-safe and efficient use of

appropriate muscle groups

to do the job
• Keep your
back straight
• Ensure a wide base of
support: keep feet
separated
• Bend from the hips and
knees; not the waist

• Use the major muscle

groups (strongest)

• Use body weight to help

push or pull

• Avoid twisting. Pivot the

whole body
• Hold heavy objects close to your body

• Push or pull instead of lifting

• Ask for help as needed

• Synchronize efforts with

client & other staff

• Use mechanical devices,

turning or lifting
sheets as needed
 From bed to chair or
wheelchair
• Identify client’s strongest side
• Lower bed, lock wheels, elevate HOB

• Place chair beside bed

• on same side as client’s

strongest side

• Wheelchair faces FOB

 If assistance in transfer is
needed:
• Place one arm under client’s shoulders
• Other arm should be placed over and
around the knees
• Bring legs over the
side of bed while
raising the client’s
shoulder off the
bed
• Dangle client
• Watch for signs of fainting or dizziness
• Stand in front of client
• Place client’s feet flat on the floor
• Brace client’s weak foot and knee
 Log rolling
• When spinal column must be kept
straight (post-injury or surgery)

• 2 or more persons are needed: Both

staff move to side of bed to which the
client is being turned
staff 1: keep client’s shoulders & hips
straight
staff 2: keep thighs & lower legs straight
• Draw client toward the both of you in
a single unified motion

• Client’s head, spine, and legs are

kept in a straight position

• Position with pillows for support and

raise side rails
• Accurate measure for crutches vital to
prevent brachial plexus injury

• Distance between axillas and arm pieces:

2-3 fingerwidths or 2.5 – 5 inches

• Elbows slightly flexed 20-30 degrees

when walking

• Stand on client’s unaffected side

• Never rest axilla on axillary bars!

• Weight supported on hand
piece; on the palm

• Place crutches 6 – 10 inches

diagonally in front of the foot

• Instruct client to stop

ambulation if numbness or
tingling in the hands or arms
occur
 Four-point gait
1. Advance left crutch
2. Advance right foot
3. Advance right crutch
4. Advance left foot

- Most stable crutch gait

- Partial weight bearing on

both legs
Three-point gait
1. Advance both crutches forward
with the affected leg and shift
weight to crutches
2. Advance unaffected leg and
shift weight onto it

- Allows affected leg to be

partially or completely free of
weight bearing

- Full weight bearing on one leg,

 Two-point gait
1. Advance left crutch and right
foot
2. Advance right crutch and left
foot

- Faster version of the four-point

gait
- More normal walking pattern

- Partial weight bearing on both

legs, balance
Swing-to & swing-through
gait
1. Advance both crutches
2. Advance both legs (or one leg
is held up)

- Faster gait

- Partial weight bearing on both

legs, strength, and balance
 Using Crutches:
Sitting and Standing
Sitting down
1. Back up to the chair or bed
until it is felt behind the knees.
Take crutches and hold them
together with one hand.

25
 Using Crutches:
Sitting and
Standing

2. Reach back for the chair

or bed with your free
hand.

26
 Using Crutches:
Sitting and
Standing

3. Slowly lower yourself

onto the chair or bed.
27
 Using Crutches:
Sitting and Standing
Standing Up
2.Hold the hand grips
of both crutches in
one hand
3.Push off from the
chair with the other
hand
4.Stand and check your
28
UP WITH GOOD
DOWN WITH
BAD
Cane

Types:

Straight cane Quad cane

30
Cane
Flex elbow 20-30 degrees angle and hold handle
Tips should have concentric rings as shock
absorber and to provide optimal stability

Tip of cane should be 6 inches lateral to

the base of the fifth toe

31
 Cane good side
h e eg
n e on t
d l l eg
ca t e d
Hold af fe c
g o o
n d n g
ne a ovi
c a m
c e e n
d van w h When going
A ne
c a up the
on
an stairs
L e
follow:
“up with the
good, 32
 Walker
• Lift and move walker forward 8-10
inches

• With partial or non-weight bearing, put

weight on wrists and arms and step
forward with affected leg, supporting
self on arms, and follow with good leg.

• Nurse should stand behind patient, hold

onto gait belt at waist, as needed, for
balance.
33
• Also known as
– Mantoux screening test
– Tuberculin sensitivity test
– Pirquet test
– PPD test
• Purpose
– To check if client was
exposed to tuberculosis
bacilli
• Equipment
What is tuberculin?
– Tuberculin
A glycerine extract of the
syringe tubercle bacilli
– Tuberculin/PPD What is PPD?
tuberculin Purified Protein
derivative

• Procedure
– Intradermal injection of 0.1 ml (5
tuberculin U)
– Read 48 to 72 hours later
5 mm + 10 mm + 15 mm +
•(Positive)
HIV positive person Positive
Recent arrivals (less Positive
Persons with no
•Recent contact of TB than 5 years) from known risk factors
high-prevalence
case for TB
countries
•Persons with nodular Injection drug users
or fibrotic changes on Residents and
chest X-ray employees of high-
consistent with old congregate settings
healed TB (e.g. prisons, nursing
homes)
•Patients with organ Mycobacteriology lab
transplants personnel
•Immunosuppresed Persons with clinical
patients conditions that place
them at high-risk (e.g.
diabetes, leukemia)
Children less than 4
years of age, or
children and
adolescents exposed to
adults in high-risk
• False-positive results
– Nontuberculosis mycobacteria
– Previous BCG vaccination
 Part 1 Part 2 Test Diagnosis
Test Result
Result
Normal --- Normal
Low Normal Pernicious
Low Low Anemia
Malabsorption
 URINE COLLECTION
• To obtain
aseptic or
sterile urine
sample for
microbiological
analysis
Normal Urine Characteristic
–Normal urine volume: 500-1,500
ml/day; Average: 1,200 ml
–Urine Color: clear, light yellow
–pH: 4.6-8.0 (average 6.0)
–Specific gravity: 1.010 – 1.030
–Protein, blood, and glucose  should
not be present in urine.
–Ketones- present in clients who are
alcoholic, fasting, starving, on high-
protein diet, and in DKA
Specimen Collection
Methods
–Clean-catch midstream
specimen
–Specimen from an
indwelling catheter
•Closed-system method
•Open-system method
–24-hour urine collection
Collecting Urine Specimens
Clean-Catch (Midstream) Specimen
• Initial urinary flow is allowed to escape
• 3-10 ml of midstream urine is collected in a
sterile container
• avoid collecting last few drops of urine
• send specimen immediately to the laboratory or
within 2 hours after collection
 Collecting Urine Specimens
Sterile Specimen from Indwelling b. Open-System Method
Catheter -Place line saver under tubing at
a. From a closed system Method junction of catheter and
drainage tubing
– clamp drainage tubing about
4”below junction of drainage -Disinfect the junction before and
tubing and catheter for 10-30 after the collection
minutes -Hold the disconnected tube
(catheter and drainage tubing)
– Clean specimen collection port
1.5-2 inches from each other
with alcohol or antiseptic
-Do not allow the catheter tip to
solution
touch container
– Collect 3-10 ml of urine with a
sterile syringe
– If no collection port is visible,
check if the catheter is self-
sealing
– For self-sealing catheter, insert
needle slowly at 450 angle taking
care not to puncture the other
Collecting Urine Specimens
24-Hour Urine Collection
• Discard the first voided urine
• Collect all the subsequent urine
passed
• At the 24th hour, collect the last
sample
• Urine should be kept cool,
refrigerated or with preservative
during the 24-hour collection
period
• Specimen sent to the laboratory
within 2 hours after collection
• Sterile gloves • Pressure
• Percutaneous transducer system
introducer kit with
• IV pole – Pressure bag
– Tubing
• Premix flush
– Flush device
solution
– Transducer
• IV tubing
• Pressure monitor
• Clean gloves
• Razor
• Sterile towels
• Sterile 4x4 sponges
• Skin antiseptic
• Stethoscope
• Lidocaine 1-2% • Sterile needle
• 3 ml syringe with holder or clamp
18-G and 25-G • Cutdown tray
needle for topical • Sterile gown
anesthesia • Cap
• Antimicrobial wipes • Mask
• Occlusive dressing • Emergency cart
or tape
• Sterile syringes
• Suture with
filled with 5 or
attached needle 10ml D5W
•Signed consent
•Enema tube and bag
•Ordered solution for enema
•Laxative
•Wheelchair
•Low residue diet 1-2 days before test
•Clear liquid diet before test; no dairy products
•One glass of water every hour for 8-10 hours
•Administer one full bottle of magnesium citrate at 2pm day
before test
•3 5-mg Dulcolax tablets at 7PM, evening before test
•Keep NPO after Dulcolax
•Administer suppository or cleansing enema early morning
before test
Barium studies should follow IVPs,
UTZ, and arteriograms. Ba interferes
with visualization. Barium enema
before barium swallow!!!
 •#12 to 14 French sterile
suction catheter
•Lab request form
•Sterile specimen
•Sterile gloves
container, with tight-
•Mask
fitting cap
•Sterile in-line specimen trap
•Gloves, if necessary
(Lukens trap)
•Label
•NSS
•Laboratory request
•Portable suction machine
forms
•O2 therapy
•Label
•Optional: Nasal airway
Oxygen Therapy
• Indication: Hypoxemia/Hypoxia

• Review: Normal ABG

– PaO2= 80-100 mmHg
– PaCO2= 35-45 mmHg
– PaHCO3= 22-26 mmHg
– pH= 7.35-7.45
– O2 Saturation= 95%-100%

120
 Methods of Delivery
Nasal Cannula
• a low-flow oxygen • Cannula prongs
should be well
delivery system placed in the
• Approximate O2 conc. client’s nares
– 1 Liter = 24%-25% • Tubing is slipped
around client’s ears
– 2 Liter = 27%-29% and under chin
– 3 Liter = 30%-33% • Secure cannula by
– 4 Liter = 33%-37% tightening the
tubing but assure
– 5 Liter = 36%-41% client’s comfort
– 6 Liter = 39%-45%
121
 Methods of Delivery
Transtracheal Catheter
• Fr 8 catheter inserted
bet. 2nd & 3rd tracheal
cartilage
• Does not interfere with
talking, eating, drinking
• Expect a stent post-op
122
 Methods of Delivery
• Venturi Mask
• High airflow oxygen
entrainment system
• For patients requiring low but
constant O2 conc. (e.g.
COPD)
• Can deliver 24-50% O2 @ 4
to 10L/min
• Does not allow CO2
rebreathing
123
Methods of Delivery
Simple Face Mask
• Low-flow system-
40to60% at 5-8
L/min
• Can be used for
aerosolization

124
 Methods of Delivery
Partial Rebreathing Mask
• Has an inflatable bag that
stores 100% O2
• Indicated for patients needing
high O2 conc.
• On inspiration, patient inhales
from mask
• On expiration, bag refills with
oxygen
• Allows mixing of inspired and
expired air 125
Methods of Delivery
Non-Rebreathing Mask
• Has an inflatable bag
that stores 100% O2
• Indicated for patients
needing high O2
conc.
• Does not allow mixing
of inspired and
expired air 126
 Methods of Delivery
CPAP Mask
• Provides expiratory and
inspiratory positive airway
pressure
• Mask provides tight seal
• Used when patient have not
responded to attempts to
increase O2 with other types
of mask
• Keeps airway open (e.g OSA
patients) 127
 Methods of Delivery
ET and tracheostomy tube with
T-piece (Briggs adapter)
• For patients who cannot
protect airway, mechanically
ventilated or not.
• Attached to T-piece usually
when weaning from
ventilator
• O2 concentrations of 21-
100% may be used. 128
 Methods of Delivery
Manual resuscitation bag
• Can be used in unintubated
client needing high O2
concentration
• Usually used in CP arrest
situation
• For hyperoxygenating
patient prior to suctioning
among ventilated patients
129
Standard Intervention
•Check for adequate oxygen source/supply
and other appropriate equipment for
function
•Humidifier should be filled with sterile
distilled water to indicated level
•Determine current vital signs, level of
consciousness, and most recent ABGs
before starting therapy
- Low Concentration (24%-28)
- High Concentration (greater than 30)
130
 Standard Intervention
• Post “NO SMOKING” signs on the patient’s door
• Be sure that electric devices are in good working
order
• Asses risk for CO2 retention especially for COPD
client
• Monitor response to therapy by oximetry.
• Gerontological Considerations
– Ciliary action decreases with age.
– Elder client’s are prone to dehydration for
procedures causing mucous membranes to dry.
– Muscular structures of the pharynx and larynx
atrophy with age 131
 Suctioning
General Principles
• Make sure suction equipment
is functional
• Monitor for signs and
symptoms to note needing
suctioning
 Suctioning
Special considerations
• Clients sensitive to decreased oxygen levels
should be suctioned for shorter durations, but
more frequently
• For pediatric clients: Two people required
• Perform any procedure which loosens
secretions before suctioning
• Suction catheter sizes
– Pediatric: 8-12 French
– Adult: 14-16 French
• Position patient appropriately
• Suction pressure
– Infants: 60-100 mmHg
– Adult: 100-120 mmHg
 Suctioning
• Hyperoxygenate the client before and after
suctioning
• Suction is applied only upon withdrawal of
the catheter
• Suction only for 10-15 seconds
• Allow 1-3 minutes of rest between
suctioning periods
• Let the client cough in between suction
periods
• After procedure, position client with head
of bed elevated at 450, side rails up, and
 Oral Airway Suctioning
• Also used to decreased halitosis and
anorexia due to excess oral secretions
• Insert catheter into the mouth along
jaw line and slide to oropharynx
• Ask client to take 3-4 breaths in
between suction period
• After suctioning, irrigate mouth with 5-
10 ml of mouth wash
• Apply petroleum jelly to lips, and
mouth moisturizer to inner lips and
 Nasopharyngeal/Nasotracheal
Suctioning
• Determine patency of nasal
passage
• Have client blow nose with
both nares open
• Clean mucous and dried
secretions from nares
• For nasotracheal: once
catheter is visible in back of
throat or resistance is felt,
ask client to pant or cough 
attempt to insert the
 Endotracheal Tube Suctioning
Special Considerations • Set oxygen on Ambu
• Clients sensitive to breathing bag to 100%
decrease oxygen levels •
must be well ventilated
Have assistant deliver
and oxygenated prior to ventilations
beginning suctioning to • If secretions are thick,
prevent CO2 build up.
place 2-3 ml saline into
• Confused or pediatric
clients may need to be ET tube, and administer
restrained. deep ventilations with
• For elderly, skin is often Ambu bag
thin and sensitive to • Suction oral airway and
pressure. Special care
should be taken to perform oral care
prevent skin breakdown
• For pediatric clients,
Hyperoxygenate before suctioning.
Depth of suction: 6 inches
 Suctioning
Complications
 Infection
 Cardiac
arrhythmias
 Hypoxia
 Mucosal
trauma
 Death
• Women with • Morbid obesity with
moderate to high no correct fit
risk of developing • Inflammatory
deep vein conditions of the
thrombosis post- lower leg
operatively • Severe
arteriosclerosis
• Edema of the legs
• Pulmonary edema
• Severe lower limb
deformity
•Disposable sitz baths with tubing
and bag
•Warm water, but cool water may
be indicated
•Towels for drying
•Thermometer
•Clean gloves, if needed
1. Verify physician’s order
2. Raise toilet seat and place sitz
bath with “front” facing the
front of the bowl
3. Fill basin with warm water up
to ½ to 2/3 full
4. Close flow clamping tube
5. Open top of plastic bag and fill
with hot water
6. Hang bag at level higher than
sitz baths
7. Insert tubing at the front or
rear of sitz baths
8. Wash hands
1. Identify client
2. Explain procedure
3. Assist client into tx area;
provide call bell
4. Check the temperature
5. Provide privacy
6. Assist client to sit in sitz bath
Duration: 15-20 minutes
8. Maintain water temperature
by continually adding
appropriate temperature to
bag
9. Assist client to dry area and
allow client to sit---prevent
hPN
10.Empty and clean sitz bath
basin (don clean gloves)
11.Discard soiled linen
1. Explain purpose and procedure
2. Obtain informed consent
3. Ensure that x-ray film has been
taken
4. Assess if client has allergies to
topical anesthetics
5. Explain that movement and
coughing will be done during the
1. Wash hands
2. Take V/S and respiratory
movement assessment
3. Administer sedative as
ordered
1. Provide adequate
4. Positioning
warmth and covering
2. Place unwrapped sterile
tray in bedside table
3. Open sterile gloves; keep
sterility
4. Assist with skin prep
5. Don clean gloves.
Instruct client not to
move, cough during
needle insertion
6. Observe for pallor,
dyspnea, tachycardia,
chest pain or vertigo.
1. Apply pressure dressing
2. Observe client every 5
mins. For the next half
hour for possible
pulmonary edema,
crepitus, cardiac
distress, or shift in
mediastinum 1. Monitor V/S and breath
3. Place client on sounds
unaffected side 2. Observe dressing,
change as needed
3. Obtain chest x-ray
4. Record color, amount,
and consistency of fluid
5. Complete lab slips and
send to lab
•Chair
•Drape
•Sterile tray
•Sterile gloves
•Bucket
•Dressing---elastic adhesive
patch
•BP equipment
•Clean gloves
1. Explain purpose and procedure
2. Obtain informed consent
3. Assess for allergies to topical
anesthetics
4. Assess for coagulation abnormalities
or bleeding tendencies
5. Handwashing
6. Assess client’s abdominal girth and
bowel sounds
7. Weigh client
8. Have client empty bladder
 • Insertion of trocar needle in
small incision
• Observe total amount of
fluid aspirated
• Apply pressure dressing
• Discard gloves and wash
hands
• Observe for leakage @
1. Positioning: Fowler’s puncture site and for scrotal
2. Drape client: blanket edema
• V/S and hPN; UO; bowel
3. V/S; check for pallor
sounds and abdominal girth
and vertigo • Weigh clients once V/S
4. Prepare tray; open stable
sterile gloves • Reinforce/change dressings
5. Skin prep PRN
6. Don clean gloves • Monitor serum electrolytes
• Document: color,
consistency, and amount;
and send to lab!!!
Chest tube drainage system
• Returns negative pressure to the
intrapleural space

• Removes abnormal accumulations of

air and fluids from the pleural space
 Interventions
• Monitor drainage: 100 ml/hour

• Mark drainage in collection chamber at

1 to 4 hour interval

• Water-seal chamber
– flucutuates with client’s breathing
– Pneumothorax: intermittent bubbling
expected
• Suction control chamber
– Normal: gentle bubbling
– Vigorous bubbling >> leak

• Occlusive sterile dressing at insertion

site

• Chest radiograph: position & lung

expansion

• Assess respiratory status

• Encourage coughing and deep breathing

• Turn client regularly >> drainage &

ventilation

• Do not strip or milk chest tube

• Bedside: clamp and sterile occlusive

dressing

• Never clamp a chest tube without written

order from doctor
• If drainage system cracks or breaks:
– insert chest tube into a bottle of sterile
water

• If chest tube pulled out accidentally:

– Pinch skin opening together
– Apply occlusive sterile dressing
– Cover dressing with overlapping pieces of
2-inch tape

• Removal: client asked to take a deep

breath and hold it, doctor removes tube
• 2 nurses to identify patient and blood
products
• Jehovah’s Witness: special written
permission
• You need an in-line filtration system!
• Use a blood warmer
• Ideal temperature: no more than 42
degrees C
1. Explain procedure
2. V/S
3. Prepare IV line- 20G
4. Obtain blood from blood
bank 30 mins. before
transfusion • Blood recipient set
5. Compare with another • IV pole
nurse
• Gloves
6. Put on protective
• Gown
equipment and prepare
blood recipient set
• Face Shield
7. Remember to prime the • Multiple-lead tubing
tubing! • Blood components
• 250 ml of NSS
• Venipuncture
equipment
• Optional: warm
compress;
ice pack
1) If administering RBCs, you can
dilute it with NSS
2) If administering whole blood, invert
bag several times to mix cells
3) Attach blood preparation to the
venipuncture device
4) Adjust the flow rate to no greater
than 5 ml/min for first 15 mins.
5) Stay with patient and observe for
any immediate reaction
6) Must infuse only for 4 hours!!!
7) Discard equipment (wear gloves) • filter can take up to
8) Return empty bag to blood bank 10 units of blood
and discard tubing and filter • you may use a
9) Record V/S pressure bag to hurry
up transfusion
• if it stops, open flow
clamp; gently rock the
bag back and forth;
flush line with NSS
• Hepatitis C
• HIV
• Cytomegalovirus
• Circulatory overload
• Hemolytic reaction
• Allergic
• Febrile
• Pyogenic
• Coagulation
disturbances
Provision of oxygen to the
brain, heart & other vital
organs until help arrives
• A - airway
• B - breathing
• C - circulation
• D–
defibrillation or
definitive
treatment

• Each step
begins with
 Adult BLS: airway
• Assessment
• Gently shake victim’s shoulders and ask “are
you okay?”
• Activate EMS: “phone first” (8 yrs. Old over)
“phone last” (below 8 yrs old)
• Supine position on firm flat surface
• 1-person rescue: on his knees, perpendicular
to victim’s sternum and facing victim
• 2-person rescue: perpendicular to head
perpendicular to sternum
• Open airway
• Head tilt – chin lift
• Jaw-thrust maneuver
• Look for any foreign material, liquids,
or solids in victim’s mouth
• Wipe out any foreign material with a
hooked index or middle finger
 Adult BLS: breathing
• Assess breathing and maintain an open
AW
• Place ear over victim’s nose and mouth
while looking for the chest to rise and
fall
• Listen for air moving in and out of lungs
• Feel for the flow of air

• Breathing victim: logroll onto side as a

Non-breathing victim
• Maintain head tilt – chin lift
• Pinch nostrils closed
• Give 2 slow full ventilations of 2 seconds per
breath (allow victim to exhale in between)
• Give 10 – 12 ventilations per minute
• If unsuccessful, check victim’s head position
and reposition if appropriate
• If unsuccessful still, check mouth for foreign
body, clear AW, and ventilate again
• Be alert to gastric distention when giving
ventilations
• Mouth to nose
• Mouth to stoma
 Adult BLS: circulation
• Assess circulation
• Always check for absence of pulse first
• Maintain an open AW
• Palpate for a carotid pulse for 5 – 10
secs
• If there is pulse, continue giving 10 –
12 ventilations per minute
• Recheck the pulse after 1 minute; if no
pulse, start chest compressions
 Adult BLS: chest
compressions
• Correct hand placement: lower half of
sternum
• With the hand closest to the victim’s
feet, locate lower margin of rib cage
• Mover fingertips along the margin to
the notch where the ribs meet the
sternum
• Place middle finger on the notch and
the index finger next to the middle
finger
• Place heel of opposite hand next to the
Ventilations adult 10 – 12/min

child 20/min

Circulation adult Carotid pulse

child Carotid pulse

infant Brachial pulse

Depth adult 1.5 – 2 inches

child 1 – 1.5 inches

infant 0.5 – 1 inch

15: 2 ratio for both one-man and 2-men rescue

• Complications of
chest
compression:
– Laceration of
internal organs
– Punctured
lungs
– Fractured ribs
or sternum
 Foreign body airway
obstruction
• Heimlich maneuver
- stand behind the victim
- place arms around the victim’s waist
- make a fist
- place the thumb side of the fist just
above the umbilicus and well below the
xiphoid process
- use chest thrusts for the obese or for
the advanced pregnancy victim
• measures the heart’s electrical activity as waveforms
• can detect MI and infarctions
• can detect rhythm and conduction disturbances
• can detect chamber enlargement
• can detect electrolyte imbalances
• can detect drug toxicities
• ECG machine
• Recording Paper
• Disposable pre-
gelled electrodes
• 4” x 4” gauze pads
• Optional: shaving I. Set up equipment at
supplies and bedside
marking pen II. Explain procedure
during setup
III. Position: supine or
low Fowler’s; arms
@ side; make sure
client is relaxed to
prevent electrical
I. To prevent muscle
I. To guarantee best
tension, place pt’s connection with leadwire,
hands under position electrodes on legs
buttocks; do not let pointing superiorly
feet touch bed board II. Do not use alcohol or
acetone pads…they will
II. Select flat, fleshy disrupt transmission of
areas to place the electrical impulses
electrodes III. Connect limb leadwires to
III. If excessively hairy, the electrodes
shave; clean excess
oil from skin
IV. Apply electrodes to
prepared site as
recommended by
manufacturer
•White or RA= right arm
•Green or RL= right arm
•Red or LL= left leg
•Black or LA= left arm
•Brown or V1 to V6= chest

I. Expose chest; position electrodes

on chest
II. If a woman, place electrodes below
breast tissue; if large-breasted,
displace breast tissue laterally
III. Paper speed: 25 mm/second
IV. If any waveform extends beyond
paper size, adjust
V. Ask patient to relax and breath
normally and not to talk
VI. Remove electrodes and clean
patient’s skin
3 basic components:
b)P wave
c)QRS complex
d)T wave

5 further divisions:
ii.PR interval
iii.J point
iv.ST segment
v.U wave
vi.QT interval
 P wave
-Represents atrial
depolarization (electrical
activation)
PR interval
- Time it takes for
impulse to travel from
atria to AV node and
bundle of His

QRS complex
-Ventricular
depolarization
-Time it takes for
impulse to travel
through bundle
J point
- Marks the end of
QRS complex and
beginning of the ST
segment
ST segment
- Represents part of
ventricular
repolarization
(restoration of
electrical potential)
T wave
- Ventricular QT Interval
U wave
repolarization - Ventricular
- Follows the T wave,
but is usually not depolarization
seen and repolarization
• Nurse • Septic joints
• Physical therapist • Acute thrombophlebitis
• Caregiver • Severe arthritic joint
inflammation
• Recent trauma with
possible hidden fractures or
internal injuries
• Determine joints that need
exercise
• Consult physician/PT for
any limitations or
precautions
• The exercises need not be • support pt’s head
done in any order or all at with hands
once • extend neck
• Schedule exercises over • flex chin to chest
• tilt head laterally to
the course of the day
• Do exercises slowly, the shoulder
• rotate head from
gently, to the end of normal right to left
ROM, or to the point of pain
 • place pt’s arms at his
side with his palm facing
up
• flex and extend his arm
at the elbow
• stabilize pt’s elbow, then
• support pt’s arm in twist hand to bring his
extended, neutral position
•Extend forearm and flex it
palm up (supination)
backward
• twist it back again to
• abduct arm outward from bring his palm down
the side of body; adduct back (pronation)
to side
• rotate shoulder
• bend elbow to touch
shoulder
• touch the mattress on the
other side of the bed for
complete internal rotation
• push arm backward for
complete external rotation
• stabilize pt’s forearm; flex
and extend wrist
• rock his hand sideways for
lateral flexion; rotate hand
for circular motion
• extend pt’s fingers, then
flex hand into a fist; repeat
extension & flexion with
each finger
• spread two adjoining
fingers apart, then bring
them together
• fully extend pt’s legs,
then bend hips and knees
toward chest allowing full
joint flexion
• move straight leg
sideways, out and away
from other leg; then back,
over and across it
• rotate his straight leg
internally toward midline,
 • flex the pt’s toes toward
the sole, then extend
them toward the top of
• bend the pt’s foot the foot
forward so that toes push • spread two adjoining
upward (dorsiflexion); toes apart, then bring
then bend foot so toes them back together
push downward (plantar
flexion)
• rotate ankle in a circular
motion
• invert ankle so that sole
is in midline; then evert
ankle so that sole faces
away from midline
 • which joints were
exercised
• patient’s tolerance of
exercises
• any edema or pressure
areas
• pain from the exercises
• range-of-motion limitation
• start passive ROM ASAP; joint disuse starts
after 24 hours
• use proper body mechanics
• if pt needs long-term rehabilitation, consult
physician/PT and teach family/caregiver
• pts on prolonged bed rest or limited activity
with no profound weakness can be taught
how to do active ROM