2. Range of Motion, Body Mechanics, Transfers & Positioning

3. Range of Motion ROM is the extent of movement that a joint is normally capable of. ROM is the extent of movement that a joint is normally capable of.

4. Hip ROM Hip ROM includes flexion, extension and lateral & external rotation Hip ROM includes flexion, extension and lateral & external rotation Adduction & Abduction Adduction & Abduction

5. Hip ROM 1

6. Hip ROM 2

7. Hip ROM 4

9. Yes, Elephants Dance Yes, Elephants Dance

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

11. Rotation

12. Pronation and Supination Quick Quiz: Which is pronation? Quick Quiz: Which is pronation?

13. Extension Extension

14. Flexion

15. Assessing Joint Mobility Size, shape, color & symmetry of opposite joints. Size, shape, color & symmetry of opposite joints. Note masses, deformities or muscle atrophy. Note masses, deformities or muscle atrophy.

16. Assessing Joint Mobility The ROM is appropriate to each joint and equal to its opposite joint. The ROM is appropriate to each joint and equal to its opposite joint.

17. Limitations

18. Limited ROM in Neck of Sable

19. Walking Sables

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

21. ROM of Motion changes with age ROM of Motion changes with age

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

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

24. Body Movement Body Movement Disruption of voluntary/involuntary movement may result in tremors and seizures. Disruption of voluntary/involuntary movement may result in tremors and seizures.

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

26. ROM and ADL’s ROM and ADL’s

27. Counter indication of ROM 1. Dislocated or unhealed fracture (fx). 2. Immediately after surgery (sx) on tendons, ligaments, muscles, joint capsules or skin.

28. Precautions with ROM 1. Infection or inflammation around a joint. 2. Pain medication 3. Osteoporosis 4. Arthritis

29. Age and sex affect ROM

30. The effect of ROM on ADL’s Movement in bed i.e. sitting in bed, rising from bed and turning over. Movement in bed i.e. sitting in bed, rising from bed and turning over.

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

32. Locomotion: walking on level ground or gentle slope

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

34. Personal Hygiene

35. Eating

36. Body Alignment

37. Keep Your Back Straight

38. Correct Lifting

39. The Correct Way to Lift

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

41. When sitting keep your back straight.

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

43. Coordinated Body Movement Coordinated Body Movement

44. Factors That Affect Body Alignment and Mobility 1. Developmental---Age of Client 2. Physical Health—Chornic or Acute Disease 3. Musculoskeletal: Congenital or acquired abnormalities 4. Nervous System: CVA 5. Cardiovascular: orthostatic hypotension, increased cardiac workload, thrombosis

45. Factors Affecting (con’t) 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…. All of These Effect….

46. LIFESTYLE LIFESTYLE

47. Normal Body Alignment… While Standing While Standing While Sitting While Sitting While Lying In Bed While Lying In Bed

48. Clients in Bed Evaluate Comfort After Positioning for Alignment Evaluate Comfort After Positioning for Alignment Reposition q2h Use Repositioning for effective ROM Reposition q2h Use Repositioning for effective ROM Use Supportive Devises for Positioning Use Supportive Devises for Positioning

49. Positioning Positioning Clients Clients

50. Fowler’s Positions Close to High Fowler’s Close to High Fowler’s Semi-Fowler’s Semi-Fowler’s

51. Supine position

52. Side-lying/Dorsal Recumbent Position Major weight on dependant hip and shoulder. Major weight on dependant hip and shoulder. Use supportive foam blocks or pillows for support Use supportive foam blocks or pillows for support

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

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

55. Prone Position 2 Airway, airway, airway!!! Airway, airway, airway!!! Pressure points Pressure points Ladies’ breasts Ladies’ breasts Men’s genitailia Men’s genitailia

56. Prone Position 3 Prone Position 3 Use support to protect pressure points, toes and feet as done in this picture. Use support to protect pressure points, toes and feet as done in this picture.

57. Sunset on the Zambeze….

67. Positioning/Moving a Client Up in 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, arms folded across chest Have patient flex knees, chin to chest, arms folded across chest Nurses tightens abdominal girdles, flex knees. Nurses tightens abdominal girdles, flex knees. Nurses shift weight, moving patient. Nurses shift weight, moving patient. Reposition HOB, bed in low position. Reposition HOB, bed in low position.

68. Use Mechanical Devises Use Mechanical Devises Lifts will save backs, yours included. Lifts will save backs, yours included.

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

70. Turning Patient (con’t) Place one hand on patient shoulder, other on hip. Place one hand on patient shoulder, other on hip. Roll patient toward you. Roll patient toward you. Position patient for comfort, support with pillows if need be. Position patient for comfort, support with pillows if need be. Raise side rails, lower bed. Raise side rails, lower bed.

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

72. Passive ROM The patient is unable to move independently and someone else manipulates body parts. The patient is unable to move independently and someone else manipulates body parts.

73. Active-Assistive ROM The nurse provides minimal support as the patient moves through ROM. The nurse provides minimal support as the patient moves through ROM.

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

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

76. Care Plan ROM should be included in the patient’s care plan unless counter indicated. ROM should be included in the patient’s care plan unless counter indicated. Move each joint to the point of resistance, NOT pain. Move each joint to the point of resistance, NOT pain. Use good body mechanics as you do ROM with your patients. Use good body mechanics as you do ROM with your patients.

77. From The Book of Prue… From The Book of Prue… Four nursing students try to carry Prue’s book….

78. Inspiration: Where is nursing going to take you? Where is nursing going to take you?--OR-- Where are you going to take nursing? Where are you going to take nursing?

82. Nursing Far Away Nursing Far Away

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

85. …from a never ending line.

86. Doing Fun Things Doing Fun Things

87. Seeing Wonders

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

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