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Higher nurse education




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BUKOVINIAN STATE Medical university

DEPARTMENT OF PATIENTS CARE AND

HIGHER NURSE EDUCATION

“APPROVED”


on the methodical conference of department

of patients’ care and higher

nurse education

“ ” ________ 200_ protocol N __

Chief of department, associate professor I.A. Plesh


METHODICAL INSTRUCTION

FOR SELF-PREPARATION OF STUDENTS

TO PRACTICAL CLASS №16


PLASTER OF PARIS.


Discipline:

nursing in surgery

for 3nd year students

of medical faculty №4,

specialty "nurse business''


Methodical instruction was prepared by:

Assistant Riabyi S.I.


Chernivtsi - 2010

1. Topic: PLASTER OF PARIS.


2. Duration of the class: 2 academic hour.

3. Study aim:

^ 3.1. The student should know:

  • definition of plaster of Paris, properties and quality.

  • classification of plaster bandages;

  • rules of applying plaster bandages;

  • nurse’s assistance during dressing of patients;

  • complication during and after applying bandages;

  • nurse’s tactics in cases of early and late complication;

  • kinds of bandages on head and neck;

  • kinds of bandages on chest and upper extremities;

  • kinds of bandages on abdomen;

  • kinds of bandages on pelvis and lower extremities;

  • peculiarities of using of elastic and net bandages.


^ 3.2. The student should be able:

  • to prepare and use modern kinds of dressing material;

  • to apply gauze bandages on different parts of human body;

  • to apply elastic and net bandages on different parts of human body;

  • to take care of surgical patients during and after dressing;

  • to assist to doctor during dressing.


^ 3.3. The student should master practical skills:

  • preparation of dressing material;

  • making of gauze towels, balls, pads etc;

  • applying gauze bandages on head;

  • applying gauze bandages on neck;

  • applying gauze bandages on chest;

  • applying gauze bandages on abdomen;

  • applying gauze bandages on pelvis;

  • applying gauze bandages on upper extremities;

  • applying gauze bandages on lower extremities;

  • applying elastic and net bandages;

  • nurse‘ assistance during dressing.




  1. Advice for students:

Preparation of gypseous bandage, longet, applyings and puttings off.

The most spread shape of bandages which harden, is available a plaster bandage which allows to fix well spalls of bones at fractures as a result of a prompt indurations.

Plaster (Gypsum) СаSО4 x 2H2O - the mineral spread in the nature. For plaster bandages use the inciderated gypsum (at an incideration he loses a part of crystal water). After wetting he enters with water a chemical combination and within several minutes is transmuted into firm mass. The medical gypsum should look like a white powder, without blobs, soft at a palpation. If in him its blobs come across is necessary sits through a bolter. To maintain gypsum it is necessary in a dry place as he easily retracts a moisture. If the gypsum has dampened, it is necessary to dry - to pour out it on an iron leaf not thick and to deliver in the heated case for some minutes at temperature +120°С.


The indication to application of plaster bandages.

 The Immobilization of fractures.

 The Immobilization of patholologically variated bones and joints.

 Correction of strains.

 Prophylaxis of strains.

 Urgent gypsuming.

 Manufacturing shapes and mould pieces of separate parts of a body with the purpose of a prosthetic repair.

 The Immobilization, as a method of treatment of combustions and arrangements of the soft tissues at absence of fractures.

Before applying of a plaster bandage it is necessary to check quality of a gypsum.


Assays on quality of gypsum.

 The Gypsum and water in the ratio 1:1 admix and make a globule; in 7-10 minutes he should harden and not be broken at slope from height 1м.

 It is plotted gypsies mixture from an admixture of a gypsum with water of a consistence of fluid sour cream which smear a lamina on saucer, thus the good-quality gypsum hardens in 5-6 minutes; at pressing by a dactyl the gypsum should not crush and on its surface the moisture should not act.

 Impose on a brush or a forearm made of 2-3 stratums gypsum and the bandage moistened by water longet: the good-quality gypsum hardens in 5-7 minutes, and at putting off from an arm such splint is not crumbled, maintaining the shape given to her.

 The Gypsum fill in metal ware and preheat on an electrical tile. Above a gypsum hold a pocket mirror. If the pocket mirror has misted over - from a gypsum steam is oozed. Such gypsum for use is unsuitable, for contains a moisture.

 The Small part of gypsum to admix with water and to define an odor of gypsum. If the gypsum has an odors of rotten eggs - he oozes a hydrogen sulfide and not applicable to use.

 At a tightening of a gypsies powder in a fist he should transit freely between dactyls and at a unclamping of a fist on a palm there should be an inappreciable quantity of a gypsum. At such assay he is considered applicable for use.

At wetting by hot water the gypsum hardens more promptly, cold - more slowly. Normally for wetting gypseous bandage use water of temperature +30-35°С.


Inventory and toolkit.

1. The Gypseous powder (or factory gypseous bandage).

2. Gauze bandage.

3. Container for bandage.

4. Container for waters (bowl).

5. The Flat tray.

6. Water.

7. The Special table for applying a gypsum.

8. Cotton

9. Instruments for operation with a gypsum (a knife, scissors, a cast cutter, forcepses for flanging a plaster bandage, etc.).

10. Protective clothes (oil-cloth aprons and oversleeves, rubber gloves).


The basic demands to plaster bandages.

1. The plaster bandage should overlap so that to trap two joints which are bound to the broken bone.

2. The material for a plaster bandage, sinked in water, should be in her up to that pore while from it blisters are oozed.

3. The same coils of gypseous bandage are necessary for imposing so that each following coil overlapped half previous.

4. Applying of a plaster bandage should not borrow{occupy} more than 10-15 minutes.

5. After terminating formation of a plaster bandage it is necessary to write directly on a bandage date of a trauma, date of applying of a plaster bandage and guessed day of putting off of a bandage, the plan of character of fracture.

The bandage completely dries up for 36-72 hours.


Manufacturing of gypseous bandage

On a table fill a gypsum, the end of bandage take one hand, and second develop bandage on 30-40 see On the developed part of bandage evenly fill a gypsum with which smooth and rub in bandage a rib of a palm of the left-hand. The part of bandage imbued by gypsum both hand leaky twist in the platen and ссовывают, untwisting for 30-40 sm bandage where yet did not rub a gypsum. Again rub a gypsum and roll up this part of bandage. Thus, prolong yet will not finish втирания a gypsum in bandage up to the end. The made gypseous bandage put in dry container.


Applying gypseous longet.

If the bandage overlaps lined, an extremity on all gap over cover a thin uniform stratum of cotton. If the bandage overlaps unlined, on places of osteal prominences impose wadded small pillows, and a pilar part grease with Vaselinum.

On an able-bodied extremity by means of a gauze stria (from bandage) measure length of a field on which will overlap gypsies лонгет and abandon it on an effective area. On a surface of a table develop factory gypseous bandage (or the self-made easily rolled gypseous bandage) on length of the measured strip of bandage. Do 6-8 stratums, controlling breadth of a gypseous stria. Roll up a gypseous stria leaky from the ends up to the middle. Holding a gypseous stria from two legs two hand dip it into a basin with water and hold until eduction of air traps will be stopped. After the bandage has completely exuded with water, its two hands for the ends take out from water and easy pressing to the middle wring out. The expressed gypseous bandage put on an effective area of a table, develop heads and some times smooth with a right hand that it was formed smooth, identical depth a surface. Prepared gypseous longet take for the ends put to immobilization parts, give extremities of a physiologic standing and smooth an exterior surface of a plaster bandage. Edges smooth down, bend outside and do their spherical. A plaster bandage after a desiccation bandage gauze bandage.


Applying gypsies longets from self-made gypseous preparation.

On an able-bodied extremity by means of a gauze stria measure length of a field on which will overlap gypseous лонгет and abandon it on an effective area. On a surface of a table develop gauze bandage on length of the measured strip of bandage. This piece of bandage pour a gypseous powder with which smooth and rub in bandage a rib of a palm of the left-hand hand. Atop of the imbued gypseous bandage impose a following stratum of gauze bandage with which similarly imbue with a gypsum. Thus control breadth longet. Longet do from 5-12 stratums of the bandage imbued by a gypsum. The made preparation лонгеты compound leaky from the ends up to the middle. Take gypseous preparation from two legs two hand for the ends, dip it into a basin with water. Bandage hold in water until eduction of air traps will be stopped. After the bandage has completely exuded with water, its two hands take out from water and easy pressing to the middle wring out. The expressed gypseous bandage, put on an effective area of a table, develop heads and some times smooth with a right hand that it was formed smooth, identical depth a surface. Prepared gypseous longet take for the ends, put to a part, which immobilization. Give extremities of a physiologic standing. Smooth an exterior surface of a plaster bandage. Edges smooth down, bend outside and do its spherical. A plaster bandage lay gauze bandage.


Applying of a circular plaster bandage.

After take out bandage from water the free end of bandage take in the left-hand, and a head - in right and start to bandage. At bandaging a right hand all time unrolls bandage, and left-hand - smoothes it. It is necessary to coat with each following round previous on 2/3. In those places where diverticulums are formed, them, undercut with scissors, press to a surface which bandage and smooth. All stratums of the imposed bandage should be bridged in a single whole, the bandage should respond a configuration of this surface precisely. During bandaging an extremity give a physiologic standing. At applying a circular plaster bandage ends of dactyls, as a rule, abandon open to track on a state of an extremity. A plaster bandage lay gauze bandage.


Putting off of plaster bandages.

For putting off of plaster bandages the special toolkit is used: scissors for a gypsum, a power saw, Volf's forceps, an expander. During a cast removal immobilization the part of a body should remain immobile. The gypsum is taken out gradually with participation of the patient.


^ 5. Study questions:

  1. Definition of bandage, dressing.

  2. The main kinds of dressing material.

  3. Classification of bandages.

  4. Rules of applying gauze bandages.

  5. Nurse’s assistance during dressing of patients.

  6. Complication during and after applying bandages.

  7. Nurse’s tactics in cases of early and late complication.

  8. Kinds of bandages on head and neck.

  9. Kinds of bandages on chest and upper extremities.

  10. Kinds of bandages on abdomen.

  11. Kinds of bandages on pelvis and lower extremities.

  12. Peculiarities of using of elastic and net bandages.


^ 6. The literature:


6.1. Basic :

  1. Textbook of basic nursing / Caroline Bunker Rosdahl. – J. B.Lippincott Company. Philadelphia. - 6th ed. –1995.– 1518 p.

  2. Fundamentals of nursing /Taylor Mary Carol, Mary Carol, Lillis Carol– J. B.Lippincott Company. Philadelphia. - 1989.– 1356 p.


6.2. Аdditional:

  1. Gostishev V.K. "Guidance to practical employments on general surgery". M., "Medicine" - 1987.

  2. Schevchenko S.I. and others. Surgery. – Kharcov. 2004



Methodical instruction was prepared by

Assistant Riabyi S.I.


A review is positive, associate professor Chomko O.J.


Tests for checkout of a datum level of knowledge:


1. The patient, 55 years, is delivered in a reception of hospital with attributes of the expressed respiratory failure. From the anamnesis it is known, that 1 hour has gained the knife wound back. At survey the wound of which thorax of edge is taped cut are stuck out at an expiration. What first aid should be given the patientin situ?


Applying of an occlusive bandage (+)

Applying of bandage Desault’s

Artificial ventilation of the lungs

Laying standing and rest

Injection of an analgesics


2. The sick M. Was converted in a fracture clinic with attributes of fracture of a radial bone in a typical place that has been X-ray confirmed. What of plaster bandages the surgeon after anesthesia and should apply repositions of osteal spalls?


longet - circular (+)

Window

Bridge-like

Gypseous corset

Circular


3. On military doctrines the military man has gained the open making through wound of a thorax. With what purpose it is necessary to use the individual dressing-room package which is available it?


gluing up of wounds formations by a proof fabric with the purpose of making of a hermetic bandage (+)

Applying of an aseptic bandage

Stopping of a bleeding

Immobilization

The individual dressing-room package is not used


4. The patient, 23 years, has entered an ENT - unit with the trauma of a nose caused by a blunt subject with the phenomena of a nasal bleeding and damage of outside soft tissues. What of the numbered bandages the surgeon after a tamponade of nasal courses and primary surgical treatment should apply?


Four-tailed (+)

"Bridle"

Desault’s bandage

"Protecting cap"

triangular scarf


5. At applying bandages the patient who was in a hospital in occasion of rubber wounds of the left-hand forearm, had giddiness. Subsequently it is erected, that manipulation was carried out in a dressing room by the nurse; the patient stood; the bandaging part of a body was in functionally convenient standing. What error is admitted?


Manipulation is executed in a dressing room

Standing of the patient (+)

The bandaging part was in functionally convenient standing

The dressing was spent by the nurse

The giddiness is not bound to a dressing


6. After applying a spiral bandage on a brachium to the patient, that was treated in a hospital in occasion of making through wound of a brachium, there was a blanching, an edema. What reason?


Hard applying of a bandage (+)

Bleeding

Incongruous view of a bandage

Affixion of a mephitic gangrene

All answers are wrong


7. At the patient, 38 years, a bruise of area of a right femoral joint with damage of outside soft tissues. The necessary descending spica bandage on a field of a joint, which applying begins with:

Circular rounds of bandage on a trunk (+)

Circular rounds of bandage on a right femur

Circular rounds of bandage on the left femur

Skew round of bandage on a forward surface of a right femur

Skew round of bandage on a forward surface of the left femur


8. The patient, 18 years, was converted in a medical institution with резаной a wound of calcaneal area. The trauma was gained with 1 hour back during bathing in lake. After a surgical treatment it is necessary to impose бинтовую a bandage. What of the numbered bandages is the most expedient?


Turtle (+)

Circular

Spiral

Spica

Glue


9. The patient, 30 years, are delivered at a fracture clinic of regional hospital with the open fracture of the inferior third of brachium. The doctor's assistant has imposed Kramer's splint, prestressly having simulated on an able-bodied arm which trapped a brachium, a forearm and a brush to metacarper-phalanx joints. The arm is hung on a scarf. What error was admitted by the doctor's assistant?


Has not imposed an aseptic bandage (+)

The wrong model operation of the splint

The scarf is not necessary

Is inexpedient to use Kramer's splint

The error misses


10. To the patient, 21 year which is treated in surgical unit in occasion of cut wounds of a brachium, the following bandage is imposed: fixative circular rounds of bandage begin with a thorax, and its rounds for fastening a shoulder joint are imposed from a neck up to a brachium. What view of a bandage is used?


Descending spica

Ascending spica

Cruciate

Bandage Desault’s

Thorax-brachium


11. The patient, 48 years, has entered unit of vascular surgery with the diagnosis „ posttromboflebitis a syndrome of the left-hand inferior extremity, a segment of an anticnemion, the ulcerative shape ”. At the survey on the left-hand anticnemion a canker in the dimension 2 х 3 sm with rough edges and the phenomena of a perifocal inflammation. What of the termed bandages is used at a preoperative stage after sanation of a canker?


Zincum - gelatinous (+)

longet gypseous

Circular gypseous

Window gypseous

longet - circular gypseous


12. The child, in the age of 1 year, has entered surgical unit with a tubercular spondylitis at level Th3-Th4. What of the numbered bandages is used with the purpose of an immobilization?

longet

Zincum - gelatinous

Gypseous bad (+)

longet - circular

Bandage Volcovich’s


13. The patient, 27 years, was converted to the doctor of a fracture clinic with complaints to pains in a field of the inferior third of forearm, its strain, sharp limitation of motions in a radiocarpal joint. Signs have occurbed after slope suffered on the rectified hand. The occluded fracture of a radial bone in a typical place is diagnosed. What plaster bandage thus should be imposed?


Zincum - gelatinous

longet (+)

Circular

Window

Gypseous bad


14. The patient, 31 year, has entered a hospital with the diagnosis „ the open fracture of bones of the left-hand anticnemion without shift ”. What bandage is expedient for using for treatment of this view of fracture?

Bandage Volcovich’s

Zincum - gelatinous

Window

Longet- circular

Longet (+)


15. The patient, 51 year, has entered a hospital with attributes of a dislocation of the left-hand brachium. What bandage is expedient for imposing to the victim after diaplasis of a dislocation?


Window

Creeping

spica

Desault’s (+)

Circular

16. Before actions on prophylaxis of decubituses it is possible to carry:


Clearing bedsheets after each reception of meal that in a bed there were no crumbs (+)

I Immersion of the patient “solid bed”

Bedding oilcloths under the patient

Change of a standing of the patient in bed each 2 hours (+)

Change of a standing of the patient in bed each 6 hours


17. Concerning development of decubituses following fields of a body are hazardous:


Forward abdominal wall

Field of a sacrum (+)

Heel (+)

Back surface thigh’s

Field of shoulder joints


18. On prophylaxis of decubituses it is possible to carry to actions:


Processing of " hazardous fields ” bodies sick 5 % a spirituous solution of an iodine

Application of the saccules filled by seeds of millet or flax (+)

Processing of " hazardous fields ” bodies of the patient of 10 % a solution of camphoric alcohol (+)

The application to places of a possible lesion of a spirituous compress

Maintenance to the patient of a constant standing on a back{spin}

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