Basic Restorative Care and Observation: ROM, Devices, Skin, and Reporting Changes
Restorative care
Restorative care keeps residents as independent as possible: encourage self-care, set up supplies, allow time, and praise effort. Range of motion is active when the resident moves the joint, passive when you move it, and assistive when they help. Move each joint gently through its full range, stop at resistance or pain, and never force. Do not perform ROM on a newly replaced joint unless ordered. Apply splints, braces, handrolls, and positioning devices exactly as ordered and check the skin beneath them. When ambulating, use a gait belt, stand on the weaker side, and place a cane on the stronger (unaffected) side; a walker is picked up and placed ahead, never slid.
Pressure injury awareness
Risk rises with immobility, poor nutrition, moisture from incontinence or sweat, friction and shear, and altered sensation. Reposition at least every 2 hours, more often for high-risk residents; keep heels off the mattress; keep skin clean and dry; and never massage a reddened area. Inspect skin at every bath and each repositioning. Report non-blanchable redness (stage 1), a blister or shallow open area (stage 2), a deep crater with slough (stage 3), damage reaching muscle or bone (stage 4), and wounds covered with eschar (unstageable).
Observation and reporting
Report objectively: what you saw, heard, and measured, and when - not your interpretation. Report immediately any change in condition: new confusion, difficulty breathing, chest pain, a fall, fever, refusal to eat or drink, low urine output, a new skin area, or a change in behavior. Document the facts, then notify the nurse; do not wait until the end of the shift.
Rule of thumb
Cane on the strong side, walker ahead, heels off the bed, red skin reported - never rubbed.