Heat and Cold Therapy PDF
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KPJ Healthcare University
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This document provides an overview of heat and cold therapy, including learning outcomes, terminology, temperature regulation, and applications. It discusses the effects of heat and cold on the body, including physiological effects and contraindications. The document is likely a study aid for healthcare professionals or students of physiotherapy or a similar field.
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HEAT AND COLD THERAPIES Learning Outcome i. Identify various modes of heat therapy. ii. Describe the physiologic effects of local heat applications (thermotherapy) iii. Identify various modes of cold therapy (cryotherapy) iv. Describe the physiologic effects of local cold applications (cryotherapy...
HEAT AND COLD THERAPIES Learning Outcome i. Identify various modes of heat therapy. ii. Describe the physiologic effects of local heat applications (thermotherapy) iii. Identify various modes of cold therapy (cryotherapy) iv. Describe the physiologic effects of local cold applications (cryotherapy) v. Identify indications and contraindications for various heat and cold therapies. vi. Identify safety precautions to consider when applying heat and cold treatments INTRODUCTION Terminology (refer chapter 24 –Pg;854 : Clinical Nursing Skills) Antipyretic Evaporation Pallor Compress Fever Radiation Conduction Hyperemia Shivering Convection Hyperthermia Suppuration Cryotherapy Hypothermia Thermotherapy Cyanosis Insulator Vasoconstriction Erythema Mottling Vasodilation TEMPERATURE REGULATION is regulated & maintained by interrelated feedback system, which can be altered by disease or environmental conditions. Temperature regulation is a homeostatic function that balances heat production & loss to maintain body temperature ( 36 °C – 37.5 °C) Controlled by – body’s thermostat, the hypothalamus Process of Heat Transfer Conduction, Convection, Radiation, Evaporation HEAT AND COLD APPLICATIONS Heat and cold are applied to the body for local and systemic effects. Local heat application : thermotherapy Cold application: cryotherapy The physiologic effects of heat Heat applications beneficial only for subacute & chronic inflammation not during the acute inflammatory phase of musculoskeletal injury. Heat produces analgesia and sedation by promoting release of endorphins and by stimulating nerve endings to block pain transmission by the gate control theory of pain modulation. Local Effects of Heat Heat has been a long-standing remedy for aches and pain, / with comfort & relief. Heat causes vasodilation & increases blood flow to the affected area, bringing oxygen, nutrients, antibodies, and leukocytes. Application of heat promotes soft tissue healing and increases suppuration. A possible disadvantage of heat is that it increases capillary permeability, which allows extracellular fluid & substances such as plasma proteins to pass through the capillary walls and may result in edema or an increase in pre-existing edema. Heat is often used for pt.s with musculoskeletal problems such as joint stiffness from arthritis, contractures, and low back pain. Local Effects of Cold The physiological effects of cold lowers the temperature of the skin and underlying tissues and causes vasoconstriction. Vasoconstriction reduces blood flow to the affected area & reduces the supply of oxygen & metabolites, decreases the removal of wastes, and produces skin pallor & coolness. Prolonged exposure to cold results in impaired circulation, cell deprivation, and subsequent damage to the tissues from lack of oxygen & nourishment. The signs of tissue damage due to cold are a bluish purple, mottled appearance of the skin, numbness, & sometimes blisters & pain. Cold is most often used for sports injuries (eg; sprains, strains, fractures) to limit postinjury swelling & bleeding. Physiological effects of heat & cold Commented [JAS1]: Refer Box 36-3; Pg- 883 HEAT COLD Systemic Effects of Heat and Cold Heat applied to a localized body area, particularly a large body area, may cause excessive peripheral vasodilation, which produces a drop in blood pressure. With extensive cold applications & vasoconstriction, a pt.’s Bp can increase because blood is shunted from the cutaneous circulation to the internal blood vessels. Shivering, a generalized effect of prolonged cold, is a normal response as the body attempts to warm itself. Thermal Tolerance Specific conditions necessitate precautions in the use of hot / cold application: i. Neurosensory impairment – people with sensory impairments ii. Impaired mental status – people who are confused iii. Impaired circulation – people with peripheral vascular disease, diabetes iv. Immediately after injury / surgery – heat increases bleeding & swelling. v. Open wound – Cold can decrease blood flow to the wound thereby inhibiting healing. Variables Affecting Physiological Tolerance to Heat and Cold Body part – The back of the hand & foot are not very temperature sensitive. The inner aspect of the wrist & forearm, the neck, & the perineal area are temperature sensitive. Size of the exposed body part. The larger the area exposed to heat & cold, the lower the tolerance. Individual tolerance ; the very young & old – lowest tolerance. Length of exposure. People feel hot & cold applications , after a period of time. Intactness of skin. Injured skin areas are more sensitive to temperature variations. Temperature for Hot and Cold Applications Commented [JAS2]: Refer Table 36-7: Pg;884 Description Temperature Application Very cold Cold Cool Tepid Warm Hot Very Hot Applying Heat and Cold Heat can be applied to the body in both dry and moist forms. Type of heat and cold therapy i. Dry heat is applied locally by means of a hot water bottle, aquanthermia pad, disposable heat pack, or electric pad. ii. Moist heat can be provided by compress, hot pack, soak, or sitz bath. iii. Dry cold – generally applied locally by means of a cold pack, ice bag, ice glove, or ice collar. iv. Continuous cold therapy (cryotherapy) following joint surgery or injury can be delivered. Guidelines for local applications of heat or cold i. Determine the pt.’s ability to tolerate the therapy. ii. Identify conditions that might contraindicate treatment (eg; bleeding, circulatory impairment) iii. Explain the application to the pt. iv. Assess the skin area to which the heat / cold will be applied. v. Ask the pt. to report any discomfort. vi. Return to the pt. 15 minutes after starting the heat / cold therapy, and observe the local skin area for any untoward signs (eg; redness). Stop the application if any problems occur. vii. Remove the equipment at the designated time, and dispose of it appropriately. viii. Examine the area to which the heat or cold was applied, and record the pt.’s response. Contraindications to the Use of Heat and Cold i. Neurosensory impairment – sensory impairment ii. Impaired mental status – confused / an altered level of consciousness iii. Impaired circulation – peripheral vascular disease iv. Open wounds Contraindicating the use of heat: v. The first 24 hours after traumatic injury : heat increases bleeding & swelling. vi. Active hemorrhage :heat – causes vasodilation & increases bleeding. vii. Noninflammatory edema: Heat increases capillary permeability & edema viii. Skin disorder – causes redness / blisters – can burn / further damage. Contraindicating the use of cold ix. Open wounds: increase tissue damage by decreasing blood flow x. Impaired circulation: impair nourishment of the tissues & cause tissue damage. xi. Allergy / hypersensitivity to cold Selected Indications of Heat and Cold ( refer Table 36-8; Pg- 884) Indication Effect of Heat Effect of Cold Muscle spasm Inflammation Pain Contracture Joint stiffness Traumatic injury Tepid Sponging Assessment Assess body temperature. Equipment Basin , 6 Small towels, Bath blanket, Thermometer. Preparation i. Ensure pt.’ body temperature ii. Gather equipment and bring to pt.’s room. iii. Check pt.’s identification band. iv. Provide privacy & explain procedure v. Perform hand hygiene. Procedure (Refer notes)