Heat And Cold Application

aileen s.adrales, rn 1

• One of the most common independent nursing action aileen s.adrales, rn 2

•Heat and cold are applied to the body for local and systemic effect aileen s.adrales, rn 3

Impulses- periphery to hypothalamus and cerebral cortex- Hypothalamusinitiates heat producing or heat reducing reactions of the body aileen s.adrales, rn 4

Local responses to heat and cold occur through stimulation of temperaturesensitive receptors in the skin. aileen s.adrales, rn 5

LOCAL EFFECTS OF HEAT AND COLD APPLICATIONS aileen s.adrales, rn 6

LOCAL EFFECTS Heat Therapy 1. Promote vasodilation 2. Promotes tissue healing 3. Increase suppuration 4. Increases capillary permeability aileen s.adrales, rn 7

LOCAL EFFECTS Cold Therapy 1. Lowers temperature of the skin and underlying tissue 2. Causes vasoconstriction =Reduces blood flow to the affected area. 3. Produces skin pallor and coolness 4. Prolonged exposure can damage skin tissue from lack of oxygen and nourishment 5. Local anesthetic aileen s.adrales, rn effects. 8

SYSTEMIC EFFECTS OF HEAT • If applied over large area, may cause excessive peripheral vasodilation and drop in blood pressure. aileen s.adrales, rn 9

SYSTEMIC EFFECTS OF COLD • With extensive application – vasoconstriction- causes blood to shunt from peripheral circulation to internal blood vessels – causing blood pressure to increase shivering. aileen s.adrales, rn 10

PHYSIOLOGIC EFFECTS OF HEAT AND COLD APPLICATION aileen s.adrales, rn 11

PHYSIOLOGIC EFFECTS COLD HEAT 1. Vasoconstriction 1. Vasodilation 2. Increases capillary 2. Decreses capillary permeability permeability 3. Decreases cellular 3. Increases cellular metabolism metabolism 4. Slows bacterial 4. Increases growth, decreases inflammation inflammation 5. Local anesthetic 12 5. Sedative effect aileen s.adrales, rn effect

FACTORS AFFECTING HEAT AND COLD TOLERANCE aileen s.adrales, rn 13

FACTORS AFFECTING HEAT AND COLD TOLERANCE 1. Body part – Certain areas of the skin have a sensitivity to temperature variations. – The inner aspect of the wrist and forearm, the neck, and the perineal area are temperature-sensitive, while the back of the hand and the foot are not as sensitive. aileen s.adrales, rn 14

FACTORS AFFECTING HEAT AND COLD TOLERANCE 2. Area of body exposed: –The larger the area exposed to heat and cold, the lower the tolerance to temperature changes. aileen s.adrales, rn 15

FACTORS AFFECTING HEAT AND COLD TOLERANCE 3. Individual tolerance – Tolerance to temperature variations is affected by age and physical condition. aileen s.adrales, rn 16

FACTORS AFFECTING HEAT AND COLD TOLERANCE 4. Duration of application: –Tolerance increases as the length of exposure increases. aileen s.adrales, rn 17

FACTORS AFFECTING HEAT AND COLD TOLERANCE 5. Intactness of the skin –Injured skin areas are more sensitive than intact areas to temperature variations. aileen s.adrales, rn 18

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THERMAL TOLERANCE aileen s.adrales, rn 21

THERMAL TOLERANCE 1. 2. 3. 4. 5. Neurosensory impairment Impaired mental status. Impaired circulation. Immediately after injury or surgery. Open wounds. aileen s.adrales, rn 22

•Heat and cold can be applied in dry and moist forms • The type of wound or injury, location, and presence of drainage or inflammation are considered when selecting moist or dry applications. aileen s.adrales, rn 23

Box 34-9 Selected Indications of Heat and Cold aileen s.adrales, rn 24

Box 34-4 Contraindications to the Use of Heat and Cold aileen s.adrales, rn 25

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Methods for Applying Dry and Moist Heat Dry heat Hot water bottle/bag Aquathermia pads Electrical heating pads Moist heat Warm Compress

Hot pack

27 aileen s.adrales, rn

Warm Soaks

Disposable heat/hot pack s

Sitz bath

Methods for Applying Dry Heat Dry heat Hot water bottle 28 aileen s.adrales, rn

Hot water bag • Fill two-thirds full with warm water and remove air at the top so the bag is easier to mold over the body part. • Cover bag with a towel or pillowcase (never apply directly on the skin surface). • Keep bag in place for 20–30 minutes and then remove. • Do not allow the client to lie on the hot water bag. s.adrales, rn aileen 29

Methods for Applying Dry and Moist Heat Dry heat Aquathermia pad 30 aileen s.adrales, rn

Aquathermia pads • Are useful in treating muscle sprains and for areas with mild inflammation or edema. • The desired temperature is usually set with a key at 45°C for adults. • Cover the pad with a thin cloth or pillowcase prior to application. • Treatment usually continues for 20–30 minutes. • Do not have client lie on pad. aileen s.adrales, rn 31

Methods for Applying Dry and Moist Heat Dry heat Disposable heat pack 32 aileen s.adrales, rn

Hot packs • Commercially prepared, disposable hot packs supply warm dry heat to an injured area. • Striking or squeezing the pack will release chemicals that create the heat. aileen s.adrales, rn 33

Methods for Applying Dry and Moist Heat Dry heat Electric pad 34 aileen s.adrales, rn

Electrical heating pads • Provide constant, even heat, are lightweight, and can easily be molded to a body part. • Unit composed of electrical coil enclosed within a waterproof pad covered with cotton or flannel cloth. • Instruct the client to avoid using high setting, to prevent burns. • Do not insert sharp objects into the pad. • Do not allow the client to lie directly on the pad, because heat will not dissipate and the client 35 may be burned. aileen s.adrales, rn

Methods for Applying Dry and Moist Heat Moist heat Compress 36 aileen s.adrales, rn

Warm compresses • Warm compresses (gauze dressing moistened in a prescribed warmed solution) • Applied to improve circulation, relieve edema, and hasten the suppurative process and healing. • For an open wound, use sterile technique. • Remove compress after 20–30 minutes and redress wound aileen s.adrales, rn 37

Methods for Applying Dry and Moist Heat Moist heat Hot pack 38 aileen s.adrales, rn

Moist heat Soak Methods for Applying Dry and Moist Heat 39 aileen s.adrales, rn

Warm soaks Cold soaks • Immersion of body part in warmed solution promotes circulation, decreases edema, increases muscle relaxation, and provides a means to debride wounds and apply medicated solution. • Can also be accomplished by wrapping body part in dressings and saturating them with warmed solution. aileen s.adrales, rn 40

Warm soaks Cold soaks • Position client comfortably, place waterproof pads under the area to be treated. • Sterile technique is generally indicated for open wounds, such as a burn. Check agency protocol regarding the temperature of the solution. aileen s.adrales, rn 41

Sitz Bath aileen s.adrales, rn 42

Definition A sitz bath (also called a hip bath) is a type of bath in which only the hips and buttocks are soaked in water or saline solution. Its name comes from the German verb "sitzen," meaning "to sit." aileen s.adrales, rn 43

Warm soaks Cold soaks • Used for clients who have had rectal surgeries, an episiotomy during childbirth, painful hemorrhoids, or vaginal inflammation. • Only the client’s pelvic area is immersed in warm fluid; the client sits in a special tub or chair or in a basin placed on the toilet seat so that the legs and feet remain out of the water (immersing the entire body causes widespread vasodilation, negating the effect of local heat to the perineum or pelvic area). • Duration of the bath is usually 15– 20 minutes. aileen s.adrales, rn 44

Warm soaks Cold soaks • Prevent overexposure and chilling by draping a bath blanket • over the client’s shoulders and thighs, and prevent drafts. • • Assess the client during the bath for extensive vasodilation, • faintness, dizziness, weakness, increased pulse rate, and pallor. aileen s.adrales, rn 45

Methods for Applying Dry Cold • Dry cold –Cold pack –Ice bag –Ice glove –Ice collar aileen s.adrales, rn 46

Ice bag, ice collar • Fill two-thirds full with crushed ice so bag is easier to mold over body part. • Cover bag with towel or pillowcase and apply to affected on the skin surface). area for 30 minutes. 47 aileen s.adrales, rn

Ice bag, ice collar • Provides cold to localized area (e.g., muscle sprain,hematoma) to prevent edema formation, control bleeding, and anesthetize body part. aileen s.adrales, rn 48

Cold packs • Commercially prepared, singleuse ice packs provide cold for designated period of time. • When the pack is squeezed or kneaded, an alcohol-based solution is released, creating the cold temperature. aileen s.adrales, rn 49

Cold compresses • Applied to either decrease or prevent bleeding and to reduce inflammation. • Procedure similar to that for warm compresses applied for 20 minutes at a temperature of 15°C (59°F). • Technique may be clean or sterile. aileen s.adrales, rn 50

Cold soaks • Procedure similar to that for warm soaks. • Desired temperature for a 20minute soak is 15°C (59°F). • • Take precautions (such as preventing drafts and draping shoulders) to prevent client from chilling. aileen s.adrales, rn 51

Dry heat applications Water is not in contact with the skin. The application stays at the desired temperature longer. Dry heat does not penetrate as deeply as moist heat. Dry heat needs higher temperatures to achieve the desired effect. Burns are a risk. aileen s.adrales, rn 52

Dry Heat Application 1. Direct Application • Hot Water Bag/bottle • Electric heating pad aquatherma pad • Disposable Heat Pad aileen s.adrales, rn 53

Dry Heat Application 2. Indirect Application • Heat Lamp • Heat Cradle aileen s.adrales, rn 54

1. To dilate blood vessels in the area 2. To encourage suppuration 3. To dry weeping or draining wounds aileen s.adrales, rn 55

To reduce swelling or pain 5. To increase joint flexibility 6. To promote healing 4. aileen s.adrales, rn 56

Moist Heat Application •With a moist heat application, water is in contact with the skin. • Moist heat has greater and faster effects than dry heat. •Heat penetrates deeper with a moist application. • To prevent injury, moist heat applications have lower temperatures than dry heat applications. aileen s.adrales, rn 57

Moist Heat Application a.Compresses – moist dressing or washcloth applied to a small body area & changed frequently during the designated application time b.Pack – moist dressing or towel applied to a large body area aileen s.adrales, rn 58

Moist Heat Application c. Soak – a warm or hot solution of tap water, normal saline or prescribed medication, in which a body part is immersed a sterile /unsterile gauze dressing saturated with solution in which a body part is wrapped d. Sitz bath – used to soak a patient’s perineal area s.adrales, rn aileen 59

1. To relieve pain and enhance client comfort 2. To promote healing, softens exudates 3. o clean the wound of tissue debris or exudate 4. To apply medication to large skin areas 5. To relax muscles aileen s.adrales, rn 60

Things to Watch Out for during Sitz Bath • Temperature of water is uncomfortable (clamp tubing, disconnect water bag, refill with water that is comfortable for patient) aileen s.adrales, rn 61

1. Vasoconstriction 2. Reduces nerve transmission aileen s.adrales, rn 62

Cold Applications Cold applications are used to: 1. Treat sprains and fractures. 2. Reduce pain, prevent swelling, and decrease 3. circulation and bleeding. • Cool the body when fever is present. • Cold has the opposite effect of heat. • When cold is applied to the skin, blood vessels constrict. • Cold applications are useful right after an aileen s.adrales, rn injury. 63

1.Dry Cold – ice bag, ice collar, ice glove, disposable cold packs 2.Moist Cold – cold compress, packs, cooling sponge, tub baths using: water (ideal) sponge bath 29ºC - 32ºC water and ice aileen s.adrales, rn 64

Dry Cold Application Taylor’s pp 311-314 aileen s.adrales, rn 65

Complications include: 1. 2. 3. Pain Burns and blisters • From intense cold • When dry cold is in direct contact with the skin Poor circulation When cold is applied for a long time, blood vessels dilate. Clients at risk for complications include: 1. Older and fair-skinned clients 2. Clients with sensory impairments aileen s.adrales, rn 66

1.To reduce marked elevations in body temperature 2.To relieve local swelling and pain aileen s.adrales, rn 67

Patients At Risk for Burns or Tissue Injury from Heat or Cold Therapy 1.Elderly patients/ clients 2.Pediatric patients aileen s.adrales, rn 68

Patients At Risk for Burns or Tissue Injury from Heat or Cold Therapy 3. Patients with open wounds, stomas, or broken skin 4. Patients with peripheral vascular problems (ex. Diabetes) aileen s.adrales, rn 69

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1. Read the physician’s orders for specific instructions (frequency, type of therapy, body area, length of time) 2. Gather equipments: Hot Water Bag Absorbent cloth aileen s.adrales, rn 71 Taylor’s pp. 299-302

Filling the water bag: • Fill the hot water bag with hot tap water to warm the bag •Then empty it to detect any leaks •Check temp of water with thermometer ( 46˚C or 115°F to 125°F) or test on your inner wrist aileen s.adrales, rn 72

•Fill the bag with one-half to 2/3 full of water •Squeeze the bag until water reaches the neck •Fasten the top and cover bag with absorbent cloth aileen s.adrales, rn 73

3. Identify patient and explain procedures 4. Assess condition of the skin where heat is to be applied (rash, irritation, excoriation) aileen s.adrales, rn 74

excoriation rash aileen s.adrales, rn 75

5. perform hand hygiene 6. close door, curtains. Bed in comfortable height 7. assist to a comfortable position to access the area to be treated. Expose area and drape patient. Put water proof pad under wound to protect the bed. aileen s.adrales, rn 76

8. apply the hot water bag 9. assess the condition of the skin and the patients response to the heat at frequent intervals (5 minutes). Do not exceed the prescribed length of time for the application 10. remove after the prescribed amount of time aileen s.adrales, rn 77

11. hand hygiene 12. document the procedure, the patient’s response, and your assessment of the area before and after the application aileen s.adrales, rn 78

Procedure in Moist Heat Compress or Packs Application 1. review the doctors order (frequency, type of therapy, body area to be treated, length of time) 2. gather supplies: basin, prescribed solution, clean towel or washcloth, bath blanket 3. identify patient and explain procedure 4. assess condition of skin to be treated/H aileen s.adrales, rn 79

Procedure in Moist Heat Compress or Packs Application 5. Place a waterproof pad under patient to protect linen from spillage 6. Use sterile technique if patient has an open wound 7. If using clean technique, place a clean towel or wash cloth in warm solution 8. Don gloves to remove dressings; discard dressings and gloves aileen s.adrales, rn 80

Procedure in Moist Heat Compress or Packs Application 9. Don sterile gloves if necessary; wring out hot compress with forceps; wring out a warm clean towel/washcloth by hand 10. Apply the towel, washcloth over the affected area for several seconds; check skin for redness aileen s.adrales, rn 81

Procedure in Sitz Bath Application 5. Raise lid of toilet. Place bowl of sitz bath with drainage ports to rear and infusion port in front. Fill bowl sitz bath about half way full with tepid to warm water ( 37C to 46C). aileen s.adrales, rn 82

Procedure in Sitz Bath Application 6. Clamp tubing on bag. Fill bag with same temp of water as above. Hang bag above patient’s shoulder height on hook or IV pole 7. Assist patient to sit on toilet. Insert tubing into infusion port. Slowly unclamp tubing and allow sitz bath to fill aileen s.adrales, rn 83

Procedure in Sitz Bath Application 9. When finished, help patient stand and gently pat bottom dry. Assist patient to bed or chair 10. Empty and disinfect sitz bath bowl. Remove gloves, hand hygiene 11. Document sitz bath (water temp, length of bath, how patient tolerated the bath) aileen s.adrales, rn 84

Things to Watch Out for during Sitz Bath • Patient complains of feeling patient ambulate by self. Let patient sit on toilet with face up until feeling subsides or help arrives to assist patient back to bed) aileen s.adrales, rn 85 light headed or dizzy (stop sitz bath. Do not let

Procedure in Dry Cold Application 1. Review the doctors order (frequency, type of therapy, body area to be treated, length of time) 2. Gather supplies: ice bag/collar/glove/ cold pack, towel, bath blanket Taylor’s pp 311-314 aileen s.adrales, rn 86

Procedure in Dry Cold Application 3. Identify patient and explain procedure 4. assess condition of skin where ice is to be applied aileen s.adrales, rn 87

Procedure in Dry Cold Application 5. hand hygiene 6. close door, curtains, bed in comfortable height 7. assist to a comfy position to access the area to be treated. Expose area and drape patient. Put water proof pad under wound to protect the bed. aileen s.adrales, rn 88

Procedure in Dry Cold Application 8. fill the bag about ¾ full with ice. Remove excess ice from device. Securely fasten the end of the bag 9. cover the device with a towel or washcloth 10. put on gloves. Remove and dispose any dressings at the site aileen s.adrales, rn 89

Procedure in Dry Cold Application 11. place the device lightly against area. Remove ice and assess the site for redness after 30 seconds. Ask patient about the presence of burning sensations 12. replace the device snugly against the site if no problems are evident. Secure it in place with gauze wrap or tape. aileen s.adrales, rn 90

Procedure in Dry Cold Application 13. reassess the treatment area every 5 minutes 14. after 20 minutes, remove the ice and dry the skin 15. apply new dressing to site 16. hand hygiene 17. document procedure, patients response, and assessment of area before and after aileen s.adrales, rn 91

1.review the doctors order (frequency, type of therapy, body area to be treated, length of time) 2.Assemble equipment and supplies: ice, water, wash cloth for compress, bath blanket, basin aileen s.adrales, rn 92

3. Explain procedure to patient, provide privacy for the patient 4. Place water and ice into a clean basin 5. Immerse wash cloth 6.Wring a compress or pack thoroughly, and apply it to the affected area aileen s.adrales, rn 93

7. Continue treatment for 20 minutes 8. Do after care. Record patient observations aileen s.adrales, rn 94

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