Exam 2 Oulines PDF

LECTURE OF CULTURE/ETHNICITY Concept of Cultural Nursing Nurses have to be: - Culturally Sensitive: non judgemental attitude, aware of di erences - Culturally Appropriate: non judgemental attitude - Culturally Competent: attends to pt TOTAL situation Characterist...

LECTURE OF CULTURE/ETHNICITY Concept of Cultural Nursing Nurses have to be: - Culturally Sensitive: non judgemental attitude, aware of di erences - Culturally Appropriate: non judgemental attitude - Culturally Competent: attends to pt TOTAL situation Characteristics & Universal Attributes Culture: is apparent in the attitudes & institutions unique to the culture - Includes non - physical traits or characteristics - It is learned & passed through generations - It is learned by each new generation through both formal & informal life experiences Includes: - Values, Beliefs, Attitudes - Practice, Habits - Likes & Dislikes - Customs & Rituals Di erentiate & Terms - Culture: is defined as a shared system of beliefs, values, & behavioral expectations (defines roles & interactions with others & in families & communities, provides social structure for daily living) - Ethnicity: sense of identification with a collective cultural group (based on group’s heritage, Ethnic Background = Ethnicity, ex: religion & language) - Religion: a system of beliefs, practices & ethical values about devine or superhuman powers - Diversity: state of being di erent (language, sexual orientation, religion, etc) - Stereotyping: assuming everyone from the same culture, race, ethnicity act alike - Cultural Imposition: belief that everyone should conform to your own belief systems - Cultural Blindness: when one ignores di erences & proceeds as they don't exist - Culture Conflict: becoming aware of cultural di erences, feel threatened & respond by ridiculing the beliefs & traditions of others to make themselves feel more secure about their own values - Subculture: large group of people who are members of the larger cultural group but who have certain ethnic, occupational, or physical characteristics that are not common to larger culture  - Cultural Acculturation or Assimilation: a minority group living with dominant group, and losing cultural characteristics that made them di erent, may take on the values of the dominant group - Cultural Shock: placed in a di erent culture they perceive as strange - Race: based on physical characteristics such as skin pigmentation, body stature, facial features, and hair texture - Discrimination: the unfair or prejudicial treatment of people and groups based on characteristics such as race, gender, age, sexual orientation - Ethnocentrism: belief that one’s ideas, beliefs, and practices of own’s one culture are superior to those of another’s culture - Prejudice: an opinion formed without adequate knowledge, thought, or a reason - Bicultural: combining cultural attitudes & customs between two nations - Dominant Vs Minority Group: the dominant group is that which holds the most power in society compared to minority groups Nursing Assessment Parameters Include Physiological Variations, Reactions to Pain, Language & Communication, Economic Barriers, Gender Roles, Mental Health, Gender Roles Physiological Variations Native Americans & Alaska Natives: - Heart Disease - Cirrhosis of the liver - Diabetes Mellitus - Fetal Alcohol Syndrome African Americans - Hypertension - Stroke - Sickle Cell Anemia - Lactose Intolerance - Keloids Asians - Hypertension - Cancer of the liver - Lactose Intolerance - Thalassemia  Hispanics - Diabetes Mellitus - Lactose Intolerance Whites - Breast Cancer - Heart Disease - Hypertension - Diabetes Mellitus - Obesity Eastern European Jews - Cystic Fibrosis - Gaucher’s Disease - Spinal Muscular Atrophy - Tay - Sachs’s Disease PAIN IS WHATEVER & WHENEVER A PATIENT SAYS IT IS Verbal Communication: language usage, voice quality, use of silence, gender of speaker, use of interpreter Non Verbal Communication: eye movement/eye contact, facial expression, use of touch, hand movement, body posture Time of Orientation Past- history & traditions guide present & future (ex: East Asia) Present- “eternal present”, instant gratification & short term benefits (ex: American, African & Native Americans) Future- Planning for future, long-term worldview (ex: Chinese & Japanese) Personal Space - Intimate Zone: 6 to 18 inches - Personal Zone: 1.5 to 4 feet - Social Zone: 4 to 12 feet Health Belief Systems Health Belief System - Is a framework influencing views on cause of illness, prevention, treatments of illness, health promotion & maintenance activities 1. Magico - Religious Health Belief System (Supernatural Forces, Evil Spirits, God’s Will) - Illness = a punishment from god  HISPANICS, AFRICAN, & CARIBBEAN 2. Scientific Health Belief System (Bio Medical): A - controlled physical & biochemical processes - analyzed & manipulated by humans 3. Holistic Health Belief System A -i e and - Natural balance or Harmony.. Ying g - VS disequilibrium or disharmony CHINESE MEDICINE & NATIVE AMERICANS Asian Folk & Traditional HC: well being-related to balance (such as yin & yan, energy, mind-body-spirit) - Hot & Cold remedies, and Herbs Nsg Considerations: may be upset w/lab results, may prefer death w intact body -> may refuse surgery Spanish Folk & Traditional HC: Curanderos (folk healers) - Respect according to age or gender - Roman Catholic Church Influential Nsg Considerations: may be di cult to convince of illness, Health & Illness = God’s will & for a reason-such as punishment Caucasian Folk & Traditional HC: self diagnosis of illness,/ Use of OTC drugs (vitamins & analgesics),/ Extensive use of exercise & exercise facilities Nsg Considerations: assess OTC medications (observe for S&S toxic medication levels, especially fat soluble vitamins),/ assess dietary habits African Americans Folk & Traditional HC: varies-may include: Herb Doctors,/ Voodoo & Faith Healing Nsg Considerations: assess folk healing,/ special care may be needed ( hair, nails) Native Americans Folk & Traditional HC: Shaman = medicine man,/ Herbs & psychological treatments,/ Ceremonies, Fasting, Medications, Heat & Massage Nsg Considerations: family = expected to participate in care,/ note-taking = taboo & insult to speaker,/ indirect eye contact preferred,/ low tone of voice = respectful Nursing Diagnosis Examples - Impaired Verbal Communication related to inability to speak English and interpreter available  - Ine ective Management of Therapeutic Regimen related to mistrust of traditional healthcare personnel Nursing Process Assessment: use of health belief system, language use, preference for family involvement, food preferences, space & time orientation Diagnosis: have some NANDA diagnosis (above) Planning: become aware of client’s cultural heritage, & health traditions,/ consider client’s cultural influences Implementation: ensure to address the gap between the nurse’s scientific world, & the client’s cultural perspectives (views),/ accommodate cultural practice Evaluation: compare client’s expected outcomes with achieved outcomes, ensure client’s health belief system has been taken into consideration  LECTURE OF THE NURSING PROCESS The Nursing Process - is an organizational framework for nursing practice What are the purposes/goals of the process - identify health status,problems, needs - create plans to address problem/needs - implement interventions - evaluate e ectiveness 5 steps of the Nursing Process 1. Assessing - collecting, validating, & communicating of client data 2. Diagnosing - analyzing client data to identify client strengths & problems 3. Planning/Outcome Identification - specifying client outcomes & related nursing interventions 4. Implementing - carrying out the plan of care 5. Evaluating - measuring extent to which the client a achieved outcomes Nursing Process Characteristics is - Interpersonal, Systematic, Dynamic, Multi-Dimensional, Based on Knowledge & Critical Thinking, Cyclical The Scientific Problem Solving is similar to Nursing Process Apply Critical Thinking to Nursing Process & 5 steps to develop it: 1. Purpose of Thinking 2. Adequacy of Knowledge 3. Potential for Problems 4. Helpful resources 5. Critique of judgment/decisions 4 Required Nurse’s Blended Skills: - Cognitive skills - Technical skills - Interpersonal skills - Ethical/legal skills STEP 1: The Assessment Phase Assessment is a systematic process of data collection involves continuous collecting, organizing, validating & documenting of data information Its purpose is to establish a database for a client in order to meet a patient's nursing care needs. Medical Assessment vs Nursing Assessment Medical Nursing Target data pointing to Focus on the patient’s response pathologic conditions to health problems Types of Assessment 1. Initial Assessment - admission & comprehensive assessment (establish data) 2. Focused Assessment - pre-existing condition (ongoing assessment) 3. Emergency Assessment - when a physiologic or psychological crisis presents 4. Time-Lapsed Assessment - schedule to compare a patient’s current status to baseline data obtained earlier Assessment Phase Purpose of Nursing Assessment & Database Determine the client’s Health status Ability to function Strengths limitations Ability to cope with stresses Plan & deliver app care Refer to other professionals Information on the Databases Includes Nursing hx/health hx Physical examination Lab results Diagnostic tests Past Medical Records Types of Data Objective Data- observable & measurable data (signs) Main way to collect objective data by - - Physical assessment - Laboratory results - & diagnostic testing results Subjective data - information that only client feels & describe (symptoms)  - Data from the client’s point of view (verbalizations) - Feelings, perception, concerns Main way to collect data by INTERVIEWING Sources of data - Primary source : client - Secondary source: family & significant others, Patient medical records, Healthcare professionals, Other experts reports, Test & diagnostic results Data collection - takes place in the assessment phase Gathered Via - observation, interview, physical assessment, diagnostics Phases of the Interview - Preparatory Phase: reviews records, gather available data - Introductory Phase: meeting, introductions & explanations of purpose of interview - Working Phase: actual interview - Termination Phase: conclusion Interviewing Techniques Direct Approach -> closed ended questions (YES or NO) Non Direct Approach -> opened ended questions Validating Data by -> DOUBLE CHECKING or VERIFYING INFORMATION Techniques Used for Physical Assessment 1. Inspect 2. Palpitation (except for GI) 3. Percussion (we don’t do in 101) 4. Auscultate PE follows Health History STEP 2: The Diagnosis Phase The North American Nursing Diagnosis Association (NANDA) - defines nsg dx as a clinical judgment about the individual, family, or community responses to actual or potential health problems or life process NSG DX = NSG INTERVENTIONS Purpose is to Identify Responses, Identify Etiologies , Identify Resources …. Medical vs Nursing Dx Medical Dx Focus: rid the body of the illness of the diseases organ - Identify/describes a disease, illness or injury - Purpose is to identify disease or pathology - Remains the same as long as disease is present Nursing Dx Focus: Behaviors, response, reactions to disease, injury, or other stressors - Actual or Potential - Holistic: biological, emotional, interpersonal, social, spiritual, environment - Can change from day to day (as pt’s response change) Examples of Dx: NSG Dx vs MEDICAL Dx Ine ective Breathing Patterns -> Chronic Obstructive Pulmonary Disease (COPD) Activity Intolerance -> Cerebrovascular Accident (CVA) Pain -> Appendectomy Body Image Disturbance -> Amputation Risk for altered body temperature -> Strep Throat Rn DO NOT diagnose medical problems Nsg dxs DO NOT include medical dxs terminology Diagnosis Phase: After the data collection or (assessment phase) Steps: 1. Interpret data/cues (analyze data) - already gathered 2. Cluster cues (organize data) 3. Confer with approved list from nanda (identify health problems, risks, strengths) 4. Formulate Dx statements (write it) Types of NSG Dx 1. Actual Dx: - Describes a problem response that exists the time of assessment - It is identified by signs & symptoms (cues) that are present Ex: Impaired Gas Exchange 2. Risk Dx: - Describes a problem response that is likely to happen in a vulnerable client if the nurse does not intervene Ex: Risk for falls, Risk for Infection 3. Possible Dx: - Describes a situation here evidence bout a health problem may be incomplete or unclear Ex: Potential risk for skin breakdown, Possible risk for infection 4. Wellness Dx: - Describes the transition of an individual, family or community from one level of wellness to a higher level of wellness (postpartum client) - There is no identified health problem Ex: Readiness for enhanced health maintenance Components of a Nursing Diagnosis PES - Problem (diagnosis or diagnostic label): identifies what is unhealthy about the client It should be refined to explain the meaning of the label or distinguish the label from similar nursing diagnoses Ex: alteration in comfort = chest pain or back pain … - Etiology (cause): identifies factors maintaining the unhealthy state Ex: alteration in comfort = chest pain related to increased oxygen demand - Sign & Symptoms (Defining Characteristics): identifies the subjective & objective data that signal the existence of a problem Ex: alteration in comfort = chest pain related to increased oxygen demand as evidence by SOB pt’s ℅ substernal chest pain rated 6/10 on pain scale. The Planning Phase The nurses work with the client & family to: prioritize problems, formulate goals, select evidence based interventions, and write nursing orders. Communicate plan of nursing care! Elements of Comprehensive Planning 1. Initial Planning: developed by the nurse who performs the initial nursing HX & PE 2. Ongoing Planning : Carried out by any nurse interacting with the client - to keep the plan up to date 3. Discharge Planning: Information or teaching needed before D/C. - this planning begins when client is admitted Plan by using Maslow’s in order to list from high priority to medium priority to low priority HIGHEST PRIORITY AT BASE GOALS: 2 Types of Goals 1. Short-Term: goals achieved within a few hours or days 2. Long-Term: goals achieved over a longer period; weeks to months or more Categories of Outcomes - COGNITIVE: Describes increase in client knowledge or intellectual behaviors - PSYCHOMOTOR: Describes patients’s achievements of new skills - AFFECTIVE: Describes changes in client's values' beliefs & attitudes NANDA -> NIC -> NOC NIC: Nursing Interventions Classification: standardized classification of interventions. Describes direct or indirect care activities by nurses Consist of label, a definition, & a list of nursing activities to carry out the intervention NOC: Nursing Outcomes Classification: a standardized system. To describe client outcomes that respond to nursing interventions 5 Steps: Subject, Verb, Conditions or Modifiers, Performance Criteria, Timing Three Types of Nursing Actions (Interventions) 1. Independent (nurse initiated) : actions performs without a physician orders 2. Collaborative (Interdependent) : actions performed whenever the nurse works jointly with other members of the team healthcare to resolve client problems (ex: reinforces exercises by the physical therapist) 3. Dependent (physician initiated): actions performed when the nurse functions under orders written by the physician (ex: administration of medications) The Implementation Phase In this stage previously planned nursing actions (interventions) are carried out. Process of the Implementation Phase: Reassess: client as needed Determine: need for assistance Organize: resources & care delivery (equipment, personnel, environment) Implement: carry out or delegate the nursing interventions Supervise: any delegated care Document: all nursing activities & interventions provided The Evaluation Phase Determines if the EO have been met, partially met, or not met 1. Review evaluative criteria & standards 2. Collect data to determine if criteria & standards were met 3. Interpret & summarize findings 4. Document judgment Evaluating Outcomes - Cognitive EO: Increase in client knowledge - ask pt to repeat or explain information, or apply new knowledge  - Psychomotor EO: Patient’s achievement in new skills - ask pt to demonstrate a new skill - A ective EO: Changes in client values, beliefs, and attitudes - observe behaviors - Physiologic EO: physical changes in the client - collect & compare data QUALITY ASSURANCE (QA) Focus= on organization, influenced by outside factors (JHCO, state mandates, etc) Goal is the evaluation of: Structure- physical environment/ standards, policies & procedures/ equipment… Process- nature & sequence of activities/ criteria & acceptable levels of performance Outcomes- Focuses on measurable changes in the health status of the client/ or the end results of nursing care Methods of Assuring Quality 1. Quality by Inspection: finding deficient workers & removing them 2. Quality by Opportunity: finding opportunities for improvement & teamwork QUALITY IMPROVEMENT (QI) known as Performance Improvement (PI), Continuous Quality Improvement(CQI), Total Quality Management (TQM) Focus= on client care rather than organizational structure - Focuses on client care - It is internally driven - Has no ends points - Goal is to improve quality rather than assure quality Nursing Audit Examines data related to: - safety measures, - treatment interventions & client responses - client teaching - pre-established outcomes used as basis for interventions - discharge planning adequacy of sta ng patterns - Concurrent or Retrospective Audits From the book - Concurrent evals. conducted by nursing direct observation of nursing care, patient interviews, & chart reviews to determine where the criteria are met Retrospective evals. may use postdischarge questionnaires, patient interviews, (by telephone or face to face), or chart review to collect date (Joint Commission) Alanis Leite Nursing 101 September 30, 2024 Unit 2 Exam Mechanical/Thermal ○ Patient Safety Significance Help the patient on a better outcome in the helping process by assessing and maintaining a safe environment, knowing where all the things are in case of an emergency (i.e. fire) Know the reason why meds are given an assess the patient before administering Environment Safety Free of clutter rooms, hallways, walkways Emergency alarms on doorway No debris Cleanliness and free of debris I.V. poles are free of the move and be unplugged for bathroom use Socket & plugs are being used safe (free of clutter) Locate fire alarm and extinguishers Make sure call bell is within reach Meds ○ Pre & Post assessment  Nurse Promotion of Patient safety Be eyes and ears ○ Don’t turn a blind eye Patient spilled a drink, pick it up ○ Infection control guidelines PPE, Handwashing, etc ○ Safety and Security ○ Security emergency hotline memorized ○ Plan Language Emergency Alerts Facility Alert Fire Evacuations Security Alert Missing Person Active Shooter Medical Alert Mass Casualty Medical Emergency Factors that affect the person's ability to protect themselves Lifestyle ○ Diet, exercise, substance abuse, sleep patterns etc. Interventions:  Educate, promote physical exercise, rehab, support groups, health screenings etc Mobility ○ Fall risk, skin breakdowns (PUs), breakages Interventions: Assistive devices, fall prevention, safe environment, exercise Sensory-Perception Alterations ○ Impaired senses (vision, hearing, touching, taste) (not able to perceive dangers) Interventions: Assess & adaptations, adequate lighting, assistive devices, clear simple communications Cognitive Awareness ○ Dementia, Alzhiemers, confusion (affect judgment and ability to recognize threats leading to unsafe behaviors) Interventions: Structured environments, provide clear instructions, memory aids, & assessments Communications ○ Language Barriers & impairment Interventions:  Assess communication abilities, adaptation methods, ensure patient understanding Environmental Factors ○ Poor lighting, pollution, clutter, unsafe equipment Interventions: Education on safe home environment, environment assessment, recommendations for modifications Asepsis Medical Asepsis - Clean Technique ○ Standard Precaution, handwashing, transmission-based precaution Surgical Asepsis - Sterile Technique ○ Only Sterile object can touch other sterile object Side Rails Pros ○ Help Turn Patient and Repositioning ○ Provide a hand to hold for getting into or out of bed ○ Give the patient a sense of comfort and security ○ Reduce the risk of the patient falling out of the bed during transportation ○ Easy access to bed Cons  ○ Suffocation ○ Strangulation ○ Injury ○ Death ○ Falls ○ Fall Risk Preventing Hospital Injuries Roles of the nurse ○ Comprehensive assessment on admission ○ Risk Assessment Previous safety Concerns: Previous injuries Previous Falls Home Hazard Issues and Concerns Common Characteristics of fall risk Pt ○ History of Falls ○ Gait Disturbance (Balance Issues) ○ Dizziness ○ Visual Impairment ○ Medication List ○ Incontinence Issues ○ Frequency Issues Nurse Interventions  ○ Side rails up ○ Educating the patient, family, and other healthcare workers of safety measures in place ○ Restraints ○ Fall alert Patient Injury: The Nurse is responsible ○ Assessing ○ Treating the problem ○ Find physician, also family ○ Stabilizing the patient ○ Notifying and completing injury report ○ Revise and change plan of care Incident Report ○ Document How the patient was found Vital Signs How did they treat the patient? Status of patient post accident Purpose of the document An investigative tool to figure out Who? What? When? Why? How?, and how are we  going to change so this won’t happen again. Also helps in lawsuits ○ Fire Safety Common Causes of fires in Hospitals Malfunction of electrical equipment Damage wires Patient or Employee smoking Unsafe discarding of cigarettes War combustion of anesthetic gasses Common Cause of Death in Fires Smoke inhalation RACE R-escue ○ Evacuate the person who is in imminent danger A-larm ○ Pull alarm (call operator, dial 911, fire alarms) C-ontain ○ Contain fire/smoke (close doors) E-xtinguish ○ Extinguish or end the fire (responsibility) PASS How to use the fire extinguisher P-ull  A-im ○ The nozzle S-queeze ○ The handle S-weep ○ From side to side ○ Developmental Considerations Fetus abnormal Growth and Development Neonate infection, falls, suffocation Infant car seat, drowning, crib compliant with railing; SIDS; burns, injury from toys, inhaling FB Toddlers injury such as cuts or burns, drowning, suffocation, inhalation FB, window lock School Age/Adolescence make sure chemical secure; pot handles; sharp objects; drowning, substance use, bullying, sport injuries Young adult MVC, drugs/alcohol, drowning, workplace injury, domestic violence, stress  Elderly safety home hazards, vision or hearing loss, less reflexes, falls, abuse, MVA ○ Restraints Physical Restraints Devices that could be material or piece of equipment that are attached to the patient or adjacent to the patient and prevent the body part from moving freely to a position of the patient choice with expectation of devices used for positioning supports necessary treatment Alternative Restraints Staff and environment involvement ○ 1 to 1 - sitters, cameras Behavior Management Structured Activities ○ I.e. set schedule Contradiction of restraints Restraints are conducted when its convenience of the staff or trying to discipline patient Before applying restraints The physician would like to know if any alternatives have been used. Emergency Protocol  If patient is a threat to themselves and others Disruption of treatment ○ I.e pulling tubes Creating physical damage No need a physician/start with least restrictive ○ MUST BE NOTIFIED IMMEDIATELY Reassessing and re-order Reassess every 24 hours by physician Documentation has to be done every 2 hours Skin integrity check Different types of restraints Belt restraints- typically used when sitting up in chair; be sure that pt cannot slip thru/under belt; known to cause strangulation if not used properly; allows for extremity and upper body mobility but does prevent rising Jacket/vest- can be used in bed or chair; allows extremities to be free but prevents rising by minimizing upper body mobility Mitt- looks like an oversized thumbless mitten; prevents fine motor grasping; typically used with patients who like to pull things out..IVs, feeding tubes, trachs, dressing, getting/scratching at wounds but still allows for upper extremity movement  Wrist/Ankle- be sure you are able to put 2 fingers under restraint; prevents any upper/lower extremity movement; used on patients who are hitting, kicking, attempting to get OOB ○ Gait Belt ○ Hot & Cold Therapies Physiologic Effects Heat (vasodilation) - works as a sedative ○ Dilates peripheral blood vessels (increases blood flow, and provides extra oxygen to the tissue that need it most) ○ Reduces blood viscosity (thins the blood and makes it less sticky) (ability of the blood to flow through the blood vessels) ○ Increases capillary permeability( may result in edema) ○ Increases inflammation & promotes healing ○ Sedative effect and muscle relaxation ○ Increase tissue metabolism Reduces muscle tension Helps relieve pain ○ ONLY FOR 20-30 MIN FOR HEAT THERAPY Cold (vasoconstriction) - works as a local anesthetic, loss of sensation such as pain ○ Constrict peripheral blood vessels (Reduce blood flow to tissue)  ○ Decreases the release of pain producing histamine ○ Reduce formation of edema, and decrease inflammation Alter tissue sensitivity - Numbness ○ reduce oxygen supply ○ Decreases capillary permeability which means impair circulation deprive cells from oxygen can cause tissue damage or death ○ ONLY 15-20 MIN FOR COLD THERAPY Rebound Phenomena After the treatment length is passed it does the opposite effect: ○ Heat Increase cardiac output Diaphoresis Increased pulse rate Decreased blood pressure Vasoconstriction ○ Cold Increased blood pressure Shivering Tissue injury Vasodilation Contradictions  Heat ○ Open wounds ○ Hemorrhage ○ Presence of edema ○ Inflamed areas ○ Localized malignant tumor ○ Testes ○ Abdomen of pregnant woman ○ Over area of a metallic implant Cold ○ Open wounds ○ When peripheral circulation is impaired ○ Hypersensitivity to cold Guideline to Thermal Therapies Tolerance Contradiction Explanation Assessment Discomfort Revisit Remove Examine Different types thermal Therapies  Heat ○ Dry Hot water bags water temperature 105°-109° do not exceed 125°; fill one- half to two thirds full or to fill mark; expel air; plug bag; cover with towel, apply to affected are for 30-45 minutes; Assess skin at frequent interval and check leaks Electric heating pads turn on and warm up pad before placement, use power with switch that cannot be turned up beyond safe temp; chi over with towel, nothing heavy; place pad anterior or lateral to affected area, never under the patient, avoid moist area; do not use pins to secure; assess skin… Aquathermia pads follow instruction; fill unit ⅔ full or to fill mark with distilled water only; temp 105° preset; attach pad tubing to unit; warm pad before use, apply 20-30 min, secure in place with gauze or tape; assess skin…  Hot packs - follow instruction; cover with washcloth; assess skin every 5-10 min, check for leaks ○ Moist Warm moist compress moist cloth with warm water, place on area, cover with impervious wrap to hold moisture, cold quickly so needs to be changed often, assess skin… Sitz bath Follow instruction, warm soak of perineum/ rectal area, used in treatment of hemorrhoids, anal fissures and postpartum, reduce inflammation and pain, water temp 93-99° Warm soaks immersion of body part in warm water, promote circulation, temp 105-109° for 15-20 min Cold ○ Dry Ice bags  fill ⅔ full with crushed ice, expel air, close cap, cover bag with towel, 30 min on so 1 hour off then 30 min on, assess skin…check for leaks Cold packs follow instructions, assess skin every 5-10 min; check for leaks Hypothermia blanket used for body temp regulation Glove Ice Pack postpartum patients Elderly Patient Considerations Lifespan Sensory Losses Decrease response in reflexes Reduce Kidney Function Health Assessment