NURSING PROCEDURE – HOT APPLICATION

Thermotherapy is the use of heat to treat symptoms of acute or chronic pain, especially those related to muscle tension or spasm. It is also a common treatment for arthritis, bursitis, tendonitis, back pain, shoulder pain and other kinds of joint pain. Hot applications result in an increase in molecular vibration and cellular metabolic rate. This form of treatment is divided into two categories, namely, superficial and deep heating modalities. These are further divided into chemical, electric or magnetic. Temperatures range from 105 to 170 degrees Fahrenheit (41 to 77 Degree celcius). Superficial modalities include infrared lamps, moist heat packs, paraffin baths, and warm whirlpools. Deep heating modalities include microwave diathermy, shortwave diathermy, and ultrasound. The body reacts with a series of local and systemic effects.

DEFINITION

Hot application means the application of an agent warmer than the skin. Heat is applied in either a moist or dry form.

PURPOSE

• Heat decreases pain
• To provide comfort
• To promote circulation
• To promote suppuration
• To relax the muscles
• To promote healing
• To relieve deep congestion
• To soften the exudates
• To stimulate peristalsis
• To counteract sudden drop in temperature
• To decrease joint stiffness
• To relieve bladder distention

CLASSIFICATIONS

Hot Applications – Local and General

Local – Dry Heat and Moist Heat

LOCAL

Dry Heat – hot water bottles, chemical heating bottles, infrared rays, shot wave diathermy, heating lamps, electric cradles, and electric heating pads

Moist Heat – warm soaks (local baths), hot fomentations (compresses), poultices (cataplasm), stupes (medical fomentations), paraffin baths, sitz bath and aquathermia pad

GENERAL

Dry Heat – sun bath, electric cradles, and blanket bed

Moist Heat – steam baths, hot packs and whirlpool bath (full immersion bath)

• Peripheral vasodilatations
• Increased capillary permeability
• Increased local metabolism
• Increased oxygen consumption
• Blood-flow is increased
• Blood viscosity is decreased
• Lymph flow is increased
• Motility of leukocytes is increased
• Muscle tone is decreased

The primary effect of hot application may last only for 20 to 40 minutes. After this time, the heat application must be discontinued and recovery time of one hour allowed, otherwise secondary effects (vasoconstriction) will take place.

Contraindications

• Heat is not used because heat increases the metabolism
• Heat is not used for the patients with impaired kidney, heart and lung functions
• Heat should not be applied to acutely inflamed areas e.g. acute appendicitis and tooth abscess
• Heat should not be applied on patient with paralysis weak and debilitated patients
• Heat should not be applied when there is open wounds and bleeding
• Heat should not be applied when there is edema associated with venous or lymphatic diseases
• Heat should not be applied on patients with metabolic disorder. E.g. patients with diabetes, arteriosclerosis
• Heat should not be applied on patients with high temperature

Principles

• Heat causes dilation of blood vessels and increases the blood supply to the area
• Heat stimulates metabolism and the growth of the new cells and tissues
• The end organs of the sensory nerves in the skin convey the sensation of heat; the sensations are interpreted in the brain
• Water is a good conductor of heat
• The flow of heat is from the hotter area to the less hot area
• Presence of stream increases the temperature of the hot applications
• The temperature tolerance varies with individuals and according to the site and area covered
• Friction produces heat

Complications

• Pain
• Burns
• Maceration (with moist heat)
• Redness of the skin
• Edema
• Hyperthermia
• Pallor (secondary effect)

General Instructions

• Protect damaged skin layers exposed layers of skin are more sensitive to temperature variations than skin layer
• Check a patient frequently during hot application, the condition of the skin indicates whether tissue injury is occurring
• Do not allow a patient to adjust temperature settings
• Never position a patient in such a way that he cannot move away from the temperature source. This avoids the risk of injuries from temperature exposure
• Never ignore the complaints of a patient however small they appear to be

KEY POINTS ABOUT HOT APPLICATION NURSING PROCEDURE

Hot applications, also known as thermal therapy, involve the application of heat to a specific area of the body for therapeutic purposes. Here are some key points for the hot application nursing procedure:

1. Indications:
   • Hot applications are typically used to promote vasodilation, increase blood flow, and relax muscles.
   • Commonly used for conditions such as muscle spasms, joint stiffness, and localized pain.
2. Types of Hot Applications:
   • Hot packs, warm compresses, electric heating pads, and warm baths are common forms of hot applications.
   • Each type may be chosen based on the specific needs of the patient and the area of the body being treated.
3. Assessment:
   • Assess the patient’s skin condition, sensitivity, and ability to perceive heat accurately.
   • Identify the specific area of the body that requires the hot application.
4. Contraindications:
   • Avoid hot applications in cases of acute inflammation, open wounds, or impaired circulation.
   • Be cautious with patients who have sensory deficits or conditions that affect the ability to perceive temperature.
5. Patient Education:
   • Explain the purpose of the hot application and the expected therapeutic effects.
   • Educate the patient about the importance of reporting any discomfort or changes in sensation during the procedure.
6. Application Technique:
   • Follow the healthcare facility’s protocols for the specific type of hot application being used.
   • Ensure that the temperature is safe and comfortable for the patient, avoiding extremes that could cause burns.
7. Monitoring:
   • Regularly check the patient’s skin for signs of redness, blistering, or any adverse reactions.
   • Monitor the patient’s response to the hot application, including pain relief and increased comfort.
8. Duration:
   • Follow the recommended duration for the hot application as per the healthcare provider’s orders.
   • Prolonged exposure may lead to complications such as burns.
9. Documentation:
   • Record the type of hot application used, duration, patient’s response, and any observations in the patient’s medical record.
10. Follow-up:

• Evaluate the effectiveness of the hot application in alleviating symptoms.
• Adjust the treatment plan as needed based on the patient’s response.