Chapter 9
Cold and Heat Therapy
Section Ⅰ Introduction
The Cold and Heat Therapy is a physical therapy method in common use. A nurse is
accountable for the whole process of the application since she is the one who administers the
treatment. Not only does she act as an administer, but also an operator, an educator, an observer, a
comforter, and an evaluator. A safe nurse determines the safety of the cold or heat application.
Before using these therapies, the nurse must understand normal body responses to cold and heat,
the therapeutic purposes of applications of cold and heat, specific patient conditions in which
these applications are contraindicated, common complications of applications, factors influencing
the effects of therapies as well as the detailed nursing procedures of cold and heat application.
Concept of Cold and Heat Therapy
The Cold and Heat Therapy 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.
Bodily Responses to Cold and Heat Therapy
Initial, or Primary Responses
Physiological Responses cold and Heat stimuli create different physiological responses.
These physiologic effects are summarized in Table 9-1. For the most past, physiological responses
to heat and cold are mirror images of one another.
Table 9-1
physiological responses to heat and cold
Heat
Cold
· Vasodilation
· Increases blood flow to the affected area;
increases supply of nutrients, oxygen, and
wastes removal
· Increases capillary permeability
· Increases cellular metabolism
· Raises body temperature and temperature of
tissues
· Increases inflammation and suppuration
· Vasoconstriction
· Reduces blood flow to the affected area;
reduces supply of nutrients, oxygen, and wastes
removal
· Decreases capillary permeability
· Decreases cellular metabolism
· Lowers body temperature and temperature of
tissues
· Slows bacterial growth, decreases
inflammation
· Reduces lymph flow
· Decreases amount and motility of leukocytes
· Increases the viscosity of the blood
· Relieve muscle tonus and relaxes muscles
· Decreases nerve impulse conduction
·
·
·
·
·
·
Increases lymph flow
Increases amount and motility of leukocytes
Decreases the viscosity of the blood
Decreases muscle tonus and relaxes muscles
Increases nerve impulse conduction
Decreases viscosity of synovial fluids
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Heat causes vasodilation, resulting in a reddened skin color; cold causes vasoconstriction,
creating a pale bluish cast to the skin. While heat increases metabolic action of cells, cold
decreases it. Heat decreases the viscosity of the blood, and cold increases it. Heat raises the
temperature of the underlying tissues; increases the amount of capillary surface available for the
osmotic transfer of bodily fluids; and increases blood flow, lymph flow, and motility of leukocytes.
Cold lowers the temperature of the tissues; and decreases blood flow, lymph flow and motility of
leukocytes. Heat increases suppuration and inflammation while cold reduces inflammation and
suppuration.
Thermal Receptors Adaptation When the heat and cold receptors 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. This phenomenon is called thermal
receptors adaptation. Sometimes adaptive responses may result in serious consequences. For
example, if the client cannot sense too hot or too cold stimulation, increasing temperature of a hot
application or decreasing temperature of a cold application after adaptation may cause damage to
the body tissues.
Secondary Responses
When the maximum therapeutic effect of the heat or cold application is achieved, the
opposite effect begins. For example, heat produces maximum vasodilation in 20 to 30 minutes;
continuation of the application beyond 30 to 45 minutes brings tissue congestion, and the blood
vessels then constricted, blood vessels are unable to dissipate the heat adequately via the blood
circulation. Similarly, cold applications can cause blood vessel constriction, but continuation of
application beyond 30 minutes to 1 hour brings vasodilation for 10-15minutes. We call these two
phenomenon secondary responses. This mechanism is protective: it helps to prevent the
impairment of body tissues exposed to heat or cold for too long time. Vasodilation for too long
time may result in tissue edema, while blood vessel constriction with too long duration may
reduce the blood flow and oxygen delivery to the area. The nursing implications in regard to the
possibility of “secondary responses” are obvious: (a) with heat application, the maximum
vasodilation and tissue temperature are achieved after 20 to 45 minutes of exposure. After this
time the heat application must be discontinued for at least an hour's physiological recovery time,
otherwise the secondary responses will reverse the initial treatment effects of heat application; (b)
with cold application, the initial exposure must last only 30 minutes to 1 hour. After this time, a
recovery time of 1 hour must be allowed or the secondary responses will occur.
Factors Influencing the Effect of Cold and Heat Therapy
Treatment method
A major consideration in the choice of treatment method is the differences between moist
heat or cold and dry heat or cold. Generally speaking, the therapeutic effects of moist application
are better than that of dry application. Because moisture is an excellent conductor of heat, it can
enhance or intensify the effectiveness of treatment. Moist applications of heat tend to soften crusts
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and exudates, to penetrate more deeply, and to have a more localized effect. They tend to reduce
the amount of body fluid that can be lost through perspiration and are less likely to burn or dry the
skin. Moist applications of cold do not require as low a temperature as dry applications of cold,
and penetrate better than dry cold.
Size of the exposed body part
The therapeutic effect of heat or cold application are related to the size of the exposed body
part. The larger the area exposed to heat and cold is, the greater the effect is and the less tolerance
the client has to extremes in temperature.
Duration of application
The duration of the application has a direct effect on the response of the body. There is. a
greater tolerance for extremes of either heat or cold if the exposure is brief. But if the duration
of .application is too great, secondary responses will occur and nullify the therapeutic effect, even
sometimes can cause damage to the body tissues.
Prior skin temperature
The prior skin temperature affects the degree of physiological responses. Generally, the body
responds best to minor temperature adjustment. If a body part is cool or warm, and a hot or cold
stimulus touches the skin, the greater the differences between prior skin temperature and stimulus
temperature, the greater the body response is.
Environmental temperature
The environmental temperature influences the effect of heat or cold applications. If the
environment is warm and humid, heat cannot be dissipated through evaporation. When the
environmental temperature is greater than or equal to the body temperature, conductive loss is
inhibited. Conversely, in a cold dry environment the application of cold will be enhanced since the
client is already losing much heat to the environment.
Body part
The foot and palm of hand have thicker skin and are therefore less temperature-sensitive. In
contrast, certain areas where the skin is thinner, such as the inner aspect of the wrist and forearm,
eyelids, the neck, and the perineal area are less tolerant to temperature variations.
Individual tolerance
The ability to tolerate both heat and cold varies significantly from person to person and from
one age group to another. In the very old person, the sensitivity to heat or cold is decreased and
therefore response to the heat and cold stimuli is retarded. Infants have limited abilities to adapt to
heat and cold because of their immature neurological functioning. Because the very young and old
have thinner skin, they can be burned easier. Besides, clients who have neurosensory impairments
may reduce or lose the ability of reception and perception of heat and cold stimuli and have more
tolerance, but the risk of injury is greater.
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Section Ⅱ Cold and Heat applications
Cold application
Therapeutic Effect of Cold
Based on the bodily physiological responses to cold application, the therapeutic effects are
summarized as follow:
Relief of congestion or hemorrhage.to the affected area
Relief of pain
Controlling inflammation
Reducing fever, etc.
Cold causes local vasoconstriction and increases blood viscosity in the part of the body
touched. These physiological responses enhance blood coagulation and are thus very useful in
controlling hemorrhage. However, if circulation to a body part is severely diminished, the
continuous application of cold can result in ischemic tissue damage. In an emergency situation, the
clinical decision to use cold applications to control hemorrhage is not easily made because of this
potential complication.
Besides, cold applications can relieve pain because of nerve impulse conduction decreases with
cold temperature. The pain of a congested body part can be prevented by the application of cold
prior to edema formation. When cold is applied, the cutaneous vessels are squeezed smaller and
the fluid in the tissues is reduced, thereby reducing swelling and pain.
Contradictions to cold applications
Impaired Local Circulation Cold application further reduces blood supply to the affected
area and may result in ischemic tissue damage and necrosis.
Chronic Inflammation and Deep Suppuration
Cold application reduces the local
circulation to the affected area and inhibits the process of dissipation of inflammation.
Clients with Cold Hypersensitivity, Heart Diseases and very Weak Clients
Contradicted Body Parts Certain body parts are contradicted to cold applications: (a)
posterior occipital, external ear and scrotum are at risk of tissue damage from cold application; (b)
precordial region by cold application may result in reflexible decreased heart rate and arrhythmia;
(c) abdominal pain and diarrhea may occur by cold application on abdomen; (d) cold application
on sole of foot can cause reflexible coronary artery constriction.
methods
Cold can be applied to the body in both dry and moist forms. Dry cold is generally. applied
by means of ice bag, ice glove, ice collar or ice cap or chemical cold pack. Moist cold can be
provided by cold compress, cold soaks or a cooling sponge bath, such as alcohol sponge bath and
tepid sponge bath.
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The preparation before operation
Assessment Before applying cold therapies, in addition to reading the client's chart, the nurse
should assess the client's physical condition for signs of potential intolerance to cold. The nurse
first observes the area to be treated for the skin integrity as well as the local circulation.
Alterations in skin integrity such as abrasion, open wounds, edema, bruising, bleeding or local
areas of inflammation increases the client's risk of injury. When assessing local circulation, the
nurse can observe the skin color and palpate skin temperature, distal pulses and edematous areas.
If signs of circulatory inadequacy are present, the nurse should question the order. Besides, the
assessment includes identification of conditions that contraindicate cold application, such as heart
diseases.
The client's level of sensation should also be assessed. One method you can use to determine
the client's local sensory perception is to ask him to close his eyes, place your fingers on the
surface to be treated, and ask him if he can feel your touch. Further distinctions may be made with
the verbally capable patient by tracing a letter or shape on the body area to be treated and asking
him to identify it. In addition, the level of consciousness influences the ability to perceive cold. If
a patient is confused or unresponsive, the nurse must make frequent observations during the
therapy.
Equipment The nurse should generally know what she is supposed to do and understand the
operation of the equipment to be used. In addition, the nurse should assess the condition of
equipment before therapy. Containers .of fluid should be checked for possible leakage; solutions
should be assessed for proper type and temperature.
The client Make the client understands the purpose of the therapy and precautions taken
during treatment.
Implementation
Use of Ice Bags
Generally they are filled with ice chips to be applied to the body part and providing some
therapeutic effect.
Purpose
1. to reduce body temperature.
2. to reduce hemorrhage, swelling and pain after sprains, head injuries and dental surgeries
Equipment
· ice bag
· cloth cover
· desired amount of ice
· basin
· towel, etc.
Procedures and key points
Steps
Rationale and Key Point
1. Wash hands and gather equipment
(1) Choose an appropriate sized ice bag
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(2) Fill the bag with water, secure the cap, invert
to check for leaks and pour out the water
(3) Fill the ice bag one half to two thirds full of
crushed ice
(4) Release any air from the bag by squeezing
its sides before screwing the cap on snugly
(5) Wipe bag of any excess moisture and place it
into a cloth cover
2. Bring the equipment to the client. Check the
client's bed number and name; explain the
purpose and procedure to the client
3. Apply the ice bag to the area to be treated
4. Apply the ice bag to the area to be treated for
no more than 30 minutes.
5. Refill the ice bag when the ice has melted or
change the cover as needed
6. Closely observe the client's responses and
application effect
7. After the application, empty the ice bag. Hang
it upside down and dry it by drafts. Place it
where it is shady and cool. Clean the cloth cover
and dry it for future use
8. Wash hands and record related information
including the type of application, location,
duration, therapeutic effect as well as the client's
responses. The client's body temperature after
reducing fever by application should be charted
on the client's temperature sheet
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· Avoid water leak when the ice melts
· So that the bag can mold easily over a body
part
· Because excess air interferes with
conduction of cold
· Cloth cover can avoid ice bag in direct
contact with the client's skins and absorb
moisture condensation on the outer surface of
the ice bag
·Identify the client and encourage cooperation
· In order to reduce fever, the ice bag can be
placed on the forehead, the top of the head or
the areas, which contain large superficial
blood vessels, such as bilateral neck, axilla
and groin. The ice bag can also be hung down
on the pole and applied on the forehead to
decrease local pressure
· To avoid secondary effects that may
influence therapeutic results
·If the appearance of
blisters, mottling,
skin maceration, redness, extreme paleness or
gray discoloration is observed or if the client
has complaints of burning sensation or
numbness, the application should be
discontinued at once to avoid cold injuries
Use of Ice caps
Purpose
To lower head temperature and prevent brain edema for unconscious clients.
Equipment
· Ice cap
· drawsheet
· desired amount of ice
· basin
· small pillow
· bucket
· sterile drape
· rectal thermometer
· sponges
Procedures and key points
Steps
Rationale and Key Point
1. Wash hands and gather equipment as the
use of ice bags; then bring them to the client
2. Check the client's bed number and name,
explain the purpose and procedure to the client
3. Take away the pillow, spread the
drawsheets under the client's head, place a
sterile drape inside the ice cap
4. 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
5. Take anus temperature every 30 minutes
and maintain it around 33℃
6. Refill the ice as needed
7. The duration of application depends on the
condition of the client. Record the body
temperature every time taken on the special
nursing sheet
8. Dispose of the equipment as the application
of ice bag
· Identify the client and ask cooperation
· Protect the linen from being damped
· Avoid cold damage to auricles and occiput
· Facilitate to keep the airway open
· Rectal temperature below 30 ℃ is not
advisable and ventricular fibrillation may occur
· Assure the effect of reducing fever
Alcohol Sponge Bath
Purpose
To reduce the client's fever by lowering the body temperature
Equipment
· tray
· big towel
· small towel·
· Basin
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· hot water bag and cover
· ice bag and cover
· clothes and trousers for patient
· screen
· bowel (200ml 25% to 35% alcohol solution in it)
Procedures and key points
Steps
Rationale and Key Point
1. Wash hands, prepare the equipments and
bring them to the client
2. Check the client's bed number and name,
explain the purpose and procedure to the client
3. Place the screen on the client's bedside
4. Assist in the client urinating and defecating
5. Place the ice bag on the top of the client's
head and hot-water bag under the bottom of
the foot
6. Implement the alcohol sponge bath
following the procedures below:
(1) Assist the client in taking off the clothes.
Then place the big towel under the upper body
parts. Immerse the small towel into the
alcohol solution, wring the towel and make it
half dry, and then wrap a hand with it as if a
glove on. Sponge and rub the body according
to centrifugal direction. Sponge from proximal
neck to the back of the hand along the external
aspect of the arm, and then from the axilla to
the palm of the hand along the internal aspect
of the arm. This procedure should be repeated
several times for 3 min. After that, dry the skin
with a big towel; then change another small
towel and use it to sponge the opposite side of
the upper body part likewise
(2) Assist the client to a lateral position,
expose the back and place a big dry towel
under it Then sponge from the neck down to
the whole back for 3 minutes with another
small towel as the same method After that dry
the skin and assist the client change his
clothes and to a supine position
(3) Assist the client in taking off the proximal
trousers and expose the lower extremity. Place
· Identify the client and ask cooperation
· Provide privacy for the client
· Place of ice bag on the top of head helps to
lower body temperature; place of hot-water
bag under the bottom of foot provides
comfort and promotes vasodilation of lower
extremities as well as heat loss
· Protect the client's bed from being affected
with damp
· Alcohol evaporates at a low temperature and
therefore removes body heat rapidly,
therefore reducing the client's fever
· Rubbing may increase heat production
· Sponging the body with towel can make
client have a feeling of comfort
· Repeated sponging such areas as axilla and
cubital fossa can help the transfer of heat,
because these areas contain large superficial
blood vessels
· Groin and popliteal fossa should be sponged
for a longer duration
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a big towel under it and use another small
towel Sponge from ilium to the back of the
feet along the external aspect of the leg, then
from the grion to the inner ankle along the
internal aspect of the leg; and last sponge from
the lower thigh via popliteal fossa to foot heel;
repeat the whole procedure several times for 3
minutes. After that, dry the skin with the big
towel; then use anther small towel to sponge
the opposite part likewise. Assist the client
change clean trousers after completing the
alcohol sponge bath
7. Observing the client's condition and
responses frequently
· Because the alcohol sponge bath is applied to
the whole body, the client may have massive
vasodilation and vasoconstriction; which may
cause the change of client's condition.
Discontinue the sponge bath immediately if
the client becomes pale or cyanotic or
shivers, or if the pulse and respiration
becomes abnormal. Then report it to the
physician
· The anterior thorax,. abdomen and sole of
foot are contraindicated areas to have alcohol
sponge bath, because these areas are quite
sensitive to the cold stimuli and adverse
consequences may happen
8. Cover the quilt for the client, take away the
hot- water bag, clear up the bed and dispose of
the equipments; then wash hands, record the
time of application and the client's response
9. Take the client's body temperature and chart
it on the temperature sheet. If the body
temperature drops below 39℃, take the ice
bag off the head
Other methods
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. If a sterile compress is ordered, the nurse should
follow the sterile principles.
Cooling sponge bath There are two choices of cooling sponge bath: alcohol sponge bath and
tepid water sponge bath. The bath consists of water or a combination of alcohol and water that is
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below body temperature. The temperatures for cooling sponge bath range from 18°C to 32°C.
During the alcohol sponge bath, the alcohol evaporates at a low temperature and removes body
heat quickly. The tepid sponge bath generally refers to one in which the water temperature is 32°C
throughout the bath. When applying cooling sponge bath, rubbing the body parts may increase
heat loss. The purpose of this application is to reduce a client's fever by promoting heat loss
through conduction and vaporization.
Chemical cold packs A cold pack is a prefilled plastic package with two separate compartments.
The nurse strikes, kneads or squeezes (depending on the manufacturer's directions) the pack to
mix one chemical compound with the other and provide a controlled temperature of 10°C to
26.1°C. This appliance is designed for “one-time” use-freezing the package for another treatment
does not attain the desired temperature. They come in various shapes and sizes to fit differently
body parts. Directions in the package tell how to administer the application.
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.
Heat application
Therapeutic effect of Heat
Based on the bodily physiological responses to heat application, the therapeutic effects are
summarized as follow:
promotes suppuration and phagocytes, and then promotes elimination and localization of
inflammation
Relief of swelling through absorption of fluids from tissues
Relief of pain, Reduction of muscle spasms and joint stiffness
Relief of deep congestion
Providing warmth and Comfort
Heat is an old remedy for aches and pains; people often equate heat with comfort and relief.
Heat decreases muscle tonus and thereby relaxes the muscle and relieves stiffness. Also, with the
increase in blood flow that heat produces, fatigued muscles become rejuvenated.
Heat applications facilitate healing by increasing the supply of leukocytes, antibodies and
nutrients to the injury and by removing waste products from the site. This is accomplished by
increasing local circulation to the area. The increased circulation also stimulates formation of new
tissue. Additionally, heat promotes suppuration and phagocytes by increasing blood flow to the
affected area.
When heat is applied to the skin, vasodilation of the skin's cutaneous arterioles occurs. This
superficial increase in blood reduces the blood available for deeper viscera. Relief of deep
congestion thus occurs. However, a possible disadvantage of heat is that it increases capillary
permeability, which allows extracellular fluid and substances such as plasma proteins to pass
through the capillary walls and may result in edema or an increase in pre-exiting edema.
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Contradictions to heat applications
Unidentified acute abdomen
Heat application can temporarily relieve pain and provide
comfort for clients, which may cover up one's true symptoms and signs and thereby delay
diagnosis and treatment.
Facial dangerous triangle area infection This area has adequate blood vessels, and is
communicated with intracranial cavernous sinus. Heat application might spread infectious
microorganisms and toxin into the blood stream and surrounding tissues, and bring intracranial
infection and septicemia.
Hemorrhagic diseases Heat tends to aggravate hemorrhage.
Injuries of soft tissues within 48 hours Heat can promote vasodilation, capillary
permeability and worsen hypodermic hemorrhage and edema, which might aggravate the pain.
Bacterial Conjunctivitis Heat will raise the local area temperature, which might promote
the bacteria growth and secretion, and worsen the symptoms.
Neurosensory impairment and impaired mental status
Clients with sensory
impairment or impaired mental status have great potential risk for damage from the application of
either heat or cold, which are not desirable for these clients.
methods
Heat application can be either wet or dry. Examples of moist heat include moist hot compress
or packs, sitz bath, hot soaks. Examples of dry heat include hot-water bag, electrical heating pad,
chemical heating pad, and heating lamp. The nurse can choose different heat therapy method and
corresponding equipment to attain better therapeutic effect.
The preparation before operation
Assessment For all heat and cold applications, the nurse should first determine the client's
ability to tolerate the therapy and identify conditions that might contraindicate treatment, such as
bleeding, circulatory impairment. As the cold therapy required, the nurse should also assess the
client's skin area including its integrity and local circulation to which the heat will be applied.
Prior to the application of heat or cold, the client's level of sensation should be assessed in the
same way.
Equipment Besides the assessment mentioned above, it is the responsibility of the nurse to
check that the equipment functions properly. In the following parts, the commonly used appliances
of heat therapy are presented. The nurse must know how this equipment should operate so she can
readily recognize when it is malfunctioning. A general check of electrical equipment includes
looking for frayed wires and damaged insulation. The electrical appliance should be plugged in
and turned on in the clean utility area to determine whether it is functioning before it is taken to
the patient's bedside. In addition, containers of fluid should be checked for possible leakage;
solutions should be assessed for proper type and temperature.
The client
Make the client understands the purpose of the therapy and precautions taken
during treatment.
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Implementation
Use of Hot-water bags
A hot-water bag is a. common source of dry heat for the application of local heat. This
appliance is used most commonly to increase circulation to a body part and thereby enhance
suppuration, to relieve edema, ischemia, and muscle spasm. Because burns due to water that is too
hot are common, the assessment for leaks before bringing it to the client is important.
Purpose
1. to relieve spasm and pain
2. to provide warmth and comfort
Equipment
· hot water bag· and cover
· dry towel
· hot water
· thermometer
Procedures and key points
Steps
Rationale and Key Point
1. Wash hands and prepare the equipments
(1) Check whether the hot water bag is intact
and stopper suits the bag or not
(2) Measure the water temperature and
regulate it to the required temperature
2. Place the hot water bag flat and remove the
bag stopper. Fill the bag with hot water about
a half to two thirds full with one hand holding
hot water bottle and pouring water into the
bag and one hand grasping the edge of bag
opening and lifting the bag while filling it
3. Place the hot water bag flat again gradually,
twist or squeeze the top of the bag and expel
the remaining air, then turn the stopper until it
is tight
4. Dry the bag and hold it upside down to
check for its leaks
5. Wrap the bag in a cloth cover and tighten its
ties
· To avoid leaks
· The water temperature is generally regulated
to 60℃~70℃. But for unconscious clients,
elders, infants, and clients who haven't regain
consciousness after anaesthesia or have
impaired peripheral circulation, the safe water
temperature should be 50℃ in order to avoid
burns·
· If the hot water bag is filled too full or with
much air, it will be dilated and become hard
and heavy, which will not be flexible enough
to mold comfortably to the body part.
Besides, air is not a good conductor of heat,
so air in the bag will interfere with the
transfer of heat
· Cloth cover can avoid direct contact between
hot water bag and client's skin and also can
help absorb the moisture
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6. Take the hot water bag to the client, check
the client's bed number and name, explain the
purpose and procedure to the client
7. Place the bag on the body site of the client
as appropriate
8. Duration of heat application should depend
on its therapy purpose Remove the bag no
more than 30 minutes after application if the
purpose is to give treatment; or the heat
application can be continuous if it is to
provide warmth
9. Observe the treatment effect and client's
responses frequently
10. After the application, empty the bag. Hang
it upside down and dry it by draft. Blow the
air into the bag and screw the stopper until it
is tight. Place it where it is shady and cool
Clean the cloth cover and dry it for future use
11. Wash hands and record related information
including the body site, duration, effect and
client's responses of the heat application
· Identify .the client, minimize client's anxiety
and promote cooperation during the
application
· For the confused client and 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. The client's skin expose.
should be examined frequently to avoid burns
· Secondary responses should be avoided
otherwise it will influence the therapeutic
effects
· Follow the shift-changing report system
strictly and ask the client and his relatives not to
adjust the water temperature of the bag
themselves
· Stop heat application once the skin exposed is
redden or painful. Vaseline should be smeared
in the affected area to protect the skin
· The two sides of the bag should be pulled
apart so they will not stick together during
drying
the Use of Hot Lamps
Types of hot lamps include infrared lamps, ultraviolet lamps, goose neck lamps. Infrared and
ultraviolet lamps, which deliver invisible heat rays from beyond the red and violet ends of the
spectrum, are usually confined to use by the physical therapist. The main purpose for the
application of infrared lamps is to increase the circulation to a body part and thereby relieve
ischemic pain and relax muscle spasms. Ultraviolet lamps are used in connection with
pigmentation of the skin, for production of vitamin D, and for bactericidal effects. The goose neck
lamps use incandescent bulbs and can be used commonly by the nurse in a variety of situations.
Purpose
1. to reduce inflammation
2. to relieve spasm and pain
3. to promote scar and granulation tissue formation
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Equipment
· infrared lamp or gooseneck lamp
Procedures and key points
Steps
Rationale and Key Point
1. Select lamp bulb of appropriate wattage as
needed. Bring the hot lamp to the client's
bedside and switch it on
· The wattage of hot lamp bulb depends on the
body area to be exposed Thorax, abdomen,
waist and back can be exposed to 500 to
l000W lamp bulb; while hands and foot
exposed to 250W lamp bulb or 40-60W
gooseneck lamp bulb
· Identify the client and promote client's
cooperation
2. Check the client's bed number and name,
explain the purpose and procedure to the
client. Then assist the client in assuming
comfortable position
3. Expose the body part to be treated and place
screen on the client's bedside if necessary
· Privacy should be provided by draping the
client's exposed but untreated body parts
4. The hot lamp is placed towards the body
part and appropriate distance between the
exposed body part and the lamp should be
maintained
· The distance is usually 30 to 50cm. The heat
given off by lamp can be felt by hand and
might be adjusted by the distance of the lamp
and body part if the heat is hot appropriate
5. Eyes should be covered with moist gauzes
or colored glasses if the client's face, cervix
and anterior thorax are exposed to the hot
lamp
6. The duration of this application is
20~30minutes. Observe the local exposed skin
closely during treatment
· To protect eyes
· If the skin appears peach-red, it suggests that
the heat produced by hot lamp is appropriate.
If the skin becomes purple-red, the radiation
should be stopped. Spread petrolatum over
the affected skin surface area so as to protect
it
7. After treatment, handle the equipments and
record duration, body part, distance from the
lamp to the skin as well as the client's
responses and skin condition
8. Observe the treatment effect and client's
responses frequently
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Hot moist compress
Compresses can be gauze, dressings or other moisture-retaining substances used in
applications of heat. Hot compress may be either sterile or nosterile. The sterile compresses are
applied to areas vulnerable to infection, such as open wounds, surgical incisions, boils expected to
open, or sensitive areas such as the eye. Compresses are not sterile when the skin is intact and the
area is not vulnerable to infection. The purposes ,of the application of the hot compresses are to
promote healing, relieve pain,·and promote drainage. Heat from hot compresses dissipates quickly.
To maintain a constant temperature, the nurse must often change the compress.
Purpose
1. to reduce inflammation and edema
2. to relieve spasm and pain
Equipment
· tray
· sterile dressing transfer forceps
· sterile petrolatum
· dressings
· sterile cotton swab
· sterile gauze
· plastic sheet
· small· rubber drawsheet
· sterile drape
· cotton mat
· boiler (hot water inside)
· electrical stove
· thermometer
· hot water bag (if necessary)
Procedures and key points
Steps
Rationale and Key Point
1. Wash hands, gather equipment and bring them
to the client
2. Check the client's bed number and name,
explain the purpose and procedure to the client
3. Assist the client assuming comfortable position
in proper body alignment. Expose the body part to
be covered with compress and put drawsheets and
sterile drape under it. Draw bedside curtains if
necessary
4. Put dressings into the hot water boiler and make
them immersed in water. Then place the .boiler on
the electric stove and set the water temperature at
50℃ to 60℃
5. Spread light coat of sterile petrolatum over skin
surface to be treated and cover a sterile gauze on it
· The equipment should be sterile if hot
compress is to be applied to open wound
· Identify the client and make the client
cooperate with the treatment
6. Take out dressings with sterile transfer forceps
and wring excess water until there is no water
dripping from dressing. Fluff up dressings and
hold them over· the wrist and feel its temperature.
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· Protect linen from being soiled
· Measure the· temperature of water using
a thermometer
· The area to be.spread petrolatum should
be larger than the area by hot compress
and protect skin from burns
· Maintain moist and warm, because moist
heat has strong penetration ability and
good effect
The temperature is appropriate if the dressing
doesn' t burn the skin. Apply the dressing onto the
area to be treated and then cover it with a plastic
sheet and cotton mat
7. Change dressings every three to five minutes
and observe skin condition
8. If client feels too hot, lift dressing at edges and
dissipate some heat
9. If continuous compresses are ordered, it can be
applied 15 to 20 minutes
10. After hot compress application, remove the
gauze and wipe off petrolatum. Keep body part
warm. Ask the client not to go out immediately
until 30 minutes after hot compress on the face
11. Clean up the client's bed and dispose of the
equipments. Wash hands and record related
information including the body part, time, effect of
hot compress as well as client's responses
· Avoid skin burns
·Hot water bag can be placed on the cotton
mat to maintain heat if it is required
· Hot compress makes local skin
vasodilation. Provide warmth and prevent
unnecessary cooling
· Change the dressings for the wound after
hot compress
Hot sitz bath
The hot sitz bath is a procedure whereby the client's pelvic area of the client is immersed in
warm fluid. The client sits in a special tub or chair or in a basin that fits on the toilet seat so that
the legs and feet remain out of the water. A variety of tubs may be used including special fixtures,
disposable plastic models, and portable, reusable models. The sitz bath is used to cleanse a wound,
relieve pain, increase circulation, promote relaxation, or stimulate voiding. The client who has had
rectal surgery, an episiotomy during childbirth, painful hemorrhoids, or vaginal inflammation may
benefit from it. The desired temperature of the sitz bath depends on the purpose of the treatment.
Lower range of temperature is used for cleansing; the higher range, for increasing circulation.
Purpose
1. to reduce edema in rectum and organs in pelvic cavity
2. to relieve edema, inflammation and pain in the area of anus and perineum
3. to clean the local area and provide comfort
Equipment
· sterile sitz bath tub
· sitz bath chair
· hot water bottle
· sitz bath solution(ordered by physician)
· steriled gauzes
· thermometer
· large bath blanket
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Procedures and key points
Steps
Rationale and Key Point
1. Wash hands, gather equipment and
bring them to the client
· The bath tub and medication fluid should be sterile
if there is wound. It' s not preferred for the female
client who is during menses, in the latter period of
pregnancy, less than 2 weeks after delivery, having
vaginal bleeding and acute inflammation in pelvic
cavity
· Identify the client and make the client cooperate
with the treatment
2. Check the client' s bed number and
name, explain the purpose and
procedure to the client
3. Ask the client to urinate and defecate
before sitz bath first and then wash
hands
4. Place the sitz bath tub in a special
chair that fits on the toilet seat. Pour the
hot water into the tub until a half full
and adjust the water temperature. Then
make prescribed solution
5. Place a screen on the client' s
bedside. Ask the client to put off the
trousers down to the knee, assist the
client in sitting in the tub with feet flat
on the floor. Cover the client's thigh
with bath blanket
6. Allow the client to have sitz bath for
15 to 20 minutes and maintain a
constant temperature by adding warm
water
7. Observe the client for pulse,
respiration and facial color and ask
whether he feels light-headed or
nauseated
8. After the sitz bath, assist the client
out of the tub, dry his hip off with clean
gauze, help him put on trousers and ask
him to rest in bed
9. After the sitz bath, dispose of the
equipments, wash hands and record
related information including the
duration of sitz bath, medication fluid,
condition of wound as well as the
· Hot water can stimulate anus and perineum area,
which can result in the reflex of urination and
defecation
· The safe water temperature should be 40℃ to 45℃.
Make the solution indicated by the physician's order.
The concentration of solution should be 1: 5000 if it
is potassium permanganate water solution
· The client's hip should be fully immersed in the
fluid. If client doesn't adapt the water temperature at
the beginning, the nurse can help clean his perineum
area with the gauze dipped with water first, then
make him sit in the tub after adaptation
· Warm keeping should be paid attention to in winter.
Prevent client from catching cold.
· Ask the client to lift his hip above the tub when
warm water is added
· Because exposure of large portion of the body to
heat can cause extensive vasodilation, which may
disrupt blood supply to vital organs such as heart.
Thus the client may have such signs as dizziness,
weakness, accelerated pulse rate and pallor. If these
signs are present, the sitz bath should be stopped
immediately. And the nurse should assist the client
up to the bed
· Change the dressings for the wound after sitz bath
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client's responses
Chemical heating bags
The chemical heating bags are sealed plastic containers containing two different kinds of
chemical compounds. When the heat treatment is to be applied, the nurse kneads, strikes or
squeezes the appliance vigorously. Because of this action, the two compounds react and produce
heat. They are of various sizes and designed to be used once and discarded, thus diminishing the
incidence of cross infection. Generally, they can provide heat for a designated time. The purposes
of this appliance are the same as those of hot-water bags.
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