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FUNDAMENTALS OF NURSING PRACTICE
CHAPTER 5
APPLICATION OF WARM AND COLD
THERAPIES
APPLICATION OF COLD THERAPY
o Cold constricts the peripheral blood vessels,
reducing blood flow to the tissues and
decreasing the local release of pain-producing
substances. Cold reduces the formation of
edema and inflammation, reduces muscle spasm,
and promotes comfort by slowing the
transmission of pain stimuli. The application of
cold therapy reduces bleeding. The application
of cold, using ice, is appropriate after direct
trauma, for dental pain, for muscle spasms, after
muscle sprains, and for the treatment of chronic
pain. Ice can be used to apply cold therapy,
usually in the form of an ice bag or ice collar, or
in a glove. Commercially prepared cold packs are
also available.
EQUIPMENET
o Ice
o Ice bag, ice collar, gloves
o Small towel or washcloth
o PPE, as indicated
o Disposable waterproof pad
o Bath Blanket
ASSESSMENT GUIDELINES
o Assess the situation to determine the
appropriateness for the application of cold
therapy.
o Assess the patient’s physical and mental status
and the condition of the body area to be treated
with the cold therapy.
o Confirm the medical order, including frequency,
type of therapy, body area to be treated, and
length of time for the application.
NURSING DIAGNOSES
o Impaired Skin Integrity
o Ineffective Tissue Perfusion
o Delayed Surgical Recovery
o Chronic Pain
OUTCOME IDENTIFICATION AND PLANNING
A. Expected outcomes may include:
o Patient experiences increased comfort.
o Patient experiences decreased muscle spasms.
o Patient experiences decreased inflammation.
o Patient does not show signs of bleeding or
hematoma at the treatment site.
EVALUATION
o Patient reports relief of pain and increased
comfort.
o Patient verbalizes a decrease in muscle spasms.
o Patient exhibits a reduction in inflammation.
o Patient remains free of any injury, including signs
of bleeding or hematoma at the treatment site.
DOCUMENTATION
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B. Document the location of the application, time of
placement, and time of removal. Record the assessment of
the area where the cold therapy was applied, including the
patient’s mobility, sensation, color, temperature, and any
presence of numbness, tingling, or pain. Document the
patient’s response, such as any decrease in pain or change
in sensation. Include any pertinent patient and family
education.
GENERAL CONSIDERATIONS
o The patient may experience a secondary defense
reaction, vasodilation that causes body
temperature to rebound, defeating the purpose
of the therapy.
o Older adults are more at risk for skin and tissue
damage because of their thin skin, loss of cold
sensation, decreased subcutaneous tissue, and
changes in the body’s ability to regulate
temperature. Check these patients more
frequently during therapy.
APPLICATION OF WARM THERAPY
C. Warm moist compresses are used to help promote
circulation, encourage healing, decrease edema, promote
consolidation of exudate, and decrease pain and
discomfort. Moist heat softens crusted material and is less
drying to the skin. Moist heat also penetrates tissues more
deeply than dry heat. The heat of a warm compress
dissipates quickly, so the compresses must be changed
frequently. If a constant warm temperature is required, a
heating device such as an Aquathermia pad is applied over
the compress.
EQUIPMENT
o Prescribed solution to moisten the compress
material, warmed to 105ºF to 110ºF
o Container for solution
o Gauze dressings or compresses
o Clean disposable gloves
o Additional PPE, as indicated
o Waterproof pad and bath blanket
o Dry bath towel
o Aquathermia or other external heating device, if
ordered or required to maintain the temperature
of the compress
ASSESSMENT GUIDELINES
o Assess for circulatory compromise in the area
where the compress will be applied, including skin
color, pulses distal to the site, evidence of edema,
and the presence of sensation.
o Assess the situation to determine the
appropriateness for the application of heat.
o Confirm the medical order for the compresses,
including the solution to be used, frequency,
body area to be treated, and length of time for
the application.
o Assess the application site frequently during the
treatment, because tissue damage can occur.
NURSING DIAGNOSES
o Anxiety
o Disturbed Body Image
o Acute Pain
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FUNDAMENTALS OF NURSING PRACTICE
o Chronic Pain
o Impaired Skin Integrity
o Risk for Impaired Skin Integrity
o Impaired Tissue Integrity
o Deficient Knowledge
OUTCOME IDENTIFICATION AND PLANNING
D. Expected outcomes may include:
o Patient show signs, such as decreased
inflammation, decreased muscle spasms, or
decreased pain, which indicate problems have
been relieved.
o Patient experiences improved wound healing.
o Patient remains free from injury.
EVALUATION
o Patient report relief of symptoms, such as
decreased inflammation, pain, or muscle spasms.
o Patient remains free of signs and symptoms of
injury.
DOCUMENTATION
E. Document the procedure, the length of time the compress
was applied, including use of an Aquathermia pad. Record
the temperature of the Aquathermia pad and length of
application time. Include a description of the application
area noting any edema, redness, or ecchymosis. Document
the patient’s reaction to the procedure, including pain
assessment. Record any patient and family education that
was provided.
GENERAL CONSIDERATIONS
o Patients with diabetes, stroke, spinal cord injury,
and peripheral neuropathy are at risk for thermal
injury, as are patients with very thin or damaged
skin.
o Be extremely careful when applying to heat-
sensitive areas, such as scar tissue and stomas
COLD OR TEPID SPONGE BATH
F. DEFINITION: Consist of the general application of cold or
tepid water to a patient’s body by means of a sponge bath.
PURPOSE:
o 1. To relieve discomfort
o 2. To stimulate circulation
o 3. To reduce temperature
GENERAL CONSIDERATIONS:
o 1. Do not allow the water to drip from the sponge
cloth sponging and keep friction.
o 2. Keep the patient’s arm away from the sides and
sponge the axilla to get a thorough cooling in the
axilla, the inside surfaces of the arms and legs
where the large blood vessels lie.
o 3. Watch the pulse and color of the patient
constantly. If the patient chills, discontinue the
treatment.
EQUIPMENT:
o 1. Tray with the following
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G. a. Pitcher of hot water
H. b. Pitcher of cold water
I. c. Basin
J. d. Ice cap with cover
K. e. Hot water bag with cover
o 2. Bath blanket
o 3. Towels
o 4. Face cloth
o 5. Bed protector
o 6. Patient’s gown
L. Tepid – 26.6-33.8℃
M. Cool – 18.3-26.6℃
N. Cold – 12.7-18.3℃
O. Very cold – below 12.7℃
GIVING A SITZ BATH
P. DEFINITION: Sitz bath is a local hot water bath which
consists of the immersion of the pelvic region of the
patient who is in a sitting position.
GIVING A SITZ BATH:
Q. To give a sitz bath, a patient is placed in a shallow tub or
basin containing enough warm water so that only the
pelvic area is submerged. The nurse should implement the
plans for the care of the assigned patient so as to allow
approximately 15 to 30 minutes for the sitz bath. Although
intended to cause vasodilation, prolonged heat may cause
the reverse effect if the warm temperature is sustained. By
coordinating the preparation of the equipment with the
patient’s readiness, the maximum effects of the procedure
are likely to be achieved.
PURPOSES:
o 1. To increase local circulation.
o 2. To reduce swelling.
o 3. To promote healing.
o 4. To help relax local muscles.
ASSESSMENT:
o 1. Read the physician’s order.
o 2. Consult the agency’s policy for the amount of
time and temperature recommended for sitz
bath.
o 3. Read the patient’s record to determine the
reason for the sitz bath such as promoting
healing of perineal incision.
o 4. Assess the patient’s mental status and any
evidence of sensory or cardiovascular diseases.
o 5. Inspect the perineal area for color, swelling,
discharge, and integrity, evidence of external
hemorrhoids, drains, packing or dressing material.
o 6. Observe the patient’s ability to sit directly on
the buttocks, note signs of discomfort.
o 7. Take the patient’s vital signs and compare them
with the recommended range for the patient’s
age, determine the pattern of the vital sign
recordings.
o 8. Ask the patient to describe the sensations
experienced in the perineum and rectum
especially with sitting, walking, and when
eliminating urine or stool.
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X.
EQUIPMENT:
o 1. Sitz bath chair
o 2. Bath thermometer
o 3. Bath towels and clean gown
o 4. Bath blanket
o 5. Sterile dressings and T – binder (optional)
o 6. Pitcher of hot water
o 7. Pail ¾ filled with tap water
STEAM INHALATION
R. DEFINITION: Steam inhalation is one of the most widely
used home remedies to soothe and open the nasal
passages and get relief from the symptoms of a cold or
sinus infection also called steam therapy, it involves the
inhalation of water vapor. The warm, moist air is thought
to work by loosening the mucus in the nasal passages,
throat, and lungs. This may relieve symptoms of inflamed,
swollen blood vessels in your nasal passages.
BENEFITS:
o Hot, humid air has been used for treating
common colds for a very long time and many
patients feel better with this treatment. Inhaling
with common salt solution moistens the mucous
membrane in the respiratory tract and liquefies
the secretion formed there. Thus one supports
the natural cleaning function of the mucous
membrane, which represents an important part
of the immune defense. The multiplication of the
cold viruses is reduced by the hot steam. The
main benefit of breathing in moist, warm steam is
that it may help ease feelings of irritation and
swollen blood vessels in the nasal passages. The
moisture may also help thin the mucus in your
sinuses, which allows them to empty more easily.
This can allow your breathing to return to normal,
at least for a short period of time. Steam
inhalation may provide some temporary relief
from the symptoms of:
S. the common cold
T. the flu (influenza)
U. sinus infections (infectious sinusitis)
V. bronchitis
W. nasal allergies
EQUIPMENTS:
o a large bowl
o water
o a pot or kettle and a stove or microwave for
heating up water
o towel
o salt
CHAPTER 6
BED MAKING
OCCUPIED AND UNOCCUPIED
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Bed Making Technique
o It is the proper adjustment of bed linens.
PURPOSES
o to provide clean environment
o to promote physical comfort
o to maintain appearance of the bed
o to prevent cross contamination
POINTS TO CONSIDER:
o Safety and comfort of patient.
o Neatness and cleanliness.
o Economy of time and material.
o Dexterity and care in handling materials.
SAFETY AND COMFORT OF PATIENTS.
o Wash hands and use gloves if necessary; other
personal protective equipment may also be
required.
o Use proper body mechanics at all times to
prevent back injury.
o Make sure the bottom sheet and draw sheet (if
used) are smooth and unwrinkled (wrinkles in
bed linens can lead to skin breakdown, especially
on bedridden patients).
o Follow the care plan for positioning the head and
foot of the bed, the number of pillows to be used,
and the use of pillows for positioning.
NEATNESS AND CLEANLINESS
o Laundry hampers placed in the hallway should be
at least one room away from clean linen carts, or
placed according to hospital policy.
o The clean linen cart is always covered; replace the
cover after removing required linen.
o Take only the linens you need into the patient’s
room.
o Linens that touch the floor are considered dirty
and are placed in the laundry hamper; they are
not used.
o Avoid contact between the linens and your
uniform (for both clean and soiled linens).
o Unused linen is never returned to the clean linen
cart; it is placed in the laundry hamper.
o Soiled linen is never placed on environmental
surfaces in the room, such as the over bed table,
chair, or floor; soiled linens are placed in the
appropriate laundry hamper.
o Fill laundry hampers no more than two-thirds full.
Keep the lid of the hamper on tightly at all times.
o Many facilities do not permit laundry hampers or
barrels to be taken into the patient’s room. Soiled
linen may be placed in a plastic bag or a
pillowcase in the room. Make a cuff at the top of
the bag or open end of the pillowcase and place
the cuff over the back of the chair. When the bag
or case is two-thirds full, secure the top and place
it in the hamper in the hallway.
o Laundry hampers or barrels are returned to the
utility room after use, or as directed by facility
policy.
ECONOMY OF TIME AND MATERIAL
o Prepare and arrange the equipment in order of
use.
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o Work on one side of the bed at a time to
complete removal of soiled linen and placement
of clean linen.
DEXTERITY AND CARE IN HANDLING MATERIALS
o Never shake bed linens, because microbes will be
released into the air.
o As soiled linen is removed from the bed, keep the
soiled areas on the inside and fold or roll the linen
toward the center.
EQUIPMENT
o LINENS
o FURNITURE
o Chairs and table
o Over-bed tables
o Closets and dressers
o Privacy curtains and room dividers
o Bedside tables
o OTHER EQUIPMENT
LINEN
o Cloth made of flax used to make sheets
o Linen is famous because of its strength and
durability hence it is known as versatile fabric.
o It is highly absorbent and can absorb up to 20% of
its own weight.
o Linen is 100% natural and oldest fabric used by
ancient Mesopotamia,
TYPES OF LINENS
o 1. Bottom Sheet
Y. Placed over the mattress pad
o 2. Bed protector/ Water proof Underpad/ Rubber
sheet
Z. Used for people who are incontinent
and for people with draining wounds;
protects the linens.
o 3. Top Sheet
AA. Is a flat sheet that covers the person
o 4. Bath blanket
BB. Used during bed baths and linen
changes
o 5. Pillowcase
CC. Used to cover pillow and protect it from
moisture and soiling
FURNITURE
o Ward furniture is ideally used in various hospitals,
medical centres and such other places.
o Ward plain bed, IV stand, bedside screen, bedside
locker deluxe, hospital washbasin stand, hospital
basin stand and other furniture comes in the
category of ward furniture.
DIFFERENT FURNITURE
o Chairs and tables
DD. A table is an item of furniture with a flat
top and one or more legs, used as a
surface for working at, eating from or
on which to place things.
EE. A chair is a type of seat. Its primary
features are two pieces of a durable
material, attached as back and seat to
one another at a 90° or slightly greater
angle
o Overbed tables
FF. It is a narrow rectangular table designed
especially for hospital patients that
spans the bed and is typically fitted with
casters and a crank for adjusting the
height and tilting the top
o Closets and dressers
GG. Closet is a cabinet or recess for
especially china, household utensils,
HH. Drawer is a piece of furniture that has
drawers for storing clothes and that
sometimes has a mirror.
o Privacy curtains and room dividers
II. A hospital curtain is also known as a
cubicle curtain and is a method of giving
privacy to a patient in a hospital.
o Bedside tables
JJ. It is a table used to store patient’s
things.
ADDITIONAL EQUIPMENT
o Call light and intercom system / Call Button
(signal device)
KK. A nurse call button is a button or cord
found in hospitals and nursing homes, at
places where patients are at their most
vulnerable, such as beside their bed and
in the bathroom.. It allows patients in
health care settings to alert a nurse or
other health care staff member
remotely of their need for help.
o Oxygen tank and accessories
LL. Oxygen tanks are filled with pressurized
oxygen and can help people with health
problems breath.
o Suction apparatus and catheter
MM.In medicine, devices are sometimes
necessary to create suction. Suction
may be used to clear the airway of
blood, saliva, vomit, or other secretions
so that a patient may breathe.
o Goose neck lamp
NN. A gooseneck lamp is a type of light
fixture in which a lamp or light bulb is
attached to a flexible, adjustable shaft
to allow the user to position the light
source without moving the fixture or
item to be illuminated.
o Kidney / EMESIS basin
OO. It is a shallow basin with a kidney-
shaped base and sloping walls used in
medical and surgical wards to receive
soiled dressings and other medical
waste.
o Padded tongue depressor
PP. It is used to moisten the lips of the
patient by soaking the pad with water.
TYPES OF BEDS
o Bed Making
QQ. Unoccupied Bed
RR. Open
SS. Close
o Obstetrical Bed
o Surgical Bed
o Occupied Bed
TERMS TO REMEMBER:
o 1. Hem – the edge or border of a garment

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TT. Bigger Hem vs Smaller Hem o Gloves/mask

UU. Right Side vs Wrong Side o Bath blanket
o 2. RIBS (Right Side Inside Bottom Sheet) o Waterproof underpad
VV. ROTS (Right Side Outside Top Sheet) o Cotton draw sheet
o 3. Miter – to join at the corner, to secure the bed o Pillow case
linen while the patient is on bed o Pillow

UNOCCUPIED BED
ZZ. BED MAKING PROCEDURE

EQUIPMENT UNOCCUPIED BED

o Bottom Sheet
o Top Sheet
DEFINITION:
o Pillow Case
o A closed bed in one that is made and designed to
o Pillow
protect the sheets from dust and have a neatly
tailored appearance.
OBSTETRICAL BED o A method of bed making for an incoming patient.

WW. A method of bed making for a patient who has gave TYPES:
birth. o a. Close Bed - is made following discharge of a
EQUIPMENT: patient and after the unit is cleaned (terminal
o Waterproof under pad\ cleaning). It remains closed until a new patient is
o Cotton draw sheet to be admitted. (The top sheet is drawn up to the
o Top Sheet (Pink) top of the bed over the pillows).
o Pillow case o b. Open Bed - is like a sign saying “welcome” to
o Pillow the new patient. It indicates that the patient’s
o Bath towel arrival has been made. (The top covers are folded
back for the patient to get in).
SURGICAL BED
PURPOSES:
XX. A method of bed making for a patient who underwent a o 1. To provide a comfortable bed for the patient.
surgical operation. o 2. For cleanliness.
EQUIPMENT: o 3. To maintain good appearance.
o Bottom Sheet (Green)
o Waterproof under pad OPEN BED
o Cotton draw sheet
o Bath towel
DEFINITION:
o Top Sheet (Pink) o An open bed in one that is originally made as a
o Pillow case close bed with the top sheet rearranged in such a
o Pillow way that is ready for use.
PURPOSE:
ADDITIONAL EQUIPMENT: o To provide a comfortable and neatly prepared
o I.V. pole bed for a patient to get into at his convenience.
o Suction apparatus MATERIALS:
o Suction catheter (fr.12-14 for adults; fr. 8-10 for o Same as in close bed
children)\
o Oxygen tank prepared with necessary
OBSTETRICAL BED
connections
o Goose neck lamp (optional)
o Kidney basin lined with tissue paper DEFINITION:
o Padded tongue depressor o A method of bed making for a patient who has
o Tissue wipes/ wash cloth gave birth.
EQUIPMENT:
o 1 bottom sheet
OCCUPIED BED o 2 cotton draw sheets (any clean cotton sheet)
o 1 waterproof under pad
o 1 top sheet
YY. It is a method of bed making with a patient in bed.
o 2 pillow cases
INDICATION: o 2 pillows
o This is commonly suggested for patients who are
unconscious, critically ill and in continuous SURGICAL OR POST OPERATIVE BED
traction. o A method of bed making for a patient who
underwent a surgical operation.
EQUIPMENTS:

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GENERAL CONSIDERATION:
o See to it that all the needed set of equipment are
assembled and ready for use before the patient
arrives from the Operating Room.

EQUIPMENT:
o Same as the unoccupied bed with the addition of
the following:
AAA. bed protector
BBB. bath towel
CCC. Gown
DDD. Blanket
EEE. Padded tongue depressor
FFF. Tissue wipes/ wash cloth
GGG. I.V. pole
HHH. Suction apparatus
III. Suction catheter (fr.12-14 for adults; fr.
8-10 for children)
JJJ. Oxygen tank prepared with necessary
connections
KKK. Goose neck lamp (optional)
LLL. Waterproof underpad (optional)
MMM. On the bedside are:
NNN. Kidney basin lined with tissue paper

OCCUPIED BED

DEFINITION:

OOO. It is a method of bed making with a patient in bed. This

is commonly suggested for patients who are unconscious,
critically ill and in continuous traction. It is a preparation or
changing of bed linens with patient on bed.

PURPOSES:
o 1. To make a bed with least possible discomfort to
patient.
o 2. To provide exercise for the patient and help
stipulate circulation.
o 3. To observe patient’s condition.

EQUIPMENT:
o 1 bottom sheet
o 1 pillow case
o 1 pair of working gloves, face mask (PPE)
o 1 top sheet
o 1 bath blanket (optional)
o gown (optional)

GENERAL CONSIDERATIONS:
o 1. Avoid jarring the bed.
o 2. Avoid unnecessary exposure of patient.
o 3. Avoid having the top sheet uncomfortably
tight.

SUMMARY:

PPP.The room, especially the bed is the patient’s home while he

or she is in the hospital or health care facility. A well-made
bed offers both comfort and safety. It is an extremely
important contribution to the well-being of the patient.