Ch 18 Hot Cold Therapy - Lecture notes 14 PDF

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Chapter 18 1. The nurse is caring for multiple patients who are ordered on thermal therapy. Which patient does the nurse recognize as being contraindicated for this therapy?

Answer: A patient with diabetes mellitus who is ordered on heat therapy for an open ulcer on the bottom of the foot The patient with diabetes mellitus is likely to have poor circulation and neuropathy. Heat therapy is contraindicated to avoid additional injury.

2. The nurse is caring for an adult patient recently diagnosed with cancer who is scheduled for surgery. The patient tells the nurse, “I have been sleeping for seven hours and I still feel tired.” Which reason can the nurse identify as most likely for the patient’s statement? Answer: The patient is receiving antianxiety and sleep-promotion medications. It would not be unusual for this patient to be ordered on antianxiety and sleep-promotion medications. The nurse is aware that these medications can interfere with (rapid eye movement) REM sleep, which prevents the patient from feeling rested.

3. The nurse is preparing to apply heat therapy to a toddler. Which safety intervention

should the nurse apply? Answer: Stay with the patient during therapy. because of the multiple variables with a toddler, the nurse can provide the best safety by staying with the patient throughout the therapy.

4. The nurse is interviewing a patient in an adult clinic. When asked about sleeping habits, the patient replies, “I rest frequently.” Which is the reason the nurse needs to further interpret the patient’s comment? Answer: The nurse needs to know how the patient defines resting and sleeping. The first thing the nurse will do is to further assess the meaning of the patient’s comment.

5. The nurse understands that a variety of pharmacological methods of pain management exists. Which types of medications are available to help control pain? Select all that apply. Answer: Ajuvant analgesics. Opiate/opioid medications. Adjuvant drugs will produce pain relief either through a mechanism different from traditional analgesics, or by potentiating or increasing the effects of opioids or nonopioid drugs. Opiate/opioid medication are narcotics that are effective in relieving mild to severe pain that is classified as visceral or deep somatic pain.

6. The nurse placed a cold pack on a patient’s knee for 30 min. When the cold pack is removed, the skin is bright pink in color. The nurse recognizes that the patient is having a rebound effect. Which cause does the nurse understand? Answer: The area has vasodilation to prevent tissue damage.

Chapter 18 When the skin temperature reaches 60°F, vasodilation will occur to prevent tissue damage. The increased circulation will cause the skin color to change to a pink or red.

7. The nurse in the intensive care unit (ICU) is concerned about the lack of restorative sleep for patients. For which reasons does the nurse recognize the need for restorative sleep? Select all that apply Answer: The healing process is faster and complete Without restorative sleep, healing is slow and incomplete.

8.

The nurse is caring for a pediatric patient after a tonsillectomy. For which primary reason will the nurse expect cold therapy to be ordered?

Answer: To promote hemostasis. The primary reason for cold therapy after a tonsillectomy is to control bleeding and promote hemostasis.

9. The nurse is caring for a patient who is experiencing a pain level of 4 on a scale of 0–10 after the administration of pain medication. Before seeking an increase in the patient’s medication order, the nurse decides to try distraction. Which activities are considered to be distractions for pain management? Select all that apply. Answer: Turning on the television Receiving a back rub Working on word puzzles 10. The nurse works in the intensive care unit (ICU). The nurse’s patient is displaying irritability and confusion. The patient expresses feeling fatigued all the time. Which condition does the nurse suspect the patient is experiencing? Answer: Sleep deprivation 11. Fluid entering the interstitial space will cause which of the following? Answer: Edema 12. The nurse is preparing to apply ice therapy to a patient after surgery to the scrotum. Which method of ice application will work best?

Answer: A disposable glove filled with ice and tied shut. 13. The nurse is caring for a patient admitted with pain from an unknown cause. The patient is requesting opioid pain medications around the clock for pain at level 7 on a scale of 0 to 10. Which factor indicates that the nurse may be resistant to pain management? Answer: The presence of pain from an unknown cause is related to drug seeking. 14. The nurse is applying heat to a patient’s swollen ankle. The patient states that the cold therapy makes the ankle less painful. Which purpose does the nurse recognize as the purpose of the heat therapy? Answer: The resulting vasodilation will help carry away the excess fluid and reduce edema.

Chapter 18 15. The nurse is preparing to apply cold therapy to a patient’s sprained ankle. The nurse observes the available equipment for applying cold therapy. Which characteristics of the equipment will best suit this patient’s needs?

Answer: Flexible, with a way to secure 16. The nurse is working in a pain management clinic. Which type of pain will the nurse identify as nociceptive pain? Select all that apply. Answer: Cutaneous pain. Osteogenic pain. Soft tissue pain. 17. The nurse is caring for a patient ordered to begin pain management with a transcutaneous electrical nerve stimulation (TENS) unit. Using knowledge about gate control theory, the nurse knows that which nerve fibers are involved with TENS therapy? Answer: Broad fibers 18. The nurse is preparing to use electrical equipment for the delivery of heat therapy. Which assessment of the equipment is unnecessary? Answer: The date when the equipment was manufactured. 19. The nurse is teaching a patient about the use of an electrical heating pad at home. Which information should the nurse include? Answer: Avoid the use of petroleum products on the skin during heat therapy. 20. The nurse is reviewing a pain assessment for a patient experiencing pain. Which areas of information are important? Select all that apply. Answers: The specific location of the pain A pain level using a 0–10 scale A description of the pain Actions that cause the pain

Indications for Heat Therapy There are numerous indications for heat therapy, or situations in which it should be used, including: • • • • •

Relaxation of muscle spasms, Pain relief, Support of the healing process, Reduction of edema once it has stabilized (stopped increasing), and Elevation of body temperature.

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Contraindications to Heat Applications Heat applications should be used judiciously because there are specific situations and conditions in which it is unwise or actually detrimental to apply heat. This list is not all-inclusive. • • • •

Suspected appendicitis: Use of heat therapy to the right lower abdomen during acute appendicitis could cause enough increased blood flow to the area to result in a ruptured appendix. Bleeding wound or injury: Applying heat to a bleeding wound or injury would dilate the vessels, increasing the bleeding. Newly injured joints: Heat increases edema, making joint mobility more difficult. Large areas of the body in certain cardiac patients: Extensive heat application can result in massive vasodilation to the superficial skin and subcutaneous layers, depriving the major organs, such as the brain, heart, lungs, and kidneys, of adequate blood supply, which can cause serious damage

Safety: Never use microwaves to heat compresses because of the dangers of burns. Safety: Leaving heat packs in place longer than 45 minutes can cause constriction of vessels instead of dilation, which is known as rebound phenomenon.

Safety: Again, be certain to place some type of cloth barrier between the patient’s skin and the heat pack. Safety: Never place heating pads under the patient because the heat cannot dissipate and may result in a severe burn. Do not apply a heating pad to an infant or a sleeping or confused patient.

Safety: A key must be used to set the temperature dial to prevent inadvertent changing of the temperature. Monitoring skin for hot spots should be done frequently. Safety: The patient’s vital signs and core temperature are constantly monitored while these blankets are in use. Follow the manufacturer’s instructions for use and maintenance of these blankets. Safety: When the patient stands after completion of the sitz bath, close monitoring is required to make certain the patient does not suffer a drop in blood pressure upon standing Safety: Children and elderly, confused, or sedated patients must NEVER be left alone in a whirlpool tub because the depth of water makes drowning a real risk. Significant vasodilation may occur, and patients must be assessed for orthostatic hypotension. Safety: The safety of the patient must be a primary concern during heat therapy. Assess the patient’s age, cognitive level of function, orientation, sedation, sensory impairment, and impairment of circulation for risks prior to heat therapy.

Safety: The temperature of the heat application should be lowered to a setting between 95°F and 100°F to reduce risk of tissue injury. The skin condition should be assessed more frequently, every 5 to 10 minutes.

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Safety: If using electrical equipment, assess the condition of the equipment and the electrical cord for defects. Do not use cords that are frayed or have a scratched insulation layer, which allows wires to show. Make sure the plug is securely attached to the cord. Make certain that electrical cords are placed where they will not cause someone to trip over them. Advise patients to use heating pads only while they are awake and for no longer than 30 minutes at a time. Safety: Before placing a patient in a whirlpool tub, disinfect the tub thoroughly to prevent crosscontamination from the previous patient. Use a lift to transfer patients in and out of the tub, which will help to prevent falls. Check the temperature of the water and make sure it is not too hot before lowering the patient into the tub.

Heating Pad Use Carries Risk In the home setting, it is more common to use heating pads as the primary source of heat therapy. The patient and family should be taught how to safely apply and monitor the heating pad. Points to include in teaching are: • • • • • • • • •

Safety: Inspect the cord and pad for fraying or bare wires. Assess the site for color and warmth to touch. Safety: Set a timer for no longer than 20 to 30 minutes. Use a low or medium setting. Safety: Avoid the highest setting. Check the skin under and around the heating pad every 10 minutes for excessive redness or signs of blistering. Safety: Never allow the patient to lie on top of the heating pad or sleep while using it. Avoid use of petroleum products on the skin during heat application. Avoid use of a heating pad on a new injury or trauma and on bleeding wounds. Avoid use on areas that continue to swell.

Indications for Cold Therapy Prevention of Edema Hemostasis Pain Relief Numbing Sensation Reduction of Muscle Spasm Fever Reduction

Effects of Local Heat and Cold Applications

Heat

Cold

Vasodilation

Vasoconstriction

Increases blood flow to site

Decreases blood flow to site, decreasing bleeding

Increases inflammatory response Delivers increased number of red and white blood cells, oxygen, and nutrients to aid healing

Decreases inflammatory response Slows bacterial growth

Increases capillary permeability

Decreases capillary permeability

Increases cellular metabolism

Decreases cellular metabolism

Will increase edema if used during the first 48 hours following trauma Will decrease edema if used after edema has stabilized

Helps prevent edema

Relaxes muscles

Relaxes muscles

Decreases pain

Decreases pain Numbs sensation

Methods of Cold Application Refillable Ice Bags, Collars, and Gloves Refillable ice bags may be made of rubber or waterproof paper, with clamp or foldable closures. Bags should be filled one-half to two-thirds full with ice and some water. Do not overfill the bag or you will find it difficult to mold the bag to the appropriate body part. Then expel the remaining air from the bag and hook the closure. Some facilities use disposable rubber gloves and fill them with ice. They are secured by tying the glove opening in a knot, as you do a balloon. These smaller ice packs are good for use on the perineum, fingers, and nose, and on small children. Use some type of barrier between the ice bag and the skin to prevent tissue damage. Refreezable Commercial Cold Packs These commercial packs are generally filled with a gel-like substance that hardens while remaining malleable when chilled in the freezer. They warm with use, necessitating re-freezing after 20 to 30 minutes. The advantage is their ease of use. Chemical Cold Packs Chemical cold packs may be smaller than refillable ice bags and must be activated. Instructions for activation are printed on the container and usually require squeezing or twisting the bag until

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the chemicals mix and become cold. They are only good for one application and then must be discarded. Cold Compresses Cold compresses can be made by wetting a folded washcloth, placing it in a zip-type plastic bag, and placing it in the freezer for a short period. Or you may use a bowl of ice water and simply dip the washcloth into the water, wring it out, and apply the washcloth to the site. If the skin is not intact, the compress should be made using sterile water and sterile dressings such as gauze 4×4s. Tepid Baths Tepid (cool but not cold) baths are used mostly for reduction of body temperature when use of medication is undesirable or ineffective. Safety: Avoid chilling the patient to the point of shivering, which raises body temperature.

Nursing Care During Cold Therapy Safety: Always use a thin cloth barrier between the ice pack and the patient’s skin to prevent frostbite and damage to the tissues. Safety: Assess the skin for pallor or mottling every 10 to 15 minutes during therapy.

Key Points • •

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• • • •

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Local application of heat results in vasodilation and increased permeability of capillaries. Indications for heat therapy include relaxation of muscle spasms, pain relief, reduction of inflammation, support of the healing process, reduction of edema once it has stabilized, and elevation of body temperature. Application of heat increases metabolism. Safety: Contraindications for the use of heat therapy include suspected appendicitis, bleeding wound, new injury or trauma, and application of heat over large areas of the body in certain cardiac patients. Local cold applications result in vasoconstriction and decreased permeability of capillaries. Indications for use of cold therapy include prevention of edema, hemostasis, pain relief, numbing of sensation, muscle relaxation, and reduction of fever. Risks for injury from cold therapy include tissue damage, frostbite, and hypothermia. Safety: Nursing assessments pertinent prior to heat and cold applications include patient’s age and cognitive level of function, orientation, sedation, sensory impairment, and impairment of circulation; the appearance, color, presence of edema, and temperature of skin; and whether or not the patient experienced any discomfort. Safety: Nursing assessments pertinent during and after heat and cold applications include appearance, color, presence of edema, and temperature of skin, as well as whether or not the patient experienced any change in comfort or discomfort level....