BACHELOR OF SCIENCE IN NURSING

SLE
HEAT AND COLD APPLICATION

• Clients who have heart or pulmonary disease and who

HEAT AND COLD have circulatory disturbances such as arteriosclerosis are
APPLICATION more prone to this effect than healthy people are.
• Heat and cold are applied to the body for local and
systemic effects. CLASSIFICATION OF HEAT APPLICATIONS
• Heat cause- vasodilation
Local (Dry Heat)
• Cold cause- vasoconstriction
• Hot water bottles Chemical heating bottles
• Infrared rays
• Ultraviolet rays
• Short wave diathermy
• Heating lamps
• Electric cradles .Electric heating pads

Local (Moist Heat)

•Warm soaks (Local baths) Hot fomentations (Compresses)
•Poultices (cataplasm)
• Stupes (medical fomentations)
•Paraffin baths
•Sitz bath
•Aquathermia pad

General (Dry Heat)

• Sun bath
•Electric cradles
•Blanket bed
HEAT APPLICATION
General (Moist Heat)
• Heat is often used for clients with musculoskeletal •Steam baths
problems such as joint stiffness from arthritis, • Hot packs
contractures, and low back pain. •Whirlpool bath (Full immersion bath)

PURPOSES OF HEAT APPLICATIONS DISADVANTAGE OF HEAT APPLICATION

• To promote healing & comfort ➔ Increase capillary permeability

• To provide warmth
• To reduce tissue swelling ➔ Extracellular fluid and substance as plasma to pass
• To reduce pain To relax muscles, promote healing decrease through the capillary walls
joint stiffness
➔ Edema or an increase in preexisting edema
MECHANISM OF HEAT TRANSFER
Complications of heat application
• CONDUCTION - Contact
• CONVECTION - Movement • PAIN
• RADIATION - Electromagnetic waves • SKIN RASH OR BURNS
• REDNESS OF the skin
LOCALS EFFECT OF HEAT • INCREASED SWELLING & INFLAMMATION
• INCREASED HEART RATE
• Vasodilation and increases blood flow to the affected area • HYPERTHERMIA

★ Bringing (oxygen, nutrients, antibodies and

leukocytes) CONTRAINDICATIONS TO THE USE OF HEAT

• Promotes soft tissue healing and increases suppuration. • The first 24 hours after traumatic injury.
• Active hemorrhage
• Used for client with joint stiffness, low back pain Sedative • Noninflammatory edema
effect • Skin disorder that causes redness or blisters

• Decreases inflammation

SYSTEMIC EFFECTS OF HEAT

➔ Heat applied on large body area

➔ Excessive peripheral vasodilation
➔ Drop in blood pressure
➔ Fainting attack

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 BACHELOR OF SCIENCE IN NURSING
SLE
HEAT AND COLD APPLICATION

COLD APPLICATION General (Dry Cold)

• Hypothermia
• Generally, the physiological effects of cold are opposite to
the effects of heat. General (Moist Cold)
•Cold sponging
• Cold is most often used for sports injuries (e.g., sprains, •Cold bath
strains, fractures) to limit post injury swelling and bleeding. •Cold packs
• Cold application is the application of a cold agent cooler
Complications of Cold application
than skin either in a moist or dry form, on the surface of the
skin.
• PAIN
• Prolonged exposure to cold results in impaired • BLISTER
circulation, cell deprivation, and subsequent damage to • THROMBUS FORMATION
the tissues from lack of oxygen and nourishment. • REDNESS
• HYPOTHERMIA
• The signs of tissue damage due to cold are a bluish
purple, mottled appearance of the skin, numbness, and CONTRAINDICATIONS TO THE USE OF COLD
sometimes blisters and pain.
•Open wound
•Impaired circulation
LOCAL EFFECTS OF COLD APPLICATION •Allergy and hypersensitivity to cold application
•Inflammatory response (swelling, joint pain)
• Lowers the temperature of the skin & underlying tissue

• Vasoconstriction SPECIFIC CONDITIONS INDICATING THE NEED

★ reduces blood flow to the affected area and thus FOR SPECIAL PRECAUTIONS DURING HEAT AND
reduces the supply of oxygen and metabolites,
decreases the removal of wastes, and produces COLD THERAPY
skin pallor and coolness.
Neurosensory impairment
• Decrease capillary permeability • People with sensory impairments are unable to perceive
that heat is damaging the tissues and are at risk for burns or
• Slow bacterial growth
are unable to perceive discomfort from cold and prevent
• Decrease inflammation and edema tissue injury.
• Local anesthetic effect
Impaired mental status
SYSTEMIC EFFECTS OF COLD APPLICATION
• People who are confused or have an altered level of
consciousness need monitoring during applications to ensure
➔ Excessive cold applications
safe therapy
➔ Vasoconstriction
➔ Increase in blood pressure
Impaired circulation
➔ Shivering
• People with peripheral vascular disease, diabetes, or
congestive heart failure lack the normal ability to dissipate
• With extensive cold applications and vasoconstriction, a
heat via the blood circulation, which puts them at risk for
client’s blood pressure can increase because blood is
tissue damage with heat and cold applications
shunted from the cutaneous circulation to the internal blood
vessels. Shivering, a generalized effect of prolonged cold, is
a normal response as the body attempts to warm itself. Open wounds
• Cold can decrease blood flow to the wound, thereby
inhibiting healing.
CLASSIFICATION OF COLD APPLICATIONS

Local (Dry Cold) Immediately after injury or surgery

• Ice bag • Heat increases bleeding and swelling.
•Ice collar
•Ice pack (poultice)
•Ice cradle
•Chemical cold packs

Local (Moist Cold)

•Ice to suck
•Cold compress
•Evaporating lotion

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 BACHELOR OF SCIENCE IN NURSING
SLE
HEAT AND COLD APPLICATION

FACTORS AFFECTING HEAT AND COLD • Decreasing the temperature of a cold application can
TOLERANCE cause pain and impair circulation.

• BODY PART: the inner aspect of the wrist and forearm, the Rebound phenomenon
neck, and the perineal area are temperature-sensitive, while
the back of the hand and the foot are not as sensitive. • OCCURS AT THE TIME THE MAXIMUM THERAPEUTIC
EFFECT OF THE HOT OR COLD APPLICATION IS
• AREA/SIZE OF BODY EXPOSED: the larger the area ACHIEVED AND THE OPPOSITE EFFECT BEGINS
exposed to heat and cold, the lower the tolerance to
temperature changes. For example, heat produces maximum vasodilation in 20 to
30 minutes; continuation of the application beyond 30
•INDIVIDUAL TOLERANCE: tolerance to temperature minutes brings tissue congestion, and the blood vessels then
variations is affected by age and physical condition. the very constrict. If the heat application is continued, the client is at
young and the aged are especially susceptible to heat and risk for burns because the constricted blood vessels are
cold. The very young and the very old generally have the unable to dissipate the heat adequately via the blood
lowest tolerance. Individuals who have neurosensory circulation. (Dilation > constriction)
impairments may have a high tolerance, but the risk of injury
is greater. Guidelines in application of hot and cold
application Determine client's ability to tolerate the
• DURATION OF APPLICATION / LENGTH OF therapy
EXPOSURE: therapeutic benefits of heat and cold
applications are achieved with short periods of exposure to •Determine the client’s ability to tolerate the therapy.
temperature variations. tolerance increases as the length of
exposure increases. People feel hot and cold applications • Identify conditions that might contraindicate treatment
(e.g., bleeding, circulatory impairment).
most while the temperature is changing. After a period of
time, tolerance increases. • Explain the application to the client.

• Assess the skin area to which the heat or cold will be

• INTACTNESS OF SKIN: injured skin areas are more applied.
sensitive than intact areas to temperature variations
• Ask the client to report any discomfort.
• AGE: thinner skin layers in children and elderly people • Return to the client 15 minutes after starting the heat or
increase the risk for burns from the heat and cold cold therapy, and observe the local skin area for any
applications. untoward signs (e.g., redness). Stop the application if any
problems occur.

Adaptation of Thermal Receptors • Remove the equipment at the designated time, and
dispose of it appropriately.
• Thermal receptors adapt to temperature changes. • Examine the area to which the heat or cold was applied,
• Receptors are strongly stimulated initially but adapt quickly, and record the client’s response.
with rapid decline in the first few seconds.
• Adaptation continues more slowly over the next half hour Safety measures "DO'S"
or longer.
• Nurses and clients need to understand this adaptive • DO EXPLAIN TO THE PATIENT SENSATIONS TO BE
response when applying heat or cold. FELT DURING THE PROCEDURE

• Clients may want to change the temperature due to • DO INSTRUCT THE PATIENT TO REPORT CHANGES IN
altered sensation from adaptation. SENSATION OR DISCOMFORT IMMEDIATELY .
★ Due to adaptation, clients may feel less hot or less
cold over time. As the thermal receptors adapt, the • DO PROVIDE A TIMER, CLOCK, OR WATCH SO THAT
initial strong sensation of heat or cold diminishes, THE PATIENT CAN HELP THE NURSE TIME THE
which can lead clients to feel less of the APPLICATION.
temperature. This may tempt them to adjust the
temperature, potentially leading to harmful effects • DO KEEP THE CALL LIGHT WITHIN THE PATIENTS
like burns or impaired circulation. REACH

• Increasing the temperature of a hot application after • DO REFER TO THE HOSPITAL'S POLICY AND
adaptation can cause serious burns. PROCEDURE MANUAL FOR SAFE TEMPERATURES

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 BACHELOR OF SCIENCE IN NURSING
SLE
HEAT AND COLD APPLICATION

Safety measures "DON'TS" ______________________

• DO NOT ALLOW ADJUST THE TEMPERATURE THE • Fill the reservoir of the unit two-thirds full of water as
specified by the manufacturer.
PATIENT TO
• Set the desired temperature. Check the manufacturer's
instructions. Most units are set at 40°C (1 04°F) for adults.
• DO NOT ALLOW THE PATIENT TO MOVE AN
APPLICATION • Cover the pad and plug in the unit. Check for any leaks or
malfunctions of the pad before use.
• DO NOT PLACE THE PATIENT IN A POSITION THAT • Apply the pad to the body part. The treatment is usually
PREVENTS MOVEMENT AWAY. FROM THE continued for 30 minutes. Check orders and agency protocol.
TEMPERATURE SOURCE • Use tape or gauze ties to hold the pad in place. Never use
safety pins. They can cause leakage
• DO NOT LEAVE UNATTENDED A PATIENT WHO IS • If unusual redness or pain occurs, discontinue the
NEUROLOGICAL IMPAIRED. treatment, and report the client reaction

Hot water bag or bottle Electric heating pads

✿ Electric pads provide a constant, even heat, are
✿ A hot water bag or bottle has been a common source of lightweight, and can be molded to a body part.
dry heat used in the home. It is convenient and relatively
inexpensive. However, because of the danger of burning ✿ Electric pads, however, can burn if the setting is too high.
Some models have waterproof covers for use when the pad
from improper use, many agencies now use other devices. is placed over a moist dressing

✿ Normal adult and child over 2 years, 46°C to 52°C (115°F ______________________
to 125°F) • Do not insert sharp objects (e.g., pins) into the pad. The pin
could damage a wire and cause an electric shock.
✿ Debilitated or unconscious adult, or child under 2 years,
• Ensure that the body area is dry unless there is a
40.5°C to 46°C (105°F to 115°F). waterproof cover on the pad. Electricity in the presence of
______________________ water can cause a shock.
• use pads with a preset heating switch so a client cannot
• Measure the temperature of the water using a bath increase the heat.
thermometer.
• Do not place the pad under the client. Heat will not
• Fill the bag about two-thirds full. dissipate, and the client may be burned.
• Expel the remaining air and secure the top. With the air
removed, the bag can be molded to the body part Sitz Baths
• Dry the bag and hold it upside down to test for leakage.
✿ A sitz bath, or hip bath, is used to soak a client’s perineal
• Wrap the bag in a towel or cover and place it on the body or rectal area. The client sits in a special tub or chair.
site. Disposable sitz baths are also available for home or hospital
use
• Remove after 30 minutes or in accordance with agency ✿ The temperature of the water should be from 40°C to
protocol. 43°C (104°F to 110°F), unless the client is unable to tolerate
the heat. Determine agency protocol.
Aquathermia pad ✿ The duration of the bath is generally 20 minutes,
depending on the client’s health.

______________________

• Assist the client into the bath. Provide support for the
client's feet; a footstool can prevent pressure on the backs of
the thighs.
✿ Aquathermia pad (K-pad) is designed with tubes that • Provide a bath blanket for the client's shoulders, and
contain water. It is connected to an electrically powered eliminate drafts to prevent chilling
control unit.
• Observe the client closely during the bath for signs of
✿ The control unit includes an opening for water and a faintness, dizziness, weakness, accelerated pulse rate, and
temperature gauge. pallor.
✿ Some pads have an absorbent surface for applying moist • Maintain the water temperature.
heat.One surface of the pad is waterproof.
• Following the sitz bath, assist the client out of the bath.
✿ The pads are disposable. Help the client to dry.

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 BACHELOR OF SCIENCE IN NURSING
SLE
HEAT AND COLD APPLICATION

Cooling Sponge bath Soaks

✿ The purpose of a cooling sponge bath is to reduce fever ✿ Soaks involve immersing a body part in a solution or
by promoting heat loss through conduction and vaporization. saturating a gauze dressing wrapped around the part with
a solution.
✿ It is used cautiously and only for clients with very high
temperatures (over 40°C or 104°F). ✿ Sterile technique is typically required for open wounds,
such as burns or unhealed surgical incisions.
✿ Rapid skin temperature drops during the bath can cause
chills, increasing heat production. ✿ Always follow agency protocol for the correct temperature
of the solution.
✿ Antipyretic medication is given alongside to reset the
hypothalamus set point. ✿ Hot soaks are commonly used to soften and remove
encrusted secretions and dead tissue.
✿ The recommended temperature range for cooling sponge
baths is 27°C to 37°C (80°F to 98°F).
Soaks
______________________
✿ Commercially prepared hot and cold packs provide heat
• Sponge the face, arms, legs, back, and buttocks. The chest or cold for a set period.
and abdomen are not usually sponged. Each area is
sponged slowly and gently. Rubbing may increase heat ✿ Instructions on the package detail how to activate the
production pack, typically by striking, squeezing, or kneading it to
initiate heating or cooling
• Leave each area wet and cover with a damp towel.

• Place ice bags and cold packs, if used, or a cool cloth on

the forehead for comfort and in each axilla and at the groin. Summary:
These areas contain large superficial blood vessels that help
the transfer of heat. Heat application can be dry or moist:

• Sponge one body part and then another. The sponge bath ● Dry heat: hot water bottle, aquathermia pad,
should take about 30 minutes. A bath given more quickly disposable heat pack, electric pad.
tends to increase the body's heat production by causing ● Moist heat: compress, hot pack, soak, sitz bath.
shivering .
Cold application can be dry or moist:
• Discontinue the bath if the client becomes pale or cyanotic
or shivers, or if the pulse becomes rapid or irregular
● Dry cold: cold pack, ice bag, ice glove, ice collar.
• Reassess the vital signs at 15 minutes and after completing ● Moist cold: compress, cooling sponge bath.
the sponge bath

Ice Bags, Ice Gloves, and Ice Collars

✿ Ice bags, ice gloves, and ice collars are filled with ice
chips or an alcohol-based solution.

✿ These are used to provide localized cold therapy.

✿ A collar is commonly applied to the throat after a

tonsillectomy.

✿ Always wrap the container in a towel or cover before

applying to the body.

Compresses
✿ Compresses can be warm or cold and are made from
moist gauze.

✿ They are applied to wounds or injuries.

✿ Hot compresses are heated to the temperature specified

by the order or protocol (e.g., 40.5°C or 105°F).

✿ Sterile technique is required when there is a break in the

skin or when the area is prone to microbial invasion (e.g., an
eye).

✿ Sterile gloves and sterile materials must be used when

applying the compress.

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 BACHELOR OF SCIENCE IN NURSING
SLE
HEAT AND COLD APPLICATION

ANSWER:

1. 2
2. 1
3. 3
4. 1
5. 3
6. Potential pressure ulcer site
7. 2
8. 1,3, & 4
9. 1,2, & 4
10. 2

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