Chapter 54 Heat and Cold Applications

1. Chapter 54Heat and Cold Applications

2. Normothermia • Normothermia or normal body temperature • Body temperature must be maintained. • Important during and after invasive procedures • Helps prevent surgical site infections (SSI) • Hypothermia • Hyperthermia

3. Heat • 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

4. Rationale 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

5. In 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

6. Methods 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

7. Heat 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

8. 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

9. Electric Heating Pad • Unsafe for • Children • Confused, irrational, or unresponsive persons • Suicidal clients • Clients with spinal cord injuries

10. Moist Heat • Warm, moist compresses, packs, and soaks • Used for • Stimulating circulation • Easing pain • Promoting wound drainage • Applying medications

11. Warm 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

12. Sitz Bath • Use of a tub or basin filled with warm, circulating water • Plastic tub often sent home with client

13. Nursing 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

14. 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.

15. Cold • 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

16. Rationale 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

17. Nursing 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

18. Specific Cold Therapies • Cold, moist compresses • Icecap or ice collar • Single-use and refreezable ice packs • Tepid sponge bath • Hypothermia blanket (cooling blanket)

19. The 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

20. Applying 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

21. Nursing 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.

22. Tepid 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!

23. Hypothermia 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!

24. Cold 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.

25. NURSING PROCEDURES • 54-3: administering a tub soak to an arm or leg • TEMP should be approx. 105 degrees F