Ambulatory AidsAmbulatory Aids PNU 145

Chapter 26

Ambulatory Aids

Cheryl Proffitt, RN,MSN

September, 2015

ObjectivesObjectivesName four activities that prepares clients for ambulation

Give two examples of isometric exercises that tone and strengthen lower extremities

Identify one technique for building upper arm strength

Explain the reason for dangling clients or using tilt table

Name two devices used to assist clients with ambulation

Give three examples of ambulatory aids

Identify the most stable type of ambulatory aids

Learning ObjectivesLearning ObjectivesDescribe three characteristics of appropriately fitted crutches

Name four types of crutch-walking gaits

Explain the purpose of a temporary prosthetic limb

Discuss two criteria that must be met before constructing a permanent prosthetic limb

Name four components of above-the-knee and below-the-knee prosthetic limbs

Describe how a prosthetic limb is applied

Discuss age-related changes that affect the gait and ambulation of older adults.

Ambulatory Aids Ambulatory Aids • Introduction

Used for clients with disorders or injuries to the

musculoskeletal system

Clients who are weak or unsteady because of age

related problems and have difficulty walking

Clients with neurological problems and have

difficulty walking

Preparing for AmbulationPreparing for Ambulation

Patient’s who are debilitated ( those who are frail or weak from prolonged inactivity) require physical conditioning before they can ambulate

Some techniques that can help to increase muscle strength and the ability to bear weight includes performing isometric exercises with the lower limbs and isotonic exercises with the upper limb, dangling at the bedside and using the tilt table.

Preparing for Ambulation Preparing for Ambulation

• Isometric exercises: Used to promote muscle strength and tone.

• Types

– Quadriceps setting: client alternately tenses and relaxes the quadriceps muscles. Enables client to stand and support the body

– Gluteal setting: client contracts and relaxes the gluteal muscles to strengthen and tone them. Assist with walking

Quadriceps and Gluteal Setting Exercises

Quadriceps and Gluteal Setting Exercises

• Upper arm strengthening: flexion and extension of the arms and wrists; raising and lowering weights with the hands; squeezing a ball or spring grip; modified hand push-ups in bed.

• Dangling: normalizes blood pressure. Sitting at the edge of the bed, helps to normalize blood pressure

• Using a tilt table- a device that raises the client from a supine to a standing position.

Preparing for AmbulationPreparing for Ambulation

Ambulation Aids Cont’dAmbulation Aids Cont’d

Assistive DevicesAssistive Devices• Devices to support and assist walking:

– Parallel bars (handrails) provide practice in ambulating

– Walking belt applied around client’s waist provides secure grip to prevent injury while ambulating

Ambulatory AidsAmbulatory Aids

• Three aids are used to help with ambulation, crutches, walker, canes

• Crutches: generally used in pairs and made of wood or aluminum

– Axillary

– Forearm

– Platform

Types of crutchesTypes of crutches

Ambulatory Aids (Cont’d)Ambulatory Aids (Cont’d)

• Cane: a hand-held ambulation device made of wood or aluminum- clients with weakness

– Rubber tips reduce possibility of slipping

• Walker: most stable device; has curved aluminum bars and three-sided enclosure with four legs for support. Used for clients needing support and assistance with balance

• Clients holds and stands within walker, takes step forward

Ambulatory Aids (cont’d)Ambulatory Aids (cont’d)

• Crutch-walking gaits- pattern of walking when ambulating with crutches.

• Types (point refers to the sum of the crutches and legs used)

– Four-point gait

– Three-point gait – non/partial weight bearing

– Two-point gait

– Swing-through gait

Using a CaneUsing a Cane

Crutch-Walking GaitsCrutch-Walking Gaits

Prosthetic Limbs Prosthetic Limbs • Is used for clients with arm/leg amputation

• Types:

• Amputation at the foot-(Syme’s amputation)

• Below the knee- (BK amputation)

• Above the knee- (AK amputation)

• Entire leg and a portion of the hip (hemi-pelvectomy)

Temporary Prosthetic limbTemporary Prosthetic limb

• Temporary prosthetic limb: immediate postoperative prosthesis (IPOP)

• Permanent prosthetic components delayed for several weeks or months to be sure that :

Incision has healed

Stump size is relatively stable

Prosthetic Limbs (cont’d)Prosthetic Limbs (cont’d)• Prosthetic components include:

• Below the knee: socket, shank, ankle/foot system.

• Above the knee: below-the-knee components plus a knee system

Applying a Leg ProsthesisApplying a Leg ProsthesisNurses are responsible for managing the care

of the stump.

(Refer to Skill 26-3 in the textbook.)

Ambulating with a lower extremity limb prosthesis requires strength and

endurance.

Nursing Implications Nursing Implications • Nursing diagnoses include:

– Impaired physical mobility

– Risk for disuse syndrome, trauma

– Unilateral neglect

– Risk for activity intolerance

– Risk for peripheral neurovascular dysfunction

– Look at care plan 26-1

General Gerontologic ConsiderationsGeneral Gerontologic Considerations

• Functional ability involves mobility and making adaptations to compensate for changes occurring with aging or disease processes

• May need encouragement and support integrating adaptations into their activities of daily living and maintaining their self-concept and body image

• Maintaining independence is important to older adults

General Gerontologic Considerations (cont’d)

General Gerontologic Considerations (cont’d)

• Mobility facilitates staying active and independent

• As a person ages, he or she may develop flexion of the spine which alters the center of gravity and may increase falls

• Ensure adequate lighting without laying electric cords in passageways

• Elevate toilet seats; install grab bars• Rearrange home furnishings

References References • Timby, B. (2009). Fundamental nursing skills and concepts

(10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

• Google pictures. (2015, August 10). Retrieved from http://www.google.com