Hot & Cold Application

Hot & Cold Application

• 2.
  SUPERFICIAL HEAT AND COLD Primarily increase or decrease temperature of skin, superficial subcutaneous tissues
• 3.
  TRANSFER OF ENERGY:HEAT, OR THE LOSS OF HEAT, OCCURS IN ANY OF THE FOLLOWING WAYS:  Conduction: Contact  Convection: movement  Evaporation: through liquid-gas transfer  Radiation: electromagnetic waves  Conversion: transfer from one energy type to another
• 4.
  THERAPEUTIC APPLICATION  HeatingAgents ◦ Transfer heat to patient’s body, between various tissue / fluids  Cooling Agents ◦ Transfer heat away from patient’s body
• 5.
  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;  To relive pain and congestion,  To provide warmth,  To promote suppuration,  To promote healing,  To decrease muscle tone and  To soften the exudates.
• 6.
  Cold application Cold applicationis the application of a cold agent cooler than skin either in a moist or dry form, on the surface of the skin;  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.
• 7.
  Dry heat Moistheat •Hot water bottles •Chemical heating bottles •Infrared rays •Ultraviolet rays •Short wave diathermy •Heating lamps •Electric cradles •Electric heating pads •Warm soaks (Local baths) •Hot fomentations (Compresses) •Poultices (cataplasm) •Stupes (medical fomentations) •Paraffin baths •Sitz bath •Aquathermia pad •Sun bath •Electric cradles •Blanket bed Dry heat Moist heat •Steam baths •Hot packs •Whirlpool bath (Full immersion bath)
• 8.
  Dry cold Moistcold •Ice bag •Ice collar •Ice pack (poultice) •Ice cradle •Chemical cold packs •Ice to suck •Cold compress •Evaporating lotion •Hypothermia Dry cold Moist cold •Cold sponging •Cold bath •Cold packs
• 9.
  Local Application ofheat and cold to the body can be therapeutic, but before using these therapies, the nurse must understand normal body responses to application of heat and cold and how and when to use.
• 10.
  CLASSIFICATION OF TEMPERATURES: FOR TREATMENTPURPOSES, ARE CLASSIFIED AS FOLLOWS: Very Cold 32 to 55 F Cold 55 to 65 F Cool 65 to 80 F Neutral 80 to 92 F Warm 92 to 98 F Hot 98 to 104 F Very Hot 104 F  Hot
• 11.
  Temperature for hotand cold applications Description Temperature Application Very cold Below 15C Ice bag Cold 15-18 C Cold packs Cool 18 – 27 C Cold compresses Tepid 27 – 37 C Alcohol sponge bath Warm 37 – 40 C Warm bath Hot 40 – 46 C Hot soak, hot compresses Very Hot Above 46 C Hot water bag for adult
• 13.
  PRIMARY / PHYSIOLOGICAL EFFECTS HOTAPPLICATION COLD APPLICATION Peripheral Vasodilatation Peripheral Vasoconstriction Increased capillary permeability Decreased capillary permeability Increased oxygen consumption Decreased oxygen consumption Increased local metabolism Decreased local metabolism Decreased blood viscosity Increased blood viscosity Decreased muscle tone Decreased muscle tone Increased blood flow Decreased blood flow Increased lymph flow Decreased lymph flow Increased motility of leucocytes Decreased motility of leucocytes
• 14.
  SECONDARY EFFECT OFHOT AND COLD APPLICATION  With the local heat application, the maximal increase in the of circulation & temperature occurs after 20 to 40 min exposure. After this time, the heat application must be discontinued & a recovery time of 1 hour allowed otherwise secondary effect (vasoconstriction) will take place.  With the cold application, the primary effects may last only for 30 min to 1 hour. After this time, a recovery time of one hour must be allowed or secondary effects (vasodilatation)
• 15.
  SYSTEMATIC RESPONSE Heat-loss viasweating and vasodilation Heat conservation via vasoconstriction, curl-up Heat production via shivering, movement
• 16.
  SYSTEMATIC RESPONSE What happensif heat is applied to a large body area?
• 17.
  ANSWER
• 18.
  EXCESSIVE PERIPHERAL VASODILATION Diverts largesupplies of blood from the internal organs Drop in the Blood Pressure Which could lead to a safety issue
• 19.
  LOCAL BODY RESPONSE Occurs through stimulation of temperature- sensitive sensory nerve endings/ thermal receptors in the skin.  Sent up the spinal cord to the hypothalamus in the brain where impulses are recognized as hot or cold  Protective adaptive responses are triggered: cold= vasoconstriction; hot= vasodilation
• 20.
  ADAPTATION OF THERMAL RESPONSE Nervereceptors strongly stimulated initially Declines rapidly during first few seconds Declines slowly over the next half hour Receptors adapt to the new
• 21.
  Exceeding normal temperature rangescan damage tissues
• 22.
  REBOUND Phenomenon: Heat Occurs at the 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
• 23.
  REBOUND Phenomenon: Heat Now the opposite effect is occurring because of reflex vascular constriction.  Recovery time of one hour is advised before reapplication
• 24.
  REBOUND Phenomenon: Cold Maximum vasoconstriction occurs when the skin temperature reaches 150 or in about 30 minutes to one hour.  Vasodilation begins as a protective device to prevent the body tissue from freezing  Recovery time of one hour is best before reapplication.
• 26.
  The nurse shouldassess WHY thermal therapy is being utilized
• 27.
  FACTORS AFFECTING HEATAND 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.
• 28.
   Area ofbody 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.
• 29.
   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. Older adults have a decreased sensitivity to
• 30.
  Scientific principles involvedin 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.
• 31.
   Moisture lefton 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  Woolen absorb moisture 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.
• 32.
  HEAT APPLICATION
• 33.
  INDICATIONS
• 34.
  THERAPEUTIC USES OFLOCAL HOT APPLICATIONS  Decreases pain  Decreases muscle tone  Promote healing  Promotes suppuration  Relives deep congestion  Softens the exudates  Provide warmth  Stimulates peristalsis
• 35.
  Contraindications
• 36.
  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
• 37.
  COMPLICATIONS
• 38.
  COMPLICATIONS OF HOT APPLICATIONS Pain  Burns  Maceration (with moist heat)  Redness of the skin  Edema  Pallor (secondary effect)  Hyperthermia
• 39.
  THERAPEUTIC EFFECTS OF HEAT
• 40.
  Hemodynamic
• 41.
   Increase circulation1.5-2x 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
• 42.
   Depth ofeffects are not as great as with cold  Vascular changes are confined to skin (1cm) BUT
• 43.
  Neuromuscular
• 44.
   Increase sensorynerve 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
• 45.
  GENERAL INSTRUCTION  Assessthe 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.
• 46.
   Expose theclient only to a safe temp.  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.  Client must have a calling signal with in reach  Never leave client even for short period  Squeeze off water from moist heat applications to prevent scalding.
• 47.
   Apply thinlayer 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.  Don’t use electrical appliances near water or other fluid.  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.
• 49.
  Hot water bag 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
• 51.
  HOT PACKS /CHEMICAL HEATING 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.  These packs are designed to maintain a constant temperature between 40.6º C &
• 53.
  AQUATHERMIA PADS  Areuseful in treating muscle sprains and for areas with mild inflammation or edema.  Unit consists of a waterproof plastic or rubber pad connected by two hoses to an electrical control unit that has a heating element and a motor. The reservoir of the unit is filled two-thirds full with distilled water.  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.
• 55.
  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 to absorb the perspiration & to insulate the pad.  Instruct the client to avoid using high setting, to prevent burns.  No wet dressing should be applied with pads.  Do not allow the client to lie directly on the pad, because heat will not dissipate and the client may be burned.
• 58.
  INFRARED LAMP  Radiantenergy  2 types luminous (infrared) and nonlumious (far infrared)  Luminous produces some visible light (as opposed to nonluminous), nonlumious is less penetrating than luminous
• 59.
  ULTRAVIOLET RAYS /LAMPS  Transmit ultraviolet rays, which are invisible heat rays.  Observe the skin carefully during and after the treatment.  Client & therapist must use protective goggles to shut out reflected harmful rays.  Duration of treatment is usually 20- 30 min
• 60.
  DIATHERMY High-frequency wave achieves deepheat penetration  Ultrasound  Shortwave  Microwave
• 61.
  ELECTRIC CRADLES /HEAT CRADLES  It is used when large body part is to be treated & covering of skin with gown or sheets is not possible.  Sheet or blankets can be added over the cradle to maintain the heat at the desire levels.  Duration of treatment is usually 20-30 min, after unit is warmed up, or can be used continuously to provide low temp.
• 62.
  HEATING LAMPS  Usedto supply heat to the body parts.  The distance between the exposed part & the lamps depend upon the wattage of the light bulb & heat tolerance.  Duration of treatment is usually 20-30 min  Recommended distances are as follows: WATT BULB DISTANCE FROM THE BODY PART 25 35 cm 40 45 cm 60 60 to 75 cm
• 65.
  FOMENTATION  Moist applicationof heat over an area by means of double thickness of flannel or other soft material wring out from hot water, protected by a waterproof covering, wool and bandage. Types:-  Simple  Medical  Surgical (applied over an open wound)
• 66.
  Purpose  To relievepain & congestion  To relieve inflammations  To relieve retention of urine  To promote suppuration  To stimulate peristalsis & relieve tympanites  To relieve intestinal & renal colic  To soften the crust & for the easy removal of the crust  To help in the absorption of the exudates  To relieve muscular spasm  To relieve congestion in the internal organs
• 67.
  TREATMENT PROCEDURE  Haveall equipment assembled at bedside before beginning treatment  Have the person remove clothing and drape with a sheet.  Explain the procedure, tell them to tell you when it is too hot & when it isn’t hot enough  The duration and frequency in changing the fomentations depend upon the desired effect.  Take care not to burn the person with too
• 68.
   Be sureperson’s feet are warm (if cold, cover with blanket).  Cover part to be treated with a bath towel.  Apply fomentation. To relieve congestion, have the fomentation cover a large area. For local effect, make the fomentation the area size.  Add another towel if the fomentation is too hot.  Remove fomentation every 3-5 minutes and use cold mitten friction or rub with cold wash cloth for 30 seconds and then dry the area.  Reapply fomentation (3-6x in total – always finish with cold).  Hot fomentation - cold mitten friction and dry area -  hot fomentation - cold mitten friction and dry area - hot fomentation - cold mitten friction and dry area.  If general perspiration was produced – neutral to cool shower or a sponge bath.  Have person rest 30 minutes.
• 69.
  Contraindications  1. Unconsciousness. 2. Careful not to burn patient  3. Paralyzed parts of the body.  4. Do not use on the legs or feet of a diabetic.  5. Edema and varicose veins and advanced vascular disease of the legs and feet.  6. Malignancy.  7. Tendency to bleed.  8. Stomach and bowel ulcers.
• 70.
  Important Considerations  Alwaysask if fomentations are burning the patient. If they are too hot, put a towel between skin and hot fomentation.  Have extra dry towels handy to layer in case fomentation is too hot.  Have the room warm before you begin treatment; make sure there are no drafts.  Caution with the thin or aged persons and children.  Parts where bone is close to skin surface are especially apt to burn.
• 72.
  STUPES (MEDICAL FOMENTATIONS) Medicine (e.g. turpentine) is applied locally to augment the effects of the hot compresses used.  Commonly used to relieve tympanites by increasing the peristalsis & relaxing the muscle spasm.  Drugs used are: turpentine (1 part) with olive oil (3 parts) for adults. For children, turpentine (1 part) with
• 73.
  POULTICES (CATAPLASM)  Applicationof moist heat in the form of a soft spongy mass that retains its heat for a varying length of time, according to the ingredient used.  Starch poultices: starch and sodium bicarbonate in the proportion of 8:1  Duration of application is 30 to 60 min
• 75.
  MOIST HEAT PACKS Canvas Pouch with Silica Gel  Pack is kept in a water-filled heating unit maintained between 160º F -170 º F  Pack maintain temperature for 30-45 minutes  Packs transfer heat by conduction  Main benefit is superficial heat to 1cm
• 76.
  MOIST HEAT PACKS Set-up ◦ Cover pack with terry cloth or towel covering ◦ Place pack on patient in comfortable manner (patient on pack is contraindicated) ◦ Check patient within 5 to 6 minutes for comfort ◦ Allow 3-4 hr minimum between treatments on the same day
• 78.
  MOIST HEAT PACK Precaution: ◦ infected areas must be covered with gauze  Contraindications: ◦ Acute conditions ◦ Peripheral vascular disease ◦ Impaired circulation ◦ Poor thermal  Indications: ◦ Subacute or chronic inflammatory conditions ◦ Reduction of subacute or chronic pain ◦ Subacute or chronic muscle spasm ◦ Decreased ROM ◦ Hematoma resolution ◦ Reduction of joint contractures ◦ Infection (discuss)
• 79.
  WARM COMPRESSES (GAUZE DRESSINGMOISTENED IN A PRESCRIBED WARMED SOLUTION)  Applied to improve circulation, relieve edema, and fasten the suppurative process and healing.  For an open wound, use sterile technique.  Solution to moisten the gauze can be heated first to 40.5°C (105°F) or procedure is similar to application of a wet to dry dressing and the use of a hot water bag or a heating pad to cover the dressing.  Remove compress after 20–30 minutes and redress wound.
• 81.
  WARM SOAKS (LOCAL BATHS) 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.  Sterile technique is generally indicated for open wounds, such as a burn. Check agency protocol regarding the temperature of the solution.
• 82.
   Temp. ofwarm water is at 105 to 110 F (40.5 to 43 C)  Duration of treatment is usually 20 min  Temp. of solution should be checked frequently & additional solution is added or the solution is replaced in order to maintain the appropriate
• 84.
  PARAFFIN BATH  Amixture of 15 to 30 ml of mineral oil to 1 pound of paraffin wax  Temperature of 118º F to 126 ºF for upper extremity tx.  Temperatures of 113 º F to 121 º F for lower extremity (circulation is less efficient)  Paraffin can provide approx. 6x the amount of heat as water due to low specific heat.
• 85.
  PARAFFIN BATH  Usedto deliver heat in uniform amounts to small irregularly shaped areas (hands, fingers, wrist and foot) especially for rheumatoid arthritis.  Wax moistens skin, water tends to dry skin
• 86.
  PARAFFIN BATH SETUP  Immersion Bath ◦ Clean body part ◦ Dip part quickly; allow 10 sec. to dry (turns milky) ◦ Dip the extremity 6-12 more times ◦ Then cover with cellophane or towel for duration of tx (10-15 min) ◦ DO NOT touch sides or bottom of bath (burns) ◦ After tx scrape off and  Pack (Glove) Method Clean extremity ◦ Immerse extremity in bath and allow wax to dry - repeat 7-12 more times ◦ After final withdrawal from wax, cover extremity with plastic bag, or wax paper. Then wrap in towel ◦ If indicated elevate body part ◦ Following tx remove wax and return to bath
• 87.
  PARAFFIN BATH  Precautions ◦Sensation is different from specific heat and thermal capacity - may cause burns  Contraindications ◦ Open wounds (options?) ◦ Skin infections ◦ Sensory loss ◦ Peripheral vascular disease  Indications ◦ Subacute and chronic inflammation ◦ limitation on ROM after immobilization
• 88.
  WHIRLPOOLS / FULL IMMERSIONBATHS  Tx temperature is between 105º-112º F for extremities and 100-108º F for whole body  Tx times usually last 10-20 minutes; watch for lethargy with WWP
• 89.
  WARM WHIRLPOOL  Precautions ◦Must be connected to ground-fault indicator ◦ Instruct patient not to turn whirlpool motor on or off while in whirlpool ◦ Patient should be continually monitored ◦ Do not run while turbine is dry ◦ Clean tank pre and post infectious wound tx ◦ Keep clothing and bandages out of whirlpool
• 90.
  WARM WHIRLPOOL  INDICATIONS ◦Decreased ROM ◦ Subacute or chronic inflammatory conditions ◦ Stiffness or soreness ◦ Irregular shaped areas  CONTRAINDICATIONS ◦ Acute conditions where water turbulence would further irritate injured area ◦ Fever above 101º F ◦ Comprimised circulation
• 91.
  SITZ BATH /HIP BATH  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).  Water temperature should be from 43° to 46°C (110° to 115°F) & Duration of the bath is usually 15–30 minutes.  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
• 92.
   Solutions used:- ◦Potassium permanganate solution 1:5000 ◦ Boric acid 1 dram to 1pint ◦ Eusol solution  Contraindications ◦ Pregnancy ◦ Menstruation ◦ Renal inflammation ◦ Increased irritability of the genital organs
• 95.
  COUNTERIRRITANTS  Drugs usedto augment the desired effects of the heat application to induce vasodilatation in the superficial tissues to affect the circulation or muscle tone in an underlying area or distant part by reflex action.  Counterirritants include mustard, turpentine, capsicum and liniments such as camphor, and methyl Salicylates.
• 96.
  RUBEFACIENTS  Simple formof counterirritant which merely reddens the skin by vasodilatation.  Its effect is immediate and lasts only for a short period.  E.g. mustard plaster, Tr. iodine, turpentine
• 98.
  INDICATIONS
• 99.
   Relieves pain Prevent gangrene  Prevent edema & reduce inflammation  Control hemorrhage  Control the growth of bacteria  Reduces the body temperature  Anaesthetize an area THERAPEUTIC USES OF LOCAL COLD APPLICATIONS
• 100.
  Contraindications