A nurse is performing range-of-motion (ROM) exercises with a client on bed rest. Which is the CORRECT technique?

RANGE-OF-MOTION EXERCISES maintain joint flexibility, prevent contractures, maintain muscle tone, improve circulation, and prevent complications of immobility. TYPES: PASSIVE ROM — nurse moves the client's joints through the range; used when client cannot participate (unconscious, complete paralysis, very weak); ACTIVE-ASSISTED ROM — nurse assists the client who can do some movement; ACTIVE ROM — client performs exercises independently; nurse provides instruction and encouragement. CORRECT TECHNIQUE: SUPPORT: hold the limb at the joint (above AND below) to stabilize and support the weight; SMOOTH AND SLOW: no jerky or rapid movements; FULL AVAILABLE RANGE: move the joint as far as it will comfortably go; STOP FOR PAIN: pain indicates possible injury or joint problem; stop, document, and report; WARMTH helps muscles and joints move more freely; some facilities encourage warm soaks prior to ROM; SEQUENCE: start at head and work down, or from proximal (closer to body) to distal (farther from body). FREQUENCY: typically 2-4 times per day; each joint 5-10 repetitions. ROM MOVEMENTS by joint type: HINGE JOINTS (elbow, knee) — flexion and extension; BALL-AND-SOCKET (shoulder, hip) — flexion, extension, abduction, adduction, rotation, circumduction; PIVOT (neck) — rotation; SADDLE (thumb) — wide variety of movements. CONTRACTURES: fixed joint deformity from muscle shortening due to prolonged immobility; prevention is key — far harder to reverse than to prevent; foot drop (plantar flexion contracture) prevented with foot board or splints and dorsiflexion ROM. PN ROLE: perform passive ROM, active-assisted ROM; document tolerance; report any pain, redness, swelling, decreased range; reinforce PT/OT instructions; educate family on ROM techniques.