11.2 Restorative Care & Range of Motion

Restorative Care: Goals You Will See on the Exam

Restorative care (restorative nursing) is planned care that helps a resident maintain or regain the highest practical level of function. It is not the same as skilled physical therapy sessions alone — though therapists set many of the techniques CNAs reinforce. On the Wisconsin knowledge exam, restorative items sit inside Aging Process and Restorative Care (~5 questions) and overlap Basic Nurse Skills mobility content.

Core Restorative Goals

Restorative care is every shift, not a once-a-week event. Skipping ambulation "because we're busy" can reverse weeks of progress. Document or report refusal, pain that limits participation, and gains or losses in ability.

Immobility Complications Restorative Care Fights

Prolonged bedrest and inactivity contribute to:

• Pressure injuries
• Contractures (permanent shortening of muscle/tendon limiting joint motion)
• Muscle wasting (atrophy)
• Blood clots (venous thrombosis risk)
• Pneumonia and atelectasis risk
• Constipation
• Depression and loss of independence
• Orthostatic hypotension and falls when finally standing

Your restorative habits — turning, ROM, mobility, hydration, and encouragement — are prevention tools, not optional extras.

Range of Motion (ROM): Types and Safety Rules

Range of motion is the full movement of a joint. Exercises move joints through available range to maintain flexibility, support circulation, and reduce contracture risk.

Active vs Passive vs Active-Assist

Never Force Past Resistance or Pain

This is a high-yield safety rule for knowledge and skills:

• Move joints slowly and smoothly — no bouncing or jerking.
• Support the limb above and below the joint being exercised.
• Stop at the point of resistance or pain; do not push through a frozen end-feel or resident report of sharp pain.
• Report new pain, swelling, redness, warmth, or sudden loss of motion to the nurse — do not "work through" a possible injury or clot risk blindly.
• Follow the care plan for which joints, how many repetitions, and any restrictions (e.g., post-surgical limits, shoulder replacement precautions).
• Provide privacy and explain each step; expose only the area needed.

If the resident says "that hurts," stop that motion, note which movement caused pain, and notify the nurse before continuing aggressive exercise. Mild stretch awareness may be described in therapy, but CNA PROM never forces.

Common Joint Motions (Vocabulary for Training)

You do not need physical-therapy certification language on every stem, but recognizing terms helps:

• Flexion / extension — bending / straightening
• Abduction / adduction — away from / toward midline
• Rotation — turning on axis (e.g., shoulder, hip)
• Pronation / supination — palm down / palm up (forearm)
• Dorsiflexion / plantar flexion — toes toward nose / pointed down (ankle)

Wisconsin Skills: ROM Hip and Knee; ROM Shoulder

The Wisconsin Headmaster skills pool includes:

1. ROM Hip and Knee
2. ROM Shoulder

Treat these as scored demonstrations of safe passive (or as directed) joint exercise.

Shared Skills Discipline

1. Knock, introduce, identify resident, explain, provide privacy, hand hygiene as required.
2. Position the resident safely (often supine for hip/knee; supine or as skill sheet directs for shoulder).
3. Support joints; move through exercises listed on the skill sheet for the required repetitions.
4. Ask about discomfort during the skill; do not force.
5. Leave the resident comfortable, covered, call light in reach, bed low/locked as required.
6. Closing hand hygiene and any recording/reporting the skill demands.

ROM Hip and Knee — Focus Points

Typical teaching sequence (always match the current Wisconsin skill sheet):

• Support the leg at knee and ankle/heel area as trained.
• Flex hip and knee by bending the knee toward the chest within comfort; then extend back down smoothly.
• May include abduction/adduction of the hip (move leg out and back) with support — only as the skill sheet specifies.
• Keep the opposite hip stable; avoid twisting the spine unsafely.
• Watch facial expression as well as verbal report of pain.

ROM Shoulder — Focus Points

• Support the arm at wrist/forearm and elbow as trained so the shoulder is not yanked.
• Common motions: flexion (arm forward/up), abduction (arm out to side), and rotation as listed on the skill sheet.
• Move slowly; shoulders are easy to injure if forced, especially in frozen shoulder or post-stroke spasticity.
• Never grab fingers alone to haul the whole arm through a wide arc.

Practice until your hands automatically cradle and control the limb. Evaluators notice rough handling, incomplete support, and ignoring pain cues.

Assistive Devices: Walker, Cane, Wheelchair

Assistive devices extend restorative goals into daily mobility. Knowledge stems test correct use principles; skills tasks cover gait belt ambulation and wheelchair transfer (Chapter 8/12 overlap).

Walker

• Used for balance and partial weight support when ordered.
• Resident should keep the walker close; step into the walker rather than pushing it far ahead and leaning.
• All legs of a standard walker should stay on the floor when the resident bears weight (no "rocking" on back legs unless a specialized device is ordered).
• Do not use a walker to pull up from sitting unless the care plan/device is designed for that — many falls start when residents pull on unstable objects.
• Ensure correct height per nurse/therapy (often wrist crease height when arms relaxed at sides — follow facility method).

Cane

• Typically held on the strong side so it supports the weak side during gait (unless care plan says otherwise).
• Advance cane and weak leg pattern as taught by therapy; CNA reinforces, does not invent a new gait pattern that conflicts with therapy.
• Check rubber tip for wear; replace if smooth or cracked (report equipment issues).

Wheelchair

• Lock brakes for transfers and when parking for care.
• Position for the resident's weak/strong side per transfer plan.
• Footrests: swing away/remove for stand-pivot; replace after seating with feet supported.
• Hips back in seat; call light and personal items in reach.
• Propelling self in the wheelchair can be a restorative activity when safe — encourage participation rather than always pushing for them if they can self-propel.

Anti-Embolic Stockings as Circulatory Support

Anti-embolic stockings (TED-style elastic stockings) are used to support venous return and help reduce clotting risk in residents with ordered need (immobility, post-op, per physician order). Wisconsin skills include Apply Anti-embolic Stocking as a scored task.

CNA Concepts (Knowledge + Skills)

• Apply to clean, dry legs; usually before the resident has been up for long periods if ordered for daytime wear — follow care plan timing.
• Turn stocking inside out to the heel, place heel correctly, then pull up smoothly without wrinkles.
• Wrinkles and rolls can act like tourniquets and harm circulation — smooth them out; report if the stocking will not stay smooth or is the wrong size.
• Check circulation: color, temperature, swelling, complaints of numbness or pain — report problems; do not ignore tight bands.
• Remove and reapply per schedule for skin inspection when ordered.
• Stockings are not a substitute for mobility, hydration, and nurse-ordered medical prevention; they are one support measure.

Never cut or alter stockings. Never apply if skin is open in a way the plan forbids — ask the nurse.

Putting Restorative Care on Headmaster Items

Correct exam choices usually:

• Encourage self-care and ambulation per plan
• Perform ROM without forcing
• Use assistive devices correctly (cane on strong side; lock wheelchair)
• Apply stockings without wrinkles and report circulation concerns
• Report pain, refusal patterns, or decline in function

Incorrect choices usually:

• Force a joint because "therapy said full range"
• Complete all ADLs for speed every time
• Leave walker far ahead or unlock wheelchair for transfer
• Ignore stocking rolls that dig into skin
• Skip ROM because the resident is in a wheelchair (wheelchair users still need joint care per plan)

Restorative nursing is the daily application of aging-process respect: protect motion, build on what remains, and never sacrifice safety for a checklist.