Health Skills IIUnit 204

Ambulation and Assistive Devices

Moving Patients General

know patient diagnosis, abilities and restrictions (physical & cognitive)

mentally and physically plan your action seek help when necessary and available explain procedure to patient and assistants

and how they can assist in the move remove obstacles to maintain a safe

environment for patient & health care worker lock wheels of movable objects

Moving Objects/Patients

Protect Yourself adjust bed height to

safe height for you. Ideally waist height

if bed isn’t adjustable, bend at hips & knees (avoid bending of back, keep hips lower than shoulders)

Moving Objects/Patients

use leg & trunk muscles for lifting

keep your feet shoulder’s width apart & one foot slightly in front of the other

keep patient close to your body by bending your elbows and keeping them close to your side

avoid twisting your back when lifting

Moving Patients

Protect Your Patient good patient communication (keep the

patient informed and instructed as to how and when they can assist you)

use smooth, rhythmical motions during movement to avoid skin friction

keep patient in good body alignment

Moving Patient to Sitting Position assist patients, and encourage them to do

as much as they can instruct patient how and when to assist, be

specific make moves slowly, and allow patient to

recover and gain balance after each move

Hydraulic Lift used for patients who

cannot assist patients too heavy for

others to safely lift bed to wheelchair bed to bath bed to stretcher bed to scale MUST be trained before

using two caregivers should

operate

Hoyer Lift Device

Dangling Patients

Dangling position defined as sitting on

edge of bed without the feet touching the floor

Sequence from Extended Bed Stay to Dangling Position check chart for orders to dangle identify yourself and patient wash hands and provide privacy adjust bed elevate head of bed lower side rail assist patient to sitting position monitor patient for balance/dizziness document outcome

Devices to Assist with Transfers and Ambulation gait belts

applied at the waist snugly

always gripped from underneath

NOT used on patient when:

pregnant history of recent

abdominal surgery history of abdominal

aortic aneurysm

gait belt

Wheelchair TransferKey Factors

From a sitting position: place patient’s feet

shoulder’s width apart and place strong leg slightly behind weaker leg

swing leg rests out of the way or remove them from wheelchair

Wheelchair Transfer Key Factors

Proper balance instruct patient to lean forward slightly

before assisting them to an upright position

this will transfer weight from their buttocks to their feet and will minimize their loss of balance from the upright position

Wheelchair Transfer Key Factors

For best support keep patient

close to you during the transfer (keep your elbows next to side of your chest) and support their weight

Wheelchair TransferKey Factors assist patient to

stand on count of three step back when

patient stands support patient in

upright position

Wheelchair TransferKey Factors cont.

backup to wheelchair

have patient place both hands on wheelchair arms

assist to lower weight to wheelchair

Wheelchair TransferKey Factors Ensure patient safety

ask patient to scoot back in wheelchair or assist by pushing against one knee at a time

place footrest on chair & lower foot plates remove gait belt secure patient in chair when appropriate DO NOT allow chair to move with patient’s feet on

the floor

Align patient use pillows, props as needed

Devices to Assist Ambulation canes

used to compensate for impaired balance or to improve stability

more functional on stairs & narrow, confined areas

can be stored & transported easier than walkers or crutches

quad canestandardcane

Key Factors of Canes

a standard cane provides limited stability because of its’ small base of support

a quad cane has a broad base, and will provide greater stability than the standard cane

Key Factors of Canes

cane used on the unaffected side ambulation begins with the cane, then the

affected side, and then the unaffected side follows through providing a 3-point base upon completion of the move

Devices to Assist Ambulation

Walkers an ambulation aid,

usually with 4 contacts that are placed on floor and a frame to support patient’s weight and provide stability during ambulation

Trochanterlevel

Key Factors of Walkers

a standard walker without wheels should be used when there is an affected side the lead foot with this

scenario is the affected side

Key Factors of Walkers

a wheeled walker is to be used when a patient is experiencing an unsteady gait or limited endurance and there is no affected side the lead foot with this

scenario is the dominant side

Key Factors DuringAmbulation with Walker

patient’s feet stationary when walker is moving patient’s feet should be shoulder’s width apart,

and one slightly ahead of the other never slide walker, unless equipped with wheels healthcare worker stands slightly behind and to

the affected side of patient in most cases grasp gait belt from underneath

Key Factors of Assistive Devices

device must be adjusted to fit patient

place hand piece of device at approximately the trochanter level (of hip), with a slight bend of patient’s elbow

slight elbow flexion

greatertrochanter

Key Factors of Assistive Devices

device does not prevent falls, however does reduce risk of falls when used properly

must not be used as device for standing

SafeguardingFalling Patient

know the patient’s capabilities/disabilities know if there is an affected side use gait belt around patient’s waist for

support and maintain hold at mid back while walking

support patient’s anterior shoulder with hand not holding gait belt to prevent forward motion in case of a fall

SafeguardingFalling Patient

healthcare worker walks on unaffected side (there will be exceptions) and slightly behind patient.

stay close to patient at all times as patient becomes limp, step one foot

between patient’s feet broadening your stance to provide a temporary support for the patient’s hips

SafeguardingFalling Patient

hand on patient’s shoulder pulls patient back against healthcare worker’s body and patient temporarily sits on thigh between their legs

the hand that was on the shoulder now drops to the belt so both hands are on the belt and approximately 6-8” apart

SafeguardingFalling Patient

keep your elbows close to your body and pull patient back short distance by stepping back from between patient’s legs

begin squatting while keeping your back straight

gently lower patient’s hips to sit on floor release belt, and slide hand up to

head/neck and support them to floor