Chapter 9

Cold and Heat Therapy

Xiao-wen ZHU

School of Nursing, Jinan University

contents
1 Physiological responses to cold and heat
therapy

2 Factors influencing the effects of cold and

heat therapy

3 Contraindications to cold and heat

applications
objectives
Compare the different physiological
responses between cold and heat therapy

Replied to factors influencing the effects of

cold and heat therapy

List out the contraindications to cold and heat

therapy
cold therapy heat therapy

ice bags ice caps

cold moist compress

tepid water sponge bath

alcohol sponge bath

water bags

hot lamps

hot moist compress

hot sitz bath

warm soak
1 Physiological Responses
 Cold and Heat Therapy
It is a therapy 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.
Mechanism
Temperature
Skin surface
stimulus

Vasoconstriction
Fluid circulation or vasodilation
and metabolic activity
Cold and heat create a series of physiological
responses,
the responses to cold and heat are opposite.

Opposite
Physiological Heat Cold
responses
Vascular condition Vasodilation Vasoconstriction
Blood flow Increased Reduced
Body temperature Raised Lowered
Blood viscosity Reduced Increased
Connective Increased Decreased
extensibility
Cellular Increased Decreased
metabolism
Capillary Increased Decreased
permeability
Questions
Which of the following diseases can be used of
heat therapy? Which can be used of cold therapy?
Why?

Epistaxis
Poor circulation
Conjunctivitis
Brain injury
secondary effect
When the maximum therapeutic effect of the
cold and heat therapy is achieved, the opposite
effect begins. We call this phenomenon
secondary effect.
2 Influencing Factors
Factors influencing cold and heat therapy

1 Treatment method

2 Body part

3 Duration of application

4 Size of the exposed body surface area

Prior skin temperature

5
6 Age and individual physical condition
3 Contraindications
Contraindications to cold therapy

1 the site of injury is 2 the client has

already edematous. impairment in circulation.

Cold further retards Cold further reduces

circulation to the area and blood supply to the
prevents absorption of the affected area
interstitial fluid
Contraindications to cold therapy

3 chronic infection and deep suppuration

4 contradict parts of the body. Such as pinna,
scrotum, and occipitoposterior are risk of tissue
damage from cold therapy. Precordia, abdominal and
the center of the foot are contradictious places
Contraindictations to heat therapy

1 The early stage of soft tissue sprain , bruise.

2 Acute abdominal pain when not diagnosed.

3 Trigonum infection around nose.

4 Visceral organ bleeding.

5 Tumor.

6 Mental status impairment.

 Cold and Heat Therapy
It is a therapeutic method that utilize
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.
Physiological responses

Cold and heat create a series of physiological

responses,
the responses to cold and heat are opposite.
1. Bodily responses to heat and cold.

 There are many skin sensory nerve receptors

within skin, including
cold receptors, warm receptors & pain receptors.
After skin sensory nerve receptors accept
temperature stimulus, nerve endings send
impulses to the cerebral cortex through afferent
nerve fibers, having cognition to the impulses and
sending indications through efferent nerve fibers,
taking action.
1. Bodily responses to heat and cold.

 The body also possesses a protective reflex

response so that, when a person touches an
extremely hot or cold stimuls, impulses travel to
the spinal cord synapse within the cord,
and return by way of a motor nerve to cause
withdrawal from the stimuls. The person
simultaneously becomes aware or the discomfort.
2.Local effects of heat and cold

HEAT

1.Vasodilation

2.Enhancing disappearance and limitation of

inflammation

3.Deceasing pain

4.Lessening congestion of deep tissues

2.Local effects of heat and cold

HEAT

5.Warm and comfort

6.Reduced blood viscosity

7.Reduced muscle tension

8.Increased tissue metabolism

9.Increased capillary permeability

2.Local effects of heat and cold
COLD
1.Vasoconstriction

2.To control spreading of inflammation

3.Local Anesthesia

4.To diminish temperature

5.Reduced cell metabolism

6.Increased blood viscosity

7.Decreased muscle tension

secondary effect
When the maximum therapeutic effect of the
cold tnad therapy is achieved, the opposite effect
begins. We call this phenomenon secondary
effect
3.Factors influencing heat and cold tolerance

3.1 Treatment method

3.2 Duration of application

3.3 Body part

3.4 Damage to body surface

3.5 Prior skin temperature

3.6 Size of the exposed body surface area

3.7 Age and individual physical condition

4.Assessment for temperature tolerance

4.1 Measure vital signs

4.2 Check whether infections exist

4.3 Check whether there is sprain to the joint and

ligament

4.4 Check painful body part and whether the

movement is limited
4.Assessment for temperature tolerance

4.5 Know whether the client is sensitive to the heat

and cold

4.6 Check whether there is mental status impairment

4.7 Clear to the age of the client

4.8 Assess the client's attitude to the treatment

5.Contrindication to heat therapy

5.1 The early stage of soft tissue sprain , bruise.

5.2 Acute abdominal pain when not diagnosed.

5.3 Trigonum infection around nose.

5.4 Visceral organ bleeding.

5.5 Tumor.

5.6 Mental status impairement.

6. Contraindiction to cold therapy

6.1 the site of injury is already edematous.

Cold further retards circulation to the area and
prevents absorption of the interstitial fluid

6.2 the client has impairment in circulation,

cold further reduces blood supply to the affected
area

6.3 shivering. Cold applications may intensify

shivering and dangerously increase body temperature
6. Contraindiction to cold therapy

6.4 chronic infection and deep suppuration

6.5 client allergic to the cold

6.6 tissue injury or split

6.7 comtraindicate parts of the bdy. Such as pinna,

scrotum, and occipitoposterior are risk of tissue
damage from cold therapy. Precordia, abdominal and
the center of the foot are contradictious places
COLD THERAPY
 the use of ice bags

 the use of ice caps

 cold moist compress

 tepid water sponge bath alcohol sponge bath

 chemo refrigeration bag

 ice blanket machine

To clean with alcohol
Aim

Assessing:

1.Client's age, condition, temperature and treatment

2.Client's condition of local skin

3.Client's state of mind, ability to move and level of

co-operation
Action:

Evaluatin:

1. Safety

2. Comfortable

3. Effective
Applying Heat
application of heat or
thermotherapy
-the use of water bags
-the use of hot lamps
-hot moist compress
-hot sitz bath
-warm soak
-chemo warm up bags
Dry hot therapy
Use of hot water bag
Aim: keep warm, comfort, spasmolysis and
analgesia

Assessment

1. client's age, condition and treatment

2. client's local skin condition such as color,

temperature, sound, paresthesia

3. client's state of mind, ability of movement and

level of co-operation
Planning

1. Equipment preparation: thermometer

2. Client's preparation

3. Environment preparation
Action

Assess the client

---- explain

---- prepare 1000ml to 1500ml hot water, 60 to 70oC

---- fill the bag two-thirds full, expel any air at the
top, and secure the cap. Wipe off any moisture on the
outside of the bag
Action

---- take the bag away after 30 minutes

---- record

---- make the bag dry and then put it downside for
use
Attention:

1. keep the water 50oC to the old, infant, coma,

client after anesthesia and client having
sensorineural deficits.

2. ensure there is no leaks.

3. never apply it directly to the skin surface.

Cover it with a towel or pillow case.
Evaluation

to check the skin changes when the hot water

bag is applied. to check the temperature and
change the water if needed. Hand over to the next
shift.
Commercial hot bags

Heat lamps: anti-inflammatory, spasmolysis and

analgesia. Promote the recovery of the wound. Better
for the bedsore, arthritis, neuritis.
30-50cm away from the part to be treated,
20-30 minutes once.
to rest 15 minutes before the client leaves the room.
Moist hot therapy

Hot moist compresses: promote the blood

circulation, relieve pain, anti-inflammatory,
detumescence. better for acute infection part.
50-60oC warm water.

Warm soaks: anti-inflammatory, analgesia, clean

and disinfect wound. Better for the early stage of
the infection of the hand, foot,
to limit the inflammation.
43-46oC hot water, 30 minutes.
Summary

Bodily responses and

contraindications to cold and
heat therapy
Thank
You!