Category: Popular Articles

What is Range of Motion? The normal movement of joints.

For many residents, a lack of mobility causes stiffness in their joints. Their muscles shrink and become weak- this is known as atrophy. Gradually, the atrophied muscles become hard and rigid. The muscles shorten in this process, and therefore joint movement is affected. Pain, discomfort and disfigurement occur. These disfigurements are known as contractures. They are, almost always, 100% preventable.

It is up to nursing staff to maintain a residents range of motion (ROM). For residents who are bed bound, wheelchair bound or who cannot ambulate, it is even more important that range of motion exercises be done correctly and often enough. Many of the activities we assist with will provide ROM for residents…bathing, dressing, grooming activities in particular offer opportunities for joint movement- SO long we we think about what we are doing. When we’re giving a bed bath for example, it makes sense to lift each leg and put it through it’s complete ROM while washing and drying it. But I’ve seen CNA’s turn the resident to the side and wash/dry them from behind, thus eliminating this opportunity for good ROM.

To be effective, ROM exercises should be performed at least twice a day, and each exercise should be done at least five times. The quick, natural opportunities for ROM are an excellent way to enhance what we do, but it should never replace a full program. The only way to fully perform all the exercises, is during AM/PM cares, with a complete focus on this one activity.

Some residents will be able to help. They can move their joints without our help-this is called ACTIVE RANGE OF MOTION. The resident can perform almost all the exercises on their own, through a dedicated program or through normal activities of daily living.

Other residents can perform SOME portion of ROM, but due to weakness, pain, paralysis and the like, they will need limited amounts of assistance. Usually they can tell you exactly what you need to do. This is called ACTIVE ASSISTED ROM.

For most of the residents we deal with, PASSIVE ROM is the norm. These residents cannot assist with this, for many reasons. It’s important to remember that these ROM exercises do not strengthen the muscles; they prevent deformity and maintain movement.

A great way to make ROM a part of AM/PM care might include applying lotion to those body parts being exercised. The lotion is calming and relaxing, and this will help with ROM. Another good time is during a bath. If you note the resident experiences pain during ROM, ask the nurse about pain medications being given 30 minutes or so before the exercises are started.

If ROM is problematic to complete due to time restraints, ask your co workers if they too are having trouble. As a group, you all could seek ways to help each other. Or, seek the advise of the charge nurses. At one nursing home I know of, the aides simply did not have time to complete ALL the ROM for each resident. The aides met with the nurses, who went to the DON to get some ideas and guidance. The DON met with the Activity Director, who implemented an exercise activity designed to provide ROM to those residents the aides could not get to in the morning. The aides marked off who received ROM and who didn’t, and the Activity Staff provided the exercises as part of special “Massages” and other aptly titled programs.

Another nursing home I know of breaks up the ROM requirements for each shift. This means third shift does some of these programs- especially for those residents who are awake during their shift.

Creative minds can ensure that vital care is provided. Dedicate TIME for this very important skill…this task…this care. ROM should not be skimped on, ever.

In the course of any given shift at work, CNA’s come across words and abbreviations and diseases and conditions we have never heard of before. There are hundreds of terms to learn. In this article we hope to make this task a little easier.

First off, scan this list of common medical abbreviations. We use them with charting. We read them in the medical histories sections of patient charts. Do we understand what they all mean?

Abbreviations are well known in our work; each facility should have it’s own list of accepted abbreviationsused in charting/orders. Without such a list, staff can use many different abbreviations, which are accepted but perhaps mean something else to each member of the team. Confusion can arise and patients can be harmed by misunderstandings.

Some terms we read are based on the human body. Terms associated with certain sections of the body are called descriptive terms.

All references to the body are made in relationship to the anatomical position. This refers to the standing forward facing body. A imaginary line is drawn down the center from head to feet which divides the body into two equal halves.

When we read the word MEDIAL it means the part is closer to to the line/center; LATERAL mean further from the line/center.
Your thumbs are more lateral than your pinky finger…

Imagine another line being drawn- this one dividing the upper and lower body into two halves. The line is right under the navel. When we read the term SUPERIOR it refers to above the line; INFERIOR means below the line.

Further, turn the body to face sideways. A line is drawn down the center, again. We’ll see terms called ANTERIOR, which means VENTRAL, towards the front. We’ll also see terms referring to POSTERIOR, or DORSAL, which mean toward the back.

Abbreviations are well known in our work; each facility should have it’s own list of accepted abbreviationsused in charting/orders. Without such a list, staff can use many different abbreviations, which are accepted but perhaps mean something else to each member of the team. Confusion can arise and patients can be harmed by misunderstandings.

Some terms we read are based on the human body. Terms associated with certain sections of the body are called descriptive terms.

All references to the body are made in relationship to the anatomical position. This refers to the standing forward facing body. A imaginary line is drawn down the center from head to feet which divides the body into two equal halves.

When we read the word MEDIAL it means the part is closer to to the line/center; LATERAL mean further from the line/center.
Your thumbs are more lateral than your pinky finger…

Imagine another line being drawn- this one dividing the upper and lower body into two halves. The line is right under the navel. When we read the term SUPERIOR it refers to above the line; INFERIOR means below the line.

Further, turn the body to face sideways. A line is drawn down the center, again. We’ll see terms called ANTERIOR, which means VENTRAL, towards the front. We’ll also see terms referring to POSTERIOR, or DORSAL, which mean toward the back.

The human abdomen is also divided into four sections, called quadrants. In your work you’re apt to read notes using these terms:
RUQ= Right upper quadrant
RLQ= Right lower quadrant
LUQ = Left upper quadrant
LLQ = Left lower quadrant
It’s pretty self explanatory where these sections are located.

There are many other forms of medical jargon to decipher. Understanding word roots, prefixes and suffixes can help this process a lot.

A word root is the foundation of a medical term.Word roots usually (not always) refer to the body part being described.
A prefix is added to the beginning of the word to change or add to it’s meaning
A suffix is added to the end of the word to change or add to it’s meaning.

Some examples of root words:
aden= gland
bronch=bronchi
chol=bile
crani=skull
dent=tooth
hem=blood
hepat=liver
hyster=uterus
my=muscle
nephr=kidney
pulm=lung
ur=urine

Some common Prefixes and sample meanings:
a=without (AFebrile or without fever)
brady=SLOW (Bradycardia or slow pulse rate)
dys=PAIN, DIFFICULTY (Dysuria or painful urination)
hyper=ABOVE, EXCESSIVE (High blood pressure or hyper tension, Hypothermia or high body temperature)
hypo=LOW, DEFICIENT (Low blood pressure or HYPO tension; HYPOthermia or low body temp)
pan= PANDEMIC (flu, Black Plague)
poly= MANY (polyuria or excessive urine)
post= AFTER (Post Operation, Post seizure)
pre=before, prior (Pre menstrual)
tachy= FAST (TACHYbradia or high pulse rate)

What medical terms can you associate with the above prefixes?

Some common suffixes:
ectomy= REMOVAL (hysterectomy)
itis=INFLAMMATION (bronchitis)
gram=RECORD (electrocardiogram)
emia=BLOOD (Anemia)
logy=STUDY OF (oncology)
oma=TUMOR (Fibroma)
otomy=INCISION (tracheotomy)
plegia=paralysis (Hemiplegia)
pnea=RESPIRATIONS (apnea)
scope=EXAM INSTRUMENT (stethoscope, otoscope)
scopy=EXAM USING A SCOPE (endoscopy)

What other medical terms can you associate with the above suffixes?

For a much more comprehensive resource for medical terms and descriptions, go to THIS SITE.

This resource also lists frequently used medical terms.

THIS SITE has an excellent graphics and descriptions of human anatomy.

HERE You’ll find a detailed list of anatomical terms frequently used.

One of the things so many people like about the Culture Change movement is the upside down chain of command structure. Residents call the shots; next the CNAs have this “power”. Nursing homes that are seeking to change their culture often do a lot of window dressing but actually change very little of the management and leadership culture. Fear is the reason for this.

When a facility is looking to really change, actions do speak very loud. Pioneer Network has been working tirelessly to assist nursing homes and assisted living facilities with culture change. Matt over at Setting The Nursing Home On Fire found this gem of an article at the Pioneer site:

Low Cost Practical Strategies to Transform Nursing Facilities
it is a pdf report.

One of the things I noted quickly was the attention to the staff break room. When the staff are respected and trusted, it shows in many ways. Having a retreat style break room is a viable and cheap idea most nursing homes could manage. With the right motivational leadership, the nurses and aides would be more than willing to assist with creating this room.

Staff Amenities
Overall Goal:
Routinely staff members have been assigned break room space in the basement of a facility that is
furnished with cast offs, has equipment and appliances that often malfunction, and space that is expected to serve the dual purpose for staff who want to socialize as well as those who want a quiet time. Reverse this trend and provide staff with an abundance of spaces including tables in main dining room, a computer station and quiet space for reading or meditation.

 

Examples of Improvement Strategies:
• Enhance the staff break room. It should have good lighting, comfortable chairs, conversation arrangements, appliances that work, flat surfaces for both eating and writing and a quiet corner

• Provide computer area or computer station for private staff use

• Designate a table and regular day as “give-away or exchange” where children’s clothes, extra produce from gardens, reading material, videos, and other items can be exchanged or given away

• Provide prayer corner or small meditation room designated for staff

• Encourage staff to use lounge or dining spaces to hold baby or wedding showers or other celebratory events. Invite residents to participate along with members of the community

A big bulletin board might be the only resemblance to the “old” break room.

Wow. Comfortable chairs and seating arrangements that mirror a living room more than a waiting room? Why not? When respected, staff deserve such spaces. Most of the furnishings for such spaces can be purchased cheaply through group purchasing associations, trade group memberships and, the old fashioned way- yard sales and thrift shops.

Another GREAT source of help is the resident families. I am quite sure most would donate a chair or small table; an area rug and some table lamps. The residents themselves could make wall quilts and other artwork. Bookcases and ottomans (YES- so the tired feet of CNA’s have a place to rest UP on);
everyone has a book or two they would be willing to give to the new staff LIBRARY located in the break room (same with DVD’s and the TV/Player to go with it).

Think outside the lead box. A transformation can happen within a week if it is truly wanted. Under the culture change movement every room has significance and front line staff have much more value and respect.