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PT 6221: Therapeutic Procedures > Heat and Cold: Indications and Contraindications > Flashcards

Heat and Cold: Indications and Contraindications Flashcards

1
Q

What are the primary treatment goals for Cryotherapy? (5)

hint: limits 3 things, reduces 1, facilitates 1

A
  1. Limit edema formation
  2. Limit inflammation
  3. Limit secondary hypoxic tissue injury
  4. Reduced pain
  5. Facilitate muscle relaxation
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2
Q

What are the indications for Cryotherapy? (12)

A
  1. Acute Injury
  2. Acute Pain
  3. Muscle Spasm (acute or chronic)
  4. Spasticity
  5. Reduction of Fever
  6. Acute Burns (not ice)
  7. Acute or Sub-Acute Inflammation
  8. Trigger Points (myofascial pain)
  9. Sprains/Strains
  10. DOMS
  11. Edema
  12. Limitation of Motion secondary to pain
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3
Q

What are the indications for heat therapy? (13)

A
  1. Subacute Trauma
  2. Chronic conditions
  3. Inflammatory conditions
  4. OA/RA
  5. Tight connective tissue (i.e., scars, contracture)
  6. Pain
  7. Muscle Spasm
  8. Before active exercise
  9. Before PROM
  10. Before E-Stim
  11. Before Traction
  12. Before massage
  13. Muscle spasm
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4
Q

Superficial Heat Contraindications (9)

A
  1. Bleeding or edema
  2. Acute infection
  3. Malignancy
  4. Poor circulation/PVD
  5. Denervation
  6. DVT
  7. Confusion, sedation, coma
  8. Sensory loss
  9. Existing fever
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5
Q

Superficial Heat Precautions (9)

A
  1. Cardiac insufficiency
  2. Poor sensation
  3. Very old/very young (less than 4 years old)
  4. Dementia
  5. While pregnant (abdomen/low back)
  6. Existing edma
  7. Acute inflammatory conditions
  8. Over topical counterirritants
  9. Implanted metal (close to skin)
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6
Q

Cryotherapy Contraindications and Precautions

A
  1. Over regenerating peripheral nerves
  2. Over open wounds
  3. HTN
  4. Decreased sensation (CVA, DM)
  5. Very old/Very young
  6. Decreased cognition
  7. Hx of frostbite
  8. Raynaud’s disease
  9. Cold hypersensitivity/intolerance
  10. Impaired circulation/PVD
  11. Angina pectoris
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7
Q

General Cryotherapy Treatment Set-Up

A
  1. Explain Rx to patient (ask about frostbite, cold sensitivity, other precautions/CIs, expectations during treatment)
  2. Expose skin of area to be treated
  3. Position & Drape (keep rest of body warm)
  4. Inspect area to be treated and during treatment (check skin)
  5. Determine patient’s ability to respond to temperature changes
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8
Q

What are the 4 stages of sensation with cryotherapy? (Acronym)

A

“UBAN”

  1. Uncomfortable sensation of cold
  2. Burning / stinging
  3. Aching
  4. Numbness

N/a to cryocuff (not as cold)

All related to nerve endings as they temporarily cease to function (decreased blood flow and nerve conduction velocity)

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9
Q

In cryotherapy, what happens to blood flow?

A

it decreases

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10
Q

In cryotherapy, what happens to nerve conduction velocity?

A

it decreases

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11
Q

What is a normal skin response after cryotherapy?

A
  • Remaining skin integrity
  • Redness may remain 20 min or longer
  • Numbness lasts for a few minutes
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12
Q

What is an abnormal skin response after cryotherapy?

A
  • frost-bite (tingling, burning, pain)
  • Mottled white/red/yellow or bluish appearance
  • blisters may form
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13
Q

What are common methods of cryotherapy treatment?

A
  1. Ice massage
  2. Cold packs
  3. Ice bags
  4. PRICE
  5. Cryopressure
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14
Q

What type of heat transfer is ice massage?

A

conduction

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15
Q

Ice massage duration should last how long?

A

5-15 minutes

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16
Q

How can ice massage increase ROM?

A

by decreasing pain/spasm in a specific area

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17
Q

What are the general ice massage procedures?

A
  1. Follow general superficial cold guidelines
  2. Properly position towels under/around area for water run-off as ice melts
  3. Rub ice using moderate speed and rhythmic motion
  4. Keep rest of body warm
  5. Continue until anesthesia is reached
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18
Q

What should you document following ice massage procedures?

A
  • method used
  • temp
  • area treated
  • patient position
  • duration of Rx
  • patient response during and after Rx
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19
Q

When using the commercial cold packs, what kind of heat transfer does the wet towel allow for?

A

conduction

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20
Q

What is the duration of commercial cold packs?

A

10-20 minutes

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21
Q

What are the indications for using a commercial cold pack?

A

edema, pain

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22
Q

What is a downfall of using commercial cold packs?

A

don’t cool as well as ice packs

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23
Q

What is the order of using a cold pack (procedure)?

A
  1. Cover area with moist towel
  2. Place pack over towel/mold to fit
  3. Insulate pack with dry towel
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24
Q

Homemade Ice Packs add 2 parts ____ and 1 part _____

A

water; rubbing alcohol

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25
Q

When making homemade ice packs, you should err on the side of more

A

water vs. alcohol

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26
Q

What does PRICE stand for?

A 
Protect
Rest
Ice
Compression
Elevation
27
Q

When is a cryopressure/cryo-cuff used?

A

Acute & post-surgically

28
Q

What is the duration of a cryocuff?

A

20 minutes

29
Q

A cryocuff may increase what due to less edema?

hint: helpful to start with this before stretching!

A

ROM

30
Q

Where should you place the cryocuff around?

A

the joint

31
Q

When preparing a cryocuff, you should elevate what until the cuff is full?

A

the resevoir

32
Q

What should you NOT use if a topical cold gel is on the skin?

A

ice

33
Q

Although studies have shown topical cold gels can reduce pain, they do not do what?

A

cool the skin or subcutaneous tissues

34
Q

When setting up for using superficial heat, what do you need to do?

A
  1. Explain Rx to patient
  2. Position patient comfortably
  3. Remove jewelry
  4. Expose skin
  5. Appropriately drape area
  6. Inspect area
  7. Cleanse area
  8. Determine patient’s ability to respond to change in temperature
35
Q

What should you document after using superficial heat?

A
  • position (how were they sitting/laying?)
  • area (what area was treated?)
  • agent (what modality did you use?)
  • dosage (how much did you use?)
  • patient response (how did they respond?)
  • observation (anything of note?)
36
Q

What are common superficial heat modalities? (4)

hint: HPFW

A
  1. Hot Packs (hydrocollator)
  2. Paraffin
  3. Fluidotherapy
  4. Whirlpool
37
Q

The hydrocollator temperature is kept at what temperature?

A

170F

38
Q

What kind of heat transfer occurs with hot packs via moist heat?

A

conduction

39
Q

The depth of penetration when using hot packs is approximately _____ or less

A

1 cm

40
Q

What is the appropriate duration for using hot packs?

A

15-20 minutes

41
Q

What are the Cardiopulmonary physiologic responses to using hot packs?

A
  1. Decreased BP
  2. Decreased CO
  3. HR may increase

NOTE: Pts w/ cardiac insufficiency may have difficulty with increased stress on the heart

42
Q

What are the endocrine responses to using hot packs?

A

Release of histamine-like substances

43
Q

What are the GI responses to using hot packs?

A

Decrease in activity and relaxation

44
Q

What are the integument responses to using hot packs?

A

Increased perspiration, erythema

45
Q

The musculoskeletal response to hot packs is

A

relaxation

46
Q

The neuromuscular responses to hot packs are

A

nerve ending sedation & analgesia

47
Q

The peripheral vascular responses to hot packs are

A

vasodilation and hyperemia

48
Q

What are the 2 specific contraindications for using hot packs?

A
  1. Acute Infection

2. Dermatologic conditions exacerbated by heat

49
Q

What are the 4 specific precautions for using hot packs?

A
  1. Increased or decreased cutaneous sensitivity
  2. Vascular compromise
  3. Patient complaint
  4. Skin inspection
50
Q

How many layers do you need to use when using hot packs?

A

6-8 layers between heat and the patient

51
Q

How many layers does the HP cover count as?

A

4 layers

52
Q

When should you increase the amount of layers you are using for hot packs?

A
  1. Frail patients

2. If lying ON the hot pack

53
Q

When using a hot pack, you should be sure that the layer next to the patient is a

A

washable towel, NOT the HP cover itself

54
Q

If you leave a patient during a hot pack procedure, what do you need to do?

A
  1. Secure HP in place
  2. Set a timer
  3. Leave a bell for patient
55
Q

How long before you check the patient’s skin when using a hot pack?

A

5 minutes

56
Q

What is a normal response to a hot pack treatment?

A
  • mild to moderate erythema

- perception of mild to moderate heat

57
Q

What is an abnormal response to a hot pack treatment?

A

(Often occurs early on in treatment within 5-10 minutes)

  1. Fair skinned individuals: bright pink-red or blotchy red
  2. Darker skinned individuals: areas of darker and lighter color
  3. Blistering
  4. Tender touch to skin
58
Q

When you are using a hot pack treatment, you need to ALWAYS do what (2)?

A
  1. Set a timer

2. Give patient bell or call light

59
Q

When using homemade rice packs, how long should they be microwaved for?

A

1-3 minutes

60
Q

ThermaCare adhesives heat to what degree?

A

104F

61
Q

ThermaCare adhesives are advantageous in that they can be worn _____ and are _____

A

all day (heat 6-8 hours); disposable

62
Q

What should be cautioned when using ThermaCare?

A

overheating sensitive skin

63
Q

Regardless of which method of applying heat you select, what is the most important things to do following application?

A
  • Stretching
  • Strengthening
  • ROM

PT 6221: Therapeutic Procedures (7 decks)

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