Perilite and Hot Sitz - Nursing Procedures

OBJECTIVES: After 4 hours of varied teaching learning activities, the level II students will be able to: 1. Define the following terms: - hot sitz bath - perilite exposure - heat application - dry heat - moist heat - episiotomy - perineorrhaphy 2. State the importance of: - hot sitz bath - perilite exposure 3. Discuss the process of heat transfer 4. Cite the physiological responses to heat 5. List variables that influences the effectiveness of heat 6. Discuss the therapeutic effect of administering the following: - hot sitz bath - perilite exposure 7. Enumerate the disadvantages/advantages of: - moist heat - dry heat 8. Identify the indications and contraindications of: - hot sitz bath - perilite exposure 9. Give the principles involved in: - hot sitz bath - perilite exposure 10. State the nursing responsibilities in: - hot sitz bath - perilite exposure 11. Explain the guidelines in: - hot sitz bath perilite exposure 12. Demonstrate beginning skills in: - hot sitz bath - perilite exposure Definition of Terms:  Hot Sitz bath – is a procedure whereby patient’s perineal area is submerged to water with solutions depending on the needs of the client. - a bath in which only the pelvic area is immersed in warm fluid.  Perilite Exposure – application of dry heat to perineal area in order to provide comfort and increase blood circulation and hasten wound healing by means of perineal lamp. - 20-50 centimeters or 18-24 inches away from the body to be exposed.  Heat application – is a process of applying heat through radiation and convection  Dry heat – requires a higher temperature and a longer period of heating  Moist heat - utilizes hot air that is heavily laden with water vapor  Episiotomy – refers to an incision through the perineum that allows for less pressure on the fetal head during delivery and prevents lacerations of the perineum.  Episiorraphy -operation for repairing the episiotomy  Perineorrhaphy – Operation for repairing laceration of perineum usually following delivery Process of Heat transfer  CONDUCTION -the transfer of heat from a warm object to cooler object or vice versa by contact -is the transfer of thermal energy from a region of higher temperature to a region of lower temperature through direct molecular communication within a medium or between mediums in direct physical contact without a flow of the material medium.  CONVECTION -heat transfer by means of movement of liquid or gas -is a combination of conduction and the transfer of thermal energy by fluid circulation or movement of the hot particles in bulk to cooler areas in a material medium. -this transfer occurs in sitz bath.  RADIATION - is the transfer of heat through electromagnetic radiation. For anybody the reflectivity depends on the wavelength distribution of incoming electromagnetic radiation and therefore the temperature of the source of the radiation. Physiological responses to heat • Vasodilation or increase in capillary surfaces - Heat causes vasodilation and increases blood flow to the affected area bringing oxygen nutrients, antibodies and leukocytes. • Increase in capillary permeability - heat increases capillary permeability which allows extra cellular fluid and substances such as plasma proteins to pass through the capillary walls and may result in edema or an increase in pre-existing edema. • Increase blood flow • Increase cell metabolism • Increase supply of nutrients • Increase removal of wastes • Relaxation of muscles • Softening of exudates • Increase peristalsis • Increase body temperature Variables that influences the effectiveness of heat 1. Individual tolerance – tolerance is influenced to some degree by age, condition of skin, the condition of nervous and circulatory system. Young children, elderly clients, diabetic clients and individuals with circulatory or sensory alterations have low tolerance for heat. - The very young and the very old generally have the lowest tolerance. Persons who have neurosensory impairments may have a high tolerance, but the risk of injury is greater. 2. General conditions of patient – shock or metabolic disorders such as diabetes increase the hazard of tissue damage. Impaired perception because of individual’s level of consciousness, medications and mental impairment may make it difficult to determine patient’s response to end potential damage from application of heat. 3. Intactness of the skin - Injured skin areas are more sensitive to temperature variations whether the heat is moist or dry – moist heat penetrates more deeply than dry heat because water is a good conductor of heat. Application of moist heat should be at a lower temperature than applications of dry heat. 5. Size of skin area to be treated – the greater the body area to be treated, the lower the temperature should be. 6. Environmental temperature – in warm or in humid environment, heat can’t be dissipated through evaporation to some degrees that it can dry or cool circumstances. 7. Length of Exposure - People feel hot applications most while the temperature is changing. After a period of time, tolerance increases. 8. Location of area to be covered – individual tolerance to heat depends on the number of heat receptors in body parts. In general, the inner aspects of thighs and arms, the axillae, the chest and the abdomen are more sensitive to heat than the other parts of the body. - The back of the hand and foot are not very temperature sensitive. In contrast the inner aspect of the wrist and forearm, the neck, and the perineal area are temperature sensitive. Therapeutic uses of heat 1. SEDATIVE EFFECT - Heat is generally considered to produce a relaxation effect and increase the contractility of muscles. 2. RELIEVES PAIN - Heat relieves pain by promoting muscle relaxation, increasing circulation, and promoting psychological relaxation and a feeling of comfort. 3. REDUCES CONTRACTURE AND INCREASES RANGE OF MOTION - This effect is achieved by allowing greater distention of muscles and connective tissue. 4. REDUCES JOINT STIFFNESS - Heat reduces joint stiffness by decreasing viscosity of synovial fluid and increasing tissue distensibility. 5. PROVIDES WARMTH AND COMFORT Dry Heat  ADVANTAGES  Less risks of burns to skin than moist application  Retains temperature longer since not influenced by evaporation  Doesn’t cause maceration  DISADVANTAGES: 1. increases body fluid loss through sweating 2. Doesn’t penetrate deep into tissues 3. Increase drying of skin Moist Heat ADVANTAGES: 1. 2. 3. 4. moist application reduces drying of skin and softens wound exudates Warm moist doesn’t promote sweating and insensible fluid loss Moist heat penetrates deeply into tissue layers Moist compresses comfort well to area of body being treated DISADVANTAGES: 1. Moist heat creates a greater risk for burns to skin since moisture conducts heat 2. Prolonged exposure can cause maceration of skin 3. Moist heat will cool rapidly because of moist evaporation -invisible heat rays readily seen in use of infrared; ultraviolet rays or electromagnetic waves IMPORTANCE OF PERILITE EXPOSURE 1. Relief of pain and muscular spasm - provides comfort by relief pain - it relaxes muscles and capillaries making pain tolerable 2. Increases blood circulation 3. Hastens wound healing following an episiotomy repair - increases circulation of blood - increases supply of oxygen and nutrient which promotes wound healing 4. Reduces edema and soreness - it releases dry heat and thus help reduce edema and soreness - alleviated by relax muscles and capillaries INDICATIONS: • Patients who have undergone rectal or perineal surgery • Post-partum patients with episiotomy wounds • Patients having vaginal inflammation or bladder spasm • Patients with painful or local irritation from hemorrhoids CONTRAINDICATIONS: • Patients with cardiovascular condition • Presence of cyst or malignancy in the area • Patients with open wounds with hemorrhage • Patients with burns or fracture at the lower limbs • Heat lamps are contraindicated in pressure ulcer care Principles involved in Perilite Exposure • HUMAN ANATOMY AND PHYSIOLOGY • through blood vessels and nerves, skin and connections they make with nerves and blood vessels of body, practically all parts of body maybe influenced by application of heat to skin. • BODY MECHANICS • position of mother is dorsal recumbent with legs and knees flexed to allow proper exposure of area to be treated • PHYSICS • application of heat employs physical agents: heat, water and light. Heat maybe transferred from one place to another by radiation (perilite exposure) and c onvection (hot sitz) bath. • PSYCHOLOGY • nurse explains purpose of treatment in order to gain cooperation. • SOCIOLOGY • the patient needs to cooperate with nurse in order for treatment to be effective and to add patients early recovery. Nursing Responsibilities in Perilite Exposure BEFORE: • Check the client’s condition before applying the procedure. • Check all electrical equipment for defects or try to switch it on and off. • Always handle equipment with dry hands • Check physicians order for each area to be treated and duration of therapy • Do perineal flushing DURING: • Position client comfortably with only area where heat is to be applied • Position lamp at a safe distance from where it is to be applied • Inspect skin and see to it that its clean and dry before applying heat • Place bed cover over lamp but not allowing bed sheet to touch the light bulb • Check skin every 5 minutes interval throughout duration of procedure • Monitor any untoward response • Perilite exposure should be given 24 hours after delivery • Place bed cover after pulling lamp and provide privacy • Position lamp at 18-24 inches away from the body part to be exposed. AFTER: • Assist the client • Do after care • Monitor clients response • Do recording; record on patients chart - time when it started - patients reaction - condition of perineum - inspect sutures and episiotomy after procedure • Inspect condition of part being treated Guidelines for Perilite Exposure • Explain procedure • Instruct patient to do perineal flushing before perilite exposure • Check the equipment for any defects • Handle equipment with dry hands especially when you’re about to plug it. • Provide privacy during procedure • During exposure, keep lamp 20-50 cm away from perineum. • Heat lamp should be left in place for 15 minutes then removed • Perilite exposure process should be repeated 3-4 times a day • Washable parts of lamp should be wiped with antiseptic solutions before it is returned to storage area or used with another patient IMPORTANCE OF HOT SITZ 1. Reduces soreness 2. Relieves swelling and pain brought about vasodilatations, increases circulation, increases capillary permeability, venous congestion of injured tissues 4. Hastens healing 5. increases blood circulation and with all its nutrients 6. Promotes comfort and relaxation 7. Cleanses and reduces inflammation of perineal, and areas of client 8. the presence of moist softens exudates and other hardened substances 9. Stimulates voiding 10. it stimulates voiding and elimination by peristaltic activity INDICATIONS: • Post partum mother with episiotomy wound • With rectal or vaginal surgery CONTRAINDICATIONS: • Patients with hemorrhage • Mother who had undergone CS delivery • Multiparity with wound • Before 24 hours of postpartum Principles involved in Hot Sitz Bath • HUMAN ANATOMY AND PHYSIOLOGY - client who has episiotomy has painful hemorrhoids or vaginal inflammation may benefit from immersing pelvic area in warm water. - -sitz bath requires special attention to body posture ad limb position to avoid cramping and constriction of circulation from pressure against edge of tub. • PSYCHOLOGY • nurse should explain first the procedure to patient to gain cooperation • nurse should know if patient is sensitive to warmness. • CHEMISTRY • heat generally is the speed of chemical reaction since metabolism is largely caused by chemical reactions, the application of heat speeds metabolism either locally or generally • the solvent action of water maybe increased by adding other substances like soap. • Magnesium Sulfate is used for preterm labor or commonly used for treatment of preeclampsia to slow uterine contractions. • PHYSICS • heat is most valuable and most versatile physical for treatment. • water has also great capacity, it undergoes change more slowly than other substances. It also gives off more heat. • heat maybe transferred from 1 place to another by conduction, convection and radiation. • application of heat & cold employs physical agents; heat, light & electricity Principles involved in Perilite Exposure • HUMAN ANATOMY AND PHYSIOLOGY • through blood vessels and nerves, skin and connections they make with nerves and blood vessels of body, practically all parts of body maybe influenced by application of heat to skin. • BODY MECHANICS • position of mother is dorsal recumbent with legs and knees flexed to allow proper exposure of area to be treated • PHYSICS • application of heat employs physical agents: heat, water and light. Heat maybe transferred from one place to another by radiation (perilite exposure) and c onvection (hot sitz) bath. • PSYCHOLOGY • nurse explains purpose of treatment in order to gain cooperation. • SOCIOLOGY • the patient needs to cooperate with nurse in order for treatment to be effective and to add patients early recovery. Nursing Responsibilities in Hot Sitz Bath BEFORE: • Check doctors order for desired solution and body part to be soaked at a desired temperature. • Assess the condition of skin of the body to be immersed • Explain procedure to the patient. • Nurse must have adequate knowledge about the procedure. DURING: • Check the temperature of water in a sitz bath before the patient enters into the tub (40.5-43.5 degrees Celsius) • Assist the patient into the tub and position her properly • Wrap a blanket around patients shoulder • Don’t leave the patient alone unless certain that its safe to do so AFTER: • Assist the patient in going out of the tub after the procedure is complete • Assist patient to her bed, its best for her to be down, avoid draft until normal condition and circulation returns • Monitor patients general response to therapy and properly document significant data • Do after care Guidelines for Hot Sitz Bath • Check physicians order • Nurse should explain the procedure • Nurse should observe privacy • Place towel at the patients back • Adequate support during birth is essential • She should make sure the perineal region is immersed • Check temperature of water for hotness • Observe patient closely for 15-20 minutes • If client feels like fainting, discontinue procedure • Monitor vital signs before and after