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  Metal implants pose risks. Metal
 Heat provides warmth conducts heat. Deep tissues can be
 Heat stimulates peristalsis burned. Pacemakers (cardiac devices)
and joint replacements are made of
Contraindications of Hot Applications
metal. Do not apply heat to an implant
 The first 24 hours after traumatic area.
injury (heat increase bleeding and  Infants, older people, and those with
swelling). fair, thin skin have less heat
 Active hemorrhage (heat causes resistance. Lowered body resistance
vasodilatation and increase bleeding. because of illness also makes body
 Non inflammatory edema (heat tissues less resistant to heat.
increases capillary permeability and  Clients who are unresponsive or
edema). anesthetized and those with neurologic
 Skin disorder (heat can burn or cause or psychological disorders or dementia
further damage to the skin). are at increased risk for injury from
 Localized malignant tumor (heat heat applications.
increase cell growth and accelerate  Impaired circulation and some
metastases ). metabolic diseases make people more
 Hypertension or other circulatory susceptible to burns (e.g., clients who
issues are present. are in shock or have any type of
Complications of Hot/Heat Applications peripheral vascular disorder, or clients
who have diabetes).
 Pain
 Burns SPECIFIC HEAT THERAPIES
 Maceration 1. DRY HEAT
 Redness of the skin 2. MOIST HEAT
 Edema
Dry Heat
 Pallor
 Hyperthermia  Aquathermia Pad
 An aquathermia (Aqua-K) pad,
Special Considerations
which produces dry heat, is used to
 Heat is applied only when specifically treat muscle sprains and mild
ordered by a primary provider and inflammations and for pain relief.
applied with the utmost caution. Temperature-controlled, distilled
 Heat is not applied to a pregnant water flows through the
woman’s abdomen. The heat can waterproof pad. Apply the pad
affect fetal growth. following specific orders. Check to
 Each person has his or her own make sure the pad is heating
sensitivity to heat. Apply the heat properly and not overheating and
source slowly and ask the client for stop treatment and report
feedback. malfunctions if overheating occurs.

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 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

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

4  NCM104 Lab - Heat & Cold Application

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

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

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.

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 It is important to follow the agency’s  If the client has a tracheostomy, a
protocol and the primary provider’s “trach mask” may be placed over the
orders. opening to provide humidity, either with
 Check frequently to make sure that or without auxiliary oxygen.
the client’s core temperature does not  A face tent, which may be used to
fall too low. provide a high concentration of
moisture in the inhaled air, is also
available.

Special Considerations

 Burns and blisters occur from intense

6. Cold Humidity cold. They also occur when dry cold is
 Cold humidity is commonly ordered for in direct contact with the skin.
clients with breathing disorders.  When cold is applied for a long time,
 In most facilities, air conditioning and blood vessels dilate. Blood flow
heating systems provide a constant increases. Prolonged application of
level of humidity. But if the humidity level cold has the same effect as heat
is not high enough, an auxiliary applications.
humidifier may be placed in the room.  Older and fair-skinned persons have
 Some clients need constant cold fragile skin. They are at great risk for
humidity in higher concentrations. complications. So are persons with
 A child may be placed in a croupette or sensory impairments.
a humidity (mist) tent.  Stop the cold application immediately
 Oxygen administered to all clients must if the client complains of numbness or
be humidified to prevent drying of the the skin appears white or spotty.
mucous membranes of the nose and  As cold decreases the flow of blood in
throat. one area of the body, flow increases
to other areas.

8  NCM104 Lab - Heat & Cold Application

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

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

 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.
Specimen Preservation The random specimen is useful for
routine screening tests to detect
Urine specimens must be obvious abnormalities. However, it may
preserved at 2 – 8 degrees Celsius, show erroneous results resulting from
which decreases bacterial growth and dietary intake or physical activity just
metabolism. If the urine is to be before collection.
cultured, it should be refrigerated
during transit and held refrigerated until b. First Morning Specimen
cultured up to 24 hours. The specimen
must return to room temperature before The first morning specimen, or 8-
chemical testing by reagent strips. hour specimen, is the ideal screening
Types of Specimen 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.
To obtain a specimen that is This specimen will not contain
representative of a patient’s metabolic any metabolites from food ingested
state, regulation of certain aspects of before the beginning of the fasting
specimen collection is often period. It is recommended for glucose
necessary. Special conditions may monitoring.
include:
 Time, length, and method of
collection; and
 The patient’s dietary and
medicinal intake.

2NCM104 Lab - Urianalysis

 d. 2-Hour Postprandial
Specimen h. Midstream Clean-Catch
Specimen
The patient is instructed to void
shortly before consuming a routine As an alternative to the
meal and to collect a specimen 2 hours catheterized specimen, the midstream
after eating. The specimen is tested for clean-catch specimen provides a safer,
glucose, and the results are used less traumatic method for obtaining
primarily for monitoring insulin therapy urine for bacterial culture and routine
in persons with diabetes mellitus. urinalysis.
Patients must be provided with
e. Glucose Tolerance appropriate cleansing materials, a
Specimens sterile container, and instructions for
cleansing and voiding. Instruct patients
Glucose tolerance specimens to wash their hands before beginning
are sometimes collected to correspond the collection. Male patients should
with the blood samples drawn during a clean the glans, which begins at the
glucose tolerance test (GTT) as an aid urethra, and withdraw the foreskin, if
to interpreting the patient’s ability to necessary.
metabolize a measured amount of Female patients should separate
glucose and are correlated with the the labia and clean the urinary meatus
renal threshold for glucose. and surrounding area. When cleansing
is complete, patients are to void first
f. 24-Hour (Timed) into the toilet, then collect an adequate
Specimen amount of urine in the sterile container,
and finish voiding into the toilet.
To obtain an accurate timed
specimen, the patient must begin and i. Suprapubic Aspiration
end the collection period with an empty
bladder. Addition of urine formed before Occasionally urine may be
the start of the collection period or collected by external introduction of a
failure to include urine produced at the needle through the abdomen into the
end of the collection period will produce bladder. Because the bladder is sterile
inaccurate results. under normal conditions, suprapubic
On its arrival in the laboratory, a aspiration provides a sample for
24-hour specimen must be thoroughly bacterial culture that is completely free
mixed and the volume accurately of extraneous contamination.
measured and recorded.
If a specimen is collected in two j. Prostatitis Specimen
containers, the contents of the
containers should be combined and The three-glass collection
thoroughly mixed before aliquoting. procedure is used to determine
g. Catheterized Specimen prostatic infection. Instead of discarding
the first urine passed, it is collected in a
This specimen is collected under sterile container. Next, the midstream
sterile conditions by passing a catheter portion is collected in another sterile
through the urethra into the bladder. container. The prostate is then
The most commonly requested test on massaged so that prostate fluid will be
a catheterized specimen is a bacterial passed with the remaining urine into a
culture. third sterile container.

3NCM104 Lab - Urianalysis

 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

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

5NCM104 Lab - Urianalysis

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