Range of Motion, Body Range of Motion, Body Mechanics, Transfers & Mechanics, Transfers &

PositioningPositioning

Range of MotionRange of Motion

• ROM is the extent ROM is the extent of movement that of movement that a joint is normally a joint is normally capable of.capable of.

Hip ROMHip ROM

• Hip ROM includes Hip ROM includes flexion, extension flexion, extension and lateral & and lateral & external rotationexternal rotation

• Adduction & Adduction & AbductionAbduction

Hip ROM 1Hip ROM 1

Hip ROM 2Hip ROM 2

Hip ROM 4Hip ROM 4

Hip ROM 4Hip ROM 4

Yes, Elephants DanceYes, Elephants Dance

Hand Movements (ROM)Hand Movements (ROM)

• ROM in wrist ROM in wrist includes flexion, includes flexion, extension, radial & extension, radial & ulner deviationulner deviation

• ROM in hands ROM in hands include abduction, include abduction, adduction, flexion, adduction, flexion, extension, extension, opposition and opposition and circumduction of circumduction of the thumb.the thumb.

RotationRotation

Pronation and SupinationPronation and Supination

• Quick Quiz: Which Quick Quiz: Which is pronation?is pronation?

ExtensionExtension

FlexionFlexion

Assessing Joint MobilityAssessing Joint Mobility

• Size, shape, color Size, shape, color & symmetry of & symmetry of opposite joints.opposite joints.

• Note masses, Note masses, deformities or deformities or muscle atrophy.muscle atrophy.

Assessing Joint MobilityAssessing Joint Mobility

• The ROM is The ROM is appropriate to appropriate to each joint and each joint and equal to its equal to its opposite joint.opposite joint.

LimitationsLimitations

Limited ROM in Neck of Limited ROM in Neck of SableSable

Walking SablesWalking Sables

Aardvark Neck LimitationAardvark Neck LimitationNote Adaptation to ADL’s (such Note Adaptation to ADL’s (such as they are….)as they are….)

ROM of Motion changes with ROM of Motion changes with ageage

Swelling, tenderness & pain Swelling, tenderness & pain are among factors that limit are among factors that limit ROM.ROM.

Body MovementBody Movement

• Movement, as in Movement, as in the case of these the case of these dancers, involves dancers, involves voluntary and voluntary and involuntary involuntary movement.movement.

Body MovementBody Movement

• Disruption of Disruption of voluntary/involuntavoluntary/involuntary movement may ry movement may result in tremors result in tremors and seizures.and seizures.

Asymmetrical MovementAsymmetrical Movement

• This type of This type of movement may be a movement may be a CNS disorder but is CNS disorder but is most often a CVA. most often a CVA.

• Examples include Examples include drooping on one drooping on one side of the body and side of the body and a foot-dragging gait. a foot-dragging gait.

• ROM and ROM and ADL’sADL’s

Counter indication of ROMCounter indication of ROM

1.1. Dislocated or unhealed fracture (fx).Dislocated or unhealed fracture (fx).

2.2. Immediately after surgery (sx) on Immediately after surgery (sx) on tendons, ligaments, muscles, joint tendons, ligaments, muscles, joint capsules or skin.capsules or skin.

Precautions with ROMPrecautions with ROM

1.1. Infection or inflammation around a Infection or inflammation around a joint.joint.

2.2. Pain medicationPain medication

3.3. OsteoporosisOsteoporosis

4.4. Arthritis Arthritis

Age and sex affect ROMAge and sex affect ROM

The effect of ROM on ADL’sThe effect of ROM on ADL’s

• Movement in bed Movement in bed i.e. sitting in bed, i.e. sitting in bed, rising from bed and rising from bed and turning over. turning over.

Transfers:Transfers:Seat-to-Seat, Toilet to Bed, etc.Seat-to-Seat, Toilet to Bed, etc.

Locomotion:Locomotion:walking on level ground or walking on level ground or gentle slopegentle slope

DressingDressing

• What affects would What affects would not being able to not being able to dress yourself have dress yourself have on you? On your on you? On your client?client?

Personal HygienePersonal Hygiene

EatingEating

Body AlignmentBody Alignment

Keep Your Back StraightKeep Your Back Straight

Correct LiftingCorrect Lifting

The Correct Way to LiftThe Correct Way to Lift

When turning, rotate your When turning, rotate your whole body, not just your back.whole body, not just your back.

When sitting keep your back When sitting keep your back straight.straight.

Balance: Keep Your Feet 12” Balance: Keep Your Feet 12” apart apart

Coordinated Body Coordinated Body MovementMovement

Factors That Affect Body Factors That Affect Body Alignment and MobilityAlignment and Mobility1.1. Developmental---Age of ClientDevelopmental---Age of Client

2.2. Physical Health—Chornic or Acute Physical Health—Chornic or Acute DiseaseDisease

3.3. Musculoskeletal: Congenital or Musculoskeletal: Congenital or acquired abnormalitiesacquired abnormalities

4.4. Nervous System: CVANervous System: CVA

5.5. Cardiovascular: orthostatic Cardiovascular: orthostatic hypotension, increased cardiac hypotension, increased cardiac workload, thrombosisworkload, thrombosis

Factors Affecting (con’t)Factors Affecting (con’t)

6.6. Pulmonary: Atelectasis, PneumoniaPulmonary: Atelectasis, Pneumonia

7.7. Metabolic: Immobility Affects Normal Metabolic: Immobility Affects Normal Metabolic FunctioningMetabolic Functioning

8.8. Integumentary: Impaired Skin IntegrityIntegumentary: Impaired Skin Integrity

9.9. Urinary: Urinary stasis, renal calculi, Urinary: Urinary stasis, renal calculi, UTIUTI

10.10.Mental Health: Physical Processes Slow Mental Health: Physical Processes Slow With DepressionWith Depression

All of These Effect…. All of These Effect….

LIFESTYLELIFESTYLE

Normal Body Alignment…Normal Body Alignment…

• While StandingWhile Standing

• While SittingWhile Sitting

• While Lying In BedWhile Lying In Bed

Clients in BedClients in Bed

• Evaluate Comfort After Positioning Evaluate Comfort After Positioning for Alignmentfor Alignment

• Reposition q2h Use Repositioning for Reposition q2h Use Repositioning for effective ROMeffective ROM

• Use Supportive Devises for Use Supportive Devises for Positioning Positioning

PositioningPositioning

ClientsClients

Fowler’s PositionsFowler’s Positions

• Close to High Close to High Fowler’sFowler’s

• Semi-Fowler’sSemi-Fowler’s

Supine positionSupine position

Side-lying/Dorsal Recumbent Side-lying/Dorsal Recumbent PositionPosition

• Major weight on Major weight on dependant hip and dependant hip and shoulder.shoulder.

• Use supportive Use supportive foam blocks or foam blocks or pillows for support pillows for support

Sims PositionSims Position

• Weight supported Weight supported by anterior aspects by anterior aspects of humerus, clavicle of humerus, clavicle and ileum.and ileum.

• These pressure These pressure points are different points are different from other from other positions, i.e. positions, i.e. supine, thereby supine, thereby preserving skin preserving skin integrity. integrity.

Prone PositionProne Position

• This prone position This prone position can be used to can be used to prevent prevent contractures in contractures in knees and hips.knees and hips.

• Prone position Prone position counter indicated counter indicated with spinal cord with spinal cord clients.clients.

Prone Position 2Prone Position 2

• Airway, airway, Airway, airway, airway!!!airway!!!

• Pressure pointsPressure points

• Ladies’ breastsLadies’ breasts

• Men’s genitailia Men’s genitailia

Prone Position 3Prone Position 3

• Use support to Use support to protect pressure protect pressure points, toes and points, toes and feet as done in this feet as done in this picture.picture.

Sunset on the Zambeze….Sunset on the Zambeze….

Positioning/Moving a Client Up Positioning/Moving a Client Up in Bedin Bed• Allow patient to move himself if he can.Allow patient to move himself if he can.

• HOB down---don’t move up hill.HOB down---don’t move up hill.

• Position height of bed for nurses’ comfort.Position height of bed for nurses’ comfort.

• Have patient flex knees, chin to chest, Have patient flex knees, chin to chest, arms folded across chestarms folded across chest

• Nurses tightens abdominal girdles, flex Nurses tightens abdominal girdles, flex knees.knees.

• Nurses shift weight, moving patient.Nurses shift weight, moving patient.

• Reposition HOB, bed in low position.Reposition HOB, bed in low position.

Use Mechanical DevisesUse Mechanical Devises

• Lifts will save Lifts will save backs, yours backs, yours included.included.

Turning a PatientTurning a Patient

• Determine what patient can do, find Determine what patient can do, find assistance if it is needed.assistance if it is needed.

• Position height of bed for nurses’ Position height of bed for nurses’ comfort.comfort.

• Position patient supine on far side of bed.Position patient supine on far side of bed.

• Patient arms across chest, far leg over Patient arms across chest, far leg over near one.near one.

• Tighten girdles, flex knees.Tighten girdles, flex knees.

Turning Patient (con’t)Turning Patient (con’t)

• Place one hand on patient shoulder, Place one hand on patient shoulder, other on hip.other on hip.

• Roll patient toward you.Roll patient toward you.

• Position patient for comfort, support Position patient for comfort, support with pillows if need be.with pillows if need be.

• Raise side rails, lower bed.Raise side rails, lower bed.

ROM GoalsROM Goals

• A goal of ROM is to A goal of ROM is to keep patient in the keep patient in the best physical best physical shape possible.shape possible.

• Another goal is to Another goal is to increase joint increase joint mobility and to mobility and to increase circulation increase circulation to the affected to the affected part.part.

Passive ROMPassive ROM

• The patient is The patient is unable to move unable to move independently and independently and someone else someone else manipulates body manipulates body parts.parts.

Active-Assistive ROMActive-Assistive ROM

The nurse provides minimal support The nurse provides minimal support as the patient moves through ROM. as the patient moves through ROM.

Active ROMActive ROM

The patient moves The patient moves independently through independently through a full ROM for each a full ROM for each joint.joint.

Only active ROM increases Only active ROM increases muscle tone, mass, strength muscle tone, mass, strength and improves cardiac and and improves cardiac and pulmonary functioning.pulmonary functioning.

Care PlanCare Plan

ROM should be included in the patient’s ROM should be included in the patient’s care plan unless counter indicated.care plan unless counter indicated.

Move each joint to the point of Move each joint to the point of resistance, NOT pain.resistance, NOT pain.

Use good body mechanics as you do Use good body mechanics as you do ROM with your patients. ROM with your patients.

From The Book of From The Book of Prue…Prue…

Four nursing students try to carry Four nursing students try to carry Prue’s book….Prue’s book….

Inspiration:Inspiration: Where is nursing going Where is nursing going to take you?to take you?

--OR----OR--

Where are you going to Where are you going to take nursing?take nursing?

Nursing Far AwayNursing Far Away

Providing nursing care Providing nursing care for people who’ve never for people who’ve never seen a doctor…seen a doctor…

……from a never ending line.from a never ending line.

Doing Fun ThingsDoing Fun Things

Seeing WondersSeeing Wonders

Seeing where the history Seeing where the history of other cultures was of other cultures was made.made.

Where do you plan to Where do you plan to take yourself while take yourself while nursing?nursing?