Page 128 - JSOM Summer 2018

3. Leg raises. With left leg straight, have the patient raise foot 2. Hold for a count of 3 to 5.
off the bed or floor, then lower. Repeat with right leg. Alter- 3. Instruct patient to breathe out slowly and completely
natively, slowly have patient lift left knee up to chest, then through pursed lips.
bring foot back to the bed or floor; repeat with right leg. 4. Have patient rest and repeat 10 times every hour.
4. Thigh stretches. While patient is lying on their back with
straight legs, have them raise one leg to 90°. Instruct pa- Code Brown: Unconscious-Patient Bowel Movement
tient to pull the leg gently toward the head and hold for up Recommend leaving unconscious patients unclothed from
to 30 seconds. Slowly bring leg back down to a flat posi- the waist down and covered with a sheet or blanket, with
tion, and repeat with other leg. linen-saver pad or towel under the buttocks for easy bowel
5. Shoulder rolls. Although developing a clot in the upper movement clean up. During assessment, check if the uncon-
body is not likely, blood still needs to keep flowing. Have scious patient has had a bowel movement and clean if needed.
the patient raise shoulders and circle them back and down 1. Gather a basin with warm, soapy water; rolled linen-saver
five times. Then reverse direction for five more repetitions. pad or towel; gloves; and washcloths.
2. Have assistant log roll the patient toward them.
Perform DVT prevention for unconscious patients at least ev- 3. Start cleaning from top of patient toward soiled linen-saver
ery 2 hours. pad or towel, obtain a new washcloth when current one is
1. Ankle plantarflexion-dorsiflexion. Hold the ankle and heel completely used.
of one foot and alternately bend the foot forward into plan- 4. When patient is cleaned as far as can be reached on that
tarflexion and then push the foot upward into dorsiflexion. side, roll soiled pad or towel on itself to contain fecal mat-
Hold each position for 5–10 seconds. ter and start to unroll new linen-saver pad, keeping clean
2. Lower extremity massage. Using both hands and starting one under dirty one.
at the ankle, apply consistent pressure, massaging the leg 5. Gently log roll patient to the other side and have assistant
in an upward motion through the thigh. (Items such as a finish cleaning soiled area; dry completely.
plastic bottle may be used to roll the skin toward the head.) 6. Discard soiled pad or towel and finish unrolling clean pad,
Ensure deep pressure is avoided when massaging behind ensuring there are no folds under patient.
the knee or over bony prominences. Alternate legs (to sim- 7. Gently roll patient to previous position of comfort and
ulate walking) for five times on each leg. cover.

Range of Motion Exercises For nursing assessment and intervention packing list, see Ap-
At least every 8 hours, perform range of motion exercises on pendix D.
all movable joints such as ankles, knees, hips, wrists, fingers,
elbows, and shoulders, except where joint mobility is restricted Hospital clinical rotations are an excellent opportunity to
by injury. learn and practice nursing assessments and interventions. The
recommended nursing skills checklist for clinical rotations is
Turn, Cough, Deep Breathe included in Appendix E.
For a conscious patient, encourage them to turn, cough, and
take deep breaths to prevent atelectasis.
1. Instruct the patient to breathe in deeply and slowly through
their nose, expanding lower rib cage, and letting abdomen
move forward.

126 | JSOM Volume 18, Edition 2/Summer 2018