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Range of Motion, Body Mechanics, Transfers & Positioning

Range of Motion

ROM is the extent

of movement that a joint is normally capable of.


Hip ROM includes

flexion, extension and lateral & external rotation Adduction & Abduction

Hip ROM 1

Hip ROM 2

Hip ROM 4

Hip ROM 4

Yes, Elephants Dance

Hand Movements (ROM)

ROM in wrist includes
flexion, extension, radial & ulner deviation ROM in hands include abduction, adduction, flexion, extension, opposition and circumduction of the thumb.


Pronation and Supination

Quick Quiz: Which is




Assessing Joint Mobility

Size, shape, color &

symmetry of opposite joints. Note masses, deformities or muscle atrophy.

Assessing Joint Mobility

The ROM is

appropriate to each joint and equal to its opposite joint.


Limited ROM in Neck of Sable

Walking Sables

Aardvark Neck Limitation Note Adaptation to ADLs (such as they are.)

ROM of Motion changes with age

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

Body Movement

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

Body Movement

Disruption of

voluntary/involuntary movement may result in tremors and seizures.

Asymmetrical Movement
This type of

movement may be a CNS disorder but is most often a CVA. Examples include drooping on one side of the body and a foot-dragging gait.

ROM and ADLs

Counter indication of ROM

1. Dislocated or unhealed fracture (fx). 2. Immediately after surgery (sx) on

tendons, ligaments, muscles, joint capsules or skin.

Precautions with ROM

1. 2. 3. 4.

Infection or inflammation around a joint. Pain medication Osteoporosis Arthritis

Age and sex affect ROM

The effect of ROM on ADLs

Movement in bed i.e.

sitting in bed, rising from bed and turning over.

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

Locomotion: walking on level ground or gentle slope


What affects would

not being able to dress yourself have on you? On your client?

Personal Hygiene


Body Alignment

Keep Your Back Straight

Correct Lifting

The Correct Way to Lift

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

When sitting keep your back straight.

Balance: Keep Your Feet 12 apart

Coordinated Body Movement

Factors That Affect Body Alignment and Mobility 1. Developmental---Age of Client 2. Physical HealthChornic or Acute

Disease 3. Musculoskeletal: Congenital or acquired abnormalities 4. Nervous System: CVA 5. Cardiovascular: orthostatic hypotension, increased cardiac workload, thrombosis

Factors Affecting (cont)

6. Pulmonary: Atelectasis, Pneumonia 7. Metabolic: Immobility Affects Normal

Metabolic Functioning 8. Integumentary: Impaired Skin Integrity 9. Urinary: Urinary stasis, renal calculi, UTI 10.Mental Health: Physical Processes Slow With Depression All of These Effect.


Normal Body Alignment

While Standing While Sitting While Lying In Bed

Clients in Bed
Evaluate Comfort After Positioning for

Alignment Reposition q2h Use Repositioning for effective ROM Use Supportive Devises for Positioning

Positioning Clients

Fowlers Positions
Close to High Fowlers Semi-Fowlers

Supine position

Side-lying/Dorsal Recumbent Position

Major weight on

dependant hip and shoulder. Use supportive foam blocks or pillows for support

Sims Position
Weight supported by
anterior aspects of humerus, clavicle and ileum. These pressure points are different from other positions, i.e. supine, thereby preserving skin integrity.

Prone Position
This prone position

can be used to prevent contractures in knees and hips. Prone position counter indicated with spinal cord clients.

Prone Position 2

Airway, airway,

airway!!! Pressure points Ladies breasts Mens genitailia

Prone Position 3

Use support to

protect pressure points, toes and feet as done in this picture.

Sunset on the Zambeze.

Positioning/Moving a Client Up in Bed

Allow patient to move himself if he can. HOB down---dont move up hill. Position height of bed for nurses comfort. Have patient flex knees, chin to chest, arms folded across chest Nurses tightens abdominal girdles, flex knees. Nurses shift weight, moving patient. Reposition HOB, bed in low position.

Use Mechanical Devises

Lifts will save backs,

yours included.

Turning a Patient
Determine what patient can do, find
assistance if it is needed. Position height of bed for nurses comfort. Position patient supine on far side of bed. Patient arms across chest, far leg over near one. Tighten girdles, flex knees.

Turning Patient (cont)

Place one hand on patient shoulder, other
on hip. Roll patient toward you. Position patient for comfort, support with pillows if need be. Raise side rails, lower bed.

ROM Goals
A goal of ROM is to
keep patient in the best physical shape possible. Another goal is to increase joint mobility and to increase circulation to the affected part.

Passive ROM

The patient is unable

to move independently and someone else manipulates body parts.

Active-Assistive ROM

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

Active ROM

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

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

Care Plan
ROM should be included in the patients care plan unless counter indicated. Move each joint to the point of resistance, NOT pain.

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

From The Book of Prue

Four nursing students try to carry Prues book.

Where is nursing going to take you? --OR-Where are you going to take nursing?

Nursing Far Away

Providing nursing care for people whove never seen a doctor

from a never ending line.

Doing Fun Things

Seeing Wonders

Seeing where the history of other cultures was made.

Where do you plan to take yourself while nursing?