Health Skills II Unit 204 Ambulation and Assistive Devices

Moving Patients General know patient diagnosis, abilities and restrictions (physical & cognitive) mentally and physically plan your action seek help when necessary and available explain procedure to patient and assistants and how they can assist in the move remove obstacles to maintain a safe environment for patient & health care worker lock wheels of movable objects

Moving Objects/Patients Protect Yourself adjust bed height to safe height for you. Ideally waist height if bed isn’t adjustable, bend at hips & knees (avoid bending of back, keep hips lower than shoulders)

Moving Objects/Patients use leg & trunk muscles for lifting keep your feet shoulder’s width apart & one foot slightly in front of the other keep patient close to your body by bending your elbows and keeping them close to your side avoid twisting your back when lifting

Moving Patients Protect Your Patient good patient communication (keep the patient informed and instructed as to how and when they can assist you) use smooth, rhythmical motions during movement to avoid skin friction keep patient in good body alignment

Moving Patient to Sitting Position assist patients, and encourage them to do as much as they can instruct patient how and when to assist, be specific make moves slowly, and allow patient to recover and gain balance after each move

Hydraulic Lift used for patients who cannot assist patients too heavy for others to safely lift bed to wheelchair bed to bath bed to stretcher bed to scale MUST be trained before using two caregivers should operate Hoyer Lift Device

Dangling Patients Dangling position defined as sitting on edge of bed without the feet touching the floor

Sequence from Extended Bed Stay to Dangling Position check chart for orders to dangle identify yourself and patient wash hands and provide privacy adjust bed elevate head of bed lower side rail assist patient to sitting position monitor patient for balance/dizziness document outcome

Devices to Assist with Transfers and Ambulation gait belts applied at the waist snugly always gripped from underneath NOT used on patient when: pregnant history of recent abdominal surgery history of abdominal aortic aneurysm gait belt

Wheelchair Transfer Key Factors From a sitting position: place patient’s feet shoulder’s width apart and place strong leg slightly behind weaker leg swing leg rests out of the way or remove them from wheelchair

Wheelchair Transfer Key Factors Proper balance instruct patient to lean forward slightly before assisting them to an upright position this will transfer weight from their buttocks to their feet and will minimize their loss of balance from the upright position

Wheelchair Transfer Key Factors For best support keep patient close to you during the transfer (keep your elbows next to side of your chest) and support their weight

Wheelchair Transfer Key Factors assist patient to stand on count of three step back when patient stands support patient in upright position

Wheelchair Transfer Key Factors cont. backup to wheelchair have patient place both hands on wheelchair arms assist to lower weight to wheelchair

Wheelchair Transfer Key Factors Ensure patient safety ask patient to scoot back in wheelchair or assist by pushing against one knee at a time place footrest on chair & lower foot plates remove gait belt secure patient in chair when appropriate DO NOT allow chair to move with patient’s feet on the floor Align patient use pillows, props as needed

Devices to Assist Ambulation canes used to compensate for impaired balance or to improve stability more functional on stairs & narrow, confined areas can be stored & transported easier than walkers or crutches quad cane standard cane

Key Factors of Canes a standard cane provides limited stability because of its’ small base of support a quad cane has a broad base, and will provide greater stability than the standard cane

Key Factors of Canes cane used on the unaffected side ambulation begins with the cane, then the affected side, and then the unaffected side follows through providing a 3-point base upon completion of the move

Devices to Assist Ambulation Walkers an ambulation aid, usually with 4 contacts that are placed on floor and a frame to support patient’s weight and provide stability during ambulation Trochanter level

Key Factors of Walkers a standard walker without wheels should be used when there is an affected side the lead foot with this scenario is the affected side

Key Factors of Walkers a wheeled walker is to be used when a patient is experiencing an unsteady gait or limited endurance and there is no affected side the lead foot with this scenario is the dominant side

Key Factors During Ambulation with Walker patient’s feet stationary when walker is moving patient’s feet should be shoulder’s width apart, and one slightly ahead of the other never slide walker, unless equipped with wheels healthcare worker stands slightly behind and to the affected side of patient in most cases grasp gait belt from underneath

Key Factors of Assistive Devices device must be adjusted to fit patient place hand piece of device at approximately the trochanter level (of hip), with a slight bend of patient’s elbow slight elbow flexion greater trochanter

Key Factors of Assistive Devices device does not prevent falls, however does reduce risk of falls when used properly must not be used as device for standing

Safeguarding Falling Patient know the patient’s capabilities/disabilities know if there is an affected side use gait belt around patient’s waist for support and maintain hold at mid back while walking support patient’s anterior shoulder with hand not holding gait belt to prevent forward motion in case of a fall

Safeguarding Falling Patient healthcare worker walks on unaffected side (there will be exceptions) and slightly behind patient. stay close to patient at all times as patient becomes limp, step one foot between patient’s feet broadening your stance to provide a temporary support for the patient’s hips

Safeguarding Falling Patient hand on patient’s shoulder pulls patient back against healthcare worker’s body and patient temporarily sits on thigh between their legs the hand that was on the shoulder now drops to the belt so both hands are on the belt and approximately 6-8” apart

Safeguarding Falling Patient keep your elbows close to your body and pull patient back short distance by stepping back from between patient’s legs begin squatting while keeping your back straight gently lower patient’s hips to sit on floor release belt, and slide hand up to head/neck and support them to floor