1. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Patient’s Mobility: Ambulation Unit 17

2. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives Spell and define terms. Describe the purpose of assistive devices used in ambulation. List safety measures for using assistive ambulation devices. Describe safety measures for using a wheelchair. 2

3. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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 3

4. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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 4

5. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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 5

6. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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 6

7. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Assistive Devices Assistive devices –Crutches –Canes –Walkers 7

8. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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 8

9. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Use of Wheelchairs Many individuals who are unable to ambulate –Can gain some independence with the use of a wheelchair 9

10. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Use of Wheelchairs The wheelchair is a mobility device, not a transportation device –Used for patient independence and socialization, not for staff convenience 10

11. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Use of Wheelchairs The wheelchair must be the proper size to fit the patient –In some situations, special wheelchairs or adaptations are needed 11

12. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Use of Wheelchairs Position patient in the 90-90-90 position –Feet supported and the knees lower than the hips 12

13. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Use of Wheelchairs Use pillows, props, adaptive devices, or restraint alternatives –This ensures that the patient can maintain an upright position 13

14. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Positioning a 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 14

15. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Some manual lifting devices, such as the TLC pad, may be used Refer to Figure 17-14C 15 Positioning a Dependent Patient in a Wheelchair

16. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16 Positioning a Dependent Patient in a Wheelchair

17. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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 17

18. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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 18

19. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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 19

20. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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 20

21. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Wheelchair Seat Hammocking of the seat promotes sliding –Place a pressure-relieving cushion with a leveling pad in the chair to correct the sagging –This distributes weight more evenly and reduces pressure 21

22. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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 22

23. © 2016 Cengage Learning ®. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 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. –Never leave the person alone 23