Introduction

Heat and cold are applied to a specific part or all of a patient's body to bring about a local
or systemic change in body temperature for various therapeutic purposes..

Hot Application
Heat application means the application of an agent warmer than the skin either in a moist
or dry from the surface of the body with the purpose of increasing heat.
Heat causes vasodilatation which increases blood flow to the affected area and supplies
oxygen and nutrients to reduce pain in joints and relax sore muscles, ligaments, and
tendons.
The heat should be warm, not too hot, and should be maintained at a consistent
temperature, if possible.

Effect of Hot Application

Heat applications for the purpose of treatment are done to a part or whole of the body
and cause local or systemic effects.

Local effects of Hot Application

Effects Therapeutic Benefits

Increases temperature
Causes vasodilation
of underlying tissue

Blood flow increases due to the increased

local temperature.

Accelerates the transport of oxygen and

nutrients to the area and facilitating the
Vasodilatation removal of wastes by increasing blood flow
to the injured area of the body.

It reduces the accumulation of venous blood

in the region (Venous congestion).

Increases tissue metabolism.

Increases in capillary permeability.

Decrease in blood
viscosity Accelerates the transport of leucocyte and
antibody to the injured area.
 Prolonging clotting time.

Reduces the pain caused by muscle

Heat reduces muscle relaxation, muscle spasm.
tension and promotes
relaxation. Reducing the viscosity of the synovial fluid,
decrease joint stiffness.

Increase in capillary
Transition of nutrients and residuum increases.
permeability

Systematic Effect of Hot Application:

The systematic effect of extensive, prolonged heat includes increased cardiac output,
sweating, increased pulse rate, and decreased blood pressure. This response occurs
when heat is applied to a large body area, increasing the blood flow to that area while
decreasing it to another part of the body, in effect, causing hypovolemic shock.

Purposes of Hot Application

• to warm and comfort the body by increasing its temperature (as in the frost bite).
• to widen blood arteries in an effort to improve circulation.
• to lessen swelling or inflammation and to clear up blood congestion.
• to encourage muscular relaxation
• to reduce stiffness and soreness in the joints.
• to encourage the suppuration and healing of wounds.
• to reduce the wounds' abrasion and soften the exudates.
• to administer medication.
• to relieve bladder distension and to promote peristalsis.
• To facilitate drainage (draws infected material out of wounds).

Scientific Principles of Hot Application

• Heat causes blood vessels to enlarge, increasing the blood flow in the area.
• Heat quickens the metabolic rate of tissue cells because it raises their internal
temperatures.
• Heat is transferred from a hotter area to a cooler one. The heat treatments will be absorbed
by the skin, warming the surroundings.
• Heat speeds up the creation of new cells and tissues.
• Heat causes blood viscosity to decrease, causing blood to become thinner. This reduces
the likelihood of blood clotting.
• Depending on the environment and place where they are working, people have different
levels of heat tolerance.
• The temperature is chosen based on the patient's condition, the duration, the application
method, and the intended use.
 • Heat sensitivity is particularly acute in the interior of the arm, the neck, and several body
regions.
• Air does not effectively conduct heat. The inclusion of air in the hot water bags and ice
caps can reduce the treatment's efficacy.
• Starting with a modest temperature, gradually increasing it to the required level, and
maintaining it there the entire application time.
• The maximal vasodilation and vasoconstriction occur in 30 minutes. After this
point, tissue congestion and reflex vasoconstriction occur.
• If the application must be continued for a longer period of time, it is halted after 20
minutes for most heat or 30 minutes for dry heat.
• Heat and cold are transferred from one substance to another using conduction,
convection, and radiation. Electricity flows easily through water.
• Heat application should not be utilized when there is edema linked to venous or lymphatic
disease, impaired vital functions, impaired metabolism, impaired perception, or impaired
vital functions.
• Monitor your vital signs both during and immediately after the application.
• Never apply heat to a kid or a sick person above 120°F/48.8°C or 160°F/71.1°C,
respectively.
• Maintain patient warmth after providing overall warmth.
• Heat sources that dry the skin are possible. Moisture-based heat may penetrate deeper.
• Surgical fomentation requires a sterile procedure.
• Nursing professionals need to be aware of the ideal temperatures in order to apply heat
and cold.

Contraindications of Hot Application

• acute inflammation, such as an acute appendicitis or a dental abscess.

• exceedingly young or old, unconscious, or paralyzed patients.
• people with DM, peripheral neuropathy, or other neurological or sensory impairments to a
high degree
• Within the first 24 hours following a traumatic injury, warmth encourages bleeding
and edema in exposed wounds.
• Malignancy.
• Blisters/Burns.
• When there is active bleeding, temperature causes vasodilation, which accelerates
bleeding.
• Patients have impaired kidney, cardiac, and lung function as well as lower than average
temperature regulation and progressive arthritis.
Dry Heat
Dry heat is the heat applied to the body without using moisture.

Application of Hot Water Bag/Bottle

It is local application of dry heat to a specific body part for a short duration using a rubber
bag. It is a commonly used method and relatively easy and inexpensive. Cover with a
thick cloth and always keep a layer of blanket or sheet between hot water bottle and the
patient.

Articles

• Hot water bag with cover,

• Boiling water,
• Towel,
• Mug to pour water into the bag,
• Bath thermometer,
• Duster,
• Kidney tray.

Procedure

S.N. Nursing Action Rationale

Identify the patient and check the

Proper assessment will
1 patient's chart for any special
prevent risk of complication.
instructions and nursing care plan.
 Reduces anxiety
2 Explain the procedure to the patient. and promotes client's
participation.

Wash hands and provide privacy if

3 Prevents cross infection.
needed.

Assemble all equipment and arrange Organized efforts facilitate

4
on the bedside. ease of performance of task.

Heat can be retained with the

Assess for presence of lotion or oil
presence of these products
5 over skin surface at the site of
and lead to increased risk of
application.
heat intolerance and burns.

Check the temperature of hot water Ensures desired temperature

6
with a bath thermometer. of water.

Check the bottle/bag for leakage

by inflating air in it. Or It ensures that there are no
7 leaks and pre-warms the
Fill the hot water bag with hot bag.
water, secure the cap and turn it
upside down.

Empty the bag and refill the hot water Filling two-third level
bag /½ to 2/3 of bag with the hot ensures comfort when
water, put the hot water level bag over applied.
8
a flat surface like table and expel all
the air by forcing the water up to the When air is removed the
neck of the bag. Cork it tightly. bag is easier apply in the
part.

Prevents chances of
Wipe the moisture of the outside of
scalding. Moisture on the
9 the bag with towel or duster and wrap
outside of bag increases risk
the bag in a towel.
of burn.

10 Take it to the bed side.

Apply hot water bottle to the area and

11 see that it is in proper place. See that Prevents chances of burn.
hot water bottle is not placed directly
 on the body part of a unconscious or
paralyzed patient.

Refill the bottle if needed when it gets

12
cold by taking it to the utility room.

Keep the bag for 20-30 minutes

in position. Inspect the area Keeping the bag for sufficient
13 carefully in between. time ensures therapeutic
effect.
Place the patient in comfortable
position.

14 Remove hot water bag.

Dry the area and inspect the area for

15 redness; if redness is present, apply Vaseline soothes the skin.
Vaseline.

After completing the treatment, wash Prevents growth of

the bottle, dry it by hanging upside microorganisms and inflating
16
down. Inflate the bottle before storing prevents its walls
it. from sticking to each other.

17 Make the patient comfortable in bed. Ensures client's comfort.

Record in the patient's charts the

Acts as a communication
18 time, site, duration of application and
between staff members.
effects observed.

General Instructions

• Turn the bottle upside down to check for leaks after adding warm water and screwing on
the cap.
• Fill the sack only halfway. Tighten the cap after removing any air from the top. The sack
can then be formed over a body part with less effort.
• Never place a water bottle or bag against the skin without first wrapping it in a towel.
• Hot water bags should be used on children, persons who have cardiac conditions,
and paralyzed adults at a temperature of 115°F to 120°F. Other patients need water
that is 120 to 150 degrees Fahrenheit in temperature.
• The bag needs to be moved around frequently.
• Never place a patient in a position where he can't escape the heat source. The likelihood
of temperature-related injuries is decreased by doing this.
• No matter how insignificant they may seem, you should never ignore a patient's problems.
Contraindications

• Open wounds,
• Hypertension,
• Metabolic disorder,
• Impaired kidney, heart and lung functions,
• Acute inflammation,
• Very young and old patient,
• Patient with sensory neural defects,
• Patient with high fever.
Electric Heating Pad

An electric heating pad is also an easy method of applying dry heat. It is light and available
in various sizes. It consists of a rubber pad containing wires with in it which is heated
through electricity. There is a heat containing mechanism with three settings (low,
medium and high). A medium setting usually provides heat between 46°C to 52°C
(115F to 125F). This temperature is usually adequate for therapeutic use. It is used to
give prolonged even heat.

Procedure

S.N. Nursing Action Rationale

Explain the procedure to the

Reduces anxiety and promotes client's
1 patient and collect all
participation.
required articles.

Assist the client for

2 Ensures client's comfort.
comfortable position.

Assemble all equipment and Organized efforts facilitate ease of

3
arrange on the bedside. performance of task.

Place a cover over the pad

before using it. Prevent the Absorbs perspiration to insulate the
4
pad from becoming moist as pad. Moisture causes electrical shock.
it may produce shock.

Never place the pad under the body

Place the heating pad above
part as the pressure on the pad may
5 or on either side of the part
cause heat to accumulate and cause
to be heated.
burn to the patient and the bed linen.
 Fix the plug in the electric
socket and regulate the heat
by setting it at medium heat.
6 Prevents from burns.
If needed, the pad can be
secured in place by meant
of bandage.

Check the area at regular

7 intervals for any signs of Ensures client's safety.
burn.

After completing the

treatment, disconnect the
8 plug from the electric socket
and remove the pad after it
becomes cold.

Record the procedure, date,

time, the patient's a
condition and reaction. Acts as communication between staff
9
Report to the ward in members.
charges or doctor if any
abnormalities are found.

Precautions

• Never provide it to a patient who is unconscious or while they are sleeping.

• When utilizing the pad, there must be no moisture because it can result in an electrical
shock.
• Request that the patient wear cotton clothing.
• The circuit needs to be regularly inspected. Inspect the pad for leaks.
• In order to insulate the pad, it should be covered with flannel or fabric to absorb sweat.
• To prevent burns, avoid using the high setting and don't let the patient lie directly on the
pad.
• If a pin meets a wire within the pad, an electric shock could result. Therefore, avoid using
pins to hold the pad in place.
• Folding the pad could squeeze the wires within and limit its functionality.
Infra-Red Lamp

The lamp that is used to emit infra-red rays is called infra-red lamp. Infra-red rays are
invisible heat rays that are transferred from a hot object to the patient by radiation. Infrared
rays (IR) relax muscles, stimulate circulation and relieve pain. They have the same effect
on the body as other forms of dry heat. The radiation heats produced by the infra-red and
ultra-violet lamps are more intense than the heat given off from the heating lamps.
Purposes

• to give a space a constant, readily controlled level of surface heat.

• to aid in the decubitus ulcer's recovery.
• to treat a stretched muscle's spasms and soreness.
• dry the casts.
• to ease stiffness in the joints.
• to make connective tissues softer

Principles

• Infrared rays are low wave length rays which produce heat in superficial layers e.g. in skin,
subcutaneous tissue but not in the muscular layer.
• The lamp should be placed at appropriate distance away from the treatment area,
at least 45 cm and low voltage bulbs. (40-60 watts) are used.
• During treatment, the client's skin should be assessed periodically to ensure that no burns
Occur.

Procedure

• Describe the procedure to the patient and gather all necessary materials.
• If necessary, screen the patient, expose the area to be treated, and use drapes as needed.
• Place the lamp 45 to 60 cm away when applying skin to the affected area.
• Turn on the lamp. Keep track of when the treatment began.
• Heat the area for 20 to 40 minutes, or as long as the patient requests. You can use
it once or twice every day.
• Tell the patient to stay away from it and to not touch it.
• Regularly check the area for burn symptoms, such as skin color changes.
• To present an abrupt change in circulation, insulate the area from the cold by covering it
until the blood circulation returns to normal.
• Disconnect the plug from the electrical socket after the treatment is over, then move it
away from the bed.
• Note the procedure, the date, the time, the patient's state, and their response. If any
abnormalities are discovered, notify the doctor or the ward manager.

Precautions

• Do not use if the cord is frayed or cracks are noted.

• Apply heat only for 20 to 30 minutes. Observe the skin carefully during and after the
treatment. The patient, nurse or therapist must wear protective goggles.
Ultra Violet Lamp

Ultra violet lamps transmit ultra violet rays beyond the visible spectrum at the violet end.
Ultraviolet rays (UV) are not as penetrating as infrared rays. They are used to treat skin
infections and wounds. The effects of the exposure to the ultraviolet lamps are
pigmentation of the skin, production of the vitamin D and bactericidal effects.
Heat Lamp

Flexible necked lamps are used to supply heat to the body part. The distance between
the exposed part and the lamps depends upon the voltage of the light bulb, the
pigmentation of the skin and the heat tolerance by the patient. Heat lamps are contra
indicated in pressure ulcer care.

The recommended distances are as follows:

• 25 watt bulb - 35 cm from the body part.

• 40 watt bulb - 45 cm from the body part.
• 60 watt bulb - 60 to 75 cm from the body part.

Procedure

• Describe the procedure to the patient and gather all necessary materials.
• Put the patient in a relaxed position.
• Maintain seclusion by shielding the area, leaving it exposed, and using drapes as needed.
• Focusing the lamp at a distance of 18 inches from the area and measuring it
precisely.
• Keep track of when the treatment began. Heat the area for 20 to 30 minutes.
• Check the area periodically for any burn symptoms, such as a change in skin color.
• Disconnect the plug from the electrical socket after the therapy is over, let it cool, and then
remove it from the patient's side.
• Note the procedure, the date, the time, the patient's state, and their response. If any
irregularities are discovered, notify the doctor or the ward manager.
Heating Cradle

An electric cradle is a bed cradle; a light source and a thermometer are fitted inside it. A
25 watt or fewer light bulbs on an extension cord are attached to a bed cradle frame
to make it a heat cradle. A sheet is used over the cradle to prevent draughts; blankets
can be added over the cradle to maintain the heat at the desired level. It is used in cases
of burns and extensive wounds to provide heat for stimulating and drying.

Procedure

• Wash your hands, set up the tools, and go over the procedure with the patient.
• Keep the patient in a relaxed position for ideal treatment area exposure.
• To keep the patient as warm as possible while the application is being made, place the
cradle with an electric light bulb over the area that has to be heated.
• Make sure that nothing, including covers or garments, touches the bulb.
• hand washing While necessary, such as when in close proximity to potential bodily
secretions, put on gloves once more.
• Set up a call light nearby.
• Every 5 minutes, check the client's reaction to the heat.
• After 20 minutes, take the lamp out.
• Replace the covers and reposition the client. Refresh the cradle.
• Wash your hands after removing the gadget from the bedside.
 • making notes and reporting.
Diathermy

Diathermy is a heat producing high frequency current furnished by a diathermy apparatus.

It is used for penetrating deep tissues like pelvic organs and bones.

Procedure

• Wash your hands after explaining the procedure, and keep the patient in a comfortable
position.
• Safety pins, hooks, hairpins, and other metal objects are all taken out of the patient's body.
• Expose the area as needed and use drapes. Request that the patient wear cotton clothing.
• Apply diathermy while maintaining the pads' position.
• Replace all items in the correct order after the treatment is finished.
• making notes and reporting.
Ultra Sonic Therapy

Ultrasound (US) is a method of applying deep, penetrating heat to muscles and tissues.
A lubricating gel is applied to the clients skin, and the paddle or wand is kept moving at
all times, to prevent burns. Ultra sound is used for diagnostic as well as therapeutic
purposes. The vibratory effect of the sound waves is used in the treatment of various
disorders of deep tissues and even to crush the stones in the kidney or elsewhere.

Procedure

• As needed, help the patient find a comfortable position in bed, on a table, or in a chair.
• Apply liquid paraffin or gelly to the part after exposing the area and draping it as necessary.
• Keep an eye on how the exposed region is doing.
• Replace all items after the therapy is finished.
• Taking notes and reporting
Moist Heat

Moist heat conducts heat through water. It conducts heat better and penetrates deeper
than the dry heat where dry heat conducts heat through air, so patients are generally able
to tolerate a higher temperature of dry heat than moist heat. Moist heat is applied as a
compress, stupes or a sitz bath, hot soaks. The method selected depends on the part of
the body needing the treatment and on the patient's condition.

Fomentation

Fomentation is a prolonged application of warm moist flannel or similar material used on

a large area of the body. It is defined as a process of applying moist heat to localized part
of body.

Classification
 • Simple fomentation: Boiling or dipping in boiling water is used for fomentation, it is called
simple fomentation.
• Medicated fomentation: Drug is added to boil water for fomentation and it is applied to
unbroken skin used to relieve tympanites by increasing the peristalsis and relaxing the
muscle spasm.
• Surgical fomentation: It is the application of moist heat, using sterile gauze or other
material to an open wound or abscess.

Purposes

• to reduce discomfort and congestion.

• so as to reduce inflammation
• to prevent urine retention
• to treat renal and intestinal colic.
• Peristalsis needs to be stimulated by nerve endings.
• to offer warmth and comfort.
• help increase blood flow to the area, accelerate healing, and lessen tissue swelling.
• to lessen stiffness in the joints.
• sterilized compresses should be used on wounds.

Procedure

• To the sufferer: Explain the process. Provide privacy if required.

• Put the patient in a comfortable position as needed.
• Put a mackintosh and a towel under the sufferer to protect the bed.
• Check the area for any skin lesions by opening it up.
• Place the patient near the edge of the bed, close to the work area.
• Apply Vaseline or olive oil to prevent the treated area from burning.
• Add the fomentation pack and start the wringer. After inserting the wringer rods, place the
basin.
• Check the temperature of the water.
• Put the fomentation cloth in the water and let it soak all the way through.
• Turn the wringer rods while holding them in your hands in the opposite direction to wring
out extra water from the pad.
• Shake off the steam and check the temperature.
• Fomentation should be applied to the area that needs to be treated.
• If a bandage is required, apply it to the area.
• When it gets cold, wring out the other two pieces and replace them with the cold ones.
Treating should continue for a further 15 to 20 minutes, or as instructed.
• Take some sterile gauze and dunk it in the surgical fomentation solution.
• Apply pressure to the gauze piece to extract the surplus solution.
• Apply to the wound after figuring out the patient's heat tolerance.
• if required, bandage the wound.
• Watch for any skin pallor, extreme redness, pain, or discomfort. Stop the procedure if the
patient has any pain or discomfort, skin pallor, or redness.
• After done, carefully dry the area all the way through.
• Put the equipment back in place after cleaning.
• Record the procedure's duration, effects, and patient's condition.
Hot Socks

Immersing the client's affected body part in warm water or a solution for a prescribed time
is called a soak. Soaks may be done in a basin if the area is small or in a tub if the area
is large. Often a soak may be combined with a whirlpool bath. This is commonly done in
the physical therapy department. The temperature of the water should be no higher
than 105 degrees Fahrenheit.

Some Reasons for Giving a Warm Soak

• Improves 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.

Some Things to Remember to do When Giving a Soak

• Test the water frequently, and add hot water slowly to prevent burning the client.
• Stir the water to distribute the heat evenly.
• The usual duration of a soak is 15 to 20 minutes.

Procedure

• With the bath towel, wrap the tub.

• Wrap the bath towel around the patient.
• Use a bath thermometer at all times and prepare the water in the tub (100-105 f).
• If the client has an open wound or rash, wear gloves.
• Lower the client's injured body portion into the water gradually.
• To allow the elbow or knee to rest on the tub's edge, adjust the padding there.
• If necessary, use a folded cushion to support the affected body portion.
• Regularly check the water's temperature. If necessary, carefully add boiling water while
stirring.
• The client's arm or leg should be taken out of the bath in 15 to 20 minutes, or as
directed.
• Dry off the customer's skin.
• Dress the wound using a sterile dressing (if one is present). Dispose of the tools and
gloves properly.
Wax Bath

Medicated wax baths are used for stiff and painful joints especially for patients with
Rheumatoid arthritis.

Special Consideration When Applying Heat Application

• Don't apply it directly to the skin. Instead, wrap the hot device in a thin towel.
 • Don't apply heat for longer than 20 minutes, unless your doctor or physical
therapist ball recommends longer.
• Don't use heat if there's swelling. Use cold first, and then heat.
• Don't use heat if you have poor circulation or diabetes.
• Don't use heat on an open wound or stitches.
• Don't lie down on a heating pad; you could fall asleep and burn your skin.

Cold Application
Application of a substance that is colder than the skin is known as cold application. Cold
application is a straightforward, low-cost treatment that has been widely accepted as a
successful pharmacologic intervention for pain management for many years.
Vasoconstriction brought on by cold reduces blood flow to an area, slows down
metabolism, and lessens pain and swelling. Sprains, strains, bumps, and bruises that can
happen from lifting or playing sports can be treated well with cold therapy.

Effects of Cold Application

Local Effects of Cold Application

• Vasoconstriction: Reduces nerve conduction velocity, blood flow to the injured

area, hemorrhage, cell metabolism, and production of cellular waste. It also
reduces swelling, pain, and muscle spasms.
• Reduces the tissues' need for oxygen due to slowed cell metabolism.
• An increase in blood viscosity raises the possibility of blood clotting in an injured
area.
• Reduce the blood spasm to improve neuromuscular communication and lessen
pain.
Systematic Effect of Cold Application

The prolonged cold application and vasoconstriction may cause an increase in the blood
pressure. Because, the way of blood flow changes towards the internal blood vessels
from the surface (cutaneous) due to the vasoconstriction. Shivering is another general
effect of long stay in the cold and a response of the body to warm itself.

Purposes of Cold Application

• To reduce body temperature.

• To reduce muscle spasm, and to relieve pain, burning or irritation.
• To provide comfort.
• To control bleeding.
• To prevent or reduce inflammation and edema.
• To decrease tissue metabolism.
• To anaesthetize an area for short periods.
 • To inhibit the bacterial growth and prevent suppuration.

Principles of Cold Application

• Blood vessel constriction brought on by the cold reduces the area's blood supply.
• The end organs of the sensory nerves in the skin communicate the experience of
cold, and the brain interprets the feelings.
• Cooling is sped up by evaporation of fluids still on the skin.
• The skin is more susceptible to maceration and skin degeneration when exposed
to wetness for an extended period of time.
• In the cold, blood becomes more viscous. As a result, blood thickens, increasing
the chance of blood clotting. Cold can be applied when coagulation is required,
like in a hemorrhage.
• The reduced tissue temperature brought on by cold also decreases cellular
metabolism. As a result, the temperature of a fever can be lowered using cold.
• Because dry cold focuses the cold in a condensed, shallow region, applying moist
cold is more effective.
• Take all essential care while applying a general wet cold application to avoid
shivering and chilling. Stop the procedure as soon as you see the patient trembling,
experiencing a heart arrhythmia, or collapsing.
• When using a cold or tepid sponge, friction should be avoided because it produces
heat.
• Under the effect of cold, the body's microbes become less active and reproduce
less.
• Cold causes numbness and lowered pain thresholds. Because it increases pain
tolerance, it can occasionally be used as a local anesthetic to lessen discomfort.
• In cases of hyperpyrexia, the body's temperature needs to be raised gradually and
slowly. A abrupt cooling could harm the patient.
• Never ignore a patient's problems, no matter how trivial they may seem.

Contraindications

• Patients who are in shock and collapse condition.

• Patients with impaired circulation e.g. diabetes, arteriosclerosis, neurological
disorders. Cold disrupts the nutrition of the tissue and can cause tissue damage.
• Patients having a sensation of numbness.
• When there is muscle spasm.
• Patients having shivering or having a very low temperature.
• Infected wound/In an open wound: Cold decreases the blood flow, so the tissue
damage may increase.
• Patients having allergy or hypersensitivity to cold.
• Low temperature.

Complications of Cold Application

• Pain
 • Blisters and skin breakdown
• Maceration with moist cold
• Gray bluish discoloration
• Thrombus formation
• Hypothermia

Cold Compress
Cold compress is the application of moist cold to a body part by means of gauze or wash
cloth.

Purposes

• To reduce body temperature and provide comfort.

• To reduce inflammation and edema.
• To relieve pain, burning sensation and irritation.
• To anesthetize for short time.
• To control hemorrhage.
• To inhibit bacterial growth and thus prevent suppuration.

Articles

A tray containing:

• Bowl with cold water, (15C/59F)

• Sponge cloth or gauze pieces
• Mackintosh and towel
• Thermometer tray
• Kidney tray
• A small bowl with non-absorbent cotton balls for plugging ears if applying to
forehead.

Procedure
S.N. Nursing Action Rationale

Obtains specific
Identify the patient. Assess for the
1 instructions and
need of cold applications.
information.

Anxiety over procedure

2 Explain procedure to the patient. due to cold application
can be reduce.

Avoids embarrassment
3 Provide privacy.
during the procedure.

Prevents cross
4 Wash hands.
contamination.

Organized efforts
Assemble all equipment and
5 facilitate ease
arrange on the bedside.
of performance of task.

Provides baseline for

Assess the patient's body
6 evaluating response to
temperature and pulse rate.
therapy.

Place the patient in a comfortable

7 Ensures client's comfort.
position.

Expose the area and place a

Prevents soiling of bed
8 mackintosh and towel under the
linen.
area to be treated.

Plug ears with cotton plugs if

Prevents from entering
9 compress is applied to forehead
water to the ears.
eyes.

Soak the sponge cloth in cold water.

Squeeze gently. Makes sure that there is
10 not dripping of water and
Change it as soon as it becomes apply it to the area.
warm.

Observe skin area every five

minutes for any adverse reactions Tissue damage can
11 like burning, numbness, occur from prolonged
bluish discoloration, mottling of vasoconstriction.
skin, erythemia or extreme pallor.
 Discontinue the procedure if Prevents from
12
adverse reactions are seen. complications.

Continue the procedure for

specified length of time, that is,
until desired result is obtained
13
/15 to 20 minutes and repeat
every 2-3 hours. Check the
temperature every 15 minutes.

When the time is over, remove Makes the patient

14
compress, and dry the area. comfortable.

Take out the cotton balls from the

15
ears.

Clean and replace the articles in its

16
proper place as appropriate.

Prevents from cross

17 Wash and dry the hands.
infection.

Record the procedure in the nurse's

Acts as a communication
18 notes. Record the vital signs in TPR
between staff members.
sheet.

General Instruction

• Applying a cold compress to the skin improves heat conduction.

• After 20 minutes, cold application causes side effects. Vasoconstriction that
is prolonged can harm tissue.
• Don't apply a cold compress to your chest.
• Before, during, and after the procedure, evaluate the treatment area.
• If the compresses are applied to an open wound, use sterile technique.
• Every 15 minutes, take your temperature; this helps you identify any
changes in your body's temperature.

Tepid Sponges

Tepid sponge bath is a bath with water below body temperature, usually in the
range of 80-95f. It is a process of sponging with tepid water to reduce body temperature
by evaporation. It is a general application of moist cold liquid to cool skin by evaporation
and by the absorption of body heat in the cold water. A tepid sponge bath may be
temporarily soothing, but it may not produce a marked temperature drop unless it is used
for an extended period.
Purposes

• To reduce body temperature when fever in itself may be deleterious e.g.

temperature between 102 to 1030f.
• To stimulate circulation.
• To decrease toxicity.
• To soothe the nerves and promote sleep.

Articles

• Bath basin,
• Tepid water (temp 98.60f) in a bucket.
• Bath thermometer,
• Wash clothes,
• Mackintosh,
• Bath blanket,
• Towels,
• Dress, linen,
• Articles for cold compress and ice cap.

Procedure

S.N. Nursing Action Rationale

Identify the patient. Assess for Obtains specific instructions

1
the need of tepid sponge. and information.

Provides baseline for

Assess the patient's body
2 evaluating response to
temperature and pulse rate.
therapy.

Anxiety over procedure due

Explain the sequence of the
3 to cold application can be
procedure.
reduce.

4 Close room door or curtain. Ensures privacy.

Prevents the chance of

5 Wash and dry hands.
cross contamination.

Arrange the articles to the Organized efforts facilitate

6
bedside. ease of performance of task.

Place a mackintosh under the

7 Prevents soiling of bed linen.
patient and remove gown.
 Keep the bath blanket over body
parts not being sponged, close
8 Ensures safety and comfort.
the windows and door and put
off the fan.

9 Check water temperature.

Immerse wash clothes in water

and apply wet cloths in each
axilla and over groin. Cover on
extremity with a wet towel.

Wet a wash cloth and wipe down

Makes sure that there is not
towards fingers/toes from outer
10 dripping of water and apply it
aspect of each extremity and
to the area.
move up from the inner aspect.
Follow the clockwise
sequence for wiping the
extremities, each in turn for 5
minutes and then the back
and the abdomen.

Reassess temperature and Ensures the outcomes of

11
pulse every 15 minutes. procedure.

When body temperature falls to

12 slightly above normal,
discontinue the procedure.

Dry externalities and body parts

13 Promotes client's comfort.
thoroughly.

Dress the patient and cover with

14 Ensures the client's comfort.
a sheet.

Observe for any symptoms of Prevents from

15
chill or any other abnormality. complications.

Position the patient comfortably

16
in the bed.

Replace the articles after

17
cleaning.

Prevents from cross

18 Wash hands.
infection.
 Record the procedure in the Documentation
19 nurse's recorded sheet and vital promotes communication
signs in TPR sheet. among staff.

Cold Sponge Bath

Cold Sponge is moist cold application using ice water when the patient's
temperature is dangerously raised to more than 103°F. The temperature of water
used for the patient's cold sponge is 60° to 70.

Purpose

To reduce body temperature

Contraindication

Patients with rigors

Procedure

• Check your body's temperature.

• To the patient: Describe the procedure.
• Prepare the water as directed by the doctor.
• Ensure privacy.
• Under the patient, place a mackintosh and a drawing sheet.
• Take off your clothes, then put the top sheet over the patient.
• To prevent a sudden bodily cooling, place a hot water bag on the bottoms of the
feet.
• Put gloves on.
• Dip your sponge cloths in the basin, then gently squeeze off the extra water.
• Dry the face with a cloth after wiping it.
• Make the upper body visible.
• Put a cool, damp sponge in the axilla of each hand. As they warm up, swap out
the washcloth.
• With a cold sponge cloth, clean your back and abdomen.
• Starting with the thigh, move laterally to the foot and medially to the groin for legs.
Maintain sponge in groin.
• Repeatedly wipe your neck and face.
• Every 15 minutes, check the patient's temperature.
• When the temperature reaches 1000F, stop the process.
• Keep going for a maximum of 20 to 30 minutes, then stop.
• After the operation is over, take off the hot water bag, makeup, and bath towel.
• With a towel, dry the patient off. Help him or her put on clothes.
• Make the patient's bed comfy.
 • After 15 minutes, 30 minutes, and an hour of treatment, take your
temperature.
• Implement additional temperature-lowering methods if the temperature stays the
same.

Hypothermia Blanket

A hypothermia blanket (cooling blanket) is a plastic mattress pad through which very cold
water flows continuously. Its role is to decrease temperature. Hypothermia blankets are
used primarily in surgery to slow body processes and to prevent complications resulting
from unstable temperature.

Ice Cap/Ice Collar

Ice cap is defined as a small rubber bag filled with small pieces of ice and salt, that serves
as a device for cold application. An ice collar is a narrow rubber or plastic bag, curved to
fit the neck. Often, prepared single use ice bags are used.

Purposes

• To relieve pain of muscle strain.

• To reduce temperature between 101-102°F.
• To relieve urinary retention.
• To relieve inflammation.
• To decrease metabolic rate of body.
• To prevent bleeding specially after thyroid surgery tonsillectomy and dental
surgery.

Articles

• Ice cap with cover

• Ice in a bowel
• Towel and makintosh
• Kidney tray
• Salt
• Duster to wipe ice cap after filling.

Procedure

• Assess the patient's temperature.

• Explain the procedure to the patient.
• Fill 2/3rd ice cap with ice cubes and expels air before closing cap.
• Add salt to ice chips. It prevents the ice from melting faster.
• Check if any leakage.
• Screw on the cap tightly and put cover over the ice cap.
• Apply the ice cap to the area for about 30 minutes.
 • Check tolerance of the patient periodically.
• Replace articles after cleaning.
• Position the patient in a comfortable position.
• Wash hands.
• Record the procedure in the nurse's notes including time of application and
observation.

Cold Pack

Cold pack is defined as application of moist cold when the temperature rises to
104°F and above.

Purposes

• To reduce temperature above 104°F.

• To treat heat stroke and malignancy hyperthermia.

Contraindication

Circulatory disorders like peripheral vascular diseases.

General Instructions

• The pack could be a washed cloth, towel, and flannel.

• A basin of cold water is prepared and the packs are immersed into it.
• When cooled the excess water is wrung out and the pack is applied to the body
area.
• Replace the packs as necessary to maintain.

Procedure

• Pour cold water into basin; add ice cubes to bring temperature to 65°f and wet bath
towels.
• Remove top sheet and protect bed with a long makintosh and big sheet.
• Remove the patient's cloths, cover with wet bath towel from chest to public area.
• Place compress on forehead, ice cap on head and hot water bag at feet.
• Wrap hand and legs with wet towel.
• Check the temperature every 15 minutes and replace wet clothes.
• Continue the procedure for 30 minutes.
• After completing the procedure, remove towels and dry the patient thoroughly.
• Change wet sheets.
• Keep the patient in a comfortable position.
• Replace articles.
• Wash hands.
• Record the procedure.
Physiological Effects of Cold and Heat Application

Cold Application Heat Application

1. Peripheral vasoconstriction. 1. Peripheral Vasodilatations.

2. Decreased capillary 2. Increased capillary

permeability. permeability.

3. Decreased local metabolism. 3. Increased local metabolism.

4. Increased oxygen
4. Decreased O2 consumption.
consumption.

5. Blood flow is decreased. 5. Blood flow is increased.

6. Blood viscosity in increased. 6. Blood viscosity is decreased.

7. Lymph flow is decreased. 7. Lymph flow is increased.

8. Motility of leukocytes is 8. Motility of leukocytes is

decreased. increased.

9. Muscle tone is decreased. 9. Muscle tone is decreased.

Sitz Bath or Hip Bath

It is bathing the perineal area which is taken in a sitting position. The patient sits in a tub
with hot water to immerse buttocks, perineal and rectal areas. The temperature of the
water should be from 40 to 43°C (105-110F), unless the client is unable to tolerate
the heat. The duration at the bath is generally 15 to 20 minutes, depending on the
client's health. Sitz bath is used after rectal or perineal surgery or vaginal delivery to
decrease inflammation and discomfort.

Purposes

• To relieve pelvic congestion.

• To promote drainage of rectal abscess e.g. haemorrhoids.
• To relieve pain and discomfort.
• To promote relaxation of bladder sphincter and retention of urine.
• To aid the healing process of perineal wounds.
• To reduce swelling and irritation.
• To increase circulation.

Indications

• Following surgery in the ano-rectal region.

 • Following incision on the perineum e.g. episiotomy.
• Swollen, painful haemorrhoids.

Contraindications

• Peripheral vascular diseases

• Impaired peripheral sensory function
• Immediate post haemoredectorny
• Pregnancy
• Menstruation
• Renal inflammation

Solutions Used

• Potassium permagnate 1:5000

• Boric acid 1 dran to 1 pint
• Eusol solution

Articles

• Sitz bath basin

• Warm water 105°F to 110°F
• Medicine if ordered
• Bath thermometer
• Clean gloves
• Towel
• Rubber sheet

Procedure

• Check the physician's order.

• Identify the patient.
• Assess the patient's condition, pain level and ability to ambulate to the bathroom.
• Wash hands.
• Explain the procedure to the patient to get his co-operation.
• Collect the required articles in the treatment room.
• Add required quantity of ordered medication e.g. potassium, betadine.
• Fill 2/3 the of basin with warm water at temperature of 105°F to 110°F
• Maintain the privacy of the patient.
• Assist the patient with removal of any dressing or peripad and assist to sit in sitz
bath basin.
• Keep the basin on a low stool/potty chair/toilet bowel with toilet seat up.
• Leave the patient to sit 20 minutes, instruct the patient to contract and relax
anal sphincter while taking sitz bath, then assist with drying and applying
dressing or perineal pad as required.
 • Assist the patient back to bed, and instruct to stay in bed for 20 minutes with
hip elevated. Use of warm water and prolonged sitting in one position may
result light headache on arising.
• Clean and replace all the reusable articles.
• Wash hands.derati
• Record date, time, solution used, temperature and duration of bath, reaction of the
patient on nurses' record and patient's chart and sign.

General Instructions

• Care must be taken to prevent burn and fainting.

• Discontinue the procedure if the patient complains of dizziness, weakness or
fainting due to shift in blood supply to the perineal area.
• Observe the patient frequently; never leave an unstable patient alone.
• Assist the patient in and out of bath basin.
• Vasodilation application over a large area of the body may cause hypotension. All
clients should be monitored closely and assisted when rising.
• If the patient has received epidural anesthesia, be sure that complete sensation
has returned before using a warm sitz bath.

Nursing Responsibilities during Hot and Cold Application

• For the location to be treated, the type of therapy, the frequency, and the length of
therapy, always check the order and hospital policy.
• To the patient: Describe the procedure.
• Evaluate the patient's condition prior to, during, and after treatment. Throughout
the treatment, periodically check the temperature.
• Analyze the patient's tolerance for the therapy and the best way to apply it.
• Check for any conditions that prevent the use of heat, such as those that
occur within 24 hours of a severe injury, active bleeding, non-inflammatory
edema, localized malignant tumours, and skin disorders that cause redness
and blisters.
• Find out if any conditions exist that call for extra care during therapy, such as
neurosensory deficits or altered mental status.
• Think about the patient's health. People who are unconscious, weak, have
circulation issues, or have skin that is broken are less tolerant of temperature
extremes.
• Depending on the status of the client, choose the temperature.
• Avoid directly applying dry heat and cold to the skin.
• Avoid applying cold compresses to the chest and abdomen.
• Apply the therapy for no more than 30 minutes, and if necessary, repeat
every two to three hours.
• Examine circuits; prevent moisture and item infiltration in electrical locations.
• Keep accurate records and reports of the treatments employed, the patient's
tolerance, and the effects of the devices. of treatment.1
•