2. 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.

4. Heat-loss via sweating and vasodilation Heat conservation via vasoconstriction, curl-up Heat production via shivering, movement

5. What happens if heat is applied to a large body area?

7. Diverts large supplies of blood from the internal organs Drop in the Blood Pressure Which could lead to a safety issue

8.  Occurs through stimulation of temperature- sensitive sensory nerve endings 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

9. 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 blood flow to an area  Decreased lymph flow  Decreased muscle tone

10. Nerve receptors strongly stimulated initially Declines rapidly during first few seconds Declines slowly over the next half hour Receptors adapt to the new temperature

11. Exceeding normal temperature ranges can damage tissues

12.  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

13.  Now the opposite effect is occurring because of reflex vascular constricton.  Recovery time of one hour is advised before reapplication

14.  Maximum vasoconstriction occurs when the skin temperature reaches 15 0 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.

16. The nurse should assess WHY thermal therapy is being utilized

17.  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

18. Prevent edema Decrease Pain Decrease or control bleeding via vasoconstriction

19.  Risk for injury RT:

20.  The patient will:

21.  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

22.  Neuro-sensory impairment  Impaired mental status  Impaired circulation  Immediately after surgery or injury  Hemorrhage

24.  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

25. ◦ 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

26. ◦ Ice bags, ice gloves, ice collars, chemical cold packs, hypothermia blanket ◦ Cold soaks, cold packs, cooling sponge baths

27. Burns Ischemia of Tissue Maceration

28.  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

29.  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