Heat and cold applicationHeat and cold application

Dr. Abdul-Monim BatihaDr. Abdul-Monim BatihaAssistant ProfessorAssistant ProfessorCritical Care NursingCritical Care Nursing

Philadelphia university Philadelphia university

ObjectiveObjective

Discuss the therapeutic uses of heat and cold therapy and their methods of application.

ADMINISTER HEAT AND COLD ADMINISTER HEAT AND COLD THERAPYTHERAPY

Cells in the hypothalamus act as a thermostat Cells in the hypothalamus act as a thermostat to regulate body temperature. When the to regulate body temperature. When the hypothalamic thermostat detects that the hypothalamic thermostat detects that the body temperature is either too high or too low, body temperature is either too high or too low, it responds systemically by instituting it responds systemically by instituting appropriate temperature-decreasing appropriate temperature-decreasing (vasodilation, sweating) or temperature-(vasodilation, sweating) or temperature-increasing (vasoconstriction, shivering) increasing (vasoconstriction, shivering) mechanisms to restore body temperature to mechanisms to restore body temperature to the normal level.the normal level.

Local responses to heat and cold Local responses to heat and cold occur through stimulation of occur through stimulation of temperature-sensitive receptors in the temperature-sensitive receptors in the skin. Impulses travel from the skin. Impulses travel from the periphery to the hypothalamus and the periphery to the hypothalamus and the cerebral cortex. The hypothalamus cerebral cortex. The hypothalamus then initiates heat-producing or heat-then initiates heat-producing or heat-reducing reactions of the body. The reducing reactions of the body. The conscious sensations of temperature conscious sensations of temperature are aroused in the cerebral cortex. are aroused in the cerebral cortex.

Heat and cold receptors adapt Heat and cold receptors adapt to changes in temperature. to changes in temperature.

On initial exposure, receptors On initial exposure, receptors are strongly stimulated by are strongly stimulated by extremes in temperature, but, extremes in temperature, but, within a short time, this within a short time, this response declines as the response declines as the receptors adapt to the new receptors adapt to the new temperature variations.temperature variations.

This adaptive ability of the body This adaptive ability of the body to temperature variations can be to temperature variations can be dangerous to clients insensitive dangerous to clients insensitive to heat and cold extremes and to heat and cold extremes and may predispose them to serious may predispose them to serious injury. Nurses and clients need to injury. Nurses and clients need to understand this adaptive understand this adaptive response when applying heat response when applying heat and coldand cold. .

Heat is one of the oldest nursing Heat is one of the oldest nursing measures used to reduce pain and measures used to reduce pain and promote healing. Heat causes promote healing. Heat causes vasodilationvasodilation and increases blood and increases blood flow to the affected area, producing flow to the affected area, producing skin redness and warmth. Heat skin redness and warmth. Heat produces maximum vasodilation in produces maximum vasodilation in 20 to 30 minutes; after this period, 20 to 30 minutes; after this period, reflex vasoconstriction occurs along reflex vasoconstriction occurs along with tissue congestion. with tissue congestion.

Periodic removal and reapplication Periodic removal and reapplication of heat will restore vasodilation. of heat will restore vasodilation. Prolonged exposure to heat Prolonged exposure to heat damages epithelial cells and damages epithelial cells and results in redness, tenderness, and results in redness, tenderness, and even blister formation. The even blister formation. The application of cold lowers the application of cold lowers the temperature of the skin and temperature of the skin and underlying tissues and causes underlying tissues and causes vasoconstrictionvasoconstriction..

Vasoconstriction reduces blood Vasoconstriction reduces blood flow to the affected area and flow to the affected area and produces skin pallor or a bluish produces skin pallor or a bluish discoloration and coolness. discoloration and coolness. Maximum vasoconstriction is Maximum vasoconstriction is achieved at 15°C (60°F); at achieved at 15°C (60°F); at temperatures below 15°C, the temperatures below 15°C, the vessels begin to dilate. vessels begin to dilate.

Prolonged exposure to cold results Prolonged exposure to cold results in a reflex vasodilation. Initially the in a reflex vasodilation. Initially the skin is reddened, but later it takes on skin is reddened, but later it takes on a bluish purple mottled appearancea bluish purple mottled appearance

with numbness and pain because of with numbness and pain because of impaired circulation and tissue impaired circulation and tissue ischemia.ischemia.

Vasodilation and vasoconstriction of Vasodilation and vasoconstriction of the blood vessels in the skin result the blood vessels in the skin result primarily from increased sensitivity primarily from increased sensitivity of the vessels to nerve stimulation of the vessels to nerve stimulation but also from a protective reflex but also from a protective reflex response that passes to the spinal response that passes to the spinal cord and then back to the vessels. cord and then back to the vessels.

The body’s response to the The body’s response to the application of heat and cold application of heat and cold is influenced by a number of is influenced by a number of factors. factors.

The following conditions The following conditions necessitate precautions in the use necessitate precautions in the use

of heat and cold applications:of heat and cold applications:

• • Neurosensory impairment: Neurosensory impairment: Clients with reduced perception of Clients with reduced perception of sensory or painful stimuli (e.g., sensory or painful stimuli (e.g., spinal cord injuries) are at an spinal cord injuries) are at an increased risk for tissue injury.increased risk for tissue injury.

Impaired mental status: Clients who Impaired mental status: Clients who are confused or unconscious need to are confused or unconscious need to be monitored and assessed be monitored and assessed frequently to ensure safety.frequently to ensure safety.• • Impaired circulation: Clients with Impaired circulation: Clients with cardiovascular and peripheral cardiovascular and peripheral vascular problems or diabetes may vascular problems or diabetes may not have the ability to dissolve heat not have the ability to dissolve heat through dilation of blood vessels and through dilation of blood vessels and are at an increased risk for tissue are at an increased risk for tissue injury.injury.

• • Skin and tissue integrity (open Skin and tissue integrity (open wounds, broken skin, scar formation, wounds, broken skin, scar formation, edema): Subcutaneous tissues are edema): Subcutaneous tissues are more sensitive to temperature more sensitive to temperature variations than are superficial tissues variations than are superficial tissues (e.g., cold can decrease blood flow to (e.g., cold can decrease blood flow to an open wound, thereby inhibiting an open wound, thereby inhibiting healing). healing).

Heat and cold can be applied in Heat and cold can be applied in dry and moist forms (Figure 35-dry and moist forms (Figure 35-15). The type of wound or 15). The type of wound or injury, location, and presence of injury, location, and presence of drainage or inflammation are drainage or inflammation are considered when selecting considered when selecting moist or dry applications. moist or dry applications.

Copyright 2008 by Pearson Education, Inc.

Methods for ApplyingMethods for ApplyingDry and Moist HeatDry and Moist Heat

Dry heatDry heat– Hot water bottleHot water bottle– Aquathermia padAquathermia pad– Disposable heat pack Disposable heat pack – Electric padElectric pad

Moist heatMoist heat– CompressCompress– Hot packHot pack– SoakSoak– Sitz bathSitz bath

Copyright 2008 by Pearson Education, Inc.

Methods for Applying Dry Methods for Applying Dry and Moist Heatand Moist Heat

Copyright 2008 by Pearson Education, Inc.

Methods for Applying Dry Methods for Applying Dry and Moist Coldand Moist Cold

Dry coldDry cold– Cold packCold pack– Ice bagIce bag– Ice gloveIce glove– Ice collarIce collar

Moist cold Moist cold – Compress Compress

– Cooling sponge bathCooling sponge bath