1. Copyright © 2008 Delmar Learning. All rights reserved. Unit 17 The Patient’s Mobility: Ambulation

2. Copyright © 2008 Delmar Learning. All rights reserved. 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.

3. Copyright © 2008 Delmar Learning. All rights reserved. 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

4. Copyright © 2008 Delmar Learning. All rights reserved. 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

5. Copyright © 2008 Delmar Learning. All rights reserved. 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

6. Copyright © 2008 Delmar Learning. All rights reserved. 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

7. Copyright © 2008 Delmar Learning. All rights reserved. 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

8. Copyright © 2008 Delmar Learning. All rights reserved. Assistive Devices Assistive devices –Crutches –Canes –Walkers

9. Copyright © 2008 Delmar Learning. All rights reserved. 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

10. Copyright © 2008 Delmar Learning. All rights reserved. Use of Wheelchairs Many individuals who are unable to ambulate –Can gain some independence with the use of a wheelchair

11. Copyright © 2008 Delmar Learning. All rights reserved. Use of Wheelchairs The wheelchair is a mobility device, not a transportation device –Used for patient independence and socialization, not for staff convenience

12. Copyright © 2008 Delmar Learning. All rights reserved. Use of Wheelchairs The wheelchair must be the proper size to fit the patient –In some situations, special wheelchairs or adaptations are needed

13. Copyright © 2008 Delmar Learning. All rights reserved. Use of Wheelchairs Position patient in the 90-90-90 position –Feet supported and the knees lower than the hips

14. Copyright © 2008 Delmar Learning. All rights reserved. Use of Wheelchairs Use pillows, props, adaptive devices, or restraint alternatives –This ensures the patient can maintain an upright position

15. Copyright © 2008 Delmar Learning. All rights reserved. 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

16. Copyright © 2008 Delmar Learning. All rights reserved. Positioning Dependent Patient in a Wheelchair Some manual lifting devices, such as the TLC pad may be used Refer to Figure 17-16A

17. Copyright © 2008 Delmar Learning. All rights reserved. Positioning Dependent Patient in a Wheelchair

18. Copyright © 2008 Delmar Learning. All rights reserved. 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

19. Copyright © 2008 Delmar Learning. All rights reserved. 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

20. Copyright © 2008 Delmar Learning. All rights reserved. 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

21. Copyright © 2008 Delmar Learning. All rights reserved. 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

22. Copyright © 2008 Delmar Learning. All rights reserved. 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

23. Copyright © 2008 Delmar Learning. All rights reserved. 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

24. Copyright © 2008 Delmar Learning. All rights reserved. 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