Chapter 9 Cold and Heat Therapy

1. Chapter 9Cold and Heat Therapy

2. Section Ⅰ Introduction Section Ⅱ Cold and Heat applications

3. Section Ⅰ Introduction • Concept of Cold and Heat Therapy • Bodily Responses to Cold and Heat Therapy • Factors Influencing the Effect of Cold and Heat Therapy

4. Concept of Cold and Heat Therapy The Cold and Heat Therapy is a therapy method that utilizes substances, the temperature of which are lower or higher than the skin surface temperature, acting on the skin, to attain local and systemic treating effects.

5. 25-30万个 • cold receptors（Krause小体):-- 真皮上层（乳头状层）,接受冷的迅息. • Heat receptors（Ruffini’s小体):-- 真皮下层（网状层),接受热的迅息. 3万个 Heat and cold receptors adapt rapidly to temperature changes in the body’s environment. 表皮 真皮

6. 热刺激 冷刺激 真皮下层 Ruffini’s小体 真皮上层 Krause小体 传入神经纤维 大脑皮质感觉中枢 传出神经纤维 反射性地引起皮肤和内脏器官血管收缩或扩张 机体产生相应运动 改变机体各系统的体液循环和代谢活动

7. Bodily Responses to Cold and Heat Therapy • Initial, or Primary Responses Physiological Responses Thermal Receptors Adaptation • Secondary Responses

8. Table 9-1 physiological responses to heat and cold Heat Cold · Vasodilation · Vasoconstriction · Increases blood flow to the affected area; increases supply of nutrients, oxygen, and wastes removal · Reduces blood flow to the affected area; reduces supply of nutrients, oxygen, and wastes removal · Increases capillary permeability · Decreases capillary permeability · Increases cellular metabolism · Decreases cellular metabolism ·Increases amount and motility of leukocytes ·Decreases amount and motility of leukocytes · Increases inflammation and suppuration ·Slows bacterial growth, decreases inflammation · Increases lymph flow · Reduces lymph flow ·Raises body temperature ·Lowers body temperature · Decreases the viscosity of the blood · Increases the viscosity of the blood · Decreases muscle tonus and relaxes muscles · Increases nerve impulse conduction · Decreases nerve impulse conduction · Decreases viscosity of synovial fluids Physiological Responses

9. Thermal Receptors Adaptation When the heat and cold receptors are subjected to an abrupt change in temperature, the receptors are strongly stimulated initially. This strong stimulation declines rapidly during the first few seconds and then more slowly during the next half hour or more as the receptors adapt to the new temperature. This phenomenon is called thermal receptors adaptation. 16～42 ℃

10. Secondary Responses继发性效应 When the maximum therapeutic effect of the heat or cold application is achieved, the opposite effect begins. We call these phenomenon secondary responses.

11. For example • heat produces maximumvasodilationin 20 to 30 minutes; continuation of the application beyond30 to 45 minutesbrings tissue congestion, and the blood vessels thenconstricted. Similarly, cold applications can cause blood vessel constriction, but continuation of application beyond 30 minutes to 1 hour brings vasodilation for 10-15minutes.

12. Factors Influencing the Effects of Cold and Heat Therapy • Treatment method • Size of the exposed body part • Duration of application • Prior skin temperature • Environmental temperature • Body part • Individual tolerance

13. Treatment method • moist heat or cold • dry heat or cold the therapeutic effects of moist application are better than that of dry application.

14. Environmental temperature • When the environmental temperature is greater than or equal to the body temperature, conductive loss is inhibited.

15. Body part • The foot and palm of hand have thicker skin and are therefore less temperature-sensitive. • certain areas where the skin is thinner, such as the inner aspect of the wrist and forearm, eyelids, the neck, and the perineal area(会阴部) are less tolerant to temperature variations.

16. Individual tolerance • very old person----the sensitivity to heat or cold is decreased and therefore response to the heat and cold stimuli is retarded. • Infants----have limited abilities to adapt to heat and cold because of their immature neurological functioning. • clients who have neurosensory impairments

17. Section Ⅱ Cold and Heat applications • Cold application • Heat application

18. Cold application • Therapy Effects of Cold • Contradictions to cold applications • methods

19. Therapy Effects of Cold • Relief of congestion or hemorrhage to the affected area(减轻局部充血和出血) • Relief of pain • Controlling inflammation • Reducing fever, and so on.

20. 减轻局部充血和出血 • 使局部血管收缩,血流减少 • 毛细血管的通透性降低 • 使血流减慢 • 血液粘稠度增加 适用于:扁桃体摘除术后; 鼻衄; 局部软组织损伤的初期,等. 减轻局部充血 促进血液凝固而控制出血

21. 减轻疼痛 使神经末稍的敏感性降低而减轻疼痛. • 抑制细胞的活动 • 减慢神经冲动的传导 • 血管收缩 • 毛细血管的通透性降低, 渗出减少 适用于: 急性损伤的初期; 烫伤; 牙痛,等. 减轻由于组织肿胀压迫神经末梢而引起的疼痛.

22. 控制炎症扩散 • 可使局部血管收缩，血流量减少 • 血流速度减慢 • 细胞代谢率和细菌的活力降低 适用于: 体表部位炎症早期.如鼻部软组织发炎 早期，可采用鼻部冰敷以控制炎症扩散.

23. 降低体温 • 冷直接与皮肤接触，通过传导与蒸发的物理 作用，降低体温; • 头部用冷: 可降低脑细胞的代谢，减少脑细胞需氧量,提高脑细胞对缺氧的耐受性,减少脑细胞的损害,有利于脑细胞功能的恢复。 适用于:高热、中中暑患者降温; 脑外伤、脑缺氧等患者.

24. Contradictions to cold applications • Impaired Local Circulation • Chronic Inflammation and Deep Suppuration • Clients with Cold Hypersensitivity, Heart Diseases and very Weak Clients • Contradicted Body Parts

25. 血液循环障碍 • 大面积组织受损 • 休克 • 微循环障碍 • 周围血管病变 • 动脉硬化 • 糖尿病 • 水肿,等 • 进一步使血管收缩 • 减少局部组织的血供 • 导致组织变性坏死 冷 疗 血管收缩，血流减少，影响细胞间液的吸收.

26. 慢性炎症或深部化脓病灶 • 关节炎 • 慢性背部疼痛 • 痔疮 • 肛周脓肿等 • 可使局部血流减少 • 阻碍炎症的吸收 冷 疗

27. Contradicted Body Parts • posterior occipital, external ear and scrotum (枕后、耳廓、阴囊); • precordial region(心前区)--may result in reflexible decreased heart rate and arrhythmia; • Abdomen(腹部)--abdominal pain and diarrhea; • sole of foot(足底)--can cause reflexible coronary artery constriction.

28. Methods • ice bag, ice cap or ice collar • chemical cold pack dry cold local • cold compress • cold soaks • cooling sponge bath moist cold alcohol sponge bath tepid sponge bath

29. preparation the client's physical condition Assessment The client's level of sensation Equipment The client understands the purpose of the therapy and precautions taken during treatment. Explanation

30. Use of Ice Bags Purpose • to reduce body temperature. • to reduce hemorrhage, swelling and pain after sprains, head injuries and dental surgeries

31. Equipment cloth cover ice bag ice, and so on basin towel

32. Procedures and key points Fill the ice bag one half to two thirds full of crushed ice .

34. Use of Ice caps Purpose to lower head temperature and prevent brain edema for unconscious clients.

35. Equipment *ice cap *drawsheet (垫单) *bucket *sterile drape (无菌治疗巾) *small pillow *Sponges *rectal thermometer(肛温计) *ice *basin

36. Procedures and key points Take away the pillow, spread the drawsheets under the client's head, place a sterile drape inside the ice cap . Place the ice cap around the client’s head, apply spongy pad beneath auricles(外耳),occiput(枕骨部) and neck, and the small pillow under client's shoulders. The drainage tube is down into the bucket.

37. Take anus temperature (肛温), maintain it around 33℃. Below 30℃ventricular fibrillation(室颤)

38. Cold moist Compress(冷湿敷) • The moist compress is a moist gauze dressing applied to the body part. • The compresses are usually immersed into the ice water and then applied to the body part. • Replace compresses are necessary to maintain coolness. (3～5min) • If a sterile compress is ordered, the nurse should follow the sterile principles.

40. Chemical cold packs 十水碳酸钠和硝酸铵 a prefilled plastic package with two separate compartments. strikes, kneads or squeezes the pack to mix one chemical compound with the other and provide a controlled temperature.

41. Hypothermia blankets(降温毯) This appliance is made based on the principle of semiconductor refrigeration. There is a circulating exchange between the cooled distilled water in the water tank and that in the hypothermia blanket via main machine. This process facilitates the heat loss of the skin in contact with the blanket, and then the body temperature is lowered.

42. tepid water sponge bath（温水擦浴） 32～34℃ • alcohol sponge bath（乙醇擦浴） 25～35% ; 30℃

43. Heat application • therapy effects of heat • contradictions to heat applications • methods

44. Therapy effects of heat • promotes suppuration and phagocytes, and then promotes elimination and localization of inflammation • Relief of deep congestion and swelling • Relief of pain, Reduction of muscle spasms and joint stiffness • Providing warmth and Comfort

45. 促进炎症的消散和局限 • 局部血管扩张 • 促进组织血液循环 • 有利于组织中毒素、废 • 物的排出; • 增强新陈代谢和白细胞 • 的吞噬功能. • 炎症早期:热疗可促进炎性渗出物的吸收和消散； • 炎症后期:可促使白细胞释放出蛋白溶解酶，溶解 坏死组织，使炎症局限.

46. 临床多用于软组织细菌性感染早期、慢性感染的辅助治疗.如: • 麦粒肿： • 早期湿热敷可促进 • 炎性渗出物的吸收和消散或促进硬结迅速化脓. • 软组织扭伤48h后: • 热湿敷可促进关节、软组织淤血的吸收和消散.

47. 减轻深部组织充血 体表血管扩张, 血流量增多 全身循环血量 重新分布 深部组织血流量减少 • 足部热疗可减轻头部充血; • 软组织损伤后期.

48. 减轻疼痛 • 降低痛觉神经的兴奋性; • 改善血液循环, 加速致痛物质的运出; • 加速炎性渗出物吸收，解除对神经末梢的压迫； • 松弛肌肉、肌腱、韧带等组织，解除肌肉痉挛和关节强直. 常用于: 腰肌劳损、关节炎的治疗; 肌肉紧张所 致的疼痛; 胃肠痉挛、肾绞痛、痛经等。

49. Contradictions to heat applications • Unidentified acute abdomen • Facial dangerous triangle area infection • Hemorrhagic diseases • Injuries of soft tissues within 48 hours • Bacterial Conjunctivitis (细菌性结膜炎) • Neurosensory impairment and impaired mental status

50. Methods • hot-water bag • heating lamp • Chemical heating bags dry heat • moist hot compress • sitz bath (坐浴) • hot soaks (浸泡) moist heat