Nursing Faculty Padjajdaran UniversityRange of Motion Irman Somantri, S.Kp. M.Kep. Nursing Faculty Padjajdaran University definisi • The maximum movement that is possible for that joint • Is the extent of movement that a joint is normally capable of • Joint range of motion varies from individual • Determined by genetic makeup, developmental pattern, the presence or absence of disease and the amount of physical activity in which person normally engages Nursing Faculty Padjajdaran University Gerakan Sendi • ROM Mundur Bedrest Nursing Faculty Padjajdaran University Types of Joint Movement • • • • • Flexion X Extension X Hyperextension Abduction X Adduction Rotation X Circumduction Eversion X Inversion Pronation X Supination . Nursing Faculty Padjajdaran University • • • • • • Fleksi : menurunkan sudut antara dua tulang Ekstensi : meningkatkan sudut antara dua tulang Hyperekstensi : Ekstensi lebih lanjut antara dua tulang atau peregangan keluar dari sendi Abduksi : pergerakan tulang menjauhi dari garis tengah tubuh Adduksi : Pergerakan tulang mendekati garis tengah tubuh Rotasi : Pergerakan dari tulang memutar dari porosnya (Gerakan kepala melihat bahu) – – Rotasi Internal : gerakan ke arah garis tengah tubuh Rotasi Eksternal : gerakan menjaui garis tengah tubuh. . Nursing Faculty Padjajdaran University • • • • • Sirkumduksi : gerakan dari bagian distal tulang mengelilingi ujung proksimal Eversi : gerakan telapak kaki keluar dengan menggerakan sendi mata kaki infersi : gerakan dari telapak kaki kedalam dengan menggerakan sendi mata kaki Pronasi : gerakan telapak tangan sehingga telapak tangan bergerak dari anterior menjadi posterior dalam posisi anatomik atau perputaran telapak tangan menghadap ke bawah. Supinasi : kebalikan dari pronasi . Nursing Faculty Padjajdaran University Extension . Nursing Faculty Padjajdaran University Flexion . Nursing Faculty Padjajdaran University PEMERIKSAAN FISIK : ROM sendi • Alat : goniometer . • Note masses. . deformities or muscle atrophy. color & symmetry of opposite joints.Nursing Faculty Padjajdaran University Assessing Joint Mobility • Size. shape. .Nursing Faculty Padjajdaran University Assessing Joint Mobility • The ROM is appropriate to each joint and equal to its opposite joint. Nursing Faculty Padjajdaran University Temporomandibular Joint Buka mulut lebar-lebar dan kemudian tutup. pada saat memuka dan menutup palpasi temporomandibular joint dengan telunjuk dan jari tengah . Nursing Faculty Padjajdaran University ROM : Cervical Spine • 450 Fleksi : sentuhkan dagu ke dada • 550 Ekstensi .hyperekstensi : lihat ke arah langit-langit • 400 Fleksi Lateral : Sentuhkan telinga ke masing-masing bahu • 700 Rotasi : Sentuhkan dagu ke masing-masing bahu . Nursing Faculty Padjajdaran University ROM : Lumbar Spine • 750 .hyperekstensi : Rentangkan ke arah belakang dengan lambat • 300 Fleksi lateral : Rentangkan ke arah kiri dan kanan • 300 Rotasi : Putar bahu ke arah kanan dan kiri .900 Fleksi : Sentuh kaki dengan jari-jari tangan • 300 Ekstensi . Nursing Faculty Padjajdaran University ROM : Bahu • 1800 Fleksi : lengan lurus dengan badan gerakan ke atas • 500 Hyperekstensi : lengan lurus digerakkan ke arah belakang • 900 Rotasi internal eksternal • 1800 Abduksi : Gerakkan tangan kondisi lurus ke atas ke arah luar • 500 Adduksi : Gerakkan tangan kondisi lurus ke badan . Nursing Faculty Padjajdaran University ROM : Siku • • • • 1600 Fleksi : sentuhkan tangan ke bahu 1800 Ekstensi : luruskan siku 900 Pronasi 900 Suppinasi . Nursing Faculty Padjajdaran University ROM : Tangan • 900 Fleksi : Bengkokan tangan ke arah bawah • 700 Ekstensi : Bengkokan tangan ke arah atas • 550 Ulnar deviasi : Bengkokan tangan ke arah luar (kelingking) • 200 Radial deviasi : Bengkokan tangan ke arah dalam (ibu jari) . Nursing Faculty Padjajdaran University ROM : Panggul Saat Klien berbaring • 1200 Fleksi : tekuk lutut gerakkan ke arah dada • 450 Abduksi : pertahankan kaki lurus, gerakkan menjauhi badan • 400 Rotasi internal • 450 Rotasi eksternal • 300 Hyperekstensi : Tengkurap, kaki diangkat Nursing Faculty Padjajdaran University ROM : Lutut • 1300 Fleksi : Bengkokan lutut • 1800 Ekstensi : Luruskan lutut Nursing Faculty Padjajdaran University ROM : Ankles • • • • • 200 Dorso Fleksi : Gerakan kaki ke atas 450 Plantar Fleksi : Gerakkan kaki menuju lantai 300 Inversi : Berjalan dengan sisi luar kaki 200 Eversi Jari kaki : 900 Fleksi (berjalan dengan jari-jari kaki) nyeri ekstremitas) .Nursing Faculty Padjajdaran University Setelah ROM selesai • Ukur panjang ekstremitas Kaki dari SIAS menyilang ke Tulang Malleus Medial • Selanjutnya ukur kekuatan otot dengan Lovet’s Scale (Syarat tidak ada kekakuan sendi. Nursing Faculty Padjajdaran University SKALA KEKUATAN OTOT KEKUATA ISTILA TANDA N H 0 Zero Tidak terlihat adanya kontraksi otot 1 2 3 4 5 Trace Poor Fair Good Tidak ada pergerakan sendi dan hanya tampak adanya kontraksi otot ROM lengkap dengan gravitasi dieliminir (hanya menggeser) ROM lengkap melawan gravitasi ROM lengkap dengan sedikit tahanan Normal ROM lengkap melawan gravitasi dengan tahanan penuh . Nursing Faculty Padjajdaran University Limitations . Nursing Faculty Padjajdaran University Limited ROM in Neck of Sable . Nursing Faculty Padjajdaran University Walking Sables . Nursing Faculty Padjajdaran University ROM of Motion changes with age . tenderness & pain are among factors that limit ROM. .Nursing Faculty Padjajdaran University Swelling. Nursing Faculty Padjajdaran University TEST DIAGNOSTIK • Radiologi • Blood Test – Serum Calcium – Serum Phosphat . Nursing Faculty Padjajdaran University • ROM and ADL’s . joint capsules or skin. ligaments. . muscles. Immediately after surgery (sx) on tendons. Dislocated or unhealed fracture (fx). 2.Nursing Faculty Padjajdaran University Counter indication of ROM 1. 3.Nursing Faculty Padjajdaran University Precautions with ROM 1. 2. Infection or inflammation around a joint. Pain medication Osteoporosis Arthritis . 4. Nursing Faculty Padjajdaran University Age and sex affect ROM . e. .Nursing Faculty Padjajdaran University The effect of ROM on ADL’s • Movement in bed i. rising from bed and turning over. sitting in bed. etc.Nursing Faculty Padjajdaran University Transfers: Seat-to-Seat. . Toilet to Bed. Nursing Faculty Padjajdaran University Locomotion: walking on level ground or gentle slope . Nursing Faculty Padjajdaran University Dressing • What affects would not being able to dress yourself have on you? On your client? . Nursing Faculty Padjajdaran University Personal Hygiene . Nursing Faculty Padjajdaran University Eating . Nursing Faculty Padjajdaran University Body Alignment . Nursing Faculty Padjajdaran University Keep Your Back Straight . Nursing Faculty Padjajdaran University The Correct Way to Lift . .Nursing Faculty Padjajdaran University When turning. not just your back. rotate your whole body. Nursing Faculty Padjajdaran University When sitting keep your back straight. . Nursing Faculty Padjajdaran University Balance: Keep Your Feet 12” apart . Nursing Faculty Padjajdaran University Coordinated Body Movement . Cardiovascular: orthostatic hypotension. Musculoskeletal: Congenital or acquired abnormalities 4. Developmental---Age of Client 2. Physical Health—Chornic or Acute Disease 3. Nervous System: CVA 5.Nursing Faculty Padjajdaran University Factors That Affect Body Alignment and Mobility 1. thrombosis . increased cardiac workload. Integumentary: Impaired Skin Integrity 9.Nursing Faculty Padjajdaran University Factors Affecting (con’t) 6. Urinary: Urinary stasis. UTI 10. Pneumonia 7. Pulmonary: Atelectasis. . Mental Health: Physical Processes Slow With Depression All of These Effect…. Metabolic: Immobility Affects Normal Metabolic Functioning 8. renal calculi. Nursing Faculty Padjajdaran University LIFESTYLE . Nursing Faculty Padjajdaran University Normal Body Alignment… • While Standing • While Sitting • While Lying In Bed . Nursing Faculty Padjajdaran University Clients in Bed • Evaluate Comfort After Positioning for Alignment • Reposition q2h Use Repositioning for effective ROM • Use Supportive Devises for Positioning . Nursing Faculty Padjajdaran University DIAGNOSA KEPERAWATAN Kerusakan Mobilitas Fisik . Nursing Faculty Padjajdaran University PERENCANAAN TUJUAN UMUM 1. Mencegah Luka Tekanan . Mencegah Ketegangan otot & Kelemahan 3. Mencegah Deformitas 2. Nursing Faculty Padjajdaran University PERENCANAAN • Atur posisi tidur • Latihan & Ambulasi Dini • Medikamentosa . Nursing Faculty Padjajdaran University Positioning Clients . Nursing Faculty Padjajdaran University Pengaturan Posisi Tidur . Nursing Faculty Padjajdaran University Fowler’s Positions • Close to High Fowler’s • Semi-Fowler’s . Nursing Faculty Padjajdaran University Supine position . • Use supportive foam blocks or pillows for support .Nursing Faculty Padjajdaran University Side-lying/Dorsal Recumbent Position • Major weight on dependant hip and shoulder. clavicle and ileum.e. i.Nursing Faculty Padjajdaran University Sims Position • Weight supported by anterior aspects of humerus. supine. • These pressure points are different from other positions. . thereby preserving skin integrity. .Nursing Faculty Padjajdaran University Prone Position • This prone position can be used to prevent contractures in knees and hips. • Prone position counter indicated with spinal cord clients. Nursing Faculty Padjajdaran University Positioning/Moving a Client Up in Bed • • • • Allow patient to move himself if he can. flex knees. moving patient. Position height of bed for nurses’ comfort. • Nurses shift weight. arms folded across chest • Nurses tightens abdominal girdles. bed in low position. . Have patient flex knees. HOB down---don’t move up hill. • Reposition HOB. chin to chest. .Nursing Faculty Padjajdaran University Use Mechanical Devises • Lifts will save backs. yours included. • Patient arms across chest. • Position patient supine on far side of bed. • Position height of bed for nurses’ comfort. find assistance if it is needed. far leg over near one.Nursing Faculty Padjajdaran University Turning a Patient • Determine what patient can do. • Tighten girdles. . flex knees. Nursing Faculty Padjajdaran University Turning Patient (con’t) • Place one hand on patient shoulder. • Roll patient toward you. • Raise side rails. other on hip. . support with pillows if need be. • Position patient for comfort. lower bed. Nursing Faculty Padjajdaran University . Nursing Faculty Padjajdaran University . Latihan Pasif – – – – Pasien Pasien Pasien Pasien semikoma atau tidak sadar usia lanjut dengan mobilitas terbatas bedrest total dengan paralisis ekstremitas total .Nursing Faculty Padjajdaran University Jenis Latihan ROM 1. Latihan Aktif – Pasien dengan paralisis ekstremitas sebagian – Pasien bedrest tanpa kontra indikasi 2. 5. Latihan Resistif dapat meningkatkan ukuran otot.Nursing Faculty Padjajdaran University Jenis …………… 3. Pasien secara sadar meningkatkan tekanan pada otot tanpa menggerakan sendi. . 4. kekuatan dan tenaga. Latihan Resistif : tdd kontraksi dari otot melawan tekanan yang berlawanan. dan perawat membantu pada bagian yang tidak mampu pasien lakukan. Latihan Isometrik / Statik : tidak ada sendi yang bergerak dan panjang dari otot tidak berubah. Latihan Aktif-Assistif : diberikan dengan jalan pasien menggerakan sendiri bagian tubuhnya. Use good body mechanics as you do ROM with your patients. Move each joint to the point of resistance. . NOT pain.Nursing Faculty Padjajdaran University Care Plan ROM should be included in the patient’s care plan unless counter indicated. Nursing Faculty Padjajdaran University .