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

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.

Rotation

Pronation and Supination

Quick Quiz: Which

is pronation?

Extension

Flexion

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.

Limitations

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/involunta
ry 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. Infection or inflammation around a

2.
3.
4.

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

Dressing

What affects would

not being able to

dress yourself have
on you? On your
client?

Personal Hygiene

Eating

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
3.
4.
5.

Disease
Musculoskeletal: Congenital or
acquired abnormalities
Nervous System: CVA
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.

LIFESTYLE

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.

Inspiration:
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?