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    THERAPEUTIC USE OF HEAT AND COLD

   

    INTRODUCTION

    Heat and cold are simple and very effective therapeutic tools. They can be

    used locally or over the whole body, and the proper application of heat and

    cold can provide pain relief, decrease swelling, help injuries heal faster

    than they normally would do, and help raise or lower body temperature.

    Improper application of heat and cold – like any improper application of a

    therapeutic technique – can be harmful and cause tissue damage and other

    injuries.

    Some of the uses of heat and cold are safe and simple, but there are other

    ways to use heat and cold as therapies that are complex. These are best used

    by a health care professional as they require special equipment and training

    in order to use them correctly and safely.

   

    OBJECTIVES

   

    When the student has finished this module, he/she will be able to:

    1. Identify two ways the body controls heat loss and heat conservation.

    2. Identify one of the body's basic responses to injury.

    3. Identify how this response is both helpful and harmful.

    4. Identify two basic ways heat and cold therapy can be therapeutic.

    5. Identify two other ways heat and cold therapy can be therapeutic.

    6. Identify the two different ways heat and cold can be applied.

    7. Identify three types of clients who need careful monitoring during heat

    or cold therapy.

    8. Identify three important assessments you must make when using heat or

    cold therapies.

    9. Identify three basic rules of using heat and cold therapy.

    10. Identify one important rule of using moist heat and moist cold.

    BASIC PRINCIPLES OF HEAT AND COLD THERAPY

   

    Heat and cold can be very effective therapeutic tools. Some of the benefits

    and risks of using heat and cold were mentioned in the introduction, and

    these benefits and risks will be discussed in a subsequent section of the

    module. In order to be able to use heat and cold effectively and safely – in

    other words, in order to gain the benefits and avoid the risks – you must

    first understand why these therapies work. To understand why they

    work you must understand some basic information about body temperature and

    how body heat and is lost and conserved. You must also know some basic

    information about injury and healing.

    Body Temperature

    Body temperature is a balance between the heat our bodies produce and the

    heat we lose. There are many ways we can increase or decrease the amount of

    heat we produce. There are also many ways we can increase or decrease the

    amount of heat we lose. Some of these we can consciously control (e.g.,

    drinking hot or cold liquids, putting on or taking of clothing), but the

    ones we are concerned about here are involuntary and involve the blood

    vessels of the circulatory system.

    The blood vessels of the circulatory system are a very effective tool for

    conserving or losing body heat, and they do this by dilating (expanding) or

    constricting (narrowing). When the blood vessels dilate, more blood

    is brought closer to the surface of the skin. When that happens, the body

    heat we produce is transferred through the blood and escapes to the

    environment. When the blood vessels constrict, blood is kept away

    from the surface of the skin, so our body heat cannot escape.

    Learning Break: The dilation and constriction of blood

    vessels is and involuntary reaction and is one of many methods the body has

    for maintaining a stable and optimal internal environment.

    Injury and Healing

   

    An injury to the body can take many forms, e.g., lacerations, burn, breaks,

    sprains, infections, etc. When injuries occur, two things happen. First,

    there is pain. Pain in an injury is caused by damage to tissues, blood

    vessels, bones, etc. Second, the body makes attempts to heal and repair the

    damage.One of the ways it does this is by dilating the blood vessels in

    and around the damaged area and increasing blood flow to the damaged area.This 

    helps the healing process by bringing oxygen and nutrients to the injured

    tissues and removing toxic waste products.

    However, the dilation of the blood vessels and all of the increased blood

    flow actually causes pain

   

        because the dilation of the blood vessels and the increased amount of

        blood in the area causes swelling and pressure to be applied to the area

        of injury.

   

    Think about it: If you have a sprained ankle, you won't walk on it because

    weight bearing causes pressure and the pressure causes pain.

    How do these two concepts apply to the therapeutic use of heat and cold?

       

  •         We use heat when we want to increase the blood flow to an area because

            heat dilates the blood vessels.

       

       

  •         We use cold when we want to decrease the blood flow to an area because

            cold constricts the blood vessels.

       

       

  •         We use either heat or cold depending on the situation of the injury.

            Heat would be applied to tissues that are infected to bring oxygen,

            nutrients, and white blood cells that fight infections to the infected

            area. Cold would help an area that is painful because of swelling (e.g.,

            a sprained ankle) to decrease blood flow to the area and decrease

            pressure.

       

       

  •         Heat and cold can be used sequentially. Standard care for a sprained

            ankle is to firstapply ice for a few days to decrease the pain

            caused by swelling and thenapply heat to increase blood supply

            and promote healing.

       

    USING HEAT AND COLD SAFELY

   

    Heat and cold can be used safely, but these therapies can also cause harm.

    In order to use heat and cold therapies safely, follow these guidelines:

       

  •         Only apply heat or cold if you are directed to do so by your supervisor

            or if these therapies have been ordered by the physician.

       

       

  •         Only apply heat and cold to the specific areas that have been outlined

            by your supervisor's instructions or the physician's orders.

       

       

  •         Make sure that you receive instructions or there are orders that clearly

            indicate what method of heat and cold should be used and how to use it,

            e.g., moist or dry heat, apply four times a day for 20 minutes per

            application, do not apply directly to the skin, etc.

       

       

  •         Closely monitor the client to make sure the therapy is effective.

       

       

  •        

                Most importantly, closely monitor the client to make sure he/she is

                not injured by the heat or cold.

           

            It is not unreasonable to check the area every five minutes.

       

   

       

  •         Be especially careful when applying heat or cold to

           

                elderly clients

           

            . Their skin is more delicate than the skin of a younger person, and

            they frequently do not have a large amount of insulating fate.

       

       

  •         Be especially careful when applying heat or cold to

           

                infants and children

           

            as their skin is very sensitive and can easily be damaged.

       

       

  •         Be careful when applying heat or cold to clients who have

           

                dementia

           

            or are disoriented. These clients may not know when they are

            being injured or might be unable to communicate that they are in pain.

       

       

  •        

                Be very, very careful when applying heat to clients who have

                diabetes.

           

            Diabetes decreases circulation and interferes with the sensation of

            pain; this makes the client with diabetes more susceptible to harm and

            less able to notice it. If heat or cold is improperly applied to a

            client with diabetes, he/she may suffer an injury but not realize the

            presence of the pain until damage has been done.

       

       

  •         Don't apply heat or cold to irritated or damaged skin. Don't apply heat

            or cold to an area with stitches or a surgical wound unless there is an

            order to do so and never apply moist heat or cold to damaged skin or an

            area with stitches or an open wound: the moisture can cause infection

            and prevent healing.

       

    When you are using cold or heat, it is almost always safer to avoid direct

    contact. Use some sort of barrier – cloth, a specialized paper cover, etc. –

    between the cold and the heat source, especially if you are using moist

    applications. The barrier prevents skin injury. Make sure you check the

    patient shortly after you begin the treatment, several times during the

    treatment, and immediately after stopping the treatment. You should closely

    examine the area. If you are using heat, look for burns or excessive

    redness. If you are using cold, look for unusually cold or pale skin or

    cyanosis. Cyanosis is a blue coloration of the skin caused by constricted

    blood vessels: remember that cold constricts the blood vessels). When using

    either heat or cold, check the area for normal sensation and circulation.

    Always make sure you document any problems and report them immediately to

    the RN or your supervisor. Most importantly, ask the client is the therapy

    was effective or if it was painful or uncomfortable. If it was, make sure

    you document this information and tell the RN or your supervisor.

    Learning Break:Heat and cold should be applied for a

    specified time; this is usually no more than 20 minutes. Never

    exceed the prescribed time limit for heat or cold therapy. It also makes

    sense when you are applying heat or cold for the first time to consider a

    trial period of therapy that is less than the prescribed amount of time;

    check with the RN or your supervisor about this.

    SPECIFIC HEAT AND COLD THERAPIES

    Heat or cold can be applied generally or locally. General

    application of heat or cold is used when a very high or very low body

    temperature puts the client's health at risk or makes the client very

    uncomfortable. Example: The patient has been exposed to cold and is

    hypothermic (body temperature less than 30°C or 86°F). However, situations

    in which general application of heat or cold is needed are unusual, and it

    is unlikely you would be caring for a client who needed this therapy.

    Local application of heat or cold is very commonly used, and there are many

    different therapies. Common uses are to treat s

   

        prains muscle pulls, arthritic joints, or local infections.

   

    Some of the therapies are prepared using at-hand materials (e.g., a warm

    compress using a towel) and some use commercially manufactured products such

    as a heat lamp. There are a lot of commercially made products for heat and

    cold therapy, so it would be impossible to provide information on how to use

    each one, and that wouldn't be necessary. All of them should come with

    directions, each institution or facility should have a policy with

    instructions on how to use them, and an RN or your immediate supervisor

    should review their use with you if you have questions.

   

    Heat Therapy

    Local application of heat can be a very effective and soothing therapy. It

    is very commonly used. It reduces tissue swelling, increases circulation,

    relaxes muscles, relieves pain, and reduces joint stiffness. Popular heat

    therapies include:

       

  •         Warm compresses: This is application of moist heat. There are several

            different types of warm compresses. There are commercially made reusable

            ones or a warm compress can be as simple as a towel that has been soaked

            in warm water, but the basics are the same regardless of what you use.

            First, prepare the compress to the

           

                proper temperature; this is very important.

           

            The temperature should be specified in the physician's orders or there

            should be a policy that specifies how hot a warm compress should be.

            Place a waterproof barrier underneath the area to be treated. Apply the

            compress then cover the compress with a barrier; the barrier prevents

            heat escaping to the air and helps focus the heat on the affected area.

       

    •    

  •         Warm soaks: A warm soak is simply immersion of a body part in warm

            water. Using the proper temperature is very important; the temperature

            can be checked with a thermometer.

       

    •    

  •         Heating pad: Heating pads are electrically operated devices that can be

            accurately set for a specified temperature. The advantage of a heating

            pad is that unlike a warm compress or a warm soak, the temperature stays

            the same for the duration of the treatment.

       

    •    

  •         Heat lamp: A heat lamp is a specially designed lamp that can be used to

            apply an accurately controlled level of heat to a very limited, specific

            area.

       

    •    

  •         Sitz bath:  A sitz bath applies warm water to the perineal and genital

            area.

       

    Cold Therapy

   

    Cold therapy is most often used to decrease pain that is caused by the

    swelling caused by a sprain or a fracture. Also follow the same principles

    as when using a warn therapy,  e.g., use a barrier, use the proper

    temperature, check the client frequently, etc.

   

       

  •         Cold compress: Follow the basic principles of using a warm compress when

            applying a cold compress.

       

    •    

  •         Cold soaks: This is the same as a warm soak. The water temperature

            should be at the specified temperature.

       

   

       

  •         Commercial cold packs

       

    •    

  •         Ice bags.

       

    All of the above are local applications of cold. It was mentioned earlier

    that heat and cold can be used as a general application but this is not

    often done. However, you may be asked to assist giving a cooling sponge

    bath. A cooling sponge bath is used to lower the body temperature when a

    client has a fever. Cold compresses are applied at areas of the body of high

    circulation in order to dilate the blood vessels and increase the heat loss.

    Learning Break:Moist and dry heat or cold are probably

    equally effective, but some people feel the moist applications provide more

    relief and may go deeper. Dry applications are easier to measure and

    control. There is no definite advantage to either, and both can be helpful.

    SUMMARY

   

    Using heat and cold therapy is relatively simple and if these therapies are

    applied properly, they can be effective and safe. To make sure you use heat

    and cold in the right way, remember these points.

   

       

  •         Only apply heat or cold if instructed to do so by the RN or your

            supervisor or if the therapy has been ordered by a physician.

       

       

  •         Only apply heat or cold using the specific therapy that has been

            ordered, only apply heat or cold to the specific area that the therapy

            has been ordered for, and only use heat or cold for the specified amount

            of time.

       

       

  •         Check the client frequently in order to prevent injuries, detect

            injuries, and determine if the therapy is effective.

       

       

  •         Look for signs and symptoms of burns, decreased circulation, and

            decreased sensation and ask the client if the therapy is painful.

       

       

  •         Make sure you document any adverse effects or client discomfort, and

            make sure these are reported immediately.

       

       

  •         Be especially careful and conscientious when applying heat or cold to

            infants and children, the elderly, clients who have dementia or are

            disoriented, or who have diabetes.

       

       

  •         Don't apply heat or cold – especially moist heat or cold – to areas of

            broken skin, to irritated skin.

       

       

  •         Never apply moist heat or cold to an area with stitches or a surgical

            wound. Some times dry heat or cold can be used for these areas.

       

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