Patient Mobility - Ambulation Unit 2

Ambulation p. 288 To ambulate: to walk Gait: the way one walks; disorders affecting gait: Stroke (CVA): hemiplegia – one side of body paralyzed Multiple sclerosis: one or both legs weakened, balance disturbed Huntington's disease: involuntary movements disturbing balance Parkinson’s disease: stiffness, tremors, slow movements, shuffling Arthritis: pain and stiffness in joints Amputation: may have a prosthesis (artificial limb) Orthopedic: injuries or disorders of musculoskeletal system

Ambulation Nurse or physical therapist evaluates patient’s abilities and needs for ambulation & mobility p. 289 Normal gait pattern has 2 phases, starts with ankle in dorsiflexion and heel touching floor first Gait training: Physical therapists work with pt, teaching how to walk, walk on different surfaces, go up and down stairs, get in and out of chair, use assistive device Guidelines for Safe Ambulation p. 290!!!! Part of skill #5

Assistive Devices p. 290 Include: Crutches, Canes, Walkers Crutches: Rarely for older adults: need balance and 2 strong arms Types: standard, forearm

Assistive Devices - Canes p. 292 Quad canes (4), tripod canes (3) give wide base of support Canes aid balance, don’t give support Always use on STRONG side Proper fit: when hand is on handgrip, pt elbow is flexed 30 Degrees Procedure 29 p. 292, Assisting Pt to walk with a cane and 3-point-gait

Assistive Devices - Canes p. 293 3-point-gait Cane/Walker on strong side goes out first Weak/affected leg is next, until it is even with cane Strong/unaffected leg last, further than cane 2-point-gait Cane/Walker on strong side goes out WITH weak/affected leg Strong/unaffected leg goes next

Assistive Devices - Walker p. 294 For general weakness in both legs, partial weight-bearing on one leg, mild balance problems Need strength in both arms to pick up walker Elbow at 30 degrees when hands on handgrips, top of walker reaches the hip joint NOT used for transfers (holding on while getting up or sitting down), only for walking Procedure 30 p. 294!

Assistive Devices - Walker p. 294 3-point-gait Patient lifts walker and puts it 6-8 inches ahead, all 4 legs of walker should come down together Brings weak/affected leg into walker Brings strong/unaffected leg even with weak foot 2-point-gait Patient lifts and moves walker AND weak leg 6-8 inches ahead

The falling patient p. 295 If pt starts to fall, assist pt onto floor as in Procedure 31, p. 296 Don’t try to hold her/him upright = injury for you and/or patient After: call nurse to assess before moving pt

Assistive Devices – Wheelchair p. 295 Used for mobility if can’t ambulate (yet) For correct fit: 4 inches between top of back and pt’s axillae Armrests support without pushing shoulders up or hanging shoulders 2-3 inches between edge of seat and pt’s knees Hand-width space between pt’s hips and sides of wheelchair 2 inches between bottom of footrests and floor 90 degree angle between feet and legs

Assistive Devices – Wheelchair p. 295 Wheelchair Safety p. 297! Especially: backing through doors/elevators/down ramps, pt positioning 90-90-90 etc Positioning pt in wheelchair correctly: see Guidelines for Chair and wheelchair positioning p. 300, especially: shoulders not shrugged or down; no bare skin on wheelchair, pressure relieving devices, hips at 90 degree angle, no pressure to back of knees How to help pt back into right position, if body shifted forward p.298, see Figures 17-14 to 17-19!

Assistive Devices – Wheelchair p. 300 Wheelchair activity: to reduce pressure on buttocks and prevent PUs Teach pt to shift weight q 15mins Wheelchair push-ups: Brakes locked, caster wheels in forward position One hand on each armrest, keeping elbows bent Lean slightly forward, push up on armrests, straightening elbows, lifting buttocks off seat Hold to count of 5 if possible Leaning: if pt can’t do push ups Brakes locked, caster wheels in forward position, feet on floor Place hands on armrests or thighs, lean slightly forward Lean to each side, relieving pressure on buttocks

Homework Textbook: Read Unit 17 p. 288-302 Workbook: p. 106: Read Unit Summary, Nursing assistant alert, answer all Completion questions, True/False, and Identification