A nurse is caring for a comatose patient and applies a hand and wrist roll in each hand of the patient to keep the thumb slightly adducted and correct position to the fingers. What is the primary purpose of this action?
A.
To prevent contractions in the hand.
B.
To prevent skin breakdown.
C.
To prevent decrease perfusion in the lower extremities.
D.
To prevent pooling of blood in the hand.
The Correct Answer and Explanation is:
The correct answer is A. To prevent contractions in the hand.
A hand and wrist roll is used primarily to maintain proper positioning and alignment of the fingers, thumb, and wrist, especially in comatose or immobilized patients. The goal is to prevent contractures, which are abnormal, often permanent shortening or stiffening of muscles, tendons, or tissues that can occur when a joint remains in a fixed position for extended periods.
Purpose of Hand and Wrist Rolls:
- Prevention of Contractures:
- Contractures are a common complication in patients who are immobile or unable to move their extremities voluntarily, such as comatose patients. Without proper positioning and movement, the muscles in the hand can shorten, causing the fingers to curl into a fist, making them difficult to extend. Over time, this can lead to a permanent contracture. Hand and wrist rolls help maintain the hand in a more natural, slightly adducted position, keeping the fingers from tightening into a fist.
- Maintaining Functional Position:
- The hand’s normal position is with the thumb slightly adducted and the fingers slightly flexed. By using a hand and wrist roll, the nurse ensures that the joints, tendons, and muscles of the hand and wrist remain in a functional alignment. This is especially important for the patient’s rehabilitation and in case the patient regains consciousness or mobility later.
Other Considerations:
- Prevention of Skin Breakdown: While proper positioning can also help reduce pressure on the skin (helping prevent skin breakdown, such as pressure ulcers), this is a secondary benefit, not the primary purpose of a hand roll. The rolls are more focused on preventing contractures than preventing skin damage.
- Perfusion and Blood Pooling: Hand rolls do not play a direct role in promoting circulation or preventing blood pooling. They do not affect the lower extremities or the vascular system directly, which eliminates answers C and D.
In conclusion, the primary purpose of applying a hand and wrist roll in a comatose patient is to prevent contractures in the hand and wrist by keeping the thumb and fingers in proper alignment, ensuring that the muscles and tendons do not become stiff or permanently shortened.