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Mobility and immobility

BODY MECHANICS
BASED ON INC SYLLABUS
PROCEDURES,TECHNIQUES,VARIOUS MOBILITY AIDS,ITS USEAGE

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Mobility and immobility

  1. 1. MOBILITY AND IMMOBILITYPRESENTED BY MISS.APARNA C LAKSHMY CLINICAL INSTRUCTOR SNEHODAYA COLLEGE OF NURSING
  2. 2. BODY MECHANICS  BODY MECHANICS is the utilization of correct muscles to complete a task safely and efficiently, without undue strain on any muscle or joint.  It is the efficient use of body as a machine and as a means for locomotion
  3. 3. Purposes of body mechanics:  To avoid stress and strain on the musculoskeletal system  It promotes proper physiological function of the body  It minimizes the expenditure of the energy  It helps in maintaining balance of the body without strain  To prevent kyphosis,lordosis,scoliosis and other deformities.
  4. 4.  It contributes to one’s beauty.
  5. 5. Principles of body mechanics  Maintain good posture in all activity by avoiding twisting the body,turn your whole body,face the area in which you are working.  It is easier to slide,pull,or roll an object than to lift it.it helps to reduce the energy needed to raise the weight .  Movements should be smooth and co-ordinated rather than jerky to prevent injury.
  6. 6.  Use strongest and longest muscles to perform tasks which require physical effort.  Keep the object as close as possible to your body when lifting,moving or carrying them.  Keep the work at a comfortable height to avoid excessive bending at the waist.  Keep your body in good physical condition to reduce the chance of injury.
  7. 7.  Place the feet apart to provide a wide base of support and better balance.  Get help if the object feels too heavy to lift.  Flex the joints(knees and hips) to come close to the object instead of bending back.  Keep work close to the body  Use the weight of the body to pull or push an object by keeping the body above the object.
  8. 8. General instructions in moving and lifting patients  Plan the movement of the patient ahead of time and be sure the path is clear.  Face the direction in which the movement will be made, to avoid twisting of the vertebral column.  Place the feet comfortably apart to provide a wide base of support.  Flex the knees and hip joints but keep the trunk as vertical as possible.
  9. 9.  Keep the patient as close to the body as possible.  Avoiding jerking and twisting during the lift.  Heavy patients should be moved in bed by sliding them rather than lifting them.  Assistance should be requested when lifting or moving heavy patients.
  10. 10.  The height of the bed should be adjusted to a height that permits the nurse to keep her back as erect as possible when moving the patient in bed.  The patient is moved to the edge of the bed before he is lifted from the bed.this helps the nurse to keep her trunk more erect.
  11. 11.  When moving a patient by more than one person,each worker assumes the responsibility for supporting one of the patient’s body sections.the areas to be supported are,  1.head,shoulders and chest  2.hips  3.thighs and ankles
  12. 12.  In order to co-ordinate the movements of the workers and to maintain the patient’s body in correct alignment throughout,the leader gives the signal by counting 1,2,3.etc.during each count a particular procedure is carried out by the workers  Unless contraindicated,encourage the patient to use his abilities as much as possible.
  13. 13.  Observe the patient for symptoms of orthostatic hypotension such as fainting,dizziness,sweating etc  Do not support the patient under his armpits,since injury to major nerves and blood vessels may occur.  Always lock the wheels of bed and stretcher prior to transferring a patient to increase marimum static friction between the wheels and the floor.
  14. 14. Positions used for comfort  Supine position or horizontal recumbent or dorsal or back lying.  Dorsal elevated or semirecumbent position  Prone position  Lateral or side-lying position  Fowler’s position  Cardiac position
  15. 15. Position used for physical examinations  Dorsal or horizontal recumbent  Dorsal recumbent position  Erect position  Sim’s lateral or left lateral prone position.  Lithotomy position  Knee chest or genupectoral position  Trendelenburg position
  16. 16. Dorsal or horizontal recumbent  used mostly for the head to foot examination.
  17. 17. Dorsal recumbent position  used for the vulval,vaginal and rectal examinations and for the operative procedures on the vulval area and for such procedures as catheterisation of the bladder.
  18. 18. Erect position  This is the normal standing position with both feet on the floor.  Used for orthopaedic and neurological disorders.
  19. 19. Sim’s lateral or left lateral prone position  The patient lies on his left side.  One pillow placed under the head with the left cheek resting on it.the left arm is drawn behind the back and right arm may be in any position comfortable for the patient.the right thigh is flexed against the abdomen.  Used mainly for the vaginal and rectal examinations
  20. 20. Lithotomy position  The patient lies on his back with one pillow under the head  The legs are well separated and the thighs are well flexed on the abdomen and the legs on the thighs.  The patient’s buttocks are brought to the extreme edge of the table and legs are supported on the stirrups.  Used for the gynaecological examinations and treatments and during the surgical procedures involving the genitourinary system.
  21. 21. Knee chest or genupectoral position  Mainly used for the examination of the rectum and vagina.  Also as an exercise for the post partum patients.
  22. 22. Trendelenburg position  The patient lies on his back .the foot of the bed is elevated at a 45 degree angle.  The body is on an inclined place and legs hang downward over the end of the table.  This position is used during the examinations or operations on the pelvic cavity into the upper abdomen.  Also used to treat shock and decreased blood pressure.
  23. 23.  Moving up in a bed  Turning a patient to lateral and prone position  Logrolling-(technique used to turn a patient whose body must at all times be kept in straight alignment.)
  24. 24.  Assisting patient to sitting position.  Transfering a patient from bed to chair.  Transfering a patient between a bed and stretcher.
  25. 25. Factors affecting body alignment and mobility.  Growth and development. In adolescence ,growth spurts may result in awkwardness that can be manifested in posture.As age advances,muscle tone and bone density decrease,joints loose flexibility,reaction time slows and bone mass decreases..
  26. 26.  Congenital problems; Eg:hip dysplasia,spina bifida,cerebral palsy .  Neuromuscular deficits Eg: muscular dystrophy,Parkinson’s disease,multiple sclerosis are progressive that impairs the ability of nervous system to control muscular movements and coordination.
  27. 27.  Musculoskeletal deficits:eg:osteoporosis,rheumatoid arthritis.  Chronic health problems: These conditions often decrease mobility because such disorders limit the oxygen and nutrients delivered to the muscle contraction and movements.  Trauma: Injury to joints,tendons,ligaments,muscles or bones affects body alignment and mobility.
  28. 28. .  Affective disorders. Eg:depression and catatonic states result in limited mobility,not because of physical impairment but due to lack of desire to move.  Therapeutic modalities : Eg :restrictive devices such as cast, splint may be used to immobilize certain areas of body to promote healing.  Nutrition: Both under and over nutrition can influence body alignment and mobility.poorly nourished people may have weakness and fatigue.vitamin D deficiency causes bone deformity during growth.inadequate calcium intake increases the risk of osteoporosis
  29. 29.  Personal values and attitudes: Choice of physical activity or type of exercises may influence by values.
  30. 30. Range of motion exercises:  Range of motion exercises refers to activity aimed at improving movement of a specific joint.  Types  Active range of motion exercise(performed by the patient without help)  Passive range of motion exercise(not performed by the patient and the health care worker moves each joint through its range of motion)  Active assistive range of motion(the patient does the exercises with some assistance from another person or equipment.
  31. 31. General rules for ROM  Use good body mechanics  Expose only the body part being exercised,  Explain to the patient what you are going to do and teach the patient how to do .  Support the extremity being exercised.  Move each joint slowly,smoothly and gently  Return the joint to a neutral position after the movement.  Repeat each exercise 3-5times
  32. 32.  Ideally these exercises should be done once per day.  Expect the patient’s heart rate and respiratory rate to increase during exercise.  Joints are exercised sequentially,starting with the neck and moving down.  Don’t continue the exercise to the point that the patient develops fatigue.  Some exercises may need to be delayed until the patient condition improves.
  33. 33. `  Trunk –gliding joint:  Flexion:bend the trunk towards the toes  Extension: straighten the trunk from the flexed position  Hyperextension:bend the trunk backward  Lateral flexion:bend the trunk to the right and left  Rotation:turn the upper part of the body from side to side.
  34. 34. Hazards associated with immobility  Types of immobility  Social:withdrawal from normal patterns of social interaction.  Emotional :it can occur when stressors exceed the coping ability of an individual.  Intellectual : It can occur in persons who lack the ability to acquire needed knowledge.  Physical :can be caused by physical problems or by necessary therapeutic measures.
  35. 35.  1.cardiovascular system:  Venous stasis:caused by prolonged inactivity that restricts or slows venous circulation  Increased cardiac workload:due to increased viscosity from dehydration and decreased venous return.  Thrombus and embolus :formation caused by slow flowing blood,which may begin clotting within hours.  Orthostatic hypotension:
  36. 36. 2.Respiratory system:  Hypostatic pneumonia :the depth and rate of respiration and the movement of secretions in the respiratory tract is decreased when a person is immobile.the pooling secretions and congestions predispose to respiratory tract infections.  Atelectasis :when areas of lung tissues are not used over a period of time,collapse of lung tissue may occur
  37. 37. Musculoskeletal system:  Muscle atrophy :disuse leads to decreased muscle size,tone,and strength.  Contracture:decreased joint movement leads to permanent shortening of muscle tissue,resistant to stretching.  Ankylosis:consolidation and immobility of a joint in a particular position due to contracture.
  38. 38. 3.Nervous system  Altered sensation caused by prolonged pressure.usually pain is felt at first and the sensation is altered,and the patient no longer senses the pain.  Peripheral nerve palsy.
  39. 39. Gastrointestinal system:  Disturbance in appetite caused by the slowing of gastrointestinal tract  Constipation  Altered protein metabolism  6.INTEGUMENTARY SYSTEM:  Risk of skin breakdown which leads to necrosis and ulceration of tissues,especially on bony areas
  40. 40. Urinary system:  renal calculi caused by stagnation of urine in the renal pelvis.  Urinary tract infections caused by urinary stasis that favours the growth of bacteria  Decreased bladder muscle tone resulting in urinary retention
  41. 41. metabolism  Decreased metabolic rate.  Altered exchange of nutrients and gases.  Increased risk of electrolyte imbalance.
  42. 42. Psychosocial functioning:  Decrease in self concept and increase in sense of powerlessness.  Body image distortions  Increased risk of depression  Decreased social interaction.
  43. 43. Maintenance of normal body alignment and mobility:  Body alignment refers to the arrangements of joints,tendons,ligaments and muscles while in a standing,sitting or lying positions.  in a correctly aligned body,a line passes through specific points while in a standing position.these points can be seen from the side and back view.  Side view,reference points are:top of ear,middle of shoulder,center of hip,front of kneecap,front of ankle bone.  Back view,reference points are: center of head,midpoint of spine,middle of buttocks, and the center point between heels.
  44. 44. Standing  Head extended  Shoulder slightly abducted  Wrist extended  Pull your abdomen in and up  Thighs extended and slightly abducted  Keep your back flat  Chest should be most forward apart  Elbows should be lightly flexed  Fingers flexed  Buttocks contracted  Knees slightly flexed  Feet parallel about 3 inches apart
  45. 45. Sitting:  Head straight  Chin tucked in  Shoulders abducted  Wrist extended  Abdomen flat and relaxed  Chest should most forward part  Elbows flexed can be supported.  Fingers flexed  Thighs flexed at right angles to the trunk.  Feet flexed at right angles to legs and supported on floor or foot rest  Get up,stretch and relax hourly when you have to sit for a long time.
  46. 46. Bending  place one foot in front of the other  Bend the knees as well as the hip  Squat while keeping the back straight to pick up an object from floor.  WHILE WORKING IN STANDING POSITIONS:  Always face towards the work  Keep your feet apart 3 inches  Keep your back straight.
  47. 47. During lifting weights  Stand with both feet placed firmly on the floor and wide apart.  Stand close to the weight.  Use the stronger leg muscles for lifting  Bend knees and hip slightly,keep back straight  Lift straight upward,in one smooth motion  Hold the weight close to the body while lifting  Avoid twisting the trunk.  Stand high enough to avoid lifting above waist.  Better to push rather than lifting.
  48. 48. carrying  Place both feet on the floor.  Hold the object close to the body near the center of gravity.  Hold head erect and spine straight.
  49. 49. pushing  stand close to the object  Place yourself in proper body alignment  Tense muscle and prepare for movement  Hold the object close to the body near the centre of gravity  Lean towards the object  Push away from utilizing body weight to add force.  PULLING:  Lean away from the object to pull it towards you
  50. 50. Reaching  To get an object above head level,  Stand directly in front of and close to the object  Avoid twisting or stretching  Use a stool or ladder for high objects  Maintain a good balance and a firm base of support.  Keep one foot forward  Keep the back straight  Reach with both hands  Before moving the object,be sure that it is not too large or too heavy
  51. 51. Exercises  Exercises is a type of physical activity defined as a planned ,structured and repetitive bodily movement performed to improve health and maintain fitness to achieve an optimal state of health.
  52. 52. Types  Classified according to  Types of muscle contraction  the source of energy.
  53. 53.  Isotonic exercise(Dynamic );  In this,muscle shortens to provide muscle contraction and active movement.  Eg:running,walking,swimming,cycling  They are active ROM exercises  It increases muscle tone,mass,strength,and maintain joint flexibility, and circulation  During isotonic exercise,both heart rate , cardiac output increase.
  54. 54. Isometric exercises(static)  There is muscle contraction without moving the joint.  Eg ;squeezing a towel or pillow bt knees  Cause mild increase in heart rate and cardiac output.but no appreciable increase in blood flow to other parts of the body.
  55. 55. Isokinetic (resistive exercise)  Involves muscle contraction or tension against resistance.  Special machines or devices provide resistance to the movements  These exercises are used in physical conditioning and are often done to build up certain muscle groups.  Increase in bp and blood flow to muscle occurs with resistance training.
  56. 56. Aerobic exercise  It is the activity during which the amount of oxygen taken into the body is greater than that used to perform activity.  This exercises use large muscle group that move repetitively.
  57. 57. Anerobic  It involves activity in which the muscles cannot drawnout enough oxygen from the bloodstream,and anaerobic pathways are used to provide additional energy for a short time
  58. 58. Nursing management. Assessment  Assessment relative to a client’s activity and exercise should be routinely addressed and includes a nursing history and a physical examination of body alignment,gait,appearance and movement of joints,capabilities,and limitations for movement,mass, and strength,activity tolerance, problems related immobility, and physical fitness.
  59. 59. Nursing history:  An activity and exercise history  Any change or difficulties with mobility.  Specific nature of the problem, its frequency, its cause, how the problem affects daily life, client's coping mechanisms, etc.
  60. 60. Physical examination:  Body alignment,gait,appearance,movement of joint,capabilities and limitations for movement,muscle mass and strength,activity tolerance,problems related to immobility.
  61. 61. Physical assessment of mobility status: component Normal findings Significant alterations General movements Voluntarily controlled,co- ordinated. Involuntary movements:tremors,chorea,dystonia, fasciculations,athetosis,oral facial dyskines. Gait and posture Head erect,vertebrae straight,knees and feet point forward,arms at side with elbows flexed.arms swing freely in alteration with leg swings. Spastic hemiparesis,scissors gait,steppage gait,sensory ataxia,cerebellar ataxia,Parkinson’s gait,use of assistive devices. Muscle mass,tone, and strength. Adequate muscle mass,tone,strength to accomplish movement and work Atrophy,hypertrophy,hypotonicity,sp astcity,paralysis
  62. 62. chorea dystonia athetosis
  63. 63.  ,oral facial dyskines.
  64. 64. Alignment: Independent maintence of correct alignment.in the standing and sitting position, a straight line can be drawn from the ear through the shoulder and hip. Abnormal spinal curvature,inabitity to maintain correct alignment independently. Joint structure and function Absence of joint deformities, full range of motion Limitations in the normal range of motion, increased joint motility, swelling or tenderness in or around the joint.redness,crepitation,deformities,mus cle atrophy, skin changes,
  65. 65. endurance Ability to turn in bed, maintain correct alignment when sitting and standing, ambulate and perform self care activities. Physiologic or psychological inability to tolerate an increase in activity. Shortness of breath,dyspnea,weakness,pallor,conf usion,vertigo,pain. Significantly increased pulse, respiration.
  66. 66. Assessing problems of immobility assessment problems  Musculoskeletal system: Measure arm and leg circumference, palpate and observe body joints, take goniometric measurements of joint ROM. Decreased circumference due to decreased muscle mass, Stiffness or pain in joints Decreased joint ROM,joint contracture Respiratory system Observe chest movements, auscultate chest. Asymmetric chest movements,dyspnea,diminished breath sounds,crackles,wheezes,increased respiratory rate.
  67. 67. Cardiovascular system Auscultate the heart, measure bp ,palpate peripheral pulses, measure calf muscle circumference, Observe calf muscles for redness, tenderness, swelling Increased heart rate,orthostatic hypotension,peripheral dependent edema,increased peripheral vein engorgement,weak peripheral pulses,edema,,thrombophlebitis Metabolic system Measure height and weight Palpate skin Urinary system: Measure fluid intake and output. Inspect urine. Palpate urinary bladder Gastrointestinal system: Observe stool,auscultate bowel sounds Weight loss due to muscle atrophy and loss subcutaneous fat.generalized edema due to blood protein levels. Dehydration,cloudy,dark urine,distended urinary bladder due to urinary retention Hard,dry,small stool.decreased bowel sounds due to decreased intestinal motility
  68. 68. Integumentary system Inspect skin Break in skin integrity Psychoneurologic system Observe behaviours,affect,cognition,monitor developmental skills in children Anger,flat affect,crying,confusion,,anxiety, decline in cognitive function, or such as sleep and appetite disturbances.
  69. 69. Nursing diagnosis  Impaired physical mobility Related to Activity intolerance Decrease in muscle control Decrease in muscle mass Decrease in muscle strength Musculoskeletal impairment
  70. 70.  Activity intolerance related to Bed rest,generalized weakness,immobility,sedentary lifestyle  Risk for activity intolerance related to Circulatory problem,respiratory condition,history of previous intolerance.  Impaired walking related to Insufficient muscle strength,musculoskeletal impairment,neuromuscular impairement,environmental barriers.
  71. 71.  impaired standing related to Injury to lower extremity,pain,neurological disorder  Impaired wheelchair mobility related to Decrease in endurance,insufficient muscle strength. Others: Ineffective airway clearance,risk for infection,risk for injury,risk for disturbed sleep pattern,
  72. 72. planning  the goals established for clients will vary according to the diagnosis and defining characteristics related to each individual.  Eg:the client will have,  Increased tolerance for physical activity  Improved capability to ambulate  Absence of injury from falling  Enhanced physical fitness  Improved social,emotional and intellectual well being.
  73. 73. Implementing:  Nursing strategies to maintain or promote body alignment and mobility involves,  Positioning clients appropriately,moving and turning clients in bed,transferring clients,  Providing ROM exercises,  Ambulating clients with or without mechanical aids,  Strategies to prevent the complications of immobility  When ever positioning,moving and ambulating clients,nurses must use proper body mechanics to avoid musculoskeletal strain and injury.
  74. 74. Home care management  Maintaining musculoskeletal function. Teach the systematic performance of ROM Exercises. Demonstrate the proper ways of exercises. Offer an ambulation schedule. Instruct the availability of assistive ambulatory devices, and correct use of them. Discuss pain control measures required before exercises.
  75. 75. Preventing injury  Provide assistive devices for moving and transferring  Discuss safety measures to avoid falls.  Teach the use of proper body mechanics.  Teach ways to prevent postural hypotension
  76. 76. Managing energy to prevent fatigue:  Discuss ways to minimize fatigue such as performing activities more slowly and shorter periods,using assistance as required.  Teach ways to increase energy.  Provide information about available resources to help with ADLs and home maintenance management.
  77. 77. Referrals  Provide appropriate information about community resources. Home care agencies, physical and occupational therapy agencies etc.
  78. 78. Ambulating clients  Ambulation is the act of walking.  Prolonged bed rest can make the client feel weak and unsteady.  Nurse should encourage clients to perform ADLs,maintain good body alignment,and carry out active ROM exercises to the maximum degree possible yet within the limitations imposed by their illness and recovery program.
  79. 79.  Clients who have been in bed for long periods often need plan of muscle tone exercises to strengthen the muscle used for walking before attempting to walk (preambulatory exercise)  Clients who have been immobilized for a few days may require assistance.
  80. 80. Care of patients having restraints:  Restraint is defined as the intentional restriction of a person’s voluntary movement or behaviours.  Principles: It should be selected to reduce client’s movement only as much as necessary Nurses should carefully explain type of restraint and reason for its use. It should not interfere with treatment. Bony prominences should be padded before applying it
  81. 81.  It should be changed when they become soiled or damp.  It should be secured away from a client’s reach  It should be attached to bed frame not to side rails.  It should be removed a minimum of every 2 hours  Frequent circulation checks should be performed when extremity are used.
  82. 82. Restraint guidelines  Doctor’s order  Informed consent  Follow proper technique  Least restrictive  Pad bony prominence  Maintain body alignment.
  83. 83. Rehabilitation aspects:  Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their physical,sensory,intellectual,psychological, and social functional levels.
  84. 84. Using mechanical aids for walking  canes Canes are light weight, easily movable devices that are made of wood or metal. Types of canes Single ended canes with half circle handle. Single ended canes with straight handles Canes with 3 or 4 prongs(qwad canes)
  85. 85. Procedure  Instruct patient to stand with weight,evenly distributed between the feet and the cane.  The cane is held on the patient’s stronger side.instruct patient to position cane 6 inches(15 cm) anterior of the foot.  Move the affected leg forward to the cane while the weight is borne by the cane and stronger leg.  Next move the unaffected leg forward ahead of the cane and weak leg while the weight is borne by the cane and weak leg.  Repeat the steps.
  86. 86. walkers  A walker is a light weight metal frame with four legs.  patient’s requirements to use walker: 1.Partial strength in both hands and wrist 2..strong elbow extensors such as triceps brachi 3.Strong shoulder depressors such as the pectoralis minor 4.Ability to bear at least partial weight on both legs
  87. 87.  Explain the method of using walker  Instruct patient to wear non-skid shoe or slipper  Instruct patient not to use walker on stairs  Have patient stand in center of walker and grasp handgrips on upper bars.  Lift walker and move it 6-8 inches forward,making sure all 4 feet of the walker stays on the floor.take a step forward with one foot.then follow through with other leg.
  88. 88.  If one leg is weaker than the other:  Move the walker and weak leg ahead together about 15 cm while your weight is borne by the affected leg and both
  89. 89. Special considerations  The patient should be taught to examine the frame daily when inspecting a walker.  Use caution when attempting to ambulate a patient who has already been given an antihypertensive or analgesic medication because the medication may cause dizziness or instability.  Caution should be used if the patient uses a walker on inclines  Care must be taken if the patient has IV line,urinary catheter etc.
  90. 90. Assisting with crutch walking:  Assisting patient to walk using crutches while providing support and balance and as a convenient method of getting from one place to another.  Types of crutches:  Axillary crutch  Lofstrand crutch(it has a handgrip and metal band that fits around the patient’s forearm.  Platform crutch :it is used by the patients who are unable to bear weight on their wrists.
  91. 91. Procedure:  Review patient’s chart: Medical history,previous activity level,current activity level.  Assess patient’s physical readiness Vital signs,orientation to time ,place and person  Assess patient for any visual,perceptual,or sensory deficits
  92. 92.  Place bed in low position and slowly assist patient to upright position.let patient sit or stand for a few minutes until balance is gained.  Make sure it is of appropriate height. There are 2 methods for measuring crutch length; 1.Client lies in a supine position and nurse measures from the anterior fold of axilla to the heel of foot and adds 2.5 cm. 2.Position crutches with crutch tips at a point of 15 cm to side and 15 cm in front of patient’s feet and crutchpad 4-5 cm below axilla.crutch pads should be 3-4 fingers width under axilla with crutch tips positioned 15 cm lateral to patient’s heel
  93. 93.  Assist patient in crutch walking by choosing appropriate gait.  1.four point gait:  This is the most stable of crutch gaits because it provides at least 3 points of support at all times  Begin in tripod position: crutches are placed 6 inches in front and 6 inches to side of each foot.  Move right crutch forward 10-15 cm.(4-6 in)  Move the left front foot forward,preferably to the level of left crutch.  Move the left crutch forward.  Move the right foot forward
  94. 94.  Three point gait  The client must be able to bear the entire body weight on affected leg.the nurse asks the client to,  1.move both crutches and the weaker leg forward.  2.Move the stronger leg forward.
  95. 95.  Two point gait  It requires at least partial weight bearing on each foot.it requires more balance.  Begin in tripod position  Move left crutch and right foot forward.  Move right crutch and left foot forward  Repeat sequences
  96. 96.  Swing to gait  Used by patients whose lower extremities are paralysed or wear weight supporting braces on their legs.  1.move both crutches forward.  Lift and swing leg to crutches, letting crutches support body weight.  Repeat previous steps.
  97. 97.  Swing -through gait; Requires that patient have the ability to sustain partial weight bearing on both feet. Move both crutches forward Lift and swing legs through and beyond crutches.
  98. 98.  Assist patient in climbing stairs;  1.begin a tripod position  2.patient transfers body weight to crutches  3.patient advances unaffected leg to stair  4.then advance affected leg and crutches  Repeat sequence until patient reaches top of stairs.
  99. 99.  Assist patient in descending stairs with crutches;  Begin in tripod position  Patient transfers body weight to unaffected leg  Move crutches to stairs and instruct patient to begin to transfer weight to crutches and move affected leg forward.  Patient moves unaffected leg to stair and align with crutches.  Repeat sequence until stairs are descended.  Record in nurse’s progress notes-type of gait patient used,amount of assistance required,distance walked,patient’s tolerance of activity.
  100. 100. Special consideration  Inspect rubber tips on bottom of ambulation device frequently  If wooden crutch is used,examine it for cracks  Remove obstacles from pathways  Avoid large crowds  Instruct patient to continue muscle strengthening exercise at home.  Teach patient with axillary crutches about the dangers of pressure on the axillae.
  101. 101.  Instruct patient to routinely inspect crutch tips.  Explain that crutch tips should remain dry
  102. 102. Equipment and assistive devices  Gait belts:  Gait belt is a device used for transferring patients and assisting with ambulation  The belt which often has handles is placed around the patient’s waist and secured with velcrofasteners.
  103. 103.  Lateral assist devices:  Lateral assist devices reduce patient’s surface friction during side to side transfer.eg:roller boards,transfer boards,slideboards
  104. 104.  Friction reducing sheet  Used under patients to prevent skin shearing when moving patients in bed and when assisting with lateral transfer.  It reduce friction and force required to move patients.
  105. 105.  mechanical lateral assist devices  It includes specialized stretches and eliminate the need to the patient manually.  Transfer chairs  Chairs that can convert into stretchers are available.  These are useful with patients who have no weight bearing capacity,cannot follow directions or cannot cooperate.
  106. 106.  Powered stand assist and repositioning lifts  These devices can be used with patients who can bear weight at least one leg, can follow directions and are co operative.  A simple sling is placed around the patient's back and under the arms  The patient rest his feet on the device’s foot rest and places his hand on the handle  The device mechanically assist the patient to stand without any assistance from the nurse
  107. 107.  Powered full body lifts:  These devices are used with patients who cannot bear any weight to move them out of bed, into and out of the chair and to a commode or stretcher  A full body sling is placed under the patient’s body including the head and torso, then the sling is attached to the lift. The device slowly lift the patient.
  108. 108. Common devices to promote correct alignment:  Pillow  Mattresses  Adjustable bed  Trapeze bar A trapeze bar is a handgrip suspended from a frame near the head of the bed. The patient can grasp the bar with one or both hands and then raise the trunk from the bed.
  109. 109.  Additional equipment:  Foot board  Sandbag-used to immobilize an extremity and support body alignment.  Trochanter rolls-used to support the hips and legs so that the donot rotate outwards.  Handwrist splints or hand rolls-to keep the thumb in correct position  Side rails
  110. 110.  Suspension or heel guard boot:  These are made of a variety of substances.they have a firm exterior and padding of foam to protect the skin.they prevent foot drop and relieve pressure on heels.  Abduction pillows:A triangular shaped foam pillow that maintains hip abduction to prevent hip dislocation following total hip replacement.
  111. 111.  Antiembolism stocking  Antiembolism stocking are often used for patient’s at risk for deep vein thrombosis, pulmonary embolism, and to help prevent phlebitis  It increases the velocity of blood flow in the superficial and veins and improve venous valve function in the legs, promoting venous return to the heart
  112. 112.  Pneumatic compression devices  They are composed of an air pump, connecting tubes, extremity sleeves.  They require a physician’s order and often prescribed for high risk surgical patients, patients with decreased mobility, patient with chronic venous disease, and patient at risk for deep vein disorder.  Pneumatic compression devices apply intermittent or sequential pressure to the legs to enhance blood flow and venous return, stimulating the normal muscle pumping action in the legs.

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