health skills ii unit 204 ambulation and assistive devices
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Health Skills IIUnit 204
Ambulation and Assistive Devices
Moving Patients General
know patient diagnosis, abilities and restrictions (physical & cognitive)
mentally and physically plan your action seek help when necessary and available explain procedure to patient and assistants
and how they can assist in the move remove obstacles to maintain a safe
environment for patient & health care worker lock wheels of movable objects
Moving Objects/Patients
Protect Yourself adjust bed height to
safe height for you. Ideally waist height
if bed isn’t adjustable, bend at hips & knees (avoid bending of back, keep hips lower than shoulders)
Moving Objects/Patients
use leg & trunk muscles for lifting
keep your feet shoulder’s width apart & one foot slightly in front of the other
keep patient close to your body by bending your elbows and keeping them close to your side
avoid twisting your back when lifting
Moving Patients
Protect Your Patient good patient communication (keep the
patient informed and instructed as to how and when they can assist you)
use smooth, rhythmical motions during movement to avoid skin friction
keep patient in good body alignment
Moving Patient to Sitting Position assist patients, and encourage them to do
as much as they can instruct patient how and when to assist, be
specific make moves slowly, and allow patient to
recover and gain balance after each move
Hydraulic Lift used for patients who
cannot assist patients too heavy for
others to safely lift bed to wheelchair bed to bath bed to stretcher bed to scale MUST be trained before
using two caregivers should
operate
Hoyer Lift Device
Dangling Patients
Dangling position defined as sitting on
edge of bed without the feet touching the floor
Sequence from Extended Bed Stay to Dangling Position check chart for orders to dangle identify yourself and patient wash hands and provide privacy adjust bed elevate head of bed lower side rail assist patient to sitting position monitor patient for balance/dizziness document outcome
Devices to Assist with Transfers and Ambulation gait belts
applied at the waist snugly
always gripped from underneath
NOT used on patient when:
pregnant history of recent
abdominal surgery history of abdominal
aortic aneurysm
gait belt
Wheelchair TransferKey Factors
From a sitting position: place patient’s feet
shoulder’s width apart and place strong leg slightly behind weaker leg
swing leg rests out of the way or remove them from wheelchair
Wheelchair Transfer Key Factors
Proper balance instruct patient to lean forward slightly
before assisting them to an upright position
this will transfer weight from their buttocks to their feet and will minimize their loss of balance from the upright position
Wheelchair Transfer Key Factors
For best support keep patient
close to you during the transfer (keep your elbows next to side of your chest) and support their weight
Wheelchair TransferKey Factors assist patient to
stand on count of three step back when
patient stands support patient in
upright position
Wheelchair TransferKey Factors cont.
backup to wheelchair
have patient place both hands on wheelchair arms
assist to lower weight to wheelchair
Wheelchair TransferKey Factors Ensure patient safety
ask patient to scoot back in wheelchair or assist by pushing against one knee at a time
place footrest on chair & lower foot plates remove gait belt secure patient in chair when appropriate DO NOT allow chair to move with patient’s feet on
the floor
Align patient use pillows, props as needed
Devices to Assist Ambulation canes
used to compensate for impaired balance or to improve stability
more functional on stairs & narrow, confined areas
can be stored & transported easier than walkers or crutches
quad canestandardcane
Key Factors of Canes
a standard cane provides limited stability because of its’ small base of support
a quad cane has a broad base, and will provide greater stability than the standard cane
Key Factors of Canes
cane used on the unaffected side ambulation begins with the cane, then the
affected side, and then the unaffected side follows through providing a 3-point base upon completion of the move
Devices to Assist Ambulation
Walkers an ambulation aid,
usually with 4 contacts that are placed on floor and a frame to support patient’s weight and provide stability during ambulation
Trochanterlevel
Key Factors of Walkers
a standard walker without wheels should be used when there is an affected side the lead foot with this
scenario is the affected side
Key Factors of Walkers
a wheeled walker is to be used when a patient is experiencing an unsteady gait or limited endurance and there is no affected side the lead foot with this
scenario is the dominant side
Key Factors DuringAmbulation with Walker
patient’s feet stationary when walker is moving patient’s feet should be shoulder’s width apart,
and one slightly ahead of the other never slide walker, unless equipped with wheels healthcare worker stands slightly behind and to
the affected side of patient in most cases grasp gait belt from underneath
Key Factors of Assistive Devices
device must be adjusted to fit patient
place hand piece of device at approximately the trochanter level (of hip), with a slight bend of patient’s elbow
slight elbow flexion
greatertrochanter
Key Factors of Assistive Devices
device does not prevent falls, however does reduce risk of falls when used properly
must not be used as device for standing
SafeguardingFalling Patient
know the patient’s capabilities/disabilities know if there is an affected side use gait belt around patient’s waist for
support and maintain hold at mid back while walking
support patient’s anterior shoulder with hand not holding gait belt to prevent forward motion in case of a fall
SafeguardingFalling Patient
healthcare worker walks on unaffected side (there will be exceptions) and slightly behind patient.
stay close to patient at all times as patient becomes limp, step one foot
between patient’s feet broadening your stance to provide a temporary support for the patient’s hips
SafeguardingFalling Patient
hand on patient’s shoulder pulls patient back against healthcare worker’s body and patient temporarily sits on thigh between their legs
the hand that was on the shoulder now drops to the belt so both hands are on the belt and approximately 6-8” apart
SafeguardingFalling Patient
keep your elbows close to your body and pull patient back short distance by stepping back from between patient’s legs
begin squatting while keeping your back straight
gently lower patient’s hips to sit on floor release belt, and slide hand up to
head/neck and support them to floor
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