unit 17

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Unit 17

The Patient’s Mobility: Ambulation


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.


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


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


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


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


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


Assistive Devices

• Assistive devices – Crutches– Canes– Walkers


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


Use of Wheelchairs

• Many individuals who are unable to ambulate– Can gain some independence with the use

of a wheelchair


Use of Wheelchairs

• The wheelchair is a mobility device, not a transportation device– Used for patient independence and

socialization, not for staff convenience


Use of Wheelchairs

• The wheelchair must be the proper size to fit the patient– In some situations, special wheelchairs or

adaptations are needed


Use of Wheelchairs

• Position patient in the 90-90-90 position– Feet supported and the knees lower than

the hips


Use of Wheelchairs

• Use pillows, props, adaptive devices, or restraint alternatives– This ensures the patient can maintain an

upright position


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



• Some manual lifting devices, such as the TLC pad may be used

• Refer to Figure 17-16A


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


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


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


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


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


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


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

unit 17

Documents

delmar learning

patient independence

positioning dependent

purpose of assistive

use of wheelchairsuse

adaptive devices

patients mobility

carpetedsome patients