PROVIDING RANGE OF MOTION EXERCISES ACTION 1. Review the physicians order and NCP for patients activity.

Identify any movement limitation. 2. Identify the pt. Explain the procedure. RATIONALE To validates the correct patient and correct procedure. Identification of limitations prevents injury. To validates the correct patient and correct procedure. Explaining the procedure, help allay anxiety and prepare the pt. for what to expect. Prevent the spread of microorganism. To provide privacy. Proper bed height helps reduce back strain while performing the procedure.

3. Perform hand hygiene and put on gloves prn. 4. Close the door and curtains. Place bed at an appropriate and comfortable working height. Adjust the head of the bed to a flat position or as low as the pt. can tolerate. 5. Stand at the side of the bed where joints are to be exercised. Only uncover the limb to be used during exercise. 6. Perform the exercise slowly and gently, providing support by holding the areas proximal and distal to the joint. Repeat each 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.

7. Perform the exercise beginning at the head and moving down one side of the body at a time. 8. Move chin down to rest on the chest. Return the head to a normal upright. 9. Move the head from side to side, bringing the chin toward each shoulder. 10. Start with the arm at the pt.s side and lift the arm forward to above the head. Return the arm to the starting position at the side of the body. 11. With the arm back at the pt.s side, move the arm laterally to an upright position above the head, and return to the original position. Move the arm across the body as far as possible.

Standing at one side to be exercised prevents strain on the nurses back. Proper draping provides privacy and warmth. Prevent discomfort and muscle spasm resulting from jerky movements. Repeated movement of the muscles and joints improves flexibility and increases circulation to the body part. Pain may indicate the exercises are causing damage. Proceeding from head to toe one side at a time promotes efficient time management and an organized approach to the task. These movements provide flexion, extension, and lateral flexion. This movement provides for rotation of neck. Provide for extension and flexion movement of the shoulder. This movement provides abduction and adduction of shoulder.

12. Raise the arm at the side until the upper arm in line with the shoulder. Bend the elbow at a 90-degree angle and move forearm upward and downward, and then return arm to the side. 13. Bend the elbow and move the lower arm and hand upward toward the shoulder. Return the lower arm and hand to original position while straightening the elbow. 14. Rotate the lower arm and hand do the palm is up. Rotate the lower arm and hand so the palm of hand is down. 15. Move the hand downward toward the inner aspect of the forearm. Return the hand to a neutral position even with the forearm. Then move the dorsal potion of the hand backward as far as possible. 16. Bend the fingers to make a fist, and then straighten them out. Spread the fingers apart and return them back together. Touch the thumb to each finger on the hand. 17. extend the leg and lift it upward. Return the leg to the original position beside the other leg. 18. Lift the leg laterally away from the pt.s body. Return the leg toward the other leg and try to extend it beyond the midline. 19. Turn the foot and the leg toward the other leg to rotate it internally. Turn the foot and leg outward away from the other leg to rotate it externally. 20. Bend the leg and bring the heel toward the back of the leg; then return the leg to a straight position. 21. Move the foot up and back until toes are upright. Move the foot with toes pointing downward. 22. Turn the sole of the foot toward the midline. Turn the sole of the foot outward. 23. Curl the toes downward and then straighten them out. Spread the toes apart and bring them together. 24. Repeat these exercises on the other side of the body. Encourage the patient to do as many of these exercises by himself as possible.

To provide for internal and external rotation of the shoulder.

To provide for extension of elbow.

flexion

and

It provide for supination pronation of the forearm.

and

It provide flexion, extension and hyperextension of the wrist.

It provide for flexion, extension, abduction, and adduction of fingers. Provide for flexion and extension of the hip. Provide for abduction adduction of the hip. and

It provide for internal and external rotation of the hip. The movements provide for flexion and extension of the knee. Provide dorsiflexion and plantar flexion of the ankle. Provide for inversion and eversion of ankle. Provide for flexion, extension, abduction, and adduction of toes. Repeating motions on the other side provides exercise for the entire body.

25. When finished, make sure the pt. is comfortable, with the side rails up and the bed in lowest position. 26. Remove the gloves if used and perform hand hygiene. Document the exercises performed, any observations and the patients reaction to the activities.

Proper positioning with the raised side rails and proper bed height provides for pt. comfort and safety. Proper glove removal and hand hygiene prevent the spread of microorganisms. Documentation promotes continuity of care and communication.

PAM PROVIDING RANGE OF MOTION EXERCISES Unexpected Situation: While performing ROM exercise, the pt complains of feeling tired. Stop the activity for that time. Space the exercise times for the parts of the day the pt is typically feeling more rested. While exercising complain of sudden, sharp pain. Stop the exercise. Reassess the pt for other symptoms. Notify the physician of the event and your findings. Special Considerations: Physicians order and specific instructions should be obtained for patients 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 in sufficient 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 1. Review the physicians order and NCP for patients activity. Identify any movement limitations and the ability of the pt to assist with turning. 2. Gather any positioning aids, prn. 3. Identify the pt. Explain the procedure to the pt. RATIONALE TO VALIDATE THE CORRECT PATIENT AND CORRECT PROCEDURE. Identification of limitation and ability help to prevent injury. Promotes efficient time management. TO VALIDATE THE CORRECT PATIENT AND CORRECT PROCEDURE.

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o 4. Perform hand hygiene and put on gloves, prn. 5. Close the door or curtains. Place the bed at an appropriate and comfortable working height. 6. Adjust the head of the bed to flat position or as low as the pt can tolerate. Place pillows, wedges, r any other supports to be used for positioning within easy reach. 7. Using the drawsheet, move the pt to the edge of the bed, opposite the side to which the pt will be returned. 8. Stand on the side of the bed toward which the pt is turning. Make sure the side rails on the opposite side of the bed from where you are standing is raised. Lower the side rail nearest you. 9. Place the pts arms across his chest and cross his far leg over the leg nearest you/ 10. Stand opposite the pts center with your feet spread about shoulder width and with 1 foot ahead of the other. Tighten your gluteal and abdominal muscles and flex your knees. Use your leg muscles to do the pulling. 11. Position your hands on the pts far shoulder and hip, and roll the pt toward you. Or you may the draw sheet to gently pull the pt over his side. 12. Use a pillow or other support behind the pts back. Pull the shoulder blade forward and out from under the pt. 13/ Make the pt comfortable and position him in proper alignment, using pillows or other supports under the leg and arm as needed. Readjust the pillow under the pts head. Elevate the head of the bed prn for comfort. 14. Place the bed in the lowest position, with the side rails up. Make sure that the call bell and other necessary items are o o o o

Explanation helps allay anxiety and prepare the pt for what to expect. To prevent the spread of microorganism. Provides privacy to the pt. Proper bed height help reduce back strain while performing the procedure. Facilitates the turning maneuver and minimizes strain on the nurse. Having supports readily available promotes efficient care. With this placement, the pt will be on the center of the bed after turning will be accomplished. This positions the nurse opposite the center of the body mass; raising the opposite side rail prevents the pt from possible injury, lowering the near side rail prevents strain on the nurse. This facilitates the turning motion and protects the pts arms during the turn. To avoid straining the nurse/s lower back. The nurse is in stable position with good body alignment and prepared to use large muscle mass to turn the pt. The maneuver supports the pts body and makes use of the nurses weight to assist with turning. Pillow will provide support and help the pt maintain the desired position. Positioning the shoulder blade removes pressure from the bony prominence. Positioning in proper alignment with supports ensure that the pt will be able to maintain the desired position and will be comfortable. Adjusting the bed height ensures pt safety.

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

Prevents spread of microorganisms, documentation promotes continuity of care and communication. PAM