Perform Passive Range of Motion to Shoulder
Care Plan: Provide flexion/extension and abduction/adduction exercises to the resident’s right shoulder three times each. The resident is not able to help with the exercises.
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What are the technical terms for each exercise?
An up/down motion is flexion/extension. This motion looks like the resident is asking a question by extending their arm upward above their head, as straight as possible. A side/side motion is abduction/adduction. This motion looks like a bird flapping their wing by bringing the arm out to the side upward toward the head and returning to lie beside the body. An around motion is called rotation. This motion can be performed by rolling the upper and lower arm toward the torso, then away from the torso.
Will all of these exercises be required for the exam?
No. All CNAs need to be aware of how each exercise is performed, only flexion/extension and abduction/adduction are performed for the state exam.
What if I perform the exercises on the wrong side?
Knowing right from left in medicine is very important. Performing exercises on the wrong side can cause injury to the patient. It is very important to follow the care plan exactly.
What if the patient experiences pain during the procedure?
The exercises should be modified so that the extremity is only moved to a point below the level of the pain. CNAs should NEVER inflict pain on a patient during any skill. The skill is completed to the level of ability and comfort for the patient and the pain is reported to the nurse.
Can I do exercises on all extremities while I am there to save time?
No. You must follow the care plan exactly. If the care plan tells you to perform exercises on the left shoulder, then that is the only joint you will exercise. Never perform range of motion exercises to an extremity that you are not ordered to do. You are not familiar with all of the patient’s medical conditions and may cause injury.
Will the patient be able to assist with this skill?
For the exam, the student will be instructed to provide PASSIVE range of motion, meaning that the patient is unable to assist with the motions. You will follow the care plan and perform the skills exactly as described. In a clinical setting, the patient may or may not be able to assist and the care plan will give you specific instructions on how the skill is to be performed.
What if the patient refuses to have the skill done?
Try to find out the reason for the refusal, if possible, and report it to the nurse. It may be something as simple as interfering with a planned activity. Maybe the last CNA caused pain during the procedure. Maybe they don’t understand what you are planning to do. It is helpful to obtain information regarding the refusal. Never perform a skill on a patient that has refused.