Safe Patient Handling
Performing Passive Range-of-Motion Exercises
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- » Performing Passive Range-of-Motion Exercises
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Take the Review Test:
Safety
- Prepare the patient. Make sure that the patient is rested and not fatigued.
- Perform exercises slowly, and provide adequate support to each joint being exercised.
- Do not exercise joints beyond the point of resistance or to the point of fatigue or pain.
- When you note resistance within a joint, do not force the joint motion. Consult with the health care provider or a physical therapist.
- Patients with spinal cord or orthopedic trauma usually require ROM exercise by specialized health care professionals or physical therapists.
Equipment
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Clean Gloves
Goniometer
PrintableDelegation
The skill of performing ROM exercises can be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Remind NAP not to perform exercises on any patient with spinal cord or orthopedic trauma, since exercising will be done by a specialized health care professional or physical therapist.
- Remind NAP to perform exercises slowly and to provide adequate support to each joint being exercised.
- Caution NAP not to exercise joints beyond the point of resistance or to the point of fatigue or pain.
- Discuss the patient’s individual limitations or preexisting conditions, such as arthritis, that may affect ROM.
Preparation
- Review the patient’s chart for physical assessment findings, health care provider’s orders, medical diagnoses, medical history, and progress.
- Obtain data on the patient’s baseline joint function. Observe for limitations in joint mobility; redness or warmth over joints; joint tenderness; joint deformities; and crepitus produced by joint motion.
- Assess the patient’s level of comfort (on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain possible) before exercising. Determine if the patient would benefit from receiving pain medication before beginning ROM exercises.
- Determine the patient’s or family caregiver’s readiness to learn. Explain all rationales for the ROM exercises, and describe and demonstrate the exercises to be performed.
- Know the patient’s home care plan. The patient may need to continue the exercise regimen or use an assistive device at home.
Follow-up
- Observe the patient performing ROM activities.
- Evaluate the patient’s response to the ROM exercises. Note any discomfort or fatigue.
- Compare the patient’s performance of ROM exercises to the baseline.
- Measure the patient’s joint motion as needed.
- Monitor the patient for any pain throughout the ROM exercise period.
Documentation
Record which joints were exercised with passive ROM exercises, type of exercise performed, number of repetitions of each exercise, extent to which the joints can be moved, any joint abnormalities, your assessment of the patient’s muscular strength and comfort after exercise, the patient’s subjective statements regarding muscular strength, and the patient’s ability to perform the exercises.
Review Questions
1. Which patient is most at risk of developing permanently impaired mobility?
A 72-year-old woman hospitalized for anemia associated with diabetic nephropathy (kidney disease)
A 55-year-old woman with mental illness who had become malnourished- An 11-year-old boy who sustained a fractured pelvis during a fall from his tree house
- A 79-year-old man recovering from surgery to release a contracture of the connective tissue in his hand
CORRECT. Although this patient's anemia will not affect her mobility, she is the patient most at risk of mobility impairment. The fact that she has diabetes, a serious chronic condition, puts her at high risk of mobility impairment. In addition, her age is a risk factor, since mobility impairment is more prevalent among older adults.
INCORRECT. Poor nutritional status is a risk factor for mobility impairment; however, this patient has no other known risk factors. Her mental illness is irrelevant to her risk of mobility impairment, except as it affects her ability to follow her provider's dietary instructions and comply with her medication schedule after discharge.
INCORRECT. This child may experience adverse consequences of impaired mobility, such as altered self-concept, diminished self-esteem, and depression. He may become restless or even show signs of aggression. It is unlikely, however, that his mobility will be permanently compromised after he recovers from his traumatic injury.
INCORRECT. This patient’s age puts him at risk of mobility impairment; however, he has no other known risk factors.
2. The nurse is performing passive shoulder and elbow exercises for a patient who is recovering from surgery to remove a soft-tissue tumor in her upper arm. Why does the nurse cup one hand around the patient’s elbow and support the forearm and wrist during the ROM exercises?
- To keep the arm above the level of the heart
- To assess the patient’s muscle tension
- To listen for crepitus in the joint
- To ensure stability while exercising the joint
INCORRECT. It is not necessary to keep the arm above the level of the heart.
INCORRECT. Muscle tension is not assessed while performing passive ROM exercises.
INCORRECT. This patient is recovering from surgery to remove a soft-tissue tumor, which would not cause crepitus, a grating sound produced as the ends of long bones rub together in a patient with arthritis.
CORRECT. The nurse supports the distal portion of the extremity in order to ensure joint stability.
3. The nurse notes that a patient's left elbow is resistant to extention and flexion while performing range of motion exercises. What is the appropriate nursing action?
- Move joint through full range of motion exercises.
- Perform range of motion to the left elbow until resistance is met.
- Omit all range of motion exercises until the health care provider is notified.
- Inform the health care provider that the patient is uncooperative with exercising.
INCORRECT. The nurse would not move the left elbow joint through the full range of motion because resistance is met.
CORRECT. The nurse would stop the range of motion exercises because resistance is met. The range of motion exercises should not continue until pain is felt by the patient.
INCORRECT. Range of motion exercises should not be omitted. When you note resistance within a joint, do not force the joint motion. Consult with the health care provider or a physical therapist.
INCORRECT. The nurse would not notify the health care provider without information to support the patient is uncooperative with exercising.
4. Which of the following are basic guidelines when assisting a patient with passive range of motion?
- Exercises should be continued until the point of fatigue and pain.
- Exercises should be done frequently to lessen pain for the patient.
- Each joint is exercised to the point of resistance but not pain.
- Exercises should be performed without the support to each joint.
INCORRECT. Joints should never be exercised to the point that fatigue or pain is felt by the patient.
INCORRECT. Exercises should be done twice a day to improve joint mobility and increase circulation. Pain will not be lessened with exercising. Pain should not be felt by the patient.
CORRECT. Joints should be exercised slowly, smoothly, and rhythmically to the point of resistance but pain should not be felt by the patient. Uncomfortable reactions should be reported.
INCORRECT. Use a variety of support measures, cupping with your hand under joint or cradling the distal portion with arm. Support measures prevent muscle strain or injury to the patient.
5. Why would the nurse ask a physical therapist to perform passive ROM exercises for a patient with lower extremity injuries sustained in a motor vehicle crash?
- The patient is an older adult or has a chronic condition.
- The patient is reluctant to perform the exercises because he is worried about reinjury.
- The patient has orthopedic trauma.
- The patient has pain exacerbated by exercise.
INCORRECT. The patient’s age or the existence of a chronic medical condition generally does not necessitate additional expertise.
INCORRECT. If a patient is concerned about injury, the nurse can address the patient’s anxiety by explaining the procedure, easing into the exercises, and offering continual reassurance.
CORRECT. Specialized expertise is usually required to perform passive ROM exercises for a patient with orthopedic trauma or spinal cord injury.
INCORRECT. If the provider is aware that the patient’s pain is worse with exercise and the provider nevertheless orders the exercise, the nurse can offer pain medication before the intervention, as prescribed, and exercise the patient as tolerated.
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