HOT AND COLD APPLICATION.Heat and cold applications promote offer comfort by reducing tissue swelling and promote healing and are ordered to relieve pain,

Heat and cold applications promote offer comfort by reducing tissue swelling and promote healing and are ordered to relieve pain, fight local infection, swelling, or inflammation, control bleeding, and reduce body temperature

1. MRS.JAYA.R BSC (N) NURSING TUTOR FON DEPARTMENT GANGA COLLEGE OF NURSING

2. HOT AND COLD APPILICATION Learning Objective Define Hot and cold application P urpose of hot and cold application. Therapeutic uses Classification of hot and cold application Effect of hot and cold application Principles of hot and cold application Indication hot and cold application General instruction hot and cold application Contraindication hot and cold application Common methods of hot and cold application

3. Heat and Cold Application

4. Definition Hot application is the application of hot agent, warmer than skin either in a moist or dry form on the surface of the body to relieve pain and congestion, to provide warmth, to promote suppuration, to promote healing, to decrease muscle tone and to softens the exudates. Cold application is the application of cold agent, cooler than skin either in a moist or dry form on the surface of the body to relieve pain and body temperature, to anaesthetize an area, to check hemorrhage, to control growth of bacteria, to prevent gangrene, to prevent edema and reduce inflammation .  

5. Purposes of hot application Hot application is the application of a hot agent, warmer than skin either in a moist or dry from on the surface of the body. Purpose :- To relive pain and congestion, To provide warmth, To promote suppuration, To promote healing, To decrease muscle tone To soften the exudates.

6. Purposes of cold application Cold therapy is also known as cryotherapy, It works by reducing blood flow to a particular area, which can significantly reduce inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.

7. THERAPEAUTIC USES

8. THERAPEAUTIC USES Therapeutic Uses of Local Hot Applications           Heat decreases pain            Heat decreases muscle tone          Heat promotes healing           Heat promotes suppuration          Heat relieves deep suppuration          Heat provides warmth          Heat stimulates peristalsis Therapeutic Uses of Local Cold Applications         Cold relieves pain        Prevents gangrene          Prevents edema and reduce inflammation         Controls hemorrhages          Checks the growth of bacteria         Reduce the body temperature          Cold anaesthetize an area

9. Classification of hot application

10. Classification of cold application

11. Effects of hot and cold application

12. CONT… HOT COLD Hot -20 to 40 mts of exposure Primary effect Cold-30 mts of exposure ONE HOUR AFTER SECONTORY EFFECT

13. Principles of Hot and Cold Applications    Water is good conductor of heat.   Air is poor conductor of heat.   Heat always flows from hotter area to the less hot area. Prolong exposure to moisture increases the skin susceptibility to maceration and skin breakdown, reducing the protection of the intact skin. Moisture left on the skin cause rapid cooling due to evaporation of the moisture.   Presence of steam increases the temperature of the hot application

14. CONT…       Oil acts as the insulator and delays the transmission of the heat.         Woolen materials absorb moisture slowly, but hold the moisture longer and cold off less quickly than the cotton materials.        When immersed in water the body becomes buoyant therefore the exercises are performed under water with less effort.    The temperature tolerance varies with individuals and according to the site and area covered.    The end organs of the sensory nerves of the skin convey the sensation of cold, heat pain and pressure. The sensation is interpreted in the brain.  Friction produces heat.

15. Indication of the hot application Indications for the application of hot packs (conductive heating) may include painful muscle spasms, abdominal muscle cramping, menstrual cramps, superficial thrombophlebitis

16. Indication of the cold application The most common indications and uses for the local application of therapeutic cold modalities include the following: To decrease swelling/edema following trauma - Cooling in water at 8ºC for 30 minutes decreases edema. To treat burns.

17. General Instructions         Asses the condition the clients before and after the hot and cold applications.         Maintain the correct temperature for the entire duration of the application         Expose the client only to the safe temperature.         Do not allow the clients to adjust the temperature control of appliance such as short wave diathermy, electric heating pads etc.         Never ignore the complaints of clients however small they appear to be.         Always make sure that the client is in position to remove the application         The client must have a calling signal within reach         Never leave a client alone even for a short period that cannot move from the appliances.    

18. CONT…   A thin layer of petroleum jelly or oil should be applied to the skin prior the application of moist heat application.   Do not use electrical appliances near to open oxygen. A small spark may cause explosion. Do not handle electrical appliances with the wet hands. Hot and cold applications must be very carefully used when the clients is unconscious, anaesthetized or otherwise unable to respond pain.   Any signs of complications should be recognized early, the procedure should be stopped immediately. After the procedure, dry the part gently by patting and not by rubbing to remove the moisture. In hyperpyrexia, the temperature of the body should be brought down gradually and steadily, sudden cooling is dangerous to the client.  

19. Contraindications of Hot Applications Heat is not used in malignancies Heat is not used in patients with heart, kidney and lung diseases Should not used in acute inflamed areas. Should not be applied on patients with paralysis. Should not be applied on open wounds Should not be applied when there is an edema associated with venous or lymphatic diseases. Should not be applied on patients with metabolic disorders. Should not be applied on very young and very old patients. Should not be applied on clients with high temperature.  

20. Contraindications of Cold Applications      Cold should not be applied on clients who are in the stage of shock and collapse Cold should not be applied when there is edema. Cold should not be applied on clients with circulatory disorders.  Cold should not be applied on patients with decreased sensation  Patients with shivering and very low temperature,  Cold should not be applied when there is infected wound.

21. Common Methods of Applying heat and cold Hot water bag (bottle) -More Common source of dry heat -Inexpensive -Improper use leads to burning Hot and cold packs Commercially prepared hot and cold packs provide heat or cold for a designated time 3. Electrical Pads -Provide constant heat -Are light weight -Some have water proof covers to place over a moist dressing Ice Bags, -Filled either with ice chips . Compresses -Can be either warm or cold -Are moist gauze dressing applied to a wound Soak -Refers to immersing a body part in a solution -Sterile technique is generally indicated for open wound 7. Sits Bath or hip bath -Used to soak a client’s pelvic area -The client’s sit on the chair and immersed in the solution 8. Cooling Sponge Bath -Promoting heat loss through conduction -Companied by antipyretic medication

22. Precautions in the use of heat and cold applications Neurosensory impairment: Clients with reduced perception of sensory or painful stimuli (e.g., spinal cord injuries)are at an increased risk for tissue injury. Impaired mental status: Clients who are confused or unconscious need to be monitored and assessed frequently to ensure safety Impaired circulation: Clients with cardiovascular and peripheral vascular problems or diabetes may not have the ability to dissipate heat through dilation of blood vessels and are at an increased risk for tissue injury. Skin and tissue integrity (open wounds, broken skin, scar formation, edema): Subcutaneous tissues are more sensitive to temperature variations than are superficial tissues. (e.g., cold can decrease blood flow to an open wound, thereby inhibiting healing)

23. Temperature of hot and cold application

24. HOT WATER BAG Hot water bags is also called hot water bottles, are rubber bags filled with hot water and used for heat therapy. It is used to manage pain, such as headache or arthritis, or keep yourself warm on a cold night. Hot water bottle are safer than electrical heating pads, which can start fires or cause electric shocks. Hot water bags may cause injury if we don’t use carefully.

25. CONT… Definition: local application of dry heat to a specific body part for a short duration using a rubber bag, Articles ; Boiling water Mug to pour water in to the bag Duster Towel Bath thermometer/lotion thermometer Vaseline or oil in a bottle –to apply if redness develops Hot water bag Kidney try /paper bag

26. LOTION THERMOMETER.

27. CONT… PROCEDURE: Identify the patient Explain the procedure Assess the skin/site wash the hand Fill the hot water bag with hot water, secure the cap and turn it up side down, ensure that there are any leaks, and pre warms the bag , Empty the bag and refill with hot water (temperature of hot water 105to115) to about two-third full. Expel all air ,and screw the cap tightly ,dry outside of the bag using duster and check it for leakage. Wipe off any moisture on the outside of the beg .

28. CONT… Put on the cover and take to the bedside if cover is not available ,use a pillow case or towel , Apply to the area Remove the bag after 20 to 30 mts, Check the site for redness, blisters, If present apply Vaseline /oil Make patient in comfortable in bed Record the procedure –time ,site, duration, effect Take all articles to the utility room. Empty the hot water bag wash outside of the bag with soap and water and hang upside down to dry it.

29. soak Arm Soak and Foot Soak: A soak refers to either immersing a body part (e.g. an arm, foot) in a solution or to wrap a part in gauze dressings and then saturating the dressing with a solution. Soaks may employ either “clean technique”. A sterile technique is indicated for any open wounds present on the area. Soaks are usually indicated for any one of the following reasons:   1. To apply heat, thus hastening suppuration and softening the exudates. 2. To apply medications. 3. To cleanse areas such as wound in which there are sloughing tissues. 4. To relieve oedema, ischemia and muscle spasm.

30. CONT…

31. Soak for open/ surgical wound Use a normal saline solution (salt water) or mild soapy water. Soak the gauze or cloth in the saline solution or soapy water, and gently dab or wipe the skin with it. Try to remove all drainage and any dried blood or other matter that may have built up on the skin. DO NOT use skin cleansers, alcohol, peroxide, iodine, or soap with antibacterial chemicals. These can damage the wound tissue and slow healing

32. CONT… The body parts to receive the moist heat application is submerged in a basin of warm water at 105 to 110 degree F. The duration of the treatment is usually 20 minutes. Ideally the temperature of the solution should be checked frequently and additional solution is added or the solution is replaced in order to maintain the appropriate temperature. The client should be in a comfortable position and the limbs are supported with pillows. Dry the surface thoroughly at the end of the treatment. Infrared Rays: (Infrared Lamp) Infrared lamps transmit infrared rays, which are visible heat rays beyond the red end of the spectrum. Ultraviolet Rays: (Ultraviolet Lamp) Ultraviolet lamps transmit infrared ray, which are invisible heat rays beyond the visible spectrum at the violet end.

33. Aquathermia Pad An aquathermia (Aqua-K) pad , which produces dry heat, is used to treat muscle sprains and mild inflammations and for pain relief. Temperature-controlled , distilled water flows through the waterproof pad . Apply the pad following specific orders. When applying an aquathermia pad follow electrical safety precautions.

34. Paraffin baths Paraffin baths , or melted paraffin with a small amount of mineral oil (seven parts paraffin , one part mineral oil), are another common form of superficial thermotherapy. ... Paraffin baths are typically used to treat the hands or feet and are best for areas that can be dipped into the paraffin .

35. Sitz bath Sitz bath is a method of applying heat using tepid or hot water to the pelvic or rectal area by sitting in a tub. The client is usually immersed from the mid thigh to the iliac crest. The temperature of the water is 110-115 degree F and the duration of the bath is 15 to 30 minutes.   Purpose: 1. To relieve congestion of the pelvic organs e.g. in dysmenorrhoea. 2. To relieve pain following cystoscopy. 3. To reduce inflammation. 4. To promote drainage of rectal abscess and haemorrhoids.  

36. CONT… Solutions Used: 1. Potassium permanganate solution 1:5000 2. Boric acid 1 dram to 1 pint. 3. Eusol solution. Contraindications: 1. Pregnancy. 2. Menstruation. 3. Renal Inflammation. 4. Increased irritability of the genital organs.

37. PROCEDURE 1.Test the water in the bath tub with a thermometer before the client is allowed to enter into the water. 2. Assist the client to the tub or into the sitz bath and position properly. 3. Wrap a blanket around the shoulders to prevent exposure and chilling. 4. Monitor the client closely for sign of weakness and fatigue and discontinue the bath if faintness, pallor, rapid pulse or nausea occurs. 5. Check the temperature of the water in between and keep it at the desired temperature by adding hot water.

38. 6. Do not leave the client alone in the bath tub. 7. When the bath is completed, assist the client to come out of the bath and dry well. 8. If the client complaints of fainting or weakness, assist him out of the bath. 9.  The client may feel sleepy due to the sedative effect of the sitz bath, so care should be taken to prevent falling. 10. Record the procedure.

39. Electrical Pads You can apply heat with an electric heating pad, hot water bottle, or warm compress. Heat should be put applied for about 20 to 30 minutes or as long and as often as directed. Always put a cloth between your skin and the heat pack to prevent burns. Check your skin for color changes or blisters about every 5 minutes .

40. Medical Fomentations Medical Fomentations: (Stupes) Medical fomentations are moist heat applications, in which a medicine (e.g. turpentine) is applied locally to augment the effects of the hot compresses used. Stupes are commonly used to relieve tympanites by increasing the peristalsis and relaxing the muscle spasm.   Articles: 1. Kettle with boiling water. 2. Wringer with wringer rods placed in a basin. 3. Lint or flannel pieces, large enough to cover the area. 4. Plates (2)

41. CONT… A tray Containing: 1. Cotton balls in a container. 2. Forceps. 3. Olive oil or Vaseline. 4. Paper bag. 5. Kidney tray. 6. Waterproof over and cotton pad. 7. Hot water bag with cover.

42. CONT… It will be necessary to insert a flatus tube to expel the flatus after the application of stupes. The drugs used are: Turpentine (1 part) well mixed with olive oil (3 parts) for adults. For children, turpentine (1 part) with olive oil (6 parts).   To apply the Turpentine Stupe: Take the turpentine and the olive oil in the correct proportion, mix them well and warm it by keeping the container in a bowl of hot water. Apply the warm oil mixture over the part, apply the hot compresses and follow the procedure as in hot compresses. After 10 to 15 minutes, insert the flatus tube and watch the expulsion of the flatus.

43. sun bath .. Sun bath . Exposure of all or part of the nude body to sunlight.

44. Ice Bags/cap

45. CONT… Fill a bag with crushed ice about half full. ... Wrap the ice pack in a cloth to protect your skin from frostbite or other injury. Put the ice over the injured area for 20 to 30 minutes or as long as directed. Check your skin after about 30 seconds for color changes or blistering.

46. CONT…. Ice Cap: Ice cap is a dry cold application. The ice cap used for the head, has a wide opening that allows it to be filled easily with ice chips, as does the ice collar, a narrow bag curved to fit the neck. Single use ice bags are frequently used. Cold Sponging: Cold sponging is used to reduce temperature in a client with hyperpyrexia. Large area of the body are sponged at one time permitting the heat of the body to transfer to the cooler solution on the body surface. Often wet towels are applied to the neck, axillae, groin and ankles where the blood circulation is close to the skin surface. Each area is dried by patting rather than by rubbing. Since the rubbing will increase the cell metabolism and raise the heat production. The vital signs are checked very frequently to detect the early signs of complications.  

47. CONT… Cold sponging is hazardous to the client if the temperature of the body is brought down rapidly from a high temperature to a very low temperature. In cold sponging, the temperature of the water is kept between 65 and 90 degree F.

48. CONT… Tepid Sponging: Tepid sponging is a safe method to reduce the body temperature in high pyrexia. It is carried out on the order of a physician. The temperature of the water is kept between 85 and 100 degree F .

49. ice pack Apply Cold Put an ice pack on your back for 10 to 20 minutes to reduce nerve activity, pain, and swelling . And be sure to wrap the ice pack in a towel to protect your skin.

50. Definition of ice collar . : An ice bag shaped to fit around the neck.

51. Compress Cold Compress: It is a local moist cold application. It may be sterile or unsterile. Sterile cold compresses are applied over open wounds or breaks in the skin. Cold compresses are made out of folded layers of gauze, lint piece or old soft linen, wring out of cold or ice water or in some evaporating lotion.  Article Required: 1. Large basin with ice. 2. Small basin with cold water. 3. Gauze pieces or small towels. 4. Waterproof pad. 5. Bath towel.

52. CONT… Procedure: 1. Explain the procedure to the client. 2. Wash hands. 3. Place the small basin with cold water into large basin with ice. 4. Place the compress in the cold water. 5. Keep the waterproof material under the part. 6. Check the area every 5 minutes. 7. Change the compress every 5 minutes or when it becomes hot.

53. CONT… 8. Remove the compress after 20 minutes. 9. Put the area dry with a bath towel. 10. Make client comfortable. 11. Clean the equipment and place it in the proper place. Discard the used articles. 12. Wash hands 13. Document the care-time, site, duration of the application

54. Role of nurse

55. CONT… Identify the patient name, age, sex, bed no. Assess the client condition History collection Physical examination Check the physician order contraindication of procedure Check the complication. Nurse should explain the procedure to the client Arrange the articles properly Hand washing Monitor the vital signs frequently

56. CONT… Follow the general instruction Nurse should take every precaution Avoid over exposure of heat and cold Nurse should maintained duration of procedure properly If patient if feel to hot and cold immediately stop the procedure and check the vital signs and give care for accordion to needs of patients During procedure closely observe the client condition and report to doctors During procedure do not use force apply gently Frequently change the site of application After procedure monitor the skin condition any complication signs of redness and numbness If any redness is present apply the oil/lotion Record and report the procedure .