Chapter 54: Physical Therapy and Rehabilitation 1

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P R O C E D U R E 545 Teaching a Patient How to Use Crutches

Goal To teach a patient how to use crutches safely.

OSHA Guidelines This procedure does not involve exposure to blood, body fluids, or tissues.

Materials A pair of crutches suited to the patient’s needs.

Method

Step Number Procedure

Points Possible

Points Earned

1. Verify the physician’s order for the type of crutches and gait to be used. 8

2. Wash your hands, identify the patient, and explain the procedure. 8

3. Elderly patients or patients with muscle weakness should be taught muscle strength exercises for their arms.

8

4. Have the patient stand erect and look straight ahead. 8

5. Tell the patient to place the crutch tips 2 to 4 inches in front of and 4 to 6 inches to the side of each foot.

8

6. When instructing a patient to use an axillary crutch, make sure the patient has a 2-inch gap between the axilla and the axillary bar and that each elbow is flexed 25 degrees to 30 degrees.*

10

7. Teach the patient how to get up from a chair:* a. Instruct the patient to hold both crutches on his affected or weaker side. b. Have the patient slide to the edge of the chair. c. Tell the patient to push down on the arm or seat of the chair on his stronger

side and use his strong leg to push up. If indicated, keep the affected leg forward.

d. Advise the patient to put the crutches under his arms and press down on the hand grips with his hands.

10

8. Teach the patient the required gait. Which gait the patient will use depends on the patient’s muscle strength and coordination. It also depends on the type of crutches, the injury, and the patient’s condition. Check the physician’s orders, and see Figures 54-11 and 54-12 for examples.*

10

9. Teach the patient how to ascend stairs:* a. Start the patient close to the bottom step, and tell him to push down with his

hands. b. Instruct the patient to step up on the first step with his good foot. c. Tell the patient to lift the crutches to the same step and then lift his other foot.

Advise the patient to keep his crutches with his affected limb. d. Remind the patient to check his balance before he proceeds to the next step.

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(continued)

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2 Chapter 54: Physical Therapy and Rehabilitation

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Step Number Procedure

Points Possible

Points Earned

10. Teach the patient how to descend stairs:* a. Have the patient start at the edge of the steps. b. Instruct the patient to bring his crutches and then the affected foot down first.

Advise the patient to bend at the hips and knees to prevent leaning forward, which could cause him to fall.

c. Tell the patient to bring his unaffected foot to the same step. d. Remind the patient to check his balance before he proceeds. In some cases, a

handrail may be easier and can be used with both crutches in one hand.

10

11. Give the patient the following general information related to the use of crutches:* a. Do not lean on crutches. b. Report to the physician any tingling or numbness in the arms, hands, or

shoulders. c. Support body weight with the hands. d. Always stand erect to prevent muscle strain. e. Look straight ahead when walking. f. Generally, move the crutches not more than 6 inches at a time to maintain good

balance. g. Check the crutch tips regularly for wear; replace the tips as needed. h. Check the crutch tips for wetness; dry the tips if they are wet. i. Check all wing nuts and bolts for tightness. j. Wear flat, well-fitting, nonskid shoes. k. Remove throw rugs and other unsecured articles from traffic areas. l. Report any unusual pain in the affected leg.

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Total Points

100

CAAHEP Competencies Achieved

XI. C (10) Identify principles of body mechanics and ergonomics

ABHES Competencies Achieved

5. (b) Identify and respond appropriately when working/caring for patients with special needs

9. (q) Instruct patients with special needs

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