BACHELOR OF SCIENCE IN NURSING:

FUNDAMENTALS OF NURSING
COURSE MODULE COURSE LAB WEEK
1 5 5

Hot and Cold Application

✓ Read course and laboratory unit objectives

✓ Read study guide prior to class attendance
✓ Read required learning resources; refer to course unit
terminologies for jargons
✓ Participate in weekly discussion board (Canvas)
✓ Answer and submit course unit tasks

At the end of this unit, the students are expected to:

1. Implement safe and quality nursing care in the performance of hot and cold application.
2. Operate appropriate equipment/technology in the performance of hot and cold application.
3. Participate in research by analyzing possible problems in the application of hot and cold
compress
4. Demonstrate caring as the core of nursing, love of God, love of country, love of people.
5. Integrate being an A.C.H.I.E.V.E.R. in the performance of nursing procedures involving hot
and cold application.

Berman, A., Snyder, S.J., and Frandsen, G. (2020) Kozier and Erb’s Fundamentals of Nursing:
Concepts, process, and Practice, 11th Edition, Skin Integrity and Wound Care (pp.883-861).
Pearson
Perry, A.G., Potter, P.A., and Ostendorf, W. (2018). Clinical Nursing Skills and Techniques, 9th
Edition, Application of Moist Heat and Cold (pp.306-308). Mosby

Ctec Nursing Skills. (2017, March). Hot or cold application [Video File]. Retrieved from
https://www.youtube.com/watch?v=adFGvCoYXqw

George Elliot Hospital. (2016, December). Applying an icepack – physiotherapy advice [Video File].
Retrieved from https://www.youtube.com/watch?v=gJOMV2mZ1B0

Computer device or smartphone with internet access (at least 54 kbps; average data subscription
will suffice)

To facilitate the practice of students’ skills demonstration, the concepts found below must be read
and fully understood. Videos of the procedure found in the references section must be viewed.

Brief Overview
In anatomy and physiology, it is taught that temperature receptors in the body adapt to
temperature changes. Nurses and clients need to understand this because a hot application can
cause burn injuries while cold application can result to pain and severe circulation impairment.

Physiologic Effects of Heat and Cold

HOT vs. COLD

1. Vasodilation 1. Vasocontriction
2. Sedative effect 2. Local anesthetic effect
3. Increase capillary permeability 3. Decrease capillary permeability
4. Increase cellular metabolism 4. Decrease cellular metabolism
5. Increase inflammation 5. Increase inflammation (slows
bacterial growth)

Therapeutic Application
Local application of heat and cold in the body can be beneficial. They can either be in moist or dry
forms. But before using these therapies, the nurse must understand the HOW and WHEN of their
usage. Table 1 summarizes this.

A. Heat Application
ü Dry heat:
- Hot water bottle/bag = mostly used, especially at home; accessible and economical
 - Aquathermia pad (K-pad) = pad is attached by a tubing to an electrically powered
control unit (waterproof); has a temperature gauge
- Disposable heat pack or electric heating pad = provide constant, even heat; can be
molded to the body part (CAUTION! Can cause burns if the setting is too high)

Figure 1. Aquathermia pad (left) and a plastic single-client sitz bath (right)
(Courtesy: Hamilton Aquamatic)

ü Moist heat:
- Hot compress = use of gauze pads or roll or towels
- Hot pack = commercially prepared; provides heat for a designated time only; directions
for use are found on the package labels to initiate heating process; applied to a wound
or injury (water temperature = 40°C)
- Hot soak = requires immersing a body part in a solution or wrapping in gauze dressings
saturated with a solution (observe sterile technique for open wounds); use to soften or
remove crusted/dead tissues
- Hot sitz bath = also known as hip bath; soak perineal or rectal area into a solution (e.g.
Epsom salt, witch hazel, lavender oils) while the client sits on a special chair or tub
(water temperature = 40-43°C)

B. Cold Application
ü Dry cold:
- Cold pack = same as hot pack but, it initiates cooling process
- Ice bag, ice glove, ice collar = filled with ice chips or alcohol-based solution; must be
wrapped in a towel or cover when being used
ü Moist cold:
- Compress
- Cooling sponge bath = to reduce fever of over 40°C by heat loss through conduction
and vaporization accompanied by antipyretics (water temperature = 27-37°C)

Table 1. Indications of Heat and Cold Application

Indication Effect of Heat Effect of Cold
Muscle Spasm Relaxes and INcreases contractility Relaxes and DEcreases contractility
Inflammation Increases blood flow, softens Vasoconstriction
exudates
Pain Relief Decreases
Contractures Reduction -
Joint stiffness Reduction -
Traumatic injury - Decreases bleeding and edema
Source: Berman, Snyder, Frandsen (2020)
PRECAUTIONS!
v Neurosensory impairment – they are unable to perceive hot and cold
temperatures that can lead to burns or tissue injuries
v Impaired mental status – they have altered level of consciousness and need
monitoring during applications to ensure safety
v Impaired circulation – those with diabetes mellitus or congestive heart failure lack
the usual ability to dissipate heat via blood circulation making them at risk for
tissue damage
v Post-surgery – heat increases bleeding and swelling
v Open wounds – cold can decrease blood flow to the wound and impair the
healing process

Thermal Tolerance Considerations

1. Body part – foot and back of hand are NOT overly sensitive to temperature
- Eyelids, neck, Inner aspect of arm, and perineal area are extremely
sensitive to temperature
- The larger the body size exposed to heat and cold, the lower the
tolerance
2. Length of exposure – tolerance increase after some time
3. Skin integrity – areas of the skin with injury/ trauma (compromised skin integrity) are more
sensitive to heat and cold

Rebound Phenomenon – occurs at the time the maximum therapeutic effect of a hot
or cold application is achieved and the opposite effect begin (Berman, Snyder, and
Frandsen, 2020) Therefore, thermal applications must be halted before this
phenomenon begins.

SKILLS PROCEDURE

IMPORTANT! Ensure all your equipment and materials are at hand before going to the client.

I. Application of Moist Heat: Moist Compress and Sitz Bath/Soak (Based on Perry, Potter, and
Ostendorf, 2018)
v FIRST: Introduce self and identify the client by asking for at least 2 identifiers (e.g. name,
birthday, age, etc.)
Assessment:
1. Verify order for type of moist heat application, location and duration, and
desired temperature.
2. Review client’s chart for medical history and contraindications that may
prohibit the use of hot or warm therapy.
3. Assess client’s vital signs and mobility.
4. Assess client’s skin around the area to be treated and client’s temperature
and pain sensitivity.
5. Inspect wound, if any, for size, color, odor, tenderness, drainage.
6. Assess client and family’s awareness, understanding of the procedure, and
related safety factors.
Planning:
1. Identify expected outcomes
2. Assemble and prepare the equipment and supplies needed.
Implementation
v Provide privacy at all times.
a. Applying moist sterile compress:
Materials needed: Moist compress (e.g. commercially prepared,
aquathermia pad, etc.); Sterile gauze pads or roll (size and
number depends on the body part of client to be treated); Heating
equipment (to warm the water to the needed temperature), Water
proof pad or clean dry towel, Water container/ basin), Gloves (1
pair clean and 2 pairs sterile)
1) Explain the procedure and purpose to the client, sensations the
client would feel and precautions to prevent burning.
2) Heat water to the desired temperature for moist compress. (For
aquathermia pad use, prepare and set the desired temperature.)
3) Perform hand hygiene and put on a pair of clean gloves
4) Keep client’s body part in proper alignment, drape client as need, exposing only the body
part to be treated.
5) Place a waterproof pad under the client’s body part, if appropriate
6) Remove any wound dressing present, inspect condition of wound and surrounding skin.
7) Dispose gloves and dressing into a biohazard bag. Then perform hand hygiene.
8) Prepare the compress:
a) Pour the warm solution into a container
***Follow instructions for warming using commercially prepared compress.
b) Wear sterile gloves
c) Using the sterile technique, open the gauze
d) Immerse gauze into the container of water
9) Pick up one layer of gauze, wring out excess water and apply onto the wound and its
surrounding skin
10) Lift gauze to initially assess for redness due to the moist heat applied
11) Pack the moist gauze snugly if client tolerates the compress covering all wound surfaces.
12) Cover moist compress with dry sterile gauze and clean bath towel. Secure as appropriate;
use pin, tie, etc. (Apply aquathermia or water-proof heating pad if available)
13) Dispose gloves properly and perform hand hygiene.
14) Check back with client after 15 minutes and assess. Change moist compress using sterile
technique if heat pad is not used.
15) After 30 minutes, or as ordered, remove the moist compress using clean gloves.
16) Reassess wound and surrounding skin condition. (Replace with dry sterile dressing, if
ordered or as necessary, using sterile technique, i.e. use sterile gloves and sterile gauze)
17) Help client to preferred comfortable position.
18) Dispose all soiled material and equipment appropriately and perform hand hygiene.

b. Applying sitz bath or warm soak to sutured wound:

Materials: Sitz bath/tub equipment; Heating equipment (to warm the water to the needed
temperature), Clean and dry blanket or bath towel, 3 pairs clean gloves
 1) Heat water to the desired temperature in a separate
container.
2) Perform hand hygiene and wear clean gloves.
3) Remove any existing dressing over the client’s wound and
inspect the condition of the wound and skin, especially the
suture line.
4) Dispose of the soiled dressing and gloves appropriately and
perform hand hygiene.
5) Apply clean gloves again and clean the suture and
surrounding skin
6) In the client’s bathroom, fill the sitz bath container with the warmed water. Check its
temperature.
7) Assist client to the bathroom or to the bedside commode and immerse body part into the
bath and cover patient with blanket or towel as needed. Remove and dispose gloves.
8) Assess client’s heart rate and ensure that client is not lightheaded. Place the call button/
call light switch is within reach.
9) After 20minutes, or as ordered, wear clean gloves, remove client from the soak. Dry
client, as necessary, and assist client back to bed on position of comfort.
10) Drain the used sitz water and clean the equipment properly. Place in the appropriate
storage area. Dispose of soiled blanket or towel and gloves and perform hand hygiene.

STOP the application immediately if any untoward incident or problem(s) occur.

Evaluation
1. Inspect the body part or wound condition for evidence of effectiveness of therapy and
sensitivity to touch.
2. Ask client to describe level of comfort and burning sensation following the treatment.
3. Obtain vital signs and compare with baseline.
4. Identify any unexpected outcome.
Recording and Reporting: Record, document, and report all pertinent information of the
procedure performed.

II. Application of Cold (Based on Perry, Potter, and Ostendorf, 2018)

v FIRST: Introduce self and identify the client by asking for at least 2 identifiers (e.g. name,
birthday, age, etc.)
Assessment:
1. Verify order for type of moist heat application, location and duration, and
desired temperature.
2. Review client’s medical history and contraindications that may prohibit the
use of cold therapy
3. Assess client’s vital signs and mobility.
4. Assess client’s skin around the area to be treated and client’s temperature
and pain sensitivity.
5. Inspect wound, if any, for size, color, odor, tenderness, drainage.
6. Assess client and family’s awareness, understanding of the procedure, and
related safety factors.
Planning:
1. Identify expected outcomes
2. Assemble and prepare the equipment and supplies needed.
Implementation
v Provide privacy at all times.
a) Applying a cold compress:
Materials needed: Cold compress may be commercially prepared, a towel, or gauze pads
or roll (size and number depend on the body part of client to be treated); Ice,
Container/basin, Waterproof pad or clean dry towel, 1 pair clean gloves
1) Explain the procedure and purpose to the client, sensations the client would feel and
precautions to prevent complications.
2) Perform hand hygiene and put on a pair of clean gloves
3) Keep client’s body part in proper alignment, drape client as need, exposing only the body
part to be treated.
4) Place a waterproof pad or towel under the client’s body part, if appropriate.
5) Place ice water into a basin and check the temperature.
6) Submerge gauze pad or towel into the water and wring out excess
moisture.
7) Apply compress to affected area, molded over the site.
8) Remove, remoisten, and reapply to maintain the cold temperature
as needed.
9) Check skin condition at appropriate and regular intervals.
10) After Remove gloves, dispose of properly, and perform hand
hygiene.
11) Help client to a comfortable position.
12) Remove, clean, dry, and store or dispose of supplies and equipment accordingly.

b) Applying an ice pack or bag

Materials needed: Ice bag or commercially prepared ice gel pack; Ice, Container/basin,
Waterproof pad or clean dry towel, 1 pair clean gloves
1) Explain the procedure and purpose to the client, sensations the client would feel, and
precautions to prevent complications.
2) Perform hand hygiene and put on a pair of clean gloves
3) Keep client’s body part in proper alignment, drape client as need, exposing only the body
part to be treated.
4) Place a waterproof pad or towel under the client’s body part, if appropriate
5) Fill bag with water (approximately 2/3 full) and ice.
6) Express excess air from bag, secure cap, and wipe the bag dry.
7) Apply over injury, mold and ensure it is secure in place.
*For commercially prepared ice gel pack, squeeze and knead then wrap with towel.
8) Check skin condition at appropriate and regular intervals.
8) After 30 minutes, or as ordered, remove gloves, dispose of properly, and perform hand
hygiene.
9) Help client to a comfortable position.
10) Remove, clean, dry, and store or dispose of supplies and equipment accordingly.

STOP the application immediately if any untoward incident or problem(s)

occur.
 Evaluation
1. Inspect the body part or wound condition for evidence of effectiveness of therapy and
sensitivity to touch.
2. Ask client to describe level of comfort and burning sensation following the treatment.
3. Obtain vital signs and compare with baseline.
4. Identify any unexpected outcome(s).
Recording and Reporting: Record, document, and report all pertinent information of the
procedure performed.

1. The use of search engines (e.g. Google, Yahoo), text/e-books, NANDA are allowed.
2. Use the above-mentioned required readings.
3. Students must submit this accomplished worksheet through email or Canvas upload.

Activity #1: The Nurse-Planner

Choose 1 case scenario only and develop a nursing care plan (NCP). (R ubrics for grading as seen
at the end of this module.)

Client E is a 14-year-old male is brought to the clinic for muscle spasm

in the leg. Client X explains he felt it this morning upon waking and stretching
out from bed. He mentioned playing street basketball yesterday with friends. He
was so happy to play again after staying home for months due to the implanted
community quarantine that they played for a full hour. Initial assessment data
are as follows: T = 37.1°C, BP = 110/80mmHg, PR = 89bpm, RR = 18cpm; pain
scale of 6/10, his legs are colder than his upper extremities, and facial grimace
and limping is noticeable while walking. As the clinic nurse, how do you plan to
care for this client?

Client C is a 16-year-old female complaining of lower abdominal and lower back pain. She
said it is her 2nd day of her menstrual period. She seldom experiences this and so far, this is the
worse. Initial assessment data: T = 36.8°C, BP = 120/80mmHg, PR = 80bpm, RR = 18cpm; pain
scale of 6/10, client presents abdominal muscle guarding. As the clinic nurse, how do you plan to
care for this client?

Client Q is a 28-year-old female who works in a BPO company. She is complaining of joint
stiffness of her right-hand fingers. She mentions working at home during the quarantine period and
now continues working in the office as part of the skeletal workforce. Her work requires responding
to client emails (around 100/day) and creating job orders for the company’s clients. As the clinic
nurse of this BPO company, how do you plan to care for this client?

Date Completed:
Date Submitted:
Activity #2: Nursing PressCom
Create your own video presentation for both hot and cold compress and sitz
bath based on the steps above-mentioned.
v Scope and Goals: Each student will work as the nurse for the above-
mentioned procedures and communicate hypothetical findings of a
chosen client living with the student (e.g. family member, friend,
significant other, relative) in a 4–7-minute video. This allows a student to
communicate and present clear and accurate information in an engaging
manner for an audience of your peers on the proper techniques of the
procedures following the nursing concepts, principles and client safety.

Note. This will be evaluated based on the rubrics found at the end of this module. The video will least
assess its technical merits (i.e. you will not get high scores because the final presentation is visually
impressive in a way that does not bear on effective procedure performance).
v Required elements for the video
ü Length. Your video should be 4–7 minutes in length, including the time for the “credit roll” to
show your references.
ü Style. You must follow the nurse-client set-up; hence, ask for a volunteer to be you “client”
for the video.
ü Title. The video should begin with a descriptive title, your name and section, the name of the
school, and the year in which it was created.
ü Originality. Aim to create your own resources. This means using your own materials that you
have at home.
ü Content. The procedure must be performed according to the steps seen in the said Checklist.
Since you will be using a real person as your “client,” contact them ahead of time to politely
request his/her role. Inform the person that it will be recorded and request his/her
consent/permission to do so (it’s the law!). Remember to be courteous and respectful of their
time; meaning, preparing and taking less than 10 minutes of their time.
ü Video release forms. Anyone who is featured and identifiable in your video must sign a
consent form, which you can obtain from your instructor. You must submit these completed
forms when you submit your video.
ü References and Credits. All images, videos, music, sound effect, people, etc. used in the
video must be cited and acknowledged at the end. You do not need to use a complete
reference. Simply include a brief description of the item and a web address where the item
was found (e.g., Picture of kitten www.spca.com). Be sure that all are subject to a Creative
Commons license. Include a separate section at the end of the video where you credit the
sources of information you used to create your video.
ü File format. Your video must be created in any of the following file formats: .mov, .mv4, mp4,
.wmv. Note that these are rendered movies, that is, files that will play on someone else’s
computer. Be sure to test your finished product ahead of the deadline.

Date Completed:
Date Submitted:
Berman, A., Snyder, S.J., and Frandsen, G. (2020). Kozier and Erb’s
Fundamentals of Nursing: Concepts, process, and Practice 11th ed.
Pearson

Brookesidepress.org. (2015). Apply heat, Basic patient care procedures.

Retrieved from https://brooksidepress.org/basic_patient_care/lessons
/lesson-1-hygiene-and-care-of-the-patient/1-17-apply-heat/

Cooke, E. (August 2019). Temperature management [Article], Royal

Children’s Hospital Melbourne (RCH). Retrieved from
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/
Temperature_Management/

Ctec Nursing Skills. (2017, March). Hot or cold application [Video File]. Retrieved from
https://www.youtube.com/watch?v=adFGvCoYXqw

George Elliot Hospital. (2016, December). Applying an icepack – physiotherapy advice [Video File].
Retrieved from https://www.youtube.com/watch?v=gJOMV2mZ1B0

Perry, A.G., Potter, P.A., and Ostendorf, W. (2018). Clinical Nursing Skills and Techniques, 9th ed.
Mosby

RCH Kids Health Info Fact Sheet on Fever in Children. (2018). Retrieved from
https://www.rch.org.au/kidsinfo/fact_sheets/fever_in_children/

Sharma, N. (February 2015). Hot and cold application [Presentation]. Retrieved from
https://www.slideshare.net/NaveenSharma45/hot-cold-application

Thomas, M. (November 2017). Nursing Assessment (CPG (Nursing)) [Article], Royal Children’s
Hospital Melbourne (RCH)Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guide
line_index/Nursing_assessment/

NAME:
YEAR AND SECTION:
PROCEDURE PERFORMED:
WEIGHT
CRITERIA EXCELLENT (4)
Prepares the necessary Excellent preparation and
materials needed for organization of materials
the procedure and needed for the procedure; none
10%
client identification missing. At least 2 client
(CO1) identifiers are asked and
verified.
Demonstrate principles Excellent maintenance of safe
of safe client care in the environment throughout the
procedure performed entire procedure. Perfectly
10%
(CO2,4) demonstrates all safe client
care measures during the
performance of the procedure.
Demonstrates skills in a Excellently and appropriately
precise and accurate assesses the client and
manner in the performs the entire procedure
performance of the with perfect precision and
procedure utilizing the accuracy with evaluation to
20%
principles of the nursing assess effectiveness.
process. Confidence is very evident in
(CO2) the performance of the
procedure; no assistance is
needed.
Demonstrates clinical Excellent rationalization of all
reasoning in caring for procedural steps, as necessary.
client while performing Always document client care
the procedure with without errors and
15%
client education and reports/refers appropriately
appropriate when needed and/or when the
documentation/ referral. situation is beyond the scope of
(CO3,6,9) nursing practice.
Manage time, Excellent development of basic
equipment, and skills for time management,
resources to support 10% resource allocation, and
the procedure done to equipment use involved in client
client care. Always follows through
EVALUATION OF STUDENT’S PROCEDURAL SKILLS PERFORMANC
COLLEGE OF NURSING – SKILLS LABORAOTRY
GOOD (3)
Good preparation of needed for
the procedure, but disorganized.
At least 2 client identifiers are
asked and verified
Good maintenance of a safe
environment throughout most of
the entire procedure.
Demonstrates at least 75% of the
safe client care measures
correctly during the performance
of the procedure.
Good and appropriate
assessment of the client and
performs the entire procedure
with 75% precision and accuracy
with evaluation to assess
effectiveness. Confidence is
somewhat evident in the
performance of the procedure;
little assistance is needed.
Good rationalization of most of
the procedural steps, as
necessary. Minimal errors are
observed in documentation of
client care, reporting and/referring
when needed and/or when the
situation is beyond the scope of
nursing practice.
Good development of basic skills
for time management, resource
allocation, and equipment use
involved in client care. Mostly
follows through with instructors’
FAIR (2)
Satisfactorily prepares and
organizes the materials needed to
perform the procedure 1 minor
material is lacking. At least 2
client identifiers are asked and
verified
A satisfactory safe environment is
maintained throughout the
procedure. Demonstrates less
than half of the safe client care
measures correctly during the
performance of the procedure.
Satisfactorily correct and
appropriate assessment of the
client is done and performs the
entire procedure with 50%
precision and accuracy with
evaluation to assess
effectiveness. Confidence is not
evident in the performance of the
procedure; assistance is mostly
needed.
Satisfactory in rationalization of
half of procedural steps, as
necessary. Some errors are
observed in documentation of
client care, reporting and/referring
when needed and/or when the
situation is beyond the scope of
nursing practice.
Satisfactory development of basic
skills for time management,
resource allocation, and
equipment use involved in client
care. Usually follows through with
 WEIGHT
CRITERIA EXCELLENT (4)
(CO7, 8, 12) with instructors’ suggestions
related to nursing procedures.
Demonstrate Speaks to client with excellent
appropriate clarity to allow understanding of
communication information. Always uses
techniques with the therapeutic communication
10%
client skills with client to allow for
(CO5, 6) comfort and comprehension
(eye contact, touch and space,
modesty).
Incorporates the Excellent display of
institutional and nursing professional and personal
profession core values integrity. Always looks and acts
into practice. in a professional manner.
15%
Pleasant to client and
(CO13, 15) significant other(s). Consistently
places the client’s welfare first.
CO 10, 11 (10%) Excellent provision of age-
appropriate and culturally
Promotes the other sensitive nursing care.
10%
dimensions of health Frequently identifies a client’s
(e.g. spiritual, risk for emotional or spiritual
emotional, and cultural). distress.
Adapted from Skill Demonstration Rubric-Google Docs (Retrieved from https://docs.google.com/document/d/1PTkPcG0231gD6HVPVqbg5z4UGkdfgUQDyS73h6nVyF4/edit#heading=h
EVALUATOR’S SIGNATURE OVER PRINTED NAME: ____________________________________________
DATE: _____________
GOOD (3)
suggestions related to nursing
procedures.
Speaks to client with good clarity
to allow understanding of
information. Uses therapeutic
communication skills mostly with
client to allow for comfort and
comprehension (eye contact,
touch and space, modesty).
Good display of professional and
personal integrity. Mostly looks
and acts in a professional
manner. Mostly pleasant to client
and significant other(s). Places
the client’s welfare first most of
the time.
Good provision of age-appropriate
and culturally sensitive nursing
care. Sometimes identifies a
client’s risk for emotional or
spiritual distress.
FAIR (2)
instructors’ suggestions related to
nursing procedures.
Satisfactorily speaks to client with
clarity to allow understanding of
information. Occasionally uses
therapeutic communication skills
with client to allow for comfort and
comprehension (eye contact,
touch and space, modesty).
Displays of professional and
personal integrity satisfactorily.
Occasionally looks and acts in a
professional manner.
Occasionally pleasant to client
and significant other(s). Places
the client’s welfare first
occasionally.
Satisfactorily provides age-
appropriate and culturally
sensitive nursing care.
Occasionally identifies a client’s
risk for emotional or spiritual
distress.