Nurse 211:Theory Questions:Week 3/Range of Motion

Explain the term range of motion or ROM and explain how it is maintained in a healthy patient.

Healthy people use their joints in a variety of ways during daily activity that work different ranges of motion and a healthy patient has normal ranges which are the measurable degree of angle that each specific joint can flex or extend and rotate that can occur without pain.

Abduction:

Is movement in the frontal plane about a sagittal axis so that the limb moves away from the mid-line of the body.

Flexion:

Is movement in the sagittal plane about the horizontal axis so that the angle at the joint decreases.

Extension:

Is movement in the sagittal plane about the horizontal axis so that the angle at the joint increases.

Supination:

Is moving a joint to face upward

Eversion :

Is turning the sole of the foot outward or laterally in the frontal plane; abduction

Define active range of motion and describe the type of patient for whom active range of motion exercises would be appropriate.

Is when the patient dose the motions on his or her own. This can be with or without therapy.

While exercising your patient's leg, he complains of sudden, sharp pain. What should you do?

What could be a possible cause? Assess the patient for other symptoms. Notify the primary care provider of the event, the patient's uncomfortable reaction, and your assessment findings. Joints should be moved until there is resistance, but not pain. Report uncomfortable reactions and halt exercises. Revise activity plan, if necessary. The possible cause could be a DVT.

When should range of motion exercises be initiated?

When all or some of the normal ADLs are impossible due to illness or injury, it is important to give attention to the joints not being used or to those that have limited use.

What situations might occur that would require you to stop the range of motion exercise on a particular joint?

While you are performing ROM exercises, the patient complains of feeling tired or while exercising or while exercising your patient's leg, he complains of sudden, sharp pain.

Which patients require a physician's order and specific instructions prior to performing range of motion exercises?

All patients must have a physician order and specific instructions prior to performing range of motion exercises.

What considerations should be made for the patient who will be discharged with decreased mobility or limited range of motion? Determine the related factors for the nursing diagnosis based on the patient's current status. Appropriate nursing diagnoses may include:

Fatigue nursing diagnosis, Risk for disuse syndrome, or Deficient knowledge diagnosis:

Define passive range of motion and describe the type of patient for whom passive range of motion exercises would be appropriate.

Passive range of motion is the complete extent of movement of which, a joint is normally capable. When a person performs routine activities of daily living ADLs , he or she is using muscle groups that help to keep many joints in an effective ROM. It is appropriate for any conditions/patient or orders that will limit mobility.

Can assist with active range of motion exercises or performing passive range of motion exercises be delegated to unlicensed personnel?

Patient teaching regarding ROM exercises cannot be delegated to nursing assistive personnel (NAP) or to unlicensed assistive personnel (UAP). Reinforcement or implementation of ROM exercises may be delegated to NAP or UAP, as well as to licensed practical/vocational nurses (LPN/LVNs).

How should the joint be supported and moved when performing passive range of motion exercises?

Perform the exercises slowly and gently, providing support by holding the areas proximal and distal to the joint. Repeat each exercise two to five times, moving each joint in a smooth and rhythmic manner. Stop movement if the patient complains of pain or if you meet resistance

What safety considerations do you need to make for both you and the patient when performing range of motion exercises?

Proper positioning with raised side rails and proper bed height provide for patient comfort and safety. Having the call bell and other essential items within reach promotes safety. Knowing when it is inappropriate to perform range of motion even if it ordered. These may include inflammatory arthritis, malignancy, tuberculosis (Pott's disease) ligamentous rupture, severe osteoarthritis severe scoliosis patients inability to relax fracture and tendinous rupture

Perform the exercises slowly and gently, providing support by holding the areas proximal and distal to the joint.

Repeat each exercise two to five times, moving each joint in a smooth and rhythmic manner according to the physicians orders and the specific care plan.

What must you assess prior to initiating active or passive range of motion exercises with your patient? Adduction:Is movement in the frontal plane about a sagittal axis so that the limb moves towards the midline of the body and may cross the body's midline Pronation : Is movement in the transverse plane about a vertical axis so that there's medial rotation of the radial/ulnar joint (palms down). Inversion: Is turning the sole of the foot inward or medially in the frontal plane; adduction Lateral Rotation: Is movement in the transverse plane about a vertical axis so that the anterior side of the bone is turning away from the midline of the body (laterally) Internal Rotation : Rotatory movement around the longitudinal axis of a bone toward the midline of the body. Opposition: Is touching each of the fingers against the thumb Dorsiflexion :Is the flexion movement of the ankle that results in the top of the foot moving toward the anterior tibia bone in the sagittal plane Rotation:Is the moving a joint to face upward External Rotation: Is turning a joint inward toward the median line Hyperextension: Is movement in the sagittal plane about the horizontal axis so that the angle moves beyond 180 degrees. Plantar Flexion : Is the extension movement of the ankle that results in the foot and/or toes moving away from the body in the sagittal plane 1. When teaching range-of-motion exercises to a dependent client's caregiver, a nurse moves the arm of the client laterally to an upright position above the client's head, and then returns it to the original position. What anatomical movements has the nurse utilized during this exercise? Select all that apply. Answer: Abduction and Adduction 2. A nurse receives an order to apply graduated compression stockings for a client at risk for venous thromboembolism. How should the nurse apply the stockings? Answer: While performing the exercises, begin at the head and move down one side of the body at a time. 3. A nurse receives an order to apply graduated compression stockings for a client at risk for venous thromboembolism. How should the nurse apply the stockings? Answer: If the client was sitting up, have him or her lie down and elevate feet for 15 minutes before applying stockings. 4. For which of the following clients would a pneumatic compression device (PCD) be most clearly indicated? Answer: A postoperative client who has had bowel surgery. 5. The nurse is applying graduated compression stockings to the legs of a postsurgical patient. The patient suddenly complains of sharp pain to his left leg as the nurse is unrolling the stockings. What is the nurse's most appropriate action? Answer: Assess the patient's leg for signs and symptoms of deep vein thrombosis and inform the primary care provider. 6. The nurse observes the client independently move all the joints through their normal motions. Which range of motion has the client demonstrated? Answer: Active Range of Motion

Review the patient's medical orders and the patients medical care plan.

What will you do if your patient complains of feeling tired while you are performing range-of-motion exercises?

Stop the activity for that time. Reevaluate the nursing care plan. Space the exercises out at different times of the day. Schedule exercise times for the parts of the day the patient is typically feeling more rested.

What is the expected outcome or goal you want the patient to achieve by performing range of motion exercises?

The expected outcome to achieve when performing ROM exercises is that the patient completes the exercises and maintains or improves joint mobility. Other outcomes include improving or maintaining muscle strength, and preventing muscle atrophy and contractures.