and Heat Cold Therapy before application of heat or cold therapy, the client should understand its purpose, symptoms and precautions taken to prevent injury Assessment for Temperature Tolerance: Before applying heat or cold therapies, the nurse must assess the client's physical condition for signs of potential intolerance First observe the area to be treated. Alterations in skin integrity increase the client's risk for injury. Baseline skin assessment provide a guide for evaluating skin changes that might occur during therapy Contraindications to Heat and Cold Therapy an area of bleeding should not be covered by a warm application because bleeding will continue warm application are contraindication when the client has an acute, localized inflammation, cardiovascular problems (vasodilatation may disrupt blood supply to vital organs) cold is contraindicated if the site of injury has edema because cold further retards circulation to the area and prevents the absorption of the interstitial fluid (edema) if the client has impaired circulation (PVD, arteriosclerosis), cold application further reduces blood supply cold therapy is contraindicated in the presence of neuropathy because the client is unable to perceive temperature and damage resulting for temperature extremes cold therapy is also contraindicated during shivering because it may intensify shivering and dangerously increase body temperature. The nurse also assesses the client's response to stimuli. Sensation to light touch, pinprick, and mild temperature variations reveals the ability of the client to recognize when heat or cold becomes excessive. if the client has peripheral vascular disease, the nurse must pay attention to the integrity of the extremities (assess circulation by assessing capillary refill, observing skin color, and palpating skin temperatures, distal pulses, and edema) if signs of circulation inadequacy are present, question the order level of consciousness influences the ability of the person to perceive heat, cold, and pain. If a client is confused or unresponsive, the nurse must make frequent observations of skin integrity during therapy the nurse must also assess the condition of the equipment being used (no leaks, cracks, or damage) and the evenness of the temperature distribution Body Responses to heat and cold exposure to heat and cold can cause systemic and local responses systemic responses occur through heat-loss mechanisms, such as sweating and vasodilatation, or mechanisms promoting heat conservation, such as vasoconstriction and poiloereection, and heat production (shivering)
local responses occur through stimulation of temperature sensitive nerve ending within the skin, which sends impulses from the periphery to the hypothalamus, which triggers adaptive responses for maintenance of normal body temperature the body can tolerate wide variations in temperature. Normal temperature of skin is 34 degrees C (93.2 degrees F), but temperature receptors usually react quickly to local temperature between 45-15 degrees C/113-59 degrees F pain develops when local temperatures exceed this range. Excessive heat burning sensation Excessive cold numbing sensation before pain The body's adaptive ability creates the major problem in protecting clients from injury resulting from temperature extremes (a person initially feels an extreme change in temp, but within a short period hardly notices it (. This can be dangerous because a person insensitive to heat and cold extremes can suffer serious tissue injury. The nurse must recognize clients most at risk for injuries from heat and cold applications
Effects of Heat application: o Improves blood flow to injured site o If heat is applied for 1 hour or more, blood flow is reduced by reflex vasoconstriction. Periodic removal and reapplication of local heat restores vasodilatation. o Continuous exposure to heat damages epithelial cells, causing redness, tenderness, and even blistering Effects of Cold Application: o Diminishes swelling and pain o Prolonged exposure to cold results in reflux vasodialation, and the cells inability to receive adequate blood flow and nutrients results in tissue ischemia, the skin turns red, then bluish purple mottling with numbness and a burning type of pain. o The skin's tissues can freeze from exposure to extreme cold Factors Influencing Heat and Cold Tolerance Better able to tolerate short exposure to temperature extremes Certain area are more sensitive to temperature variations (neck, inner wrist and forearm, and perineal region) The foot and palm of hand are less sensitive to temp variations Exposed skin layers are more sensitive to temp variations
The body responds best to minor temp adjustments. If a body part is cool and a hot stimulus touches the skin, the response is greater than if the skin were already warm A person has less tolerance to temp changes with age. Clients who are very young and old are most sensitive to heat and cold If a client's physical condition reduces the reception or perception of sensory stimuli, tolerance to temp extremes is high, and the risk of injury is high Uneven temp distributions suggest that equipment is NOT functioning properly
Conditions that Increase Risk of Injury from Heat and Cold Application
Condition Very young clients Very old clients Open wounds, broken skin, stomas Peripheral vascular disease (diabetes, arteriosclerosis) Risk Factors Thin layers of skin increase risk for burns Reduced sensitivity to pain Sub Q and visceral tissues are more sensitive to temperature variations. They contain no temperature receptors and fewer pain receptors Extremities are less sensitive to temperature and pain stimuli because of circulatory impairment and local tissue injury. Cold application further compromises blood flow Perception of sensory or painful stimuli is reduced Alteration sin nerve pathways reception prevent of sensory or painful stimuli Infection is highly localized. Application of heat may cause rupture with spread of microorganisms systemically Effects of Heat Application Therapeutic effect Improves blood flow to injury site, promotes delivery of nutrients and removal of waste, lessens venous congestion Improves delivery of leukocytes and antibiotics to injury site Promotes muscle relaxations and reduces pain from spasm of stiffness Increases blood flow; provides local warm Promotes movement of waste products and nutrients
Confusion or unconsciousness Spinal cord injury Abscess tooth or appendix
Physiological response Vasodilation
Reduces blood viscosity Reduces muscle tension Increased tissue metabolism Increased capillary permeability
Physiological response Vasoconstriction
Local anesthesia Reduced cell metabolism Increased blood viscosity Decreased muscle tension
Effects of Cold Application Therapeutic benefit Reduces blood flow to injury site, prevents edema formation, and reduces inflammation Reduces localized pain Reduces oxygen needs of tissues Promotes blood coagulation at site Relieves pain
Conditions treated Direct trauma (sprains, strains, fractures, spasm),superficial laceration or puncture wound; minor burn; suspected malignancy in area of injury or pain, arthritis and join trauma
Application of Heat and Cold Requires a physician's order which should included the body site to be treated, and the type, frequency, and duration of application. Consult agency's procedure manual for correct temps to use Choice of Moist or Dry Application Type Advantages Disadvantages Moist - Reduces drying of the skin and softens - prolonged exposure to moist wound exudate application can cause maceration of - moist compresses stick to site well skin - moist heat penetrates deeply into - moist heat will cool rapidly because of tissue layers moisture evaporation - warm, moist heat does not promote - most heat creates greater risk for sweating and insensible fluid loss burns, because moistness conducts heat Dry - dry heat has less risk of burns than moist heat - does not cause skin maceration - retinas temperature longer (not influenced by evaporation) - dry heat increases body fluid loss through sweating - dry applications do not penetrate deep into tissues - dry heat causes increased drying of the skin
Warm, Moist Compresses: for open wounds, sterile, warm, moist compresses improve circulation, relieve edema and promote consolidation of pus and drainage heat from warm compresses diminishes quickly, so the nurse must change the compress often or apply a warm aquathermic pad or waterproof heating pad over the compress because moisture conducts heat, the temperature setting should be lower for a moist compress than for a dry application
a layer of plastic wrap or a dry towel can be used to insulate the compress and retain heat moist heat may cause the client to feel chilly, so the nurse should control drafts and keep the client covered with a blanket Warm Soaks warm soaks promote circulation, lessens edema, increases muscle relaxation, and can debride wounds and apply medicated solution for a warm soak, position the client comfortably; place a waterproof pad under the area to be treated, and the solution to about 105-110 degrees F. after immersing the body part, cover the container and extremity with a towel to reduce heat loss removed the cooled solution and add heated solution every 10 minutes (never add a hotter solution while body part is in the basin) after any soak, the nurse dries the body part to prevent maceration Sitz baths used after rectal surgery, childbirth, hemorrhoids, vaginal inflammation only the pelvic area is immersed in warm fluid usually lasts about 20 minutes prevent overexposure of the client by draping bath blankets around client's shoulders and thighs, and by controlling drafts assess pulse and facial color, nausea or lightheadedness? (exposure to heat can cause extensive vasodilatation) Aquathermia Pad water flow pad used for treating muscle sprains and areas of mild inflammation or edema distilled water circulates through hollowed channels within the pad to the control unit where water is heated r cooled safer than heating pads check equipment for malfunctions recommended temp 105-110 degrees F if the distilled water in the unit runs low, fill the reservoir 2/3 full. Plain tap water is never added to an Aquathermia pad because it might leave mineral deposits in the unit Do not place pad directly on skin to avoid burning. Rather, place a thin towel or pillow case over the unit [ins are never used with Aquathermia pads, because they may cause a leak check the client's skin for signs of burning application only 20-30 minutes if the pad is to be applied to the back, the client should lie in prone or on one side Commercial Hot Packs apply warm, dry heat to an injured area strike, knead, or squeeze the pack to allow chemicals to release heat
Cold, Moist, and Dry Compresses applied for 20 minutes at 59 degrees F to relieve inflammation and swelling observe for burning or numbness, mottling of the skin, redness, extreme paleness, and a bluish skin discoloration Cold Soaks 20 minutes at 59 degrees F nurse control drafts and uses outer covering to protect client from chilling Ice Bags or Collars Ice bags are used for muscle sprains, localized hemorrhage, hematomas, or after dental surgery to control bleeding and anesthetize the body part Fill bag with water, secure cap, turn it over to check for leaks, and then pour water out. Fill bag 2/3 full with crushed ice, release any air by squeezing it before securing the cap (excess air interferes with conduction of cold), wipe off excess moisture, and cover the bag with a flannel cover, towel, or pillow, apply the bag to injury site for 20-30 minutes May be reapplied in 1 hour