 Welcome to Nursing School Explained and this video on application of an ACE WRAP. ACE WRAPs are indicated in many musculoskeletal injuries and they can provide a nice support for the affected joint of the patient. So we'll take a look on how to apply it to different joints, specifically the ankle as well as the knee today in this video. Keep in mind that whenever we apply an ACE WRAP we always want to start from the most distal end and work our way up to the proximal part of the joint because we want to kind of promote the blood flow as we're applying the ACE WRAP. If we went the other direction it would be kind of, it would be in danger of kind of trapping the blood down there, especially if the joint is affected in such a way that it's swollen or there is some hematoma. So always from the distal to the proximal end and we'll take a look at it here in a practical application. So first we'll remove the patient's sock here and we'll support the affected joint as best as we can so that we're not causing any additional pain for the patient. And then once we make this loud popping noise, the ACE WRAP's most of them have a Velcro at the very beginning and then on the inside so at the very end. And it's nice because the Velcro will stick to the ACE WRAP itself right here and actually it's set up in such a way that the end will unroll exactly in such a way that you can then put the Velcro on the ACE WRAP and you won't need any additional adhesives or any tools that will help you keep it in place. So like I mentioned before we always want to work our way from the more distal to the proximal part of the patient. And for an ankle it's always beneficial if we wrap it in a what's called a figure eight form. So we're going to go around the foot then around the anterior foot here and then around the back of the foot here with the Achilles tendon and then come around in such a way that we're really supporting this joint right here. So I'm going to start by gently putting some or extending this elastic here on the wrap and putting it tight but not too tight and that's always a matter of practice in order for you to figure out what the right amount of tightness is. Of course we also can always ask our patient for feedback. In case this wrap didn't have the Velcro right here I could just tuck it underneath and then secure it twice around which will give me a nice base light here. So then from here I will wrap it could you bend your knee a little bit and just put the foot there you go. I will wrap it around the ankle and then I'll come back and I'll go around the front of the foot and I'll always gently apply pressure so the elastic will stretch so that it'll have a nice support for our patient here. Now once I notice that I'm coming to the end of the ace wrap here I will stop here at the top of the ankle which is more of the proximal part and here is that part of the Velcro that I was talking about earlier so we can gently undo it and then just apply it on itself which will make it work really well and then we'll gently support the patient's leg again and now we have the ace wrap applied the heel will look out but the ace wrap is nicely supporting the ankle right here. As always with any muscular skeletal injury we want to check the five piece after the application of any kind of supportive device whether that's an ace wrap a splint some sort of a knee brace for example and in this case we're going to check the five piece right now which are pain pallor paralysis pulse and peristhesia so in this case since I just applied the ace wrap and I know that there's not an open wound or any kind of injury right here I can actually gently lift up the ace wrap and slide my fingers underneath and feel for the patient's a pedal pulse to make sure that the wrap is not too tight and that's right here that's really nice in case that wasn't an option where I couldn't feel for the pedal pulse I can always check the patient's cab refill but I need to make sure that I check all five toes because the support here is around the ankle and so all five toes could be affected. So rather than pinching the toe nail I personally like to pinch the top of the toe which gives me a little bit of a better look right here plus if the patient had some nail polish for example or some fungus there it would be really hard to see it. Okay so that's our pulse our circulation I can see the patient's foot is maybe a little bit pale but it didn't change from pre-application of the ace wrap and in this case the color is normal for this particular patient and then in terms of paralysis so I'm going to ask him to move can you wiggle your toes please excellent so those are there and then in terms of peristhesia we'll need to ask for numbness and tingling do you feel any numbness or tingling in your foot? No. Excellent and now I'm going to touch you all five toes and let me know if you can feel that please can you feel me touch you here? Yes. And here? Yes. And here? Yeah. And here? Yes. And here? Yep. Okay great so I want to make sure that I touch all five toes again to make sure that I didn't pinch the nerve or cut off any circulation here and again all five toes it's important because the wrap affects the entire ankle here so we've checked for paralysis peristhesia we've checked the pulse we've checked the color and then the pain is this causing you any pain right now? No. Okay very good so here we are with our ace wrap on the ankle now let's look at how we apply it on the knee so now we're applying ace wrap to the knee in this case we just applied it to the ankle where we kind of went about it in this figure eight motion that's not really that much of an option on the knee and it's actually a little bit simpler on the knee so I'm going to just slide your shorts up here a little bit to expose the knee all the way and remember we want to support the joint here so I always want to go a little bit above and below the affected joint starting at the more distal end of the joint and then working my way up again this ace wrap here has the velcro so I'll make sure to start it out the right way can you please bend your leg a little bit and just set the heel on the table there we go thank you if this was like a severe injury with a patella fracture I would have a second person here supporting the leg while I apply the ace wrap to make sure that we're not hurting our patient so then again I'll apply it down here at the distal end first applying some gentle tension to that elastic securing it with the velcro here if I didn't have the velcro I'll just go a second round I kind of like to do that anyway because it just holds it in place a little bit better and then I'll work my way up here around the knee joint overlapping each elastic each ace wrap with the previous strip and as you can see it's about halfway so I'm starting with half the ace wrap and then overlapping the half of the one that I just previously placed and I'll continue working my way up here until again I'll find the velcro on the other end loosen that up and then secure it to the ace wrap itself now in this case if this was a significant knee injury I might want to double up and use a second ace wrap maybe start here and then work my way up also be careful if you apply the velcro that you're not applying it to the patient's hair because that might be very tender when it comes off it might just get tangled so now we're done with this you can straighten up out your leg and then we'll take care of our patient as always and it might have to be adjusted when the patient gets up because with gravity it might want to slide down or you might need another ace wrap to secure it it just really depends on the patient's activity level and how much pressure they're able to tolerate and then again just like we did in the ankle wrap we need to make sure we check the five p's again but I'm not going to demonstrate that because we already did that and it's the same exact thing because we have the same affected left extremity here for our patient so thank you for watching this video on nursing school explain and how to apply an ace wrap please also check out the other videos in the skills checklist and I'll see you soon right here on nursing school explain thanks for watching