Body Mechanics and Applications of Heat and Cold Therapy in Nursing
BODY MECHANICS
Benefits of Exercise
Helps physiological function, stimulates circulation, improves ventilation, favors the expulsion of secretions, improves tissue oxygenation, stimulates intestinal peristalsis, favors the expulsion of intestinal gas and waste, facilitates the emptying of the renal pelvis (lower the risk of infection and stone formation).
Systems that Benefit from Exercise:
- Cardiovascular
- Lung
- Metabolism
- Gastrointestinal
- Musculoskeletal
- Exercise tolerance
- Urinary
- Neurological
Contraindications to Exercise
- Hyperthermia
- Spinal cord injury
- Internal bleeding
- Head injuries
Systems Involved in Movement
- Muscular
- Skeletal
- Nervous
- Circulatory
Moving Parts of the Human Body
- Head
- Trunk
- Extremities: Hands, Feet, Fingers
Types of Exercise
Passive Exercise
Done by one person to another. Helps prevent contracture but does not greatly increase strength or muscle tone.
Active Exercise
The subject performs themselves.
Isometric Exercise
The patient steadily increases tension in the muscles, but does not move joints.
Isotonic Exercise
Moving the limbs or elsewhere in the body, improves tone and joint mobility. The exercise should be done as tolerated (no fatigue) and increasing the period of the year little by little.
Factors Affecting Exercise Tolerance
Emotional Factors
- Anxiety
- Depression
- Chemical addiction
Physiological Factors
- Abnormal skeletal muscle disorders
- Febrile disorders
- Pain disorders (if the pain is caused by immobility, movement can be made)
- Infectious processes
- Multiple injuries
- Age
Developmental Factors
- Age
- Sex
- Pregnancy
Body Mechanics
A series of rules about treating the patient to prevent skeletal muscle injuries. It consists of a coordinated effort of the musculoskeletal and nervous systems with the objective to maintain balance, posture, and proper body alignment when performing any kind of movement. When using proper body mechanics, it reduces the risk of musculoskeletal injuries. Proper body alignment, the relationship between one body part and another, reduces contracture and enhances muscle tone and balance.
Principles of Body Mechanics
- The higher the support base, the greater the stability.
- The lower the center of gravity (closer to the base of support), the greater the stability.
Effects of Immobility
Immobility: Decreased or absent activity usually carried out.
Types of Immobility:
- Mild: Performs daily activities
- Moderate: With assistance (cane) but can engage in daily activities
- Severe: Needs both material and human assistance
Musculoskeletal Problems
- Muscle contractures
- Atrophy
- Muscle hypotonia (loss of strength)
- Osteoporosis
Genitourinary Problems
- Urinary tract infections
- Urinary stasis
- Urinary stones
- Incontinence
Gastrointestinal Problems
- Paralytic ileus
- Stress ulcers
- Abdominal distension due to accumulation of gas
- Constipation
- Fecal impaction
- Anorexia
Respiratory Problems
- Accumulation of secretion
- Secretion retention, and consequently tracheobronchial infections and pneumonia
- Reduced lung capacity and ventilation
- Edema
- Pulmonary embolism
Neurological and Psychological Problems
- Fear of avoiding danger
- Loneliness
- Apathy
- Decreased self-esteem
- Hostility
- Aggression
Cardiovascular Problems
- Decreased cardiac output
- Edema in parts of the sacral venous stasis
- Orthostatic hypotension
- Thrombosis
Integumentary Problems
- Decubitus ulcers
Thermoregulation
Cold Therapy: Cryotherapy
Heat Therapy: Thermotherapy
Effects of Heat
- Relaxes muscles
- Decreases contracture
- Increases blood flow (promotes healing and tissue repair)
- Blends secretions
- Softens exudates
- Increases joint mobility
- Relieves pain (analgesic)
- Relieves inflammation (inflammatory)
Indications of Heat
- Muscle spasm
- Inflammation
- Contractures
- Joint stiffness
- Pain
- Wounds
- Nasal congestion
Effects of Cold
- Vasoconstriction (anti-hemorrhagic)
- Reduces capillary permeability
- Reduces inflammation
- Decreases cellular metabolism
- Reduces pain (anesthetic)
- Reduces conduction velocity
- Lowers body temperature (fever reducer)
Indications of Cold
- Injury
- Inflammation
- Muscle spasm
- Pain
- Fever
- Bleeding
Rules for the Application of Heat and Cold
- Adaptation of thermal receptors
- Rebound phenomenon
- Systemic effects
- Tolerance and contra-adaptation of the thermal receivers
Adaptation of Thermal Receptors
These receptors give rise to afferent stimuli that reach the posterior hypothalamus and from there it activates the mechanism necessary to preserve heat (vasoconstriction) or cold (vasodilation).
Rebound Phenomenon
In the case of cold, if ice is prolonged on a joint, it will slow the flow of blood in that area. Removing the cold, the body sends a massive amount of blood to that area to restore normal temperature as soon as possible. If the problem is a sore and/or inflamed area, the high blood supply to rewarm a cold area in excess can cause inflammation and rekindle the pain. In the case of heat: it produces vasodilation (30-35 min). After this time, it can cause sunburn and rebound.
Systemic Effects
Heat: Metabolic processes increase to a point where, although the temperature rises, the metabolic process lowers.
Cold: Hypothermia can occur.
Contraindications, Tolerance, and Variables Affecting Physiological Tolerance to Cold or Heat
- Zone
- Body size display area
- Individual tolerance
- Duration of exposure
- Skin integrity
Contraindications of Using Heat
- Hemorrhage
- Non-inflammatory edema
- Acute inflammation
- Developing fetus
- Localized malignant tumor
- Disorders of the skin
- Metal implants
Contraindications of Using Cold
- Open wounds
- Circulatory compromise
- Hypersensitivity
Precautions to the Use of Heat and Cold
- Commitment
- Neurosensory impairment
- Impairment of mental status
- Circulatory compromise
- Open wounds
What We Should Evaluate Before Applying Heat and Cold
- Patient’s level of consciousness and general condition
- State of the treatment area
- Vital signs
Types of Dry Heat Applications
- Bolsa
- Heating pad
- Acuatermia pad
- Development of waste heat
- Heat lamps
- Hyperthermia rugs
Types of Moist Heat Applications
- Immersion
- Bath seat
- Wet compresses
- Poultices
Types of Dry Cold Applications
- Ice pack
- Collar ice
- Ice gloves
- Disposable cold promotion
- Hypothermia blankets
- Jets of fresh air
Types of Wet Cold Applications
- Bathrooms with cold
- Sponge, towels, and wet development
- Lotions and rubbing cold