Heat and Cold Applications Notes

Key Terms and Abbreviations

  • Compress: A soft pad applied over a body area.

  • Constrict: To narrow.

  • Cyanosis: Bluish (cyano) color.

  • Dilate: To expand or open wider.

  • Pack: Wrapping a body part with a wet or dry application.

  • Abbreviations:

    • C: Centigrade

    • F: Fahrenheit

    • ID: Identification

Objectives of Heat and Cold Applications

  • Define key terms and abbreviations.

  • Explain the purpose, effects, and complications.

  • Identify persons at risk for complications.

  • Describe moist and dry heat applications.

  • Describe moist and dry cold applications.

  • Describe rules for applying heat and cold.

  • Explain how cooling and warming blankets are used.

  • Explain how to promote PRIDE in the person, the family, and yourself.

Uses of Heat and Cold Applications

  • Applied to the skin to:

    • Promote healing.

    • Promote comfort.

    • Reduce tissue swelling.

  • Heat and cold have opposite effects on body functions.

    • Heat increases circulation: Tissues receive more oxygen and nutrients.

    • Cold decreases circulation: Tissues receive less oxygen and nutrients.

  • Severe injuries and changes in body function can occur, so the risks are great.

Focus on Children and Older Persons: Heat and Cold Applications

  • Children:

    • Infants and young children have fragile skin and are at risk for burns, needing careful attention.

    • Always respond when a child cries, as it can communicate pain.

Delegation Guidelines: Heat and Cold Applications

  • Applying heat and cold applications is a nursing responsibility that may be delegated.

  • Before applying heat or cold, ensure:

    • Your state allows you to perform the procedure.

    • The procedure is in your job description.

    • You have the necessary training.

    • You know how to use the equipment.

    • You review the procedure with a nurse.

    • A nurse is available to answer questions and guide/assist you.

Heat Applications

  • Heat applications can be applied to almost any body part.

  • Used for musculoskeletal injuries or problems (sprains, arthritis).

  • Effects of Heat:

    • Relieves pain.

    • Relaxes muscles.

    • Promotes healing.

    • Reduces tissue swelling.

    • Decreases joint stiffness.

  • When heat is applied, blood vessels in the area dilate (expand or open wider).

    • Blood flow increases.

    • Excess fluid is removed faster.

    • The skin becomes red and warm.

Complications of Heat Applications

  • High temperatures can cause burns. Report pain, excess redness, and blisters immediately.

  • Observe for pale skin. Prolonged heat application causes blood vessels to constrict (narrow).

    • Blood flow decreases.

    • Tissues receive less oxygen.

    • Tissue damage occurs, and the skin appears pale.

  • Older and fair-skinned persons have fragile skin easily burned.

  • Persons with problems sensing heat and pain are also at risk due to:

    • Nervous system damage.

    • Altered awareness.

    • Circulatory disorders.

    • Confusion and some drugs.

  • Metal implants pose risks because metal conducts heat, potentially burning deep tissues. Pacemakers and some joint replacements are made of metal. Do not apply heat to an implant area.

  • Heat is not applied to a pregnant woman's abdomen as it can affect fetal growth.

Moist and Dry Heat Applications

  • Moist Heat Applications:

    • Water has contact with the skin.

    • Water conducts heat.

    • Moist heat has greater and faster effects than dry heat.

    • Heat penetrates deeper with a motion.ist application

    • Moist heat applications have lower (cooler) temperatures than dry heat to prevent injury.

    • Examples:

      • Hot compress: A soft pad applied over a body area (usually cloth). Sometimes an aquathermia pad is applied over the compress to maintain temperature.

      • Hot soak: A body part is immersed in water, usually for smaller parts like a hand, foot, or lower leg. A tub is used for larger areas.

      • Sitz bath: The perineal and rectal areas are immersed in warm or hot water. Common for hemorrhoids, post-rectal or pelvic surgeries, and after childbirth. Used to:

        • Clean perineal and anal wounds.

        • Promote healing.

        • Relieve pain and soreness.

        • Increase circulation.

        • Stimulate voiding.

      • Hot pack: Involves wrapping a body part with a wet or dry application. Can be single-use (disposable) or re-usable. Some are used for heat or cold. Follow manufacturer's instructions for activation and cleaning.

  • Dry Heat Applications:

    • Water does not have contact with the skin.

    • Dry heat application stays at the desired temperature longer.

    • Dry heat does not penetrate as deep as moist heat.

    • Dry heat needs higher (hotter) temperatures for the desired effect.

    • Burns remain a risk.

    • Some hot packs and warming therapy pads are dry heat applications.

    • Aquathermia pad (Aqua-K, K-Pad): Tubes inside the pad are filled with distilled water (water purified with contaminants removed). Heated water flows to the pad through a hose, and another hose returns water to the electric heating unit. Reheated water flows back into the pad.

Focus on Long-Term Care and Home Care: Moist and Dry Heat Applications

  • Home Care:

    • Heating pads have electrical coils made of wire, presenting fire hazards if they break. Ensure the heating pad is in good repair.

    • Heating pad temperatures are easy to adjust, but burns are a great risk. Check the temperature often and ensure the person has not changed it.

    • Some devices serve as both heat and cold applications. For cold, the pad is kept in the freezer until needed. To use as a heating pad, follow the manufacturer's instructions.

Cold Applications

  • Often used to treat sprains and fractures.

  • Effects of Cold:

    • Reduce pain.

    • Prevent swelling.

    • Decrease circulation and bleeding.

    • Cool the body when fever is present.

  • Cold has the opposite effect of heat. When cold is applied, blood vessels constrict.

    • Blood flow decreases.

  • Cold is useful right after an injury. Decreased blood flow reduces bleeding, and less fluid collects in the tissues. Cold numbs the skin, relieving pain.

Complications of Cold Applications

  • Complications include pain, burns, blisters, and poor circulation.

  • Burns and blisters occur from intense cold or dry cold in direct contact with the skin.

  • Prolonged cold application causes blood vessels to dilate, increasing blood flow, which has the same effect as heat applications.

  • Older and fair-skinned persons have fragile skin and are at great risk for complications, as are persons with sensory impairments.

Moist and Dry Cold Applications

  • Moist cold applications penetrate deeper than dry ones and are warmer than dry cold applications.

  • Examples:

    • Moist Cold: Cold compress

    • Dry Cold: Ice bags, ice collars, and ice gloves filled with crushed ice.

  • Cold packs can be moist or dry. Commercial cold packs are single-use (disposable) or re-usable. To activate, strike, knead, or squeeze the pack. Keep re-usable cold packs in the freezer and clean them after use. Discard single-use cold packs after use.

Focus on Long-Term Care and Home Care: Moist and Dry Cold Applications

  • Home Care:

    • Disposable ice packs are common. A bag of frozen peas or corn can serve as an ice bag, as can plastic bags.

    • If using a plastic bag:

      • Fill the plastic bag with ice.

      • Close the bag securely to prevent leaks.

      • Wrap the pack, bag of peas/corn, or plastic bag in a towel, dishcloth, or pillowcase.

Applying Heat and Cold

  • Protect the person from injury.

Rules for Applying Heat and Cold

  • Know how to use the equipment; follow the manufacturer's instructions.

  • Measure the temperature of moist applications using a water thermometer or agency policy.

  • Follow agency policies for safe temperature ranges.

  • Do not apply very hot applications (above 106°F106°F or 41.1°C41.1°C). A nurse applies very hot applications.

  • Ask the nurse what temperature to use.

  • Use cooler temperatures for persons at risk when applying heat, and warmer temperatures for persons at risk when applying cold.

  • Have the nurse show you the application site.

  • Cover dry heat or cold applications before applying them with a flannel cover, towel, or other cover as directed.

  • Provide for privacy. Properly screen and drape the person, exposing only the body part involved.

  • Maintain comfort and body alignment.

  • Observe the skin every 5 minutes. Do not let the person change the temperature of the application.

  • Apply heat and cold for no longer than 15 to 20 minutes.

  • Follow electrical safety rules when using electrical appliances.

  • Place the call light within the person's reach.

  • Complete a safety check before leaving the room.

Heat and Cold Temperature Ranges

  • Hot: 99°F99°F to 106°F106°F (37°C37°C to 41°C41°C)

  • Warm: 93°F93°F to 98°F98°F (34°C34°C to 37°C37°C)

  • Tepid: 80°F80°F to 92°F92°F (26°C26°C to 34°C34°C)

  • Cool: 65°F65°F to 79°F79°F (18°C18°C to 26°C26°C)

  • Cold: 50°F50°F to 64°F64°F (10°C10°C to 18°C18°C)

Focus on Communication: Applying Heat and Cold

  • The person may not report pain or discomfort or know what symptoms to report. Ask:

    • "Does the application feel too hot or too cold?"

    • "Do you feel any pain, numbness, or burning?"

    • "Do you feel weak, faint, or drowsy?" (If yes: "Tell me how you feel.")

Teamwork and Time Management: Applying Heat and Cold

  • Check the person and the application every 5 minutes. Plan your work to stay in or near the person's room. For example:

    • Make the bed and straighten the person's unit.

    • Provide care to the person's roommate.

    • Help the person complete the menu.

    • Read cards and letters to the person.

    • Address envelopes and other correspondence.

    • Take time to visit with the person.

Delegation Guidelines: Applying Heat and Cold

  • Information needed from the nurse and the care plan:

    • What application to apply

    • How to cover the application

    • What temperature to use

    • The application site

    • How long to leave the application in place

    • What observations to report and record:

      • Complaints of pain, discomfort, numbness, or burning

      • Excess redness

      • Blisters

      • Pale, white, or gray skin

      • Cyanosis (bluish color)

      • Shivering( rapid contraction and relaxation of the muscle)

      • Rapid pulse, weakness, faintness, and drowsiness (sitz bath)

      • Time, site, and length of application

    • When to report observations

    • What patient or resident concerns to report at once

Promoting Safety and Comfort: Applying Heat and Cold

Safety

  • Keep the call light within reach and check the person every 5 minutes. Also follow these safety measures.

    • Sitz bath: Observe for signs of weakness, fainting, or fatigue due to increased blood flow to the perineum and rectum. Protect the person from injury, chills, and burns.

    • stay with the person

    • secure the gown above the waist

    • Commercial hot and cold packs: Read warning labels and follow manufacturer's instructions.

    • Aquathermia pad:

      • Follow electrical safety measures.

      • Check the device for damage or flaws.

      • Follow the manufacturer's instructions.

      • Place the heating unit on an even, uncluttered surface.

      • Check the hoses for kinks or bubbles.

      • Place the pad in a flannel cover.

      • Secure the pad in place with ties, tape, or rolled gauze. Do not use pins.

      • Do not place the pad under a body part.

      • Give the temperature setting key to the nurse. The temperature is usually set at 105°F105°F (40.5°C40.5°C) with a key.

  • Do not apply heat over areas with medicated patches or ointments.

Comfort

  • Cold applications can cause chills and shivering. Provide warmth using bath blankets or other blankets as needed.

Applying Heat and Cold Applications - Quality of Life

  • Knock before entering the person's room.

  • Address the person by name.

  • Introduce yourself by name and title.

  • Explain the procedure before and during the procedure.

  • Protect the person's rights during the procedure.

  • Handle the person gently during the procedure.

Pre-Procedure

  1. Follow Delegation Guidelines.

  2. Practice hand hygiene.

  3. Collect equipment.

    • For a hot compress:

      • Basin

      • Water thermometer

      • Small towel, washcloth, or gauze squares

      • Plastic wrap or aquathermia pad

      • Ties, tape, or rolled gauze

      • Bath towel

      • Waterproof under-pad

    • For a hot soak:

      • Water basin or arm or foot bath

      • Water thermometer

      • Waterproof under-pad

      • Bath blanket

      • Towel

    • For a sitz bath:

      • Disposable sitz bath

      • Water thermometer

      • 2 bath blankets, bath towels, and a clean gown

    • For an aquathermia pad:

      • Aquathermia pad and heating unit

      • Distilled water

      • Flannel cover or other cover as directed

      • Ties, tape, or rolled gauze

    • For a hot or cold pack:

      • Commercial pack

      • Pack cover

      • Ties, tape, or rolled gauze (if needed)

      • Waterproof under-pad

    • For an ice bag, ice collar, or ice glove:

      • Ice bag, collar, or glove

      • Crushed ice

      • Flannel cover or other cover as directed

      • Paper towels

    • For a cold compress:

      • Large basin with ice

      • Small basin with cold water

      • Gauze squares, washcloths, or small towels

      • Waterproof under-pad

  4. Identify the person using two identifiers. Check the ID (identification) bracelet against the assignment sheet. Use 2 identifiers. Also call the person by name.

Procedure

  1. Provide for privacy.

  2. Position the person for the procedure.

  3. Place the waterproof under-pad (if needed) under the body part.

  4. For a hot compress:

    • Fill the basin 12\frac{1}{2} to 23\frac{2}{3} full with hot water as directed. Measure water temperature.

    • Place the compress in the water and wring out.

    • Apply the compress over the area. Note the time.

    • Cover the compress as directed.

      • Apply plastic wrap and then a bath towel. Secure the towel in place with ties, tape, or rolled gauze.

      • Apply an aquathermia pad.

  5. For a hot soak:

    • Fill the container 12\frac{1}{2} full with hot water. Measure water temperature.

    • Place the part into the water. Pad the edge of the container with a towel. Note the time.

    • Cover the person with a bath blanket for warmth.

  6. For a sitz bath:

    • Place the sitz bath on the toilet seat.

    • Fill the sitz bath 23\frac{2}{3}full with water. Measure water temperature.

    • Secure the gown above the waist.

    • Help the person sit on the sitz bath. Note the time.

    • Provide for warmth. Place a bath blanket around the shoulders and another over the legs.

    • Stay with the person if he or she is weak or unsteady.

  7. For an aquathermia pad:

    • Fill the heating unit to the fill line with distilled water.

    • Remove the bubbles. Place the pad and tubing below the heating unit. Tilt the heating unit from side to side.

    • Set the temperature as the nurse directs (usually 105°F105°F [40.5°C40.5°C]). Remove the key.

    • Place the pad in the cover.

    • Set the heating unit on the bedside stand. Keep the pad and connecting hoses level with the unit.

    • Plug in the unit. Let water warm to the desired temperature.

    • Apply the pad to the part. Note the time.

    • Secure the pad in place with ties, tape, or rolled gauze.

  8. For a hot or cold pack:

    • Squeeze, knead, or strike the pack as directed by the manufacturer.

    • Place the pack in the cover.

    • Apply the pack. Note the time.

    • Secure the pack in place with ties, tape, or rolled gauze. Some packs are secured with Velcro straps.

  9. For an ice bag, collar, or glove:

    • Fill the device with water. Put in the stopper. Turn the device upside down to check for leaks.

    • Empty the device.

    • Fill the device 12\frac{1}{2} to 23\frac{2}{3} full with crushed ice or ice chips.

    • Remove excess air by bending, twisting, or squeezing the device, or pressing it against a firm surface.

    • Place the cap or stopper on securely.

    • Dry the device with paper towels.

    • Place the device in the cover.

    • Apply the device. Note the time.

    • Secure the device with ties, tape, or rolled gauze.

  10. For a cold compress:

    • Place the small basin with cold water into the large basin with ice.

    • Place the compresses into the cold water.

    • Wring out a compress.

    • Apply the compress to the part. Note the time.

  11. Place the call light and other needed items within reach. Unscreen the person if appropriate.

  12. Raise or lower bed rails. Follow the care plan.

  13. Do the following every 5 minutes:

    • Check the person for signs and symptoms of complications. Remove the application if any occur. Tell the nurse at once.

    • Check the application for cooling (hot application) or warming (cold application).

  14. Remove the application after 15 to 20 minutes.

Post-Procedure

  1. Provide for comfort.

  2. Place the call light and other needed items within reach.

  3. Raise or lower bed rails. Follow the care plan.

  4. Unscreen the person.

  5. Clean, rinse, dry (with clean, dry paper towels), and return re-usable items to their proper place. Follow agency policy for used linens. Wear gloves.

  6. Complete a safety check of the room.

  7. Remove and discard the gloves. Practice hand hygiene.

  8. Report and record your observations.

Cooling and Warming Blankets

  • Cooling and warming blankets are used to cool or warm the body.

    • Cooling is used for fever and heat-related illnesses.

    • Warming is used for hypothermia (very low body temperature).

  • Treatment may involve a cooling or warming blanket made of rubber or plastic.

  • Warm or cool fluid flows through tubes in the blanket.

  • Vital signs are measured often.

Focus on Children and Older Persons: Cooling and Warming Blankets

  • Children:

    • Rapid temperature changes can occur in infants and children. Observe them closely.

    • Measure temperature and other vital signs as the nurse directs.

    • Report the following at once:

      • The temperature measurement and other vital signs measurements

      • Changes in vital signs

      • Changes in the child's condition

Focus on Pride: The Person, Family, and Yourself

Personal and Professional Responsibility

  • You are responsible for the tasks you perform. Never perform a task that is not in your job description or that you are not comfortable doing. The person may be harmed.

  • Do not be afraid, embarrassed, or ashamed to ask the nurse about your concerns. Take pride in acting responsibly.

Rights and Respect

  • Respect the right to privacy. Be sure the person is properly screened and covered. This will vary by application site, method, and personal preference. For example:

    • A sitz bath is ordered. Ensure that the person is covered and no one enters the bathroom during the procedure.

    • A resident receiving a hot soak to a foot wants the privacy curtain to remain pulled.

    • A patient has an ice bag on 1 hand. So roommates can talk, the patient would like to be unscreened during the application.

Independence and Social Interaction

  • Patients and residents can plan if they know what will happen. For example, a person wants to make a phone call before a hot compress or wants a hot soak done before visitors arrive.

  • You promote independence when you involve the person in planning.

Delegation and Teamwork

  • Safety and comfort measures require time and planning. Heat and cold are usually applied for 15 to 20 minutes.

  • The procedure involves:

    • Meeting elimination needs before the procedure

    • Positioning the person for comfort

    • Placing needed items within reach—call light, water mug, reading material, electronic devices, phone, remotes, other requested items

    • Checking the person often

    • Reporting and recording task completion and your observations

Ethics and Laws

  • Complications from heat and cold can be severe. Safety is a priority.

  • Harm and legal action can result if you:

    • Apply a heat or cold application without an order.

    • Use the equipment without training.

    • Apply an application that is too hot or too cold.

    • Do not cover an application as directed.

    • Neglect to check the person often.

    • Leave the application on longer than directed.

    • Fail to report complications to the nurse.

  • Follow the rules in Box 42-1. Take pride in protecting the person from injury.
    *

Focus on Pride: Application

  • Providing comfort is an important part of every task. What special considerations are needed for heat and cold applications? How will you know if you have met the person's comfort needs?

test

1d

2b

3d/b( OLD PERSON WITH NERVE DAMAGE ARE A GREAT RISK of severe burns or frostbite due to decreased sensitivity in their skin. It is crucial to monitor their reactions to temperature closely to prevent injuries. )

4a

5d/c(99 TO 106 DEGRE)

6b/a( it is so hot 110 degree cannot be at least 110 degrees)

7b

8//c(when using the aquadermia pad check for kinks in the hoses)

9a

10b

11d

12b

13 A (moist cold are used no longer than 20 minutes at a time to prevent damage to the skin and underlying tissues. )

14a/B