Chapter 9Chapter 9 Cold and Heat TherapyCold and Heat Therapy

Section IntroductionⅠ

Section Cold and Heat applicationsⅡ

Section IntroductionⅠSection IntroductionⅠ

Concept of Cold and Heat Therapy

Bodily Responses to Cold and Heat Therapy

Factors Influencing the Effect of Cold and Heat Therapy

Concept of Cold and Heat Concept of Cold and Heat TherapyTherapy

The Cold and Heat Therapy is a therapy method that utilizes substances, the temperature of which are lower or higher than the skin surface temperature, acting on the skin, to attain local and systemic treating effects.

cold receptors （ Krause 小体 ): -- 真皮上层（乳头状层） , 接受冷的迅息 .

Heat receptors （ Ruffini’s 小体 ): -- 真皮下层（网状层 ), 接受热的迅息 .

25-30 万个

3 万个

Heat and cold receptors adapt rapidly to temperature changes in the body’s environment.

表皮真皮

冷刺激冷刺激

真皮上层 Krause 小体

热刺激热刺激

真皮下层 Ruffini’s 小体

传入传入神经纤维神经纤维

大脑皮质感觉中枢

传出传出神经纤维神经纤维

机体产生相应运动 反射性地引起皮肤和内脏器官血管收缩或扩张

改变机体各系统的体液循环和代谢活动

Bodily Responses to Bodily Responses to Cold and Heat TherapyCold and Heat Therapy

Initial, or Primary Responses

Physiological Responses

Thermal Receptors Adaptation Secondary Responses

Physiological ResponsesPhysiological ResponsesHeat Cold

· Vasodilation · Vasoconstriction

· Increases blood flow to the affected area; increases supply of nutrients, oxygen, and wastes removal

· Reduces blood flow to the affected area; reduces supply of nutrients, oxygen, and wastes removal

· Increases capillary permeability · Decreases capillary permeability

· Increases cellular metabolism · Decreases cellular metabolism

·Increases amount and motility of leukocytes

·Decreases amount and motility of leukocytes

· Increases inflammation and suppuration ·Slows bacterial growth, decreases inflammation

· Increases lymph flow · Reduces lymph flow

·Raises body temperature ·Lowers body temperature

· Decreases the viscosity of the blood · Increases the viscosity of the blood

· Decreases muscle tonus and relaxes muscles

· Increases nerve impulse conduction · Decreases nerve impulse conduction

· Decreases viscosity of synovial fluids  

When the heat and cold receptors are subjected to an abrupt change in temperature, the receptors are strongly stimulated initially. This strong stimulation declines rapidly during the first few seconds and then more slowly during the next half hour or more as the receptors adapt to the new temperature. This phenomenon is called thermal receptors adaptation.

Thermal Receptors AdaptationThermal Receptors Adaptation

16 ～ 42 ℃

Secondary ResponsesSecondary Responses继发性效应继发性效应

When the maximum therapeutic effect of the heat or cold application is achieved, the opposite effect begins. We call these phenomenon secondary responses.

For exampleFor example

heat produces maximum vasodilation in

20 to 30 minutes; continuation of the application beyond 30 to 45 minutes brings tissue congestion, and the blood vessels then constricted.

Similarly, cold applications can cause blood vessel constriction, but continuation of application beyond 30 minutes to 1 hour brings vasodilation for 10-15minutes.

Factors Influencing the Effects Factors Influencing the Effects of Cold and Heat Therapyof Cold and Heat Therapy

Treatment method Size of the exposed body part Duration of application Prior skin temperature Environmental temperature Body part Individual tolerance

Treatment methodTreatment method

moist heat or cold dry heat or cold

the therapeutic effects of moist application are better than that of

dry application.

Environmental temperatureEnvironmental temperature

When the environmental temperature is greater than or equal to the body temperature, conductive loss is inhibited.

                                                                                                     

 

Body partBody part

The foot and palm of hand have thicker skin and are therefore less temperature-sensitive.

certain areas where the skin is thinner, such as the inner aspect of the wrist and forearm, eyelids, the neck, and the perineal area( 会阴部 ) are less tolerant to temperature variations.

Individual toleranceIndividual tolerance

very old person----the sensitivity to heat or cold is decreased and therefore response to the heat and cold stimuli is retarded.

Infants----have limited abilities to adapt to heat and cold because of their immature neurological functioning.

clients who have neurosensory impairments

Section ⅡSection Ⅱ Cold and Heat applications Cold and Heat applications

Cold applicationHeat application

Cold applicationCold application

Therapy Effects of ColdContradictions to cold applicationsmethods

Therapy Effects of ColdTherapy Effects of Cold

Relief of congestion or hemorrhage to the affected area ( 减轻局部充血和出血 )

Relief of painControlling inflammationReducing fever, and so on.

细胞代谢细胞代谢 增加增加 减少减少需氧量需氧量 增加增加 减少减少血管血管 扩张扩张 收缩收缩毛细血管通透性毛细血管通透性 增加增加 减少减少血液黏稠度血液黏稠度 降低降低 增加增加血液流动血液流动 增快增快 减慢减慢淋巴流动淋巴流动 增快增快 减慢减慢结缔组织伸展性结缔组织伸展性 增强增强 减弱减弱神经传导速度神经传导速度 增快增快 减慢减慢体温体温 上升上升 下降下降

生理效应生理效应 用用 热热 用用 冷冷

细胞代谢细胞代谢 增加增加 减少减少需氧量需氧量 增加增加 减少减少血管血管 扩张扩张 收缩收缩毛细血管通透性毛细血管通透性 增加增加 减少减少血液黏稠度血液黏稠度 降低降低 增加增加血液流动血液流动 增快增快 减慢减慢淋巴流动淋巴流动 增快增快 减慢减慢结缔组织伸展性结缔组织伸展性 增强增强 减弱减弱神经传导速度神经传导速度 增快增快 减慢减慢体温体温 上升上升 下降下降

生理效应生理效应 用用 热热 用用 冷冷

细胞代谢细胞代谢 增加增加 减少减少需氧量需氧量 增加增加 减少减少血管血管 扩张扩张 收缩收缩毛细血管通透性毛细血管通透性 增加增加 减少减少血液黏稠度血液黏稠度 降低降低 增加增加血液流动血液流动 增快增快 减慢减慢淋巴流动淋巴流动 增快增快 减慢减慢结缔组织伸展性结缔组织伸展性 增强增强 减弱减弱神经传导速度神经传导速度 增快增快 减慢减慢体温体温 上升上升 下降下降

生理效应生理效应 用用 热热 用用 冷冷

细胞代谢细胞代谢 增加增加 减少减少需氧量需氧量 增加增加 减少减少血管血管 扩张扩张 收缩收缩毛细血管通透性毛细血管通透性 增加增加 减少减少血液黏稠度血液黏稠度 降低降低 增加增加血液流动血液流动 增快增快 减慢减慢淋巴流动淋巴流动 增快增快 减慢减慢结缔组织伸展性结缔组织伸展性 增强增强 减弱减弱神经传导速度神经传导速度 增快增快 减慢减慢体温体温 上升上升 下降下降

生理效应生理效应 用用 热热 用用 冷冷

减轻局部充血和出血减轻局部充血和出血

使局部血管收缩 ,血流减少 毛细血管的通透性降低

使血流减慢 血液粘稠度增加

适用于 : 扁桃体摘除术后 ; 鼻衄 ; 局部软组织损伤的初期 , 等 .

减轻局部充血

促进血液凝固而控制出血

减轻疼痛减轻疼痛

抑制细胞的活动 减慢神经冲动的传导

血管收缩 毛细血管的通透性降低 , 渗出减少适用于 : 急性损伤的初期 ; 烫伤 ; 牙痛 , 等 .

使神经末稍的敏感性降低而减轻疼痛 .

减轻由于组织肿胀压迫神经末梢而引起的疼痛 .

控制炎症扩散控制炎症扩散

可使局部血管收缩，血流量减少 血流速度减慢 细胞代谢率和细菌的活力降低

适用于 : 体表部位炎症早期 . 如鼻部软组织发炎早期，可采用鼻部冰敷以控制炎症扩散 .

降低体温降低体温

冷直接与皮肤接触，通过传导与蒸发的物理 作用，降低体温 ;头部用冷 : 可降低脑细胞的代谢，减少脑细胞

需氧量 , 提高脑细胞对缺氧的耐受性 , 减少脑细胞的损害 ,有利于脑细胞功能的恢复。

适用于 : 高热、中中暑患者降温 ; 脑外伤、脑缺氧等患者 .

Contradictions to cold applicationsContradictions to cold applications

Impaired Local Circulation Chronic Inflammation and Deep

SuppurationClients with Cold Hypersensitivity, Heart

Diseases and very Weak ClientsContradicted Body Parts

血液循环障碍血液循环障碍

大面积组织受损 休克 微循环障碍 周围血管病变 动脉硬化 糖尿病 水肿 , 等

•进一步使血管收缩

• 减少局部组织的血供

•导致组织变性坏死

冷疗

血管收缩，血流减少，影响细胞间液的吸收 .

慢性炎症或深部化脓病灶慢性炎症或深部化脓病灶

关节炎 慢性背部疼痛 痔疮 肛周脓肿等

可使局部血流减少

阻碍炎症的吸收

冷疗

Contradicted Body PartsContradicted Body Parts

posterior occipital, external ear and scrotum

( 枕后、耳廓、阴囊 ); precordial region( 心前区 )--may result in

reflexible decreased heart rate and arrhythmia; Abdomen( 腹部 )--abdominal pain and

diarrhea; sole of foot( 足底 )-- can cause reflexible

coronary artery constriction.

MethodsMethods

ice bag, ice cap or ice collar chemical cold pack

moist cold

cold compresscold soaks cooling sponge bath

dry cold

alcohol sponge bath

tepid sponge bath

local

preparationpreparation

Assessment

the client's physical condition

Equipment

The client's level of sensation

Explanation The client understands the purpose of the therapy and precautions taken during treatment.

Use of Ice BagsUse of Ice Bags

Purpose

to reduce body temperature.to reduce hemorrhage, swelling and pain after sprains, head injuries and dental surgeries

EquipmentEquipment

ice bagcloth cover

towel

basin

ice, and so on

Procedures and key pointsProcedures and key points

Fill the ice bag one half to two thirds full of crushed ice .

Use of Ice capsUse of Ice caps

Purpose

to lower head temperature and prevent brain edema for unconscious clients.

EquipmentEquipment

*ice cap *drawsheet ( 垫单 )

*bucket

*sterile drape ( 无菌治疗巾 )

*small pillow

*Sponges

*rectal thermometer( 肛 温计 )

*ice *basin

Procedures and key pointsProcedures and key points

Take away the pillow, spread the drawsheets under the client's head, place a sterile drape inside the ice cap .

Place the ice cap around the client’s head, apply spongy pad beneath auricles( 外耳 ), occiput( 枕骨部 ) and neck, and the small pillow under client's shoulders. The drainage tube is down into the bucket.

Take anus temperature ( 肛温 ),

maintain it around 33 .℃

Below 30℃ ventricular fibrillation( 室颤 )

Cold moist CompressCold moist Compress(( 冷湿敷冷湿敷 ))

• The moist compress is a moist gauze dressing applied to the body part.

• The compresses are usually immersed into the ice water and then applied to the body part.

• Replace compresses are necessary to maintain coolness. (3 ～ 5min)

• If a sterile compress is ordered, the nurse should follow the sterile principles.

Chemical cold packsChemical cold packs

a prefilled plastic package with two separate compartments.

strikes, kneads or squeezes the pack to mix one chemical compound with the other and provide a controlled temperature.

十水碳酸钠和硝酸铵

Hypothermia blanketsHypothermia blankets(( 降温毯降温毯 ))

This appliance is made based on the principle of semiconductor refrigeration. There is a circulating exchange between the cooled distilled water in the water tank and that in the hypothermia blanket via main machine. This process facilitates the heat loss of the skin in contact with the blanket, and then the body temperature is lowered.

tepid water sponge bath（温水擦浴） 32 ～ 34℃

alcohol sponge bath（乙醇擦浴） 25 ～ 35% ; 30℃

Heat applicationHeat application

therapy effects of heat contradictions to heat applicationsmethods

Therapy effects of Therapy effects of heatheat

promotes suppuration and phagocytes, and then promotes elimination and localization of inflammation

Relief of deep congestion and swelling Relief of pain, Reduction of muscle spasms

and joint stiffnessProviding warmth and Comfort

促进炎症的消散和局限促进炎症的消散和局限

局部血管扩张 促进组织血液循环

•有利于组织中毒素、废 物的排出 ;•增强新陈代谢和白细胞 的吞噬功能 .

炎症早期 : 热疗可促进炎性渗出物的吸收和消散；炎症后期 : 可促使白细胞释放出蛋白溶解酶，溶解

坏死组织，使炎症局限 .

临床多用于软组织细菌性感染早期、慢性感染的辅助治疗 . 如 :

• 麦粒肿： 早期湿热敷可促进炎性渗出物的吸收和消散或促进硬结迅速化脓 .

• 软组织扭伤 48h 后 :

热湿敷可促进关节、软组织淤血的吸收和消散 .

减轻深部组织充血减轻深部组织充血

体表血管扩张 ,血流量增多

•足部热疗可减轻头部充血 ;•软组织损伤后期 .

深部组织血流量减少

全身循环血量

重新分布

减轻疼痛减轻疼痛

• 降低痛觉神经的兴奋性 ;• 改善血液循环 , 加速致痛物质的运出 ; • 加速炎性渗出物吸收，解除对神经末梢的压迫；• 松弛肌肉、肌腱、韧带等组织，解除肌肉痉挛和

关节强直 .

常用于 : 腰肌劳损、关节炎的治疗 ; 肌肉紧张所致的疼痛 ; 胃肠痉挛、肾绞痛、痛经等。

Contradictions to heat applicationsContradictions to heat applications

Unidentified acute abdomen Facial dangerous triangle area infection Hemorrhagic diseases Injuries of soft tissues within 48 hours Bacterial Conjunctivitis (细菌性结膜炎 )Neurosensory impairment and impaired

mental status

MethodsMethods

hot-water bag heating lamp Chemical heating bags

moist heat

moist hot compress sitz bath ( 坐浴 ) hot soaks (浸泡 )

dry heat

preparationpreparation

Assessmentthe client's skin area

Equipment

The client's level of sensation

Explanation The client understands the purpose of the therapy and precautions taken during treatment.

Use of Hot-water bagsUse of Hot-water bags

Purposeto relieve spasm and painto provide warmth and comfort

EquipmentEquipment

hot water bag and cover

hot water(60℃~70℃ )

dry towel

thermometer

ProceduresProcedures

* Place the hot water bag flat, Fill the bag with hot water about a half to two thirds full .

* turn the stopper until it is tight

* Place the hot water bag flat gradually and expel the remaining air

Wrap the bag in a cloth cover and tighten its ties

Dry the bag and hold it upside down to check for its leaks

Place the bag on the body site of the client as appropriate

key pointskey points

For unconscious clients, elders, infants, and clients who haven't regain consciousness after anaesthesia, the safe water temperature should be 50℃ in order to avoid burns.

For the client with impaired sensation, a large towel should be put over the bag with a cloth cover or a blanket is used to wrap the bag.

Remove the bag no more than 30 minutes after application if the purpose is to give treatment.

Use of Hot LampsUse of Hot Lamps

Purpose

to reduce inflammationto relieve spasm and painto promote scar and granulation tissue formation

EquipmentEquipment

gooseneck lamp

Procedures and key pointsProcedures and key points

The distance is usually 30 to 50cm

eyes should be covered

The duration of this application is 20~30minutes.

Observe the local exposed skin closely during treatment

Hot moist compressHot moist compress

Purposeto reduce inflammation and edema to relieve spasm and pain

EquipmentEquipment

· tray · sterile dressing transfer forceps · dressings

· sterile petrolatum · sterile cotton swab · sterile gauze

· plastic sheet · small rubber drawsheet · sterile drape

· cotton mat · electrical stove · thermometer

· boiler (hot water (50 ～ 60 )℃ · hot water bag (if necessary)

ProceduresProcedures

cover a sterile gauze on it.

Spread light coat of sterile petrolatum over skin surface to be treated.

Put dressings into the hot water(Put dressings into the hot water(5050~60~60℃℃))

Take out dressings with sterile transfer forceps and wring excess water. Apply the dressing onto the area to be treated.

then cover it with a plastic sheet and cotton mat.

key pointskey points

Change dressings every 3 to 5 minutes and observe skin condition.

If continuous compresses are ordered, it can be applied 15 to 20 minutes.

Hot sitz bathHot sitz bath

Purpose

To reduce edema in rectum and organs in pelvic cavity ( 盆腔 ).to relieve edema, inflammation and pain in the area of anus and perineum( 会阴 ).to clean the local area and provide comfort.

EquipmentEquipment

· hot water bottle

· sitz bath solution

· steriled gauzes

· thermometer

· large bath blanket

•sterile sitz bath tub

•sitz bath chair

ProceduresProcedures

Place the sitz bath tub in a special chair. Pour the hot water(40~45℃) into the tub until a half full. Then make prescribed solution.

Allow the client to have sitz bath for 15 to 20 minutes and maintain a constant temperature by adding warm water.

Observe the client for pulse, respiration and facial color. (light-headed or nauseated)

After the sitz bath, assist the client out of the tub.

key pointskey points

The bath tub and medication fluid should be sterile if there is wound.

It' s not preferred

for the female client

during menses( 月经 ) in the latter period of

pregnancy ( 妊娠后期 ) less than 2 weeks after

delivery ( 产后 2周内 ) having vaginal bleeding

( 阴道出血 ) having acute inflammation

in pelvic cavity.盆腔器官急性炎症

hot soaks

• 43 ～ 46℃

• 30min