Ambulation Aids

Nursing Fundamentals

CH 26

Debilitated clients

• Those who are frail or weak from prolonged inactivity

• They require physical conditioning before they can walk again

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

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

Isotonic exercise

• Activity that involves movement and work

• Again, as in aerobic exercise, movement of all parts

TONE

• Means the ability of muscles to respond when stimulated

STRENGTH

• Means the power to perform

Active people

• Maintain tone and strength in everyday activities

• Both tone and strength are needed to maintain mobility

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

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

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

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

Upper Arm Strength

• Pts who will use a walker, cane or crutches need upper body strength

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

Flexion

• decreasing the angle of a joint greater than 180 degrees

Extension

• Straightening the angle of a joint to 180 degree

Flexion vs. Extension

Dangling

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

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

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

• 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

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

Symptoms to watch for…

• Dizziness

• hypotension

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

What to watch for while pts are up

• Pallor – pale

• Weakness

• dizziness

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

LOCK BED

• Before getting a pt up OOB, ALWAYS lock the bed or chair that pt will be sitting in

Ambulatory aids

• Canes

• Walkers

• crutches

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

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

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

WALKERS

• Pts who need considerable assistance with balance use walkers

• A WALKER IS THE MOST STABLE FORM OF AMBULATORY AID

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)

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

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

Gait

• Refers to one’s manner of walking

Crutch Walking Gait

• Is the walking pattern used when ambulating with crutches

• There are 4 different ways to walk with crutches

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

BKA

• Below the knee amputation

AKA

• Above the

• knee amputation

Hemipelvectomy

• The entire leg and a portion of the hip are removed

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

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.

What is the remainder of the amputated limb referred to?

• A stump

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

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

The End