HOT AND COLD APPLICATION

WITH COUNTERIRRITANT
 Definition of Terms:


 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


 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.

Moist Applications
Advantages Disadvantages
Moist applicat ion reduces frying of skin Prolonged exposure can cause
and soft ens wound exudat es. m acerat ion of skin
Moist com presses conform well t o body Moist heat will cool rapidly because of
area being t reat ed. m oist ure evaporat ing.
Moist heat penet rat es deeply int o t issue Moist heat creat es great er risk for burns
layers. t o skin because m oist ure conduct s heat .
Warm moist heat does not promote
sweating and insensible fluid loss.

Dry Applications
Advantages
Dry heat has less risk of burns to skin than
moist application.
Dry application does not cause skin
maceration
Dry heat retains temperature longer because
it is not influenced by evaporation.
Disadvantages
Dry heat increases body fluid loss through
sweating.
Dry applications do not penetrate deep into
tissues.
Dry heat causes increased drying of skin.
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

3.) INDICATIONS OF HEAT AND COLD :

HEAT COLD
Muscle Spasms Relaxes muscles, contractility Relaxes muscles,
contractility
Inflammation blood flow, Vasoconstriction capillary permeability,
softens exudates Blood flow, slows cellular metabolism

Pain Relieves pain possibly by promoting muscle Pain by slowing nerve

relaxation, circulation, promoting psychologic Conduction rate & blocking nerve impulses,
relaxation & a feeling of comfort; acts as a produces numbness, acts as a counter-
counter-irritant 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
NTRAINDICATIONS TO THE USE OF HEAT AND COLD

HEAT COLD


The first 24 hours after traumatic Open wounds.



injury
Impaired Circulation.


Active hemorrhage.
 


Allergy or Hypersensitivity to cold.


Noninflammatory Edema.


Localized malignant tumor.



Skin disorder that causes redness or



blisters.
 Methods of
pplication :
1. Dry cold
 -used on the body to decrease swelling and pain with extreme
temperature
q 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
q 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

2.

Moist Cold
q 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
q 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:

qCold Com p r e sse s qCold

Pa ck s

qIce Ba g s( la r g e r ) ,
Ice Glov e s, Ice
Colla r s( d isp osa b le )
3. Moist heat
q 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
q 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: qH o t M o ist
C o m p re s s

qW a rm •S itz b a th o r H ip b a th
so a k
 q 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
q Heat Lamp
 - Infrared lamps give off therapeutic doses of infrared. Heat is
transferred to the patient by radiation.
q
q 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.


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


q CONVECTION
Did you get it?
Summary:
Scientific principles involved in hot and cold
application
Ø Anatomy and Physiology
 - End organs of sensory nerves in the skin convey the
sensations that are interpreted in the brain
Ø 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.
Ø Time and Energy
 -It is best to prepare all materials needed
 -Time or duration of the application is also a factor to this
therapy
Ø 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.
Ø Pharmacology
 - through the use of different counter-irritants
Ø 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.
Ø Microbiology
 - the application of heat and cold to open wounds or to
lesions that may rupture demands a sterile technique
Ø 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.
 S p e cific co n d itio n s th a t n e ce ssita te p re ca u tio n s in th e u s e o f h o t o r co ld
a p p lica tio n s
v Neurosensory Impairment
 People 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)
v Impaired Mental Status
 People who are confused or have an altered level of consciousness need
monitoring during applications to ensure safe therapy
v 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.
v Immediately after injury or surgery
 Heat increases bleeding and swelling
v Open wounds, broken skin and stomas
 Cold can decrease blood flow to the wound, thereby inhibiting healing
v Abscessed tooth of appendix
 Infection is highly localized. Application of heat may cause rupture with
 TEMPERATURES FOR HOT AND COLD
APPLICATION
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
ACTORS THAT AFFECT 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.
  

 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 use
 c. 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 membranes
 e. do not bandage
 f. do not apply to wounds or damaged skin
ommonly Used Counterirritants :
8.) Guidelines for all Local Applications for Heat and Cold:


Determine the client’s ability to tolerate the therapy

Identify conditions that might contraindicate treatment (e.g.
bleeding, circulatory impairment)
Explain the application to the client
Assess the skin area to which the heat or cold will be applied
Ask the client to report any discomfort
Return 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 occur
Remove the equipment at the designated time, and dispose
of it appropriately
Examine 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)


v Measure the temperature of the water using a bath

thermometer
v Fill the bag about two/thirds full
v Expel the remaining air and secure the top. With the air
removed, the bag can be molded to the body part
v Dry the bag and hold it upside down to test for leakage
v Wrap the bag in a towel or cover and place it on the body site
v Remove after 30 minutes or in accordance with agency
protocol

 ---THE END---
Members:
Maluenda, Camille
Ocanada, Gretchil
Mantalaba, Mae-Ann
Lawas,Argie
Nacario, Gale
