Ambulatory Aids Notes

Ambulatory Aids

Preparing for Ambulation

  • Isometric Exercises:

    • Quadriceps setting: Client alternately tenses and relaxes the quadriceps muscles.

    • Gluteal setting: Client contracts and relaxes the gluteal muscles to improve their strength and tone.

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

  • Dangling: Helps normalize blood pressure before ambulation.

  • Using a tilt table: Assists clients in adjusting to being upright and bearing weight on their feet.

Ambulatory Assistive Devices

  • Walking (gait) belt: Applied around the client’s waist to provide the nurse with a secure grip, preventing injury during ambulation.

  • Parallel bars (handrails): Used to provide practice in ambulating.

  • Observations of the ambulating client

Ambulatory Aids

  • Cane: A hand-held ambulation device made of wood or aluminum.

    • Rubber tips reduce the potential for slipping.

    • Types of canes:

      • Standard cane

      • T-handle cane

      • Quad cane

  • Walker: The most stable form of ambulatory aid.

    • Suitable for clients who require considerable support and assistance with balance.

    • Features curved aluminum bars and a three-sided enclosure with four legs for support.

    • Nurses provide instruction on how to use a walker properly.

  • Crutches: Generally used in pairs and constructed of wood or aluminum.

    • Require a great deal of upper arm strength and balance.

    • Types of crutches:

      • Axillary crutches

      • Forearm crutches

      • Platform crutches

  • Crutch-walking gaits: The walking pattern used when ambulating with crutches.

    • Four-point gait

    • Three-point gait

    • Two-point gait

    • Swing-through gait

Prosthetic Limbs

  • Temporary prosthetic limb: Immediate postoperative prosthesis (IPOP).

  • Permanent prosthesis construction: Delayed for several weeks or months until the wound has healed and the stump size is relatively stable.

  • Prosthetic components:

    • Below-the-knee (BK): Socket, shank, and ankle/foot system.

    • Above-the-knee (AK): Below-the-knee components plus a knee system.

  • Ambulation with a lower limb prosthesis requires strength and endurance.

  • Nursing care for clients with a prosthesis is essential.

General Gerontologic Considerations

  • Maintaining independence is important to older adults, and this is facilitated by mobility.

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

  • Older adults may need encouragement and support to integrate adaptations for mobility to maintain their activities of daily living.

  • As a person ages, he or she may develop flexion of the spine, which can alter the center of gravity and may increase fall risk.

  • Vascular changes may lead to numbness and a decreased sensory ability to perceive contact with the ground, which can also change a person’s gait.

  • Rearrange homes so all necessary furnishings are on one level

  • Ensure adequate lighting without laying electric cords in passageways

  • Elevate toilet seats; install grab bars