1. Nursing Fundamentals CH 26
Ambulation Aids
Nursing Fundamentals
CH 26

2. Debilitated clients
Those who are frail or weak from prolonged inactivity
They require physical conditioning before they can walk again

3. Exercises Techs for increasing muscular strength include:
Isometric exercise – active contraction where the force generated by the muscle is = to resistance, like in wt lifting or body building, the body is kept stationary
Isotonic exercise – active muscle contraction where the force exerted remains constant and muscle length changes. There is movement and work as in aerobic exercise, all parts of the body are moving, causing the muscles to contract

4. Isometric Exercise Used to promote muscle tone and strength
Stationary exercises that are generally performed AGAINST RESISTIVE FORCE
Again, as in wt lifting or body building

5. Isotonic exercise Activity that involves movement and work
Again, as in aerobic exercise, movement of all parts

6. TONE
Means the ability of muscles to respond when stimulated

7. STRENGTH
Means the power to perform

8. Active people Maintain tone and strength in everyday activities
Both tone and strength are needed to maintain mobility

9. Types of isometric exercises
1) Quadriceps setting (thigh muscles)
2) Gluteal setting (butt muscles)
These promote tone and strength in weight bearing muscles, this gets a pt ready for crutch walking

10. Both exercises can be performed while in bed or while sitting in a chair

11. Quadriceps setting
The person alternately tenses and relaxes the quadricep muscles
A.K.A. “Quad setting”
The quadricep muscle covers covers the front and side of the thigh. Together they aid in extending the leg
It allows the client to stand and support their body wt

12. Gluteal setting
Contraction and relaxation of the gluteal muscles to strengthen and tone them
As a group, the muscles in the buttocks aid in extending, abducting and rotating the leg…functions that are essential to walking

13. Upper Arm Strength
Pts who will use a walker, cane or crutches need upper body strength

14. Flexion & Extension
To strengthen upper arms, one must flex and extend the upper arms and wrists
Raising and lowering weights with the hands
Squeezing a ball or spring grip
Performing modified hand push-ups in bed

15. Flexion
decreasing the angle of a joint greater than 180 degrees

16. Extension
Straightening the angle of a joint to 180 degree

17. Flexion vs. Extension

18. Dangling
Sitting on the edge of the bed to help normalize B.P.

19. Valsalva maneuver
Act of closing the glottis (the epiglottis covers the trachea, the glottis is the space below the epiglottis) and contracting the pelvic and abd muscles to increase abd pressure
Do not encourage in pts that are ambulating, can cause pt to faint d/t stimulation of the vagal nerve
Pt needs to breathe through movement

20. Tilt Table
Is a device that raises the pt from a supine position to a standing position
It helps the client to adjust to being upright bearing wt on their feet
Usually done in P.T. dept

21. TED hose are applied before the table is tilted to help compress vein walls and preventing pooling of blood in extremities that may trigger fainting
SCD – sequential compression device

22. If symptoms occur while table is being tilted then the pt is returned to the laying position

23. Symptoms to watch for…
Dizziness
hypotension

24. Assistive Devices to Aid in Ambulation
Parallel bars – 2 bars to help pt walk
Walking belt – wraps around the pt’s waist, nurse can better support the pt

25. What to watch for while pts are up
Pallor – pale
Weakness
dizziness

26. What to do if pt has symptoms???
Help the pt to a chair or the bed if close
Hold pt under the axilla and the nurse places a foot to the side and rests the pt on her hip until help arrives
Slide the pt to the floor gently like in video if necessary

27. LOCK BED
Before getting a pt up OOB, ALWAYS lock the bed or chair that pt will be sitting in

28. Ambulatory aids
Canes
Walkers
crutches

29. CANES Used for people who have weakness to one side of the body
Canes must be the right height for the pt to use effectively

30. Sizing up a cane
Cane handle should be parallel with the pt’s hip, providing elbow flexion of approx 30 degrees
Canes can be shortened by removing a portion of the lower end of a wooden cane OR
Depressing the button on a metal cane and shortening the cane

31. Where does the nurse stand…
The nurse should apply a waist belt for safety
The nurse stands behind the pt ON THE WEAKER SIDE OF THE PT
A cane IS NOT an extension of their bad leg, their leg may never get better, they need to strengthen the good leg

32. WALKERS Pts who need considerable assistance with balance use walkers
A WALKER IS THE MOST STABLE FORM OF AMBULATORY AID

33. How To Use A Walker… Stand with the walker and hold onto it
Pick up walker and move it forward 6-8 inches
Take a step forward
Pt will support the body wt on the handgrips when moving the weaker leg (sort of dragging it along)

34. Sitting down with a walker
Pt stands in front of their chair and grips the arm rest with one arm while placing the other hand on the walker and uses the stronger leg for support

35. Crutches Axillary – rests under axilla, no pressure should be applied
Forearm crutches – used by permanent crutch users to aid in walking like an C.P. pt
Platform crutches – used for people who can’t bear wt with their hands or wrists, arthritis pts use these

36. Gait
Refers to one’s manner of walking

37. Crutch Walking Gait
Is the walking pattern used when ambulating with crutches
There are 4 different ways to walk with crutches

38. Prosthetic Limb
Substitute for an arm or leg without the assistance of crutches or other ambulatory aids
Some pts use no crutches or walker with their prosthetic limb

39. BKA
Below the knee amputation

40. AKA
Above the
knee amputation

41. Hemipelvectomy
The entire leg and a portion of the hip are removed

42. Temporary prosthetic limb
Pts returning from surgery will be given this IPOP (immediate post-op prosthetic)
It facilitates early ambulation and promotes an intact body image immediately after surgery

43. What kind of pain do pts have after a limb has been amputated
Phantom pain – pain form the area of amputation. Pts feel as though their limb is still there. Very painful
Neurontin relieves this phantom NERVE pain..taken P.O.

44. What is the remainder of the amputated limb referred to?
A stump

45. Amputation and the use of a cane
If pt decides to use a cane after amputation, he holds the cane in the hand opposite the prosthetic limb

46. Possible Nursing Diagnoses with inactive clients
Impaired physical mobility
Risk for disuse syndrome
Unilateral neglect
Risk for trauma
Risk for peripheral neurovascular dysfunction
Risk for activity intolerance

47. The End