Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 54 Heat and Cold Applications

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Cover the pad with a pad cover, sheet, pillowcase or towel May also use on top of a warm, moist pack if ordered

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Electric Heating Pad Unsafe for –Children –Confused, irrational, or unresponsive persons –Suicidal clients –Clients with spinal cord injuries

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Moist Heat Warm, moist compresses, packs, and soaks Used for –Stimulating circulation –Easing pain –Promoting wound drainage –Applying medications

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Sitz Bath Use of a tub or basin filled with warm, circulating water Plastic tub often sent home with client

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Specific Cold Therapies Cold, moist compresses Icecap or ice collar Single-use and refreezable ice packs Tepid sponge bath Hypothermia blanket (cooling blanket)

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 minutes STOP the procedure if the client becomes chilled or begins to shiver!

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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!

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins NURSING PROCEDURES 54-3: administering a tub soak to an arm or leg –TEMP should be approx. 105 degrees F