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

Copyright © 2008 Delmar Learning. All rights reserved.

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

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

Documents

delmar learning

falling patient slide

wheelchair slide

patient independence

dependent patient

wheelchairs position

independence slide

ambulation slide