25 terms

Application of hot and Cold

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Body Responses to Cold
vasoconstriction
reduced cellular metabolism
anesthesia and slowed conduction
decreased muscle tone (less elastic/contractile)
increased blood viscosity
Cold: Conditions commonly treated:
trauma
superficial lacerations
minor burns
comfort following injections
arthritis/joint injury
h/a
Body responses to Heat
vasodilatation
reduced muscle tension (decreases synovial viscosity)
decreased blood viscosity
increased tissue metabolism
acceleration of inflammatory process
Relieves pain (decreases fluid-less pressure); closes gate to pain
Heat: Conditions commonly treated
inflammation or edema of body part (trauma related)
Infected wound/localized abscess
arthritis or degenerative joint disease
joint or muscle strain
low back pain
menstrual cramps
perianal inflammation or trauma
Conduction
H2O bottle, ice collar, K-pad, disposable applications, compresses
Radiation
heat lamp, sun
Convection
whirlpool, hot tub, sitz
Evaporation
sweating, sponge bath for temp
Rebound vasoconstriction
seen aprox. 20 min after heat application
paradoxical cold induced vasodilation
when cold application to distal extremities exceeds 15 min. Can exceed 15 on other body parts
Cold: at skin temp of ~ 55º- so don't let temp get below 57º
Seen in distal extremities after 15' @ temp below 1oC
consensual vasodilation
with heat
Spinal cord reflex that results in vasodilation at site and in distal cutaneous area
E.g. application of heat to lower back results in peripheral vasodilation (e.g foot of someone with diabetes/PVD)
adipose tissue
acts as an insulator and needs to be taken into consideration for time of applications for heat or cold.
Appropriate Uses of Cold
Up to 72 hours (varies) after a traumatic injury (always intermittently)-controls swelling and bleeding
Temp remains low for 1-2 hours so usually repeated every 1-2 hours
inflammation
muscle spasms
pain
rheumatoid arthritis
lower body part or body temperature
Appropriate Uses of Heat
pain relief
Inflammation/edema
Muscle soreness/joint stiffness
Infection (Promotes wound healing-moist heat best)
warm a body part (hypothermia exposure)
reduce edema or chronic inflammation (MS injury)
promote circulation to injured area after inflammation subsides (after 72 hr)
Contraindications (heat)
immediately after trauma
hemorrhage
noninflammatory edema
localized malig tumor
developing fetus
skin disorders
metallic implants
Poor circulation
Contraindications (cold)
open wounds
impaired circulation
Hypersensitivity
Raynaud's disease
Nursing Interventions pt. education
Purpose
Length of time, give timer
Sensation (normal and abnormal), report changes
Never lay directly on heat/cold source
In hospital, give call light and instruct to call.
Do not allow to adjust temperature (e.g. temperature setting locked on K-pad)
Never leave unattended if risk for injury (unable to move from source, unable to sense temperature changes)
Tepid bath procedure
Use warm water and gradually add cool to reach temperature of 98.6; immerse washcloths and wring out over chest and back; this prevents shivering. NEVER immerse in very cold or ice water.
Fan also used (heat loss through convection); turn down environmental temp to 68-72 degrees
If doing in bed place ice bags in axilla, groin, forehead, neck, wrists
Check skin and temp q 15' and when desired temperature reached stop procedure
STOP if shivering
Types of cold
Dry
Ice bags, collars
Check for leaks, fill 2/3 full, use cover
Cold packs (commercial)
Hypothermia blanket (?)-more shivering than tepid bath; used for hyperthermia
Frozen peas/corn at home
Moist
Cold compresses
Tepid bath (?? Fever)
NOT effective in treating febrile children-use other cooling measures
Does reduce fever in critically ill adults in some instances (e.g. paralyzed)
Used for hyperthermia (e.g. heat stroke)
Moist heat Advantages
Less skin drying; softens exudate
Conforms to area being treated
Penetrates deep
No insensible fluid loss
Moist heat disadvantages
Skin maceration
Cools rapidly due to evaporation
Greater burn risk
Dry heat advantages
Less burn risk
No skin maceration
Retains temp longer (no evaporation)
Dry heat disadvantages
Increased sweating
Doesn't penetrate deep tissue
Increased risk of skin drying
Very Cold
below 59 degrees
hot
105-115
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