Canadian Clinical Nursing Skills Study Notes

Canadian Clinical Nursing Skills

Chapter 41 Review

  • Reference Page: 592
  • Review tables on pages 1163-1164.

Patients at Risk

  • Patients with vascular diseases (e.g., peripheral vascular disease, diabetes) are at an increased risk for injuries from hot or cold therapies due to:
    • Decreased sensation in hands, feet, and other areas.
    • Consequently, a patient may not perceive sensations of burning or numbness.
    • Source: Perry, Potter & Ostendorf, 2014, p. 978

Uses of Heat

  • Heat is used to achieve several physiological effects:
    • Promote vasodilation (widening of blood vessels) to improve blood flow.
    • Reduce joint stiffness by decreasing the viscosity of synovial fluid.
    • Relieve pain by increasing circulation to ischemic (lacking oxygenated blood) areas.

Types of Heat Applications

  • May be dry or moist:
    • Moist heat feels warmer and can damage tissues faster than dry heat.

Moist Heat Applications

  • Provided through conduction (one surface touching another):
    • Sitz bath.
    • Soaks.
    • Compresses (use sterile technique with open wounds).

Dry Heat Applications

  • Provided through conduction:

    • Aquathermia pad.
    • Electric pad.
    • Disposable chemical pack.

  • Dry heat by radiation (sent out in rays) includes:

    • Heat lamp (less common today, previously used in maternity for episiotomy).

Adaptation to Temperature Change

  • Problems with heat or cold application:
    • The body adapts to temperature changes; extreme temperature noted initially, then patient adapts and hardly notices.
    • This poses a risk to patients who are insensitive to heat and cold.

Maximum Length of Application

  • 20 to 30 minutes max because:
    • Initial Phase (first 20-30 minutes):
    • Heat application causes vasodilation.
    • This increases blood flow, promoting oxygen and nutrients, aiding pain relief and muscle relaxation.
    • Rebound Effect (after 30 minutes):
    • Prolonged heat triggers body’s protective mechanisms.
    • Blood vessels begin to vasoconstrict to prevent excessive heat loss and tissue damage.
    • This reduces blood flow, increasing the risk of burns, as the skin becomes less able to dissipate heat.

Contraindications for Heat Application

  • Do not apply heat under the following conditions:
    • Within the first 24 hours after traumatic injury, as heat will increase bleeding.
    • On skin conditions exhibiting redness & blisters.
    • In cases of acute inflammation (e.g., appendicitis—could cause rupture).
    • For clients with cardiovascular problems; applying heat to large areas disrupts blood supply to vital organs.

Medical Orders

  • A medical order is required for the application of heat.

Guidelines to Prevent Injury

  • To prevent injury, follow these guidelines:
    • Adhere to time frames for application (use a timer or provide patients with a watch and instruct them to notify the nurse when time is up).
    • Instruct clients to report any changes in sensation felt or discomfort.
    • Perform frequent assessments, especially on those sensitive to heat (e.g., children and older adults).
    • Do not allow clients to lie on heating pads as pressure against the mattress prevents normal heat dissipation.

Uses of Cold Application

  • Application of cold is typically ordered to:
    • Decrease inflammation by causing vasoconstriction.
    • Prevent edema.
    • Decrease bleeding.
    • Reduce body temperature.
    • Lower the body’s metabolic rate.
    • Relieve pain.

Cold Application Devices

  • Cold compress (disposable, single use).
  • Cryo/Cuff includes integrated cooler (AirCast).

Rebound Effect with Cold Application

  • A rebound effect occurs with cold application; after reaching maximal therapeutic effects (maximal vasoconstriction), blood vessels start to dilate (prevents body tissue from freezing).

Medical Orders for Cold

  • A medical order is required for the application of cold.

Factors Influencing Heat and Cold Tolerance

Duration of Application

  • Shorter durations are better tolerated.

Sensitivity by Body Part

  • Certain body parts are more sensitive to temperature changes:
    • More sensitive areas include: neck, inner wrist, forearm, perineal region.
    • Less sensitive: foot and palm of hand.

Skin Sensitivity

  • Exposed skin layers are more sensitive, especially broken skin.

Prior Skin Temperature

  • A better response is observed under minor temperature changes with prior temperature considerations.

Body Surface Area

  • Tolerance decreases when a large area of the body is exposed to temperature.

Age & Physical Condition

  • Infants and the elderly are most sensitive to heat and cold.
  • Conditions that reduce sensory perception increase tolerance to temperature extremes and raise the risk of injury.

Signs of Potential Intolerance to Heat and Cold

Skin Integrity

  • Assess for: abrasions, open wounds, edema, bruising, bleeding, or localized inflammation—these increase the risk of injury.

Contraindications for Therapy

  • Conditions where warmth should not be applied include:
    • Active bleeding areas.
    • Localized inflammation (e.g., appendicitis). Heat could cause rupture.
    • History of cardiovascular problems; do not apply heat to extensive body areas (vasodilation may impede blood supply to vital organs).

Level of Consciousness

  • The level of consciousness affects the ability to perceive heat and cold.
    • With confused or unresponsive clients, frequent skin monitoring is necessary during treatment.