may also be brown, gray, or tan. The eschar
must be débrided before the wound can heal by
using sharp, mechanical, chemical, or autolytic
débridement.- a.Hot water bags or bottles: Relatively inexpensive
and easy to use; may leak, burn, or make the
patient uncomfortable from their weight
b.Electric heating pad: Can be used to apply dry
heat locally; it is easy to apply and relatively
safe and provides constant and even heat.
Improper use can result in injury.
c. Aquathermia pad: Commonly used in
healthcare agencies for various problems
including back pain, muscle spasms,
thrombophlebitis, and mild inflammation.
Safer than a heating pad but still must be
checked carefully.
d.Heat lamps: Provide dry heat to increase circu-
lation to a small area, such as a pressure ulcer.
Assess skin exposed to the heat every 5
minutes.
e.Heat cradles: A heat cradle is a metal half-circle
frame that encloses the body part to be treated
with heat. Precautions should be taken to pre-
vent burning.
f. Hot packs: Commercial hot packs provide a spec-
ified amount of dry heat for a specific period.
g.Warm moist compresses: Used to promote
circulation and reduce edema. Must be changed
frequently and covered with a heating agent.
h.Sitz baths: Patient is placed in a tub filled with
sufficient water to reach the umbilicus; the legs
and feet remain out of the water.
i. Warm soaks: The immersion of a body area into
warm water or a medicated solution to increase
blood supply to a locally infected area; to aid in
cleaning large sloughing wounds, such as
burns; to improve circulation; and to apply
medication to a locally infected area. Makes
manipulation of a painful area much easier
because of the buoyancy.
APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.What nursing intervention would be appropriate to
prevent skin irritation and the development of pres-
sure ulcers for Mr. Bentz?
The nurse should review the patient chart to deter-
mine the cause and extent of previous wounds and
institute measures to minimize these risks in the
future. The nurse should be aware that larger than
normal amounts of subcutaneous and tissue fat
(which has fewer blood vessels) in people who areobese may slow wound healing because fatty tissue
is more difficult to suture, is more prone to
infection, and takes longer to heal.
To protect Mr. Bentz, the nurse should implement
turning and positioning schedules, as well as the
use of appropriate support surfaces (tissue load
management surfaces) and reposition him at least
every 2 hours.
In the event of a reoccurrence of pressure ulcers,
nursing interventions should focus on preventing
infection, promoting wound healing, preventing
further injury or alteration in skin integrity,
promoting physical and emotional comfort, and
facilitating coping.
2.What would be a successful outcome for this patient?
Following discharge instructions, Mrs. Bentz will
vocalize proper measures to assist her husband with
hygiene, diet, positioning, and turning in bed. At fol-
low-up appointment, Mr. Bentz will manifest intact
skin free of skin irritations, infections, and wounds.
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: knowledge of the phases of wound
healing and factors that affect wound healing
Technical: ability to correctly use the products, pro-
tocols, and equipment necessary to prevent and
treat pressure ulcers and other skin alterations
Interpersonal: ability to establish trusting
professional relationships that enlist patients and
their caregivers in a plan to prevent or treat
pressure ulcers and other skin alterations
4.What resources might be helpful for Mr. Bentz and
his wife?
Home healthcare visits, printed and/or AV materials
on prevention of pressure ulcers
PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
Mrs. Chijioke, an 88-year-old womanwho lived
alone for years, was brought to the hospital after
neighbors found her lying at the bottom of her cel-
lar steps. She had broken her hipand underwent
hip repair surgery 3 days ago. The nurse assigned to
care for Mrs. Chijioke noticed during the patient’s
bath that the skin of her coccyx, heels, and elbows
was reddened. The skin returned to a normal color
when pressure was relieved in these areas. There
was no edema, nor was there induration or blister-
ing. Although Mrs. Chijioke can be lifted out of bed
into a chair, she spends most of the day in bed,
lying on her back with an abductor pillow between
her legs. At 5 feet tall and 89 pounds, Mrs. Chijioke
looks lost in the big hospital bed. Her eyes are
bright,and she usually attempts a warm smile, butCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:384 ANSWER KEY
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