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 1. Cane/Walker on strong side goes out first 2. Weak/affected leg is next, until it is even with cane 3. Strong/unaffected leg last, further than cane • 2-point-gait 1. Cane/Walker on strong side goes out WITH weak/affected leg 2. 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 1. Patient lifts walker and puts it 6-8 inches ahead, all 4 legs of walker should come down together 2. Brings weak/affected leg into walker 3. Brings strong/unaffected leg even with weak foot • 2-point-gait 1. Patient lifts and moves walker AND weak leg 6-8 inches ahead 2. Brings strong/unaffected leg even with weak foot 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