Name: _____________________________________________

HOT WATER BAG/ICE CAP APPLICATION

1. Do handwashing. 5
2. Gather necessary materials. 7
3. Introduce yourself and explain the procedure. 4
4. Measure the temperature of the water using a bath 3
thermometer.
5. Make sure to use the appropriate temperature. 3
6. Fill the bag with about 2/3 full. 8
7. Expel the remaining air and secure the top. 10
8. Dry the bag. 5
9. Hold the bag upside down. 12
10. Wrap the bag in a towel or flannel cloth. 5
11. Place it on the body site. 6
12. Remove it after 30-45mins or in accordance with 5
agency protocol.
13. Ability to answer Q. 16
14. Ergonomics. 6
15. Misc. 5
TOTAL 10
0
Date Performed:
Signature of Student:
Signature of CI: