Hot and Cold Application

Introduction

Heat and cold are applied to a specific part or all of a patient's body to bring about a local or systemic change in body temperature for various therapeutic purposes. These are the two most common types of non-invasive and non-addictive pain-relief therapies for muscle and joint pain. Physiological responses to heat and cold are modified by the method and duration of application, the degree of heat and cold applied the patient's age and physical condition, and the amount of body surface covered by the application.

Hot Application

Heat application means the application of an agent warmer than the skin either in a moist or dry from the surface of the body with the purpose of increasing heat. Heat causes vasodilatation which increases blood flow to the affected area and supplies oxygen and nutrients to reduce pain in joints and relax sore muscles, ligaments, and tendons. The heat should be warm, not too hot, and should be maintained at a consistent temperature, if possible.

Effect of Hot Application

Heat applications for the purpose of treatment are done to a part or whole of the body and cause local or systemic effects.

Local effects of Hot Application

Systematic Effect of Hot Application:

The systematic effect of extensive, prolonged heat includes increased cardiac output, sweating, increased pulse rate, and decreased blood pressure. This response occurs when heat is applied to a large body area, increasing the blood flow to that area while decreasing it to another part of the body, in effect, causing hypovolemic shock.

Purposes of Hot Application

• to warm and comfort the body by increasing its temperature (as in the frost bite).
• to widen blood arteries in an effort to improve circulation.
• to lessen swelling or inflammation and to clear up blood congestion.
• to encourage muscular relaxation
• to reduce stiffness and soreness in the joints.
• to encourage the suppuration and healing of wounds.
• to reduce the wounds' abrasion and soften the exudates.
• to administer medication.
• to relieve bladder distension and to promote peristalsis.
• To facilitate drainage (draws infected material out of wounds).

Scientific Principles of Hot Application

• Heat causes blood vessels to enlarge, increasing the blood flow in the area.
• Heat quickens the metabolic rate of tissue cells because it raises their internal temperatures.
• Heat is transferred from a hotter area to a cooler one. The heat treatments will be absorbed by the skin, warming the surroundings.
• Heat speeds up the creation of new cells and tissues.
• Heat causes blood viscosity to decrease, causing blood to become thinner. This reduces the likelihood of blood clotting.
• Depending on the environment and place where they are working, people have different levels of heat tolerance.
• The temperature is chosen based on the patient's condition, the duration, the application method, and the intended use.
• Heat sensitivity is particularly acute in the interior of the arm, the neck, and several body regions.
• Air does not effectively conduct heat. The inclusion of air in the hot water bags and ice caps can reduce the treatment's efficacy.
• Starting with a modest temperature, gradually increasing it to the required level, and maintaining it there the entire application time.
• The maximal vasodilation and vasoconstriction occur in 30 minutes. After this point, tissue congestion and reflex vasoconstriction occur.
• If the application must be continued for a longer period of time, it is halted after 20 minutes for most heat or 30 minutes for dry heat.
• Heat and cold are transferred from one substance to another using conduction, convection, and radiation. Electricity flows easily through water.
• Heat application should not be utilized when there is edema linked to venous or lymphatic disease, impaired vital functions, impaired metabolism, impaired perception, or impaired vital functions.
• Monitor your vital signs both during and immediately after the application.
• Never apply heat to a kid or a sick person above 120°F/48.8°C or 160°F/71.1°C, respectively.
• Maintain patient warmth after providing overall warmth.
• Heat sources that dry the skin are possible. Moisture-based heat may penetrate deeper.
• Surgical fomentation requires a sterile procedure.
• Nursing professionals need to be aware of the ideal temperatures in order to apply heat and cold.

Contraindications of Hot Application

• acute inflammation, such as an acute appendicitis or a dental abscess.
• exceedingly young or old, unconscious, or paralyzed patients.
• people with DM, peripheral neuropathy, or other neurological or sensory impairments to a high degree
• Within the first 24 hours following a traumatic injury, warmth encourages bleeding and edema in exposed wounds.
• Malignancy.
• Blisters/Burns.
• When there is active bleeding, temperature causes vasodilation, which accelerates bleeding.
• Patients have impaired kidney, cardiac, and lung function as well as lower than average temperature regulation and progressive arthritis.

Dry Heat

Dry heat is the heat applied to the body without using moisture.

Application of Hot Water Bag/Bottle

It is local application of dry heat to a specific body part for a short duration using a rubber bag. It is a commonly used method and relatively easy and inexpensive. Cover with a thick cloth and always keep a layer of blanket or sheet between hot water bottle and the patient.

Articles

• Hot water bag with cover,
• Boiling water,
• Towel,
• Mug to pour water into the bag,
• Bath thermometer,
• Duster,
• Kidney tray.

Procedure

General Instructions

• Turn the bottle upside down to check for leaks after adding warm water and screwing on the cap.
• Fill the sack only halfway. Tighten the cap after removing any air from the top. The sack can then be formed over a body part with less effort.
• Never place a water bottle or bag against the skin without first wrapping it in a towel.
• Hot water bags should be used on children, persons who have cardiac conditions, and paralyzed adults at a temperature of 115°F to 120°F. Other patients need water that is 120 to 150 degrees Fahrenheit in temperature.
• The bag needs to be moved around frequently.
• Never place a patient in a position where he can't escape the heat source. The likelihood of temperature-related injuries is decreased by doing this.
• No matter how insignificant they may seem, you should never ignore a patient's problems.

Contraindications

• Open wounds,
• Hypertension,
• Metabolic disorder,
• Impaired kidney, heart and lung functions,
• Acute inflammation,
• Very young and old patient,
• Patient with sensory neural defects,
• Patient with high fever.

Electric Heating Pad

An electric heating pad is also an easy method of applying dry heat. It is light and available in various sizes. It consists of a rubber pad containing wires with in it which is heated through electricity. There is a heat containing mechanism with three settings (low, medium and high). A medium setting usually provides heat between 46°C to 52°C (115F to 125F). This temperature is usually adequate for therapeutic use. It is used to give prolonged even heat.

Procedure

Precautions

• Never provide it to a patient who is unconscious or while they are sleeping.
• When utilizing the pad, there must be no moisture because it can result in an electrical shock.
• Request that the patient wear cotton clothing.
• The circuit needs to be regularly inspected. Inspect the pad for leaks.
• In order to insulate the pad, it should be covered with flannel or fabric to absorb sweat.
• To prevent burns, avoid using the high setting and don't let the patient lie directly on the pad.
• If a pin meets a wire within the pad, an electric shock could result. Therefore, avoid using pins to hold the pad in place.
• Folding the pad could squeeze the wires within and limit its functionality.

Infra-Red Lamp

The lamp that is used to emit infra-red rays is called infra-red lamp. Infra-red rays are invisible heat rays that are transferred from a hot object to the patient by radiation. Infrared rays (IR) relax muscles, stimulate circulation and relieve pain. They have the same effect on the body as other forms of dry heat. The radiation heats produced by the infra-red and ultra-violet lamps are more intense than the heat given off from the heating lamps.

Purposes

• to give a space a constant, readily controlled level of surface heat.
• to aid in the decubitus ulcer's recovery.
• to treat a stretched muscle's spasms and soreness.
• dry the casts.
• to ease stiffness in the joints.
• to make connective tissues softer

Principles

• Infrared rays are low wave length rays which produce heat in superficial layers e.g. in skin, subcutaneous tissue but not in the muscular layer.
• The lamp should be placed at appropriate distance away from the treatment area, at least 45 cm and low voltage bulbs. (40-60 watts) are used.
• During treatment, the client's skin should be assessed periodically to ensure that no burns Occur.

Procedure

• Describe the procedure to the patient and gather all necessary materials.
• If necessary, screen the patient, expose the area to be treated, and use drapes as needed.
• Place the lamp 45 to 60 cm away when applying skin to the affected area.
• Turn on the lamp. Keep track of when the treatment began.
• Heat the area for 20 to 40 minutes, or as long as the patient requests. You can use it once or twice every day.
• Tell the patient to stay away from it and to not touch it.
• Regularly check the area for burn symptoms, such as skin color changes.
• To present an abrupt change in circulation, insulate the area from the cold by covering it until the blood circulation returns to normal.
• Disconnect the plug from the electrical socket after the treatment is over, then move it away from the bed.
• Note the procedure, the date, the time, the patient's state, and their response. If any abnormalities are discovered, notify the doctor or the ward manager.

Precautions

• Do not use if the cord is frayed or cracks are noted.
• Apply heat only for 20 to 30 minutes. Observe the skin carefully during and after the treatment. The patient, nurse or therapist must wear protective goggles.

Ultra Violet Lamp

Ultra violet lamps transmit ultra violet rays beyond the visible spectrum at the violet end. Ultraviolet rays (UV) are not as penetrating as infrared rays. They are used to treat skin infections and wounds. The effects of the exposure to the ultraviolet lamps are pigmentation of the skin, production of the vitamin D and bactericidal effects. 

Heat Lamp

Flexible necked lamps are used to supply heat to the body part. The distance between the exposed part and the lamps depends upon the voltage of the light bulb, the pigmentation of the skin and the heat tolerance by the patient. Heat lamps are contra indicated in pressure ulcer care.

The recommended distances are as follows:

• 25 watt bulb - 35 cm from the body part.
• 40 watt bulb - 45 cm from the body part.
• 60 watt bulb - 60 to 75 cm from the body part.

Procedure

• Describe the procedure to the patient and gather all necessary materials.
• Put the patient in a relaxed position.
• Maintain seclusion by shielding the area, leaving it exposed, and using drapes as needed.
• Focusing the lamp at a distance of 18 inches from the area and measuring it precisely.
• Keep track of when the treatment began. Heat the area for 20 to 30 minutes.
• Check the area periodically for any burn symptoms, such as a change in skin color.
• Disconnect the plug from the electrical socket after the therapy is over, let it cool, and then remove it from the patient's side.
• Note the procedure, the date, the time, the patient's state, and their response. If any irregularities are discovered, notify the doctor or the ward manager.

Heating Cradle

An electric cradle is a bed cradle; a light source and a thermometer are fitted inside it. A 25 watt or fewer light bulbs on an extension cord are attached to a bed cradle frame to make it a heat cradle. A sheet is used over the cradle to prevent draughts; blankets can be added over the cradle to maintain the heat at the desired level. It is used in cases of burns and extensive wounds to provide heat for stimulating and drying.

Procedure

• Wash your hands, set up the tools, and go over the procedure with the patient.
• Keep the patient in a relaxed position for ideal treatment area exposure.
• To keep the patient as warm as possible while the application is being made, place the cradle with an electric light bulb over the area that has to be heated.
• Make sure that nothing, including covers or garments, touches the bulb.
• hand washing While necessary, such as when in close proximity to potential bodily secretions, put on gloves once more.
• Set up a call light nearby.
• Every 5 minutes, check the client's reaction to the heat.
• After 20 minutes, take the lamp out.
• Replace the covers and reposition the client. Refresh the cradle.
• Wash your hands after removing the gadget from the bedside.
• making notes and reporting.

Diathermy

Diathermy is a heat producing high frequency current furnished by a diathermy apparatus. It is used for penetrating deep tissues like pelvic organs and bones. 

Procedure

• Wash your hands after explaining the procedure, and keep the patient in a comfortable position.
• Safety pins, hooks, hairpins, and other metal objects are all taken out of the patient's body.
• Expose the area as needed and use drapes. Request that the patient wear cotton clothing.
• Apply diathermy while maintaining the pads' position.
• Replace all items in the correct order after the treatment is finished.
• making notes and reporting.

Ultra Sonic Therapy

Ultrasound (US) is a method of applying deep, penetrating heat to muscles and tissues. A lubricating gel is applied to the clients skin, and the paddle or wand is kept moving at all times, to prevent burns. Ultra sound is used for diagnostic as well as therapeutic purposes. The vibratory effect of the sound waves is used in the treatment of various disorders of deep tissues and even to crush the stones in the kidney or elsewhere.

Procedure

• As needed, help the patient find a comfortable position in bed, on a table, or in a chair.
• Apply liquid paraffin or gelly to the part after exposing the area and draping it as necessary.
• Keep an eye on how the exposed region is doing.
• Replace all items after the therapy is finished.
• Taking notes and reporting

Moist Heat

Moist heat conducts heat through water. It conducts heat better and penetrates deeper than the dry heat where dry heat conducts heat through air, so patients are generally able to tolerate a higher temperature of dry heat than moist heat. Moist heat is applied as a compress, stupes or a sitz bath, hot soaks. The method selected depends on the part of the body needing the treatment and on the patient's condition. 

Fomentation

Fomentation is a prolonged application of warm moist flannel or similar material used on a large area of the body. It is defined as a process of applying moist heat to localized part of body.

Classification

• Simple fomentation: Boiling or dipping in boiling water is used for fomentation, it is called simple fomentation.
• Medicated fomentation: Drug is added to boil water for fomentation and it is applied to unbroken skin used to relieve tympanites by increasing the peristalsis and relaxing the muscle spasm.
• Surgical fomentation: It is the application of moist heat, using sterile gauze or other material to an open wound or abscess.

Purposes

• to reduce discomfort and congestion.
• so as to reduce inflammation
• to prevent urine retention
• to treat renal and intestinal colic.
• Peristalsis needs to be stimulated by nerve endings.
• to offer warmth and comfort.
• help increase blood flow to the area, accelerate healing, and lessen tissue swelling.
• to lessen stiffness in the joints.
• sterilized compresses should be used on wounds.

Procedure 

• To the sufferer: Explain the process. Provide privacy if required.
• Put the patient in a comfortable position as needed.
• Put a mackintosh and a towel under the sufferer to protect the bed.
• Check the area for any skin lesions by opening it up.
• Place the patient near the edge of the bed, close to the work area.
• Apply Vaseline or olive oil to prevent the treated area from burning.
• Add the fomentation pack and start the wringer. After inserting the wringer rods, place the basin.
• Check the temperature of the water.
• Put the fomentation cloth in the water and let it soak all the way through.
• Turn the wringer rods while holding them in your hands in the opposite direction to wring out extra water from the pad.
• Shake off the steam and check the temperature.
• Fomentation should be applied to the area that needs to be treated.
• If a bandage is required, apply it to the area.
• When it gets cold, wring out the other two pieces and replace them with the cold ones. Treating should continue for a further 15 to 20 minutes, or as instructed.
• Take some sterile gauze and dunk it in the surgical fomentation solution.
• Apply pressure to the gauze piece to extract the surplus solution.
• Apply to the wound after figuring out the patient's heat tolerance.
• if required, bandage the wound.
• Watch for any skin pallor, extreme redness, pain, or discomfort. Stop the procedure if the patient has any pain or discomfort, skin pallor, or redness.
• After done, carefully dry the area all the way through.
• Put the equipment back in place after cleaning.
• Record the procedure's duration, effects, and patient's condition.

Hot Socks

Immersing the client's affected body part in warm water or a solution for a prescribed time is called a soak. Soaks may be done in a basin if the area is small or in a tub if the area is large. Often a soak may be combined with a whirlpool bath. This is commonly done in the physical therapy department. The temperature of the water should be no higher than 105 degrees Fahrenheit.

Some Reasons for Giving a Warm Soak

• Improves circulation.
• Increases blood supply to an infected area.
• Assists in breaking down infected tissue.
• Applies medications.
• Cleans draining wounds.
• Loosens scabs and crusts from encrusted wounds.

Some Things to Remember to do When Giving a Soak

• Test the water frequently, and add hot water slowly to prevent burning the client.
• Stir the water to distribute the heat evenly.
• The usual duration of a soak is 15 to 20 minutes.

Procedure

• With the bath towel, wrap the tub.
• Wrap the bath towel around the patient.
• Use a bath thermometer at all times and prepare the water in the tub (100-105 f).
• If the client has an open wound or rash, wear gloves.
• Lower the client's injured body portion into the water gradually.
• To allow the elbow or knee to rest on the tub's edge, adjust the padding there.
• If necessary, use a folded cushion to support the affected body portion.
• Regularly check the water's temperature. If necessary, carefully add boiling water while stirring.
• The client's arm or leg should be taken out of the bath in 15 to 20 minutes, or as directed.
• Dry off the customer's skin.
• Dress the wound using a sterile dressing (if one is present). Dispose of the tools and gloves properly.

Wax Bath

Medicated wax baths are used for stiff and painful joints especially for patients with Rheumatoid arthritis.

Special Consideration When Applying Heat Application

• Don't apply it directly to the skin. Instead, wrap the hot device in a thin towel.
• Don't apply heat for longer than 20 minutes, unless your doctor or physical therapist ball recommends longer.
• Don't use heat if there's swelling. Use cold first, and then heat.
• Don't use heat if you have poor circulation or diabetes.
• Don't use heat on an open wound or stitches.
• Don't lie down on a heating pad; you could fall asleep and burn your skin.