Hot and cold application

Hot and cold application

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  Definition- Hot Application Hot applicationis the application of a hot agent, warmer than skin either in a moist or dry from on the surface of the body; Purpose:-  To relive pain and congestion,  To provide warmth,  To promote suppuration,  To promote healing,  To decrease muscle tone  To soften the exudates. Cold application Cold application is the application of a cold agent cooler than skin either in a moist or dry form, on the surface of the skin. Purpose  To reduce pain and body temperature,  To anaesthetize an area,  To control hemorrhage,  To control the growth of bacteria,  To prevent gangrene,  To prevent edema and  To reduce inflammation.
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  Classification of temperatures: TemperatureFahrenheit Very Cold Cold Cool Neutral Warm Hot Very Hot . 32 to 55 F 55 to 65 F 65 to 80 F 80 to 92F 92 to 98 F 98 to 104F 104 F TRANSFER OF ENERGY: HEAT  Conduction: Contact  Convection: movement  Evaporation: through liquid-gas transfer  Radiation: electromagnetic waves
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   Conversion: transferfrom one energy type to another THERAPEUTIC APPLICATION  Heating Agents ◦ Transfer heat to patient’s body, between various tissue / fluids  Cooling Agents ◦ Transfer heat away from patient’s body. Physiological Effects of hot application:-  Peripheral vasodilatation  Increased capillary permeability  Increased oxygen consumption  Increased local metabolism  Decreased blood viscosity  Decreased muscle tone  Increased blood flow  Increase Lymph flow  Increase motility of leucocytes Physiological effect of cold application:-  Peripheral Vasoconstriction  Decreased capillary permeability  Decreased oxygen consumption  Decreased local metabolism  Increased blood viscosity  Decreased muscle tone  Decreased blood flow  Decreased lymph flow  Decreased motility of leucocytes Systemic response of hot application Application of hot packs for long time Excessive peripheral vasodilatation Drop in blood pressure Rebound Phenomenon Of Heat
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   Occurs atthe time that maximum therapeutic effect of hot or cold application is achieved  Heat produces maximum vasodilatation in 20-30 minutes.  Continuation beyond 30-45 minutes causes tissue congestion, the blood vessels constrict  Now the opposite effect is occurring because of reflex vascular constriction.  Recovery time of one hour is advised before reapplication Rebound Phenomenon of Cold  Maximum vasoconstriction occurs when the skin temperature reaches 150 or in about 30 minutes to one hour.  Vasodilatation begins as a Recovery time of one hour is best before reapplication. Factors Affecting Heat And Cold Tolerance  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.  Duration of application: Therapeutic benefits of heat and cold applications are achieved with short periods of exposure to temperature variations. Tolerance increases as the length of exposure increases.  Area of body exposed: The larger the area exposed to heat and cold, the lower the tolerance to temperature changes.  Damage to body surface area: Injured skin areas are more sensitive than intact areas to temperature variations.  Individual tolerance: Tolerance to temperature variations is affected by age and physical condition. The young and the aged are especially susceptible to heat and cold.  Neurosensory impairments may interfere with the reception and perception of stimuli, increasing the risk of injury.  Age: Thinner skin layers in children and elderly people increase the risk for burns from the heat and cold applications. Scientific principles involved in hot and cold applications  Water is a good conductor of heat  Air is a poor conductor of heat  The flow of heat is from the hotter are to the less hot area  Prolonged exposure to moisture increases the skin’s susceptibility to maceration and skin breakdown, reducing the protection of the intact skin.  Moisture left on the skin causes rapid cooling due to evaporation of the moisture  Presence of steam increases the temperature of the hot application  Oil acts as insulator and delays the transmission of heat
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   Woolen absorbmoisture slowly, but hold moisture longer and cool off less quickly than the cotton materials. The temperature tolerance varies with individuals and according to the site and area covered Friction produce heat. Hot application Indication of hot application:-  Decreases pain  Decreases muscle tone  Promote healing  Promotes suppuration  Relives deep congestion  Softens the exudates  Provide warmth  Stimulates peristalsis Contraindications Of Hot Applications  Malignancies  Impaired kidney, heart & lung functions  Acutely inflammed areas  On clients with paralysis  Open wounds  Edema associated with venous or lymphatic diseases  Headache  Client with metabolic disorders  Very young & very old client  Client with very high temperature Complications Of Hot Applications  Pain  Burns  Maceration (with moist heat)  Redness of the skin  Edema  Pallor (secondary effect)  Hyperthermia
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  Therapeutic effect ofhot application 1.Hemodynamic Increase circulation 1.5-2x normal Increased metabolism (contraindicated in 2-3 days post injury) Increased inflammation, phagocytosis, & wound healing Decreased pain (analgesia); not as effective as cryotherapy for acute pain Decreased muscle spasm Decreased tissue stiffness (fluids less viscous and collagen releases Depth of effects are not as great as with cold Vascular changes are confined to skin (1cm) 2. . Neuromuscular Increase sensory nerve conduction Analgesic effects both distal and proximal to area treated This is why non-acute back patients use heat instead of ice Reducing muscle spasm Inhibits muscle contraction General instruction :-  Assess the condition of the client prior to, during & after the application of the heat & cold application.  Check vital signs.  Maintain correct temp. for the entire duration of the application.  Never use any equipment unless understand its operation completely.  There must be a recovery period between the application.  Expose the client only requires part..  Don’t allow the client to adjust temp. control  Never ignore the complaints of a client  Make sure that the client is in a position to remove the application if it is causing him discomfort or advice patient to call for help.  Call bell must be in reach to children.  Never leave client even for short period  Squeeze off water from moist heat applications to prevent scalding.  Apply thin layer of petroleum jelly or oil to skin prior to the application of moist heat application. It will reduces soaking of the skin & therefore maceration.  Don’t use electrical appliances close to the open oxygen.  If any sign of complication recognized stop procedure immediately.  After procedure, dry the body area gently by patting not by rubbing to remove the moisture.
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   Hot waterbag to be fill two-thirds to half full with warm water and remove air at the top so the bag is easier to mold over the body part.  Dry the outside of the bag & test for leakage by holding the bag upside down.  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. Cold application Therapeutic Uses Of Local Cold Applications  Relieves pain  Prevent gangrene  Prevent edema & reduce inflammation  Control hemorrhage  Control the growth of bacteria  Reduces the body temperature  Anaesthetize an area Contraindications Of Cold Applications  Client in the state of shock & collapse  Edema  Diseases associated with impaired circulation  Muscle spasm  Decreased sensation  Client have shivering or having very low temperature  Cold hypersensitivity or intolerance  Cryoglobulinemia Uncommon disorder Aggregation of serum proteins in distal circulation when distal extremities cooled Proteins form a “gel” that can impair circulation, Causes local ischemia, gangrene  Paroxysmal Cold Hemoglobinuria Release of hemoglobin into urine from lysed red blood cells, In response to local or general exposure to cold  Raynaud’s Disease Paroxysmal digital cyanosis Sudden pallor followed by redness of skin of digits, Precipitated by cold or emotional upset Relieved by warmth
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  Bilateral and symmetric(women)  Raynaud’s Phenomenon Generally only in one extremity May be associated with thoracic outlet, carpal tunnel syndrome or trauma  Regenerating Nerves Local vasoconstriction or decreased nerve conduction may delay regeneration  Circulatory compromise or peripheral vascular disease Chronic peripheral vascular disease may have edema. Cold may increase this edema. Pallor and coolness Theraputic Effect Of Cold Application 1. Hemodynamic Effects  Immediate vasoconstriction Less then 15 min Stimulates smooth muscles of vessels to contract Decreases release of histamine, prostaglandins (vasodilators) Increases blood viscosity (increases resistance to flow) Decreases blood flow to maintain core temperature After 15 minutes, vasodilatation occurs Mostly distal extremities Temperatures < 10 C (350 F) >15 minutes ◦ Cold induced vasodilatation (COVD) Amount of vasodilatation usually small Skin redness NOT due to vasodilatation due to increase in oxyhemoglobin concentration of blood Cold decreases oxyhemoglobin dissociation Makes less oxygen available to tissues  Hunting Response Response to pain associated with extreme cold  Raynaud's Phenomenon A vascular reaction to cold application or stress that results in a white, red, or blue discoloration of the extremities. This happens because the blood vessels under the skin tighten. When blood does not reach parts of the body, these areas may turn blue and feel cold.
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  2. Neuromuscular Efects Decreased muscle spasm by decreasing muscle spindle activity.  Intramuscular fibers (muscle spindle) runs parallel to fibers of the muscle.  Muscle contraction causes spindle contraction so it remains sensitive. The lower the temperature, the lower the spindle activity. 3. Decreased Nerve Conduction Velocity  Decreased NCV of sensory and motor nerves occurs ◦  Greatest effect in myelinated, small fibers pain transmitters  Least effect in unmyelinated, large fibers 4. Increased Pain Threshold 5. Metabolic Effects:-  The decrease in metabolism allows them to live without as much oxygen. ◦ Normal body temperature is 37 ° C. ◦ Increase above 45° C (113° F) proteins denature 6. Inflammation Control  Decreases chemical reactions secondary to acute inflammatory response  Decreased blood flow secondary to vasoconstriction, increased viscosity 7. Edema Control Decreases intravascular fluid pressure via decreasing blood flow, increased viscosity Most effective if applied immediately, in conjunction with elevation and compression. Complication :- Tissue Death Frost Bite Nerve damage :- Unwanted vasodilation due to prolonged vasoconstriction, ischemia, thromboses in smaller vessels. Freezing of tissues :- damage at 39 degrees F To avoid, duration limited to under 45 minutes and tissue temperature above 39 degrees F When goal is vasoconstriction, treatment limited to 10-15 minutes. General instruction:-  Assess patient and establish goals of treatment  Determine if cryotherapy most appropriate treatment  No Contraindications  Select appropriate mode of application based on body part and desired response  Explain procedure, reasons for treatment, and expected sensations  Fill two-thirds full with crushed ice so bag is easier to mold over body part.
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   Cover bagwith towel or pillowcase and apply to affected area for 30 minutes.  Provides cold to localized area (e.g., muscle sprain, hematoma) to Ice bag, ice collar Guidelines In Application of hot and cold application:-  Check the order, check armband  Assess general condition of the patient Assess the skin area where application going  Check functioning of equipment  Reassess patient and response in 15 minutes  Stop treatment at designated time  Examine the place where the treatment will occur.  Record the patient’s response Safety Measures “DO’s”  Do explain to the patient sensations to be felt during the procedure  Do instruct the patient to report changes in sensation or discomfort immediately  Do provide a timer, clock, or watch so that the patient can help the nurse time the application  Do keep the call light within the patients reach  Do refer to the agency’s policy and procedure manual for safe temperatures Safety Measures Do “NOTS”  Do not allow the patient to adjust the temperature  Do not allow the patient to move an application  Do not place the patient in a position that prevents movement away from the temperature source Do not leave unattended a patient who is