Applying Heat and Cold notes PDF

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Fundamentals of Nursing Care Applying Heat and Cold 1. Applying Heat and Cold 2. Vasoconstriction vs. Vasodilation  Vasoconstriction o Narrowing of the veins and capillaries o Caused by local application of cold to a site  Vasodilation o Increased capillary permeability and cellular metabolism o Caused by the application of heat to a site 3. Conditions Related to Heat and Cold Application  Edema: swelling due to excessive fluid in the interstitial spaces (During the first 4872 hours do NOT apply heat. This will increase swelling. After the edema has stabilized, heat will dilate the capillaries and veins allowing them to carry away the excess fluid, reducing the edema.)  Mottling: irregular blue or purplish blotches  Pallor: pale or white skin tone  Phlebitis: inflammation of a vein due to IV therapy (You must have an order to apply heat for this. The order can be a standing order or a physician order. There may also be a policy at your facility for use of heat for phlebitis.) 4. Local and Systematic Effects of Heat and Cold Application  Local effects o Affects the body’s cutaneous layers; underlying subcutaneous tissue; and muscles and vascular structures and their functions  Systemic effects o Involves more than a specific area and can affect entire body systems 5. Multiple Choice Question Which of the following is an effect of the application of heat to a body part? A. Decreased blood flow to the site B. Increased permeability of capillary walls C. Edema prevented through vasoconstriction D. Active bleeding stopped (hemostasis) 6. Answer B. Increased permeability of capillary walls Rationale: Heat increases blood flow to the site. Cold therapy helps to prevent edema through vasoconstriction. Vasoconstriction through cold therapy helps to stop active bleeding (hemostasis). 7. Effects of Heat Application 1

Vasodilation of vessels underlying the area Increased flow of oxygenated and nutrient-rich blood to the site Increased permeability of the pores in the capillary walls Increased plasma, red and white blood cells, and nutrients travel from the capillaries into the cells and interstitial spaces between cells 8. Effects of Cold Application  Decreases blood flow to site, decreasing bleeding  Decreases inflammatory response; slows bacterial growth  Decreases capillary permeability and cellular metabolism  Helps prevent edema  Relaxes muscles and decreases pain 9. Indications for the Application of Heat Therapy  Relaxation of muscle spasms  Pain relief  Support of the healing process  Reduction of edema once it has stabilized  Elevation of body temperature 10.Process of Phagocytosis  Increased blood flow delivers the extra phagocytes (WBCs), oxygen, and nutrients that are needed to prevent infection and build new tissue to heal the wound (increased metabolism)  Phagocytes surround, engulf, and digest offending microorganisms and debris in the cells and exudate to prevent infection  Without the increased metabolism, the tissue does not heal properly in a timely manner 11.Contraindications for Heat Therapy (This is only a partial list.)  Suspected appendicitis (This could cause enough increased blood flow to the area that it results in a ruptured appendix.)  Bleeding wound or injury (This would dilate the vessels, increasing the bleeding.)  Newly injured joints (This would increase edema, making joint mobility more difficult.)  Large areas of the body in certain cardiac patients (This can result in massive vasodilation to the superficial skin and subcutaneous layers, depriving the major organs, like the brain, heart, lungs, and kidneys, of adequate blood supply, which can cause serious damage.)  Those with loss of sensation. (unable to feel in injury is occurring due to heat application)    

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12.Methods of Delivering Heat Therapy  Hot water bottles o Fill two-thirds full with warm water, expel remaining air, place cloth between bottle and patient’s skin (to prevent burns)  Commercial heat packs o Activate by squeezing, striking, or twisting (place cloth between pack and patient’s skin)  Heating pads o Keep on low to medium temperature (SAFETY: Never place under the pt., the heat cannot dissipate and may result in severe burns. Do not apply to an infant or a sleeping or confused pt.) 13.Methods of Delivering Heat Therapy (cont.)  Aquathermia pads o Can be used continuously because they maintain a specific temperature (This is a small, electrically heated water storage tank with two tubes connected to a network of tubing inside of a disposable pad. SAFETY: A key must be used to set the temperature dial to prevent inadvertent of pt. changing of the temperature.)  Hypothermia blankets o Usage depends on the design; can be placed either under or over the patient, or both (One kind is a disposable blanket with large tubes; heated air is pumped through them. The blanket is placed on the patient over a sheet with a bath blanket over top of it. It is used on patients who have a temp below 96oF when they come out of surgery. SAFETY: Monitor the pt.’s VS and core temp constantly while using this.) 14.Methods of Applying Moist Heat  Hot compresses o Dip gauze or cloth in hot solution, wring out, and apply to inflamed area (NEVER heat in a microwave to prevent burning your patient.)  Soaks o Submerge patient’s body part in water that is between 105°F and 110°F 15.Methods of Applying Moist Heat (cont.)  Sitz baths o Fill basin with warm water (105°F to 110°F) and set on toilet, unclamp tubing to allow water to flow over perineum  Whirlpools o Generally administered by physical therapy; fill tub with water above level of jets (SAFETY: Children, the elderly, confused, or sedated patients must NEVER be left alone, as the water depth poses a drowning risk.) 3

16.Guidelines For Applying Heat Therapy  Apply for 20 to 30 minutes every 2 to 3 hours  Remember that leaving heat packs in place longer than 45 minutes can cause rebound phenomenon o Constriction of vessels instead of dilation o Can worsen the condition 17.Patient Assessments Made Prior to Application of Heat Therapy  Age (Infants and elderly have very fragile skin.)  Cognitive level of function  Orientation  Sedation  Sensory impairment  Impairment of circulation 18.Skin Assessments for Patients With Diabetes/Peripheral Vascular Disease  Prior to heat applications assess skin for o temperature o color o sensation o edema o integrity 19.True/False Question The skin of elderly patients is thicker; therefore, the temperature should be raised to 115°F for application of heat therapy. A. True B. False 20.Answer B. False Rationale: The skin of elderly patients is thinner and drier, making it easier to damage tissues with heat therapy. The temperature should be lowered to a setting between 95°F and 100°F. 21.Multiple Choice Question Which of the following is a recommended guideline for the safe use of heating pads? A. Lie on top of the heating pad B. Use the heating pad on a new injury C. Set timer for no longer than 30 to 45 minutes D. Use on a low or medium setting

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22.Answer D. Use on a low or medium setting Rationale: the patient should not lie on the heating pad or sleep with it on, the heating pad should not be used on a new injury, and a timer should be set for 20 to 30 minutes on a low or medium setting 23.Assessments Made During Heat Therapy  Reassess the area and surrounding skin in 5 minutes to check for blistering or redness  Check the site every 10 to 15 minutes until therapy is completed  Assess a continuous K-pad hourly  Place patient call light within reach before leaving room 24.Assessments Made Following Heat Therapy Application  Reassess the skin for redness or blistering  Ask the patient if the therapy helped  Evaluate the effectiveness of the treatment 25.Indications for Cold Therapy  Prevention of edema (Vasoconstriction reduces the amount of fluid that leaves the capillaries and leaks into the interstitial space, resulting in less edema. Cold therapy is used for the first 48-72 hours after an injury that could result in swelling or after joint surgery.)  Hemostasis (Helps to stop active bleeding. Used after trauma, dental surgery, tonsillectomies, and to stop nosebleeds.)  Pain relief (Used for hemorrhoidectomy, skeletal surgery incisions, perineal lacerations and episiotomies from childbirth, the forehead and occipital areas for H/A, the face for sinus congestion pain, migraine H/A, TMJ, and chronic back/neck muscle spasms. Used to prevent edema which causes increased pressure on nerve endings.)  Numbing sensation (Helps relieve itching from insect bites or allergic rashes, and minor burns, including sunburn.)  Reduction of muscle spasm (Helps interrupt the cycle of muscle tension and spasm. Treatment of choice if spasm is acute.)  Fever reduction (Ice packs may be placed on the head [with a towel against the skin], in the axillae, and on the inguinal areas. If the pt. begins to shiver, stop, it will cause the temp to increase and requires more oxygen.) 26.Methods Used to Apply Cold Therapy  Refillable ice bags or collars  Refreezable commercial cold packs  Chemical cold packs  Cold compresses  Tepid baths (Used to decrease fever. If the pt. begins to shiver, stop, it will cause the temp to increase.) 27.Nursing Care During Cold Therapy 5

 Maintain a thin barrier between ice pack and skin  Leave cold packs in place no longer than 20 to 30 minutes  Assess the skin for pallor or mottling every 10 to 15 minutes  Place blanket on patient if needed  Limit time in tepid bath to 10 to 15 minutes  Evaluate effects of cold therapy and assess patient’s response 28.Making Cold Compresses  Fold a washcloth, place in reclosable plastic bag, and place in freezer for short period  Use a bowl of ice water and dip a washcloth into it, wring it out, and apply to the site  Use sterile water if the skin is not intact

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