&

APPLICATION
Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
ELAINE FRANCES M. ILLO, RM, RN
COLLEGE OF HEALTH SCIENCES
INTRODUCTION

Applications of heat and cold are commonly used in

the hospital and homes as therapeutic measures. In
the hospitals, these measures are carried out at the
direction of the physician. heat and cold applications
also serve as comfort measures. applications of heat
and cold are also used in the course of physical
medicine as part of a rehabilitation programme such
as paraffin bath, whirlpool bath etc.
HEAT & COLD
APPLICATIONS
Heat and cold are applied
to a part or all of the
patient’s body to bring about
a local or systematic change
in body’s temperature for
various therapeutic
purposes.
SUPERFICIAL HEAT AND COLD

Primarily increase or
decrease temperature
of skin, superficial
subcutaneous tissues.
 TRANSFER OF
ENERGY
• CONDUCTION
• CONVECTION
• EVAPORATION
• RADIATION
• CONVERSION
 THERAPEUTIC APPLICATION
• HEATING AGENTS
- Transfer heat to patient’s body, between
various tissue/fluids.
• COOLING AGENTS
- Transfer heat away from
patient’s body
 HEAT
APPLICATION
Temperature is between
•
30 – 45 deg. C. 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.
 COLD
APPLICATION
Temperature is between 0 to
•
12 deg. Celsius; cool is
considered between 13 to 18
degree Celsius. Cold
Application is the application of
a cold agent cooler than skin
either in a moist or dry form, on
the surface of the skin.
CONTRAINDICATIONS TO
THE USE OF HEAT AND
COLD
• Determine the presence of any conditions indicating
the need for special precautions during heat and
cold therapy:
• Neurosensory impairment.
• Impaired mental status.
• Impaired circulation.
• Open wounds.
CONTRAST - HEAT THEN
COLD APPLICATION
• Alternating heat then
cold causes a flushing
effect – blood vessels
dilate then constrict,
causing an overall
increase of circulation to
the area, tissue healing
and reduces swelling.
1. Applied in a ratio of 3:1,
2. The greater the difference in temperature of
the application, the greater the effect on the
local circulation.
3. Always end with cold application to prevent
congestion
EXAMPLES OF CONTRAST
APPLICATIONS
1. Arm/Foot Baths
2. Compresses
SELECTED INDICATIONS OF
HEAT AND COLD
INDICATION EFFECT OF HEAT EFFECT OF COLD

Relaxes muscles Relaxes muscles and

MuscleSPASMS
MUSCLE spasm and increases their decreases muscle
contractility contractility.

Vasoconstriction
INFLAMMATION Increases blood decreases capillary
Inflammation flow, softens permeability, decreases
exudates. blood flow, slows cellular
metabolism.
 Indication Effect of Heat Effect of Cold
Relieves pain, possibly by Decreases pain by
promoting muscle relaxation, slowing nerve conduction
increasing circulation, and rate and blocking nerve
PAIN
Pain promoting psychological impulses; produces
relaxation and a feeling of numbness, acts as a
comfort; acts as a counterirritant, increases
counterirritant. pain threshold.
Reduces contracture and
increases joint range of motion
Contracture by allowing greater distention  
CONTRACTURE
of muscles and connective
tissue.
 Indication Effect of Heat Effect of Cold
Reduces joint stiffness
by decreasing viscosity
JointSTIFFNESS
JOINT stiffness of synovial fluid and  
increasing tissue
distensibility.
Decreases bleeding by
constricting blood
TRAUMATIC
Traumatic injury   vessels; decreases
INJURY edema by reducing
capillary permeability.
LISTS TEMPERATURES OF
HOT AND COLD
DescriptionAPPLICATIONS
Temperature Application
Very cold Below 15°C (59°F) Ice bags
Cold 15°C–18°C (59°F–65°F) Cold pack
Cool 18°C–27°C (65°F–80°F)° Cold compresses
Tepid 27°C–37°C (80°F–98°F) Alcohol sponge bath
Warm 37°C–40°C (98°F–104°F) Warm bath, aquathermia
pads
Hot 40°C–46°C (104°–115°F) Hot soak, irrigations, hot
compresses*
Very hot Above 46°C (Above 115°F) Hot water bags for adults*
PHYSIOLOGICAL EFFECTS OF HEAT AND
COLD
HEAT
Vasodilation
Increases capillary permeability
Increases cellular metabolism
Increases inflammation
Sedative effect
Increased oxygen consumption
Increased blood flow
COLD
Vasoconstriction
Decreases capillary permeability
Decreases cellular metabolism
Slows bacterial growth,
Decreases inflammation
Local anesthetic effect
Decreased oxygen consumption
Decreased blood flow
 REBOUND
PHENOMENON
occurs at the time the maximum therapeutic
effect of the hot or cold application is achieved
and the opposite effect begins.
Continued cold causes
alternating vasodilation and
vasoconstriction (called the
Lewis Hunting effect).
 HOT
APPLICAT
IONS
PURPOSES
• To promote circulation
• To relieve congestion and
reduce edema or inflammation
• To increase suppuration
• To promote tissue relaxation
• To relieve pain
INDICATIONS FOR HOT
1.
APPLICATION
With chronic injuries
2. Fibromyalgia.
3. Osteoarthritis.
4. Tension headaches.
5. With colds, sinusitis or respiratory tract
infections
6. For relaxation (baths).
7. Before deep stretching.
8. After deep tissue work from a therapist.
9. Before exercise to warm the muscles
 CONTRAINDICATIONS OF
HOT APPLICATION
1. Malignancies
2. Impaired kidney, heart & lung functions
3. Acutely inflamed areas
4. The first 24 hours after traumatic injury
5. Headache
6. Active hemorrhage
7. Non inflammatory edema
8. Skin disorder
9. Hypertension or other circulatory issues are
present.
COMPLICATIONS OF
HOT APPLICATION
1. Pain
2. Burns
3. Maceration (with moist heat)
4. Redness of the skin
5. Edema
6. Pallor (secondary effect)
7. Hyperthermia
 APPLYING HEAT &
COLD
Heat can be applied to the body in both dry and moist forms.

Dry heat
• hot water bottle
• aquathermia pad
• disposable heat
pack
• electric pad.
Moist heat
• compress
• Hot pack
• Soak
• Sitz Bath
Dry Cold
• Cold pack
• Ice bag
• Ice glove
• Ice Collar

Moist Cold
• Cold Compress
• Cooling Sponge Bath
 HOT WATER BAG
More Common source of dry heat
• Inexpensive
• Improper use leads to burning
• Fill two-thirds to half full with warm
water and remove air at the top so
the bag is easier to mold over the
body part.
• Cover bag with a towel or pillowcase
(never apply directly on the skin
surface).
AQUATHERMIA PAD
• Also referred to as a K-pad
• Constructed with tubes containing
water
• Are useful in treating muscle
sprains and for areas with mild
inflammation or edema.
• The desired temperature is usually
set with a key at 45 C for adults.
 HOT AND COLD
•
PACKS
Provide heat or cold for a designated
time
• Directions on the package tell how to
initiate the heating or cooling process,
for example, by striking, squeezing, or
kneading the pack.
• These packs are designed to maintain a
constant temperature between 40.6 C &
46 C for 30 min to 1 hour.
 ELECTRIC
•
HEATING PADS
provide a constant, even heat,
are lightweight, and can be
molded to a body part.
• can burn if the setting is too high.
• Some models have waterproof
covers for use when the pad is
placed over a moist dressing.
• No wet dressing should be
applied with pads.
To apply Electric Pads
1. Do not insert sharp objects (e.g., pins) into the pad. The
pin could damage a wire and cause an electric shock.
2. Ensure that the body area is dry unless there is a
waterproof cover on the pad. Electricity in the presence
of water can cause a shock.
3. Use pads with a preset heating switch so a client cannot
increase the heat.
4. Do not place the pad under the client. Heat will not
dissipate, and the client may be burned.
 COLD
APPLICATIONS
 PURPOSES
• To reduce inflammation.
• To relief pain.
• To prevent edema, and
reduce inflammation.
• To control hemorrhage.
• To decrease metabolism
and thus prevent gangrene.
• To reduce body
temperature.
• To anaesthetize an area for
a short period.
• To inhibit bacterial growth
and prevent suppuration
COMPLICATIONS OF
COLD APPLICATION
1. Pain
2. Blisters and skin breakdown
3. Maceration (with moist cold)
4. Grey or bluish discoloration
5. Thrombus Formation
6. Redness (secondary effect)
7. Hypothermia
 CONTRAINDICATIONS OF
COLD APPLICATION
1. Reynaud's Disease or
decreased skin sensitivity to
temperature is present.
2. The person feels chilled .
3. Impaired circulation.
4. Do not use over new wounds.
5. Edema
6. Muscle spasm
7. Decreased sensation
ICE BAGS, ICE GLOVES,
AND ICE COLLARS
• Fill two-thirds full with crushed ice so
bag is easier to mold over body part.
• Cover bag with towel or pillowcase
and apply to affected area for 30
minutes
• Provides cold to localized
area (e.g., muscle sprain,
hematoma) to prevent
edema formation)
COLD PACKS
• Commercially prepared single – use
ice packs provide cold for
designated period of time.
• When the pack is squeezed or
kneaded an alcohol-based solution
is released, creating the cold
temperature.
 COMPRESSES
• can be either warm or cold.
• a moist gauze dressing applied to a wound or injury
• When hot compresses are
ordered, the solution is
heated to the temperature
indicated by the order or
according to agency protocol,
for example, 40.5°C (105°F).
 SOAKS
• immersing a body part (e.g., an arm) in a solution or to
wrapping a part in gauze dressings and then saturating the
dressing with a solution.
• Sterile technique is generally
indicated for open wounds, such
as a burn or an unhealed surgical
incision.
• Hot soaks are frequently done to
soften and remove encrusted
secretions and dead tissue.
 COOLING SPONGE
•
BATHS
reduce a client’s fever promoting heat loss through
conduction and vaporization.
• Cool sponge baths are used with extreme caution, and only
for clients with very high temperatures, such as over 40°C
(104°F), because rapid skin temperature drop can cause
chills that actually increase heat production.
• The bath is accompanied by antipyretic medication that
acts to reset the hypothalamus set point.
• The temperatures for cooling sponge baths range from
27°C to 37°C (80°F to 98°F).
• 
1. Assemble the equipment at
the bedside.

PREPARATION
2. Perform hand hygiene
and observe other
appropriate infection
prevention procedures.
 1. Prior to performing the procedure,
introduce self and verify the client’s
identity using agency protocol.

PROCEDURES
2. Provide for client privacy.
3. Determine the client’s
ability to tolerate the
therapy.

4. Identify conditions that

might contraindicate
treatment (e.g., bleeding,
circulatory impairment).
4. Assess the skin area to which
the heat or cold will be applied.

5. Place the bag into the skin area to which the heat or
cold will be applied.
 6. Ask the client to report
any discomfort.

7. Return to the client 15 minutes after starting the

heat or cold therapy, and observe the local skin
area for any untoward signs (e.g.,redness). Stop
the application if any problems occur.
 8. Remove the equipment at
the designated time, and
dispose of it appropriately.

9. Examine the area to which the heat or cold was

applied, and record the client’s response.