Quality of Life
• Knock before entering the person's room.
• Address the person by name.
• Introduce yourself by name and title.
• Explain the procedure before starting and during the procedure.
• Protect the person's rights during the procedure.
• Handle the person gently during the procedure.
Pre-Procedure
1 Follow Delegation Guidelines: Range-of-Motion Exercises. See Promoting Safety and Comfort:
Range-of-Motion Exercises.
2 Practice hand hygiene.
3 Identify the person. Check the ID (identification) bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
4 Obtain a bath blanket.
5 Provide for privacy.
6 Raise the bed for body mechanics. Bed rails are up if used.
Procedure
7 Lower the bed rail near you if up.
8 Position the person supine.
9 Cover the person with the bath blanket. Fan- fold top linens to the foot of the bed.
10 Exercise the neck if allowed by your agency and if the nurse instructs you to do so (Fig. 34-12, p.
538).
a Place your hands over the ears to support the head. Support the jaw with your fingers.
b Flexion—bring the head forward. The chin touches the chest.
c Extension—straighten the head.
d Hyperextension—bring the head backward until the chin points up.
e Rotation—turn the head from side to side.
f Lateral flexion—move the head to the right and to the left.
g Repeat flexion, extension,
hyperextension, rotation, and lateral flexion 5 times—or the number of times stated on the care plan.
FIGURE 34-12 Range-of-motion exercises for the neck.
11 Exercise the shoulder (Fig. 34-13, p. 538).
a Support the wrist with 1 hand. Support the elbow with the other hand.
b Flexion—raise the arm straight up in front and over the head.
c Extension—bring the arm down to the side.
d Hyperextension—move the arm behind the body. (Do this if the person is in a straight-backed chair or is standing.) e Abduction—move the straight arm away
from the side of the body.
f Adduction—move the straight arm to the side of the body.
g Internal rotation—bend the elbow. Place it at the same level as the shoulder. Move the forearm and hand so the fingers point down.
h External rotation—move the forearm and hand so the fingers point up.
i Repeat flexion, extension, hyperextension, abduction, adduction, and internal and external rotation 5 times—or the number of times stated on the care plan.
FIGURE 34-13 Range-of-motion exercises for the shoulder.
12 Exercise the elbow (Fig. 34-14, p. 538).
a Support the wrist with 1 hand. Support the elbow with your other hand.
b Flexion—bend the arm so the same-side shoulder is touched.
c Extension—straighten the arm.
d Repeat flexion and extension 5 times—or the number of times stated on the care plan.
537
FIGURE 34-14 Range-of-motion exercises for the elbow.
13 Exercise the forearm (Fig. 34-15, p. 538).
a Continue to support the wrist and elbow.
b Pronation—turn the hand so the palm is down.
c Supination—turn the hand so the palm is up.
d Repeat pronation and supination 5 times
—or the number of times stated on the care plan.
FIGURE 34-15 Range-of-motion exercises for the forearm.
14 Exercise the wrist (Fig. 34-16, p. 538).
a Support the wrist with both of your hands.
b Flexion—bend the hand down.
c Extension—straighten the hand.
d Hyperextension—bend the hand back.
e Radial flexion (deviation)—turn the hand toward the thumb.
f Ulnar flexion (deviation)—turn the hand toward the li le finger.
g Repeat flexion, extension, hyperextension, radial flexion
(deviation), and ulnar flexion (deviation)
5 times—or the number of times stated on the care plan.
FIGURE 34-16 Range-of-motion exercises for the wrist.
15 Exercise the thumb (Fig. 34-17, p. 538).
a Support the person's hand with 1 hand.
Support the thumb with your other hand.
b Abduction—move the thumb out from the inner part of the index finger.
c Adduction—move the thumb back next to the index finger.
d Opposition—touch each fingertip with the thumb.
e Flexion—bend the thumb into the hand.
f Extension—move the thumb out to the side of the fingers.
g Repeat abduction, adduction, opposition, flexion, and extension 5 times—or the number of times stated on the care plan.
FIGURE 34-17 Range-of-motion exercises for the thumb.
16 Exercise the fingers (Fig. 34-18, p. 538).
a Abduction—spread the fingers and thumb apart.
b Adduction—bring the fingers and thumb together.
c Flexion—make a fist.
d Extension—straighten the fingers so the fingers, hand, and arm are straight.
e Repeat abduction, adduction, flexion, and extension 5 times—or the number of times stated on the care plan.
FIGURE 34-18 Range-of-motion exercises for the fingers.
17 Exercise the hip (Fig. 34-19, p. 539).
a Support the leg. Place 1 hand under the knee. Place your other hand under the ankle.
b Flexion—raise the leg.
c Extension—straighten the leg.
d Hyperextension—move the leg behind the body. (Do this if the person is standing.)
e Abduction—move the leg away from the body.
f Adduction—move the leg toward the other leg.
g Internal rotation—turn the leg inward.
h External rotation—turn the leg outward.
i Repeat flexion, extension, hyperextension, abduction, adduction, and internal and external rotation 5 times—or the number of times stated on the care plan.
FIGURE 34-19 Range-of-motion exercises for the hip.
18 Exercise the knee (Fig. 34-20, p. 539).
a Support the knee. Place 1 hand under the knee. Place your other hand under the ankle.
b Flexion—bend the knee.
c Extension—straighten the knee.
d Repeat flexion and extension 5 times—or the number of times stated on the care plan.
FIGURE 34-20 Range-of-motion exercises for the knee.
19 Exercise the ankle (Fig. 34-21, p. 539).
a Support the foot and ankle. Place 1 hand under the foot. Place your other hand under the ankle.
b Dorsiflexion—pull the foot upward. Push down on the heel at the same time.
c Plantar flexion—turn the foot down. Or point the toes.
d Repeat dorsiflexion and plantar flexion 5 times—or the number of times stated on the care plan.
FIGURE 34-21 Range-of-motion exercises for the ankle.
20 Exercise the foot (Fig. 34-22, p. 539).
a Continue to support the foot and ankle.
b Pronation—turn the outside of the foot up and the inside down.
c Supination—turn the inside of the foot up and the outside down.
d Repeat pronation and supination 5 times
—or the number of times stated on the care plan.
FIGURE 34-22 Range-of-motion exercises for the foot.
21 Exercise the toes (Fig. 34-23, p. 539).
a Flexion—curl the toes.
b Extension—straighten the toes.
c Abduction—spread the toes.
d Adduction—put the toes together.
e Repeat flexion, extension, abduction, and adduction 5 times—or the number of times stated on the care plan.
FIGURE 34-23 Range-of-motion exercises for the toes.
22 Cover the leg. Raise the bed rail if used.
23 Go to the other side. Lower the bed rail near you if up.
24 Repeat steps 11 through 21. Cover the leg when done.
Post-Procedure
25 Provide for comfort. (See the inside of the back cover.)
26 Cover the person with the top linens. Remove the bath blanket.
27 Place the call light and other needed items within reach.
28 Lower the bed to a safe and comfortable level.
Follow the care plan.
29 Raise or lower bed rails. Follow the care plan.
30 Fold and return the bath blanket to its proper place. Or follow agency policy for used linens.
31 Unscreen the person.
32 Complete a safety check of the room. (See the inside of the back cover.)
33 Practice hand hygiene.
34 Report and record your observations.