Copyright © 2008 Delmar Learning. All rights reserved. Unit 17 The Patient’s Mobility:...
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Transcript of Copyright © 2008 Delmar Learning. All rights reserved. Unit 17 The Patient’s Mobility:...
Copyright © 2008 Delmar Learning. All rights reserved.
Unit 17
The Patient’s Mobility:
Ambulation
Copyright © 2008 Delmar Learning. All rights reserved.
Objectives
• Spell and define terms.• Describe the purpose of assistive
devices used in ambulation.• List safety measures for using assistive
devices. • Describe safety measures for using a
wheelchair.
Copyright © 2008 Delmar Learning. All rights reserved.
Objectives
• Describe nursing assistant actions for:– Ambulating a patient using a gait belt– Propelling a patient in a wheelchair– Positioning a patient in a wheelchair– Transporting a patient on a stretcher
Copyright © 2008 Delmar Learning. All rights reserved.
Objectives
• Demonstrate the following procedures:– Procedure 30 Assisting the Patient to Walk
with a Cane and Three-Point Gait– Procedure 31 Assisting the Patient to Walk
with a Walker and Three-Point Gait– Procedure 32 Assisting the Falling Patient
Copyright © 2008 Delmar Learning. All rights reserved.
Ambulation
• Ambulate– To walk– Some patients may not be able to walk
because of a disease or an injury– Patients who cannot walk may be able to
self-propel wheelchairs to increase their independence
Copyright © 2008 Delmar Learning. All rights reserved.
Patient Footwear
• Nonslip footwear should be worn in health care facilities with tile floors
• In facilities that are carpeted– Some patients may need shoes with a
different type of sole
• Inform the nurse if a footwear evaluation is needed
Copyright © 2008 Delmar Learning. All rights reserved.
Normal Gait Pattern
• There are two phases to a normal gait– Leg is on the floor during the first phase– Leg is brought forward in the second phase
• Gait training– Physical therapist may work with a patient
on this
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Assistive Devices
• Assistive devices – Crutches– Canes– Walkers
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The Falling Patient
• If a patient starts to fall:– You must protect both yourself and the
patient– Do not try to hold him or her upright– This will strain your back and may injure
the patient
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Use of Wheelchairs
• Many individuals who are unable to ambulate– Can gain some independence with the use
of a wheelchair
Copyright © 2008 Delmar Learning. All rights reserved.
Use of Wheelchairs
• The wheelchair is a mobility device, not a transportation device– Used for patient independence and
socialization, not for staff convenience
Copyright © 2008 Delmar Learning. All rights reserved.
Use of Wheelchairs
• The wheelchair must be the proper size to fit the patient– In some situations, special wheelchairs or
adaptations are needed
Copyright © 2008 Delmar Learning. All rights reserved.
Use of Wheelchairs
• Position patient in the 90-90-90 position– Feet supported and the knees lower than
the hips
Copyright © 2008 Delmar Learning. All rights reserved.
Use of Wheelchairs
• Use pillows, props, adaptive devices, or restraint alternatives– This ensures the patient can maintain an
upright position
Copyright © 2008 Delmar Learning. All rights reserved.
Positioning Dependent Patient in a Wheelchair
• Dependent person may slide down in the wheelchair– This requires assistance to regain body
alignment
• Several procedures can be used to correct the dependent patient’s position in the wheelchair
Copyright © 2008 Delmar Learning. All rights reserved.
Positioning Dependent Patient in a Wheelchair
• Some manual lifting devices, such as the TLC pad may be used
• Refer to Figure 17-16A
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Positioning Dependent Patient in a Wheelchair
Copyright © 2008 Delmar Learning. All rights reserved.
Wheelchair Activity
• Pressure over the buttocks is dramatically increased when the patient is sitting
• Teach the patient to periodically relieve the pressure– Weight should be shifted every 15 minutes
Copyright © 2008 Delmar Learning. All rights reserved.
Leaning
• If a patient cannot do push-ups– Teach patient to place the hands on the
armrests or thighs• Have patient lean forward slightly and then to
each side to relieve pressure on the buttocks
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Other Preventive Measures
• If the patient is wearing a hospital gown– Place a folded bath blanket, reusable
(cloth) underpad, or pressure relieving pad in the seat of the wheelchair • This prevents the patient’s skin from contacting
the vinyl chair seat
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The Wheelchair Seat
• Sling seat of the wheelchair – Tends to hammock (sag) in the center
when a patient sits on it– Sagging causes rotation of the inner thighs
• This increases pressure on the coccyx and buttocks
• Two common sites of pressure ulcers
Copyright © 2008 Delmar Learning. All rights reserved.
The Wheelchair Seat
• Hammocking of the seat promotes sliding– Placing a pressure relieving cushion with a
leveling pad in the chair corrects the sagging
– Distributing weight more evenly and reducing pressure
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The Wheelchair Seat
• Although a foam cushion and leveling pad help correct positioning problems– They also trap heat– Heat is a contributing factor to pressure
ulcers– Move the patient often so the skin cools
Copyright © 2008 Delmar Learning. All rights reserved.
Transporting a Patient by Stretcher
• Before moving a patient on a stretcher– Make sure that the side rails are up and all
safety belts are fastened