Nursing Care Management 114

Geriatrics
Procedural Checklist in
Administering Passive Range of Motion (ROM) Exercises

Name: ____________ Date: ______Year/Sec: ___

Rating:
General Objectives: To administer patient passive range of motion (ROM) exercises with
maximum comfort and safety for the patient and nurse.
Specific Objectives:
1. Be aware of the client’s medical diagnosis.

2. Familiarize yourself with the client’s current range of motion.

3. Assess client consciousness and cognitive function.

4. Client will maintain or improve current functional joint mobility.

5. Client will regain or improve strength and movement in involved areas.

6. Client will avoid complications of immobility.

Item Weight Descriptors Verbal Interpretation

4 Excellent Performed the procedure with great ease and confidence,
observing work ethics (prudent, accepts criticisms and
suggestions), able to rationalize scientifically and shows
diligence in documenting observations at all times .
3 Very Performed the procedure with less confidence, observing work
ethics (prudent, accepts criticisms and suggestions), able to
Satisfactory
rationalize scientifically and shows minimal diligence in
documenting observations.
2 Satisfactory Performed the procedure but requires close supervision and
shows potential for improvement.
1 Needs Failed to perform the procedure, unable to function well and
 Improvement needs repeated specific/ detailed guidance or direction.
CRITERIA:

I. Skills 4.0 3.0 2.0 1.0 Remarks

1. Wash hands and wear gloves.

2. Explain procedure to client.

3. Provide for privacy, exposing only the

extremity to be exercised.

4. Adjust bed to comfortable height for

performing ROM.

5. Lower bed rail only on the side you are

working.

6. Describe the passive ROM exercises you

are performing.

7. Start at the client’s head and perform ROM

exercises down each side of the body.

8. Repeat each ROM exercise as the client

tolerates to a maximum of five times.

9. Head
With the client in a sitting position, if
possible.
 Rotation: Turn the head from side to
side.
 Flexion and extension: Tilt the head
toward the chest and then slightly
upward.
 Lateral flexion: Tilt the head on each
side so as to almost touch the ear to the
shoulder.
10. Neck
With the client in a sitting position, if
possible.
 Rotation: Rotate the neck in a
semicircle while supporting the head.
11. Trunk
With the client in a sitting position, if
possible.
 Flexion and extension: Bend the trunk
forward, straighten, and then extend
slightly backward.
 Rotation: Turn the shoulders forward
and return to normal position.
 Lateral flexion: Tip trunk to the left side,
straighten, and tip to the right side.
12. Arm
 Flexion and extension: Extend a straight
arm upward toward the head, then
downward along the side.
 Adduction and abduction: Extend a
straight arm toward the midline and
away from the midline.
13. Shoulder
 Internal and external rotation: Bend the
elbow at a 90⁰ angle with upper arm
parallel to the shoulder. Move the lower
arm upward and downward.
14. Elbow
 Flexion and extension: Supporting the
arm, flex and extend the elbow.
 Pronation and supination: Flex elbow,
move the hand in a palm-up and palm-
down position.
15. Wrist
 Flexion and extension: Supporting the
wrist, flex and extend the wrist.
 Adduction and abduction: Supporting
the lower arm, turn wrist right to left, left
to right, then rotate the wrist in a circular
motion.
16. Hand
 Flexion and extension: Support the
wrist, flex and extend the fingers.
 Adduction and abduction: Support the
wrist, spread fingers apart and then
bring them close together.
 Opposition: Supporting the wrist, touch
 each finger with the tip of the thumb.
 Thumb rotation: Support the wrist;
rotate the thumb in a circular manner.
17. Hip and leg
With the client in a supine position, if
possible.
 Flexion and extension: Support the
lower leg, flex the leg toward the chest
and then extend the leg.
 Internal and external rotation: Support
the lower leg, angle the foot inward and
outward.
 Adduction and abduction: Slide the leg
away from the client’s midline and then
back to the midline.
18. Knee
 Flexion and extension: Support the
lower leg, flex and extend the knee.
19. Ankle
 Flexion and extension: Support the
lower leg, flex and extend the ankle.
20. Foot
 Adduction and abduction: Support the
ankle, spread the toes apart and then
bring them close together.
 Flexion and extension: Support the
ankle, extend the toes upward and then
flex the toes downward.
21. Observe client for signs of exertion, pain, or
a fatigue.
22. Replace covers and position client in proper
body alignment.
23. Place side rails in original position.
24. Place call light within reach.
25. Wash hands.
Comments: (Strengths & Weaknesses)

Conforme: Evaluated by:

___________________ ____________________________________
Student’s Signature CI’s Signature over Printed Name
Date: Date: