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CHAPTER 32 Skin Integrity & Wound Healing
Applying Heat Therapy Local application of heat is used to relieve the stiffness and discomfort associated with musculoskeletal problems. It may also be used for patients with wounds. When heat is applied to a large area of the body, vasodilation may cause a drop in blood pressure and a feeling of faintness. Warn patients to be alert for this effect if they will be administering heat at home. ■ Increases blood flow to an area through the mecha- nisms of vasodilation, increased capillary permeabil- ity, and reduced blood viscosity. Increased blood flow brings oxygen and white blood cells to the wound and aids in the healing process. ■ Promotes the delivery of nutrients and removal of waste products from the tissue. ■ Promotes relaxation and decreases stiffness and mus- cle tension. Either moist heat or dry heat may be used, depending on the patient situation and the goal of therapy. ■ Moist heat. Adding moisture to heat amplifies the intensity of the treatment. Moist heat can be applied in several forms, depending on the skin condition. Washcloth or towel. If heat is being applied for relax- ation and the skin is intact, you can soak a wash- cloth or towel in warm water and wring out the excess moisture before applying to the skin. Do not microwave moistened towels to warm them. This causes unequal heat distribution and may cause burns to the patient. Gauze compress. If there are any open areas, you still need to use a sterile gauze compress. Soaks. A soak involves immersion of the affected area. Soaking helps cleanse a wound and remove encrusted material. Baths. A bath is a modification of a soak in which a special tub or chair may be used. The most used bath is a sitz bath (Fig. 32-17). A Sitz bath soaks the patient’s perineal area. Disposable sitz baths are often used to help prevent infection. ■ Dry heat. You may use electric heating pads, dispos- able hot packs, or hot-water bags to apply dry heat. Caution patients to place the heating pad or device over the body area and never to lie on it. The pad or bag should be covered with its own cover or a towel. Electric heating pads have the advantage of providing a constant temperature, but the risk of burns is high. Aquathermia pads (Fig. 32-18) may also be used for dry heat application. Aquapads are plastic or vinyl pads that circulate water in the interior of the pad to create a constant temperature. Disposable hot packs and hot-water bags or bottles are also available. Hot-water bags are common for in-home use but not for healthcare agencies because of the danger of burns from improper use.
come in rolls and in various widths, commonly 1.5 to 7.5 cm (0.5 to 3 in.). Use a narrow width on small body parts, such as a finger, and wider bandages on the arms and legs. ■ Cloth bandages are most used as slings to immobilize an upper extremity or to hold large abdominal dress- ings in place. ■ Gauze is the most frequently used type of bandage. It is available in many sizes and forms and readily con- forms to the shape of the body. It may also be impreg- nated with medications for application to the skin or with plaster of Paris, which, when dried, hardens to form a cast. ■ Elastic bandages are used to apply pressure and give support (e.g., to improve venous circulation in the legs). Ace bandages are the most common form of elasticized bandage. ■ A rolled bandage is a continuous strip of gauze, stretchable gauze, or elastic webbing that you unroll as you apply it to a body part. To learn how to apply roller bandages, See Chapter 32, Procedure 32-11: Applying Bandages, in Volume 2. Using Heat and ColdTherapy Local application of heat or cold has been used for ther- apeutic purposes for centuries. Temperature-sensitive nerve endings respond readily to temperatures between 59°F and 113°F (15°C and 45°C). The response to heat or cold depends on the area being treated, the nature of the injury, the duration of the treatment, patient age and physical condition, and the condition of the skin. When heat or cold is first applied, the thermal recep- tors react strongly, and the person feels the temperature most intensely. Over about 15 minutes, the receptors adapt to the new temperature, and the person notices it less. Cau- tion patients not to change the temperature when this occurs because doing so can cause tissue injury. Monitor the patient especially carefully in the following situations: ■ Extremes of age . The very young and the very old are the least tolerant of heat and cold therapies. ■ Sensory impairment. Patients with sensory impairment are at increased risk for injury related to the use of heat and cold therapy because they may not perceive temperature changes, burns, or ischemia. ■ Highly vascular areas. Highly vascular areas, such as the fin- gers, hand, face, and perineum, are very sensitive to tempera- ture changes and thus are at high risk for injury from heat and cold. ■ Application to a large area. Application of cold or heat to a large body surface area decreases the patient’s tolerance of the treatment.Application to a small area is best tolerated. ■ Injured skin or wounds. Intact skin tolerates heat and cold therapy better than skin that has been injured or has open wounds.
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