Meeting the therapeutic needs of the patient

By Pn Wan

 At the end of this session, student should be able to:
1. Identify two ways the body controls heat loss and heat

conservation.
2. Identify one of the body’s basic responses to injury.
3. Identify how this response is both helpful and harmful.
4. Identify two basic ways heat and cold therapy can be

therapeutic.
5. Identify two other ways heat and cold therapy can be

therapeutic.

6. Identify the two different ways heat and cold can be
applied.

7. Identify three types of clients who need careful
monitoring during heat or cold therapy.

8. Identify three important assessments you must make
when using heat or cold therapies.

9. Identify three basic rules of using heat and cold therapy.
10. Identify one important rule of using moist heat and moist

cold.

What is hot application in nursing?
 In nursing intervention hot application is defined

as stimulation of the skin and underlying tissues with
heat for the purpose of decreasing pain, muscle
spasms or inflammation.



1. Relieve local pain, stiffness, or aching, particularly of
muscles and joints

2. Assist in wound healing
3. Reduce inflammation and infection
4. Make the chilly client more comfortable
5. Raise body temperature to help maintain normothermia
6. Promote drainage (draw infected material out of wounds)



WARMER BLANKET

 Apply dry heat with a heating blanket, warm-water bag,
waterproof, water-filled heating pad (aquathermia pad),
heat lamp, electric heat cradle, or electric heating pad.

 Moist heat warms the skin more quickly and is more
penetrating than dry heat, because water is a better heat
conductor than air.

 Apply moist heat with compresses, packs, or soaks,
including the sitz bath.

 Sometimes wet compresses are used in combination with
the aquathermia pad to provide longer-lasting moist heat.

 Skin maceration (abnormal softening) may develop when
moisture is applied directly to the skin for long periods.

 The client’s skin may be protected by first applying a thin
layer of petroleum jelly, if ordered. The provider’s order
typically specifies the length of time for heat applications
to be administered. For example, the order may be:“Moist
compresses for 15 minutes every hour WA (while awake).”

Heat is applied only when specifically ordered by a
primary provider and applied with the utmost caution.
Rationale: Nerves in the skin are numbed easily. The client
may not feel the pain of a burn, especially if heat has been
applied often.

• Specific body parts, such as the eyelids, neck, and
inside an arm, are especially sensitive to heat.

• Each person has his or her own sensitivity to
heat. Apply the heat source slowly and ask the client for
feedback. Rationale: This helps determine how much heat
is safe and for how long.

 Infants, older people, and those with fair, thin skin have less
heat resistance. Lowered body resistance because of illness also
makes body tissues less resistant to heat. Rationale: It is
important to consider each client individually.

• Clients who are unresponsive or anesthetized and those
with neurologic or psychological disorders or dementia are at
increased risk for injury from heat applications. Rationale:
These clients are often unable to report when heat is too
intense.

• Impaired circulation and some metabolic diseases make
people more susceptible to burns (e.g., clients who are in shock
or have any type of peripheral vascular disorder, or clients who
have diabetes). Rationale: Changes in body systems interfere
with skin integrity and healing and may impair the client’s
ability to identify discomfort.

1. Cold treatment reduces blood flow to an injured area.
This slows the rate of inflammation and reduces the risk
of swelling and tissue damage.

2. It also numbs sore tissues, acting as a local anesthetic,
and slows down the pain messages being transmitted to
the brain.

3. Ice can help treat a swollen and inflamed joint or muscle.
It is most effective within 48 hours of an injury.

4. Rest, ice, compression and elevation (RICE) are part of
the standard treatment for sports injuries.

5. Note that ice should not normally be applied directly to
the skin.

1. a cold compress or a chemical cold pack applied to the
inflamed area for 20 minutes, every 4 to 6 hours, for 3
days.

2. immersion or soaking in cold, but not freezing, water
3. massaging the area with an ice cube or an ice pack in a

circular motion from two to five times a day, for a
maximum of 5 minutes, to avoid an ice burn









 is a general application of moist cold liquid to cool skin, by
evaporation and by the absorption of body heat in the cold
water.

 Tepid sponge is a process of sponging with tepid water to
reduce body temperature by evaporation.

 The temperature of water used for tepid sponge is 26-32◦C.



 Tepid sponge helps to reduce the temperature 38 - 39 ◦C.
 Cold sponge helps reduce the temperature of above 39 ◦C.
 To stimulate circulation
 To decrease toxicity
 Nervousness and delirium
 To soothe the nerves and promote sleep

 Cold sponging is used to reduce temperature in a patient
with hyperpyrexia

 Large areas of the body are sponged at one time,
permitting the heat of the body to transfer to the cooler
solution on the body surface.

 Often wet towels are applied to the neck, axillae, groin and
ankles, where the blood circulation is close to the skin
surface

 The vital signs are checked very frequently to detect the
early signs of complications

 The physiological effect of the cold applications are vaso-
constriction, decreased blood circulation, decreased
capillary permeability, decreased metabolism, decreased
blood viscosity, etc.

 The application moist cold is more effective than the
application of dry cold as the moisture distributes the cold
to large and deep area

 There must be a written order for tepid sponge or cold
sponge

 Use long strokes for sponging and avoid circular
movements or friction while sponging

 Keep the hot water bag ready at the foot end of the bed

1. The doctors order for any specific instructions
2. General condition and diagnosis
3. Self-care ability of the patient
4. Assess the duration of application
5. For contraindication to cold application
6. Articles available in the unit

1. Explain the sequence of the procedure
2. Provide privacy
3. Check the initial temperature and should be checked

every 15 minutes intervals
4. Position the patient comfortably in the bed
5. Remove the patient gown and place with bath blanket
6. Bring the patient to the edge of the bed

7. Place the long Mackintosh and draw sheet under the
patient

8. Arrange the articles to the bedside

1. A large basin of water 7. Bath towel – 1
for tepid sponging 8. Face towel – 1
9. Thermometer tray
2. Jug with cold water 10. Ice cap with cover
3. Basin with ice pieces 11. Spirit rub
4. Bath thermometer 12. Bucket
5. Mackintosh and draw

sheet
6. Sponge clothes – 6



1. Explains procedure to patient and provides privacy
2. Prepares trolley and sends to the bedside
3. Washes and dries hands
4. Takes patient's temperature, pulse and respiration and

records
5. Arranges top bed clothes leaving top sheet
6. Protects bottom sheet and undresses the patient

7. Washes and dries face to refresh patient
8. Leaves a flannel rung out of cold water on the patient's

forehead
9. Places 6 pieces of flannel into basin or tepid water
10. Places a wet flannel in each axilla and groin, squeezes

out excess water
11. Changes the wet flannel frequently to keep them tepid

12. Sponges upper arms, trunk, lower limbs and back in strokes
leaving small drops of water on the skin

13. Changes water as often as necessary
14. Leaves patient for 15-20 minutes
15. Dresses patient up and rechecks temperature and records
16. Thanks and makes patient comfortable
17. Washes and dries hands and serves cold drink if necessary
18. Documents procedures and reports findings
19. Check the temperature at 20 minutes interval and record it in

the TPR chart



1. Remove the sponge clothes from the axilla and groin.
Discard it in kidney tray

2. Dry the body with bath towel
3. Remove the Mackintosh and draw sheet
4. Replace the gown and remove the bath blanket
5. Observe for any symptoms of chill or any other

abnormality

6. If needed give patient drinks
7. Position the patient comfortably in the bed
8. Replace the articles after cleaning
9. Wash hands
10. Record the procedure in the nurse’s record sheet and

vital signs in TPR sheet

BY PN WAN















 Hospitalised patients with respiratory conditions,
particularly those who have undergone chest or
abdominal surgery, should perform breathing and
coughing exercises in order to prevent further issues
and complications (Allina Health 2015).

 Breathing and coughing exercises are crucial for assisting
breathing and clearing excess secretion in the recovery
stage. If sputum builds up in the lungs, it may become
infected and increase the risk of pneumonia (My Health
Alberta 2019; Penn Medicine 2016).

 Furthermore, excess sputum impedes the ability of the
lungs to oxygenate effectively (Stewart 2019).

 A study by the University of Melbourne found
that preoperative education and teaching of respiratory
exercises halves the rate of post-surgery
complications for major abdominal surgery patients
(Boden & Denehy 2018).

Breathing and coughing exercises are crucial for
clearing excess secretion, as it may become
infected and increase the risk of pneumonia.

1. Patients with chronic obstructive pulmonary disease (COPD);
2. Patients with an interstitial lung disease;
3. Patients with cystic fibrosis;
4. Patients undergoing lung, chest or abdominal surgery;
5. Patients with a muscle-wasting disorder that affects breathing

muscles;
6. Patients with asthma;
7. Patients undergoing surgery for a lung transplant or lung

cancer; and
8. Any patient who may be immobile for whatever reason.

1. Strengthen accessory muscles around the lung, as they
become weak when a patient is not able to mobilise;

2. Strengthen the diaphragm, allowing it to assist with lung
expansion and improve air reaching the base of the lung;

3. Take the burden off other muscles in the neck, back and chest
that are used when the diaphragm is not working to full
capacity;

4. Clear the airway of excess sputum;
5. Improve lung function; and
6. Reduce the risk of developing respiratory infections or

atelectasis (alveoli collapse).

1. Consider administering analgesia prior to starting. If the patient
has pain they will not be able to perform the exercises.

2. Mobilise the patient to ensure they do not acquire a lung infection
or atelectasis.

3. Sit the patient out of bed or up in bed (the aim is to optimise lung
expansion).

4. Critical care patients can sit out of bed if they are
haemodynamically stable (this allows for better lung expansion).
Ensure you have two to three clinicians assisting with any
intravenous lines, cardiac monitoring, drain tubes etc.

5. Ensure the patient is comfortable.
6. Place a folded towel up against the patient’s chest or abdomen to

provide comfort and security around any wounds they may have.

1. Breathing control;
2. Chest expansion exercises; and
3. Huffing (forced expiration technique).