Heat & Cold Application

 Applications of heat and cold are HEAT APPLICATION

commonly used in the hospital and
 Hot application is the application of hot
homes as therapeutic measures.
agent, warmer than skin either in a
 In the hospitals, these measures are moist or dry form on the surface of
carried out at the direction of the the body
physician.
 To relieve pain and congestion
 Heat and cold applications also serve
 To provide warmth
as comfort measures.
 To promote suppuration
 Promote healing & comfort
 To promote healing
 Reduce tissue swelling
 To decrease muscle tone
Indication for Therapy  To softens the exudates.
 Safe heat or cold applications will be CLASSIFICATION
provided to patients as part of pain
management programs wherever
these applications are appropriate
and effective.
 Therapeutic effects of heat can
assist in relieving sore, stiff muscles
or joints.
 As a general rule, in the case of
injury, heat therapy should not be used
for the first 48 hours as this will have
Effects of Hot/Heat Application
the opposite effect of cold therapy,
instead apply R.I.C.E. (Rest, Ice,  Peripheral vasodilation
Compression, and Elevation)  Increased capillary permeability
Equipment  Increased oxygen consumption
 Increased local metabolism
 Hot/Cold Gel Pack
 Decreased blood viscosity
 Hot/Cold Surgical pack
 Decreased muscle tone
 Ice Pack/Bag
 Increased blood flow
 A designated microwave for micro
 Increased lymph flow
waving gel packs only
 Increased motility of leucocytes
 Sitz tub (half-filled)
 Pitcher of water Therapeutic Uses of Local Hot Applications
 Bath thermometer  Heat decreases pain
 Bath towel  Heat decreases muscle tone
 Bath blanket  Heat promotes healing
 Heat promotes suppuration

1  NCM104 Lab - Heat & Cold Application

 Heat relieves deep suppuration
 Heat provides warmth
 Heat stimulates peristalsis
Contraindications of Hot Applications
 The first 24 hours after traumatic
injury (heat increase bleeding and
swelling).
 Active hemorrhage (heat causes
vasodilatation and increase bleeding.
 Non inflammatory edema (heat
increases capillary permeability and
edema).
 Skin disorder (heat can burn or cause
further damage to the skin).
 Localized malignant tumor (heat
increase cell growth and accelerate
metastases ).
 Hypertension or other circulatory
issues are present.
Complications of Hot/Heat Applications
 Pain
 Burns
 Maceration
 Redness of the skin
 Edema
 Pallor
 Hyperthermia
Special Considerations
 Heat is applied only when specifically
ordered by a primary provider and
applied with the utmost caution.
 Heat is not applied to a pregnant
woman’s abdomen. The heat can
affect fetal growth.
 Each person has his or her own
sensitivity to heat. Apply the heat
source slowly and ask the client for
feedback.
2  NCM104 Lab - Heat & Cold Application
 Metal implants pose risks. Metal
conducts heat. Deep tissues can be
burned. Pacemakers (cardiac devices)
and joint replacements are made of
metal. Do not apply heat to an implant
area.
 Infants, older people, and those with
fair, thin skin have less heat
resistance. Lowered body resistance
because of illness also makes body
tissues less resistant to heat.
 Clients who are unresponsive or
anesthetized and those with neurologic
or psychological disorders or dementia
are at increased risk for injury from
heat applications.
 Impaired circulation and some
metabolic diseases make people more
susceptible to burns (e.g., clients who
are in shock or have any type of
peripheral vascular disorder, or clients
who have diabetes).
SPECIFIC HEAT THERAPIES
1. DRY HEAT
2. MOIST HEAT
Dry Heat
 Aquathermia Pad
 An aquathermia (Aqua-K) pad,
which produces dry heat, is used to
treat muscle sprains and mild
inflammations and for pain relief.
Temperature-controlled, distilled
water flows through the
waterproof pad. Apply the pad
following specific orders. Check to
make sure the pad is heating
properly and not overheating and
stop treatment and report
malfunctions if overheating occurs.
 Heat Lamp Treatments and or clients who have spinal cord
Ultrasound injuries.
 Specially trained personnel give
heat lamp and ultrasound
treatments, because the client’s
exposure to light rays must be
carefully regulated to prevent
injury. The nurse must have
specific in-service education to
administer infrared (IR), ultraviolet
(UV), or ultrasound (US)
treatments.
 The Heat Cradle
 In rare instances, a lamp or special
heater is mounted inside a bed Moist Heat
cradle to provide dry heat. The
 Warm, Moist Compresses and Packs
primary provider must clearly
 Warm, moist compresses and
specify the time limits and these
packs apply moist heat to an area
orders must be followed exactly.
to stimulate circulation, ease pain,
As with any heat application,
and promote wound drainage.
monitoring the client closely is vital,
They are also used to apply
to prevent burns. Some heat
medications. The primary provider
cradles have an automatic timer
prescribes the type of application,
that turns the lamp on and off at
where it is to be applied, and the
preset intervals.
schedule of applications. The
 Electric Heating Pad
order also includes the solution to
 An electric heating pad is a
use, most often plain water, a mild
covered network of wires that
antiseptic solution (e.g., 2% boric
emits heat when electricity passes
acid), or normal saline.
through it. Pads with a waterproof
 Warm Soaks
cover are the safest. The client
 Another method for applying moist
who is paralyzed, has very
heat consists of immersing the
sensitive or friable (fragile) skin, or
client’s affected body part in
has a neurologic impairment is
warm water or medicated solution
particularly vulnerable to a burn
for a prescribed time. This
from the electric pad. These
procedure is called a soak. A
heating pads are also unsafe to
warm soak:
use with children; confused,
 Improves circulation
irrational, or unresponsive
 Increases blood supply to an
persons; clients who are suicidal;
infected area

3  NCM104 Lab - Heat & Cold Application

  Assists in breaking down infected
tissue
 Applies medications
 Cleans draining wounds
 Loosens scabs and crusts from
encrusted wounds.
 Sitz Bath
 The purpose of a sitz bath (sitting
in a tub of warm water) is to
provide moist heat to the pelvic,
perineal, and/or perianal area.
They are most often used
following infant delivery or
rectal/perineal surgery.
Disposable sitz basins are used.
The basin fits inside the commode
and is equipped with a bag, tubing,
and nozzle, to allow water to flow
freely to the affected area. In the
client’s home, a regular bathtub
containing enough water to cover
the client’s hips and perineum is
often used.
 Nursing Alert: Vasodilation from
heat application over a large area
of the body may cause
hypotension (low blood pressure).
All clients should be monitored
closely and assisted when rising.
4  NCM104 Lab - Heat & Cold Application
Difference Between Dry Heat and Moist
Heat
 Moist heat is more effective than dry
heat in deeper tissue heating.
 Moist heat penetrates more than dry
heat at the same temperature.
 Patients often report greater relief of
symptoms from moist heat.
 Moist heat is preferred over dry heat
as a treatment or component of the
treatment for the following conditions:
o Pain, stiffness and secondary
muscle spasm in chronic arthritis
o Acute temporo-mandibular joint
closed lock condition
o Pain and muscle spasm on
posterior neck and back in
patients with ankylosing spondylitis
 Moist heat has the additional capacity
to change the tissue temperature
rapidly and obtain a more vigorous
response from temperature
receptors.
COLD APPLICATION
 Cold application is the application of
cold agent, cooler than skin either in a
moist or dry form on the surface of
the body.
 To relieve pain and body temperature,
 To anaesthetize an area,
 To check hemorrhage,
 To control growth of bacteria,
 To prevent gangrene,
 To prevent edema and reduce
inflammation.
R.I.C.E. ELEVATION

 Cold therapy uses four basic methods  If possible, elevating the injured area
of pain relief and a speedy recovery - above the heart helps reduce internal
RICE bleeding and swelling.
 Rest Classification of Cold therapy
 Ice
 Compression
 Elevation
REST

Rest is important immediately after an

injury for two reasons:

 First, rest is vital to protect the injured

muscle, tendon, ligament or other
tissue from further injury.
 Second, your body needs to rest so it
has the energy it needs to heal itself
most effectively.
ICE
 Applying cold therapy (Cryotherapy)
is the best method for soft tissue
injuries to provide short term pain
relief.
 Cold therapy will help reducing
swelling, bleeding, spasms and pain.
 Apply as soon as possible after an
injury has occurred and continue for
48 to 72 hrs.
 Most doctors recommend 20 minutes
of cold therapy followed by 20 to 60
minutes off.
COMPRESSION
 For a severe injury, immediate
compression (pressure) is important
to decrease bleeding and keep fluids
from pooling in the area.
 Compression should be continued
throughout the day and removed at
night.
Effects of Cold Applications
 Peripheral vasoconstriction
 Decreased capillary permeability
 Decreased oxygen consumption
 Decreased local metabolism
 Increased blood viscosity
 Increased muscle tone
 Decreased blood flow
 Decreased lymph flow
 Decreased motility of leucocytes
Therapeutic Uses of Local Cold
Applications
 Cold relieves pain
 Prevents gangrene
 Prevents edema and reduce
inflammation
 Controls hemorrhages
 Checks the growth of bacteria
 Reduce the body temperature
 Cold anaesthetize an area

5  NCM104 Lab - Heat & Cold Application

Contraindications of Cold Applications

 Reynaud's Disease or decreased skin

sensitivity to temperature is present.
 The person feels chilled.
 Impaired circulation.
 Do not use over new wounds.
 Hypothermia
Complications of Cold Applications

 Pain
 Blisters and skin breakdown
 Maceration
2. Icecap or Ice Collar
 Gray or bluish discoloration
 The icecap, ice collar, or ice bag is a
 Thrombus formation
dry cold application.
 Redness
 The icecap, used for the head, has a
 Hypothermia
wide opening that allows it to be filled
Specific Cold Therapies easily with ice chips, as does the ice
1. Cold, Moist Compresses collar, a narrow bag curved to fit the
2. Ice cap or Ice Collar neck.
3. Single-Use and Re-freezable Ice  Single-use ice bags are frequently
Packs used.
4. Tepid Sponge Bath  The primary provider may prescribe
5. Hypothermia Blanket dry cold to treat a specific area of
6. Cold Humidity the body.
 However, an ice bag is often used for
a headache or in an emergency, such
1. Cold, Moist Compresses as a sprain or nosebleed, without an
 Cold, moist compresses are used to order (Dependent Nursing Action)
reduce swelling and inflammation in
soft tissue injuries or after tooth
extraction.
 The size of the compress depends on
the area to be treated.
 Gauze 4- X 4-inch pads are
frequently used for tooth pain.
 They are applied externally and are
changed frequently because they
warm rapidly, thereby losing their
effectiveness.

6  NCM104 Lab - Heat & Cold Application

3. Single-Use and Re-freezable Ice
Packs
 Healthcare agencies and emergency
services often provide ready-for-use
ice packs.
 These ice packs also are used by
sports teams, hikers, and camping
organizations.
 Sometimes, these can be refrozen,
but only for one client.
 Rationale: Using the pack for multiple
clients could promote the spread of
pathogens.
 Tepid sponge baths are inadvisable
for people with inelastic arteries
(hardening of the arteries—
arteriosclerosis), clients with arthritis
or lowered resistance to disease (as
a result of immunosuppression), and
very young children.
 Rationale: The water has the initial
effect of depressing body systems

5. Hypothermia Blanket
 A hypothermia blanket (cooling
4. Tepid Sponge Bath
blanket) is a mattress pad through
 A tepid sponge bath is a bath with
which very cold water flows
water below body temperature,
continuously.
between 80°F and 95°F (26.6°C to
 Hypothermia blankets may be used in
35°C).
surgery to slow body processes or
 This type of bath may be ordered to
elsewhere in the facility to lower
reduce a client’s elevated temperature.
dangerously high body temperatures.
 The first effect of this water on the
 NOTE: Today, it is more common to
skin is blood vessel constriction.
warm clients during surgery, to help
 A tepid sponge bath may be
prevent hypothermia and infections.
temporarily soothing, but may not
 Hypothermia blankets are equipped
produce a marked temperature drop
with electrical control units that can
unless used for an extended time,
be set to a desired temperature.
about 30 minutes.

7  NCM104 Lab - Heat & Cold Application

 It is important to follow the agency’s
protocol and the primary provider’s
orders.
 Check frequently to make sure that
the client’s core temperature does not
fall too low.
6. Cold Humidity
 Cold humidity is commonly ordered for
clients with breathing disorders.
 In most facilities, air conditioning and
heating systems provide a constant
level of humidity. But if the humidity level
is not high enough, an auxiliary
humidifier may be placed in the room.
 Some clients need constant cold
humidity in higher concentrations.
 A child may be placed in a croupette or
a humidity (mist) tent.
 Oxygen administered to all clients must
be humidified to prevent drying of the
mucous membranes of the nose and
throat.
8  NCM104 Lab - Heat & Cold Application
 If the client has a tracheostomy, a
“trach mask” may be placed over the
opening to provide humidity, either with
or without auxiliary oxygen.
 A face tent, which may be used to
provide a high concentration of
moisture in the inhaled air, is also
available.
Special Considerations
 Burns and blisters occur from intense
cold. They also occur when dry cold is
in direct contact with the skin.
 When cold is applied for a long time,
blood vessels dilate. Blood flow
increases. Prolonged application of
cold has the same effect as heat
applications.
 Older and fair-skinned persons have
fragile skin. They are at great risk for
complications. So are persons with
sensory impairments.
 Stop the cold application immediately
if the client complains of numbness or
the skin appears white or spotty.
 As cold decreases the flow of blood in
one area of the body, flow increases
to other areas.
 Continued application of cold affects Examples of contrast applications
deeper tissues. It is important to  Arm/Foot Baths: for contrast, fill one
monitor the client closely. sink with warm/hot water and the other
 Cold often is applied to a sprain, side with cool/cold water (use plastic
strain, fracture, or burn. bins for feet); place body part(s) in
Contrast: Heat then Cold Application warm side first then the cool side;
repeat 3 times.
 Alternating heat then cold causes a
 Compresses: have both a hot water
flushing effect – blood vessels dilate
basin and a cold-water basin
then constrict, causing an overall
available; dip one cloth in hot water,
increase of circulation to the area,
wring out and place on area; dip the
tissue healing and reduces swelling.
other cloth in the cold water, wring out
 It is also thought that the brain is
and replace the hot compress with the
momentarily distracted away from
cold one.
sending or receiving pain messages
through the use of contrasting Approximate Range of Temperatures for
Hot and Cold Applications
temperatures.
 Applied in a ratio of 3:1, 3 minutes of
heat to 1 minute of cold and repeat 3
times for maximum effect.
 The greater the difference in
temperature of the application, the
greater the effect on the local
circulation.
 Always end with cold application to
prevent congestion Conversion
Indications of Contrast application

 Approximately 2 days to 2 weeks

after an injury.
 The presence of inflammation,
swelling and heat should be
diminishing.

9  NCM104 Lab - Heat & Cold Application

 Urianalysis
Urine Specimen
Urine is a biohazardous substance that
requires the observance of Standard
Precautions. Gloves should be worn at
all times when in contact with the
specimen.
Specimen Container
Specimens must be collected in
clean, dry, leak-proof containers and
should have a wide mouth to facilitate
collections from female patients and a
wide, flat bottom to prevent overturning.
Containers should be made of a clear
material to allow for determination of
color and clarity. The recommended
capacity of the container is 50 mL,
which allows 12 mL of specimen
needed for microscopic analysis,
additional specimen for repeat analysis,
and enough room for the specimen to
be mixed by swirling the container.
Disposable containers are
recommended because they eliminate
the chance of contamination due to
improper washing.
Specimen Labeling
Labels must be attached to the
container, not to the lid, and should not
become detached if the container is
refrigerated or frozen.
All specimen label must contain:
 Patient’s name
 Patient’s identification number
 Date and time of collection
 Patient’s age
 Physician’s name
 Method of collection/type of
specimen
 Possible interfering medications
 Patient’s clinical information.
The time the specimen is
received in the laboratory should be
recorded on the form. Improperly
labeled and collected specimens
should be rejected, and appropriate
personnel should be notified to collect a
new specimen. Unacceptable
situations include:
 Specimens in unlabeled
containers
 Nonmatching labels and
requisition forms
 Specimens contaminated with
feces or toilet paper
 Containers with contaminated
exteriors
 Specimens of insufficient
quantity
 Specimens that have been
improperly transported.
Specimen Handling
The fact that a urine specimen is
so readily available and easily collected
often leads to laxity in the treatment of
the specimen after its collection.
Following collection, specimens should
be delivered to the laboratory promptly
and tested within 2 hours. A specimen
that cannot be delivered and tested
within 2 hours should be refrigerated or
have an appropriate chemical
preservative added.

A requisition form must

accompany specimens delivered to the
laboratory. The information on the form
must match the information on the
specimen label. Additional information
on the form can include:

1NCM104 Lab - Urianalysis


Specimen Preservation
Urine specimens must be
preserved at 2 – 8 degrees Celsius,
which decreases bacterial growth and
metabolism. If the urine is to be
cultured, it should be refrigerated
during transit and held refrigerated until
cultured up to 24 hours. The specimen
must return to room temperature before
chemical testing by reagent strips.
Types of Specimen
To obtain a specimen that is
representative of a patient’s metabolic
state, regulation of certain aspects of
specimen collection is often
necessary. Special conditions may
include:
 Time, length, and method of
collection; and
 The patient’s dietary and
medicinal intake.
2NCM104 Lab - Urianalysis
a. Random Specimen
Random specimen is the
most commonly received specimen
because of its ease of collection and
convenience for the patient. It may be
collected at any time, but the actual
time of voiding should be recorded on
the container.
The random specimen is useful for
routine screening tests to detect
obvious abnormalities. However, it may
show erroneous results resulting from
dietary intake or physical activity just
before collection.
b. First Morning Specimen
The first morning specimen, or 8-
hour specimen, is the ideal screening
specimen. It is also essential for
preventing false-negative pregnancy
tests and for evaluating orthostatic
proteinuria. The first morning specimen
is a concentrated specimen, thereby
assuring detection of chemicals and
formed elements that may not be
present in a dilute random specimen.
The patient should be instructed to
collect the specimen immediately on
arising and to deliver it to the laboratory
within 2 hours.
c. Fasting Specimen
(Second Morning)
A fasting specimen differs from a
first morning specimen by being the
second voided specimen after a period
of fasting.
This specimen will not contain
any metabolites from food ingested
before the beginning of the fasting
period. It is recommended for glucose
monitoring.
 d. 2-Hour Postprandial
Specimen
The patient is instructed to void
shortly before consuming a routine
meal and to collect a specimen 2 hours
after eating. The specimen is tested for
glucose, and the results are used
primarily for monitoring insulin therapy
in persons with diabetes mellitus.
e. Glucose Tolerance
Specimens
Glucose tolerance specimens
are sometimes collected to correspond
with the blood samples drawn during a
glucose tolerance test (GTT) as an aid
to interpreting the patient’s ability to
metabolize a measured amount of
glucose and are correlated with the
renal threshold for glucose.
f. 24-Hour (Timed)
Specimen
To obtain an accurate timed
specimen, the patient must begin and
end the collection period with an empty
bladder. Addition of urine formed before
the start of the collection period or
failure to include urine produced at the
end of the collection period will produce
inaccurate results.
On its arrival in the laboratory, a
24-hour specimen must be thoroughly
mixed and the volume accurately
measured and recorded.
If a specimen is collected in two
containers, the contents of the
containers should be combined and
thoroughly mixed before aliquoting.
g. Catheterized Specimen
This specimen is collected under
sterile conditions by passing a catheter
through the urethra into the bladder.
The most commonly requested test on
a catheterized specimen is a bacterial
culture.
3NCM104 Lab - Urianalysis
h. Midstream Clean-Catch
Specimen
As an alternative to the
catheterized specimen, the midstream
clean-catch specimen provides a safer,
less traumatic method for obtaining
urine for bacterial culture and routine
urinalysis.
Patients must be provided with
appropriate cleansing materials, a
sterile container, and instructions for
cleansing and voiding. Instruct patients
to wash their hands before beginning
the collection. Male patients should
clean the glans, which begins at the
urethra, and withdraw the foreskin, if
necessary.
Female patients should separate
the labia and clean the urinary meatus
and surrounding area. When cleansing
is complete, patients are to void first
into the toilet, then collect an adequate
amount of urine in the sterile container,
and finish voiding into the toilet.
i. Suprapubic Aspiration
Occasionally urine may be
collected by external introduction of a
needle through the abdomen into the
bladder. Because the bladder is sterile
under normal conditions, suprapubic
aspiration provides a sample for
bacterial culture that is completely free
of extraneous contamination.
j. Prostatitis Specimen
The three-glass collection
procedure is used to determine
prostatic infection. Instead of discarding
the first urine passed, it is collected in a
sterile container. Next, the midstream
portion is collected in another sterile
container. The prostate is then
massaged so that prostate fluid will be
passed with the remaining urine into a
third sterile container.
 Clinitest has two methods:
k. Pediatric Specimen o 5-drop method – most
common
Collection of pediatric o 2. 2-drop method – detect
specimens can present a challenge. more extract percentages
Soft, clear plastic bags with when high levels of
hypoallergenic skin adhesive to attach glucose are found in the
to the genital area of both boys and girls urine.
are available for collecting routine
specimens.

l. Drug Specimen
Collection

Urine specimen collection is the

most vulnerable part of a drug-testing
program. Correct collection procedures
and documentation are necessary to
ensure that the results are those of the
specific individual submitting the
specimen. For urine specimens to
withstand legal scrutiny, it is necessary
to prove that no tampering of the
specimen occurred, such as
substitution, adulteration, or dilution.

Urine Glucose Test

A urine glucose test measures

the level of glucose, or sugar, in the
urine. It is less invasive than a blood
glucose test, but it also tends to be less
accurate. It is often performed to check
for diabetes and may also be done to
check for kidney problems or a urinary
tract infection.

Types of Urine Glucose Tests

a. Clinitest
b. Reagent Strip Test
The clinitest is a method of urine
testing for sugar (glucose) using a The reagent strip test is a
tablet that is dropped into the urine in a method of urine testing for sugar
test tube. It uses an alkaline copper (glucose) using strips that are dipped
sulfate reagent tablet to test for into the urine in a test tube.
reducing substances; e.g. sugars, in
urine. Gives a quantitative result by
color changes from green (0.5%
glucose) to orange (2% glucose)

4NCM104 Lab - Urianalysis


c. Urinalysis Using
Benedict’s Solution
Benedict’s Test is used to test for
simple carbohydrates. It identifies
reducing sugars (monosaccharide’s
and some disaccharides), which have
free ketone or aldehyde functional
groups. Benedict’s quantitative
reagent contains potassium
thiocyanate and is used to determine
how much reducing sugar is present.
Benedict’s solution is a deep-
blue alkaline solution used to test for
the presence of the aldehyde functional
group, – CHO. One liter of Benedict’s
solution can be prepared from 100 g of
anhydrous sodium carbonate, 173 g of
sodium citrate and 17.3 g of copper (II)
sulfate pentahydrate.
The color of the mixture serves
as a guide to the amount of sugar in
the urine:
o blue-sugar absent;
o green-0.5% sugar;
o yellow-1% sugar;
5NCM104 Lab - Urianalysis
o orange-1.5%sugar;
o brick red-2 % or
more sugar.
Urine Albumin Test
An albumin test checks the urine
for a protein called albumin. Albumin is
normally found in the blood and filtered
by the kidneys. It is a protein your body
uses for tissue growth and repair.
Ideally, waste products end up in
the urine while albumin and other
proteins stay in the blood vessels. If
albumin shows up in the urine, it may
be a sign of kidney damage. Albumin in
the urine is called albuminuria
(proteinuria).
Signs of Albumin in the Urine
 Early stages of kidney damage
will mostly be asymptomatic.
The only way to know if albumin
is present in the urine is to have
a urine test.
 When kidney damage gets
worse and large amounts of
protein escape through the
urine, the following symptoms
may be noticed:
o Foamy, frothy or bubbly-
looking urine
o Swelling in your hands,
feet, abdomen or face
Urinalysis Using Acetic Acid

In a community setting,
urinalysis using acetic acid is a good
tool for nurses to have an idea about
the albumin in the urine. This is done for
people with history of hypertension.
The turbidity of the mixture
serves as a guide to the amount of
albumin in the urine:
 No turbidity: negative
 Faint turbidity: (+)1
 Heavy Turbidity: (+)2
 Solid (opaque): (+)3

6NCM104 Lab - Urianalysis