HEALTH ACCESSORIES

 

Syllabus:

Introduction to health accessories including wheel chairs, canes and crutches, bed-pans, vaporizers, syringes and needles, First Aid supplies, Hot water bottles, ice bags, clinical thermometers.

 

Questions:

Q1. Discuss the uses and maintenance of wheel chairs, canes and crutches, syringes and needles and hot water bottles. [2001] (12)

Q2. Short notes on first-aid supply. [2001], (4)

Q3. Write the precautions to be taken in the use of (i) Wheel chairs, (ii) Syringes & Needles, (iii) Hot water bottles, (iv) Vaporizers. [2000] (12)

Q4. Write a note on the use and precautions in uses for syringes and needles and first aid supplies. [1999]  (10)

Q5. Discuss the use of wheel chairs, first aid supplies and vaporizers in hospital. [1998] (10)

Q6. First Aid supplies [1998] (8)

 

WHEEL CHAIRS

·        A wheel chair is a chair with wheels to move a person who is not able to walk. Wheel chairs are standard or battery powered. A standard wheel chair can be pushed by someone or moved by rolling the wheels with patient’s hands. Other wheel chairs have a battery-powered motor to move the chair.

·        The lower front part of the chair has metal leg plates and footplates to rest the feet. The footrests may be moved to the side of the chair or taken off. This makes it easier to get in and out of the chair and to store the chair. The wheels usually have a lock to keep the chair from moving when the patient gets in or out.

Use

• The patient has an illness or injury that does not allow him/her to walk.
• The patient is too weak to walk long distances.
• The patient is recovering from surgery.

Precautions

·        The floor must be clean, dry, and well lighted.

·        All electrical cords must be out of the way.

·        The patient should try to stay to the right side of halls (big rooms) and footpaths when outside home. This gives people room to move around the patient. The patient must slow down at corners. This gives the patient a chance to see people or objects that might cause an accident.

 

N.B.

Standard wheel chair: A standard wheel chair can be used by most people. The standard chair comes ready-made but changes to the chair can be made to fit your needs. Your caregiver will help you decide what your special needs are and how to change your wheel chair.

Battery powered wheel chair: A motorized wheel chair gets the power from a battery. This battery is usually near the floor on the back of the chair. The batteries are charged at night so that you have enough power to use the chair the next day. Some motorized chairs have a toggle switch that you turn with your hand to move the chair. The switch is usually turned in the direction you want to move. Other motorized chairs have a mouthpiece if you cannot use your hands. Usually the mouthpiece is attached to a tube, which is connected to the motor. You blow into the mouthpiece to move the chair. Another type of motorized chair has a chin device. This chin device may be attached to an arm of the chair that is connected to the battery cable. You can push the device in the direction you want to move with your chair.

 

CANES AND CRUTCHES

Cane

A walking cane serves two purposes:

(i) Weight transfer – It provides a mean to reduce the weight of the weak limb. e.g. if a patient carries a cane on the side of his weak limb and puts 50lbs of weight on it, then he transfers 50lbs off his weak limb.

(ii) Balance– During walking good balance is required. Whenever people walks by keeping their feet apart the center of gravity (e.g.) transfers from on limb to another. When a foot is raised the e.g. transfers to the other foot to avoid falling. This is called “waddling”. The patient should carry the cane on the side of his strong limb to avoid waddling thus keeping the e.g. on the strong limb.

Cane Fitting

After holding the cane during walking the patient’s arm should make an angle of 150–160⁰(from vertical) bend at elbow because it is the best position of firm support.

Height of the cane: The tip of the cane is placed at 4 inches in front of the toe and at 45⁰ angle.

Crutches

Fore arm crutches:

They are commonly known as Canadian Crutches and Lofstrand crutches. It is a shaft made of wood or aluminium channels. On the lower end a tip is fitted. On the upper side a collar or cuff is present so that it encircles the fleshiest part of the forearm. The cuff is open in one side so that the patient can throw away the crutch if the he / she falls. The handgrip projects from the main shaft and it is held in a direction so that it points forward.

Commonly two-point gait is adopted.

Axillary Crutches

These are wooden or aluminiumm under-arm crutches. The crutch is fitted under the armpit. In erect condition there should be 1.5 inches gap in between the armpit and the top of the crutch. The handgrip is positioned so that the elbow bends when the patient holds the handgrip.

There are different axillary crutch gait:

1.      Four-point gait: The safest and most common gait is four-point gait. Patient moves left crutch. Moves his right leg forward. Moves his right crutch up to right leg. Moves his left leg forward. Moves his left crutch up to left leg.

2.      Two-point gait: Both left crutch and right leg move forward. Both right crutch and left leg move forward.

3.      Three-point gait: There are two type swing-to and swing-through gait.

Swing-to gait: Both crutches move forward. Both legs swing forward simultaneously but up to a point in between the two tips of the crutches.

Swing-through gait: Both crutches move forward. Both legs swing forward simultaneously but up to a ahead of the two tips of the crutches.

4.      Hemiplegic gait: Single axillary crutch placed in the strong side. Crutch moves forward along with the weak limb. Strong limb moves then.

BED PANS

Use

Bed pans are used for collection of feces of bedridden patients.

Construction: It may be round or oval in shape. It may be made of plastic, stainless steel, enamelware or porcelain. There is also available a smaller, sloping and flatter bedpan (called fracture bedpan) used for urine collection of immobilized or overweight patients.

Precautions:

When using a bedpan the back and knee should be elevated. In patient’s home four or five pillows should be placed behind the back for comfortable use of bedpan.

VAPORIZERS

Use: The vaporizers generates hot steam for the relief of upper respiratory illnesses e.g. colds, sinusitis etc. Portable room humidifiers are used to humidify rooms and chambers those are dried out by room heater during winter season. The cool-mist generated by the humidifiers produce expectorant action in the upper respiratory tract.

Construction:

The vaporizer is a electric kettle to generate heat and steam. They are equipped with a regulator so that when they are dry the heating unit automatically shuts off.

The portable humidifier is an instrument that produces a cool-mist to humidify the dry air of a room.

Precautions: The steam-vaporizers are very hot hence should be kept out of reach of children.

SYRINGES

Syringes are instruments intended for injecting injectable preparations in to the body or its cavities.

Classification on the basis of principle of action:

(a)    plunger syringes e.g. hypodermic syringes

(b)   bulb syringes e.g. ear syringes, ulcer syringes

(c)    gravity syringes e.g. fountain syringes.

Classification on the basis of size:

(a) small: capacity less than or equal to 10ml e.g. hypodermic syringe

(b) medium: capacity ranges from 10 to 100ml in volume e.g. ear and ulcer syringes.

(c) large: capacity more than 500ml e.g. enema and vaginal syringes.

Use:

Hypodermic syringes

These syringes are used to administer medication subcutaneously (under the skin), intradermally (into the dermis), intravenously (into a vein or artery) or intramuscularly (into the muscle).

e.g. Luer Syringes: In this syringe the outside barrel and the plunger are both made of ground-glass so that they fit air-tightly. The barrel is graduated in ml or minims or unit of insulin.

e.g. The tuberculin syringe (also called vaccine syringe) is a small syringe with minimum graduation of 0.1 to 0.01ml per division.

e.g. The disposable syringes carry a single dose of an injection and also fitted with the needle. They are packed in sterile packs. After administration the syringe and the needle should be disposed off.

Precautions

To test the efficiency of a hypodermic syringe the tip is closed with a finger and the plunger is withdrawn. If the plunger and barrel fits perfectly then the vacuum created in the cylinder will prevent the withdrawal of the plunger.

HYPODERMIC NEEDLES

Hypodermic needles fitted with Luer syringes are of metal, and consists of a hub that locks to the ground glass tip of the syringe by friction. The shaft diameter and length varies.

They are made of stainless steel, carbon steel, chromium, nickeloid, platinum, platinum-iridium, silver or gold.

Size: Selection of size of a needle in governed by four factors:

(a) safety, (b) flow rate, (c) comfort of patient and (d) depth of penetration.

Length: The length of the shaft (excluding the hub) ranges within ¼ to 3 ½ inches.

Gauge : The gauge of a needle is measured by the outside diameter of needle shaft. The usual range of diameter is 13 gauge (largest diameter) to 27 gauge (smallest diameter).

Use:

(a)    Long-bevel or long tapered needles are used for local anaesthesia, aspirating and for subcutaneous administration.

(b)   A short-bevel needle is used for intravenous injections, infusions and transfusions.

(c)    A special short-bevel needle is used for intradermal and spinal administration.

(d)   Some other special needles are available for abcess, eye, hemorrhoidal, tonsil, laryngeal and pneumothorax use.

FIRST-AID SUPPLY

The following items fall in this class: absorbent cotton, cotton balls and buds, sterile rolls and pads of gauze, elastic bandages, disposable fabric tissues and underpads, eye pads, sponges, tissues and towels, adhesive elastic bandages, aerosol adherent, spray dressings, first-aid kits, scissors, scissors, tweezers, and applicators.

The family medicine cabinet

There is place in every home where the medicine is placed. This should contain medicines, information literature on first-aid, poison antidotes etc.

Precaution:

The medicine cabinet should either be locked or completely out of reach of children.

Every bottle or box should be labeled clearly.

Unused prescription medication and OTC drugs and expired drugs should be removed.

Snake bite kits

Anyone in snake, bee or wasp country should carry snakebite kit. They usually are available in compact plastic or metal case maintaining a tourniquet rubber or other lymph constrictor, antiseptic, razor blade, or knife, one or more suction cups or syringes.

Hot water bottle

Hot water bottles are made of rubber and has an opening through which warm water is poured inside and the opening is closed with a stopper.

Hot-water bottles are used as “face bottle” in neuralgia of the head, back pains, spondilytis etc.

Precautions:

§  When filling hot-water bottle, it should be touched with the back of the hand or fore-arm to insure that the temperature is not too high.

§  Bare rubber should never be allowed to come in contact with skin, or burns may result. The bottle should be wrapped with a rubber pad, flannelette bags or even with a towel gives necessary heat and comfort.

§  After use the empty hot-water bottles should be hung in inverted condition for complete drainage of water.

§  Water of boiling temperature, oil, grease, alcohol or turpentine oil should not come in contact with rubber bottle.

§  When not in use all rubber devices should be protected from direct light to avoid hardening of rubber.

Ice bags

These are rubbers or rubberised macintosh bag with a large opening in the top to introduce crushed ice.

Use:

§  In deep inflammation like appendicitis application of cold gives some relief.

§  Ice-caps are placed on the head in high fever conditions.

§  Collar-shaped rubber bags are used for throat inflammation.

§  Long ice-bags are required for throat and spinal inflammations.

Clinical thermometers

Thermometers are instruments used for measurement of body temperature. It is made of glass with a capillary bored at the center. At the bottom a bulb full of mercury is placed.  Graduations are there in both Centigrade and Fahrenheit scale. The range given in the scale is 35 to 42⁰C and 94 to 108⁰F.

Use:

1.      Determination of temperature in fever.

2.      Determination of temperature to prepare the basal temperature graph to prepare the ovulation chart.

Types of thermometer

Three bulb types of clinical thermometers are available:

(a)    the oral type, having slender mercury reservoir most sensitive for taking temperature from under the tongue.

(b)   the rectal type has a blunt, strong, pear-shaped bulb for safety and ensure retention in the rectum and

(c)    the universal, security or snub is a small, sturdy, short bulb for oral and rectal use in children and irritational patients.

Taking body temperature

For oral temperature the thermometer is placed in the mouth with the bulb placed under the back of the tongue. The lip should be closed. The thermometer is rotated from time to time. In this way it is placed for at least 3 minutes.

Rectal temperature should be taken with a rectal or stubby bulb thermometer. The bulb is first sterilized, lubricated with vaseline and then gently inserted deeply enough to pass the constricting muscle, leaving about the thermometer exposed.

Babies should be held firmly face down, their buttock separated with one hand and the thermometer held with the other hand. The thermometer should be placed at least for 4 minutes in the rectum.

Axillary (under arm) temperature is taken only when all other methods are immposible.

Normal temperature

Oral:      98.6⁰F                   Rectal:   99.6⁰F

Special features of clinical thermometers

The capillary has a constriction just above the bulb. When the bulb of the thermometer comes in contact with high temperature the mercury rises through the capillary tube but it can not come down on its own due to the constriction above the bulb. So clinical thermometer is a self-registering device. After taking the reading the thermometer should be shaken so that the mercury returns back into the bulb.

Precaution

1.      Before taking the reading the thermometers should be sterilized by alcohol and shaken down below 97⁰F.

2.      When taking the reading the thermometer should be held horizontally with the right hand, about 1 ft from the eyes. The thermometer is rotated slowly until the mercury is visible.

3.      The bulb should never be held with the hand while taking reading.

4.      After taking the reading the thermometer should be shaken own so that it is ready for taking next reading.

5.      Thermometers should never be exposed to heat sources, sunrays etc.

6.      Oral temperatures should not be taken within 30 minutes after exercise, smoking, eating or taking hot or cold fluid.

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