Therapeutic Procedures

Therapeutic Procedures
Chapter 38 Therapeutic Procedures Define therapeutic procedures. Discuss the various types of therapeutic procedures. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1

Ear Irrigation Performed: To remove cerumen and foreign object
To soothe inflamed membranes Supplies and Equipment Review the anatomy of the ear. Define irrigation and cerumen. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2

Ear Irrigation (cont.) Points to emphasize:
Direct solution toward the roof of the canal Solution temperature: 98.6° to 100° F Never block the ear canal with the syringe Tip the head toward the affected side Straighten ear canal, pulling ear up and back for adults Patient might become dizzy during procedure Why is the temperature important? What could happen if the solution is too hot or too cold? How should the ear canal be positioned in a child? Why? Is a signed consent necessary for this procedure? Define equilibrium. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3

Irrigating a Patient’s Ear
What should the medical assistant do if the patient complains of intense pain during the ear irrigation? Why must the air be expelled from the syringe prior to irrigation? Demonstrate Procedure 38-1. Have the students practice Procedure 38-1. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4

Instilling Ear Medication
Ear canal must be patent Medication must be labeled with word “otic” Head is tilted in the direction of unaffected ear Never let the dropper touch the ear canal Rest with unaffected side down for 5 minutes Insert moist cotton ball or gauze square into ear canal opening, if ordered Define instillation and patent. Before any medication is used check for correct medication it must say “otic” and expiration date. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5

Instilling Ear Medication (cont.)
Why must medication for the ear be warmed prior to instillation? What are the different positions for the ear canal when instilling drops into an ear in an adult and child? Medication must be placed drop by drop along the side of the ear canal. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6

Instilling Ear Medication (cont.)
Discard any unused medication left in a dropper. Why should the patient be instructed to rest on the unaffected side for 5 minutes. Demonstrate Procedure 38-2. Have the students practice Procedure 38-2. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7

Caring for an Infected Ear
Infected ear very painful Take care not to contaminate medication or dropper used to instill medication Touching the dropper to the patient or outside of the bottle contaminates the medication and the bottle. Discuss signs and symptoms of an infected ear. Discuss various medications used to treat an infected ear. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8

Eye Irrigation Performed to remove: Use only sterile solutions
Irritants Discharges Foreign particles Use only sterile solutions Do not contaminate tip of syringe; if contaminated, discard Tilt head away from unaffected eye Why must eye irrigation solutions be sterile? Why must the patient’s head be tilted away from the unaffected eye? Review the anatomy of the eye. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9

Irrigating a Patient’s Eye
Why is the temperature of the solution important? What positions can be used for this procedure? Demonstrate Procedure 38-3. Have the students practice Procedure 38-3. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10

Instilling Eye Medication
Liquid or ointment Do not touch eye with tip of eyedropper All eye medication is sterile Warm medication by rolling between hands Have patient look up during instillation Place medication into lower conjunctival sac Have patient rotate eye to distribute If the eye dropper or tip of the sterile container of eye drops touches the patient’s eye it must be discarded. Why is it important to warm the medication prior to it being instilled? Why must the medical assistant not place the eye medication directly on the eye? What should be done with any remaining medication left in an eye dropper? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11

Instilling Eye Medication (cont.)
Why should the patient be looking up at the ceiling? Exactly where should the medication be placed? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12

Preventing Cross-Contamination
Avoid touching surface of the affected eye to avoid contamination of: Syringe Eyedropper Finger Wear gloves Why must optic medications be sterile? Demonstrate Procedure 38-4. Have the students practice Procedure 38-4. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13

Uses for Bandages Support or immobilization Secure a dressing
An injured part Secure a dressing Using gauze roller bandage Apply pressure To control bleeding Explain the difference between a bandage and a dressing. Should a bandage be sterile? Why must the medical assistant be familiar with the types of bandages and the basic bandage turns? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14

Types of Bandages Elastic bandages Kling-type bandages
Can be stretched and molded around a body part Can be washed and reused Kling-type bandages Stretch, but not elastic Mold around irregular areas Stretchable gauze Never reuse a soiled elastic bandage. What is the purpose of a Kling-type bandage? Why is it important to be able to mold a bandage around a body part? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15

Types of Bandages (cont.)
Tubular gauze Cotton, loose elastic fiber Uses a metal tube for application Tubular gauze is used to cover rounded body parts. Name some body parts where it is advantageous to use tubular gauze. Is tubular gauze sterile? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17

Procedure: Applying Tubular Gauze
Points to remember: Gently slide applicator over appendage Tube gauze must be held in place to prevent sliding Pull applicator about 1 inch beyond appendage Anchor bandage in place Apply desired number of layers of tubular gauze Anchor with adhesive tape Why must the bandage be anchored in place? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18

Tubular Gauze Why is adhesive tape applied at the base of the appendage? Demonstrate 38-5. Have the students practice Procedure 38-5. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19

Circular Turn A circular bandage turn anchors a bandage.
A circular bandage turn is used on what body areas? Why must each turn overlap the previous turn? Demonstrate how to perform a circular bandage turn. Have the students practice performing a circular bandage turn. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20

Spiral Turn Why must the spiral bandage turn progress upward?
Why must each turn overlap the previous turn? Demonstrate the spiral bandage turn. Have the students practice the spiral bandage turn. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21

Spiral Reverse Turn What is the purpose of the spiral reverse bandage turn? Demonstrate the spiral reverse bandage turn. Have the students practice the spiral reverse bandage turn. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22

Figure-Eight Turn What is the main purpose for the figure-eight bandage turn? Why should each turn overlap the previous turn? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23

Figure-Eight Turn (cont.)
Why is it important for the bandage to progress upward and then downward? Demonstrate how to perform a figure-eight bandage turn. Have the students performing the figure-eight bandage turn. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 24

Recurrent Turn What is the purpose of the recurrent bandage turn?
Demonstrate how to perform the recurrent bandage turn. Have the students practice performing a recurrent bandage turn. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 25

Cold Therapy Used to: Types of cold therapy include:
Reduce or prevent swelling Reduce bleeding Provide temporary anesthesia Types of cold therapy include: Ice bag Cold compress Cold pack Discuss varies situations where cold therapy is needed. How does cold therapy work? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 26

Procedure: Applying an Ice Bag
Device that holds ice cubes/chips Points to remember: Use a protective covering Leave bag in place for prescribed time ordered by physician (usually minutes) Refill bag with ice as needed Provide verbal and written instructions to the patient What type of ice works best in an ice bag and why? Why use a protective covering? What happens if the ice bag is left on a body part for longer than 30 minutes? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 27

Applying an Ice Bag How full should the ice bag be filled?
Why must the air be extracted from the ice bag? Demonstrate Procedure 38-6. Have the students practice Procedure 38-6. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 28

Procedure: Applying a Cold Compress
Points to remember: Wring out compress until moist, but not dripping wet Apply gently and gradually to affected area Place additional compresses in cold water to be ready to use Repeat application every 2 to 3 minutes for duration of 15 to 20 minutes What type of material is best for a cold compress? What is the purpose of a cold compress? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 29

Applying a Cold Compress
Why is it best to use large ice cubes in this procedure? Demonstrate Procedure 38-7. Have the students practice Procedure 38-7. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 30

Procedure: Applying a Chemical Cold Pack
Points to remember: Follow manufacturer’s directions to activate cold pack Shake chemical crystals to bottom of the bag Apply firm pressure to break inner fluid bag Apply cover to bag Apply to affected area Why must a chemical pack never be applied directly to the skin? Never reuse a chemical pack. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 31

Applying a Chemical Cold Pack
Demonstrate Procedure 38-8. Have the students practice Procedure 38-8. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 32

Heat Therapy Serves to: Increase blood flow to a body area Reduce pain
Speed up inflammatory process Promote cell growth Remove wastes faster Increase nutrients to area When heat is applied to a body part do the blood vessels dilate or constrict? When should heat therapy be used? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 33

Procedure: Applying a Hot Water Bag
Points to remember: Fill bag one-third to one-half full of water Expel excess air from bag—air is a poor conductor of heat and cold Place protective covering over bag What should be the water temperature used in a hot water bottle? Why must air be expelled from the hot water bottle? Why should a protective cover be used? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 34

Procedure: Applying a Hot Water Bag (cont.)
Accepted temperature ranges are 115° to 125° F for adults, 105° to 115° F for children and older adults Treatment time typically 10 to 20 minutes Check skin for redness or swelling Why does the water temperature vary for infants, children, and adults? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 35

Applying a Hot Water Bag
Why must the hot water bag be “burped”? Why must a hot water bottle have a cover? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 36

Procedure: Applying a Heating Pad
Points to remember: Inspect electrical wires before each use Place pad in a protective covering Don’t use pins; don’t use pad near wet dressings Should not be in place more than 30 minutes Should not be used when patient is sleeping Check area for redness and swelling Heating pads are not frequently used in the office but the patient will use one at home. Patient’s need to be instructed in the proper use of a heating pad or burns could result. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 37

Applying a Heating Pad Why is a protective covering used?
Demonstrate Have the students practice Procedure Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 38

Procedure: Applying a Hot Compress
Points to remember: Moist compress penetrates tissues more deeply Heat increases circulation to an area for healing Hot water should be between 105° and 115° F Apply compress gradually and gently Application time between 15 and 20 minutes Check water temperature frequently, replacing compresses as needed What is the purpose of a hot compress? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 39

Applying a Hot Compress
Why must all jewelry be removed in the area to be treated? Why must the patient’s skin be checked between hot compresses? What is the correct temperature of the water? Demonstrate Procedure Have the students practice Procedure Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 40

Procedure: Applying a Hot Soak
Points to remember: Body part submerged in hot water that may contain medication Used to clean open wounds Increases blood supply to area Sterile technique used for open wounds Temperature ranges between 105° and 115° F Soak for approximately 15 to 20 minutes Check water temperature periodically A hot soak is usually applied to an extremity. Why should sterile technique be used for open wounds? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 41

Applying Hot Soaks What is the correct temperature of the water?
Demonstrate Procedure Have the students practice Procedure Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 42

Ultrasound Uses Ultrasound uses high-frequency waves
Pain relief for muscle spasms Relieve inflammation (e.g., tennis elbow) Arthritis Ultrasound uses high-frequency waves Moves or stimulates soft tissue in the body, producing heat (massage-like action) Coupling agent (water-soluble gel) spread over area to be treated Dosage prescribed in watts and time frame Never apply the coupling agent to the ultrasound wand. Tell the patient the coupling agent may feel cold. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 43

Procedure: Administering an Ultrasound Treatment
Points to remember: Set machine at the minimum position, and timer to the required time ordered by physician Increase intensity to ordered level Place applicator head at right angle into coupling agent on patient’s skin Move applicator either in circular motion or back and forth Stop treatment if patient complains of pain If the intensity level is uncomfortable for the patient, turn it down and inform the physician. On what areas of the body is ultrasound therapy never used? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 44

Administering an Ultrasound Treatment
The back-and-forth sweeping motion is used for the larger areas of the body. The circular motion is used for smaller areas of the body and over bony prominences. The applicator head must be in constant motion to prevent the tissue from overheating and causing a hot spot or burn. Demonstrate Procedure Have the students practice Procedure Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 45

Ambulatory Devices Types include: Used: Crutches Walkers Canes
After injury After surgery Due to disease Due to congenital deformity Define ambulatory device. Why must a medical assistant know how to fit and adjust ambulatory devices? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 46

Improperly Fitting Ambulatory Devices
Improper fit causes: Decreased stability Increased use of energy Decreased function Decreased safety for the patient Development of bad gait patterns Define gait. What happens if the ambulatory devices is not fitted properly? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 47

Procedure: Measuring a Patient for Crutches
Points to remember: Measurements must be taken with the patient wearing at least one good walking shoe Position crutch tips approximately 4 to 6 inches anterior and 4 to 6 inches lateral to the foot, creating a triangle Describe a good walking shoe. Always measure a patient for crutches while they are standing. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 48

Procedure: Measuring a Patient for Crutches (cont.)
Adjust crutches to allow two or three finger widths between top of crutch and armpit Adjust handgrips to allow 20- to 30-degree flexion at elbows using a goniometer Why must there be a 20 to 30 degree flexion at the elbows? Define goniometer. Demonstrate how to use a goniometer. Have the students practice using the gonimeter. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 49

Adjusting Crutches Demonstrate Procedure 38-14.
Have the students practice Procedure Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 50

Types of Crutches Axillary Forearm (Lofstrand) Platform
Used for no weight-bearing on lower extremity Need good strength in upper extremities and trunk Forearm (Lofstrand) Used when need more stability than a cane Requires superior standing balance and upper body strength Platform Used when patients have poor arm strength Why does the patient using axillary crutches need to have good upper body strength? How are forearm crutches different from axillary crutches. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 51

Gait Patterns Depends on injury and condition of patient Balance
Coordination Strength Ability to bear weight Energy level and age Define gait patterns. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 55

Gait Patterns (cont.) Types of gaits include: Four-point Two-point
Three-point Swing-through Demonstrate Procedure Have the patient practice Procedure Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 56

Walkers Used when patient needs: Advantages Optimal stability Support
Way to be mobile Advantages Many styles available Most can be folded up for easy storage Easily adjustable What instructions would a medical assistant give a patient using a walker? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 61

Procedure: Measuring for a Walker
Points to remember: Top of walker should be just below patient’s waist (same height as hipbone) Elbows bent at a 30-degree angle Move walker ahead approximately 6 inches and walk into it Move dominant foot, then nondominant foot into the cage of the walker Do all patients using a walker have a leg injury? How is the height of a walker adjusted? Why should the patient’s elbows be at a 30-degree angle? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 62

Measuring and Using Canes
Used primarily to relieve weight bearing Placed on “good” side Top of cane should be at wrist level Elbow flexed at 15 to 25 degrees Force of cane directed downward Quad cane (four-legged): positioned away from patient (reduces risk of catching foot on leg of cane) Why is the cane placed on the good side? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 64

Purpose of a Cast Used to immobilize body part for proper alignment until bones or injured part heals Fractured bone, severe sprains, orthopedic surgery Rigid dressings Materials for casts Plaster Fiberglass Describe the various types of casts. Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 66

Procedure: Assisting During Cast Application
Points to remember: Apply stockinette to protect skin at edges of cast Apply cast padding to protect skin when cast removed Apply cast material or tape; plaster or fiberglass Keep from pressure until completely dry Define stockinette and cast padding. Demonstrate Procedure 38-18 Have students practice Procedure Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 67

Cast Education Plaster Fiberglass
Wet bandages contain calcium sulfate crystals Patient instructed not to lay a cast against anything until completely dry (72 hours) Fiberglass Made from plastic resins Dries fast, resists water, and lighter weight Protect cast from dents until dry Observe fingers and toes for color, warmth Discuss various ways to dry a cast. Why must fingers and toes be observed for color and warmth after a cast has been applied? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 68

Cast Removal Cast cutter divides cast into two parts (top and bottom)—called bivalve Saw vibrates back and forth Cast spreader used to open up the cast Bandage scissors cut through cast padding and stockinette Reassure that cast saw will not cut the skin Does a cast cutter truly cut? Who will be most afraid of the cast saw? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 70

Conclusion Less chance of errors when medical assistant is knowledgeable about procedures he or she performs Patients receive quality care when procedures are performed properly Review the various types of therapeutic procedures in this chapter. Can a medical assistant perform all these types of therapeutic procedures? Copyright © 2010, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. 73

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