FUNDAMENTALS OF NURSING

PROF. DORITHY B. INOT, MSN,RN, LPT

Hot and Cold Application
At the end of this unit, the students are expected to:

1. Implement safe and quality nursing care in the performance of

hot and cold application.
2. Operate appropriate equipment/technology in the performance
of hot and cold application.
3. Participate in research by analyzing possible problems in the
application of hot and cold
compress
4. Demonstrate caring as the core of nursing, love of God, love of
country, love of people.
5. Integrate being an A.C.H.I.E.V.E.R. in the performance of nursing
procedures involving hot and cold application.

Brief Overview

Temperature receptors in the body adapt to

temperature changes. Nurses and clients need to understand this
because a hot application can
cause burn injuries while cold application can result to pain and
severe circulation impairment.

Physiologic Effects of Heat and Cold

Therapeutic Application

Local application of heat and cold in the body can be beneficial.

They can either be in moist or dry forms. But before using these
therapies, the nurse must understand the HOW and WHEN of their
usage.

A. Heat Application
A. Dry heat:
- Hot water bottle/bag = mostly used, especially at home; accessible
and economical

Aquathermia pad (K-pad) = pad is attached by a tubing to an

electrically powered control unit (waterproof); has a temperature
gauge

- Disposable heat pack or electric heating pad = provide constant,

even heat; can be molded to the body part (CAUTION! Can cause
burns if the setting is too high)

B. Moist Heat

Hot compress- use of gauze pads or roll or towels

Hot pack - commercially prepared; provides heat for a designated
time only; directions for use are found on the package labels to initiate
heating process; applied to wound or injury (water temperature =
40°C)
Hot soak = requires immersing a body part in a solution or wrapping in
gauze dressings saturated with a solution (observe sterile technique
for open wounds); use to soften or remove crusted/dead tissues

Hot sitz bath = also known as hip bath; soak perineal or rectal area
into a solution (e.g. Epsom salt, witch hazel, lavender oils) while the
client sits on a special chair or tub (water temperature = 40-43°C)

Cold Application
Dry cold:
- Cold pack = same as hot pack but, it initiates cooling process
- Ice bag, ice glove, ice collar = filled with ice chips or alcohol-based
solution; must be wrapped in a towel or cover when being used
Moist cold:
- Compress
- Cooling sponge bath = to reduce fever of over 40°C by heat loss
through conduction and vaporization accompanied by antipyretics
(water temperature = 27-37°C)

PRECAUTIONS!

1. Neurosensory impairment – they are unable to perceive hot and

cold temperatures that can lead to burns or tissue injuries

2. Impaired mental status – they have altered level of consciousness

and need monitoring during applications to ensure safety

3. Impaired circulation – those with diabetes mellitus or congestive

heart failure lack the usual ability to dissipate heat via blood
circulation making them at risk for tissue damage

4. Post-surgery – heat increases bleeding and swelling

5. Open wounds – cold can decrease blood flow to the wound and
impair the healing process
Thermal Tolerance Considerations
1. Body part – foot and back of hand are NOT overly sensitive to
temperature
- Eyelids, neck, Inner aspect of arm, and perineal area are
extremely sensitive to temperature
- The larger the body size exposed to heat and cold, the lower
the tolerance
2. Length of exposure – tolerance increase after some time
3. Skin integrity – areas of the skin with injury/ trauma
(compromised skin integrity) are more sensitive to heat and
cold

REBOUND PHENOMENON
–occurs at the time the maximum therapeutic effect of a hot or cold
application is achieved and the opposite effect begin (Berman,
Snyder, and Frandsen, 2020) Therefore, thermal applications must be
halted before this phenomenon begins.
HOT APPLICATION

• Heat produces maximum vasodilation in 20-30 minutes.

• Continuation beyond 30-45 minutes causes tissue congestion,

the blood vessel constrict

• Now the opposite effect is occurring because of reflex vascular

constriction.

• Recovery time of one hour is advised before reapplication

COLD APPLICATION
• Maximum Vasoconstriction occurs when the skin temperature
reaches 150 or in about 30 minutes to one hour.

• Vasodilation begins as a protective device to prevent the

body tissue from freezing.

• Recovery time of one hour is best before reapplication

Guidelines in application

1. Check the order, check armband

2. Assess general condition of patient
3. Assess area where application going
4. Check functioning equipment
5. Reassess patient and response in 15 minutes
6. Stop treatment at designated time
7. Examine the place where treatment occur
8. Record the patient response
Contraindication of hot application
1. The first 24 hours after traumatic injury
2. Active hemorrhage (heat causes vasodilatation and increase
bleeding.
3. Local Malignancies
4. Impaired kidney, heart and lung functions
5. Acutely inflamed areas
6. On clients with paralysis
7. Open wounds
8. Edema associated with venous or lymphatic disease
9. Headache
10. Client with metabolic disorders
11. Very young and very old
12. Client with very high temperature.
Contraindications for cold application

Cold application is not suitable for the following conditions:

•Deep vein thrombosis

•Peripheral vascular disease

•Open wound

•Skin sensation impairment (e.g. some diabetic patients)

•Severe cognitive impairment (e.g. dementia patients)

•Cold allergy
STOP the application immediately if any untoward incident or
problem(s) occur.
EVALUATION

1. Inspect the body part or wound condition for evidence of

effectiveness of therapy and
sensitivity to touch.
2. Ask client to describe level of comfort and burning sensation
following the treatment.
3. Obtain vital signs and compare with baseline.
4. Identify any unexpected outcome(s).
Recording and Reporting: Record, document, and report all
pertinent information of the
procedure performed.