ambulatory aids pnu 145 chapter 26 ambulatory aids cheryl proffitt, rn,msn september, 2015
TRANSCRIPT
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Ambulatory AidsAmbulatory Aids PNU 145
Chapter 26
Ambulatory Aids
Cheryl Proffitt, RN,MSN
September, 2015
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ObjectivesObjectivesName four activities that prepares clients for ambulation
Give two examples of isometric exercises that tone and strengthen lower extremities
Identify one technique for building upper arm strength
Explain the reason for dangling clients or using tilt table
Name two devices used to assist clients with ambulation
Give three examples of ambulatory aids
Identify the most stable type of ambulatory aids
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Learning ObjectivesLearning ObjectivesDescribe three characteristics of appropriately fitted crutches
Name four types of crutch-walking gaits
Explain the purpose of a temporary prosthetic limb
Discuss two criteria that must be met before constructing a permanent prosthetic limb
Name four components of above-the-knee and below-the-knee prosthetic limbs
Describe how a prosthetic limb is applied
Discuss age-related changes that affect the gait and ambulation of older adults.
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Ambulatory Aids Ambulatory Aids • Introduction
Used for clients with disorders or injuries to the
musculoskeletal system
Clients who are weak or unsteady because of age
related problems and have difficulty walking
Clients with neurological problems and have
difficulty walking
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Preparing for AmbulationPreparing for Ambulation
Patient’s who are debilitated ( those who are frail or weak from prolonged inactivity) require physical conditioning before they can ambulate
Some techniques that can help to increase muscle strength and the ability to bear weight includes performing isometric exercises with the lower limbs and isotonic exercises with the upper limb, dangling at the bedside and using the tilt table.
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Preparing for Ambulation Preparing for Ambulation
• Isometric exercises: Used to promote muscle strength and tone.
• Types
– Quadriceps setting: client alternately tenses and relaxes the quadriceps muscles. Enables client to stand and support the body
– Gluteal setting: client contracts and relaxes the gluteal muscles to strengthen and tone them. Assist with walking
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Quadriceps and Gluteal Setting Exercises
Quadriceps and Gluteal Setting Exercises
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• Upper arm strengthening: flexion and extension of the arms and wrists; raising and lowering weights with the hands; squeezing a ball or spring grip; modified hand push-ups in bed.
• Dangling: normalizes blood pressure. Sitting at the edge of the bed, helps to normalize blood pressure
• Using a tilt table- a device that raises the client from a supine to a standing position.
Preparing for AmbulationPreparing for Ambulation
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Ambulation Aids Cont’dAmbulation Aids Cont’d
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Assistive DevicesAssistive Devices• Devices to support and assist walking:
– Parallel bars (handrails) provide practice in ambulating
– Walking belt applied around client’s waist provides secure grip to prevent injury while ambulating
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Ambulatory AidsAmbulatory Aids
• Three aids are used to help with ambulation, crutches, walker, canes
• Crutches: generally used in pairs and made of wood or aluminum
– Axillary
– Forearm
– Platform
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Types of crutchesTypes of crutches
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Ambulatory Aids (Cont’d)Ambulatory Aids (Cont’d)
• Cane: a hand-held ambulation device made of wood or aluminum- clients with weakness
– Rubber tips reduce possibility of slipping
• Walker: most stable device; has curved aluminum bars and three-sided enclosure with four legs for support. Used for clients needing support and assistance with balance
• Clients holds and stands within walker, takes step forward
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Ambulatory Aids (cont’d)Ambulatory Aids (cont’d)
• Crutch-walking gaits- pattern of walking when ambulating with crutches.
• Types (point refers to the sum of the crutches and legs used)
– Four-point gait
– Three-point gait – non/partial weight bearing
– Two-point gait
– Swing-through gait
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Using a CaneUsing a Cane
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Crutch-Walking GaitsCrutch-Walking Gaits
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Prosthetic Limbs Prosthetic Limbs • Is used for clients with arm/leg amputation
• Types:
• Amputation at the foot-(Syme’s amputation)
• Below the knee- (BK amputation)
• Above the knee- (AK amputation)
• Entire leg and a portion of the hip (hemi-pelvectomy)
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Temporary Prosthetic limbTemporary Prosthetic limb
• Temporary prosthetic limb: immediate postoperative prosthesis (IPOP)
• Permanent prosthetic components delayed for several weeks or months to be sure that :
Incision has healed
Stump size is relatively stable
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Prosthetic Limbs (cont’d)Prosthetic Limbs (cont’d)• Prosthetic components include:
• Below the knee: socket, shank, ankle/foot system.
• Above the knee: below-the-knee components plus a knee system
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Applying a Leg ProsthesisApplying a Leg ProsthesisNurses are responsible for managing the care
of the stump.
(Refer to Skill 26-3 in the textbook.)
Ambulating with a lower extremity limb prosthesis requires strength and
endurance.
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Nursing Implications Nursing Implications • Nursing diagnoses include:
– Impaired physical mobility
– Risk for disuse syndrome, trauma
– Unilateral neglect
– Risk for activity intolerance
– Risk for peripheral neurovascular dysfunction
– Look at care plan 26-1
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General Gerontologic ConsiderationsGeneral Gerontologic Considerations
• Functional ability involves mobility and making adaptations to compensate for changes occurring with aging or disease processes
• May need encouragement and support integrating adaptations into their activities of daily living and maintaining their self-concept and body image
• Maintaining independence is important to older adults
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General Gerontologic Considerations (cont’d)
General Gerontologic Considerations (cont’d)
• Mobility facilitates staying active and independent
• As a person ages, he or she may develop flexion of the spine which alters the center of gravity and may increase falls
• Ensure adequate lighting without laying electric cords in passageways
• Elevate toilet seats; install grab bars• Rearrange home furnishings
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References References • Timby, B. (2009). Fundamental nursing skills and concepts
(10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
• Google pictures. (2015, August 10). Retrieved from http://www.google.com