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PROVIDING RANGE OF MOTION EXERCISES

ACTION RATIONALE1. Review the physicians order and NCPfor patients activity. Identify anymovement limitation.

To validates the correct patientand correct procedure.Identification of limitations

prevents injury.2. Identify the pt. Explain the procedure. To validates the correct patient

and correct procedure. Explainingthe procedure, help allay anxietyand prepare the pt. for what toexpect.

3. Perform hand hygiene and put ongloves prn.

Prevent the spread of microorganism.

4. Close the door and curtains. Place bedat an appropriate and comfortableworking height. Adjust the head of the

bed to a flat position or as low as the pt.can tolerate.

To provide privacy. Proper bedheight helps reduce back strainwhile performing the procedure.

5. Stand at the side of the bed wherejoints are to be exercised. Only uncoverthe limb to be used during exercise.

Standing at one side to beexercised prevents strain on thenurses back. Proper drapingprovides privacy and warmth.

6. Perform the exercise slowly and gently,providing support by holding the areasproximal and distal to the joint. Repeateach exercise 2 to 5 times, moving each

joint in a smooth and rhythmic manner.Stop movement if the pt. complains of

pain or if you meet resistance.

Prevent discomfort and musclespasm resulting from jerkymovements.

Repeated movement of themuscles and joints improvesflexibility and increases circulation

to the body part. Pain may indicate the exercises are

causing damage.7. Perform the exercise beginning at thehead and moving down one side of thebody at a time.

Proceeding from head to toe oneside at a time promotes efficienttime management and anorganized approach to the task.

8. Move chin down to rest on the chest.Return the head to a normal upright.

These movements provide flexion,extension, and lateral flexion.

9. Move the head from side to side,bringing the chin toward each shoulder.

This movement provides forrotation of neck.

10. Start with the arm at the pt.s sideand lift the arm forward to above thehead. Return the arm to the startingposition at the side of the body.

Provide for extension and flexionmovement of the shoulder.

11. With the arm back at the pt.s side,move the arm laterally to an uprightposition above the head, and return tothe original position. Move the arm acrossthe body as far as possible.

This movement provides abductionand adduction of shoulder.

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12. Raise the arm at the side until theupper arm in line with the shoulder. Bendthe elbow at a 90-degree angle and moveforearm upward and downward, and thenreturn arm to the side.

To provide for internal and externalrotation of the shoulder.

13. Bend the elbow and move the lower

arm and hand upward toward theshoulder. Return the lower arm and handto original position while straighteningthe elbow.

To provide for flexion andextension of elbow.

14. Rotate the lower arm and hand do thepalm is up. Rotate the lower arm andhand so the palm of hand is down.

It provide for supination andpronation of the forearm.

15. Move the hand downward toward theinner aspect of the forearm. Return thehand to a neutral position even with theforearm. Then move the dorsal potion ofthe hand backward as far as possible.

It provide flexion, extension andhyperextension of the wrist.

16. Bend the fingers to make a fist, andthen straighten them out. Spread thefingers apart and return them backtogether. Touch the thumb to each fingeron the hand.

It provide for flexion, extension,abduction, and adduction offingers.

17. extend the leg and lift it upward.Return the leg to the original positionbeside the other leg.

Provide for flexion and extension ofthe hip.

18. Lift the leg laterally away from thept.s body. Return the leg toward theother leg and try to extend it beyond the

midline.

Provide for abduction andadduction of the hip.

19. Turn the foot and the leg toward theother leg to rotate it internally. Turn thefoot and leg outward away from the otherleg to rotate it externally.

It provide for internal and externalrotation of the hip.

20. Bend the leg and bring the heeltoward the back of the leg; then returnthe leg to a straight position.

The movements provide for flexionand extension of the knee.

21. Move the foot up and back until toesare upright. Move the foot with toespointing downward.

Provide dorsiflexion and plantarflexion of the ankle.

22. Turn the sole of the foot toward the

midline. Turn the sole of the foot outward.

Provide for inversion and eversion

of ankle.23. Curl the toes downward and thenstraighten them out. Spread the toesapart and bring them together.

Provide for flexion, extension,abduction, and adduction of toes.

24. Repeat these exercises on the otherside of the body. Encourage the patient todo as many of these exercises by himselfas possible.

Repeating motions on the otherside provides exercise for theentire body.

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25. When finished, make sure the pt. iscomfortable, with the side rails up andthe bed in lowest position.

Proper positioning with the raisedside rails and proper bed heightprovides for pt. comfort and safety.

26. Remove the gloves if used andperform hand hygiene. Document theexercises performed, any observationsand the patients reaction to theactivities.

Proper glove removal and handhygiene prevent the spread ofmicroorganisms.

Documentation promotescontinuity of care andcommunication.

PAM

PROVIDING RANGE OF MOTION EXERCISES

Unexpected Situation:

While performing ROM exercise, the pt complains of feeling tired. Stopthe activity for that time.

Space the exercise times for the parts of the day the pt istypically feeling more rested.

While exercising complain of sudden, sharp pain. Stop the exercise.Reassess the pt for other symptoms. Notify the physician of the eventand your findings.

Special Considerations:

Physicians order and specific instructions should be obtained forpatients with acute arthritis, fractures, torn ligaments, joint dislocation.AMI, and bone tumors or metastatis.

ASSESSMENT: Review the medical record and the NCP for any conditions or orders that

limit the mobility.

Perform a pain assessment prior to the time for the exercises.

If the pt reports pain, administer the prescribed medication insufficient time to allow full affect of the analgestic.

Assess ability of the pts to assist with moving and the need for a 2nd

person to assist with the activity.

ACTION RATIONALE1. Review the physicians order and NCP

for patients activity. Identify anymovement limitations and the ability ofthe pt to assist with turning.

o TO VALIDATE THE CORRECT

PATIENT AND CORRECTPROCEDURE.o Identification of limitation and

ability help to prevent injury.2. Gather any positioning aids, prn. o Promotes efficient time

management.3. Identify the pt. Explain the procedureto the pt.

o TO VALIDATE THE CORRECT

PATIENT AND CORRECTPROCEDURE.

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o Explanation helps allay anxiety and

prepare the pt for what to expect.4. Perform hand hygiene and put ongloves, prn.

o To prevent the spread of

microorganism.5. Close the door or curtains. Place thebed at an appropriate and comfortableworking height.

o Provides privacy to the pt.

o Proper bed height help reduce

back strain while performing theprocedure.

6. Adjust the head of the bed to flatposition or as low as the pt can tolerate.Place pillows, wedges, r any othersupports to be used for positioning withineasy reach.

o Facilitates the turning maneuver

and minimizes strain on the nurse.Having supports readily availablepromotes efficient care.

7. Using the drawsheet, move the pt tothe edge of the bed, opposite the side towhich the pt will be returned.

o With this placement, the pt will be

on the center of the bed afterturning will be accomplished.

8. Stand on the side of the bed toward

which the pt is turning. Make sure theside rails on the opposite side of the bedfrom where you are standing is raised.Lower the side rail nearest you.

o This positions the nurse opposite

the center of the body mass;raising the opposite side railprevents the pt from possibleinjury, lowering the near side railprevents strain on the nurse.

9. Place the pts arms across his chestand cross his far leg over the leg nearestyou/

o This facilitates the turning motion

and protects the pts arms duringthe turn.

10. Stand opposite the pts center withyour feet spread about shoulder widthand with 1 foot ahead of the other.

Tighten your gluteal and abdominal

muscles and flex your knees. Use your legmuscles to do the pulling.

o To avoid straining the nurse/s

lower back. The nurse is in stableposition with good body alignmentand prepared to use large muscle

mass to turn the pt.

11. Position your hands on the pts farshoulder and hip, and roll the pt towardyou. Or you may the draw sheet to gentlypull the pt over his side.

o The maneuver supports the pts

body and makes use of the nursesweight to assist with turning.

12. Use a pillow or other support behindthe pts back. Pull the shoulder bladeforward and out from under the pt.

o Pillow will provide support and help

the pt maintain the desiredposition. Positioning the shoulderblade removes pressure from thebony prominence.

13/ Make the pt comfortable and position

him in proper alignment, using pillows orother supports under the leg and arm asneeded. Readjust the pillow under thepts head. Elevate the head of the bedprn for comfort.

o Positioning in proper alignment

with supports ensure that the ptwill be able to maintain the desiredposition and will be comfortable.

14. Place the bed in the lowest position,with the side rails up. Make sure that thecall bell and other necessary items are

o Adjusting the bed height ensures

pt safety.

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within easy reach.15. Perform hand hygiene and documentthe position change/hospital policy.

o Prevents spread of

microorganisms, documentationpromotes continuity of care andcommunication.

PAM