Ch 26 Ambulatory Aids.docx

Ch. 26 Ambulatory Aids Gerontologic considerations: - Mobility facilitates staying active and independent in older populations - Functional ability- involves both mobility and making adaptations to compensate for changes that are associated with aging or disease processes - An...

Ch. 26 Ambulatory Aids Gerontologic considerations: - Mobility facilitates staying active and independent in older populations - Functional ability- involves both mobility and making adaptations to compensate for changes that are associated with aging or disease processes - An elevated toilet seat and grab bars may be needed to improve an older adult's ability to transfer safely and maintain independence - Tighten/ contract quadriceps muscles by flattening the backs of the knees into the mattress. If not possible, use a rolled towel under the knee or heel before attempting to tighten quadriceps muscles. If knee caps move forward, client is performing correctly. Hold for count of five, relax and repeat 2-3 times each hour - Tighten/ contract the gluteal muscles by clenching the cheeks of the buttocks together, hold contraction for a count of 5, relax and repeat 2-3 times each hour 1. **Canes**- for clients who have weakness on one side of the body - Half circle handle cane- for clients who need minimal support - T-handle cane- has handgrip with slightly bent shaft, offering the user more stability - Quad cane- has four supports at the base and provides even more stability Ex. A client that has poor balance needs an aid with a strong base of support such as a quad cane - A cane must be the right height for the client. Cane's handle should be parallel with the client's hip, which provides elbow flexion of about 30 degrees. Canes have an adjustable height - When clients first use a cane, a nurse assists by applying a gait belt and standing toward the back of the client's stronger side - Cane must be 4 to 6 inches from the toes on strong side of the body - Move the cane forward at the same time as the weaker side 2. **Walker**- for clients who require considerable support and assistance with balance. Walkers are the most stable form of ambulatory aid - Clients who have been on bed rest or after hip surgery are some examples of clients who use walkers - Some walkers have wheels at the front and some have a seat - Walkers also have an adjustable height - To use walker, the client must advance the walker by 6 to 8 inches and then take a step forward - For clients with partial or non-weight-bearing on one leg, support the body weight on the handgrips when moving the weaker leg 3. **Crutches**- generally used in pairs, requires great deal of upper arm strength and balance, older adults and weak clients do not commonly use them - 3 types: axillary, forearm, and platform - Axillary crutches- require 2 finger space beneath axilla. Used by client's who need brief, temporary assistance with ambulation - Forearm crutches-used by experienced clients who need permanent assistance with walking - Platform crutches- support the forearm and used by clients who cannot bear weight with their hands and wrists. Many clients with arthritis use them - Sometimes a client uses one axillary and one platform crutch, for example when one arm is broken **Gait**- one's manner of walking **Crutch-walking gait**- walking pattern used when ambulating with crutches, walkers or canes **Point**- sum of crutches and legs used when performing the gait \*nurses are responsible for assisting clients who are learning to walk with crutches 4 types of crutch-walking gaits: 1. **Two-point** some strength and coordination 2. **Three-point non-weight bearing** one amputated or injured, disabled leg or severe ankle sprain 3. **Three-point partial weight-bearing** amputee learning to use prosthesis, minor injury to one leg, or previous injury showing signs of healing 4. **Four-point**bilateral weakness or disability such as arthritis or cerebral palsy 5. **Swing through**injury or disorder affecting one or both legs such as paralyzed client with leg braces or an amputee being fitted with prosthesis Prosthetic limb types: - Passive prosthetic - Body powered prosthetic - Electrically powered - Activity- specific **Syme amputation**- extremity amputated at the foot **AK amputation**- above the knee amputation or entire leg and portion of the hip removed **BK amputation**- below the knee amputation or disarticulation at the knee In many cases, clients who return from surgery with an (**IPOP) immediate postoperative prosthesis**, temporary artificial limb. Consists of walking pylon, permits removal when client is not ambulating. Controls stump swelling. Nurse is responsible for ensuring that the incision heals and that no complications arise. Complication examples are, joint contractures, or infection, which delay rehabilitation. Contractures interfere with limb and prosthetic alignment which can affect the client's ability to walk **Permanent prosthesis**- delayed for several weeks or months, until the wound helps and stump size is relatively stable. The permanent prosthesis is custom made, to conform to the stump and meet the client's needs. **For BK amputees**- includes a socket, a shank, and ankle/foot system **AK prosthesis**- also include a knee system to replace the knee joint, and includes a socket, molded cone, which holds the stump and enables amputee to move the prosthesis. And held in place by suction or leather belt/ sling. Some clients wear multiple socks over the stump as a layer between stump and socket. Knee system allows flexion and extension to accommodate sitting and a more natural gait. shank of prosthesis is shaped like a natural lower leg to transfer body weight to walking surface. Shank is painted to client's skin color **Stump socks**- wool or cotton, come in a variety of thickness to accommodate slight changes in stump size. Tube socks are not appropriate. Stump socks must be replaced when holes develop to prevent skin breakdown Ambulation with lower limp prosthesis requires strength and endurance. The more natural joints are preserved, the more the natural gait appears