Autism, disorder that severely impairs development of a person’s ability to communicate, interact with other people, and maintain normal contact with the outside world. The disorder was first described in 1943 by American psychiatrist Leo Kanner. One of the most common developmental disabilities, autism affects 2 to 5 out of every 10,000 children and appears before the age of three. It is four to five times more common in males than in males.

CAUSES

It is a brain disorder present from birth which affects the way the brain uses information but the cause of autism is still unknown.

Some researches suggest a physiological problem affecting those parts in the brain that process language and information coming in from the senses – pre-natal and or post-natal infections, chromosomal disorders, CNS dysfunction, seizures, vaccines, brain injury.

There are some imbalance of certain chemicals in the brain.

Genetic factors may sometimes be involved. In many families there appears to be a pattern of autism or related disorders which suggest a gene(s)-based cause, however, at this time no gene has been directly linked to autism

Autism may also result from a combination of several causes.

Vaccinations

Food Allergies

LEARNING PROBLEMS TO BE ADDRESSED

Organization – children with autism are frequently immobilized and sometimes will not be able to begin their required task.

Distractibility – it takes many forms in a the classroom; reacting to outside noises or visually following movements instead of completing the required work.

Sequencing – difficulty in remembering precise order of tasks because they focus concretely on specific details and do not always see relationships between them.

Generalization – difficulty in applying what has been learned in one situation to similar things.

Receptive language – many children with autism, especially at a very young age, may not understand language.

INDICATORS
Physical Health

Generally healthy
Generally good-looking
Is a picky-eater, tends to smell food/objects and put things in the mouth
Exhibits disturbed sleeping patterns
Does not seek attention when hurt, has high pain threshold, unable to localize pain.

Gross Motor
Walks on ___ especially during early years
Is hyperactive, uninhibited
Is fast and strong and does not tire easily
May either have good or poor perceptual-motor skills depending on level of attention span

Fine Motor
Is absorbed by some objects with tendency to get attracted to spin around/ whirling objects
Self-stimulates by touching surfaces/edges, arranging/aligning objects precisely/repetitively

Psychosocial
Demonstrates unusual fears
Is socially immature and handicap
Is maladaptive to changes in food, clothes, routine, routes of arrangements of things
Tends to be self-injurious

Self-Help
Is delayed in performing eating, dressing, and grooming tasks
Is unable to assume age-appropriate responsibilities
Lags behind in discriminating and avoiding dangers

Language-Cognitive/Intellectual/Achievement
Shows deficit in the use of language
Under-reacts or overreacst to sounds
Under-reacts to language and visuals
Demonstrates rate learning
Is echolalic
Is delayed in language-conceptual abilities- reasoning, inferential thinking, problem solving, deductive and inductive thinking
Is delayed in overall intellectual response
Exhibits repetitive movements, body rocking, hand wiggling, whirling, “ritual of walking to and fro” etc
Is either echopraxic or non-imitative of gestures

Epididymitis is an infection of the epididymis that usually results from an infected prostate or urinary tract. It may also develop as a complication of gonorrhea. In men younger than 35 years of age, the major cause is Chlamydia trachomatis infection.

CLINICAL MANIFESTATIONS
·    Unilateral pain and soreness in the inguinal canal along the course of the vas deferens.
·    Pain and swelling in the scrotum and groin.
·    Extremely painful and swollen epididymis; temperature elevated.
·    Pyuria and bacteriuria with resulting chills and fever.

MEDICAL MANAGEMENT
·    If seen within 24 hours after onset of pain, spermatic cord may be infiltrated with a local anesthetic agent for relief.
·    If chlamydial in origin, patient and patient’s sexual partners must be treated with antibiotics.
·    Observe for abscess formation.
·    If no improvement within 2 weeks, consider underlying testicular tumor.
·    Epididymectomy (excision of the epididymis from the testes) is done for recurrent, incapacitating episodes or chronic, painful conditions.

NURSING MANAGEMENT
·    Place patient on bed rest with scrotum elevated with a scrotal bridge or folded towel to prevent traction on spermatic cord and improve venous drainage and relieve pain.
·    Give antimicrobial medications as prescribed.
·    Provide intermittent cold compresses to scrotum to help ease pain; later, local heat or sitz baths may hasten resolution of inflammatory process.
·    Give analgesic agents as prescribed for pain relief.
·    Instruct patient to avoid straining, lifting, and sexual stimulation until infection is under control.
·    Instruct patient to continue with analgesic and antibiotic medications as prescribed and to use ice packs as necessary for discomfort.
·    Explain that it may take 4 weeks or longer for the epididymis to return to normal.

Bell’s Palsy (facial paralysis) is due to peripheral involvement of the seventh cranial nerve on one side, which results in weakness or paralysis of the facial muscles. The cause is unknown, but possible cause may include vascular ischemia, viral disease (herpes simplex, herpes zoster), autoimmune disease, or a combination. Bell’s palsy may represent a type of pressure paralysis in which ischemic necrosis of the facial nerve causes a distortion of the face, increased lacrimation (tearing), and painful sensations in the face, behind the ear, and in the eye. The patient may experience speech difficulties and may be unable to eat on the affected side owing to weakness.

MEDICAL MANAGEMENT

The objectives of management are to maintain facial muscle tone and to prevent or minimize denervation. Steroidal therapy may be initiated to reduce inflammation and edema, which reduces vascular compression and permits restoration of blood circulation to the nerve. Early administration of corticosteroids appears to diminish severity, relieve pain, and minimize denervation. Facial pain is controlled with analgesic agents or heat applied to the involved side of the face. Additional modalities may include electrical stimulation applied to the face to prevent muscle atrophy, or surgical exploration of the facial nerve. Surgery may be performed if a tumor is suspected, for surgical decompression of the facial nerve, and for surgical rehabilitation of a paralyzed face.

NURSING MANAGEMENT

Patients need reassurance that a stroke has not occurred and that spontaneous recovery occurs within 3 to 5 weeks in most patients. Teaching patients with Bell’s palsy to care for themselves at home is an important nursing priority.

TEACHING EYE CARE

Because the blink reflex is diminished, the involved eye may not close completely and the needs to be protected to prevent corneal irritation and ulceration. Inform the patient of potential complications, including corneal irritation and ulceration, overflow of tears, and absence of blink reflex. Key teaching points include:
· Cover the eye with a protective shield at night.
· Apply eye ointment to keep eyelids closed during sleep.
· Close the paralyzed eyelid manually before going to sleep.
· Wear wrap-around sunglasses or goggles to decrease normal evaporation from the eye.

TEACHING ABOUT MAINTAINING MUSCLE TONE
· Show patient how to perform facial massage which gentle upward motion several times daily when the patient can tolerate the massage.
· Demonstrate the facial exercises, such as wrinkling the forehead, blowing out the cheeks, and whistling in an effort to prevent muscle atrophy.
· Instruct patient to avoid exposing the face to cold and drafts.
· Remind patient and family of the importance of participating in health promotion activities and recommended health screening practices.

CLINICAL MANIFESTATIONS
·    Itching and scratching, often more severe at night (itch-scratch-itch cycle)
·    Excoriations, redness, raised areas on the skin (wheals), as a result of scratching.
·    Infections or changes in pigmentation
·    Debilitating itching, in severe cases.

MEDICAL MANAGEMENT
The cause of pruritis needs to be identified and treated. The patient is advised to avoid washing with soap and hot water. Cold compresses, ice cubes, or cool agents that contain soothing menthol and camphor may be applied.
·    Bath oils (Lubriderm or Alpha Keri) are prescribed, except for elderly patients or those with impaired balance, who should not add oil to the bath because of the danger of slipping.
·    Topical steroids are prescribed to decrease itching.
·    Oral antihistamines (diphenhydramine [Benadryl] ) are sometimes used.
·    Tricyclic antidepressants (doxepin [Sinequan]) may be prescribed when pruritis is of neuropsychogenic origin.

NURSING MANAGEMENT
·    Reinforce reasons for the prescribed therapeutic regimen.
·    Remind patient to use tepid (not hot) water and to shake off excess water and blot between intertriginous areas (body folds) with a towel.
·    Advise patient to avoid rubbing vigorously with towel, which overstimulates skin, causing more itching.
·    Instruct patient to avoid scratching and to trim nails short to prevent skin damage and infection.
·    Advise patient to avoid situations that cause vasodilation (warm environment, ingestion of alcohol or hot foods and liquids).
·    Lubricate skin with an emollient that traps moisture (specifically after bathing).
·    Keep room cool and humidified.
·    Advise patient to wear soft cotton clothing next to skin and avoid activities that result in perspiration.
·    When the underlying cause of pruritis is unknown and further testing is required, explain each test and the expected outcome.

A cataract is an opacity of the eye’s normally clear, transparent crystalline lens. It is commonly associated with aging (senile cataracts) but can develop at any age. It may also be associated with blunt or penetrating trauma, long-term corticosteroid use, systemic disease such as diabetes mellitus, hypoparathyroidism, radiation exposure, expose to long hours of bright sunlight (ultraviolet), or other eye disorders. Vision impairment depends on the size, density, and location in the lens.

CLINICAL MANIFESTATIONS
·    Diminished visual acuity, disabling sensitivity to glare, painless, dimmed or blurred vision with distortion of images, poor night vision. Other effects include myopic shift, astigmatism, monocular diplopia (double vision), color shift (aging lens becomes progressively more absorbent at the blue end of the spectrum), brunescence (color values shift to yellow brown), and reduced light transmission.
·    Yellowish, gray, or white pupil
·    Develops gradually over a period of years; as the cataract worsens, stronger glasses no longer improve sight
·    May develop in both eyes, although one is more compromised than the other

ASSESSMENT AND DIAGNOSTIC METHODS
·    Degree of visual acuity is directly proportionate to density of the cataract.
·    Snellen visual acuity test
·    Opthalmoscopy
·    Slit-lamp biomicroscopic examination
·    A-scan ultrasonography

MEDICAL MANAGEMENT
There is no medical treatment for cataracts, although use of vitamin C and E and beta-carotene is being investigated. Glasses or contact, bifocal, or magnifying lenses may improve vision Mydriatics can be used short term, but glare is increased.

SURGICAL MANAGEMENT
Two surgical techniques are available: intracapsular cataract extraction (ICCE) and extracapsular cataract extraction (ECCE) including phacoemulsification. Less than 15% of people with cataracts require surgery.

Indications for surgery are loss of vision that interferes with normal activities or a cataract that is causing glaucoma. Cataracts are removed under local anesthesia on an outpatient basis. Lens replacement may involve aphakic eyeglasses, contact lens, and intraocular lens (IOL) implants. When both eyes have cataracts, one eye is surgically treated at a time.

NURSING MANAGEMENT
·    Because surgery is performed on an outpatients basis, instruct patient to make arrangements for transportation home, care that evening, and a follow-up visit to the surgeon the next day.
·    Withhold any anticoagulants the patient is receiving, if medically appropriate. Aspirin should be withheld for 5 to 7 days, nonsteroidal anti-inflammatory drugs (NSAIDs) for 3 to 5 days, and warfarin (Coumadin) until the prothrombin time of 1.5 is almost reached.
·    Administer dilating drops every 10 minutes for four doses at least 1 hour before surgery. Antibiotic, corticosteroid, and NSAID drops may be administered prophylactically to prevent postoperative infection and inflammation.
·    Instruct patient to wear a protective eye patch for 24 hours after surgery to prevent accidental rubbing or poking of the eye. After 24 hours, eyeglasses (sunglasses in bright light) should be worn during the day and a metal shield worn at night for 1 to 4 weeks.
·    Provide postoperative discharge teaching concerning eye medications, cleansing and protection, activity level and restrictions, diet, pain control, positioning, office appointments, expected postoperative course, and symptoms to report immediately to the surgeon.
·    Instruct patient to restrict bending and lifting heavy objects.
·    Caution patient that vision may blur for several days to weeks.
·    Inform patient that vision gradually improves as the eye heals; IOL implants improve vision faster than glasses or contact lenses.
·    Reinforce that vision correction is usually needed for remaining visual acuity deficit.

This is the fear of being in open spaces and situations in which the person thinks there is no escape or help would be difficult to obtain. As such, the person fear being in busy streets or in crowded stores, theaters, or churches. The fear maybe so incapacitating that the person may not even dare leave home. Two-thirds of those agoraphobia are women. If they are married, there is usually marital discord because their husbands do not understand their behavior and tends to be critical. Most people with agoraphobia are perfectionist and have personality disorders. Symptoms develop between the ages of 18 and 35. The onset may be sudden or gradual. Agoraphobia often starts unpredictability of the panic attacks “trains” the individual to anticipate future panic attacks and, therefore, to fear any situation in which an attack may occur. As a result, the person avoid going into any place or situation where previous panic attacks have occurred.

NURSING INTERVENTION:
Treatment for phobia is either behavior therapy or medication or a combination of both.

1.    Behavior therapy by systematic desensitization – the patient meets with a trained therapist and confronts the feared object or situation in a carefully planned, gradual way. The person first imagines the feared object or situation, works up to looking at pictures that depict the object or situation, and finally actually experiences the situation or comes in contact wit the feared object. By confronting rather than fleeing the object of fear, the person becomes accustomed to it and can lose the terror, horror, panic, and dread he or she once felt.
2.    Medications re used to control the panic experienced during a phobic situation as well as the anxiety aroused by anticipation of that situation and are the treatment of first choice for social phobia and agoraphobia.
3.    Nursing Care:
·    Do not reason out of behavior.
·    Videotaping with review and feedback and role-playing are two therapeutic strategies that can help a person with social phobia.
·    Caring for patients with phobias can involve monitoring medications for effectiveness and adverse reactions, reinforcing concepts presented in therapy, and educating patients and their families on the significance of the phobia as debilitating problem and not just a “character flaw” to be overcome.
·    Nurses can also teach patients to recognize the signs of increasing anxiety and to select anxiety-reduction measures appropriate for them. One of the most important things for nurses to remember when caring for a patient experiencing phobia is to refrain from confronting or humiliating them.
·    Be sure to carefully screen for suicidal ideation among people with phobias because environmental factors that predispose to phobias also contribute to the risk factors for suicide. When social phobia is identified, especially among young adults, screening for substance abuse and depression is also important.
·    Culture may be an important overlooked factor that impacts the experience and expression of phobias. A problem with the interpretive process and cultural influences can hinder the detection or evaluation of a phobic disorder. Culture may also influence treatment seeking and adherence with medication and therapeutic management.

AGE
Infants and growing children have much greater fluid turnover than adults because their higher metabolic rate increases fluid loss. Infants lose more fluid through the kidneys because immature kidneys are less able to conserve water than adult kidneys. In addition, infants respirations are more rapid and the body surface area is proportionately greater than that of adults. Increasing insensible fluid losses. The more rapid turnover of fluid plus the losses produced by disease can create critical fluid imbalances in children much more rapidly than in adults.

In elderly people, the normal aging process may affect fluid balance. The thirst response often is blunted. Antidiuretic hormone levels remain normal or may even be elevated, but the nephrons become less able to conserve water in response to ADH. Increased levels of atrial natriuretic factor seen in older adults may also contribute to this impaired ability to conserve water. These normal changes of aging increase the risk of dehydration. When combined with the increased likelihood of heart diseases, impaired renal function, and multiple drug regimens, the older adult’s risk for fluid and electrolyte imbalance is significant. Additionally, it is important to consider that the older adult has thinner, more fragile skin and veins, which can make an intravenous insertion more difficult.

GENDER AND BODY SIZE
Total body water also is affected by gender and body size. Because fat cells contain little or no water and lean tissue has a high water content, people with a higher percentage of body fat have less body fluid. Women have proportionately more body fat and less body water than men. Water accounts for approximately 60% of an adult man’s weight, but only 52% for an adult woman. In an obese individual this may be even less, with water responsible for only 30% to 40% of the person’s weight.

ENVIRONMENTAL TEMPERATURE
People with an illness and those participating in strenuous activity are at risk for fluid and electrolyte imbalances when the environmental temperature is high. Fluid losses through sweating are increased in hot environments as the body attempts to dissipate heat. These losses are even greater in people who have not been acclimatized to the environment.

Both salt and water are lost through sweating. When only water is replaced, salt depletion is a risk. The person who is salt depleted may experience fatigue, weakness, headache and gastrointestinal symptoms such as anorexia and nausea. The risk of adverse effects is even greater if lost water is not replaced. Body temperature rises, and the person is at risk for heat exhaustion or heatstroke. Heatstroke may occur in older adults or ill people during prolonged periods of heat; it can also affect athletes and laborers when their heat production exceeds the body’s ability to dissipate heat.

Consuming adequate amounts of cool liquids, particularly during strenuous activity, reduces the risk of adverse effects from heat. Balanced electrolyte solutions and carbohydrate-electrolyte solutions such as sports drinks are recommended because they replace both water and electrolyte lost through sweat.

LIFESTYLE
Other factors such as diet, exercise, and stress affect fluid, electrolyte and acid-base balance.

The intake of fluids and electrolytes is affected by diet. People with anorexia nervosa or bulimia are at risk for severe fluid and electrolyte imbalance because of inadequate intake or purging regimens (e.g. induced vomiting, use of diuretics and laxatives). Seriously malnourished people have decreased serum albumin levels, and may develop edema because the osmotic draw of fluid into the vascular compartment is reduced. When calorie intake is not adequate to meet the body’s needs, fat stores are broken down and fatty acids are released, increasing the risk of acidosis.

Regular weight-bearing physical exercise such as walking, running, or bicycling has a beneficial effect on calcium balance. The rate of bone loss that occurs in postmenopausal women and older men is slowed with regular exercise, reducing the risk of osteoporosis.

Stress can increase cellular metabolism, blood glucose concentration and catecholamine levels. In addition, stress can increase production of ADH, which in turn decreases urine production. The overall response of the body to stress is to increase the blood volume.

Other lifestyle factors can also affect fluid, electrolyte, and acid-base balance. Heavy alcohol consumption affects electrolyte balance, increasing the risk of low calcium, magnesium, and phosphate levels. The risk of acidosis associated with breakdown of fat tissue also is greater in the person who drinks large amounts of alcohol.

According to the Philippine Overseas Employment Administration, the top six countries which employ Filipino nurses are the United States, Saudi Arabia, United Arab Emirates, United Kingdom, Taiwan and Ireland.

The United States and the United Kingdom seem to be the most popular target work locations for Filipino nurses.  In the US, some nurses are paid by the hour and there those who get fixed monthly salaries.  On the average, nurses paid by the hour earn an income of about $53,595 a year; while those who occupy salaried positions receive an annual salary of $65,065.

Hourly nurses work either on full-time or part-time basis.  The average base rate per hour is said to be $19.00 while part-timers are offered as much as $35.10 per hour.  Part timers are paid more since they do not have health insurance and other employee benefits enjoyed by full-time nurses.  Rates are also higher for nurses who work on graveyard shifts and even higher for shifts during weekends.

Just like other jobs, more experience commands higher pay.  More experienced nurses are offered an average hourly rate of $30.65 The median salary for nurses with 1-4 years experience is about $45,000.

Locality also affects the salary of nurses.  Rates differ from one state to another.  The top five states where nurses are in demand are New York, California, Illinois, New Jersey and Massachusetts.  Larger cities offer higher salaries for nurses but of course, working in larger cities means a more stressful workload. The median salary in New York is $54,000 and $50,000 in California.

Facilities in suburban areas pay their nurses more compared to facilities in urban and rural areas.   Nurses in suburban facilities are said to be paid at an average of $30.30 per hour which is $1.05 more than what nurses in urban facilities earn. Those in rural facilities earn $5.30 less than nurses in suburban facilities.

Nurses are also paid depending on their specialty.  OR nurses earn the most, followed by nurses working in ambulatory surgery/outpatient settings, ICU/CCU, OBG/newborn care and medical/surgery nurses.

In the United Kingdom, the National Health Service created the Agenda for Change program which recommends the pay and career structure for nurses.  Nurses are classified from grade A to grade I.  Newly registered nurses begin at grade D.  Grade D nurses are those with limited duties and who work with a senior practice nurse.  The starting base pay for a grade D nurse is £17,057 with an hourly rate of £8.73.  Grade I nurses receive the highest pay.  Their starting base pay is £29,512 with an hourly rate of £15.11.

Of course, private hospitals pay higher rates than NHS facilities.  The Agenda for Change pay scale can be used as a gauge on how much nurses earn in the UK.

Requirements for nurses in the US are quite stringent compared to the requirement imposed in the UK.  In order to work as a full-time nurse in the US, an English proficiency examination (TOEFL or IELTS) and a competency test (NCLEX) must be passed. These examinations are quite rigid. In the UK, nurses are accepted as long as they have at least two years of work experience.

Date posted: 11/18/2006 

CLINICAL MANIFESTATIONS
·    Lower right quadrant pain usually accompanied by low-grade fever, nausea, and sometimes vomiting.
·    At McBurney’s point (located halfway between the umbilicus and the anterior spine of the ilium), local tenderness with pressure and some rigidity of the lower portion of the right rectus muscle.
·    Rebound tenderness may be present; location of appendix dictates amount of tenderness, muscle spasm, and occurrence of constipation or diarrhea.
·    Rovsing’s sign (elicited by palpating left lower quadrant, which paradoxically causes pain in right lower quadrant).
·    If appendix ruptures, pain becomes more diffuse; abdominal distention develops from paralytic ileus, and condition worsens.

ASSESSMENT AND DIAGNOSTIC METHOD
·    Diagnosis is based on a complete physical examination and laboratory and radiologic tests.
·    Leukocyte count greater than 10,000/mm3; neutrophil count greater than 75%; abdominal radiographs, ultrasound studies, and CT scans may reveal right lower quadrant density or localized distention of the bowel.

GERONTOLOGIC CONSIDERATIONS
In the elderly, signs and symptoms of appendicitis may vary greatly. Signs may be very vague and suggestive of bowel obstruction or another process; some patients may experience no symptoms until the appendix ruptures. The incidence of perforated appendix is higher in the elderly because many of theses people do not seek health care as quickly as younger people.

MEDICAL MANAGEMENT
·    Surgery is indicated if appendicitis is diagnosed and should be performed as soon as possible to decrease risk of perforation.
·    Administer antibiotics and intravenous fluids until surgery is performed.
·    Analgesic agents can be given after diagnosis is made.

COMPLICATIONS OF APPENDECTOMY
·    The major complication is perforation of the appendix, which can lead to peritonitis or an abscess.
·    Perforation generally occurs 24 hours after onset of pain (symptoms include fever (37.7°C [100°F] or greater), toxic appearance, and continued pain or tenderness).

NURSING MANAGEMENT
·    Nursing goals include relieving pain, preventing fluid volume deficit, reducing anxiety, eliminating infection due to the potential or actual disruption of the gastrointestinal tract, maintaining skin integrity, and attaining optimum nutrition.
·    Preoperatively, prepare patient for surgery, start intravenous line, administer antibiotic, and insert nasogastric tube (if evidence of paralytic ileus). Do not administer an enema or laxative (could cause perforation).
·    Postoperatively, place patient in semi-Fowler’s position, give narcotic analgesic as ordered, administer oral fluids when tolerated, give food as desired on day of surgery (if tolerated). If dehydrated before surgery, administer intravenous fluids.
·    If a drain is left in place at the area of the incision, monitor carefully for signs of intestinal obstruction, secondary hemorrhage, or secondary abscesses (eg. fever, tachycardia, and increased leukocyte count).

PROMOTING HOME AND COMMUNITY-BASED CARE

Teaching Patients Self-Care
·    Teach patient and family to care for the wound and perform dressing changes and irrigations as prescribed.
·    Reinforce need for follow-up appointment with surgeon.
·    Discuss incision care and activity guidelines.
·    Refer for home care nursing as indicated to assist with care and continued monitoring of complications and wound healing.

NURSING ALERT:
a.    Warm water should not be used if considerable congestion is already present.
b.    The patient should be observed closely for signs of weakness and faintness.
c.    After the patient is in the tub or the chair, check to see whether or not there is pressure against the patient’s thighs or legs.
d.    Support patient’s back in the lumbar region.

CHARTING:
a.    Type of solution
b.    Length of time of application
c.    Type of heat application
d.    Condition and appearance of wound
e.    Comfort of patient

EQUIPMENT: Available bathroom with appropriate size tub for patient.
a.    Towels and bathmat
b.    Bath blanket
c.    Inflatable ring
d.    Patient’s clean clothes

ACTION
1. Check physician’s order for sitz bath patient.
Rationale:   To know if it is indicated for the patient.

2. Prepare the materials needed:
a.    Take linen to bathroom.
b.    Fill clean tub about one-third full with warm
water.
c.    Check with your hand to determine that temperature
Of water is between 105°F and 110°F (40.5°C to 43.3°C).
d.    Place towel or inflatable ring, if appropriate, on tub
bottom and bathmat on floor beside tub.
Rationale: To save time and effort

3. Explain purpose and procedure to patient.
Rationale: For the patient to be aware on the purpose and procedure.

4. Instruct patient top undress.
Rationale: Undress everytime you take a bath (especially the hip is exposed)

5. Test the water in a sitz with a thermometer before the patient enters the tub. If the purpose of the sitz bath is to
apply heat, water at a temperature of 43°C to 46°C for 15 minutes will produce relaxation of the parts involved after a short contraction. Warm water should not be used if considerable congestion is already present. If the purpose of the sitz bath is to produce relaxation or to help promote healing in a wound by cleaning it of discharge and debris, then water at a temperature of 34°C to 37°C is used.

6. Assist the patient into the tub and position him properly. Check to see whether there is pressure against the patient’s thighs or legs. If the patient’s feet do not touch the floor, and the weight of the legs is resting on the edge of the tub, a stool should be used to support the feet and to relieve the pressure on the back of the legs. It may also be necessary to place a towel in the water to support the patient’s back in the lumbar region. The bath can seem very long if one’s body is not in good alignment and comfortable.

7. Wrap a bath blanket around the patient’s shoulders, and drape the ends over the tub. This protects the patient’s from feeling chilly and form exposure.

8. Observe the patient closely for signs of weakness and fatigue. A cold compress may be placed at the back of the neck or forehead, to help prevent the patient from feeling weak. Discontinue the bath if the patient’s condition warrants. Typical signs of faintness include skin pallor, a rapid pulse rate, and nausea.

9. Test the water in the tub several times, and keep it at the desired temperature. Additional hot water may be added by pouring it slowly form a pitcher or by opening a hot-water fauce a little bit. The water should be agitated by stirring it as hot water and added to prevent burning the patient.

10. Do not leave the patient alone unless it is absolutely certain that it is safe to do so.

11. Help the patient out of the tub when the bath is completed. Normally, a hot sitz bath should be continued for 15 to 30 minutes. Help the patient dry, and cover the patient adequately.

12. Assist the patient to his bed, where it is best for him to lie down, and out of drafts until normal circulation returns.