PROVIDING RANGE OF MOTION EXERCISES

ACTION RATIONALE
1. Review the physician’s order and NCP  To validates the correct patient
for patient’s activity. Identify any and correct procedure.
movement limitation. Identification of limitations
prevents injury.
2. Identify the pt. Explain the procedure.  To validates the correct patient
and correct procedure. Explaining
the procedure, help allay anxiety
and prepare the pt. for what to
expect.
3. Perform hand hygiene and put on  Prevent the spread of
gloves prn. microorganism.
4. Close the door and curtains. Place bed  To provide privacy. Proper bed
at an appropriate and comfortable height helps reduce back strain
working height. Adjust the head of the while performing the procedure.
bed to a flat position or as low as the pt.
can tolerate.
5. Stand at the side of the bed where  Standing at one side to be
joints are to be exercised. Only uncover exercised prevents strain on the
the limb to be used during exercise. nurse’s back. Proper draping
provides privacy and warmth.
6. Perform the exercise slowly and gently,  Prevent discomfort and muscle
providing support by holding the areas spasm resulting from jerky
proximal and distal to the joint. Repeat movements.
each exercise 2 to 5 times, moving each  Repeated movement of the
joint in a smooth and rhythmic manner. muscles and joints improves
Stop movement if the pt. complains of flexibility and increases circulation
pain or if you meet resistance. to the body part.
 Pain may indicate the exercises are
causing damage.
7. Perform the exercise beginning at the  Proceeding from head to toe one
head and moving down one side of the side at a time promotes efficient
body at a time. time management and an
organized approach to the task.
8. Move chin down to rest on the chest.  These movements provide flexion,
Return the head to a normal upright. extension, and lateral flexion.
9. Move the head from side to side,  This movement provides for
bringing the chin toward each shoulder. rotation of neck.
10. Start with the arm at the pt.’s side  Provide for extension and flexion
and lift the arm forward to above the movement of the shoulder.
head. Return the arm to the starting
position at the side of the body.
11. With the arm back at the pt.’s side,  This movement provides abduction
move the arm laterally to an upright and adduction of shoulder.
position above the head, and return to
the original position. Move the arm across
the body as far as possible.
12. Raise the arm at the side until the  To provide for internal and external
upper arm in line with the shoulder. Bend rotation of the shoulder.
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  To provide for flexion and
arm and hand upward toward the extension of elbow.
shoulder. Return the lower arm and hand
to original position while straightening
the elbow.
14. Rotate the lower arm and hand do the  It provide for supination and
palm is up. Rotate the lower arm and pronation of the forearm.
hand so the palm of hand is down.
15. Move the hand downward toward the  It provide flexion, extension and
inner aspect of the forearm. Return the hyperextension of the wrist.
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  It provide for flexion, extension,
then straighten them out. Spread the abduction, and adduction of
fingers apart and return them back fingers.
together. Touch the thumb to each finger
on the hand.
17. extend the leg and lift it upward.  Provide for flexion and extension of
Return the leg to the original position the hip.
beside the other leg.
18. Lift the leg laterally away from the  Provide for abduction and
pt.’s body. Return the leg toward the adduction of the hip.
other leg and try to extend it beyond the
midline.
19. Turn the foot and the leg toward the  It provide for internal and external
other leg to rotate it internally. Turn the rotation of the hip.
foot and leg outward away from the other
leg to rotate it externally.
20. Bend the leg and bring the heel  The movements provide for flexion
toward the back of the leg; then return and extension of the knee.
the leg to a straight position.
21. Move the foot up and back until toes  Provide dorsiflexion and plantar
are upright. Move the foot with toes flexion of the ankle.
pointing downward.
22. Turn the sole of the foot toward the  Provide for inversion and eversion
midline. Turn the sole of the foot outward. of ankle.
23. Curl the toes downward and then  Provide for flexion, extension,
straighten them out. Spread the toes abduction, and adduction of toes.
apart and bring them together.
24. Repeat these exercises on the other  Repeating motions on the other
side of the body. Encourage the patient to side provides exercise for the
do as many of these exercises by himself entire body.
as possible.
25. When finished, make sure the pt. is  Proper positioning with the raised
comfortable, with the side rails up and side rails and proper bed height
the bed in lowest position. provides for pt. comfort and safety.
26. Remove the gloves if used and  Proper glove removal and hand
perform hand hygiene. Document the hygiene prevent the spread of
exercises performed, any observations microorganisms.
and the patient’s reaction to the  Documentation promotes
activities. 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:
 Physician’s 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 pt’s to assist with moving and the need for a 2nd
person to assist with the activity.

ACTION RATIONALE
1. Review the physician’s order and NCP o TO VALIDATE THE CORRECT
for patient’s activity. Identify any PATIENT AND CORRECT
movement limitations and the ability of PROCEDURE.
the pt to assist with turning. 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 procedure o TO VALIDATE THE CORRECT
to the pt. PATIENT AND CORRECT
PROCEDURE.

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 pt’s arms across his chest
and cross his far leg over the leg nearest
you/
10. Stand opposite the pt’s 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 pt’s 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 pt’s 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
pt’s 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 Explanation helps allay anxiety and
prepare the pt for what to expect.
o To prevent the spread of
microorganism.
o Provides privacy to the pt.
o Proper bed height help reduce
back strain while performing the
procedure.
o Facilitates the turning maneuver
and minimizes strain on the nurse.
Having supports readily available
promotes efficient care.
o With this placement, the pt will be
on the center of the bed after
turning will be accomplished.
o 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.
o This facilitates the turning motion
and protects the pt’s arms during
the turn.
o 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.
o The maneuver supports the pt’s
body and makes use of the nurse’s
weight to assist with turning.
o Pillow will provide support and help
the pt maintain the desired
position. Positioning the shoulder
blade removes pressure from the
bony prominence.
o Positioning in proper alignment
with supports ensure that the pt
will be able to maintain the desired
position and will be comfortable.
o Adjusting the bed height ensures
pt safety.
within easy reach.
15. Perform hand hygiene and document o Prevents spread of
the position change/hospital policy. microorganisms, documentation
promotes continuity of care and
communication.

PAM