Skill 14

Cold Applications

There are a variety of cold (cryotherapy) modalities, such as moist cold compresses, chemical or cold packs, electromechanical or compression devices, or cold soak immersion of a body part. Cold therapy treats localized inflammatory responses that lead to edema, hemorrhage, muscle spasm, or pain (Table 14-1). Cold exerts a profound physiological effect on the body, reducing inflammation caused by injuries to the musculoskeletal system (Markert, 2011). Because reduction of inflammation is the primary goal, cryotherapy is the treatment of choice for the first 24 to 48 hours after an injury (Gottschalk, 2011). When used appropriately, cold applications significantly lessen pain and immobility by reducing swelling of injured tissues (Physiotherapy Canada, 2010). This is an important point for nurses to know when choosing heat or cold for the treatment of acute injuries. Cold is also indicated as an adjunct analgesic for chronic pain and spasticity control.

TABLE 14-1

Pathophysiological Effects of Hot and Cold Applications

	COLD	HOT
Pain	↓	↓
Spasm	↓	↓
Metabolism	↓	↑
Blood flow	↓	↑
Inflammation	↓	↑
Edema	↓	↑
Extensibility	↓	↑

Modified from Garner A, Fendius A: Temperature physiology, assessment and control, Br J Neurosci Nurs 6(8):397, 2010; Superficial heat, Physiother Can 62(5):47, 2010, DOI:10.3138/ptc 2009-09-s6.

Delegation Considerations

The skill of applying cold applications can be delegated to nursing assistive personnel (NAP) in special situations (see agency policy). The nurse must assess and evaluate the patient and explain the purpose of the treatment. If there are risks or complications, the skill is not delegated. Direct NAP to: