what assessment should you do before ambulating?
-Physical and cognitive ability with the Pre-Handling Check
•Pain control adequate for movement
•Equipment and environment ready; non-slip footwear
•Ensure glasses, hearing sides in (be aware of visual and auditory deficits that could affect ambulation)
•Note weight bearing status
•Check care plan so you know transfer type (1 assist? 2 assist? Mechanical lift?)
•REFER TO POLICY AND PROCEDURES—IH HAS A NO LIFT POLICY FOR EXAMPLE
what do you have to make sure of when transferring someone into a wheelchair?
- Ensure brakes are on
- Remove foot plates
- If patient requires seat belt ensure engaged (part of care plan and is technically a restraint)
- Ensure patient sits as far back in the chair to ensure proper posture
- Patients with upper body strength, unable to weight bear, can use a transfer board to slide from w/c to bed
- Ensure board is on w/c and mattress so it doesn’t slip off during transfer
what are the types of mobility aids?
crutches, canes, and walkers
what are the rules for canes?
- Length should permit the elbow to be flexed(15-30 degrees)
- Cane handle should fit comfortably in hand
- Cane is held on the stronger side of the body and moved forward with the weaker leg
- Provides less stability than a walker
what are the rules for crutches?
- The axillary rest of the crutch should be2-3 finger widths (5cm) below the axilla
- With elbows flexed at 15-30 degrees the hand is resting on the hand bar
- Make sure the bottom has the rubber tips to prevent slipping
- Different gaits depends on weight bearing status and ability of the patient
what is the tripod position?
its related to crutches and its when the crutches lay infront of feet by 15cm
what are the rules for walkers?
- When standing up straight (or as straight as they can):
- Top of walker should line up with crease on inside of wrist
- Elbows flexed 15-30 degrees whenstanding inside walker, hands on grips
-Contractures= permanent shortening of a muscle followed by eventual shortening of associated ligaments and tendons.
what are signs and symptoms of orthostatic hypotension?
- light headedness
what is the aim of the care for patients with immobility?
-Aim of care plan is to improve functional status, promote self-care, maintain psychological well being, and reduce hazards of immobility.
what are the four planes of body?
what does limited ROM and active ROM often indicate?
limited ROM: inflammation, such as arthritis, fluid in the joint, or altered nerve supply
active ROM: paralysis, sedation, or general weakness
what is activity tolerance?
type and amount of exercise or work that a person is able to perform without undue exertion or possible injury.
what is the activity tolerance assessment?
- if they’re standing: normal s in spine, proper leg alignment in trunk
- if they’re sitting: good posture, feet on floor
what are general tips for ambulating?
• Explain what you're going to do and how • Use simple language • One worker leads, one follows • Set up your environment • If you think its unsafe, go slow Take your time. No rush
what are the benefits of ambulation?
- Maintenance of muscle tone
- Maintenance of Strength
- Joint flexibility
- Function of respiratory, cardio, and gastrointestinal systems
how can you minimize orthostatic hypotension when a patient is in bed?
by allowing patients legs to dangle off side of bed (with legs able to touch floor) with legs moving back and forth.
• Circulatory system can equilibrate
what are the different crutch gaits?
- four-point gait: most stable crutch gait because both legs are on ground at all times and using crutch for support (usually used with some sort of paralysis)
- three-point gait: all weight on one foot (affected leg does’t touch ground-used for broken leg etc)
- swing-to gait: used when lower half is paralyzed (both feet swing through air)
how do you test to see if someone is able to get out of bed?
- In bed: Bridge- knees bent, person lifts their hips off the bed (hold feet to assist if necessary)
- Sit upright on bed/chair unsupported
- In sitting: extended at the knee, leg held straight/unsupported
- In sitting: lean forward, then straighten up
Understand: follows directions (verbal/visual/tactile) cooperatively