[Music] so today we're going to start out with range of motion of the hip knee and ankle okay range of motion of the hip being ankle now we already know a little bit about range of motion because we learned shoulder on Monday the process is exactly the same when you're doing any range of motions you have to look at the care plan to find out what exercises we need to perform what extremity we need to perform those exercises on and how many repetitions to do and not all care plans are going to be the same you might have a care plan in room two that tells you to do range of motion of the hip and knee but only flexion extension you might have a range of motion care plan on room eight that tells you to do range of motion of the hip knee and ankle but they that patient needs flexion extension abduction adduction and rotation so it's super important that you pay attention that care plan it will be different for everybody based on their own level of ability the other thing that I need to explain to you about range of motion is that there's two kinds of range of motion there's active and passive now active range of motion is when you ask the patient to do the exercises and they do them and you critique them so you would say something like mr. Jones we need to do some active range of motion I need you to extend your left arm above your head like you're asking a question and then the patient will extend their arm up and you would say something like okay I need you to straighten that elbow get it nice and straight for me and bring it down so you're giving prompts they're doing the work you're making sure it's done correctly that's active range of motion and you will be asked to do that occasionally in a clinical setting we do this a lot in the activity room with different types of exercise routines and things to get the patients involved in a little bit more creative and fun way than just you know boring exercises but passive range of motion is what we learned on Monday passive range of motion means the patient isn't doing the work we are and that's what CNAs do more often in a clinical setting is passive range of motion so this means that we're doing all the work so when we are helping patients with passive range of motion you want to lift from below with flat palms we're not the claw machine at Walmart right we're not going to pick something up like this because in your fingertips dig into them and that can lead bruising and damaged tissue so we always look below with flat palms and you want to support at the joints so when we did range of motion of the arm we supported at the elbow and the wrist you always have to have two places of support so the elbow and the wrist now today we're gonna learn range of motion on the hip knee and ankle we're gonna lift below but we're gonna support at the knee and the ankle as we left okay range of motion hip knee and ankles so this is what we need to know those of you who have your white book this is on page 57 of your white book so you can open up and read along so our care plan tells us to provide the following range of motion to the residents right remember we have to know which one we're working on right or left right hip knee and ankle flexion extension now if you remember on Monday we learned that flexion extension is up-down motion we're going to provide three repetitions of the exercise and the resident is not able to help with the exercises and if you look here it says passive so we're going to do the the work for the patient now if you go down here to the bottom you can see for the test that this should take about four minutes it will be done on a live student that student will be in bed and no charting is required on this page it gives you step-by-step directions on exactly how to do this skill and then up here you have a gray box that has the kind of the cliff notes for the the short version so that is our care plan for this skill now something I want to show you guys that we have available is to make it a little bit easier for you to learn a lot of these skills I have these flashcards that you can order they're on my website and there's 53 flashcards they're full-color but they have a card for each skill that you learn how to do in that gray box that you just saw is actually on the flashcard so you can learn all of those steps the abbreviated steps by getting the flashcards but there's more to it than that we also have supply flash cards that are in here as well that goes over the supplies that you need for each skill and then those principals remember that we learned the opening guys remember that opening all the steps that were in the opening this lists all of those steps so that you can memorize them and learn them and these flash cards are available for you if you wanted to order them or you can just get some index cards and make your own you know writing something out helps you remember it but if you wanted something that's easy for you to take with you and learn on the go we do have these available on our website but you need to learn those gray boxes because that's how you're going to review the skill at the end to kind of remember did I do all of those steps so having these gray boxes will make it super easy for you to mentally review as you perform the skill so this on page 57 this care plan tells us to perform flexion extension now if you remember on Monday we learned that flexion extension is a straightening and a bending of a body part at the joint so when we're doing flexion extension of the hip and knee it's going to be done together so the hip and knee are going to be exercised at the same time it's a two-for-one exercise so I'm going to back up here so that you can see real quick turn to the side so if you look at me standing here you can see that my leg is straight your leg is in the extended position normally that's its kind of default position is extended but if I bend the knee up to my chest kind of like I'm climbing stairs if I bend my knee up to my chest you can see that both my knee and my hip bend at the same time and then if we straighten it back out that's back to extension so when you're doing range of motion of the hip knee and ankle the patient is laying in bed you're gonna lift the leg up supporting out the knee and the ankle and you're gonna bend that knee and bring it up to the chest which finn's both the hip and the knee and then all the way back down to the bed remember you have to go all the way to the start position you want to make sure you're providing support and moving slowly to make sure that there's no pain for the patient and we'll do that three times so knee to the chest back down to the bed knee to the chest back down to the bed knee to the chest back down to the bed then we're gonna work on the ankle now when flexion extension is done on the ankle remember that say straightening and bending so what we're gonna do if you've got the foot on the bed you're gonna bend the toes forward and then back toward the head forward and back toward the head but you don't want the heel to scrape against the sheet as you do that because that can that can irritate the skin it can cause sores skin tears things like that so you want to lift the heel off of the bed while you're bending and flexing any questions no all right so I'm gonna show you this video again I don't have a live person that I can put in the bed to show you these skills I'm going to show you the video I'm gonna mute you before I show you the video if you have any questions please let me know [Music] [Music] hello hi mr. Jones my name is Patti I'm your CNA today how are you doing great how about you wonderful I need to do some exercises on your right hip knee and ankle is that okay yes I'm gonna close your curtain let me go wash my hands and I'll be right back okay okay I'm gonna do all the work all you have to do is let me know if there's any pain or discomfort as we do this okay okay the first exercise is going to bend your knee up to your chest and back down to the bed like you're climbing stairs we'll do this three times so please let me know if there's any pain all right I'm gonna support under the knee and under the ankle and we're gonna lift and Bend all the way up and all the way back down feel okay yes we're gonna do this again all the way up and all the way back down still okay one more all the way up and all the way back down next exercise we're going to do will be on your ankle I'm gonna lift your foot off the bed and we're going to bend forward and backward like you're stepping on a gas pedal we'll do this three times so I'm gonna lift and move them forward and backward one forward and backward to feel okay yes and one more okay any pain or discomfort no is there anything else I can get for you on here no magazine perhaps no thank you okay let me get your call light for you and I'm going to open the curtain all right thank you here's your call light if you should need anything at all please let me know thank you I'm gonna go wash my hands after washing my hands I'll review the steps of my skill make any Corrections and tell the evaluator my skill is done [Music] okay I mean any questions on that any questions okay according to this care plan how many repetitions do we have to do will it always be three injured that is correct and the patient so we have to follow the care plan I'm very good if I got you to understand nothing else I got you to understand the care plan and that will help you pass the test if the test is all about following the care plan that's what they're grading you on and as long as you're following that care plan you will be just fine [Music] you [Music]