Post on 22-Dec-2015
Local Application of heat 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.
Heat-loss via sweating and vasodilation
Heat conservation via vasoconstriction, curl-up
Heat production via shivering, movement
Diverts large supplies of blood from the internal organs
Drop in the Blood Pressure
Which could lead to a safety issue
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
Heat Vasodilation Increase capillary
permeability Increase local cellular
metabolism Increase blood flow to
an area Increase lymph flow Increase muscle tone
Cold Vasoconstriction Decrease capillary
permeability Decreased local cellular
metabolism Decreased nerve
conduction Decreased blood flow
to an area Decreased lymph flow Decreased muscle tone
Nerve receptors strongly stimulated initially
Declines rapidly during first few seconds
Declines slowly over the next half hour
Receptors adapt to the new temperature
Occurs at the time that maximum therapeutic effect of hot or cold application is achieved
Heat produces maximum vasodilation 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 constricton.
Recovery time of one hour is advised before reapplication
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.
Relax muscles
Reduces swelling
Accelerates the inflammatory process to fight infection
Promotes healing and formation of new tissue through accelerated cellular metabolism
Reduction of pain
Duration and degree of heat or cold applied Body part Condition of the skin / body surface covered Prior skin temperature Body surface area covered by application Age– very young or elderly Physical condition
Neuro-sensory impairment
Impaired mental status
Impaired circulation
Immediately after surgery or injury
Hemorrhage
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
After applying a heat treatment, the patient puts on call light and says it is too hot.
What should the nurse do?
◦Aquatherma pad, K-pad, disposable instant heat pack, gel-filled heat packs, heating pad, heat lamp, thermal blanket
◦Sitz bath, compresses, whirlpool therapy, paraffin bath
◦ Ice bags, ice gloves, ice collars, chemical cold packs, hypothermia blanket
◦Cold soaks, cold packs, cooling sponge baths
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
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 unable to sense temperature changes or move from the temperature source
Patient says that the heating pad must be broken because it no longer feels warm.
What should the nurse do?