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UNIT 4 Supporting Physiological Functioning
Clinical Insight 32-2 ➤ Applying Local ColdTherapy
Preparation ■ Determine whether there are any contraindications to the treatment, such as impaired circulation, bleeding, wound complications, or inability to tolerate the treatment. ■ Explain the application and rationale to the patient. ■ Assess for indications for cold application. Measure the patient’s temperature. Cooling Baths A cooling bath is often used to treat a high fever (above 104°F [40°C]). It promotes heat loss through conduction and vaporization. ■ Prepare a pan of water with a temperature from 65°F to 90°F (18°C to 32°C). ■ You may add a fan to increase heat loss if the temperature is markedly elevated. ■ Slowly sponge the face, arms, legs, back, and buttocks with the cool water. Do not dry the area; cover with a damp towel. ■ Take about 30 minutes to complete the bath. Cooling the body too rapidly will cause shivering, which will increase heat production. ■ You may also place ice bags or cold packs on the forehead in the axillae and the groin. ■ Assess the patient constantly during a cooling bath. If the patient begins to shiver, the temperature may begin to rise. Cold Compresses ■ Apply a cool, damp cloth or towel to the body part. ■ Renew the compress or cloth frequently. The temperature of the compress or cloth will rapidly rise toward body temperature.
Collars, Ice Bags, Commercially Prepared Cold Packs, Aquapads ■ You can make an ice bag out of a nonsterile glove or small plastic bag by filling it with ice chips and tying a knot in the top. ■ Fill the ice bag with ice chips or an alcohol-based solution. ■ Cover ice bags or packs with a towel or soft cover. ■ Apply to the skin for a maximum of 15 minutes and then remove.You may reapply the cold pack in 1 hour. Safety Precautions for Cooling Devices ■ Measure water temperature with a bath thermometer. ■ Tell the patient to report any discomfort during the treatment. ■ Avoid direct contact with the cooling device. Cover the cold pack with a washcloth, towel, or fitted sleeve. ■ Apply cold intermittently, leaving it on for no more than 15 minutes at a time in an area. Helps to prevent tissue injury (e.g., impaired circulation). It also makes the therapy more effective by preventing the rebound phenomenon: At the time the cold reaches maxi- mum therapeutic effect, the opposite effect (vasodilation) begins. ■ Observe for tissue damage: bluish purple, mottled appearance of the skin, numbness, and sometimes blisters and pain. ■ Monitor for elevated blood pressure.
ASSESSMENT GUIDELINES AND TOOLS
History Questions for Skin and Wound Assessment ➤ What is your typical activity level? ➤ Do you ever use a wheelchair or mobile device to get around? Do you require assistance to get out of bed or a chair? ➤ Tell me about your usual diet. ➤ How much liquid do you drink each day? ➤ Do you have any areas of numbness and tingling? ➤ Have you had any recent changes in your skin? ➤ Do you have any sores or open areas? If so, how long have you had the wound? ➤ Have you ever had difficulty with wound healing?
➤ What kinds of healthcare problems have you been having? ➤ What medications—prescribed, herbal, or over the counter—are you taking? ➤ What is your typical hygiene routine? ➤ Do you ever lose control of your bladder or bowels? ➤ Do you use tobacco? ➤ How much time do you spend outdoors? ➤ Do you have diabetes? If so, how often do you check your feet? How often do you see a podiatrist? What is your average blood sugar?
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