Using a Hydraulic LiftHydraulic lifts, such as the Hoyer lift, are an example of assistiveequipment to take the place of manual lifts and transfers. The liftcan be used in transferring the client between the bed and a wheel-chair, the bed and the bathtub, and the bed and a stretcher. TheHoyer lift consists of a base on casters, a hydraulic mechanicalpump, a mast boom, and a sling (Figure 44-53 ■). The sling mayconsist of a one-piece or two-piece canvas seat. The one-piece seatstretches from the client’s head to the knees. The two-piece seathas one canvas strap to support the client’s buttocks and thighs anda second strap extending up to the axillae to support the back. It isimportant to be familiar with the model used and the practices thataccompany use. Before using the lift, the nurse ensures that it is inworking order and that the hooks, chains, straps, and canvas seatare in good repair. Most agencies recommend that two nurses op-erate a lift. Check agency policy.

Providing ROM ExercisesWhen people are ill, they may need to perform ROM exercisesuntil they can regain their normal activity levels. Active ROM ex-ercises are isotonic exercises in which the client moves eachjoint in the body through its complete range of movement, max-imally stretching all muscle groups within each plane over the

joint. These exercises maintain or increase muscle strength andendurance and help to maintain cardiorespiratory function in animmobilized client. They also prevent deterioration of joint cap-sules, ankylosis, and contractures.

Full ROM does not occur spontaneously in the immobilized in-dividual who independently achieves ADLs, moves about in bed,transfers between bed and wheelchair or chair, or ambulates a shortdistance, because only a few muscle groups are maximallystretched during these activities. Although the client may success-fully achieve some active ROM movements of the upper extremi-ties while combing the hair, bathing, and dressing, the immobilizedclient is very unlikely to achieve any active ROM movements ofthe lower extremities when these are not used in the normal func-tions of standing and walking about. For this reason, most clientswho use a wheelchair and many ambulatory clients need activeROM exercises until they regain their normal activity levels.

At first, the nurse may need to teach the client to perform theneeded ROM exercises; eventually, the client may be able to ac-complish these independently. Instructions for the client per-forming active ROM exercises are shown in the accompanyingClient Teaching feature.

During passive ROM exercises, another person moves eachof the client’s joints through its complete range of movement,maximally stretching all muscle groups within each plane overeach joint. Because the client does not contract the muscles,passive ROM exercises are of no value in maintaining musclestrength but are useful in maintaining joint flexibility. For thisreason, passive ROM exercises should be performed only whenthe client is unable to accomplish the movements actively.

Passive ROM exercises should be accomplished for eachmovement of the arms, legs, and neck that the client is unable toachieve actively. As with active ROM exercises, passive ROMexercises should be accomplished to the point of slight resist-

1146 UNIT X / Promoting Physiologic Health

HOME CARE CONSIDERATIONS Transferring from Bed to a Chair

■ The caregiver and client should practice transfer technique(s) inthe hospital or long-term care setting before being discharged.● Assess furniture in the home. Does the client’s favorite chair

have arms for ease of using and sitting? Examine the fabric—is itrough? Will it cause skin abrasions? If the client will be using a

wheelchair, is there enough space in the bedroom and bath-room for a safe transfer?

● Observe client and caregiver transfer technique in the home set-ting to reinforce prior teaching.

Figure 44-53 ■ A one-piece seat hydraulic lift.

CLIENT TEACHING Active ROMExercises

■ Perform each ROM exercise as taught to the point of slight re-sistance, but not beyond, and never to the point of discomfort.

■ Perform the movements systematically, using the same se-quence during each session.

■ Perform each exercise three times.■ Perform each series of exercises twice daily.

ELDERS

■ For elders, it is not essential to achieve full range of motion in alljoints. Instead, emphasize achieving a sufficient range of motionto carry out ADLs, such as walking, dressing, combing hair, show-ering, and preparing a meal.

koz74686_ch44.qxd 11/8/06 6:14 PM Page 1146