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Unit 17

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Unit 17

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  1. Unit 17 The Patient’s Mobility: Ambulation

  2. Objectives • Spell and define terms. • Describe the purpose of assistive devices used in ambulation. • List safety measures for using assistive devices. • Describe safety measures for using a wheelchair.

  3. Objectives • Describe nursing assistant actions for: • Ambulating a patient using a gait belt • Propelling a patient in a wheelchair • Positioning a patient in a wheelchair • Transporting a patient on a stretcher

  4. Objectives • Demonstrate the following procedures: • Procedure 30 Assisting the Patient to Walk with a Cane and Three-Point Gait • Procedure 31 Assisting the Patient to Walk with a Walker and Three-Point Gait • Procedure 32 Assisting the Falling Patient

  5. Ambulation • Ambulate • To walk • Some patients may not be able to walk because of a disease or an injury • Patients who cannot walk may be able to self-propel wheelchairs to increase their independence

  6. Patient Footwear • Nonslip footwear should be worn in health care facilities with tile floors • In facilities that are carpeted • Some patients may need shoes with a different type of sole • Inform the nurse if a footwear evaluation is needed

  7. Normal Gait Pattern • There are two phases to a normal gait • Leg is on the floor during the first phase • Leg is brought forward in the second phase • Gait training • Physical therapist may work with a patient on this

  8. Assistive Devices • Assistive devices • Crutches • Canes • Walkers

  9. The Falling Patient • If a patient starts to fall: • You must protect both yourself and the patient • Do not try to hold him or her upright • This will strain your back and may injure the patient

  10. Use of Wheelchairs • Many individuals who are unable to ambulate • Can gain some independence with the use of a wheelchair

  11. Use of Wheelchairs • The wheelchair is a mobility device, not a transportation device • Used for patient independence and socialization, not for staff convenience

  12. Use of Wheelchairs • The wheelchair must be the proper size to fit the patient • In some situations, special wheelchairs or adaptations are needed

  13. Use of Wheelchairs • Position patient in the 90-90-90 position • Feet supported and the knees lower than the hips

  14. Use of Wheelchairs • Use pillows, props, adaptive devices, or restraint alternatives • This ensures the patient can maintain an upright position

  15. Positioning Dependent Patient in a Wheelchair • Dependent person may slide down in the wheelchair • This requires assistance to regain body alignment • Several procedures can be used to correct the dependent patient’s position in the wheelchair

  16. Positioning Dependent Patient in a Wheelchair • Some manual lifting devices, such as the TLC pad may be used • Refer to Figure 17-16A

  17. Positioning Dependent Patient in a Wheelchair

  18. Wheelchair Activity • Pressure over the buttocks is dramatically increased when the patient is sitting • Teach the patient to periodically relieve the pressure • Weight should be shifted every 15 minutes

  19. Leaning • If a patient cannot do push-ups • Teach patient to place the hands on the armrests or thighs • Have patient lean forward slightly and then to each side to relieve pressure on the buttocks

  20. Other Preventive Measures • If the patient is wearing a hospital gown • Place a folded bath blanket, reusable (cloth) underpad, or pressure relieving pad in the seat of the wheelchair • This prevents the patient’s skin from contacting the vinyl chair seat

  21. The Wheelchair Seat • Sling seat of the wheelchair • Tends to hammock (sag) in the center when a patient sits on it • Sagging causes rotation of the inner thighs • This increases pressure on the coccyx and buttocks • Two common sites of pressure ulcers

  22. The Wheelchair Seat • Hammocking of the seat promotes sliding • Placing a pressure relieving cushion with a leveling pad in the chair corrects the sagging • Distributing weight more evenly and reducing pressure

  23. The Wheelchair Seat • Although a foam cushion and leveling pad help correct positioning problems • They also trap heat • Heat is a contributing factor to pressure ulcers • Move the patient often so the skin cools

  24. Transporting a Patient by Stretcher • Before moving a patient on a stretcher • Make sure that the side rails are up and all safety belts are fastened