Physical Agents to Promote Tissue Healing

Key Terms

ambulation (AM-byoo-LAY-shun)

ambulatory

compress (KOM-press)

edema (uh-DEE-muh)

erythema (err-uh-THEE-muh)

exudate (EKS-oo-date)

soak

sprain

strain

suppuration (SUP-er-AY-shun)

LEARNING OBJECTIVES	PROCEDURES
Local Application of Heat and Cold
1. State examples of moist and dry applications of heat and cold. 2. State the factors to consider when applying heat and cold. 3. List the effects of local application of heat, and state reasons for applying heat. 4. List the effects of local application of cold, and state reasons for applying cold.	Apply each of the following heat treatments: Heating pad Hot soak Hot compress Chemical hot pack Apply each of the following cold treatments: Ice bag Cold compress Chemical cold pack
Ambulatory Aids
5. List factors that are taken into consideration when ambulatory aids are prescribed. 6. Explain the difference between an axillary crutch and a forearm crutch. 7. State conditions that may result when axillary crutches are not fitted properly. 8. List the guidelines that should be followed by the patient to ensure safe use of crutches. 9. State the use of each of the following crutch gaits: four-point gait, two-point gait, three-point gait, swing-to gait, and swing-through gait. 10. List and describe the three types of canes. 11. Identify the patient conditions that warrant the use of a cane or walker.	Measure a patient for axillary crutches. Instruct a patient in the proper use of crutches. Instruct a patient in the proper procedure for each of the following crutch gaits: Four-point Two-point Three-point Swing-to Swing-through Instruct a patient in the use of a cane. Instruct a patient in the proper use of a walker.

Introduction to Tissue Healing

Physical agents are often employed in the medical office to promote tissue healing for individuals who experience a disability as a result of injury, disease, or loss of a body part. Physical agents are used therapeutically to improve circulation, provide support, and promote the return of motion so that the individual can perform the activities of daily living. Physical agents frequently used in the medical office include heat and cold applied locally and ambulatory aids, such as crutches, canes, and walkers.

Local Application of Heat and Cold

The application of heat and cold is used therapeutically to treat conditions such as infection and trauma. The medical assistant may be responsible for applying various forms of heat and cold at the medical office or for instructing patients in the proper procedure for applying heat or cold at home. The medical assistant should have a basic understanding of the physiologic effects of heat and cold on the body and of possible adverse reactions if they are not administered correctly.

Heat and cold can be applied in moist or dry forms. Common applications of dry and moist heat and cold are as follows:

1. Dry heat: heating pad, chemical hot pack

2. Moist heat: hot soak, hot compress

3. Dry cold: ice bag, chemical cold pack

4. Moist cold: cold compress

Heat and cold are applied for short periods (generally 15 to 30 minutes) to produce the desired therapeutic results. The application may be repeated at time intervals specified by the physician. Prolonged application of heat or cold is not recommended because it can result in adverse secondary effects. The type of heat or cold application used for a particular condition depends on the purpose of the application, the location and condition of the affected area, and the age and general health of the patient. The physician instructs the medical assistant to apply a heat or cold treatment based on these factors.

Heat and cold receptors in the skin readily adapt to changes in temperature, eventually resulting in diminished heat or cold sensations. The temperature actually remains the same and is providing the intended therapeutic effects. The patient, not perceiving the same degree of temperature, may want to increase the intensity of the application, however, without realizing the inherent dangers. Excessive heat or cold could result in tissue damage. A common example of this situation is a patient who turns up the setting of a heating pad from medium to high when the heating pad no longer feels warm. The medical assistant should fully explain to the patient the necessity of maintaining a safe temperature range during the application.

Putting It All into Practice

My name is Marlyne Cooper, and I am a certified medical assistant. I work in a community health center. My primary responsibilities are to take patients back to the examination rooms and to prepare them for procedures and treatments. I take the patient’s chief complaint and the health history. I greet each patient in a kind and calm way. This helps put the patient at ease before the physician goes into the examining room.

I once worked in a private office with a small waiting room and a narrow hall. One of my regular patients was a healthy 20-year-old man who was confined to a wheelchair by a spinal injury from an automobile accident. He had great difficulty maneuvering his motorized chair in tight spaces, and he felt embarrassed and conspicuous sitting in the middle of the waiting room. I began bringing him through the larger back door into the physician’s office, directly into an examination room. Talking about things we had in common, such as interests in sports and movies, made him feel more at ease. By making the situation as easy as possible for him, I was able to help him keep his dignity while not drawing attention to his special needs.

Factors Affecting the Application of Heat and Cold

Before applying heat or cold, certain factors must be taken into consideration to prevent unfavorable reactions, such as tissue necrosis. The temperature may need to be adjusted based on the following conditions:

1. The age of the patient. Young children and elderly patients tend to be more sensitive to the application of heat or cold.

2. Location of the application. Certain areas of the body are more sensitive to the application of heat or cold, especially thin areas of the skin and areas that are usually covered by clothing, such as the chest, back, and abdomen. The skin on the hands and face is not as sensitive and is better able to tolerate temperature change. Broken skin, such as is found with an open wound, is more sensitive to heat and cold and is more prone to tissue damage.

3. Impaired circulation. Patients with impaired circulation tend to be more sensitive to heat and cold. This impairment may be at the site of the application or may be a systemic problem involving the entire body that is a result of certain conditions, such as peripheral vascular disease, diabetes mellitus, or congestive heart failure.

4. Impaired sensation. Patients with impaired sensation, such as diabetic patients, must be watched carefully because tissue damage may occur from the application of heat or cold without the patient’s awareness.

5. Individual tolerance to change in temperature. Some individuals cannot tolerate temperature change as easily as others.

The medical assistant should observe the area to which the heat or cold has been applied before, during, and after treatment for signs indicating that a modification of temperature is needed. Prolonged erythema or paleness, pain, swelling, and blisters should be reported to the physician. The medical assistant also should ask the patient whether the application feels comfortable or is too hot or too cold.

Heat

Local Effects of Heat

The application of moderate heat to a localized area of the body for a short time (approximately 15 to 30 minutes) produces dilation, or an increase in diameter, of the blood vessels in the area as the body tries to rid itself of excess heat (Figure 22-1). This results in an increased blood supply to the area, and tissue metabolism increases. Nutrients and oxygen are provided to the cells at a faster rate, and wastes and toxins are carried away faster. The skin in the area becomes warm and exhibits erythema. Erythema is reddening of the skin caused by dilation of superficial blood vessels in the skin.

Figure 22-1 Effects of the local application of heat and cold.

These physiologic effects of moderate heat applied to a localized area promote healing. Prolonged application of heat (longer than 1 hour) produces secondary effects, however, that reverse this healing process. Blood vessels constrict, and blood supply to the area decreases. The medical assistant must be careful to apply heat for the length of time specified by the physician.

Procedures 22-1, 22-2, 22-3, and 22-6 (see later) present the proper application of heat with a heating pad, a hot soak, a hot compress, and a chemical hot pack.

Procedure 22-1 Applying a Heating Pad