Heat and cold application
Dr. Abdul-Monim Batiha
Assistant Professor
Critical Care Nursing
Philadelphia university
Objective

Discuss the therapeutic uses of heat and cold
therapy and their methods of application.
ADMINISTER HEAT AND COLD
THERAPY

Cells in the hypothalamus act as a thermostat
to regulate body temperature. When the
hypothalamic thermostat detects that the body
temperature is either too high or too low, it
responds
systemically
by
instituting
appropriate
temperature-decreasing
(vasodilation, sweating) or temperatureincreasing
(vasoconstriction,
shivering)
mechanisms to restore body temperature to the
normal level.

Local responses to heat and cold occur
through stimulation of temperaturesensitive receptors in the skin. Impulses
travel from the periphery to the
hypothalamus and the cerebral cortex.
The hypothalamus then initiates heatproducing or heat-reducing reactions of
the body. The conscious sensations of
temperature are aroused in the cerebral
cortex.
Heat and cold receptors adapt
to changes in temperature.
 On initial exposure, receptors
are strongly stimulated by
extremes in temperature, but,
within a short time, this
response declines as the
receptors adapt to the new
temperature variations.


This adaptive ability of the body
to temperature variations can be
dangerous to clients insensitive to
heat and cold extremes and may
predispose them to serious injury.
Nurses and clients need to
understand this adaptive response
when applying heat and cold.

Heat is one of the oldest nursing
measures used to reduce pain and
promote healing. Heat causes
vasodilation and increases blood
flow to the affected area, producing
skin redness and warmth. Heat
produces maximum vasodilation in
20 to 30 minutes; after this period,
reflex vasoconstriction occurs along
with tissue congestion.

Periodic
removal
and
reapplication of heat will restore
vasodilation. Prolonged exposure
to heat damages epithelial cells
and results in redness, tenderness,
and even blister formation. The
application of cold lowers the
temperature of the skin and
underlying tissues and causes

Vasoconstriction reduces blood
flow to the affected area and
produces skin pallor or a bluish
discoloration and coolness.
Maximum vasoconstriction is
achieved at 15°C (60°F); at
temperatures below 15°C, the
vessels begin to dilate.
Prolonged exposure to cold results in
a reflex vasodilation. Initially the
skin is reddened, but later it takes on
a bluish purple mottled appearance
 with numbness and pain because of
impaired circulation and tissue
ischemia.


Vasodilation and vasoconstriction of
the blood vessels in the skin result
primarily from increased sensitivity
of the vessels to nerve stimulation
but also from a protective reflex
response that passes to the spinal
cord and then back to the vessels.

The body’s response to the
application of heat and cold is
influenced by a number of
factors.
The following conditions necessitate
precautions in the use of heat and
cold applications:

• Neurosensory
impairment: Clients
with reduced perception of sensory or
painful stimuli (e.g., spinal cord
injuries) are at an increased risk for
tissue injury.
Impaired mental status: Clients who
are confused or unconscious need to
be monitored and assessed frequently
to ensure safety.
 • Impaired circulation: Clients with
cardiovascular
and
peripheral
vascular problems or diabetes may
not have the ability to dissolve heat
through dilation of blood vessels and
are at an increased risk for tissue
injury.


• Skin and tissue integrity (open wounds,
broken skin, scar formation, edema):
Subcutaneous tissues are more sensitive
to temperature variations than are
superficial tissues (e.g., cold can decrease
blood flow to an open wound, thereby
inhibiting healing).

Heat and cold can be applied in
dry and moist forms (Figure 3515). The type of wound or injury,
location, and presence of drainage
or inflammation are considered
when selecting moist or dry
applications.
Methods for Applying
Dry and Moist Heat

Dry heat




Hot water bottle
Aquathermia pad
Disposable heat pack
Electric pad

Moist heat




Compress
Hot pack
Soak
Sitz bath
Copyright 2008 by Pearson Education, Inc.
Methods for Applying Dry
and Moist Heat
Copyright 2008 by Pearson Education, Inc.
Methods for Applying Dry
and Moist Cold

Dry cold




Cold pack
Ice bag
Ice glove
Ice collar

Moist cold

Compress

Cooling sponge bath
Copyright 2008 by Pearson Education, Inc.