Cold Application

Subject: Fundamentals of Nursing

Overview

Cold Application

Application of a substance that is colder than the skin is known as cold application. Cold application is a straightforward, low-cost treatment that has been widely accepted as a successful pharmacologic intervention for pain management for many years. Vasoconstriction brought on by cold reduces blood flow to an area, slows down metabolism, and lessens pain and swelling. Sprains, strains, bumps, and bruises that can happen from lifting or playing sports can be treated well with cold therapy.

Effects of Cold Application

Local Effects of Cold Application

  • Vasoconstriction: Reduces nerve conduction velocity, blood flow to the injured area, hemorrhage, cell metabolism, and production of cellular waste. It also reduces swelling, pain, and muscle spasms.
  • Reduces the tissues' need for oxygen due to slowed cell metabolism.
  • An increase in blood viscosity raises the possibility of blood clotting in an injured area.
  • Reduce the blood spasm to improve neuromuscular communication and lessen pain.

Systematic Effect of Cold Application

The prolonged cold application and vasoconstriction may cause an increase in the blood pressure. Because, the way of blood flow changes towards the internal blood vessels from the surface (cutaneous) due to the vasoconstriction. Shivering is another general effect of long stay in the cold and a response of the body to warm itself.

Purposes of Cold Application

  • To reduce body temperature.
  • To reduce muscle spasm, and to relieve pain, burning or irritation.
  • To provide comfort.
  • To control bleeding.
  • To prevent or reduce inflammation and edema.
  • To decrease tissue metabolism.
  • To anaesthetize an area for short periods.
  • To inhibit the bacterial growth and prevent suppuration.

Principles of Cold Application

  • Blood vessel constriction brought on by the cold reduces the area's blood supply.
  • The end organs of the sensory nerves in the skin communicate the experience of cold, and the brain interprets the feelings.
  • Cooling is sped up by evaporation of fluids still on the skin.
  • The skin is more susceptible to maceration and skin degeneration when exposed to wetness for an extended period of time.
  • In the cold, blood becomes more viscous. As a result, blood thickens, increasing the chance of blood clotting. Cold can be applied when coagulation is required, like in a hemorrhage.
  • The reduced tissue temperature brought on by cold also decreases cellular metabolism. As a result, the temperature of a fever can be lowered using cold.
  • Because dry cold focuses the cold in a condensed, shallow region, applying moist cold is more effective.
  • Take all essential care while applying a general wet cold application to avoid shivering and chilling. Stop the procedure as soon as you see the patient trembling, experiencing a heart arrhythmia, or collapsing.
  • When using a cold or tepid sponge, friction should be avoided because it produces heat.
  • Under the effect of cold, the body's microbes become less active and reproduce less.
  • Cold causes numbness and lowered pain thresholds. Because it increases pain tolerance, it can occasionally be used as a local anesthetic to lessen discomfort.
  • In cases of hyperpyrexia, the body's temperature needs to be raised gradually and slowly. A abrupt cooling could harm the patient.
  • Never ignore a patient's problems, no matter how trivial they may seem.

Contraindications

  • Patients who are in shock and collapse condition.
  • Patients with impaired circulation e.g. diabetes, arteriosclerosis, neurological disorders. Cold disrupts the nutrition of the tissue and can cause tissue damage.
  • Patients having a sensation of numbness.
  • When there is muscle spasm.
  • Patients having shivering or having a very low temperature.
  • Infected wound/In an open wound: Cold decreases the blood flow, so the tissue damage may increase.
  • Patients having allergy or hypersensitivity to cold.
  • Low temperature.

Complications of Cold Application

  • Pain
  • Blisters and skin breakdown
  • Maceration with moist cold
  • Gray bluish discoloration
  • Thrombus formation
  • Hypothermia

Cold Compress

Cold compress is the application of moist cold to a body part by means of gauze or wash cloth.

Purposes

  • To reduce body temperature and provide comfort.
  • To reduce inflammation and edema.
  • To relieve pain, burning sensation and irritation.
  • To anesthetize for short time.
  • To control hemorrhage.
  • To inhibit bacterial growth and thus prevent suppuration.

Articles

A tray containing:

  • Bowl with cold water, (15C/59F)
  • Sponge cloth or gauze pieces
  • Mackintosh and towel
  • Thermometer tray
  • Kidney tray
  • A small bowl with non-absorbent cotton balls for plugging ears if applying to forehead.

Procedure 

S.N. Nursing Action Rationale
1 Identify the patient. Assess for the need of cold applications. Obtains specific instructions and information.
2 Explain procedure to the patient. Anxiety over procedure due to cold application can be reduce.
3 Provide privacy. Avoids embarrassment during the procedure.
4 Wash hands. Prevents cross contamination.
5 Assemble all equipment and arrange on the bedside. Organized efforts facilitate ease of performance of task.
6 Assess the patient's body temperature and pulse rate. Provides baseline for evaluating response to therapy.
7 Place the patient in a comfortable position. Ensures client's comfort.
8 Expose the area and place a mackintosh and towel under the area to be treated. Prevents soiling of bed linen.
9

Plug ears with cotton plugs if compress is applied to forehead eyes.

 Prevents from entering water to the ears.
10

Soak the sponge cloth in cold water. Squeeze gently. 

Change it as soon as it becomes warm.

 Makes sure that there is not dripping of water and apply it to the area.
11 Observe skin area every five minutes for any adverse reactions like burning, numbness, bluish discoloration, mottling of skin, erythemia or extreme pallor. Tissue damage can occur from prolonged vasoconstriction.
12 Discontinue the procedure if adverse reactions are seen. Prevents from complications.
13 Continue the procedure for specified length of time, that is, until desired result is obtained /15 to 20 minutes and repeat every 2-3 hours. Check the temperature every 15 minutes.  
14 When the time is over, remove compress, and dry the area. Makes the patient comfortable.
15 Take out the cotton balls from the ears.  
16 Clean and replace the articles in its proper place as appropriate.  
17 Wash and dry the hands. Prevents from cross infection.
18 Record the procedure in the nurse's notes. Record the vital signs in TPR sheet. Acts as a communication between staff members.

 

General Instruction

  • Applying a cold compress to the skin improves heat conduction.
  • After 20 minutes, cold application causes side effects. Vasoconstriction that is prolonged can harm tissue.
  • Don't apply a cold compress to your chest.
  • Before, during, and after the procedure, evaluate the treatment area.
  • If the compresses are applied to an open wound, use sterile technique.
  • Every 15 minutes, take your temperature; this helps you identify any changes in your body's temperature.

Tepid Sponges

Tepid sponge bath is a bath with water below body temperature, usually in the range of 80-95f. It is a process of sponging with tepid water to reduce body temperature by evaporation. It is a general application of moist cold liquid to cool skin by evaporation and by the absorption of body heat in the cold water. A tepid sponge bath may be temporarily soothing, but it may not produce a marked temperature drop unless it is used for an extended period.

Purposes

  • To reduce body temperature when fever in itself may be deleterious e.g. temperature between 102 to 1030f.
  • To stimulate circulation.
  • To decrease toxicity.
  • To soothe the nerves and promote sleep.

Articles

  • Bath basin,
  • Tepid water (temp 98.60f) in a bucket.
  • Bath thermometer,
  • Wash clothes,
  • Mackintosh,
  • Bath blanket,
  • Towels,
  • Dress, linen,
  • Articles for cold compress and ice cap.

Procedure

S.N. Nursing Action Rationale
1

Identify the patient. Assess for the need of tepid sponge.

 Obtains specific instructions and information.
2 Assess the patient's body temperature and pulse rate. Provides baseline for evaluating response to therapy.
3 Explain the sequence of the procedure. Anxiety over procedure due to cold application can be reduce.
4 Close room door or curtain. Ensures privacy.
5 Wash and dry hands. Prevents the chance of cross contamination.
6 Arrange the articles to the bedside. Organized efforts facilitate ease of performance of task.
7

Place a mackintosh under the patient and remove gown.

 Prevents soiling of bed linen.
8

Keep the bath blanket over body parts not being sponged, close the windows and door and put off the fan.

 Ensures safety and comfort.
9 Check water temperature.  
10

Immerse wash clothes in water and apply wet  cloths in each axilla and over groin. Cover on extremity with a wet towel.

Wet a wash cloth and wipe down towards fingers/toes from outer aspect of each extremity and move up from the inner aspect. Follow the clockwise sequence for wiping the extremities, each in turn for 5 minutes and then the back and the abdomen.

 Makes sure that there is not dripping of water and apply it to the area.
11 Reassess temperature and pulse every 15 minutes. Ensures the outcomes of procedure.
12 When body temperature falls to slightly above normal, discontinue the procedure.  
13 Dry externalities and body parts thoroughly. Promotes client's comfort.
14 Dress the patient and cover with a sheet. Ensures the client's comfort.
15 Observe for any symptoms of chill or any other abnormality. Prevents from complications.
16 Position the patient comfortably in the bed.  
17 Replace the articles after cleaning.  
18 Wash hands. Prevents from cross infection.
19 Record the procedure in the nurse's recorded sheet and vital signs in TPR sheet. Documentation promotes communication among staff.
Things to remember

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