HOT AND COLD APPLICATION WITH COUNTERIRRITANT

Cold Application- Cold relates to the material that has a low temperature, that is little or no warmth. Cold applications can reduce the acute pain from inflamed joints. Ice massage and application of cold packs are two types of cold therapy that are particularly effective for pain relief.

Heat Application- Heat is the average kinetic energy, or the energy of the motion of molecules of a material. This can help relieve the pain from a tension headache Heating pads or hot water bottles may be used but clients should be taught not to lay on the heating element because burning could occur.

Heat and Cold Application relieve pain and promote healing. The selection of heat versus cold interventions varies with clients’ conditions.

Aquathermia Pads- Also called the water-flow pad, used for treating misble sprains and areas of mild inflammation or edema. It consists of a waterproof plastic or rubber pad connected by two hoses to an electrical control until that has a heating element and motor. The recommended temperature is 40.5 degrees to 43 degrees Celsius or 105 degrees to 110 degrees Fahrenheit.

Heat Lamp- Infrared lamps give off therapeutic doses of infrared. Heat is transferred to the patient by radiation.

Definition of Terms:

Electric Heating Pads- The electric heating pad is a very popular means for applying dry heat locally. It is easy to apply, provides constant and even heat, and is relatively safe to use.

Ice Collar- for a client who has a muscle sprain, localized hemorrhage, or hematoma, removal of the tonsils commonly known as tonsillitis) or who has undergone dental surgery

Ice Bag- The disadvantage of an ice bag is that they may leak and their weight often makes them uncomfortable for the patient. These bags are sealed containers that are filled with a nontoxic substance. The bags are frozen in the freezing compartment of a refrigerator. Not only are they relatively easy to use and inexpensive, but also the frozen solutions of these bags remains pliable and can be molded easily to fit a body part. Their cover consists of a ribbed, cotton sleeve so that the bag can be slipped onto an extremity. Or, the bag can simply be placed on a body part, such as the head.

Compress- Several layers of moist, absorbent cloth or gauze folded to cover a small body area. Hot Compress- consists of several layers of moist gauze folded to cover a small

body area. Materials and the solution must then be sterile, and the person applying them wears sterile gloves.

Cold Compress- moist, cold and local applications. They might be used for an injured eye, headache, tooth extraction, and in some situations for hemorrhoids. A washcloth makes an excellent compress for the head or the face. The material used for application is immersed in a clean basin that contains pieces of ice and a small amount of water. The compress should be wrung thoroughly before it is applied. The compresses should be changed frequently. The application should be continued for 15 to20 minutes and repeated every 2 to 3 hours.

Convection- is the transfer of heat away by air movement. Example: a fan promotes heat loss through convection.

Conduction- is the transfer of heat from one object to another with direct contact.

Counter Irritant- is a remedy applied to the body externally which relieves a discomfort somewhere else by producing a local irritation. They effect relied by reflex action due to the sensation they impart to the nerves of the skin below. The term is more specifically applied to such irritating substances as when applied to the skin, redden or blister or produce pustules, purulent tissues.

Hyperthermia- An elevated body temperature related to the body’s inability to promote heat loss or reduce heat production.

Hypothermia- Occurs when body temperature is below the average normal range. 94° F or lower Death may occur when the temperature falls approximately 34 degrees Celsius. It is important to observe patient closely when body temperature falls below normal.

Rebound Effect- Pronounced opposite results to those intended effect. Example: a nasal spray and drop have a rapid, but generally short action. When used as recommended for 3 to 4 days, their effect is generally satisfactory. However, if used for a long time a rebound effect often occur. The rebound effect can lead to a vicious cycle because it leads to more frequent use of the substance that caused it. Therefore, a person using nasal decongestant sprays or drops should follow the directions carefully.

Radiation- is the transfer of heat from the surface of one object to the surface of another without direct contact between the two.

Vasoconstriction- A decrease in the caliber of blood vessels. Therapeutic effects of heat and cold application in vasoconstriction is the reduction of blood flow to injured body parts, preventing edema formation; reduces inflammation.

Vasodilatation- An increase in the caliber of blood vessels. Therapeutic effects of heat and cold application in vasodilatation is improvement of blood flow to injured body part; promotes delivery of nutrients and removal of wastes; lessens venous congestion in injured tissues.

Advantages Disadvantages

Moist application reduces frying of skin and softens wound exudates.

Prolonged exposure can cause maceration of skin

Moist compresses conform well to body area being treated.

Moist heat will cool rapidly because of moisture evaporating.

Moist heat penetrates deeply into tissue layers.

Moist heat creates greater risk for burns to skin because moisture conducts heat.

Warm moist heat does not promote sweating and insensible fluid loss.

Advantages Disadvantages

Dry heat has less risk of burns to skin than moist application.

Dry heat increases body fluid loss through sweating.

Dry application does not cause skin maceration

Dry applications do not penetrate deep into tissues.

Dry heat retains temperature longer because it is not influenced by evaporation.

Dry heat causes increased drying of skin.

Moist Applications

Dry Applications

Importance:

Cold Application -controls bleeding by constricting blood vessels -to produce an anesthetic effect; relieve pain -to reduce body temperature - to limit the accumulation of fluid in body tissues; reduce edema

Hot Application -promote circulation to an injury thereby promoting healing -relief of pain or aching particularly in muscles and joints by

promoting muscle relaxation -helps overcome feeling of chillness -raises the body temperature

HEAT COLD

Muscle Spasms Relaxes muscles,

contractility

Relaxes muscles,

contractility

Inflammation blood flow,

softens exudates

Vasoconstriction capillary

permeability, Blood flow, slows

cellular metabolism

Pain Relieves pain possibly by promoting

muscle relaxation, circulation,

promoting psychologic relaxation & a

feeling of comfort; acts as a counter-

irritant

Pain by slowing nerve

Conduction rate & blocking nerve

impulses, produces numbness,

acts as a counter-irritant, pain

threshold

Contracture Contracture & joint range of

motion by allowing greater distention of

muscles and connective tissue

Joint Stiffness Joint stiffness by viscosity of synovial

fluid and tissue distensability

Traumatic

Injury

Bleeding by constricting blood

vessels,

Edema by reducing capillary

permeability

3.) INDICATIONS OF HEAT AND COLD:

HEAT COLD The first 24 hours after

traumatic injury

Active hemorrhage.

Noninflammatory Edema.

Localized malignant tumor.

Skin disorder that causes redness or blisters.

Open wounds.

Impaired Circulation.

Allergy or Hypersensitivity to cold.

CONTRAINDICATIONS TO THE USE OF HEAT AND COLD

1. Dry cold-used on the body to decrease swelling and pain with extreme temperature

Ice Bags(larger), Ice Gloves, Ice Collars(disposable) -Provides cold to localized area (e.g. muscle sprain, hematoma) to

prevent edema formation, control bleeding, and anesthetize body part -(ice collar) is often applied to the throat following a tonsillectomy -Made up of rubber or plastic

Cold Packs -Used for tonsillectomies, perineal wounds, sprains, nose bleeds, fractures of bones, dental extractions, and reduction of postoperative swelling of some parts of the body

-The temperature of these packs ranges from 50-80F because of the controlled temperature, there is no possibility of a freeze burn to the patient

-The action lasts from 30 minutes to 4 hours depending on the size of t he pack and the specific product used

-Commercially prepared cold packs provide cold for a designated time. Directions on the package tell how to initiate the cooling process, for example, by striking, squeezing, or kneading the pack. -When the pack is squeezed or kneaded, an alcohol-based solution is released, creating the cold temperature.

-Reserved for the larger body surfaces

Methods of Application:

2. Moist Cold Cold Compresses

-generally consists of gauze or cloth material (washcloths, towels, and gauze pad) placed in basin containing ice chips and a small amount of cold water

-Remains effective for 15-20 minutes depending on the environmental temperature and patient’s temperature

-Applied to either decrease or prevent bleeding and to reduce inflammation

-Procedure similar to that or warm compresses applied for 20 minutes at a temperature of 15C (59F)

-Technique may be clean or sterile Cooling sponge bath

-Reduce a client’s fever by promoting heat loss through conduction and vaporization

-Used with extreme caution, and only for clients with very high temperatures such as over 40C(104F), because rapid skin temperature drop can cause chills that actually increase heat production

-Accompanied by antipyretic medication -The temperature for cooling sponge bath range from 18C-32C

(65F-93F) 

Pictures:

Ice Bags(larger), Ice Gloves, Ice Collars(disposable)

Cold PacksCold Compresses

3. Moist heat Hot Moist Compress

-Warm compresses (gauze dressing moistened in a prescribed warmed solution)

-Applied to improve circulation, relieve edema, and hasten the suppurative process and healing

-For an open wound, use sterile technique.-Remove compress after 20-30 minutes and redress wound-Solutions are heated to the temperature indicated by the order or

according to agency protocol Warm soak

-Direct immersion of body part in warmed solution -Used to aid in cleansing burns, to apply medication to an infected

area, to aid suppuration and to increase circulation to a particular area-The duration of soaks to the body, arm, foot or leg is normally 15-

20 minutes administered several times a day-The temperature should be approximately 105F (40.6C)-

110F(43.3C)-If body is immersed, be sure the head and extremities are supported in a comfortable position

-Check the temperature of the solution with a thermometer every 5-15 minutes so that a steady temperature can be maintained throughout the soak

Pictures: Hot Moist Compress

Warm soak •Sitz bath or Hip bath

Sitz bath or Hip bath-also called a hip bath; a type of bath in which only the

hips and buttocks are soaked in water or saline solution. Its name comes from the German verb “sitzen” meaning ‘to sit”.

-Used to soak a client’s pelvic area-A special tubs or chairs preferred because when the legs

are also immersed, as in a regular bathtub, blood circulation to the perineum or pelvic area is decreased

-Usually immersed from the midthighs to the iliac crests or umbilicus

-The temperature of the water should be from 40C to 43C (105F to 110F)

-The duration of the bath is generally 15 to 20 minutes, depending on the client’s health

4.)Dry Heat Heat Lamp

- Infrared lamps give off therapeutic doses of infrared. Heat is transferred to the patient by radiation.

Electric Heating Pads- The electric heating pad is a very popular means for

applying dry heat locally. It is easy to apply, provides constant and even heat, and is relatively safe to use.

Hot Water bag-( may be sterile or unsterile) in detailed with beginning skills

below

5. Three processes of Heat Transfer-process by which energy in the form of heat is exchanged between bodies or parts of the same body at different temperatures.

CONDUCTION (physical contact)-is the transfer of heat within a substance, molecule by molecule.

CONVECTION -is heat transfer by the mass movement of a fluid in the vertical (up/down) direction. This type of heat transfer takes place in liquids and gases.

RADIATION-allows heat to be transferred through wave energy, called Electromagnetic Waves.For example, energy travelling from the sun to your skin, you can feel your skin getting warmer as energy is absorbed.

Did you get it?Summary:

Anatomy and Physiology- End organs of sensory nerves in the skin convey the sensations that are interpreted in the brain

Chemistry-Heat generally increases the speed of chemical reaction.-The use of soap and water to mechanically remove bacteria-Some metabolism is largely due to chemical reactions; where in the application of heat speeds up the metabolism.

Time and Energy-It is best to prepare all materials needed-Time or duration of the application is also a factor to this

therapy Psychology

-The procedure should be explained well to the patient to gain cooperation and reduce anxiety-Application of heat and cold on the skin gives a relaxing effect to the patient-Providing comfort and privacy to avoid embarrassment.

Scientific principles involved in hot and cold application

Pharmacology- through the use of different counter-irritants

Sociology- Nurses should know how to approach his/her patient.-Person’s differ on their degree of toleration-Being always ready to answer the patient’s questions.-Asking patient’s reaction towards the temperature of the application.

Microbiology- the application of heat and cold to open wounds or to lesions that may rupture demands a sterile technique

Physics- Conduction, convection and radiation may transfer heat from one place to another- The intensity to light can be suitable adjusted by

varying the distance between the equipment and by regulating the length of exposure.

Rebound Phenomena and its effects-occurs at the time the maximum therapeutic effect of the hot and cold application is achieved and the opposite effect begins.

Heat produces maximum vasodilation in 20-30 mins;continuation of the

application beyond 30-45 mins brings tissue congestion and the blood vessels

begin to constrict for reasons unknown. If the application is continued, the client is at risk for burns because the constricted vessels are unable to dissipate the heat

adequately via the blood circulation.

With cold application, maximum vasoconstriction accurs when the involved skin reaches a temperature of 15◦C (60◦F).

Below 15◦C, Vasodilation begins. This mechanism is protective. It helps prevent the freezing of the body tissues normally

exposed to the cold, such as the nose and ears. It also explains the ruddiness of the skin of a person who has been walking in

the cold weather.

Vasoconstriction; would lead to impaired circulation (reduced bloodflow) decreases the local release of pain-producing subsances (e.g. histamine, serotonin, bradykinin) in turn reduces edema and inflammationalters tissue sensitivity (numbness)promotes comfort by slowing the transmission of pain stimuliBluish-purple mottled appearnce, as a sign of tissue damageincreased blood coagulationMost often used in sport injuries to limit postinjury swelling and bleedingSystemic• (vasoconstriction) Increased blood

pressure• Shivering as the normal response as

the body's attempt to warm itself (heat producing)

• Goose bumps or piloerection (heat conserving)

Cold

Local• Vasodilation and increases blood

flow to the affecetd area bringing oxygen, nutrients, antibodies and leukocyes; reduces blood viscosity

• promotes soft tissue healing and increases suppuration

• increases capillary permeability (may cause an edema or may also improve the delivery of leukocytes and nutrient, removal of wastes and prolonging clotting time

• Often used for clients with musculoskeletal problems (e.g. joint stiffness from arthritis, contractures and low back pain

Systemic• (vasodilation) increased cardiac

output, sweating, increased pulse rate and decreased blood pressure (occurs when heat is applied to a large area increasing the blood flow to that area while decreasing it to another part of the body; in effect causing hypovolemic shock)

• a significant drop in blood pressure may also cause fainting

Hot

Neurosensory ImpairmentPeople with sensory impairments are unable to perceive that heat is damaging the

tissues and are at risk for burns or they are unable to perceive discomfort from cold and which causes tissue injury. It is also present in very young clients (thinner skin layers in children increase risk of burns) or in older clients (have reduced sensitivity to pain) Impaired Mental Status

People who are confused or have an altered level of consciousness need monitoring during applications to ensure safe therapy Impaired Circulation

People with peripheral vascular disease (e.g. arteriosclerosis, diabetes or congestive heart failure) lack the normal ability to dissipate heat via the blood circulation, which puts them at risk for tissue damage with heat and cold applications. Body’s extremities are and pain stimuli because of circulatory impairment and local tissue injury. Cold Application is contraindicated for these people. Immediately after injury or surgery

Heat increases bleeding and swelling Open wounds, broken skin and stomas

Cold can decrease blood flow to the wound, thereby inhibiting healing Abscessed tooth of appendix

Infection is highly localized. Application of heat may cause rupture with spread of microorganisms systematically

Specific conditions that necessitate precautions in the use of hot or cold applications

DECRIPTION TEMPERATURE APPLICATION

Very Cold Below 15C(59 F) Ice bags

Cold 15-18C(59-65F) Cold packs

Cool 18-27C(65-80F) Cold compress

Tepid 27-37C(80-98F) Alcohol sponge bath

Warm 37-40C(98-105F) Warm bath, aquathermia pad

Hot 40-46C(105-115F) Hot soak, irrigations, hot compress, hot sitz bath

Very hot Above 46C(above115F) Hot water bags for adults

TEMPERATURES FOR HOT AND COLD APPLICATION

o  Individual Tolerance -Tolerance to temperature variations is affected by age and physical condition. The young and the aged are especially susceptible to heat and cold. Neurosensory impairments may Interfere with the reception and perception of stimuli, increasing the risk of injury.

o Body Part-Certain areas of the skin have sensitivity to temperature variations. The inner aspect of the wrist and forearm, the neck, and the perineal are temperature- sensitive, while the back of the hand and the foot are not as sensitive.

o Area of Body exposed- The larger the area exposed to heat and cold, the lower the tolerance to temperature changes.

o Age & General Condition/ Status of the Patient-Thinner skin layers in children and elderly people increases the risk for burns from The heat and cold applications. Older adults have a decreased sensitivity to pain. Elderly patients and people with impaired circulation tolerate cold less well than younger people with good

o Condition of Specific Body Area/Intactness of Skin-Injured skin areas are more sensitive than intact areas to temperature variations.

o Duration of Treatment/Length of Exposure-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.

o Use of Moist or Dry Application-Moist application penetrates better than dry ones; therefore moist applications do not require as low/as high a temperature as dry applications.

FACTORS THAT AFFECT HOT AND COLD APPLICATION:

 

Counter-irritant-relieve pain at a deeper level and promote comfort- an agent used to produce an irritation in one part of the body intended to relieve irritation in some other part; n an irritant that blocks perception of pain by diverting attention to the sensation that it produces.

 ☺ Indications:

For the temporary relief of aches and pains of muscles and joints associated with backache, lumbago, strains, bruises, sprains and arthritic or rheumatic pain, pain of tendons and ligaments. For tired, aching muscles.

  Counterindications:

a. "External use only"b. if rash or irritation occurs discontinue usec. the application of external heat, such as an electric heating pad, may result in excessive skin irritation or skin burn.d. avoid contact with the eyes and mucous membranese. do not bandagef. do not apply to wounds or damaged sking. For all methylsalicylate containing products: do not use this product if you are allergic to salicylates or if you are taking anticoagulant medications.h. For all pump spray formulations (non-aerosol): Do not inhale.

POULTICE- acts as a counter-irritant, producing a redness and congestion of the skin. In medicine, a poultice is a soft moist application applied externally to some part of the body either

hot or cold, but generally hot. The simple poultice is made with linseed meal and boiling water, spread out with a

uniform thickness on a cloth or rag, and is used where it is desired to hasten the progress of inflammation. Its moisture

causes relaxation of the skin, and thereby lessens the discomfort or pain.

Capsaicin- a component of capsicum. When used topically, capsaicin can prevent the transmission of pain. It is also a

potent topical irritant and can trigger dermatitis.

Turpentine -A thin volatile essential oil; used as a medicinally as a liniment; is utilized in experimental models of inflammation to induce a systemic inflammatory immune

response.

Croton- Applied externally, it produces inflammation of the skin attended with pustular eruption, and has been used as a counter-irritant in rheumatism gout, neuralgia, bronchitis,

etc.

Commonly Used Counterirritants:

8.) Guidelines for all Local Applications for Heat and Cold:

Determine the client’s ability to tolerate the therapyIdentify conditions that might contraindicate treatment (e.g. bleeding, circulatory impairment)Explain the application to the clientAssess the skin area to which the heat or cold will be appliedAsk the client to report any discomfortReturn the client 15 minutes after starting the heat or cold and observe the local skin area for any untoward signs (e.g. redness) Stop the application if any problems occurRemove the equipment at the designated time, and dispose of it appropriatelyExamine the area to which the heat or cold was applied, and record the client’s response

Beginning Skills in Applying Hot Water Bag:A hot water bag or bottle has been a common source of

dry heat used in the home. It is convenient and relatively inexpensive Adult / child (over 2 years) 46 ◦C- 52 ◦C (115◦F-125◦F)Debilitated / unconscious adult / child under 2 years 40.5◦C-46◦C (105◦F-115◦F)

Measure the temperature of the water using a bath thermometer

Fill the bag about two/thirds full Expel the remaining air and secure the top. With the air

removed, the bag can be molded to the body part Dry the bag and hold it upside down to test for leakage Wrap the bag in a towel or cover and place it on the body site Remove after 30 minutes or in accordance with agency

protocol

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