Chapter 54 Heat and Cold Applications

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 54

Heat and Cold Applications

Chapter 54

Heat and Cold Applications


NormothermiaNormothermia

• Normothermia or normal body temperature

– Body temperature must be maintained.

– Important during and after invasive procedures

– Helps prevent surgical site infections (SSI)

• Hypothermia

• Hyperthermia


HeatHeat

• Heat causes vasodilation, increasing blood flow to a specific area.

– Increases the oxygen, nutrients, and various blood cells delivered to body tissues

– Aids in removal of wastes from injured tissues, such as debris from phagocytosis


Rationale for Heat ApplicationRationale for Heat Application

• *Heat application serves to

– Relieve local pain, stiffness, or aching, particularly of muscles and joints

– Assist in wound healing

– Reduce inflammation and infection

– Make the chilly client more comfortable

– Raise body temperature to help maintain normothermia

– Promote drainage


In Practice: Using an Aquathermia (Aqua-K) PadIn Practice: Using an Aquathermia (Aqua-K) Pad

• Used to treat muscle sprains and mild inflammations and for pain relief

• See NURSING ALERT BOX!

• Refer to Nursing Procedure 54-1.

• Cover the pad with a pad cover, sheet, pillowcase or towel

• May also use on top of a warm, moist pack if ordered


Methods of Heat TherapyMethods of Heat Therapy

• Dry heat

– Aquathermia (aqua-K) pad uses water to transport heat but heat is not a “moist” heat therapy

– Heat lamps

– Ultrasound

– Heat cradle

• Moist heat

– Warm, moist compresses, packs, and soaks


Heat Lamp Treatments and UltrasoundHeat Lamp Treatments and Ultrasound

• Infrared rays (IR)

– Relax muscles, stimulate circulation, and relieve pain

• Ultraviolet rays (UV)

– Not as penetrating as infrared rays

• Ultrasound (US)

– Way of applying deep, penetrating heat to muscles and tissues


Heat Lamp Treatments and Ultrasound, cont.Heat Lamp Treatments and Ultrasound, cont.

• Heat cradle

– Lamp, light bulb, or special heater mounted on the inside of a bed cradle

– Requires physician order

– Specific distance, lamp wattage, and timing of treatment monitored closely


Electric Heating PadElectric Heating Pad

• Unsafe for

– Children

– Confused, irrational, or unresponsive persons

– Suicidal clients

– Clients with spinal cord injuries


Moist HeatMoist Heat

• Warm, moist compresses, packs, and soaks

• Used for

– Stimulating circulation

– Easing pain

– Promoting wound drainage

– Applying medications


Warm SoaksWarm Soaks• Helps improve circulation

• Increases blood supply to an infected area

• Assists in breaking down infected tissue

• Applies medications

• Cleans draining wounds

• *Loosens scabs and crusts from encrusted wounds

• May be combined with a whirlpool bath

• Temp should not be greater than 40.5 C or 105 F

• Test water temp frequently, add hot water slowly and stir to distribute heat evenly


Sitz Bath Sitz Bath

• Use of a tub or basin filled with warm, circulating water

• Plastic tub often sent home with client


Nursing AlertNursing Alert

• Vasodilation from heat application over a large area of the body may cause hypotension (low blood pressure).

• All clients should be monitored closely and assisted when rising.

• Rationale: This helps to prevent injuries.

• Heat application may be contraindicated in clients with known cardiac conditions or those taking certain cardiac medications or antihypertensives


Nursing Alert, cont.Nursing Alert, cont.

• The application of heat is almost always contraindicated if a client is actively bleeding.

• Rationale: Heat application can increase blood flow and thus increase the bleeding.


ColdCold

• Cold causes vasoconstriction (shrinkage of blood vessels), decreasing blood flow to an area and slowing the body’s metabolism and its demand for oxygen.

• The therapeutic goals of cold applications

– Controls hemorrhage

– Reduces edema

– Eases inflammation

– Blocks pain receptors


Rationale for Cold ApplicationRationale for Cold Application

• Slows or stops bleeding and bacterial activity

• Relieves pain

• Reduces swelling in injured tissues

• Prevents peristalsis

• Controls pain and fluid loss

• Diminishes muscle contraction and muscle spasms

• Slows the basal metabolism for certain types of surgery


Nursing care guidelines 54-2Nursing care guidelines 54-2

• Stop cold application immediately if the client complains of numbness or the skin appears white or spotty

• Cold often is applied to a sprain, strain, fracture or burn


Specific Cold TherapiesSpecific Cold Therapies

• Cold, moist compresses

• Icecap or ice collar

• Single-use and refreezable ice packs

• Tepid sponge bath

• Hypothermia blanket (cooling blanket)


The Icecap and the Ice CollarThe Icecap and the Ice Collar

• Icecap

– Round, flat rubber bag with a leak proof, screw-in top

• Ice collar

– Narrow rubber or plastic bag, curved to fit the neck


Applying cold, moist compressesApplying cold, moist compresses

• Put compress in basin containing pieces of ice and small amount of water

• Wring the compress thoroughly and apply

– If ice water drips, it may startle client

• Continue tx as ordered

– Repeat q 2-4 hours as ordered


Nursing AlertNursing Alert

• Many ice bags, particularly ones with the capsule or crystals, become very cold.

• They can cause frostbite fairly quickly.

• Therefore, use extreme caution when applying these.

• **If the client’s skin becomes blanched or extremely red, discontinue treatment immediately and check to see what should be done.


Tepid Sponge BathTepid Sponge Bath

• Bath with water below body temperature, usually in the range of 80° to 95° F

• Sponge each limb for 5 minutes and the back and buttocks for 10-15 minutes

• STOP the procedure if the client becomes chilled or begins to shiver!


Hypothermia Blanket, Cold Humidity, and CroupetteHypothermia Blanket, Cold Humidity, and Croupette

• Hypothermia blanket (cooling blanket)

– Plastic mattress pad through which very cold water flows continuously

• Ensure temp does not go too low!


Cold HumidityCold Humidity

• Cold humidity

– For clients with breathing disorders

• Croupette or a humidity (mist) tent

• Trach mask

• Face tent

• Oxygen administered to all clients must be humidified to prevent drying of the mucous membranes of the nose and throat.


NURSING PROCEDURES NURSING PROCEDURES

• 54-3: administering a tub soak to an arm or leg

– TEMP should be approx. 105 degrees F

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Chapter 54 Heat and Cold Applications