ROM exercises, in which a body part is moved through a range of motion, are carried out to promote circulation, maintain muscle tone & promote flexibility. In doing this, joint stiffness & debilitating contractures are prevented. Active ROM is range of motion carried out by the patient. It is a form of isotonic exercise & as such, it maintains strength, tone & flexibility. In patients unable to move body parts due to paralysis or extreme illness, ROM is performed by someone else. This is called passive ROM exercise. Passive exercise helps to maintain joint flexibility & prevent stiffness & contractures. Because this type of exercise involves no active movement on the part of the muscles, it does not contribute to muscle tone or strength.
ROM exercises are planned as a regular part of nursing activities. During a bath, for example, the nurse has an excellent opportunity to move the patient ’ s limbs through their full range of motion. The patient is encouraged to exercise actively those muscles that can be used. However, in certain cases, the nurse may need to assist the patient in performing ROM (active assisted ROM), or to perform passive ROM.
ROM requires energy & increased circulation, any illness/disorder where increased use of energy or increased circulation is hazardous is contraindicated; puts strain/stress in soft tissues of the joint & bony structures, therefore not done with swollen, inflamed joints.
Start with the head and move down, always do bilaterally
Do not grasp the joint directly
Cup the joint gently (prevents pressure)
Do not grasp fingernail or toenail
Important joints – thumb, hip, knee, ankle
Return to correct anatomic position
Move joint through movement 5 times/session
Start at the Neck P&P p. 830 Neck Flexion – look @ the toes Extension – look straight ahead Hyperextension – look up @ ceiling Lateral flexion – look straight ahead, tilt head to shoulder Shoulder Flexion – raise arm forward & overhead Extension – return arm to side of body Abduction – raise arm to side to position above head with palm away from head. Adduction – return arm & bring across chest Internal rotation – elbow flexed, rotate the shoulder by moving arm til thumb is turned inward & toward the back (fingers to the floor) External rotation – elbow flexed, move arm until thumb is upward & lateral to head. (fingers point up) Circumduction – move arm in full circle (arm straight out, move hand as if to draw a circle.
Elbow Elbow Flexion – bend elbow Extension – straighten elbow Hyperextension – bend lower arm back as far as possible Forearm Supination – turn lower hand so palm is up Pronation - turn lower hand so palm is down Wrist Flexion – bend wrist forward Extension – straighten wrist (fingers, wrist & arm in same plane) Hyperextension – bring dorsal surface of hand as far back as possible Abduction (radial flexion) – bring wrist medially towards the thumb Adduction (ulnar flexion) – bend wrist laterally towards 5 th finger
Fingers & Thumb Fingers & thumb Flexion – bend fingers & thumb into palm make a fist Extension – straighten fingers & thumb Hyperextension – bend fingers as far back as possible Abduction – spread fingers apart / extend thumb laterally Adduction – bring fingers together/ thumb back to hand Circumduction – move finger/thumb in circular motion Opposition – touch thumb to each finger of same hand
Hip Hip Flexion – move leg forward (ROM 90-120 deg) Extension – move leg back beside other leg Hyperextension – move leg backwards (ROM 30-50 deg) Abduction – move leg laterally away from body (ROM 30-50 deg) Adduction – move leg back to medial position & beyond if possible (ROM 30-50 deg) Knee Flexion – bring heel toward back of thigh (120-130 deg) Extension – return leg to floor
Ankle Ankle Dorsiflexion – move foot so toes are pointed upward Plantarflexion – move foot so toes are pointed downward Foot Inversion – turn sole of foot medially (ROM 10 deg) Eversion – turn sole of foot laterally (ROM 10 deg) Flexion – curl toes downward (ROM 30-60 deg) Extension – straighten toes (ROM 30-60 deg) Abduction – spread toes apart Adduction – bring toes together
Spine Spine Flexion – when standing – bend forward from the waist Extension – straighten up Hyperextension – bend backward Lateral flexion – bend to the side Rotation – twist from the waist
In addition to ROM exercises, some immobilized clients may be able to perform muscle-strengthening exercises.
Isotonic – cause muscle contraction & change in muscle length – walking, aerobics, moving arms & legs against light resistance.
Isometric – tightening or tensing of muscles without moving body parts. This increases muscle tension but do not change the length of muscle fibers. Isometric exercises are easily performed by an immobilized patient in bed.
Isotonic and isometric exercises help to prevent muscular atrophy and combat osteoporosis.
Applying Antiembolism Stockings (Elastic) P&P p. 842
Thromobophlebitis – the development of a thrombus or clot along with the inflammation of the vein & may be classified as superficial or deep.
Three elements contribute to the development of a clot.
Hypercoagulability of the bld – clotting disorders, dehydration, pregnancy & 1 st 6 weeks postpartum if the woman was confined to bed, oral contraceptives.
Venous wall damage – local trauma, orthopedic surgeries, major abdominal surgery, varicose veins, arteriosclerosis
High fowlers – same as above, with HOB elevated 45-90 deg. Utilized for clients experiencing difficulty breathing.
Semi fowlers – as above with HOB elevated less than 45 deg.
Orthopneic – sit on side of bed with over bed table across lap, pillow on table, lean forward & rest head & arms on table. Utilized for patients with extreme difficulty breathing – promotes lung expansion.
Safety is a major concern when transferring. Falls are a common hazard. If a patient starts to fall – do not try to stop the fall, instead assist the patient to the floor while protecting the head from injury. This will reduce the risk of patient as well as staff injury.
Complete a thorough nursing assessment before you move the patient to determine if she/he has suffered any injuries.
Prevention of injury is the key, be aware of the client ’ s motor deficit, ability to support their body weight and use effective body mechanics & lifting techniques.
When in doubt regarding the patient ’ s ability- GET ASSISTANCE
Nursing Process - Transfers Assessment Activity orders Client capabilities Planning Decide appropriate transfer technique Explain procedure to the patient Implementation Wash hands Position chair 45 deg angle to bed on clients stronger side Lock bed brakes, lower bed, raise HOB as high as patient tolerates Lower side rail Assist to sitting (lift upper body & swing legs around) Assist with robe & slippers Position feet on floor Take wide stance, bend knees, grasp patient “ 1 2 3 stand ” Pivot to chair
Nursing Process (cont.) Evaluation Of note: Body in alignment, patient comfortable, no injuries Nurse maintains good body alignment Two person lift (same as above) except one nurse is on each side of the patient Never lift under the axilla – can damage nerves Mechanical lifts – enables you to lift heavy patients, or those unable to help. (Use 2 people)
3 point gait – able to wt. bear on one foot, full wt. on unaffected leg then on both crutches – begin in tripod position, move crutches & affected leg ahead, move stronger leg forward and repeat.
4 point gait – (most stable crutch walk) weight on both legs and both crutches – muscular weakness, improves balance by providing a wide base of support, lack of coordination, move each independently – rt crutch-lt foot-lt crutch-rt leg