Application of heat means
the application of an agent
warmer than the skin.
Withdrawal of heat means
putting an agent that is
cooler than the skin on it.
e.g. cold materials.
3. HOT APPLICATIONS
Heat is applied in either a moist or dry form. In dry
applications, moisture is not used on the skin. e.g.
giving hot water bag, Infra red rays.
4. TYPES OF HOT APPLICATION
• In giving moist hot applications, the body, or a part
of it, is wet.
• It includes baths, packs, compresses, stupes,
fomentations and poultices.
5. COLD APPLICATIONS
• Cold applications are also either moist or dry.
• Moist applications include cold compresses, packs, sponge baths.
• Dry applications include giving the ice bag.
• Moist applications of either heat or cold are more penetrating than dry
Hot Applications Cold Applications
1 Peripheral vasodilatation Peripheral vasoconstriction.
2 Increased capillary permeability. Decreased capillary permeability.
3 Local metabolism is increased Local metabolism is decreased
4 Oxygen consumption is increased. Oxygen consumption is decreased
5 Blood viscosity is decreased. Blood viscosity is increased.
6 Blood flow is increased. Blood flow is decreased.
7 Lymph flow is increased. Lymph flow is decreased.
8 Motility of leucocytes is increased. Motility of leucocytes is decreased.
9 Muscle tone is decreased. Muscle tone is decreased.
7. Secondary Effects of Hot and Cold
After giving local heat applications the circulation
and tissue temperature increases to its maximum
after 20 to 40 minutes. The heat application
should be discontinued at this time and a
recovery time of one hour should be allowed,
otherwise secondary effects i.e. vaso constriction
will take place.
After giving cold applications the primary effects
lasts only for 30 minutes to one hour. Recovery
time should be given for one hour, otherwise
secondary effects i.e. vaso dilatation will take
8. USES OF HOT APPLICATIONS
suppuration and draws
blood to an inflammed
area or from a
It relaxes muscles and
relieves fatigue and
exchange of oxygen
and hastens absorption
circulation and there
by increases the
9. USES OF HOT APPLICATIONS
Heat increases blood supply to
an area and thereby increases
the supply of leucocytes,
antibodies and nutrients to an
injured area and promotes
Heat reduces pain by
increasing blood supply to that
Heat provides warmth. It softens fibrous tissue.
10. USES OF COLD APPLICATIONS
It prevents fluid
congestion in sprains.
It reduces body
Cold causes vaso
constriction and increases
blood viscosity, so that
bleeding is under control.
Cold decreases tissue
metabolism and prevents
Cold relieves pain by
decreasing nerve impulse
Cold diminishes the
formation and absorption
of bacterial poisons and
checks the growth of
Cold anaesthetize an area.
11. CONTRAINDICATIONS OF HOT APPLICATIONS
and tooth abscess.
heart and lung
Patients with high
12. CONTRAINDICATIONS OF COLD APPLICATIONS
Patients who are
in shock and
a sensation of
When there is a
13. Cold Applications
Definition - A moist cold application
is given to a part with a cloth or a
• To reduce fever.
• To relieve pain and inflammation.
• For treatment of sprain, epistaxis
and black eye.
Local cold Applications
14. Articles - In a square tray - 1) Bowl with ice water, 2) Folded lint pieces or
gauze pieces, 3) narrow mackintosh and towel.
1. Place equipment to the beside of the patient.
2. Explain the procedure to the patient and relatives.
3. Place mackintosh and towel under the area to be treated.
4. Soak compress in cold water and apply to the area.
5. Continue to do until desired result is obtained or for half an hour.
6. Remove and place equipment to its usual place.
7. Record the result on case paper and nurses record with date and
15. ICE CAP
• To check the bleeding.
• To relieve pain.
• To relieve congestion.
• To reduce oedema.
Articles Needed - In a square tray -
• 1) Ice cap with cover, 2) Ice in bowl, 3) Water in a bowl, 4) Ice-pick, 5)
Salt 6) Tea spoon, 7) Duster to wipe ice cap.
16. Procedure -
• Crack ice until the pieces are of required size.
• Add salt.
• Fill ice cap half full of ice, and expel air from the cap.
• Screw on cap tightly.
• Put cover over ice cap.
• Apply ice cap to area as required.
• Record the procedure on case paper and nurses record with date and
• Record any discolouration or numbness and report it to ward sister.
N.B. While giving ice cap to check the internal
bleeding e.g. bleeding from gastric or
pulmonary area use bed cradle to hang the ice
17. General cold Applications
Definition - A cold or tepid sponge is a general application of moist cold liquid to
cool the skin by evaporation and by the absorption of heat in the cold water.
Temperature of water - The water used for a tepid sponge is 80F to 90 F [23.9 de
to 26.7 deg C]. The water used for a cold sponge is below 70 deg F [ 21.1 deg C ].
• To reduce temperature.
• To stimulate circulation and respiration.
• To decrease toxicity, nervousness and delirium.
Articles Needed - A tray containing -1) basin, 2) Jug of cold water, 3) A bath
thermometer, 4) small bowl with cold or ice water and compresses to apply to
the head, 5) Hot water bag, 6) Bath towel. 7) sponge bags 6, 8) face towel, 9)
soap, spirit and talcum powder, 10) towels 2, 11) long mackintosh.
COLD OR TEPID SPONGING
19. General Instructions -
There must be written order of a physician for cold / tepid sponging.
Use long strokes for sponging.
Avoid circular movements or friction while sponging.
Keep hot water bag ready at the foot end of the bed.
The water should be between 80 to 90 deg. F for sponging.
20. Procedure -
• Explain the procedure to the patient or his relatives.
• Maintain privacy by using curtains.
• Collect required articles and arrange it conveniently at bedside locker.
• Take patient's temperature before starting.
• Fanfold top covers to foot end of bed, and replace with bath blanket.
• Place long mackintosh and bath blanket under the patient.
• Remove patient's gown.
• Place ice cap to patient's head and hot water bag to foot end of the bed.
• The face is first sponged and dried with face towel.
• Place a cold sponge bag in each axilla and groin and change as they
21. Procedure conti..
• Use long sweeping strokes and sponge the neck and right arm for
three minute. Change sponge bag when it becomes warm. Do not
dry the part. The water will evaporate, thus cooling the part.
• The left arm, chest and abdomen are sponged each for three
• Cover the upper half of the body and expose the lower half of the
• Sponge the right and left lower limb for 3 minutes.
• The patient is then carefully turned to the side and back is
sponged with long strokes from neck to the buttocks. Care should
be taken of pressure points. Use spirit, back powder.
• Remove long mackintosh and bath blanket. Replace gown,
replace top cover.
• Leave ice cap at head and hot water bag at feet for half an hour
• Take patient's temperature after half an hour and record it.
22. After care of patient and Articles -
• Make the patient comfortable.
• Take all articles to utility room. Clean with soap and water. Rinse and dry
and place it to their usual places.
• Observe the temperature at the end of half an hour.
• Recording and Reporting -
• Record date and time, effect of tepid sponge, whether the temperature
is reduced or not, in the nurses record and temperature chart.
• Report any reaction to the ward sister and doctor.
23. COLD PACK
• In this procedure a bed sheet is immersed in the
cold water and patient's body is covered in it.
• This method is applied to reduce the
hyperpyrexia of the patient.
• Usually body is covered in cold pack 2 to 3 times
and about 5 to 10 minutes each time.
• There should be written order for the treatment.
• Emergency medications must be kept ready and
record the temperature of the patient before
and half an hour after the procedure.
24. Hot Applications
HOT WATER BAG
• To stimulate circulation by dilating blood
• To relieve pain.
• To relieve congestion by encouraging the
flow of blood in the part.
• To combact infection by bringing more
white blood Cells to the area.
• To supply warmth and comfort.
• To promote healing.
• To relieve retension of urine.
• To relieve muscle spasms.
Applications of Local DryHeat
25. Articles - 1) Hot water bag with cover, 2) Boiled water in a jug and cold
water in another jug, 3) Duster, 4) Bath thermometer, 5) Towel, 6) Oil.
• Hot water bag should not be given to Babies, unconscious patients or
• The temperature of the water should be between 115 deg. F to 120 deg
F. While giving the hot water bag to children, heart diseases patients
and paralised patients.
• For other patients the temp of the water must be between 120 deg F to
150 deg F.
• Never give a hot water bag without cover
• Wash hands to prevent cross infection.
• Fill the hot water bag 1/3 to 1/2 of bag with the hot water. Put the hot
water bag over a flat surface like table and expell all the air by forcing
the water up to the neck of the bag.
• Cork it tightly, dry outside of the bag and check it for leakage by turning
the bag upside down.
• Put on the cover and take it to the patient.
• Apply to the area as ordered and cover it with the towel or sheet. See
that the pressure of the water do not come to the part.
• Keep the bag for 20 to 30 minutes and then remove it, observe the area
27. After care of patient and Articles -
• Remove the hot water bag after completion of the treatment.
• Observe the area for any redness. If redness is present apply oil over it.
• Give comfortable position to the patient.
• Take all articles to utility room. Empty the hot water bag and wash out
side of the bag with soap and water hang up side down to dry it.
• Clean all articles with soap and water and keep it to their usual places.
• When the bag is dry, fill it with air cork it and keep it in its proper place.
28. Recording, Reporting
• Record the procedure with date, time, effect of application and
complication due to the procedure etc. on temperature chart and
• Report to the ward sister about the treatment.
29. ELECTRIC HEATING PAD
• Electric heating pad is used to give
• The pad is made up of an electric coil
inside of a water proof rubber
• It has a control which is set the desired
temperature and is maintained until
readjusted or discontinued.
30. Precautions -
• It must never be used on an unconscious patients not during sleep.
• There must be no moisture present when using the pad, because it
causes electrical shock.
• The pads should be covered with a flannel cloth to absorb the
perspiration and to insulate the pad.
• Check for leakage or shorts in wires before using the electric pad.
• Infra-red Rays [ Infra - red Lamp ] -
• Infra - red rays are long invisible rays of the spectrum and used
therapeutically for the production of heat in the tissues.
31. Purpose -
• It promotes healing of decubitus ulcer.
• It softens connective tissue.
• It relieves pain and the spasm of the strained muscle.
Apply the heat only for 20 to 30 minutes.
Observe the skin carefully during and after the treatment.
The patient and nurse / therapist must wear protective goggles during the
32. HEAT CRADLE
• A 25 watt or less light bulb on an extension cord
is attached to a bed cradle frame to make it a
• Heat cradle is used in burn cases and extensive
wounds to provide heat, for stimulating and
drying of large plaster body casts.
• The duration of the treatment is usually 20 to 30
minutes, or depends upon the physicians order.
33. Methods of Applying Moist Heat
• Moist heat is applied as a compresses, stupes or a sit'z bath.
• The method selected depends on the part of the body needing the
treatment and on the patient's condition.
34. FOMENTATIONS -
• Fomentations are prolonged applications of warm moist flannel or
similar material used on large areas of the body.
• Simple - Boiled or dipped in boiling water.
• Medicated - Medicine is used.
• Surgical - Applied over an open wound.
35. Purpose -
• To relieve retention of urine.
• To relieve swelling.
• To relieve pain and congestion.
• To promote suppuration.
• To increase circulation to the area.
• To stimulate peristalsis and to relieve tympanitis.
• To relieve congestion in the internal organs.
Articles - 1)Boiling water in a kettle, 2) Wringer or towel, 3) Pieces of
flannel or lint 4)plastic paper larger than the area lint or flannel 5)
Cotton pad, 6) Bandage and safety pins, 7) Vaseline to prevent tender
areas from burning 8)Basin.
36. Procedure -
• Wash hands and collect required articles.
• Screen the patient to maintain privacy. Put off the fans.
• Explain the procedure to the patient and his relatives.
• Boil material for fomentation in wringer. Water should cover material
• Take equipment to the bedside of the patient.
• Fan fold top bedding.
• Apply vaseline to the area to be treated.
37. • Wring fomentation two pieces as dry as possible.
• Shake steam out, and see that it is not too hot.
• Place fomentation over the area ordered.
• When it becomes cold. Wring out the other two pieces and replace the
coldones. Continue treatment for fifteen to twenty minutes or as
• Apply the lint piece over the area. Cover it with a waterproof cover and
a cotton pad.
• Apply bandage over it.
38. After Care of Patient and Articles -
• Remove the dressing after 20 minutes of the procedure.
• Dry the area with the towel.
• Ask the patient to remain in bed for one to two hours to prevent
• Make the patient comfortable.
• Collect all articles to utility room, clean with soap and water, dry them
and keep to their usual places.
• Disinfect the lint piece and wash them.
• Wash hands.
Recording, Reporting -
• Record the procedure with date, time, kind and duration of the
treatment, effect of the treatment any side effect etc. on temperature
chart and nurses record book and sign.
• Report to the ward sister.
39. Soaks or Local
It is a "clean complete immersion of part in a hot water or a
solution. Soaks may be given either with clean technique or
sterile technique. A sterile technique is indicated for any
open wound present in the area.
40. Purpose -
• To apply heat or medicated solution to an extremity.
• To promote drainage.
• To relieve oedema.
• To check the growth of the micro-organisms.
• To increase circulation.
Articles- Solution normal saline, magnesium sulphate, sterile water,
Treatment mackintosh, Bath tub, Extra towel, Piece of woolen blanket.
Temperature of water - It should be between 105 deg. F to 110 deg F.
41. Procedure -
• Wash hands and collect required articles.
• Place the articles at bedside locker conveniently.
• Explain the procedure to the patient.
• Screen the bed to maintain privacy.
• Place treatment mackintosh to protect bed linen.
• Keep bath tub on the mackintosh.
• Allow the part to soak for prescribed legth of time, usually 15 to 20
• Check the temperature of the solution frequently and add additional
solution to replace in order to maintain the appropriate temperature.
• Dry the area at the end of the treatment.
• Record the treatment on temperature chart with date and time and its
effect and sign.
42. SIT'Z BATH
Definition -It is a bath which is taken in a
sitting position. The patient is usually
immersed from the mid thighs to the
To relieve pelvic
rectal abscess &
To relieve pain
43. Contraindications -
irritability of the
• Potassium permagnate - 1:5000.
• Boric acid - 1 dram to 1 pint.
• Eusol solution.
Temperature of the solution / water - 110 deg to 115 deg F or 43 deg to
46 deg C.
Duration of Bath -The duration of bath is 15 to 20 minutes.
Articles -1) Basin or bath tub, 2) Bath blanket and safely pins, 3) Bath
towel, 4) Bath thermometer, 5) Rubber ring.
• Wash hands.
• Collect the required articles in the treatment room.
• Explain the procedure to the patient to get his co-operation.
• Fill tub1/3 to 1/2 full of water. Check the temperature with bath
• Place bath towel and rubber ring in bottom of tub.
• Assist patient into the bath tub. Temperature of water is 100 deg F.
Increase temperature gradually to 110 deg F.
• Add hot water protecting the patient's skin.
45. • Envelope patient in bath blanket.
• Leave patient in tub for 10 to 20 minutes or as ordered.
• Observe patient's condition at least every 5 minutes.
• Care must be taken to prevent burns and fainting.
• If the patient complaints of weakness or fainting due to shift in blood
supply to the perineal area, he should be assisted out of the sit'3 bath,
dried the normal circulation is re-established.
• Assist the patient in drying and put on clothing to prevent chilling.
46. After care of patient and Articles -
• The patient may feel sleepy due to the sedative effect of the sit'z bath.
So care must be taken to prevent falling.
• Give lying down position to patient.
• Clean the equipments with soap and water, rinse and dry and return to
their proper places.
Recording, Reporting -
• Record date, time, solution used, temperature and duration of bath,
reaction of patient, on nurses record and patient's chart and sign.
• Report any reaction of patient to ward sister and doctor.
47. COUNTER - IRRITANTS
Definition -A counter irritant is a substance which dilates superficial blood
vessels to relieve or counteract other deeper inflammation which in turn
produce the constriction of deeper vessels. Counter - irritants include
mustard, turpentine, and liniments such as camphor and methyl
• To relieve congestion and irritation by promoting free
• To relieve pain.
• To cause absorption and removal of inflammatory products.
48. TURPENTINE STUPE
• Turpentine stupe is given to relieve flatulence by increasing peristalsis.
• dram 1) Articles Screen, at-sweet2) Articles oil. For needed children for -
mixture medical of fomentation, 1 part turpentine 3) For and adult 10 -
part mixture sweet of oil. 1/2 keep dram the turpentine mixture in and a
bowl2/3of hot water, 4) Swabsticks, 5) kidney tray.
49. Procedure -
• Wash hands and collect the required articles.
• Keep the articles at bedside locker of the patient.
• Screen the bed to maintain privacy.
• Explain the procedure to the patient and relatives.
• Fan fold the top bedding and expose the required, part only.
• The mixture should be well mixed.
• Apply the warm oil mixture with swab stick. Apply it from xypi sternum
to the symphysis pubis.
• Apply the mixture in a single layer and don’t rub ait.
• Apply the hot compresses [ medical fomentation.]
• After 10 to 15 minutes, insert the flatus tube and watch for the
expulsion of gases.
50. Scientific Principles
• All parts of the body may be influenced by heat.
• The skin consists of two layers - the epidermis and corium. The outer
layer of the epidermis is composed of horny like cells which constantly
• The epidermis protects the delicate sensitive organs underneath.
• The dermis contains nerves, blood vessels, hair follicles and sebaceous
• End organs of sensory nerves in the skin convey the sensations of heat,
cold, pain and pressure.
Hot and Cold Applications
Anatomy & Physiology
51. • The skin has rich supply of blood vessels and lymph vessels.
• An increased blood supply increases the number of leucocytes which
aids in wound healing.
• Heat relaxes muscles and relieves stiffness and fatigue.
• Heat promotes suppuration and draws blood to an inflammed area or
from a congested area.
• Heat increases exchange of oxygen and promotes absorption of
• Heat may be antispasmodic, analgesic, decongestant or sedative in its
action on tissues.
52. • Extreme heat and cold may destroy tissue if their application is
continued over prologe period.
• Due to heat, blood is brought to the skin as the blood vessels in the skin
are dilated. The blood leaves deeper parts and relieves pressure there
and deep congestion is relieved.
• Heat and cold act as irritants. Heat and cold applied by stupes, baths,
compresses or dry appliances penetrate only two millimeters. Sensation
from the application is carried to the spinal cord by sensory nerves.
• All reactions of heat and cold are modified by mode and duration of
application, the degree of heat or cold applied, the condition of the
tissue and the surface of the body covered by application.
• Heat produces peripheral vasodilatation, raises capillary blood pressure
by relaxing capillaries, increases the area of the capillary wall available
for fluid exchange.
• A sterile technique must be used for surgical fomentation.
• Hot compresses for the eye must be sterile because they are used in
conditions that make the conjunctiva very susceptible for infection.
• Sterilization of articles must be done by autoclaving.
• The nurse must wash her hands before and after the procedure to
prevent cross infection.
• To avoid transferring bacteria, hot water bags, ice caps are washed with
soap and water and dried well after each patient's use ., because soap
and water mechanically removes bacteria and drying kills bacteria.
• Cold diminishes the formation and absorption of bacterial poisons. A
cold application may conduct so much heat from the tissues that
organisms causing infection may be checked.
54. Physics and Chemistry
• While giving hot and cold applications physical agents e.g. heat, water,
light and electricity are used. Water is a good conductor of heat. Moist
heat or moist cold applications are more effective than the dry heat and
cold applications to get the desired effects.
• The presence of moisture increases the changes of burns or maceration
of the skin, so care must be taken to prevent burns and macerations of
• Air is a poor conductor of heat. Presence of air in the hot water bags
and ice caps can reduce the heat conduction and makes the treatment
55. • Presence of air under the hot on cold applications makes them less
effective when fomentations and packs are applied keep them snugly
around the area.
• Flannel is used for stupes because its loose weave holds large amounts
of warm water.
• Gauze used in sterile procedures, does not hold heat as well as wool,
therefore gauze compresses need to be renewed offener than flannel
• Oil acts as insulator and delays transmision of heat, so vaseline is
applied on the skin before the applications of moist heat, to prevent
• The flow of heat is from the hotter area to the less hot area. The heat
from the hot applications will flow to the skin and makes the area warm.
56. • The heat from the skin will flow to the cold applications and makes the
• Alcohol is used in sponge bath to reduce the temperature, because it
evaporates faster than the water, so the cooling of the skin will be more
• Evaporation is faster on a large surface than a small one.
• Friction produces heat, so friction should be avoided during a cold /
• Heat usually increases the speed of a chemical reaction, since
metabolism is largely due to chemical reactions. The application of heat
• Pressure is not exerted on a hot application, because, pressure reduces
the air layer and increases the risk of burning.
57. • Water conduct heat well. So the materials should be wrung as dry as
possible. Damp bedding may conduct heat from the body.
• Electric pads should be insulated well, because water is a good
conductor of electricity, and short circuit may occur from wetting open
• The solvent action of water may be increased by adding other
substances such as soap or magnesium sulphate to water, used for
baths, crusts and scaly skin will be penetrated by solutions of low
surface tension and will be removed easily.
• Chemical heating bottles may make use of sodium salts.
• The addition of the drug reinforces the effect desired from the hot
application. Irritant drugs often use dare turpentine and mustard.
• Turpentine is diluted with oil and painted on the skin.
• Mustard is used in the form of plasters and local baths. Mustard
contains enzyme myrosin which acts on the sinigrin in mustard in the
presence of warm water and changes it to dextrose and volatile oil. The
volatile oil is destroyed by hot water, so luke warm water is used.
• Boric acid and salt is used to give hot fomentations.
• Boric acid is a mild antiseptic.
• A salt solution is non-irritating.
• Explain the procedure to the patient to get the co-operation.
• As patients are afraid of pain the nurse must check temperature of
warm solutions carefully before bringing the solution to the bed side.
• Warm the patient just before applying the hot or cold material so that
the patient will be prepared for a difference in temperature.
• Watch the patient carefully during hot or cold applications, so that the
patient will not be injured and will obtain the benefits from the