Kurdistan Regional Government

Ministry of Higher research

University of Duhok

A report submitted to the

College of Nursing

Student name: Deni Salah Husen

Moodle Email: deninazy1212@gmail.com
Year: 1st
Course: Fundamental
Course code: NUB0702
Instructor: Dr. Omed Saadallah
Zuhair Rushdi
Date: 2019-2020
 Table of Contents

Subjects Page No.

Topic One

Introduction
Physiology of Defecation
Defecation
Factors that affect defecation
What Are Changes in Bowel Habits?
What Are the Types of Bowel Habit Changes? 1-14
How Are Changes in Bowel Habits Diagnosed?
Fecal elimination problems
Bowel Diversion Ostomes
Nursing Management
Administrating Enema
Ostomy Appliance
Topic Two
Heat and Cold Application
Local effects of heat
Local effects of Cold
Systemic effects of Heat and Cold
15-20
Thermal Tolerance
Adaptation of Thermal Receptors
Rebound Phenomenon
Topic Three
What are the hot water bags?
Aquathermia and Heating Pads
What is a cold pack?
What is an electrical heating pad?
Ice Bag 21-28
Ice Gloves
Ice Collars
Cold Compresses
Sitz Bath
References 29
 Topic One

Introduction

Defecation is the term given for the act of expelling feces from the digestive tract via the
anus. It is a complex function that requires coordinated involvement from the gastrointestinal
system, the nervous system, as well as the musculoskeletal system.  The frequency of
defecation within a 24-hour period varies depending on age and diet, but most people tend to
have a bowel movement 1 to 3 times daily.

Physiology of Defecation
Defecation is elicited by the presence of fecal material in the rectum due to peristaltic
propagation of colonic motility. Consequently, sensory stimuli in the anal canal provoke a
sudden drop in the tone of the internal anal sphincter. By voluntary control, defecation starts
with relaxation of the puborectalis and the levator. The distension of the rectum evokes a
wave of contractions of the rectum and defecation can be completed by a voluntary increase
in intra-abdominal pressure. The act of defecation depends on maturational control, a process
that can be trained when the child slowly discovers the ability to control the pelvic muscles.
First, the child feels the satisfaction and gains approval from parents by using the potty chair.
Later, toileting changes to something that is done for self-approval and comfort. Before the
age of 4 years, most children acquire autonomy, and defecation becomes a private, hardly
thought about activity.
Normally, a decline in stool frequency from more than four stools per day during the first
week of life to one to two per day at 4 years of age is observed, with a corresponding increase
in stool size. Approximately 97% of 1- to 4-year-old children pass stool three times daily to
once every other day.

Defecation
There are two main anal sphincters; an internal and external sphincter. The internal anal
sphincter is controlled by parasympathetic fibres which relax involuntarily. The external
anal sphincter is skeletal muscle that is controlled by a somatic nerve supply, which allows
conscious control of defecation.

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 When the rectum is distended the rectosphincteric reflex is initiated and relaxes the internal
sphincter. If defecation is not desired, voluntary contraction of the external sphincter can
delay it. If defecation is appropriate, then a series of reflexes take place that lead to:

 Relaxation of the external sphincter

 Contraction of abdominal wall muscles
 Relaxation of pelvic wall muscles

Peristaltic waves then facilitate the movement of faeces through the anal canal. Defecation
can also be assisted by taking a deep breath and attempting to expel the air against a closed
glottis, this is known as the Valsalva maneuver.

However, if a delay in defection is needed then voluntary contraction of the external

sphincter is usually sufficient to override the reflexes that anal distension initiates.

Feces

body waste discharged from the intestine; called also stool, excrement, and excreta. The fec
es are formed in the colon and pass down into the rectum by the process of peristalsis. When t
he rectum is sufficiently distended, nerve endings in its wall signal a need for evacuation, whi
ch is made possible by a voluntary relaxation of the sphincter muscles around the outer part o

2
f the anus. The frequency of bowel movements varies according to the individual body make-
up, type of intestine, eating habits, physical activity, and custom. Although one bowel movem
ent a day is the average, a movement every 2 or 3 days may be considered normal. A balance
d diet and an established routine can promote regular bowel movements.

Normally feces are soft and formed and brownish in color. An abnormality in color, odor, or 
consistency usually indicates a disorder of the intestinal tract or of the accessory organs of the 
digestive system. Black, tarry feces may indicate intestinal bleeding, especially in the upper p
ortion of the tract. Some drugs, such as those containing iron or bismuth, can produce tarry fe
ces. Bright red blood in the feces can indicate a wide variety of disorders ranging from HEMO
RRHOIDS to a malignancy of the rectum. Clay-colored feces result from an absence or deficie

ncy of BILE in the intestinal tract, indicating obstruction of the biliary tract or decreased prod
uction of bile by the liver. Greenish-colored feces often accompany diarrhea, especially in inf
ants, and may be caused by growth of certain bacteria.

Bulky, fatty feces with a foul odor are characteristic of CYSTIC
FIBROSIS. Other causes of fatty feces include gallbladder disease, pancreatic disorders, SPRUE

, and excessive intake of fat in the diet. Feces containing large amounts of mucus often occur 
in COLITIS and IRRITABLE BOWEL SYNDROME.

The feces of a newborn, fullterm infant is called meconium. It is a dark greenish brown color, 
smooth and semisolid in consistency.

Factors that affect defecation

Development:

 Newborn and infant pass meconium (the first fecal material possessed by the
newborn).
 In Elderly constipation is common problem duo to reduce activity level, inadequate
amount of fluid and fiber intake and muscle weakness

Diet

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regular daily food intake helps maintain a regular pattern of peristalsis in the colon.
FIBER: nondigestible residue provides the bulk of fecal material. High fiber diet improves
the likelihoof of a normal elimination pattern.

Bulk Forming Foods:whole grains, fresh fruits, vegetables help flush the fat & waste product
w/ more efficiency. help keep stool soft. Diets high in vegetables and fruits have been linked
to decreased risk of colorectal cancer.

Food intolerance is nor an allergy but rather a food that causes distress within a few hours of
ingestion.

Fluid Intake

fluid liquefies intestinal contents easing its passage through the colon.
Reduced fluid slows passage of food resulting in hardening of stool contents.
Adult needs to drink at leas 1100 to 1400 mL of fluid daily.

Physical activity
physical activity promotes peristalsis & immobilization depresses it. Maintaining muscle tone
is important. weakened muscle tone impairs the ability to increase intraabdominal pressure &
control the external sphincter leading to constipation.

Psychological factors
Sometimes it's not what's going on inside your body, but what's going on inside your head,
that influences bowel elimination. For example, psychological factors, such as a person
suffering from depression, which is a mental condition characterized by prolonged periods of
sadness, may experience a slowing of peristalsis, which is the muscular movements within
the digestive tract that push food along.

What Are Changes in Bowel Habits?

Bowel habits can vary from person to person. This includes how often you have a bowel
movement, your control over when you have a bowel movement, and the bowel movement’s

4
consistency and color. Alterations in any aspect of these habits over the course of a day
represent a change in bowel habits.

While some bowel movement changes can represent temporary infections, others may
indicate greater cause for concern. Knowing when to seek medical help can prevent an
emergency condition from worsening.

What Are the Types of Bowel Habit Changes?

While some people have a bowel movement several times per day, others may pass stool only
once per day. According to the Cleveland Clinic, going more than three days without having
a bowel movement is too long. Normal stools should be easy to pass and are typically brown
in color.

Abnormal changes in the color of your stool can include:

 black, tarry stools

 clay-colored stools

 deep red stools

 white-colored stools

Changes in the consistency of stool include:

 dry stools

 hard stools

 mucus or fluid that leaks out around the stool

 watery, loose stools (known as diarrhea)

You may also experience changes in the frequency of your stools; they may become more or
less frequent. If you do not have a bowel movement for more than three days or experience
diarrhea for longer than a day, you should contact your doctor. Also, if you lose the ability to
control your bowels, this is an indication of a concerning change in bowel habits.

5
What Causes Changes in Bowel Habits?

Changes in bowel habits can be caused by a range of conditions, from a temporary infection
to an underlying medical disorder. Examples of chronic conditions that can cause changes in
bowel habits include:

 celiac disease

 Crohn’s disease

 diverticulosis

 irritable bowel syndrome (IBS)

 thyroid disorders

 ulcerative colitis

Medications, including many antibiotics, can cause changes in bowel habits. Read the side
effects on your medication’s package or contact your doctor or pharmacist if you have
recently started taking a new medication and experience changes in your bowel habits.
Taking excessive amounts of laxatives can also affect your bowel habits.

Cancers, nerve damage from stroke, and spinal cord injuries can all affect your ability to
control your bowel movements.

How Are Changes in Bowel Habits Diagnosed?

When you get medical attention, a doctor will take a medical history and ask you to describe
your symptoms. You may be asked to provide a stool sample to test for the presence of blood
if you are experiencing blood in your stool.

Additional tests that may be used to determine potential causes for changes in bowel habits
include:

 blood tests

6
  colonoscopy, a test that views the inner lining of the colon to identify tumors, polyps,
pouches known as diverticula, or areas of bleeding

 CT scan to view tumors or other bowel irregularities

 X-ray imaging to view trapped air in the bowel

Fecal elimination problem

Diarrhea: Passage of liquid feces and an increase frequency of defecation.

Constipation: may define as fewer than three bowel movement per one week, this infers the
passage of dry hard stool or the passage of no stool.

Bowel incontinence: (Fecal incontinence) Loss of voluntary ability to control fecal and
gaseous discharge through anal sphincter.

Flatulence Three source of flatus: Action of bacteria in the large intestine Swallowed air
Gas that defuses between the blood stream and the intestine.

What Is Bowel Diversion Surgery?

Bowel diversion surgery allows stool to safely leave the body when (because of disease or
injury) the large intestine is removed or needs time to heal. Bowel is a general term for any
part of the small or large intestine.

Some bowel diversion surgeries (those called ostomy surgery) divert the bowel to an opening
in the abdomen where a stoma is created. A surgeon forms a stoma by rolling the bowel's end
back on itself, like a shirt cuff, and stitching it to the abdominal wall. An ostomy pouch is
attached to the stoma and worn outside the body to collect stool.

Other bowel diversion surgeries reconfigure the intestines after damaged portions are

removed. For example, after removing the colon, a surgeon can create a colon like pouch out
of the last part of the small intestine, avoiding the need for an ostomy pouch.

7
Cancer, trauma, inflammatory bowel disease (IBD), bowel obstruction,
and diverticulitis are all possible reasons for bowel diversion surgery.

What are the different types of bowel diversion surgery?

Several surgical options exist for bowel diversion.

 Ileostomy diverts the ileum to a stoma. Semisolid waste flows out of the stoma and
collects in an ostomy pouch, which must be emptied several times a day.
An ileostomy bypasses the colon, rectum, and anus and has the fewest complications.

 Colostomy is similar to an ileostomy, but the colon (not the ileum)is diverted to a
stoma. As with an ileostomy, stool collects in an ostomy pouch.

 Ileoanal reservoir surgery is an option when the large intestine is removed but the
anus remains intact and disease-free. The surgeon creates a colonlike pouch, called an
ileoanal reservoir, from the last several inches of the ileum. The ileoanal reservoir is
also called a pelvic pouch or J-pouch. Stool collects in the ileoanal reservoir and then
exits the body through the anus during a bowel movement. People who have
undergone ileoanal reservoir surgery initially have about six to 10 bowel movements a
day. Two or more surgeries are usually required, including a temporary ileostomy,
and an adjustment period lasting several months is needed for the newly formed
ileoanal reservoir to stretch and adjust to its new function. After the adjustment
period, bowel movements decrease to as few as 4 to 6 a day.

 Continent ileostomy is an option for people who are not good candidates for ileoanal
reservoir surgery because of damage to the rectum or anus but do not want to wear an
ostomy pouch. As with ileoanal reservoir surgery, the large intestine is removed and a
colon-like pouch, called a Kock pouch, is made from the end of the ileum. The
surgeon connects the Kock pouch to a stoma. A Kock pouch must be drained each day
by inserting a tube through the stoma. An ostomy pouch is not needed and the stoma
is covered by a patch when it is not in use.

8
 Nursing management

Assessing:

 Nursing history
 Physical exam
 Inspect the feces
 Diagnostic study

Diagnoses:

 Bowel incontinence
 Constipation risk for constipation
 Diarrhea

Planning

 Maintain or restore normal bowel elimination pattern

 Maintain or regain normal stool consistency
 Prevent associated risks such as fluid and electrolyte imbalance

Implementation

 Promote regular defecation:

 Privacy
 Timing
 Nutrition and fluid For constipation and diarrhea and flatulence
 Exercise
 Positioning
 Teaching about medication
 Laxative
 Administered enema

9
The procedure

Warming the enema solution to body temperature may be beneficial as heat stimulates the
rectal mucosa. Dougherty and Lister (2004) recommend a solution temperature of 40.5-43.3
degs C for non-oil-based enemas. Cold solutions should be avoided as they may cause
cramping.

Advising the patient to empty her or his bladder before the procedure may reduce the feeling
of discomfort.

The equipment required to perform an enema is as follows:

 Gloves and disposable apron;

 Incontinence pads;

 Lubricating solution;

 Jug with water, warmed to the desired temperature;

 Water thermometer;

 Bedpan/commode;

 Prepared solution.

The procedure is as follows:

 Obtain informed consent, identifying allergies and any contraindications.

 Provide the patient with reassurance.

 Assess patient privacy and dignity and take steps to maximise both.

 Ascertain prescription details if required.

 Wash hands and don plastic apron.

 Check the enema for expiry and intactness. Warm the solution to desired temperature.

10
  Position the patient on left side, lying with the knees drawn to the abdomen. This
eases the passage and flow of fluid into the rectum. Gravity and the anatomical
structure of the sigmoid colon also suggest that this will aid enema distribution and
retention.

 Position an ‘incontinence’ sheet underneath the patient.

 Assess the area and perform a digital rectal examination if this has not already been
carried out.

 Break the enema seal. Lubricate the nozzle. Air should be expelled.

 Gently separate the buttocks, identifying the anus. Insert the lubricated nozzle into the
rectum slowly to a depth of approximately 10cm (in adults).

 Gently expel the contents into the rectum, rolling the container from the bottom up to
reduce backflow.

 Keeping the container rolled/compressed withdraw the container. Attend to peri-anal

hygiene.

 Ask the patient to retain the enema for as long as required or suggested in the
manufacturer’s recommendations, providing a commode or nurse-call system as
indicated.

 Dispose of any waste, remove apron, wash hands.

 Document the procedure accurately, completing drug record if required.

 Ensure effect is noted and documented accurately.

Ostomy Appliances

Bags, pouches, appliances....whatever you choose to call them, come in many shapes and
sizes. The trick is to find the right one for you and your skin type. For the purposes of this
page, I'll commonly refer to them as bags, because that is exactly what they are!
I have heard stories of people using tins, rubber gloves, and even coconut shells over their
stomas to collect the waste products. I've even heard a story of one ostomate who used to
sleep on their stomach at night with their stoma strategically placed over a hole in the

11
mattress with a pot underneath catching the waste products! Thankfully, these horror stories
are a thing of the past for most ostomates. Today's bags are thin, lightweight, odour proof and
have a very low profile once you're wearing them.

The kind of bag you will need depends on the type of ostomy surgery you have had. In some
cases, you will not need to wear a bag at all. Whilst you are in hospital and when you first
leave the hospital, you will probably have a clear bag. The only advantage to clear bags is
that your doctors and nurses can see what's happening in the bag without removing the whole
thing. Once you come home, you'll probably want to switch to opaque bags - after all - who
wants to see what's happening in there?

Ileostomy Bags
People with an ileostomy need to wear a bag on a full time basis. This is because you cannot
control when the stoma is going to work - in fact it will probably work 95% of the time! It is
therefore, essential that you find an appliance system that suits both your skin type and your
lifestyle.

You will have the choice of either a one- or a two-piece system. There is no better system - it
is simply a matter of what you prefer. Both types are drainable, meaning that you can undo
the tie or clip at the bottom of the pouch and empty it as needed. Bags can also be disposable
(ie are thrown away once they are finished with) or reusable. There are also some non-
adhesive systems available which do not have a wafer which adheres to the skin. These are
especially helpful for those who have problems with allergies from the wafer material.

A One-Piece System is designed to be disposable (this does not mean that they can be flushed
down the toilet - most toilets react very badly to having plastic bags flushed down them!). A
one-piece system is just that - one-piece. It means that the wafer (the part that attaches the
bag to your skin) and the bag itself, are all in one and cannot be pulled apart.

12
Some one-piece bags may come with tape around the wafer designed to help the wafer stick
better. However, many people discover they are allergic to the tape and cut it off. This is
perfectly acceptable and will not interfere with the wafer sticking in any way.

Two-piece Systems means that the wafer and the bag are separate and are joined together by
what is commonly referred to as a "tupperware-type ring" on the wafer. The wafer is
designed to stay put for a while and the only thing that you will need to change on most
occasions is the bag itself - just attach the new bag to the wafer.

Two piece bags can either be disposable or reusable.

If the bags are reusable, the ostomate usually has about two or three bags which can be
rotated in wear time. The used bag is cleaned, dried and aired then reattached later on when
needed. This has the advantage in that if you pay for your ostomy appliances, it is a huge
saving not having to buy new bags for every change, although eventually the bags do wear
out and you will have to splurge occasionally.

13
Pros and cons of a one-piece system versus a two-piece system include:
One-piece systems are very quick and easy to apply (a distinct advantage for those with
arthritis, etc).

One-piece systems are a little less bulky than the two-piece system as they do not have the
"tupperware ring" to contend with.

With a two-piece system, you can easily change your bag depending on the need without
changing the wafer as well, ie you may want to change to a mini-bag for intimate moments or
swimming, with the minimum of fuss - it is not possible to do this with a one-piece system
unless you change the whole appliance.

Two-piece systems are a little easier to "burp" when the need arises - you just lift the bag
from the ring and let the excess gas out. You can burp your bag with a one-piece system by
undoing the clip and letting out the gas but a little more care is needed in case more than gas
comes out! I would advise "burping" your bag only if you are the only one in the room - the
resulting odour can be a little over-powering!

Two-piece system bags can unattach themselves from the wafer at times - esp if the bag
becomes too full or if the bag wasn't attached properly in the first place. This is what is
commonly known to ostomates as a "blow-out".

Both systems come with both pre-cut openings in the wafer and those that you have to cut
yourself. At first, it's probably better to go for the ones you have to cut yourself as you stoma
will change in size considerably during the first 6 months or so of it's life. Once your stoma
has settled down, you can opt for pre-cut appliances to save you time when changing. It
depends on the system you use as to how large you cut the hole, ie with Stomahesive it's
recommended you cut the hole in the wafer 1/8" larger than your stoma - for most others you
should cut it the same size as your stoma. In addition, many people's stomas are not a
perfectly round shape and the pre-cut wafers may not be suitable for them.

Colostomy Bags
For those colostomates who don't irrigate, the choice in bags is the same as for ileostomies
above.
However, for those who do choose to irrigate, once you have your routine down pat, you
probably won't have to wear a bag full time. Most times you will probably only need to wear

14
what's called a "stoma plug" over your stoma or if you prefer, a small bag as for ileostomates
but it need not be drainable - it will have a closed end.

If you do irrigate, you will need to get hold of some special equipment. On average it takes
approximately an hour a day to irrigate but it does mean that usually you don't have to worry
about your stoma for the other 23 hours of the day - or longer if your stoma allows it.
To find out what it means to irrigate, check out Mich's Article on Irrigating . However, your
stoma nurse will be the best person to tell you what you need and how to perform the
irrigation.

Topic Two

Introduction

Applications of heat and cold are commonly used in the hospital and homes as therapeutic
measures. in the hospitals, these measures are carried out at the direction of the physician.
heat and cold applications also serve as comfort measures. applications of heat and cold are
also used in the course of physical medicine as part of a rehabilitation programme such as
paraffin bath, whirlpool bath etc.  

Local and Systemic Effects of Heat and Cold

The local and systemic effects of cold modalities

Inflammation - since there is a decrease in cell metabolism and therefore cell waste,there is a
decrease in prostaglandins. Since the rate of prostaglandins slowed down, there is a decrease
in edema and pain.

1. Edema reduction/control - Since there is a decrease in blood flow and capillary

permeability, the cold modalities can provide the optimal healing environment for
acute injuries. This is because there is a decrease in capillary permeability, leading to
improved oxygen and nutrient delivery.
2. Muscle spasm - When there is a nine-degree change in skin temperature, there is a
decrease in sensitivity of muscle spindle activity and this therefore leads to a decrease
in pain. In addition, there is a decrease in afferent output and nerve conduction
velocity. This shuts down the feedback loop and lowers sensitivity to movement.

15
 3. Pain - With the application of cold modalities, the patient feels the following
sensations: cold, a burning sensation, then aching, and finally numbness sets in. The
numbing sensation allows for the analgesic effect of the modality. Also, because there
is a decrease in nerve conduction velocity there is a decrease in pain. Cold and hot
modalities both rely on the gate control theory to block out pain and try to stop the
pain-spasm-pain cycle.

The local and systemic effects of heat modalities

Inflammation/edema - Heat speeds up the inflammation rate because there is an increase in

blood flow and metabolic rate. Phagocytosis is initiated by an increase in leukocytes in the
area.

1. Muscle spasm - The muscle spindles are less sensitive to stretching when there is an
increase in temperature. When the muscle spindles are less sensitive, this then
decreases the spasm present. Also, heat increases ROM by increasing the collagen
extensibility.
2. Pain control - The increased circulation caused by heating modalities helps lessen the
pain because the "pain-producing" chemicals in the area are in less concentration.
Heat also causes a feeling of sedation and a state of analgesia. This feeling is present
when the heat is on and dissipates when the heat is taken away.

Physiological effects of cryotherapy

 Local effects include:

1. Decrease in pain
2. Vasoconstriction
3. Decrease in muscle spasm
4. Reduction in inflammation
5. Decrease in rate of cell metabolism
 Decrease in the need of oxygen
 Decrease in cell waste

16
  Systemic effects include:
1. General vasoconstriction
2. Decrease in heart rate and respiration
3. Shivering and increase in muscle tone

* To have systemic effects, there needs to be a .2 degree Fahrenheit change in the core body
temperature.

Physiological effects of thermotherapy

 Local effects include:

1. Vasodilation
2. Decreased muscle tone and spasm
3. Increased elasticity of ligaments, capsules and muscles
4. Analgesia and sedation of nerves
5. Edema formation
6. Increased rate of cell metabolism
7. Increased capillary permeability

 Systemic effects include:

1. Increased body temp
2. Increased pulse rate
3. Increased respiratory rate
4. Decreased blood pressure

* The use of heat is often used in the subacute and chronic stages

Thermal Tolerance

The study of thermal tolerance is the first step to understanding species vulnerability to
climate warming. This work aimed to determine the upper thermal limits of various fish and
crustaceans in a temperate estuarine ecosystem and an adjacent coastal area. Species were

17
ranked in terms of thermal tolerance and intraspecific variability was evaluated. The method
used was the Critical Thermal Maximum (CTMax). The CTMax was found to be higher for
species typically found in thermally unstable environments, e.g. intertidal, supratidal,
southern distributed species and species that make reproduction migrations because they are
exposed to extreme temperatures. Subtidal, demersal and northern distributed species showed
lower CTMax values because they live in colder environments. Species from different taxa
living in similar habitats have similar CTMax values which suggests that they have evolved
similar stress response mechanisms. This study showed that the most vulnerable organisms to
sea warming were those that occur in thermally unstable environments because despite their
high CTMax values, they live closer to their thermal limits and have limited acclimation
plasticity. Among the demersal species studied, two sea-breams (Diplodus
bellottii and Diplodus vulgaris) are potentially threatened by sea warming because their
CTMax values are not far from the mean water temperature and they are already under
thermal stress during current heat waves.

Adaptation of thermal receptors

Thermal receptors - although attempts have failed to identify the actual receptors responsible
for thermal sensations, experimental studies using heat pulses and recording electrical
reactions suggest that these receptors lie at a depth of about 200 (10-6m) below the skin
surface. These studies also suggest that there are separate receptors for:

cold - max. firing rate = 30°C; cease to fire at 38°C; fire again >45°C
and warm - max. firing rate = 40°C.

Some researchers propose that the sensation of "hot" arises from both warm and cold
receptors firing. Skin temperature and activity of receptors also varies by body site.

RECEPTOR SITES
Skin is generally sensitive to heat and cold over most of body area, but most sensitive places
are:

18
heat receptors: fingertips, nose, elbows (hence hold hot drink cupped in hands and close to
face on cold day)

cold receptors: upper lip, nose, chin, chest, fingers (hence sip cold drinks on hot day, put fan
at face level, etc.)

Fingertips are most sensitive to rate of heat conduction (hence steel at room temperature feels
colder than wood at room temperature).

Mean skin temperature

Estimated by taking the weighted sum of skin temperatures over various parts of body:
Tskin = 0.12Tback + 0.12Tchest + 0.12Tabdomen + 0.14Tarm + 0.19Tthigh + 0.13Tleg +
0.05Thand + 0.07Thead + 0.06Tfoot

Mean body temperature

Derived from weighted sum of body core (rectal) temperature and mean skin temperature.
Tbody = 0.67Trectal + 0.33Tskin

Adaptation
As with all sensory receptors, thermal receptors show adaptation e.g. one hand in cold water,
one hand in hot water, after a time neither feels cool or hot. Both hands put in tepid water and
cold hand feels warm and warm hand feels cold. Normal range of adaptation temperatures for
skin is 29°C (84.2°F) to 37°C (98.6°F) although this differs for different parts of the body.

Sensations of Warm and Cold in Rooms

Although we talk about rooms as being warm or cold, we cannot sense air temperature
directly--what we sense is temperature at skin receptors. For this reason it is very difficult to
predict person's sensations of warmth or cold from air temperature or skin temperature.

Relationship between skin temperature and sensation is different above and below thermal
neutrality. Below neutral leads to decreased skin temperature with decreasing ambient.
temperature and as temperature falls below 33.5°C (92°F)(comfortable level), cold sensation
increases and slower increase of cold discomfort.

Above thermal neutrality, there is an increased temperature sensation until sweating starts

19
and then there is only a slow sensation of increased temperature. Thermal discomfort doesn't
follow temperature sensation directly. In part this is because of effect of skin wettedness and
this seems to be a good predictor of warm discomfort.

skin wettedness = actual evaporation loss from skin / max. evaporation loss from skin if it
were completely wet
e.g. if skin wettedness = 0.5 this equals 1/2 body wet and 1/2 body dry.

An increase in humidity will not affect sweat rate but will decrease maximum theoretical heat
loss via evaporation and effectively decreasing skin wettedness. This increase is usually
perceived as "stickiness".

Rebound phenomenon
(1) A temporary deviation from a normal state in the opposite direction following an abrupt
removal or discontinuation of a variable, such as a treatment suddenly discontinued after a
long-term use, a passive resistance released suddenly, an undershoot, etc., in an effort to
restore balance or homeostasis
(2) A condition wherein the maximum therapeutic effect is reached, and the opposite effect
ensues

Supplement

For example, a rebound phenomenon occurs when the sudden discontinuation

of medication results in the relapse of symptoms that are worse than those before
the treatment. Thus, treatments capable of causing rebound effects have to be withdrawn
gradually. Another example is the posthypoglycemic hyperglycemia characterized by a
rebound hyperglycemia after a period of hypoglycemia. When the blood glucose level is low
the body tends to compensate by producing regulatory hormones that incite the liver to
produce glucose from stored glycogen. Thus, the outcome is an increase of blood
glucose or hyperglycemia. Another is the Stewart-Holmes sign seen in individuals
with cerebellar deficit or a lesion in the cerebellum.
Rebound phenomenon is also described when rebound effects ensues after the individual

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 developed tolerance to the drug. An example is the prolonged use of pain killers that lead to
the development of tolerance to these drugs. Eventually, the pain killers become less
effective. This leads to headaches that are more frequent or worse than before.

Topic Three

What are the hot water bags? 

Traditionally, hot water bags or containers were made from rubber and filled up with hot
water. The bag or container also had a stopper at its mouth (to avoid spilling or leakage). Hot
water bags are basically pain relief aids that help alleviate any discomfort through the local
application of heat. A globally popular phenomenon, this form of heat therapy is extremely
effective not just in terms of efficiency, but also when it comes to cost, size and user-
friendliness.

When is the right time to use hot water bags? Hot water bags can be used to treat or relieve a
wide array of conditions and physical discomfort, including the following: 

 Menstrual cramps
 Pulled/tense muscles
 Upper back pain
 Lower back pain
 Cervical pain
 Shoulder pain
 Elbow pain
 Knee pain
 Sore stomach
 Headache
 Cold hands and feet

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 Blood circulation problems
 Joint pain
 Arthritis
 Aches related to cold and flu
 
Apart from the aforementioned conditions, hot water bags are also effective as bed warmers.
The non-explosive design of modern hot bags ensures that it is easy for you to use them in
cold winters to spread a bit of warmth while you sleep.

Aquathermia and Heating Pads

A water-flow pad such as an aquathermia pad, electric heating pads, and commercial heat
packs are common forms of dry heat therapy. Dry heat devices are applied directly to the
surface of the skin; for this reason you need to take extra precautions to prevent burns, dry
skin, and loss of body fluids. The aquathermia pad (water-flow pad) used in health care
settings consists of a waterproof rubber or plastic pad connected by two hoses to an electrical
control unit that has a heating element and motor. Distilled water circulates through hollowed
channels in the pad to the control unit where water is heated (or cooled). In most health care
facilities, the central supply department sets the temperature regulators to the recommended
temperature. A temperature of 40° C (104° F) is safe for skin exposure for a long duration.
A conventional heating pad used in the home care setting consists of an electric coil
enclosed in a waterproof cover. A cotton or flannel cloth covers the outer pad. The pad
connects to an electrical cord that has a temperature-regulating unit for high, medium, or low
settings. Because it is so easy to readjust temperature settings on heating pads, instruct
patients not to turn the setting higher once they have adapted to the temperature. Instruct
patient and family not to use the highest setting.
https://nursekey.com/

What is a cold pack?

Popular and effective in treatments to ease pain and swelling from minor injuries, cold packs
come in many different varieties. Some are sacks of gel that turn into ice packs in your
freezer; others are packets designed to turn cold instantly with a simple squeeze, no

22
refrigeration or freezing required. You can also make your own cold pack by wrapping some
ice or a bag of frozen vegetables in a towel.

How does a cold pack work?

Cold packs are very effective at reducing swelling and numbing pain. An injury swells
because fluid leaks from blood vessels; cold causes vessels to constrict, reducing their
tendency to ooze. The less fluid that leaks from blood vessels, the less swelling results. Cold
also eases inflammation and muscle spasms, two common sources of pain.

The sooner you apply an ice pack to a sprain or strain, the sooner it can do its job reducing
pain and swelling. For chronic problems such as low back pain or muscle spasms, ice
whenever the symptoms start up.

When should you use a hot pack?

Heat can increase blood flow and help restore movement to injured tissue. Warmth can also
reduce joint stiffness, pain, and muscle spasms. As with cold packs, heat packs have a role in
easing pain from both acute and chronic injuries, such as sprains, strains, muscle spasms,
whiplash, and arthritis. Doctors often suggest using cold packs for the first day or two, and
then switching to heat if the symptoms persist or become more chronic.

In fact, for some folks, nothing soothes a sore back like a hot pack. In a study published in the
journal Spine, investigators at the University of Medicine and Dentistry of New Jersey found
that the continuous application of low-level heat eased low back pain better than two
common over-the-counter painkillers.

How long should you use a hot pack?

Apply a hot pack wrapped in a towel for 20 to 30 minutes at a time. Some physical therapists
recommend alternating between heat and cold for people with painful muscle spasms or
chronic problems such as arthritis.

What is an electrical heating pad?

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The purpose of an electrical heating pad is the same as a normal hot water bottle bag, which
is used to regulate the pain on a specific part of the body. Though the water is not used here
and in place of that an electrical circuit is used to get the temperature.

There are two main types of electric heating pads you can use to quickly reduce pain and
discomfort: Traditional heating pads and far infrared heating pads. Both of these options
are believed to ease muscle stiffness and promote healing.

Traditional electric heating pads are the most common and affordable. They often
resemble blankets and have an insulated wire within the fabric casing that generates heat
when turned on. You'll want the models that feature both dry and moist heat options for
versatility and automatic timed shut-offs for safety. Traditional electric heating pads are a
great choice for fast relief of cramps, back, shoulder, and leg pain.

Far infrared heating pads on the other hand, typically work by using infrared waves to
warm natural stones like jade to produce heat and negative ions to relax your muscles.
They can penetrate an inch or so into the body to provide a deeper warming effect. These
are better suited for chronic pain and can cost significantly more than the traditional units.

Ice bag
A flexible, watertight bag with a sealable opening large enough to permit ice cubes or chippe
d ice to be added. It is used in any condition requiring local application of cold. In an emerge
ncy any sturdy, flexible plastic bag can be used, with the open end sealed by a knot. A simple 
ice pack can be made at home by mixing 3 cups of water and 1 cup of rubbing alcohol in a re
sealable plastic bag and placing the sealed mixture in the freezer for 8 to 12 hours. The soluti
on will not freeze but will attain a gel-like consistency that molds to the body part on which it 
is used. Alternatively, a bag of frozen peas may be used as a conforming ice bag. The usual a
pplication time for an ice bag is alternating 10 min on, 20 min off.

Ice gloves

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Ice gloves are a pair of chilling gloves which are used for handling hot objects. They are
obtained by killing the Ice Queen residing in her lair inside White Wolf Mountain. Level
50 Mining is required to mine the rocks to enter the lair.

They are used in a variety of quests, such as being used to pick up the Entranan
firebird's feather during Heroes' Quest, and the black cog during Clock Tower. They are also
used to hold onto weapons while fighting Fareed during Desert
Treasure and Flambeed during Recipe for Disaster: Defeating the Culinaromancer, and their
subsequent rematches in the Dominion Tower. They can also be used to pick cave
nightshade.

The ice gloves can be re-obtained as many times as the player wishes. In case of mishaps
(death, accidental discarding etc), it is suggested that the player obtain more than one pair of
ice gloves. There is no quest requirement to actually obtain the gloves. After the completion
of Heroes' Quest the gloves can be reclaimed from the High Priest of Entrana. They can also
be re-obtained from the Storage Chest at May's Quest Caravan after putting 150 quest points
into the Hub Track. Note that the player must have completed Heroes' Quest in order to
retrieve them from the Storage Chest, even though the destroy dialogue will say that the
player can retrieve them from the chest before having completed that quest.

Ice Collars

Ice Collars designed to be placed around the neck, covering the throat, as a collar. These
devices consist of a rubber or soft plastic bag with an appropriate size and shape for
comfortable use as a collar. They include a cap that can be threaded or otherwise fixed to the
bag once the bag is filled and may also include external attachments (e.g., tabs, Velcro) to
facilitate fixing around the throat. Collar ice bags are intended to alleviate pain and/or to
promote healing in minor injured areas of the throat, neck, and/or head (e.g., after minor
surgery, tonsillectomy, to alleviate sore throat).

(https://www.sciencedirect.com/)

Cold compress

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A cold compress is a frozen or chilled material, such as an ice pack or a cool, wet washcloth.
When used correctly, they can help to relieve pain and swelling or cool a fever. Cold
compresses take a variety of forms, including commercially available products and
homemade solutions.

A cold compress can aid in treating:

 minor injuries

 fevers

 headaches

 eye pain or allergies

Different types of compress will help with different injuries. For example, a bag of ice may
be too cold to place comfortably on the eye area, while a cool cloth may do nothing for a
serious injury.

https://www.medicalnewstoday.com/

What’s a sitz bath?

A sitz bath is a warm, shallow bath that cleanses the perineum, which is the space between
the rectum and the vulva or scrotum. A sitz bath can also provide relief
from pain or itching in the genital area.

You can give yourself a sitz bath in your bathtub or with a plastic kit that fits over your toilet.
This kit is a round, shallow basin that often comes with a plastic bag that has long tubing on
the end. This bag can be filled with warm water and used to safely fill the bath via the tubing.
The basin is slightly larger in size than a standard toilet bowl so it can be easily and securely
placed underneath the toilet seat to allow you to remain seated while taking a sitz bath. The
kit is available in many stores and pharmacies.

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When is a sitz bath used?

A sitz bath doesn’t require a doctor’s prescription. Some people use sitz baths regularly as a
way to cleanse the perineum. In addition to its use in cleansing, the sitz bath’s warm water
increases blood flow to the perineal area. This can promote faster healing. A sitz bath also
relieves:

 itching

 irritation

 minor pain

Common reasons why you might want to consider using a sitz bath include:

 recently having surgery on the vulva or vagina

 recently having given birth

 recently having hemorrhoids surgically removed

 having discomfort from hemorrhoids

 having discomfort with bowel movements

Both children and adults can use sitz baths. Parents should always supervise their children
during a sitz bath.

Doctors sometimes prescribe medications or other additives to put in a sitz bath. An example
is povidone-iodine, which has antibacterial properties. Adding table salt, vinegar, or baking
soda to the water can also create a soothing solution. But you may take a sitz bath using only
warm water.

Sponge baths

Sponge baths, or bed baths, are used to bathe people who are are bedridden or unable to bathe
on their own due to health reasons. Giving a bed bath involves washing and rinsing the entire
body one section at a time while the patient remains in bed. It is important to gather all the

27
supplies needed before you begin so you do not have to leave the patient unattended. A good
bed bath will leave the person feeling clean and comfortable.

How to give your newborn a sponge bath

In the first weeks after Baby’s birth, keeping your little one clean can seem like the least of
your worries. But doctors recommend washing newborns two to three times per week, so
knowing the best way to give Baby a sponge bath is important, especially because newborns
shouldn’t go all the way in the tub until their umbilical cords fall off.

Supplies

Before attempting to bathe Baby, make sure you’ve got all your supplies handy. Many
parents choose to purchase a newborn bath, but an inflatable tub, a water basin, or even a
well-prepared sink will do the trick. You will also need mild baby soap, cotton balls,
washcloths, a towel, clean diapers, and clean clothes.

Giving the bath

1. Since you’ll be bathing Baby outside the tub at first, simply fill a bowl or the sink
with lukewarm water and wrap her in a towel, then place her lying down on her back.
2. Dip a cotton ball in water and wipe Baby’s eyes, making sure to use a fresh ball for
each eye.
3. Next, dampen a washcloth and wipe her face and ears, without using soap. Don't
forget her skin-folds, or behind her ears, but be sure not to wash or let water drip into
Baby's inner ear canal.
4. Place a little soap on the cloth and wash Baby’s neck, scalp, and the rest of her body.
She probably doesn't have much in the way of hair yet, so rubbing a damp, soapy
washcloth over her scalp should keep her squeaky-clean. Newborns who DO in fact
arrive with a full head of hair could need a more thorough hair-wash, which you can read
more about here.
5. There's some divided opinion about washing Baby's umbilical stump, so check in with
the doctor if you're unsure, but generally, as long as the stump is clean, keeping it clean
and dry and untouched by the sponge bath is the way to go. If there's some crustiness, you
can carefully wipe it clean with a clean, damp cloth, and then pat or air it dry.

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6. Rinse off the soap and dry, rewrapping Baby with a towel. Baby's head is likely to get
cold after a bath, especially if she has a luscious head of hair, so covering her head with a
dry towel is a great way to keep her from getting a chill.
7. Some newborns come into the world with that fabled soft skin, but others are a little
more sensitive, and bathing can dry sensitive newborn skin out even further. If Baby's
skin is a little dry or peeling, if you want to, you can gently rub some mild baby
moisturizer into her skin before popping her back into her onesie.
8. Put on a clean diaper and clothes, and resume cuddling!

References:

1. https://www.oviahealth.com/
2. (https://www.ncbi.nlm.nih.gov/)
3. https://www.healthline.com/
4. http://www.medicalproductguide.com/
5. https://runescape.fandom.com/

6. https://medical-dictionary.thefreedictionary.com/

7. (https://www.bustle.com/)

8. (https://tinibees.com/)
9. https://consumer.healthday.com/
10. https://www.seniority.in/
11. https://www.biologyonline.com/

12. http://ergo.human.cornell.edu/

13. https://www.sciencedirect.com/
14. http://www.angelfire.com/
15. http://www.ostomyinternational.org/
16. https://www.nursingtimes.net/
17. https://web2.aabu.edu.jo/
18. https://www.medicinenet.com/
19. https://web2.aabu.edu.jo/

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20. https://www.healthline.com/
21. (https://quizlet.com/)

22. (https://teachmephysiology.com/)

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