WCU Funds Nursing 100 Week 4 Assessment 3 Notes + Crutches, Canes, & Walkers

Crutch Adjustment

Adjusting crutches based on patient's height and hand grip. they can be adjusted from the top or the bottom

All weight should be on

the hand grips, not on axillae(armpit)

Hand grips should be even with the

top of the hip line

when the patient uses the handgrips, the elbow should be

Elbow should be bent at 30 degrees when using handgrips

before a patient starts ambulating with crutches, they must be wearing a

Gait Belt

Tripod Position

Starting position for walking with crutches, looks like a triangle

2 Point Gait

Move right crutch and left foot together, then left crutch and right foot together

4 Point Gait

Move right crutch, then left foot, then left crutch, then right foot

3 Point Gait

Move both crutches and injured leg together, then move non-injured leg

Swing-To Gait

Move both crutches, then swing both legs to placement of crutches

Swing-Through Gait

Move both crutches, then swing both legs forward past placement of crutches

Which leg is used when going down the stairs with crutches or canes

Good Leg

Which leg is used when going DOWN stairs with crutches or canes

Bag leg

Remember, Good leg=up, bad leg=down

the good leg goes first when going UP stairs followed by the bad leg

The bad leg goes first when going DOWN the stairs, followed by the good leg

How to Go Up Stairs with Crutches

Good leg goes up on step followed by crutches, then bad leg goes up step

How to Go Down Stairs with Crutches

Move crutches on step, followed by bad leg, then move good leg down on step

How to sit down with crutches?

Backing up to chair, feeling chair with good leg, using crutches for support, bending good leg while sitting down

How to stand up with crutches

Using crutches for support, pushing up on non-injured side, standing up

How to Adjust a Cane

Most canes are adjusted from the bottom

Two ways to know if a cane fits a patients

1. Top of cane even with Great Trochanter(prominence of the Femur)

2. top of the cane should be even with the wrist crease closest to hand

What degree should the patients elbow be at when holding a cane?

Elbow should be flexed at a 15-30 degree angle when holding a cane

Should the patient be wearing a gait belt when practicing with a cane?

Patient should wear gait belt when practicing with a cane

Where should the patient hold their cane? Where should the nurse stand next to the patient?

Nurse stands on weak side, patient holds cane on strong side

Approximately how many inches should the cane be held from the side of the foot?

Cane should be held approximately 4 inches from side of foot

How would a patient ambulate with a cane?

Move cane with weak side forward, then move strong side forward

How does a patient go up and down stairs with a cane?

Going up and down stairs using a cane

Going Up Stairs with Cane

Hold cane on good/strong side, move good leg up onto step, put weight on cane, then move cane and bad leg up onto step

Going Down Stairs with Cane

Move cane down on step with bad leg, then move good leg down onto step

Sitting Down with Cane

Backing up to chair, feeling chair with back of legs, using cane for support, bending weak leg while sitting down

Standing Up from chair with Cane

Placing cane on strong side, leaning forward, pushing up on armrest, standing up

How to adjust a walker?

Adjust walker at the bottom, each leg adjusted separately

Walker needs to be adjust before patient use

What are the two ways to know if a walker fits the patient?

1. have the patient hold the walker handgrips with both hands and there should be a 15-30 degree bend in elbows

2 the patients wrists are even with the handgrips

Patient should wear what before they use a walker? and which side should the nurse stand on?

Patient should wear gait belt and nurse stands on weak side

Walker Starting Position

Back tips of walker match up with middle of foot

How to ambulate with a walker?

Lift walker and move forward, move weak side, then move strong side

Sitting Down with Walker

Backing up to chair, extending weak leg, feeling for chair armrest, sitting down

Standing Up from chair with Walker

Leaning forward, extending weak leg, pushing up on armrest, standing up

Human Senses

Sight, smell, hearing, taste, and touch

Sensory Alterations

Inability to see, smell, hear, taste, or feel

Sensory Deficits

Difficulty with one or more main senses

Sensory Deprivation

Lack of ability to receive sensory stimulus perception

Sensory Overload

Receiving stimuli beyond ability to process

Cataracts

Cloudy area on eye lens caused by proteins breaking down and clumping together, causing cloudy and blurry vision, difficulty seeing at night, double vision, faded and yellowing colors

Diabetic Retinopathy

Affects blood vessels in the retina, leading to vision loss and complete blindness, can cause glaucoma

What Increases risk for cataracts and diabetic retinopathy?

Smoking

Sleep

Essential for health and healing, inadequate sleep affects almost every system in the body, can lead to chronic health problems like depression, heart disease, hypertension, and diabetes

Circadian Rhythm

Internal process that controls sleep-wake cycle, occurs every 24 hours, regulates biological clock and sleep-wake patterns, synchronized with environmental cues like light and temperature

Sleep-Wake Homeostasis

Assists body in remembering to sleep after a given time; regulates level of sleep based on sleep deprivation; affected by factors like lighting, medications, caffeine, sleep environment, and stress

Stages of Sleep: Stage 1

Wake/lightest stage of sleep, transition from wakefulness to sleep, easily aroused, relaxed but aware of surroundings, normal breathing and skeletal muscle tone, lasts 1-5 minutes, 5% of total sleep cycle

Stages of Sleep: Stage 2

Deeper sleep, difficult to awaken, decreased heart rate and body temperature, first cycle lasts 25 minutes and becomes longer with each cycle, consumes 50% of total sleep cycle, number of cycles increase with aging

Stages of Sleep: Stage 3

Mental cloudiness if awoken in this stage, immune system strengthens, muscles, tissues, and bones repair and regenerate, number of cycles decline with aging, can last up to 40 minutes

Stages of Sleep: Stage 4

Includes REM (dreaming stage), irregular and erratic breathing, elevated heart rate, begins 90 minutes after falling asleep, initial cycle lasts 10 minutes and becomes longer throughout the night, can last up to 1 hour

Recommended Hours of Sleep for Newborns,

14-17 hours

Recommended Hours of Sleep INFANTS

12-15 hours

Recommended hours of sleep TODDLERS

11-14 hours

Recommended Hours of Sleep for Preschool, School-Age Children, and Adolescents

10-13 hours,

Recommended Hours of Sleep School-Age Children

9-11 hours,

Recommended Hours of Sleep: ADOLESCENTS

8-10 hours

Recommended Hours of Sleep for Young Adults

7-9 hours

Recommended Hours of Sleep for Middle Adults

7-9 hours,

Recommended Hours of Sleep for Older Adults

7-8 hours

Sleep Deprivation

Occurs when client does not meet body's biological sleep requirements, affects cognitive function, judgment, response time, can trigger seizure disorders, migraines, and tension headaches

Sleep Disorders: Insomnia

Ongoing inability to sleep despite opportunity to do so

Sleep Disorders: Apnea

Absence of inspiratory airflow for at least 10 seconds

Sleep Disorders: Hypopnea

Decrease in oxygen saturation lasting 10 seconds or longer

Sleep Disorders: Obstructive Sleep Apnea (OSA)

Recurrent episodes of upper airway collapse and obstruction while sleeping, combined with waking from sleep

Sleep Disorders: Narcolepsy

Chronic sleep condition characterized by sudden sleepiness and sudden periods of sleep

Sleep Disorders: Hypersomnia

Excessive daytime fatigue without improvement after more sleep

Sleep Disorders: Restless Leg Syndrome (RLS)

Uncontrollable urge to move legs during sleep

Promoting Sleep: Avoid Stimulants

Avoid caffeine, alcohol, and nicotine 4-6 hours before bedtime

Promoting Sleep: Remove Light and Noise

Create a dark and quiet sleep environment

Promoting Sleep: Bedtime Routine

Establish a routine like taking a warm shower or bath

Promoting Sleep: Room Conditions

Keep room dark, quiet, and at a comfortable, cold temperature

Promoting Sleep: Bedtime Habits

Go to bed only when tired, if no sleep in 20 minutes, go to another room and engage in relaxing activities

Promoting Sleep: Consistent Sleep Schedule

Go to bed and wake up at the same time each day

Promoting Sleep: Nap Guidelines

Keep naps short and before 3 p.m.

Promoting Sleep: Exercise Timing

Complete exercise at least three hours before bedtime

Promoting Sleep: Bedroom Environment

Remove work items and televisions from the bedroom, use the bedroom only for sleep and sexual activity

Joint Movements: Abduction

Lateral movement away from the midline

Joint Movements: Adduction

Lateral movement towards the midline

Joint Movements: Circumduction

Circular movement

Joint Movements: Flexion

Decreasing the angle of a joint

Joint Movements: Extension

Increasing the angle of a joint

Joint Movements: Hyperextension

Flexion of a joint beyond its normal limits

Joint Movements: Dorsiflexion

Flexion at the ankle, lifting the foot upwards

Joint Movements: Plantar Flexion

Flexion at the ankle, pointing the foot downwards

Joint Movements: Rotation

Circular movement around an axis

Joint Movements: Internal Rotation

Rotation towards the body

Joint Movements: External Rotation

Rotation away from the body

Joint Movements: Supination

Rotation of the forearm so that the palm faces up (supine position)

Joint Movements: Pronation

Rotation of the forearm so that the palm faces down (prone position)

Joint Movements: Inversion

Turning the sole of the foot inward

Joint Movements: Eversion

Turning the sole of the foot outward

Three Types of Muscles: Skeletal

Works with tendons and bones to move the body, voluntary control

Three Types of Muscles: Cardiac

Forms the bulk of the heart, produces contractions that create a heartbeat, involuntary control

Three Types of Muscles: Smooth/Visceral

Forms walls of hollow organs and blood vessels, involuntary control

Factors Influencing Mobility

-Developmental considerations

-Physical health

-Muscular, Skeletal, or Nervous System Problems

-Problems Involving Other Body Systems

-Mental health

-Lifestyle

-Attitude and values

-Fatigue and stress

-External factors

Effects of Immobility

Cardiovascular System

Respiratory System

GI System

Urinary system

Musculoskeletal System

Metabolic System

Integument System

Psychological Well-Being

Variables Leading to Back Injury in Health Care Workers

Uncoordinated lifts

Manual Lifting and transferring of patients without assistive devices

Lifting when fatigued or after recent back injury recovery

Repetitive movements such as lifting, transferring, and repositioning patients

Standing for long periods of time

Transferring patients

Repetitive tasks

Transferring/repositioning uncooperative or confused patients

Proper Body Mechanics

Using proper body movement in daily activities, preventing and correcting posture problems, enhancing coordination and endurance