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Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 54
Heat and Cold Applications
Chapter 54
Heat and Cold Applications
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
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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
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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
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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
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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
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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
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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
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Electric Heating PadElectric Heating Pad
• Unsafe for
– Children
– Confused, irrational, or unresponsive persons
– Suicidal clients
– Clients with spinal cord injuries
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Moist HeatMoist Heat
• Warm, moist compresses, packs, and soaks
• Used for
– Stimulating circulation
– Easing pain
– Promoting wound drainage
– Applying medications
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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
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Sitz Bath Sitz Bath
• Use of a tub or basin filled with warm, circulating water
• Plastic tub often sent home with client
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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
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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.
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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
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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
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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
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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)
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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
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
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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.
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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!
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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!
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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.
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NURSING PROCEDURES NURSING PROCEDURES
• 54-3: administering a tub soak to an arm or leg
– TEMP should be approx. 105 degrees F