CNA · Basic Nursing Skills · 6 min read
Warm and Cold Applications and Anti-Embolism Stockings
- Explain the physiological effects, methods, and essential safety guidelines for warm and cold therapy applications.
- Identify the signs of complications, including the rebound effect and tissue injury, that require immediate reporting to the nurse.
- Describe the purpose, proper procedure for applying, and daily monitoring requirements for anti-embolism stockings.
Principles and Types of Heat Applications
Heat therapy is a therapeutic intervention used to promote comfort and physical recovery. When heat is applied to a targeted area of the body, it dilates blood vessels in a process known as vasodilation. Vasodilation from heat applications increases blood flow to the treated body area. By increasing the circulation of blood, heat therapy promotes tissue healing by bringing more oxygen and nutrients to the area. This increased circulation supports the body's natural cellular recovery mechanisms.
In addition to enhancing blood flow, heat applications help relax muscles and relieve muscle spasms. When tense muscles relax, pressure on sensitive nerve endings decreases. For this reason, heat therapy can ease joint stiffness and decrease pain, making movement far more comfortable for the resident. For example, a resident experiencing stiffness in a joint may find that a warm soak relieves discomfort and loosens tight surrounding tissues.
Heat applications are classified into moist and dry categories. Moist heat applications include warm compresses, warm soaks, and sitz baths. Dry heat applications include warm water bags, heating pads, and aquamatic K-pads. Moist heat penetrates deeper into underlying tissues than dry heat, making it especially effective for deep muscle or joint discomfort. However, heat applications should not be applied to a freshly bleeding wound because heat increases bleeding by expanding the local blood vessels.
Common mistakes
- Leaving a heat or cold application on longer than directed increases the risk of tissue injury and may cause a rebound effect; follow the time specified in the care plan.
- Applying dry heat devices, ice bags, or chemical cold packs directly to a resident's bare skin without a protective cloth or towel barrier.
- Applying anti-embolism stockings after the resident has been standing or sitting up, rather than putting them on in the morning while the resident is resting in a supine position.
- Rolling or folding down the top edge of an anti-embolism stocking, which creates a tight constriction ring that restricts blood circulation and can cause pressure injuries.
Key points
- Heat therapy dilates blood vessels (vasodilation), increasing blood flow to promote tissue healing, relax muscles, ease joint stiffness, and decrease pain, but it must not be used on fresh bleeding.
- Cold therapy constricts blood vessels (vasoconstriction), decreasing blood flow to prevent and reduce localized swelling and edema, numb sensory nerves to relieve acute pain, and control bleeding.
- Moist applications penetrate deeper than dry applications; dry heat and dry cold devices must always be wrapped in a protective cloth cover and never placed directly on bare skin.
- The nurse aide checks the resident's skin within 5 minutes of applying heat or cold and removes the application after 15 to 20 minutes (or per the care plan) to prevent tissue injury and the rebound effect.
- Anti-embolism stockings (TED hose) require a provider order, apply graduated compression to return venous blood to the heart, and prevent deep vein thrombosis, blood clots, and lower leg edema.
- Apply stockings as directed in the care plan, preferably before the resident gets out of bed; keep them smooth without wrinkles or rolled edges, and remove them for skin inspection and hygiene as directed.
- The nurse aide must promptly report extreme redness, burns, frostbite, shivering, cold or cyanotic toes, leg pain, numbness, or skin breakdown to the nurse and accurately record all care provided.
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