Chapter 26- Ambulatory Aids
Chapter Overview
Introduction to ambulatory aids and their importance in patient care.
Learning Objectives
Name activities that prepare clients for ambulation.
Examples of isometric exercises to strengthen lower extremities.
Identify techniques for building upper arm strength.
Explain the reasons for dangling clients or using a tilt table.
Name devices used to assist clients with ambulation.
Provide examples of ambulatory aids.
Identify the most stable type of ambulatory aid.
Describe characteristics of appropriately fitted crutches.
Name types of crutch-walking gaits.
Explain the purpose of a temporary prosthetic limb.
Identify four components of above-the-knee and below-the-knee prosthetic limbs.
Describe how a prosthetic limb is applied.
Discuss age-related changes affecting the gait and ambulation of older adults.
Integrate patient-centered care, safety, nursing judgment, teamwork, and collaboration.
Preparing for Ambulation
Importance of Preparation: Physical preparation is essential for enabling safe and effective ambulation. It builds the necessary muscle strength, improves joint flexibility, and prepares the cardiovascular system for the transition from a sedentary to an upright position. Preparation reduces the risk of falls and post-ambulation exhaustion.
Quadriceps Setting
Definition: An isometric exercise where the client alternately tenses and relaxes the quadriceps muscles without moving the joints.
Purpose: Helps maintain the strength of the quadriceps, which are critical for stabilizing the knees while standing and walking.
Procedure:
Tighten (contract) the quadriceps by flattening the backs of the knees into the mattress.
Ensure the kneecaps move upward, indicating correct execution of the rectus femoris muscle.
Hold the contracted position for a count of .
Relax for a count of and repeat the cycle to times each hour during waking hours.
Gluteal Setting
Definition: An isometric exercise focused on contracting and relaxing the gluteal muscles to improve strength and tone in the buttocks.
Purpose: Essential for stabilizing the pelvis and supporting the trunk in an upright position during ambulation.
Procedure:
Contract the gluteal muscles by clenching the buttocks together as if trying to hold a coin between them.
Hold the position for a count of .
Relax and repeat the exercise to times every hour.
Additional Exercises
Upper Arm Strengthening:
Significance: Critical for patients who will rely on ambulatory aids like crutches or walkers, which require significant strength in the triceps and biceps to lift or support body weight.
Techniques:
Flexion and extension of arms and wrists to maintain range of motion.
Raising and lowering small weights or household items to build resistance.
Squeezing a rubber ball or spring grip to improve hand strength for gripping handles.
Modified Hand Push-ups: While in a seated or supine position, the client uses their palms to push their body weight off the mattress or chair seat.
Dangling:
Definition: The process of sitting on the edge of the bed with the legs hanging (dangling) over the side.
Purpose: Normalizes blood pressure and prevents orthostatic hypotension (a sudden drop in blood pressure upon standing). It allows the cardiovascular system to adjust to the change in position.
Safety Protocol: Nurses should monitor for signs of dizziness, tachycardia, or pallor while the patient dangles for to minutes before attempting to stand.
Using a Tilt Table:
Description: A motorized table that can be adjusted from a horizontal to a vertical position in increments.
Function: Facilitates a gradual adjustment to being upright and bearing weight on the feet for clients who have been immobile for long periods.
Monitoring: Blood pressure and heart rate are measured at each increment (e.g., , , degrees) to ensure the patient tolerates the change.
Ambulatory Assistive Devices
Nursing Assessment:
Observe clients for any signs of pallor, weakness, or dizziness during ambulation.
The nurse supports the client by sliding an arm under the axilla and placing a foot to the side to form a wide base of support.
If necessary, the nurse can balance the client on a hip until help arrives or slide them down the leg to prevent injury.
Types of Ambulatory Aids
Devices designed to support and assist walking:
Walking Device: A gait belt applied around the client’s waist allows the nurse to maintain a secure grip and prevent falls.
Parallel Bars: Handrails used for ambulating practice.
Canes
Definition: Hand-held ambulation devices made from wood or aluminum, equipped with rubber tips to reduce slipping.
Types of Canes:
Standard cane
T-handle cane
Quad cane
Walkers
Definition: Considered the most stable form of ambulatory aid, designed for clients needing significant support and assistance with balance.
Characteristics:
Made of curved aluminum bars and features a three-sided enclosure with four legs for stability.
Nurses may provide instructions on proper walker use.
Crutches
Definition: Generally used in pairs, made of wood or aluminum; require upper arm strength and balance for effective use.
Types of Crutches:
Axillary crutches
Forearm crutches
Platform crutches
Crutch-Walking Gaits
Definition: The various walking patterns used while ambulating with crutches, including:
Four-point gait: slow and stable, involves moving crutches and legs alternately.
Three-point gait: faster, requires the individual to move both crutches and the weaker leg together, then the strong leg.
Two-point gait: a combination mimicking normal walking; one crutch and the opposite leg move together.
Swing-through gait: used by clients with good upper body strength, involves swinging legs forward past the crutches.
Review Questions
Question #1: Which ambulatory aid is used mostly by clients diagnosed with arthritis of the hands or wrists?
A. Canes
B. Auxiliary crutches
C. Walkers
D. Platform crutches
Correct Answer: D. Platform crutches (They accommodate arthritis by allowing weight to be placed on forearms rather than hands.)
Prosthetic Limbs
Temporary Prosthetic Limb: Immediate postoperative prosthesis intended to promote early ambulation and maintain body image while waiting for a permanent prosthesis to be constructed.
Permanent Prosthesis: Construction is often delayed until wound healing and stump size stabilization occur, usually taking several weeks to months.
Prosthetic Components
Below-the-Knee (BK) Prosthesis:
Components: socket, shank, and ankle/foot system.
Above-the-Knee (AK) Prosthesis:
Includes all below-the-knee components plus a knee system.
Ambulation Requirements: Clients using lower limb prostheses must possess sufficient strength and endurance.
Nursing Care: Specific techniques and considerations in caring for clients with prostheses.
Review Questions on Limbs
Question #2: True or False: Amputees should avoid strenuous activities, as these can lead to further complications.
Correct Answer: False (Amputees can engage in strenuous activities like skiing if using sturdier modified prostheses.)
General Gerontologic Considerations
Emphasizing the importance of maintaining independence in elderly individuals through mobility.
Functional Ability: Involves mobility adaptations compensating for age-related changes or diseases.
Support Needs: Older adults might require encouragement to integrate mobility adaptations and maintain daily activities.
Age-related Changes:
Flexion of the spine altering center of gravity may increase fall risks.
Vascular changes causing numbness can affect sensory perception and gait.
Home Safety for Elderly Patients
Living Environment: Recommendations to enhance home safety for seniors include:
Rearranging homes to keep necessary furnishings on one level.
Ensuring adequate lighting without exposing electric cords in passageways.
Elevating toilet seats and installing grab bars for support in bathrooms.