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Perform Passive Range of Motion to Hip, Knee and Ankle

Care Plan: Provide the following range of motion exercises to the resident’s right hip, knee and ankle: flexion/extension of hip/knee and dorsiflexion/plantar flexion to the ankle three times each. The resident is unable to help with the exercises.

FAQ’s

Click on each question below to view the answers…

Will all of these exercises be required for the state test?

The hip and knee will need flexion/extension exercises (an up/down motion) but that is the only exercise that can be done on a hinge joint (like the knee). This will look like the resident is climbing stairs. The ankle will require dorsiflexion/plantar flexion exercises (up/down motion) as well. These are the only exercises to be done for the exam. Always follow the care plan.

When are the knee exercises done?

The knee is a hinge joint and only moves in one direction:  up and down.  This motion is integrated into the flexion/extension (up/down) hip exercise.  Both the hip and knee joints are bent during this motion (looks like the patient is climbing stairs).  This is the only exercise performed on the knee.  Performing exercises other than this one can cause injury because the joint is not designed to move in those directions.

Where should I hold the leg for these exercises?

CNAs should always provide support at two points on the extremity being exercised.  The CNA should never use a “claw” motion (grasping the extremity from above and lifting it) as this can cause bruising or tissue damage.  The extremity should be supported from below during lifting, preferably with flat palms or a gently cupping grasp.  The student should be aware of where their hands are placed on the leg, keeping them slightly above or below the knee (when necessary), to prevent intrusion into the patient’s private area.

Should I raise the bed to a comfortable working height before performing this skill?

Yes, you may raise the entire bed to a comfortable working height.  The head of the bed should remain flat for this skill, in order to achieve a complete range of motion.  If you raise the entire bed to a comfortable working height, you MUST lower it to the lowest position during your closing at the end of the skill.  Leaving a bed elevated is a safety risk as the floor is much further away than the patient anticipates and may cause the patient to fall when getting out of bed.

What is the difference between elevating the head of the bed and the entire bed?

The head of the bed is elevated (Fig. 1) for comfort (some patients prefer to be sitting up or semi-reclined while in bed) and must be elevated for safety in some skills (mouth care, denture care, feeding).  The head of the bed is always adjusted for comfort at the end of every skill, according to patient preference.  However, raising the ENTIRE bed (Fig. 2) is a different matter.  The entire bed can be raised for YOUR comfort when performing skills. The test does not require that you raise the entire bed for any skill, it is done strictly for your comfort.  But if you raise the entire bed, you MUST lower it at the end of the skill (Fig. 3) to prevent the patient from falling.

bed examples