationale Š Assess the patient’s condition.

Š Check the diagnosis and doctor’s instruction.
A lamp with required voltage To apply heat Š Inspect, clean and dry the body area.
Measuring tape To check proper distance of the Š Determine the distance of the lamp and frequency of
lamp and the body treatment.
Screen To maintain privacy Š Check the working condition of the instrument.
Vaseline To prevent skin burning
Preparation of the Patient (Planning)
An extra bed-sheet To drape the patient
Š Explain the purpose of the procedure to build rapport.
Š Maintain proper privacy. Drape patient as needed.
Š Provide a comfortable position.

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 Steps of Procedure
Textbook of Nursing Foundations for KUHS

Action/steps Rationale
Implementation
1. Screen and drape the patient To maintain privacy
2. Wash hands and dry properly To prevent cross-infection
3. Measure the proper distance from the lamp to the body To get the maximum benefit of treatment
4. Focus the lamp at a proper angle To supply heat
Evaluation
5. Inspect the area for redness To observe for any injury

After Care of Patient and Articles

Š Switch off the lamp, cool it and keep it back in the inventory.
Š Make the patient comfortable.
Š Wash hands and record procedure.
Š Apply Vaseline or oil if there is any redness.

Heat Cradles Š No wet dressing should be applied while using heating

pad.
Heat cradles are metallic half circle frames (bed cradle), in
Š Do not apply heating pad with pressure since this reduces
which several electrical light sources and sockets for luminous
the number of air spaces between patient and appliance.
bulbs and a thermometer are installed. They are used when a
It increases chance of burns.
large body part is to be heated such as abdomen, chest or legs.
Š Instruct patient not to lean or lie against the heating pads
Purposes
Infrared Lamp
Š To dry large plaster body casts
Š To dry the wounds in burns or when patient’s condition Infrared lamp supply radiant heat or infrared rays (invisible
does not allow covering of the skin with gown or sheets. heat rays beyond the red end of the spectrum). Infrared
Š To take the weight off the body of top clothes lamp is used to provide heat to a localized area of the body.
It penetrates 3 mm of tissue at the most. Thus, it provides
Steps of Procedure surface heat only.
The advantages over other forms of heat application:
Š Place the cradle with electric light bulbs over the required
Š Dosage can be regulated easily.
area. Often this is covered by top bedding in order to hold
Š The application has no weight and the patient can be made
in the heat and to prevent cooling by the circulatory air. comfortable and undisturbed throughout the procedure.
Temperature should not exceed 52°C or 125°F.
Š After the prescribed duration (20–30 minutes), cool the
Uses
cradle and remove and replace. It may be used continu-
ously, provided a low temperature is maintained. Š Frequently used in treatment of decubitus ulcers.
Š Used in obstetrical and gynecological cases to promote
Electric Pads healing of suture area of the perineum.

Electric pads and electric blankets are frequently used as a Cautions

means of providing dry heat. These are composed of an electric
coil with a waterproof rubber covering and heat control switch Š Check that the patient’s skin is dry
to maintain temperature at a desired level. Š Ask patient to wear cotton clothes
Š The lamp should be placed 18–24 inches above the skin
Precautions area
Š The rays should strike the skin at right angle
Š It should be covered with a flannel cloth to absorb the Š Observe patient frequently, note his reaction and termi-
perspiration and to insulate the pad. nate application at first sign of redness or pain

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Duration of Treatment for diathermy, the nurse must see that all forms of metals are

Chapter 53 Hot Application

removed from patient’s body.
Š It is from 15 to 45 minutes. The length of time depends on
the amount of erythema present during treatment.
LOCAL MOIST HEAT APPLICATION
Ultraviolet Lamps
Application of moist heat means the use of an agent warmer
Ultraviolet lamps are exposure of the body to the ultraviolet than the skin which is applied in moist form to produce local
portion of light spectrum. A mercury vapor lamp or a cold heat.
quartz lamp is used for producing ultraviolet rays.
Fomentations
Uses
Fomentations are local application of moist heat to the skin
Š The effects of exposure to ultraviolet lamps are by means of double thickness of flannel or other soft material.
pigmentation of the skin, production of vitamin D and They are of two types:
bactericidal effects. It is mostly used for a number of skin Š Medical fomentation
conditions. Š Surgical fomentation
Š The lamp is placed 30–36 inches away from the skin and
the duration is 20–30 minutes. Medical Fomentation
Medical fomentation is done by using only hot water with or
Caution
without medicine.
Š Patient and therapist must wear protective goggles as it
may cause conjunctivitis. Purposes
Š To stimulate circulation and relax muscle tissue
Diathermy Š To relieve pain and congestion in inflamed areas
Shortwave or diathermy is a method of heating to convert Š To relieve retention of urine
electrical or vibrational energy into thermal energy to Š To promote suppuration
provide heat, deep in the tissues. In preparation of a client Š To stimulate absorption of serous exudates and effusion
from body cavities

SKILL: FOMENTATION APPLICATION

Preparation of Articles

Articles Rationale
A kettle with boiling water To have boiling water at required temperature
Wringer with wringer rods placed in a basin/two artery forceps To wring out the hot compress
Three pieces of flannel large enough to cover the To apply warmth
area/fomentation pads
Cotton balls in a container To apply oil
Forceps To hold cotton balls

Paper bag To receive used swabs

Kidney tray To receive used compress
Waterproof cover and cotton To insulate the compress and to prevent heat loss
An abdominal binder and safety pin To keep the compress in position
A hot water bag with cover To keep over the compress
Screen, if necessary To provide privacy

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 Preliminary Assessment Preparation of Patient and Unit (Planning)
Textbook of Nursing Foundations for KUHS

Š Identify the patient Š Identify patient and explain procedure

Š Check diagnosis and physician’s order Š Screen the patient. Drape according to the need and
Š Inspect body parts expose only the needed part
Š Determine the duration and frequency of treatment Š Switch off the fan
Š Check the patient’s general condition Š Place the patient slightly off the center of the bed towards
Š Check the available articles the edge of the bed for better proximity for treatment
Š Place a mackintosh and a towel under the patient
Š Keep the abdominal binder in place ready for application
Š Prepare the part and apply oil or Vaseline

Steps of Procedure

Action/steps Rationale
1. Wash hands To prevent cross-infection
2. Screen and drape patient To maintain privacy
3. Prepare hot compresses at bedside To prevent heat loss to air. Moisture causes rapid cooling
4. Place the wringer and fomentation cloth in the basin with the Wringer helps to remove excess water from fomentation cloth
free end outside. without burning the nurse’s hands
5. Test the temperature by applying at the back of the hand To ensure that it will not cause a burn
6. Apply compress over the area. Change the compress Cover maintains constant temperature
frequently or cover with heating agent (hot water bottle, Also protects bed clothes from getting wet
heating pad). Cover with waterproof cover and a cotton pad
7. Secure the binder with bandage To get the maximum benefit of the treatment

After Care of Patients and Articles Special Points

Š Change compress every 3 minutes for 15 minutes if a Š Avoid chilling in between fomentations
hot water bottle is not used. If single application is made Š Report any redness and take immediate steps
and kept warm by hot water bottle, remove the last Š Always apply fomentation after ascertaining patient’s
fomentation after 20 minutes. sensitivity to heat
Š Dry the skin, observe for redness and blister. Report if
any, and apply vaseline. Evaluation
Š Cover the patient and provide comfortable position. Observe for its effectiveness
Documentation
Š Report and chart the procedure.
Š Wash all articles. Disinfect pads and replace them in
proper place.

Surgical Fomentation
Surgical fomentation is local application of moist heat requiring surgical asepsis when the skin is broken.

Purposes
Š To promote suppuration by circulation
Š To reduce swelling around a wound
Š To hasten separation of slough
Š To help in drainage of exudates

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 Chapter 53 Hot Application
SKILL: SURGICAL FOMENTATION

Articles Required
Š A kettle of boiling water
Š Tray containing 2 sterile basins, 2 sterile fomentation pads, 2 sterile forceps, 2 sterile small bowls, a piece of plastic cover
binder, a kidney tray and paper bag
Š Dressing trolley
Š Screen
Steps of Procedure
Action/steps Rationale
Implementation
1. Assess area for any circulation impairment (numbness, tingling, Circulatory impairment may interfere to perceive heat and
impaired sensation, cyanosis) place the patient at risk of burns
2. Check physician’s order and explain the procedure Explanation encourages patient’s cooperation and redness
apprehension
3. Gather equipment Provides for an organized approach to the task
4. Wash hands To prevent cross–infection
5. Close doors and switch off the fan. Expose the area To provide privacy and warmth
6. Place mackintosh with waterproof lining under the patient To protect the bed clothing
7. Assist patient to a comfortable position that provides easy access To provide comfort and care of application
8. Open the dressing, observe the amount and nature of discharge. Document the condition of the wound prior to the
Discard dressing in kidney tray application
9. Clean the wound. Place sterile fomentation pad into the sterile basin To maintain aseptic technique
10. Pour boiling water over sterile fomentation and squeeze moisture Excess moisture may contaminate the surrounding area and
from it with the help of forceps and apply carefully and gently mould is uncomfortable. Moulding compress to the skin promotes
around the wound retention of warmth around the wound
11. Cover with sterile towels followed by a plastic cover, fix in place with Towels provide additional insulation
a binder
12. Check frequently for any sign of burns Impaired circulation may affect sensitivity to heat
13. After 30 minutes, remove warm compress. Observe skin condition Maximum therapeutic effect of heat occurs within
and patient’s response 20–30 minutes
14. Apply sterile dressing Protects wound from infection
15. Make patient comfortable To give comfort to the patient
16. Wash equipment and replace them To keep it ready for reuse
Documentation
17. Record with date, time, duration of treatment and condition of wound Provides accurate documentation of procedure

Evaluation
Observe for its effectiveness.

Stupes
Stupes are medicated local application of moist heat where distention or tympanites. Heat stimulates contraction of
turpentine is used locally to augment the effects of the hot intestinal muscle, thereby increasing peristalsis and relaxing
compress used. These are commonly used to relieve abdominal muscle spasm

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 Articles Required Making a Starch Poultice
Textbook of Nursing Foundations for KUHS

Š Same as for medical fomentation Take starch and sodium bicarbonate in the proportion of 1:8.
Š A drachm glass containing turpentine mixed with olive Make a paste with cold water. Add more boiling water when
oil or sweet oil 1:2–3 in adults and 1:6 for children the mixture is being stirred. Cook the mixture and make
Š A swab stick in a container a jelly mass. Spread the jelly on a lint piece with spatula to
Š Articles for insertion of a flatus tube thickness of one fourth of half an inch. Cover it with another
piece (leaving sufficient margin to turn it neatly). Take it to
Steps of Procedure the patient, keeping it in hot plates. Apply on the area as in
case of hot compress. It is left in place for half an hour to
Š Adopt same procedure as done for hot compress.
1 hour.
Š Take turpentine and olive oil in correct proportion, mix
well and warm the mixture by keeping the container in a
Plaster (Emplastrum)
bowl of hot water.
Š Apply warm oil over the part with the help of swab stick. Plaster is made up of substance containing drugs which may
Š Apply hot compress and follow same procedure. be either irritating or soothing in character. The examples are
Š After 10–15 minutes, insert flatus tube for expulsion of belladonna and opium plaster applied for a soothing effect
flatus. and a mustard plaster used as a counter-irritant. Application
Š Report and chart time, duration and result of treatment. is similar to poultice.

Remember
Local Bath (Warm Soaks)
Š Mix turpentine and oil thoroughly Local bath is a simple method of applying moist heat to the
Š Avoid blistering of the skin by carefully watching the area in extremity or any part of the body by immersing the body part
every 15 minutes in warm water/medicated solution or to wrap a part in gauze
Š Avoid chills
dressing and then suturing the dressing with the solution.
Š Be sure to report the effect of the treatment carefully
Soaks may employ either a clean or sterile technique. Sterile
technique is indicated for open wounds.
Poultices (Cataplasm) and
Plasters (Emplastrum) Purposes
A poultice is an application of moist heat in the form of a Š To increase blood supply to locally infected area, thus
soft spongy mass that retains its heat for a length of time. hastening suppuration and softening the exudates.
According to the ingredients used, its effect depends on the Š To apply medications.
heat they supply. The types of poultices are artiphlogestine, Š To aid in cleaning large sloughing wounds such as burns.
linseed, mustard, charcoal, starch, etc. As these are not used, Š To relieve edema, ischemia and muscle spasm.
details are not given. Detailed preparation of starch poultice
is given below.

SKILL: LOCAL BATH

Articles Required Solutions Used

Š A bathtub with required solution at a correct temperature Š Sodium bicarbonate: To relieve itching
(105–110°F), arm bath tub, foot bath tub Š Boric acid: To sooth irritated skin, add 3 ounces of boric
Š A mackintosh with cover acid to a gallon of water at a temperature of 35.5°C
Š A bath thermometer Š Potassium sulfate: To destroy parasites. Add ½–3 oz of
Š A hot water bottle with cover (for foot and arm bath) potassium sulphate to ½ gallon of water
Š A screen and extra blanket (for foot and sitz bath) Š Potassium permanganate: To treat fungal infection and
Š A dressing tray, if required athlete foot, add one gram of potassium permanganate to
Š A kidney tray and paper bag one quarter of water
Contd...

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 Chapter 53 Hot Application
Steps of Procedure Š Place the folded towel between the legs and the edge of
the tub (or bring the bath towel up to cover the edge of
Š Steps are the same as for hot compress tub where the back of the patient’s legs is pressing against
Š Prepare the solution in a bathtub at a correct temperature the tub). The patient’s own towel can also be used.
and take to the bedside Š Hold the blanket in position while drawing down the
Š Explain the procedure and screen the patient cover. Keep the feet in water for 20–30 minutes. Keep the
Š Loosen top cover at the foot of the bed for giving foot jug with water nearby and add from the side of the bath
bath as required.
Š Place the folded extra blanket at the foot of the bed Š Uncover the tub at one corner only when pouring water.
Š Turn back the bed clothes above the knees, covering the Raise the foot and pour in gradually and not near the
patient to prevent scalding.
unaffected foot with a blanket.
Š Turn back the top clothes leaving the blanket over the
Š Remove soiled dressing, if any
knees.
Š Flex the knees or raise the patient to a sitting position Š Remove the towel from the edge of the tub.
Š Place the mackintosh and towel under the feet and test Š Raise the leg, hold over the tub to drain water and then
the temperature again lower the legs over the towel.
Š Place the foot tub on the towel. Raise the feet, draw the Š Same steps are followed for giving arm bath using arm
tub in place and slowly lower the feet into the water bath tub.

Paraffin Bath/Wax Bath the body part is covered with a plastic bag and then a heat
pack is placed over the injury to keep it in the heat.
The paraffin bath is commonly used for painful hands and
knees especially for patients with rheumatoid arthritis. Sitz Bath
The mixture for this treatment consists of 15–30 mL of
mineral oil to 1 pound of paraffin wax. It is also used for Sitz bath is a local application of moist heat to the pelvic
patients having leprosy. organs. The patient is usually immersed from the mid-thigh
to the iliac crest. The temperature should be 110–115°F.
There are two common methods for use: Duration of bath is 15–30 minutes.
1. Immersion bath: The patient dips the body part in the
wax and removes it so that it dries, then re-dips 6–12 times Purposes
while allowing it to dry between dips. Then the patient Š To relieve congestion of the pelvic organs, e.g., in treating
immerses the body part for 5–10 minutes, with care being dysmenorrhea
taken to avoid burning. Š To relieve pain following cystoscopy
2. Pack glove method: This method is safer than the Š To relieve inflammation and pain (hemorrhoids, cystitis)
immersion bath because there is less chance of burning. Š To relieve pain in retention and painful micturition
With this, the patient dips the body part in the wax and Š To promote wound healing by cleaning off the discharge
lets it dry. This is repeated 7–12 times. After the last dip, and debris

SKILL: SITZ BATH

Solutions Used Equipment

Š Potassium permanganate solution 1:5000 Š A bed-screen if treatment is to be done at bedside
Š Boric acid 1 dram to 1 pint Š A suitable bathtub or basin/sitz bath tub
Š Eusol solution Š A bath thermometer
Š Dettol 1:40 Š A jug with warm water
Contd...

529
 Š A bedside stool Š Observe closely for any sign of weakness or fatigue.
Textbook of Nursing Foundations for KUHS

Š Gown Discontinue the bath if the patient has signs of faintness,

Š Towel for drying pallor, rapid pulse and nausea
Š Test the water in the tub several times and keep it at the
Steps of Procedure desired temperature 105°F. Additional hot water may be
added by pouring it slowly from the jug
Š Explain the purpose of the procedure. Š Allow the patient to remain in the basin for 15–30 minutes
Š Fill the tub with water about half full at a temperature of Š Do not leave the patient alone unless it is absolutely
100°F. certain that it is safe to do so
Š Screen the patient if at bedside or wheel him to the Š Help the patient to come out of the basin when the bath is
bathroom in a chair if his condition permits. completed. Stand in front of him. Place hands under the
axilla and partially lift him from the tub to the stool
Š Assist the patient to undress and avoid unnecessary
Š Dry the patient with the bath towel and cover him
exposure. Stand directly at the patient’s back; help the patient
adequately. Assist him into the bed
to sit down in the tub with the feet flat on the floor. There
Š Avoid chill
should be no pressure on the sacrum or thighs.
Š Rinse the basin, scrub well with soap, rinse, dry and
Š Be sure that the thighs, buttocks and lower abdomen are replace
immersed in the solution. Š Leave the patient comfortable. Leave the bathroom in
Š Drape the patient’s legs and thighs. Wrap a bath blanket order. Remove the bedside stool
around the patient’s shoulder to protect him/her from Š Record time, duration, type of solutions used and reaction
chill. of the patient

Aquathermia Pads Š To provide a warm bed with blankets and hot water
bottles, thus preventing and treating surgical shocks.
Aquathermia pads come in various sizes. Instructions
should be followed according to the manufacturer. These
Steps of Procedure
are waterproof pads used for treating muscle sprains, areas
of mild inflammation or redness. It consists of a waterproof Š The hot dry pack frequently follows a hot bath
plastic or rubber pad connected by two hoses to an electrical Š Wrap the patient in hot dry blankets
control unit that has a heating element and motor. Distilled Š Keep 2–3 hot water bottles surrounding the blanket
water circulates to the control unit where water is heated or Š Give hot drinks like hot soup
cooled depending on setting of the temperature. Setting is Š Cold application may be done at the head if the patient
fixed by inserting a plastic key into the temperature regulator. has headache or throbbing pain
Mostly the temperature is maintained between 105°F and
110ºF. Plain tap water is never added to the unit as it might
leave mineral deposits. The pad is never applied directly on GENERAL MOIST HEAT APPLICATIONS
the skin. A thin towel or pillow cover should be fitted over
this heating pad and later secured with the tape or gauze roll. Hot Moist Packs
Any type of pin is never used as it may cause a leak. Duration It is the application of hot moist blankets or flannel pieces to a
of total application is 20–30 minutes. Frequent observation of larger area (sometimes whole body is covered). The hot packs
the skin is done for redness and burning. The patient should may be used to relieve muscle spasms in poliomyelitis.
not be allowed to lie on the bed.
Whirlpool Bath or Full Immersion Bath
GENERAL APPLICATION OF DRY HEAT It is helpful in promoting sedation, relieving pain and
encouraging debridement of widespread surface burns.
Hot Dry Packs When immersed in water, the body becomes buoyant
and exercises are, therefore, performed with less efforts.
Purposes
It is expensive and inconvenient to use a warm whirlpool.
Š To prevent chilling Despite this, it is good for covering large, irregular surface
Š To relieve retention of urine areas. The temperature should range from 105°F to 110°F,

530
and the duration of treatment should last from 15 to Steam Inhalation

Chapter 53 Hot Application

20 minutes.
Inhalation of warm steam to liquefy the secretions and to
relieve congestion in the lungs is called steam inhalation.
Counter-Irritants
These are drugs used to augment the desired effect of heat Purposes
application to induce vasodilation in the superficial tissues. Š To loosen the secretion and for easy expectoration
When the skin absorbs counter-irritants, they irritate the Š To moisten the mucous membranes
sensory nerve endings and produce vasodilatation by reflex Š To relieve irritation and congestion
action. Š To relax muscles and thus, relieve cough

Types of Counter-irritants Assessment

They are classified according to their effects and degree of Š Assess the patient’s ability for self care
irritation produced: Š Assess the level of consciousness
Š Rubefacients: It is a simple form of counter-irritant, Š Assess the general condition of the patient
which causes only reddening of the skin. The effect is Š Auscultate the lungs to assess for the presence of secretions
immediate and lasts only for a short period. Common
Nursing Diagnosis
rubefacients are mustard plaster, iodine, turpentine,
camphor, etc. Š Impaired gas exchange
Š Vesicants: These counter–irritants cause blister formation Š Ineffective breathing pattern
and are not practiced commonly. Š Activity intolerance
Š Pustulants: They are counter-irritants which when Š Anxiety
applied on the skin, form pustules. Š Ineffective therapeutic regimen

SKILL: STEAM INHALATION

Planning
Articles Required
Articles required for steam inhalation are shown in Figure 4.
Š A tray lined with towel containing
 Enamel or steel bowl (big in size)
 Nelson’s inhaler wrapped with towel
 Mouth piece which snugly fits Nelson’s inhaler or
electric inhaler
 Cotton balls and gauze pieces in a bowl
 Kidney tray and paper bag
Š Kettle with boiling water (120°–160°F)
Š Sputum cup
Š Medications as per order such as:
 Tincture benzoin 5 mL/500 mL of water
 Eucalyptus 2 mL/500 mL of water
 Methyl salicylate few drops in water Fig. 4: Articles for steam inhalation
 Few crystals of menthol in water
Contd...

531
 Textbook of Nursing Foundations for KUHS

Steps of Procedure
Action/steps Rationale
Implementation
1. Check for the doctor’s order To plan the care
2. Explain the procedure to the patient Enhances cooperation and removes fear
3. Rinse the Nelson’s inhaler with hot water
4. Pour hot water into the inhaler from the kettle till the level of To prevent injury (scald)
the spout (two third of the inhaler)
5. Add medicine, if ordered. Close the inhaler with the mouth To prevent heat loss
piece
6. Switch off the air conditioner/fans and close windows and To avoid draughts and chills to patient
doors
7. Wrap the inhaler with towel and keep it in a bowl. Wrap the To prevent heat loss
mouth piece with gauze piece and plug cotton balls into the
spout of the inhaler
8. Take it to bed-side and position the patient in Fowler’s position To provide support
and support with cardiac table or extra pillows.
9. Keep the sputum cup within easy reach of the patient To expel the sputum as need arises
10. Place the inhaler and ask the patient to inhale deeply with To liquefy the secretions and loosen the secretions
mouth, hold it to a count of three, exhale through the spout To promote atmospheric air entry through spout.
during expiration and remove it during inspiration (Fig. 5)

Fig. 5: Inhalation of steam

11. Continue the procedure for 10 minutes or till the steam remains For effectiveness
12. Keep the patient warm during and after the procedure To prevent chills
13. Give chest physiotherapy, encourage the patient to cough and To mobilize the secretions
spit the sputum into the sputum cup
14. Keep the sputum cup near the patient for 15–30 minutes To expel the sputum
15. Reposition the patient comfortably To promote comfort
16. Replace the articles For the next time
17. Document the procedure done: Date, time, duration and To prevent duplication of care and serves as legal evidence
medication added

Evaluation
Š Evaluate the patient’s response Š Evaluate the color, thickness and odor of sputum
Š Auscultate the lungs to assess the lung sounds Š Monitor the respiratory rate

532
CONCLUSION of the body differ in tolerance to heat and cold and so does

Chapter 53 Hot Application

the physiological tolerance of individual. Warm applications
The safe use of heat therapy requires an assessment of the are effective for improving circulation to wound sites and
patient’s sensory function, identification of risk factors and promoting muscle relaxation.
understanding the physiological effect of heat. Different parts

B ibliography
1. The Trained Nurses Association of India. Fundamental of Nursing: Procedure Manual. TNAI Publication. pp. 412-29.
2. Sr. Nancy. “Stephanie’s Principles and Practice of Nursing senior Nursing Procedure and Nursing administration”, vol. 2,
4th edition. NR Brothers; 2005. pp. 461-82.
3. Lindeman CA, McAthie M. Fundamentals of contemporary nursing practice, 1st edition. Saunders: Philadelphia; 1999.
4. White L. Basic Nursing: Foundation of Skills and Concepts. Delmar/Thomson Learning, 2002.

This is NNL Advertisement

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