Definition-

Hot Application

Hot application is the application of a hot agent, warmer than skin either in a moist or dry from
on the surface of the body;

Purpose:-

 To relive pain and congestion,

 To provide warmth,
 To promote suppuration,
 To promote healing,
 To decrease muscle tone
 To soften the exudates.

Cold application

Cold application is the application of a cold agent cooler than skin either in a moist or dry form,
on the surface of the skin.

Purpose

 To reduce pain and body temperature,

 To anaesthetize an area,
 To control hemorrhage,
 To control the growth of bacteria,
 To prevent gangrene,
 To prevent edema and
 To reduce inflammation.
Classification of temperatures:

Temperature Fahrenheit

Very Cold 32 to 55 F

Cold 55 to 65 F

Cool 65 to 80 F

Neutral 80 to 92F

Warm 92 to 98 F

Hot 98 to 104F

Very Hot 104 F

TRANSFER OF ENERGY: HEAT

 Conduction: Contact
 Convection: movement
 Evaporation: through liquid-gas transfer
 Radiation: electromagnetic waves
  Conversion: transfer from one energy type to another

THERAPEUTIC APPLICATION

 Heating Agents ◦ Transfer heat to patient’s body, between various tissue / fluids
 Cooling Agents ◦ Transfer heat away from patient’s body.

Physiological Effects of hot application:-

 Peripheral vasodilatation
 Increased capillary permeability
 Increased oxygen consumption
 Increased local metabolism
 Decreased blood viscosity
 Decreased muscle tone
 Increased blood flow
 Increase Lymph flow
 Increase motility of leucocytes

Physiological effect of cold application:-

 Peripheral Vasoconstriction
 Decreased capillary permeability
 Decreased oxygen consumption
 Decreased local metabolism
 Increased blood viscosity
 Decreased muscle tone
 Decreased blood flow
 Decreased lymph flow
 Decreased motility of leucocytes

Systemic response of hot application

Application of hot packs for long time

Excessive peripheral vasodilatation

Drop in blood pressure

Rebound Phenomenon Of Heat

  Occurs at the time that maximum therapeutic effect of hot or cold application is achieved
 Heat produces maximum vasodilatation in 20-30 minutes.
 Continuation beyond 30-45 minutes causes tissue congestion, the blood vessels constrict
 Now the opposite effect is occurring because of reflex vascular constriction.
 Recovery time of one hour is advised before reapplication

Rebound Phenomenon of Cold

 Maximum vasoconstriction occurs when the skin temperature reaches 150 or in about 30
minutes to one hour.
 Vasodilatation begins as a
Recovery time of one hour is best before reapplication.

Factors Affecting Heat And Cold Tolerance

 Body part: Certain areas of the skin have a sensitivity to temperature variations. The
inner aspect of the wrist and forearm, the neck, and the perineal area are temperature-
sensitive, while the back of the hand and the foot are not as sensitive.
 Duration of application: 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.
 Area of body exposed: The larger the area exposed to heat and cold, the lower the
tolerance to temperature changes.
 Damage to body surface area: Injured skin areas are more sensitive than intact areas to
temperature variations.
 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.
 Age: Thinner skin layers in children and elderly people increase the risk for burns from
the heat and cold applications.

Scientific principles involved in hot and cold applications

 Water is a good conductor of heat

 Air is a poor conductor of heat
 The flow of heat is from the hotter are to the less hot area
 Prolonged exposure to moisture increases the skin’s susceptibility to maceration and
skin breakdown, reducing the protection of the intact skin.
 Moisture left on the skin causes rapid cooling due to evaporation of the moisture
 Presence of steam increases the temperature of the hot application
 Oil acts as insulator and delays the transmission of heat
 Woolen absorb moisture slowly, but hold moisture longer and cool off less quickly
than the cotton materials.
 The temperature tolerance varies with individuals and according to the site and area
covered
 Friction produce heat.

Hot application

Indication of hot application:-

 Decreases pain
 Decreases muscle tone
 Promote healing
 Promotes suppuration
 Relives deep congestion
 Softens the exudates
 Provide warmth
 Stimulates peristalsis

Contraindications Of Hot Applications

 Malignancies
 Impaired kidney, heart & lung functions
 Acutely inflammed areas
 On clients with paralysis
 Open wounds
 Edema associated with venous or lymphatic diseases
 Headache
 Client with metabolic disorders
 Very young & very old client
 Client with very high temperature

Complications Of Hot Applications

 Pain
 Burns
 Maceration (with moist heat)
 Redness of the skin
 Edema
 Pallor (secondary effect)
 Hyperthermia
 Therapeutic effect of hot application
1.Hemodynamic
Increase circulation 1.5-2x normal
Increased metabolism (contraindicated in 2-3 days post injury)
Increased inflammation, phagocytosis, & wound healing
Decreased pain (analgesia); not as effective as cryotherapy for acute pain
Decreased muscle spasm
Decreased tissue stiffness (fluids less viscous and collagen releases
Depth of effects are not as great as with cold
Vascular changes are confined to skin (1cm)

2. . Neuromuscular
Increase sensory nerve conduction
Analgesic effects both distal and proximal to area treated This is why non-acute back
patients use heat instead of ice
Reducing muscle spasm
Inhibits muscle contraction

General instruction :-

 Assess the condition of the client prior to, during & after the application of the heat &
cold application.
 Check vital signs.
 Maintain correct temp. for the entire duration of the application.
 Never use any equipment unless understand its operation completely.
 There must be a recovery period between the application.
 Expose the client only requires part..
 Don’t allow the client to adjust temp. control
 Never ignore the complaints of a client
 Make sure that the client is in a position to remove the application if it is causing him
discomfort or advice patient to call for help.
 Call bell must be in reach to children.
 Never leave client even for short period
 Squeeze off water from moist heat applications to prevent scalding.
 Apply thin layer of petroleum jelly or oil to skin prior to the application of moist heat
application. It will reduces soaking of the skin & therefore maceration.
 Don’t use electrical appliances close to the open oxygen.
 If any sign of complication recognized stop procedure immediately.
 After procedure, dry the body area gently by patting not by rubbing to remove the
moisture.
  Hot water bag to be fill two-thirds to half full with warm water and remove air at the top
so the bag is easier to mold over the body part.
 Dry the outside of the bag & test for leakage by holding the bag upside down.
 Cover bag with a towel or pillowcase (never apply directly on the skin surface)
 Keep bag in place for 20–30 minutes and then remove.
 Do not allow the client to lie on the hot water bag.

Cold application

Therapeutic Uses Of Local Cold Applications

 Relieves pain
 Prevent gangrene
 Prevent edema & reduce inflammation
 Control hemorrhage
 Control the growth of bacteria
 Reduces the body temperature
 Anaesthetize an area

Contraindications Of Cold Applications

 Client in the state of shock & collapse

 Edema
 Diseases associated with impaired circulation
 Muscle spasm
 Decreased sensation
 Client have shivering or having very low temperature
 Cold hypersensitivity or intolerance
 Cryoglobulinemia
Uncommon disorder
Aggregation of serum proteins in distal circulation when distal extremities cooled
Proteins form a “gel” that can impair circulation,
Causes local ischemia, gangrene
 Paroxysmal Cold Hemoglobinuria
Release of hemoglobin into urine from lysed red blood cells,
In response to local or general exposure to cold
 Raynaud’s Disease
Paroxysmal digital cyanosis
Sudden pallor followed by redness of skin of digits,
Precipitated by cold or emotional upset
Relieved by warmth
 Bilateral and symmetric (women)
 Raynaud’s Phenomenon
Generally only in one extremity
May be associated with thoracic outlet, carpal tunnel syndrome or trauma
 Regenerating Nerves
Local vasoconstriction or decreased nerve conduction may delay regeneration
 Circulatory compromise or peripheral vascular disease
Chronic peripheral vascular disease may have edema. Cold may increase this
edema.
Pallor and coolness

Theraputic Effect Of Cold Application

1. Hemodynamic Effects
 Immediate vasoconstriction

Less then 15 min

Stimulates smooth muscles of vessels to contract

Decreases release of histamine, prostaglandins (vasodilators)
Increases blood viscosity (increases resistance to flow)
Decreases blood flow to maintain core temperature

After 15 minutes, vasodilatation occurs

Mostly distal extremities

Temperatures < 10 C (350 F) >15 minutes ◦
Cold induced vasodilatation (COVD)
Amount of vasodilatation usually small
Skin redness NOT due to vasodilatation due to increase in oxyhemoglobin
concentration of blood
Cold decreases oxyhemoglobin dissociation
Makes less oxygen available to tissues

 Hunting Response
Response to pain associated with extreme cold
 Raynaud's Phenomenon
A vascular reaction to cold application or stress that results in a white, red, or blue
discoloration of the extremities. This happens because the blood vessels under the
skin tighten. When blood does not reach parts of the body, these areas may turn
blue and feel cold.
 2. Neuromuscular Efects
 Decreased muscle spasm by decreasing muscle spindle activity.
 Intramuscular fibers (muscle spindle) runs parallel to fibers of the muscle.
 Muscle contraction causes spindle contraction so it remains sensitive. The lower
the temperature, the lower the spindle activity.
3. Decreased Nerve Conduction Velocity
 Decreased NCV of sensory and motor nerves occurs ◦
 Greatest effect in myelinated, small fibers pain transmitters
 Least effect in unmyelinated, large fibers
4. Increased Pain Threshold
5. Metabolic Effects:-
 The decrease in metabolism allows them to live without as much oxygen. ◦
Normal body temperature is 37 ° C. ◦ Increase above 45° C (113° F) proteins
denature
6. Inflammation Control
 Decreases chemical reactions secondary to acute inflammatory response
 Decreased blood flow secondary to vasoconstriction, increased viscosity
7. Edema Control
Decreases intravascular fluid pressure via decreasing blood flow, increased viscosity
Most effective if applied immediately, in conjunction with elevation and compression.

Complication :-

 Tissue Death
 Frost Bite
 Nerve damage :- Unwanted vasodilation due to prolonged vasoconstriction, ischemia,
thromboses in smaller vessels.
 Freezing of tissues :- damage at 39 degrees F
 To avoid, duration limited to under 45 minutes and tissue temperature above 39
degrees F
 When goal is vasoconstriction, treatment limited to 10-15 minutes.

General instruction:-

 Assess patient and establish goals of treatment

 Determine if cryotherapy most appropriate treatment
 No Contraindications
 Select appropriate mode of application based on body part and desired response
 Explain procedure, reasons for treatment, and expected sensations
 Fill two-thirds full with crushed ice so bag is easier to mold over body part.
  Cover bag with towel or pillowcase and apply to affected area for 30 minutes.
 Provides cold to localized area (e.g., muscle sprain, hematoma) to Ice bag, ice collar

Guidelines In Application of hot and cold application:-

 Check the order, check armband

 Assess general condition of the patient
Assess the skin area where application going
 Check functioning of equipment
 Reassess patient and response in 15 minutes
 Stop treatment at designated time
 Examine the place where the treatment will occur.
 Record the patient’s response

Safety Measures “DO’s”

 Do explain to the patient sensations to be felt during the procedure

 Do instruct the patient to report changes in sensation or discomfort immediately
 Do provide a timer, clock, or watch so that the patient can help the nurse time the
application
 Do keep the call light within the patients reach
 Do refer to the agency’s policy and procedure manual for safe temperatures

Safety Measures Do “NOTS”

 Do not allow the patient to adjust the temperature

 Do not allow the patient to move an application
 Do not place the patient in a position that prevents movement away from the temperature
source Do not leave unattended a patient who is