Principles for Nursing Practice
Heat and Cold Application
Dr. Belal Hijji, RN, PhD
February 25, 2012
Learning Outcomes
At the end of this lecture, students will be able to:
• Discuss the therapeutic uses of heat and cold therapy and their
methods of application.
2
Regulation of Heat and Cold
• The hypothalamus acts as a thermostat to regulate body
temperature. When the body temperature is either too high or
too low, the hypothalamus responds by instituting temperaturedecreasing (vasodilation, sweating) or temperature-increasing
(vasoconstriction, shivering) mechanisms to restore normal
body temperature.
• Local responses to heat and cold occur through stimulation of
temperature-sensitive receptors in the skin. Impulses travel
from the periphery to the hypothalamus and the cerebral
cortex. The hypothalamus then initiates heat-producing or
heat-reducing reactions of the body. The conscious sensations
of temperature are aroused in the cerebral cortex.
3
Heat Application and Its Benefits
• Heat is a nursing measure used to reduce pain and promote
healing. After application, it causes maximum vasodilation in
20 to 30 minutes and increases blood flow to the affected area.
After this period, reflex vasoconstriction occurs along with
tissue congestion. Periodic removal and reapplication of heat
will restore vasodilation.
• Heat increases delivery of oxygen, nutrients, leukocytes, and
antibodies to ease the inflammatory process. It facilitates
removal of wastes and toxins, and produces a local warming
effect. In addition, heat increases absorption of fluid by
capillaries and promotes removal of excess fluid from
interstitial spaces, thereby reducing edema. Finally, heat
promotes muscle relaxation and decreases pain from spasm or
stiffness.
4
Cold Application and Its Benefits
• Cold application lowers the skin and underlying tissues
temperature and causes vasoconstriction, which reduces blood
flow to the affected area and produces skin pallor, numbness,
and pain. Maximum vasoconstriction occurs at 15°C. At
temperatures below 15°C, the vessels begin to dilate.
Prolonged exposure to cold results in a reflex vasodilation.
• Vasodilation and vasoconstriction of the blood vessels in the
skin result primarily from increased sensitivity of the vessels
to nerve stimulation and from a protective reflex response that
passes to the spinal cord and then back to the vessels.
5
Cold Application and Its Benefits (Continued…)
• The benefits of cold application include decreasing blood flow
to site of injury, thereby decreasing inflammation and edema
formation, and facilitating clotting and control of bleeding.
• In addition, cold reduces tissues’ oxygen consumption, and
raises the threshold of pain receptors, thereby decreasing pain.
6
Factors Affecting Heat and Cold Tolerance
• Body part: Certain areas of the skin have a sensitivity to
temperature variations. The inner aspect of the wrist and
forearm are temperature-sensitive, while the back of the hand
and the foot are not as sensitive.
• Duration of application: Therapeutic benefits of heat and
cold applications are achieved with short periods of exposure
to temperature variations. Tolerance increases as the length of
exposure increases.
• Damage to body surface area: Injured skin areas are more
sensitive than intact areas to temperature variations.
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Factors Affecting Heat and Cold Tolerance (Continued..)
• Physical condition: Neurosensory impairments may interfere
with the reception and perception of stimuli. Diabetes mellitus
and atherosclerosis can impair neurosensory pathways and
result in deficits in sensation, thus, increasing the risk of
injury.
• Age: Thinner skin layers in children and elderly people
increase the risk for burns from heat and cold applications.
Older adults have a decreased sensitivity to pain.
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Nursing Checklist for Heat and Cold Application
• Obtain a physician’s order that details the site to be treated, the
type of therapy, and the frequency and duration of application.
• Select temperature on the basis of client status and agency
policy.
• Thoroughly explain procedure and expected benefits to client.
• Assess client’s status before, during, and after treatment is
performed to prevent injury.
• Document effects of therapy.
9
Thank You
Any Questions?