NCM 103 Fundamentals of

Nursing
Heat and Cold Application

Prepared by: NCM 103 Instructors

Objectives:
The students will be able to
• Identify the physiologic effect of Heat and Cold
Applications
• Enumerate the indications and Contraindications of
Heat and Cold Therapy
• Identify the different methods of heat and cold therapy
 Introduction
In our life we encounter different injuries
caused by accidents one of which is
suffering from sprain or strain. The hot and
cold applications are essential to manage
these ailments. Hence, it is important to
identify the indications and
contraindication of these applications to
promote comfort to our clients.
 Concept of Cold and Heat Therapy
The Cold and Heat Therapy
•It is a method that utilizes substances, the
temperature of which are lower or higher than the
skin surface temperature, acting on the skin, to attain
local and systemic treating effects.
Local Effect of Heat
• Old remedies for aches and pain for comfort and relief

• Causes Vasodilation and increases blood flow to the affected

area
• Brings Oxygen, nutrients, antibodies and leukocytes

• Promotes soft tissue healing and increases suppuration.

Local Effect of Heat
•Disadvantage:

It increases capillary permeability, which allows extracellular

fluid and substances that may result in edema or an increase in
preexisting edema .
Heat can be apply in two ways:

HEAT DRY AND HEAT MOIST:

Heat dry: applied locally for conduction using bottle water,

electric pad, aquathermia pad or disposable heat pack.

Heat moist: can be provided through conduction by compress,

hot pack, soak or sitz bath.
Local effect of Cold
•Lowers the temperature of the skin and underlying tissues and
causes Vasoconstriction.
•Prolonged exposure to cold results in impaired circulation,
cell deprivation, and subsequent damage to the tissues from
lack of oxygen and nourishment.
•Cold is most often used for sports injuries to limit post injury
swelling and bleeding.
Physiologic Effect of heat and cold
HEAT
vasodilation
Increase capillary permeability
Increases cellular metabolism
Relaxes muscles
Increases inflammation
Decrease pain by relaxing muscles
Sedatives effect
Reduces joint stiffness by decreasing
viscosity of synovial fluids
COLD
vasoconstriction
Decrease capillary permeability
Decrease cellular metabolism
relaxes muscle by decrease contractility
Slow bacterial growth, decreases
inflammation
Decrease pain by numbing the area,
slowing the flow of pain impulses and by
increasing threshold
Local anesthetic effect
Decrease bleeding
Systemic effect
HEAT
•Heat may cause excessive peripheral vasodilation,
which produces a drop in blood pressure. A
significant drop in blood pressure can cause fainting.

COLD
•Extensive cold applications and vasoconstriction, a
client’s blood pressure can increase.
•Shivering, a generalized effect of prolonged cold
Thermal Tolerance
• Determine the presence of any conditions indicating the need for
special precautions during heat and cold therapy
• Neurosensory impairment
unable to perceive that heat is damaging the tissues and are at risk for burns or are unable
to perceive discomfort from cold and prevent tissue injury.
• Impaired mental status
altered level of consciousness need monitoring during applications to ensure safety therapy.
• Impaired circulation
People with peripheral vascular disease, diabetes, or congestive heart failure lack the normal
ability to dissipate heat via the blood circulation, which puts them at risk for tissue damage
with heat and cold applications.
Cold applications
• Open wounds.
• Impaired circulation
• Allergy or hypersensitivity to cold

Heat Applications
• The first 24 hours after traumatic injury. Heat
increases bleeding and swelling.
 Active hemorrhage
 Noninflammatory edema
 Skin disorder that causes redness or blisters
Variables affecting physiologic Tolerance
to Heat and Cold
• Body Parts
• Site of the exposed body parts
• Individual tolerance
• Length of exposure
• Intactness of skin
Adaptation of Thermal Receptor
• When they are subjected to an abrupt change in
temperature, the receptors are strongly stimulated
initially
•This strong stimulation declines rapidly during the first few
seconds and then more slowly during the next half hour or more as
the receptors adapt to the new temperature.
Rebound Phenomenon
• Occurs at the time the maximum therapeutic effect of
the hot or cold application is achieved and the opposite
effect begins. ( 20-30mins- 30-45mins ) or cold
application ( 15 C )is achieved and the opposite effect
begins
Safety Alert :

An understanding of the rebound

phenomenon is essential for the nurse
and client. Thermal applications must
be halted before the rebound
phenomenon begins.
Applying Heat And Cold
Heat can be applied to the body in both dry and
moist forms.

• Dry heat is applied locally by means of a hot

water bottle, aquathermia pad, disposable heat
pack, or electric pad. Moist heat can be
provided by compress, hot pack, soak, or sitz
bath.
Applying Heat And Cold
•Dry cold is generally applied locally by means
of a cold pack, ice bag, ice glove, or ice collar. In
addition, continuous cold therapy (cryotherapy)
following joint surgery or injury can be
delivered by a cooling unit similar to the
aquathermia pad (Su et al., 2012). Moist cold
can be provided by compress or a cooling
sponge bath.
Guidelines in Applying Heat And Cold

1. Determine the client’s ability to tolerate the

therapy.
2. Identify conditions that might contraindicate
treatment.
3. Explain the application to the client.
4. Assess the skin area to which the heat or cold
will be applied.
5. Ask the client to report any discomfort.
Guidelines in Applying Heat And Cold

6. 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.
7. Remove the equipment at the designated time,
and dispose of it appropriately.
8. Examine the area to which the heat or cold
was applied, and record the client’s response
Methods

• hot-water bag
• heating lamp dry heat
• Chemical heating bags

 moist hot compress

moist heat  sitz bath
 hot soaks
Methods
Hot Water bag or bottle
•Common source of dry heat used in the home.
• It is convenient and relatively inexpensive.
•The following temperatures of the water used to
fill the bag are considered safe in most situations
and provide the desired effect:
• normal adult and child over 2 years, 46°C to 52°C
(115°F to 125°F);
• debilitated or unconscious adult, or child under 2
years, 40.5°C to 46°C (105°F to 115°F).
 Procedures
* Place the hot water bag
flat, Fill the bag with hot
water about a half to two
thirds full .

* turn the stopper

until it is tight

* Place the hot water bag

flat gradually and expel the
remaining air
Dry the bag and hold it upside down to check for its leaks

Wrap the bag in a cloth

cover and tighten its ties

Place the bag on the body

site of the client as
appropriate
Aquathermia Pad
Aquathermia Pad
• Also referred to as a K-pad
• It is constructed with tubes containing water. The pad is
attached by tubing to an electrically powered control unit that
has an opening for water and a temperature gauge .
• Some aquathermia pads have an absorbent surface through
which moist heat can be applied. The other surface of the pad
is waterproof. These pads are disposable. steps:
Aquathermia Pad
Procedure:
• Fill the reservoir of the unit two-thirds full of water
• Set the desired temperature. Check the manufacturer’s instructions. Most
units are set at 40°C (104°F) for adults.
• Cover the pad and plug in the unit. Check for any leaks or malfunctions of
the pad before use.
• Apply the pad to the body part
• Use tape or gauze ties to hold the pad in place. Never use safety pins.
• If unusual redness or pain occurs, discontinue the treatment, and report the
client’s reaction.
 key points

For unconscious clients, elders, infants, and clients

who haven't regain consciousness after
anaesthesia, the safe water temperature should be
50℃ in order to avoid burns.
For the client with impaired sensation, a large
towel should be put over the bag with a cloth cover
or a blanket is used to wrap the bag.
Remove the bag no more than 30 minutes after
application if the purpose is to give treatment.
Use of Hot Lamps

to reduce inflammation

to relieve spasm and pain
Purpose
to promote scar and granulation
tissue formation
Equipment

gooseneck lamp
 Procedures and key points

eyes
should be
covered

The distance
is usually 30
to 50cm

 The duration of this application is 20~30minutes.

Observe the local exposed skin closely during treatment

Hot moist compress

to reduce inflammation and

Purpose edema
to relieve spasm and pain
 Equipment

· tray · sterile dressing transfer forceps · dressings

· sterile petrolatum · sterile cotton swab · sterile
gauze
· plastic sheet · small rubber drawsheet · sterile drape
· cotton mat · electrical stove ·
thermometer
Procedures

cover a sterile gauze

Spread light coat of
on it.
sterile petrolatum over
skin surface to be treated.
 Put dressings into the hot water(50~60℃)

then cover it with a

plastic sheet and cotton
mat.

Take out dressings with sterile

transfer forceps and wring
excess water. Apply the
dressing onto the area to be
treated.
 key points

Change dressings every 3 to 5 minutes

and observe skin condition.
If continuous compresses are ordered, it
can be applied 15 to 20 minutes.
Hot sitz bath

To reduce edema in rectum and

organs in pelvic cavity.
Purpose to relieve edema, inflammation
and pain in the area of anus and
perineum.
to clean the local area and provide
comfort.
 Equipment

· hot water bottle

· sitz bath solution
•sterile sitz bath tub
· steriled gauzes
•sitz bath chair
· thermometer
· large bath blanket
 Procedures
Place the sitz bath tub in a special chair. Pour
the hot water(40~45℃) into the tub until a half
full. Then make prescribed solution.
Allow the client to have sitz bath for 15 to 20
minutes and maintain a constant temperature
by adding warm water.
Observe the client for pulse, respiration and
facial color. (light-headed or nauseated)
After the sitz bath, assist the client out of the
tub.
 key points
 The bath tub and medication fluid should be sterile
if there is wound.
 during menses
 in the latter period of
pregnancy
 It' s not preferred  less than 2 weeks after

for the female client delivery

 having vaginal bleeding
 having acute inflammation
in pelvic cavity.
Hot soaks

• 43 ～ 46℃
• 30min
 Methods
 ice bag, ice cap
or ice collar
dry cold
 chemical cold pack
local
cold compress
cold soaks
moist cold
cooling sponge bath

alcohol sponge bath

tepid sponge bath
 Preparation

the client's physical condition

Assessment
The client's level of sensation

Equipment

The client understands the purpose of the

Explanatio therapy and precautions taken during treatment.
n
Use of Ice Bags
to reduce body temperature.
to reduce hemorrhage,
Purpose swelling and pain after
sprains, head injuries and
dental surgeries
Equipment

cloth cover
ice bag
basin

towel

ice, and so on
Procedures and key points

Fill the ice bag one half

to two thirds full of
crushed ice .
Use of Ice caps

Purpose
to lower head temperature and prevent
brain edema for unconscious clients.
Equipment
*ice cap
*drawsheet
*bucket
*sterile drape
*small pillow
*Sponges
*rectal thermometer
*ice
*basin
 Procedures and key points

Take away the pillow, spread

the drawsheets under the
client's head, place a sterile
drape inside the ice cap .

Place the ice cap around the client’s head,

apply spongy pad beneath auricles,
occiput and neck, and the small pillow
under client's shoulders. The drainage
tube is down into the bucket.
• Take anus temperature ,
maintain it around 33℃.

Below 30℃ ventricular fibrillation

 Cold moist Compress
• The moist compress is a moist gauze
dressing applied to the body part.
•The compresses are usually immersed into the
ice water and then applied to the body part.
•Replace compresses are necessary to
maintain coolness. (3 ～ 5min)
•If a sterile compress is ordered, the nurse
should follow the sterile principles.
 Chemical Cold Packs
a prefilled plastic package with
two separate compartments.

strikes, kneads or squeezes the

pack to mix one chemical
compound with the other and
provide a controlled
temperature.
Hypothermia blankets
This appliance is made based on the principle of
semiconductor refrigeration. There is a circulating
exchange between the cooled distilled water in the
water tank and that in the hypothermia blanket via
main machine. This process facilitates the heat loss of
the skin in contact with the blanket, and then the
body temperature is lowered.
Tepid water sponge bath
32 ～ 34℃

Alcohol sponge bath

25 ～ 35% ; 30℃
Thank You!