APPLICATION OF HEAT AND COLD THERAPIES

Body temperature represents the difference between the heat produced in the body and heat
lost. Heat regulation takes place in the hypothalamus. Heat is lost from the skin by radiation,
conduction, convection and evaporation.

Many factors affect body temperature, including body rhythms, menstrual cycle, muscle
action, age, deficient sweat glands, environmental conditions, medications, etc. Because many
health decisions are based on body temperature readings, accuracy in temperature–taking is
essential.

Problems of hyperthermia and hypothermia require nursing assessment, planning,

implementation, and frequent evaluation. Applications of heat and cold therapies are part of this
treatment. Whether the application is cold or warm, temperature tolerance varies with the
individual and the part of the body to which it is applied, length of time of the application, size of
area under application, and whether it is moist or dry.

Heat and cold therapies are applied frequently in both the home and the hospital. In the
hospital setting, a doctor’s order is required before heat is applied.

I - APPLICATION OF ICE CAP

Purposes:
Uses of Cold Application
1. To provide topical anesthesia (for example, by placing an ice bag on the injection site
before giving the injection).
2. To prevent edema after bruises, spasms and sprains.
3. To lessen hemorrhage.
4. To reduce inflammation.
5. To decrease metabolism.
6. To lower body temperature.

Cold applications are either local or general, moist or dry.

Special Consideration:

Cold applications cause vasoconstriction with reduced blood flow to the skin, therefore the
skin becomes pale, mottled, cool to touch and numb. Whether the application is cold or warm,
temperature tolerance varies with the individual, the part of the body to which it is applied, the
area of application, and the length of time it is applied.

Equipment:

1. ice bag and cover 3. gel preparation

2. cracked ice 4. hand towel
Procedure

Action Rationale

1. Assess the need for application

2. Identify client and explain the An explanation facilitates cooperation of the

procedure. client.

3. Fill the ice bag with small pieces of ice

chips to approximately 2/3 full.

4. Press the air out of the bag and
tighten. Then test for leaks by
inverting the ice cap.
Air is a poor conductor of heat which will
interfere with the removal of heat from the
body surface. Inverting the ice bag would
determine the tightness of the cover. Leakage
can cause discomfort to the patient.

5. Cover the bag or case with towel.
Bring to the bedside and apply to the
area. Refill when the ice melts.
Observe the length of application as
ordered.
A cover should be used to provide for
absorption of the moisture which condenses
on the outside of the bag.

6. Do after care. Proper care of equipment ensures its

durability.

7. Wash hands. Handwashing deters the spread of

microorganisms.

8. Document the site, time, duration of Charting provides accurate documentation of

application and the client’s response. the implementation of treatment and the
client’s progress.

Note:
1. To be effective, the ice bag should be applied for ½ to 1 hour with an interval of
approximately 1 hour. In this way, the tissues are able to react to the effects of cold.
2. Placing the ice directly on the skin could cause burn.

After care of ice bag:

1. Empty ice bag.

2. Soap and rinse under running water.
3. Turn upside down to dry.
4. When dry, inflate with air to prevent damage of rubber lining. Screw cover in place.
5. Return to proper place.
 SAN PEDRO COLLEGE
Davao City

PERFORMANCE CHECKLIST
APPLICATION OF ICE CAP
Name:_________________________________ Grade: ________________
Year and Sec.: _________________ Date : ________________

Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 – Poor

Rating
5 4 3 2 1
1. Checks the physician’s order
2. Identifies client and explains the procedure.
3. Washes hands.
4. Assembles equipment.
5. Tests bag for leaks.
6. Fills ice bag with small pieces of ice about 2/3 full.
7. Expels air correctly.
8. Covers the bag.
9. Applies bag to the area.
10. Does after care.
11. Records procedure and client’s reaction.
12. Maintains body mechanics throughout the
performance of the procedure.
13. Manifests neatness in the performed procedure.
14. Receptive to criticisms.
15. Observes courtesy.
16. Shows calmness while performing the procedure.
17. Uses correct English.
18. Shows mastery of the procedure.
Remarks:
Criteria : I Knowledge (quiz) 30%
II Performance 70%
100%

________________________________ __________________________
Student’s Signature Over Printed Name Date
________________________________ __________________________
Instructor’s Signature Over Printed Name Date
 TECHNIQUE FOR THE APPLICATION OF HOT WATER BAG

Purposes:
1. To relieve pain.
2. To reduce swelling, congestion and inflammation.
3. To relieve muscle spasm.
4. To provide comfort.
5. To decrease the blood supply in other areas of the body.
6. To raise the body temperature.
7. To increase the blood supply to the injured part thus promotes healing.
8. To stimulate metabolism.

Special Considerations

Prolonged exposure to heat can damage tissues from thermal burns. Special care is required
when heat is applied to the very young and very old who cannot tolerate heat well. Special care is
also given to persons who have circulatory disorders, debilitated, unconscious and with impaired
sensation, decreased or absent response to pain which may lead to the risk of burns. Direct heat
treatment is contraindicated if the patient has an open wound and a sprained limb as vasodilation
would increase pain and swelling.
Hot applications must be ORDERED by the PHYSICIAN.

Equipment:

1. Hot water bag and cover

2. Bath thermometer
3. A pitcher of hot water
4. A pitcher of cold water
5. Empty pitcher
6. Hand towel

Desired Temperature

Infants under 2 years - 105 – 1150F (40.50 - 460 C)

Children over 2 years and adult - 1150 – 1250F (460 - 510 C)

Procedure

Action Rationale

1. Check that there is a physician’s order Reading the order clarifies the procedure.
for heat application and obtain the
treatment (blue) ticket.
2. Identify client and assess for any
circulatory impairment to the area
where the compress is to be applied
(numbness, tingling, impairment in
temperature, sensation or cyanosis).
Circulatory impairment may interfere with the
client’s ability to perceive heat and place him
at risk for injury from the application of heat.

3. Explain the procedure to the client. An explanation encourages the client’s

cooperation and reduces apprehension.
4. Gather the equipment. Organization promotes efficient time
management.
5. Pour an adequate amount of tap To determine the right temperature.
water into an empty pitcher and add
hot water to meet the desired water
temperature .
6. Test the temperature of water using
the bath thermometer. Right temperature of water prevents burning.

7. Pour the water from the pitcher into

the bag until it is about ½ - 2/3 full.
8. Expel the air from the bag by resting
the bag on the table. Holding the
neck of the bag upright, flatten bag
against the table until the water
reaches the neck portion. Or expel
air by holding the bag up and
pressing the unfilled portion until
the water fills the neck of the bag.
More than this amount of water will make the
bag heavy.
The bag can easily be molded to the body
parts when applied. Absence of air makes it
less flat and less bulky.
Expelling air would make the bag more
flexible.

9. Screw the stopper or fasten the top

tightly. To prevent leakage or accidental spill of hot
water which can result to burns.
10. Turn upside down and examine for
leakage. To ensure safe application.
11. Dry the bag using the hand towel.
12. Place the cloth cover of the bag and
fasten securely.
13. Place the prepared hot water bag
Provides opportunity to test the temperature
over one’s arm with the opening
of the hot water bag and protects the nurse
away from you. Bring to the bedside.
from burns.
14. Apply it on the affected area with Prevents the risk of burn.
the neck of the bag away from the
client’s body.
15. Stay with the client for the first 15 Impaired circulation may affect the sensitivity
minutes to monitor the client’s to heat and to ensure client’s safety.
response to heat application.

16. Remove the hot water bag. Carefully Maximum therapeutic effects of heat occur
evaluate the skin’s condition and within 20–30 minutes. Extended use of heat
effectiveness of the heat (beyond 45 minutes) results in tissue
application. congestion and vasoconstriction. This
rebound phenomenon results in increased
risk of burns from the application of heat.

These techniques support the principle of

17. Do the after care of equipment. asepsis.
Wash your hands.
Written records provide documentation of
18. Record the treatment and the the procedure.
client’s response.

SAN PEDRO COLLEGE

Davao City
 PERFORMANCE CHECKLIST
APPLICATION OF HOT WATER BAG

Name: _________________________________ Grade: __________________

Year and Sec.: _________________ Date : __________________
Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 – Poor

Rating

5 4 3 2 1
1. Confirms the written physician’s order.
2. Identifies client and explains the procedure.
3. Assesses the area for any circulatory impairment
4. Washes hands.
5. Assembles the equipment.
6. Tests the temperature of the water.
7. Pours water from the pitcher into the bag until it is about
one – half full.
8. Expels the air correctly.
9. Screws in the stopper securely.
10. Wipes the bag.
11. Examines very well for leaks.
12. Covers bag with cloth.
13. Applies to affected area with the neck away from the
client’s body.
14. Assesses the response of the client to the heat.
15. Removes the hot water bag after 30 minutes or according
to the time prescribed by the physician.
16. Replaces wet linen.
17. Assists the client to a safe and comfortable position.
18. Does the after care of equipment appropriately.
19. Washes hands.
20. Charts the procedure and other significant observations.
Remarks:
Criteria : I Knowledge (quiz) 30%
II Performance 70%
100%
________________________________ __________________________
Student’s Signature Over Printed Name Date
________________________________ __________________________
Instructor’s Signature Over Printed Name Date
 GIVING A SITZ BATH

Definition: Sitz bath is a local hot water bath which consists of the immersion of the pelvic
region of the client who is in a sitting position.
Giving a Sitz Bath:
To give a Sitz bath, a client is placed in a shallow tub or basin containing enough warm
water so that only the pelvic area is submerged.

The nurse should implement the plans for the care of assigned clients so as to allow
approximately 15 to 30 minutes for the sitz bath. Although intended to cause vasodilation,
prolonged heat may cause the reverse effect if the warm temperature is sustained. By coordinating
the preparation of the equipment with the client’s readiness, the maximum effects of the procedure
are likely to be achieved.

Purposes:

1. To increase local circulation.

2. To reduce swelling.
3. To promote healing.
4. To help relax local muscles.
5. To relieve pain.

Assessment:
1. Ensure that there is a physician’s written order.
2. Consult the agency’s policy for the amount of time and temperature recommended for
Sitz bath (if not ordered).
3. Read the client’s record to determine the reason for the Sitz bath, such as promoting
healing of perineal incision.
4. Assess the client’s mental status and any evidence of sensory or cardiovascular disease.
5. Inspect the perineal area for color, swelling, discharge, integrity, evidence of external
hemorrhoids, drains, packing or dressing material.
6. Observe the client’s ability to sit directly on the buttocks; note signs of discomfort.
7. Take the client’s vital signs and compare them with the recommended range for the
client’s age; determine the pattern of the vital sign recordings.
8. Ask the client to describe the sensations he experiences in the perineum and rectum
especially with sitting, walking and when eliminating urine or stool.

Equipment:
1. Sitz bath chair
2. Bath thermometer
3. Bath towels and clean gown
4. Bath blanket
5. Sterile dressings and T – binder (optional)
6. Pitcher of hot water
 7. Pail ¾ filled with tap water
8. 2 Safety pins (large)

Procedure

Action Rationale
1. Check the physician’s order. It is a way of insuring that the procedure is
implemented according to the physician’s
directions.
2. Identify the client and explain the An explanation relieves apprehension and
procedure. promotes of cooperation.

3. Assess the client’s condition. Serves as a baseline data.

Take patient’s vital signs.
4. Wash your hands and assemble Handwashing reduce the transient
equipment. microorganism thus, deters the spread to
client and self.
5. Pour some amount of hot water Using the thermometer is the most reliable
into the pail and test the method for determining the actual temperature.
temperature of the water with a
bath thermometer and maintain at
43-46 ‘C or 110-115 ‘F.
When the client’s hips are submerged, the
6. Fill the Sitz basin 1/3 to ½ full. water will be displaced and the level of the
water will increase.

7. Close the door and window in the To provide privacy.

private room or by drawing the
curtains in the ward.

8. Have the patient void. Prevents interruption of the procedure as warm

water stimulates voiding.

9. Remove clothing from below the

Leaving the upper part of the body covered
waist. Wrap the towel around the
maintains modesty and warmth. Towel
waist with opening at the back
prevents undue exposure of the lower part of
portion.
the body.
10. Assist the client to sit in the basin Direct pressure may heighten discomfort.
without pressure on the perineum Changes in the distribution of blood and
and with the feet flat on the floor.
Provide a foot stool if necessary

11. Cover the client’s back,
shoulders, and lower legs with a
cotton bath blanket.
12. Stay with client and observe
closely for signs of weakness,
vertigo, pallor, tachycardia and
nausea. If noted, stop the
procedure and assist the client to
sit. Take the vital signs and
inform CI/NOD.
13. Help the client out of the chair
upon completion of the procedure
and assist to dry and change with
clean clothes/gown.
14. Help the client return to bed.
Recheck the pulse and instruct to
stay in bed for 30 minutes.
15. Notify the doctor for presence of
vaginal/rectal plugs. (Do not
attempt to remove.)
16. Empty the Sitz basin, clean and
dry before returning to the utility
room. Wipe away water that may
have dripped on the floor.
17. Wash your hands.
18. Document pertinent
observations.
Sample Documentation
DATE TIME
4 / 25 /2017 10 AM
external heat can increase the potential for
adverse effects.
A footstool can prevent pressure at the back of
the thigh.
This maintains body warmth and prevents
chilling.
The nurse should not leave the client alone
unless absolutely certain that it safe to do so.
Being clean and dry promotes a refreshed
feeling.
The client may feel dizzy with changes in
posture and the redistribution of blood volume
to the pelvic region.
Removal of rectal / vaginal plugs might induce
bleeding.
Water left on the floor can lead to accidental
falls and injury.
Washing reduce the transient microorganism
thus, deters the spread to client and self.
Accurate written report provides a permanent
record of the individuals care.
NURSES NOTES
Minimal amount of bloody drainage noted
on peri-pad from the area of
 hemorrhoidectomy. Verbalized that the
area is tender and that sitting is difficult.
Has not felt the urge to defecate since
surgery (4-23-17).
10:15 AM Hot sitz bath provided at 43-46’C for 20
minutes as ordered. Verbalized “Maghulat
gyud ko ani kay maayo akong pamati
pagkahuman.”
10:30 Rectal plug removed by Dr. Arce. Dry and
sterile dressing applied.

Angel Locsin, St.N.

 SAN PEDRO COLLEGE
Davao City
PERFORMANCE CHECKLIST
HOT SITZ BATH
Name: __________________________________ Grade:_____________________
Year and Sec.: _________________ Date : _____________________
Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 – Poor
Rating
5 4 3 2 1
1. Checks the physician’s order.
2. Identifies client and explains procedure.
3. Checks client’s vital signs and general condition.
4. Washes hands.
5. Assembles equipment.
6. Tests the temperature of the water with a bath
thermometer (43-460C or 110-1150F).
7. Fills the Sitz basin 1/3 to ½ full.
8. Provides privacy.
9. Asks client to void.
10. Removes client’s clothing and wraps towel around the
waist with the opening at the back .
11. Assists the client into the sitz basin.
12. Covers the client’s back, shoulders and lower legs with a
blanket.
13. Observes the response of the client frequently.
14. Helps the client out of the sitz bath chair and assists to dry
and put on clean bed clothes/ gown.
15. Assists client to return to bed.
16. Rechecks the client’s VS and instructs to stay in bed for
30 minutes.
17. Empties the Sitz basin, cleans and dries it before
returning to the utility room.
18. Washes hands.
19. Documents pertinent observations.
Remarks:
Criteria : I Knowledge (quiz) 30%
II Performance 70%
100%
________________________________ __________________________
Student’s Signature Over Printed Name Date
________________________________ __________________________
Instructor’s Signature Over Printed Name Date
 TEPID SPONGE BATH

Definition: A bath using tepid water and wash cloth or sponge to reduce fever.
Purpose/s:
Equipment:
Basin
Pitcher filled with hot water.
Pitcher with cold water.
Waterproof underpad or rubbersheet
Bath blanket
Wash clothes (about 6 pieces)
Bath towel
Thermometer in a thermometer tray
Working gloves
Bath thermometer

Procedure

Action Rationale

1. Identify the client and take vital
signs. Assess patient’s condition.
2. Explain the procedure to client or
watcher.
Provides the baseline data to be used when
evaluating the client’s response to the
treatment.
Informing the client elicits cooperation.

3. Wash hands and assemble all Removes transient microorganism and reduces
equipment and bring to bedside. the risk of cross-contamination to client and
self.
4. Close doors and windows in To provide privacy, and protect from draft.
private rooms or draw curtains in
the ward. Put off air conditioner
or electric fan.

5. Adjust the bed to the working Protects your back from strain.
height.
6. Don gloves. Lay the waterproof Prevents the linens from getting wet.
underpad.
7. Change the topsheet with a bath Avoids exposure to draft.
blanket. Remove client’s gown.
Starting from the farther arm.
 NOTE: If with IVF, refer to
cleansing bed bath for the
removal of gown.
8. Pour/ mix water in a basin with
This is the normal range of water temperature
the temperature of 27-370C (80-
in a tepid bath.
980F). Immerse 6 washcloths into
the basin. Pour cold water and
mix with hot water until the
temperature reaches 27-37 oC
(80-90OF).
9. Wring, roll and apply washcloth These areas contain large superficial blood
to the forehead. vessels that help the transfer of heat.
Note: Check regularly the
temperature of the washcloths.
10. Gently pat the 6 wash cloths on Promotes a decrease in temperature within a
the client’s face, neck extremities, safe time frame and avoid the chance of
back and buttocks. The whole chilling.
procedure should last for 30 A bath given less than 30 minutes tend to
minutes. increase body heat production by causing
shivering.
Abdomen and chest are not Blood vessels are located deeper and TSB is
usually sponged. not very effective to reduce temperature.
11. After sponging each body part, The friction caused by rubbing may raise the
pat dry with bath towel and cover body temperature and covering prevents
it with the bath blanket. exposure to draft.
12. Monitor the client’s reaction to When client’s temperature is slightly above
treatment, and recheck TPR after normal, procedure can be discontinued to
15 minutes and after completing prevent rebound effect.
the bath. Temperature will go down naturally.
Discontinue procedure if 1-20F
above desired level is obtained.
13. Remove washcloths from Light clothing maintains the body temperature.
forehead, axillae, groins and pat Excessive clothing and covering can result to a
dry these areas. Change the temperature elevation.
client’s gown and replace the bath
blanket with the topsheet.
14. Lower the bed to its previous Promotes client’s safety and convenience.
height.
15. Do the aftercare of equipment
used.
 16. Document the treatment Provides information to the health care team
performed, client’s vital signs, regarding the client’s response to the
response and any complications. treatment; a legal record of the care giver.

DOCUMENTATION:

DATE TIME NURSES NOTES

5- 22 -17 8 AM Vital signs checked.
Temperature 39‘C. Tepid
sponge bath done
continuously for 20 minutes.
Temperature rechecked
8:15 AM 38’C. Encouraged to
increase oral fluid intake.
Temperature decreased to
8:30 AM 37.5‘C . Kept comfortable in
bed

Sandra Park, St.N.