Chapter 3. Safer Patient Handling, Positioning, Transfers and Ambulation Show
Immobility in hospitalized patients is known to cause functional decline and complications affecting the respiratory, cardiovascular, gastrointestinal, integumentary, musculoskeletal, and renal systems (Kalisch, Lee, & Dabney, 2013). For surgical patients, early ambulation is the most significant factor in preventing complications (Sanguinetti, Wild, & Fain, 2014). Lack of mobility and ambulation can be especially devastating to the older adult when the aging process causes a more rapid decline in function (Graf, 2006). Ambulation provides not only improved physical function, but also improves emotional and social well-being (Kalisch, Lee, & Dabney, 2013). Prior to assisting a patient to ambulate, it is important to perform a patient risk assessment to determine how much assistance will be required. An assessment can evaluate a patient’s muscle strength, activity tolerance, and ability to move, as well as the need to use assistive devices or find additional help. The amount of assistance will depend on the patient’s condition, length of stay and procedure, and any previous mobility restrictions. Before ambulating, the patient may need assistance getting to a sitting position. Assisting Patient to the Sitting PositionPatients who have been immobile for a long period of time may experience vertigo, a sensation of dizziness, and orthostatic hypotension, a form of low blood pressure that occurs when changing position from lying down to sitting, making the patient feel dizzy, faint, or lightheaded (Potter et al., 2017). For this reason, always begin the ambulation process by sitting the patient on the side of the bed for a few minutes with legs dangling. Checklist 29 outlines the steps to positioning the patient on the side of a bed prior to ambulation (Perry et al., 2018).
Assisting a Patient to AmbulateAmbulation is defined as moving a patient from one place to another (Potter et al., 2010). Once a patient is assessed as safe to ambulate, the nurse must determine if assistance from additional healthcare providers or assistive devices is required. The following checklists provide guidance in assisting to ambulate using a gait belt or transfer belt (see Checklist 30), walker (Checklist 31), crutches (Checklist 32), and a cane (Checklist 33).
Watch the video How to Ambulate With or Without a Gait Belt or Transfer Belt (2018) by Kim Morris of Thompson Rivers University School of Nursing.
Watch the video How to Ambulate With Crutches (2018) by Kim Morris of Thompson Rivers University School of Nursing.
Watch the video How to Ambulate with a Cane (2018) by Kim Morris of Thompson Rivers University School of Nursing. Critical Thinking Exercises
AttributionsFigure 3.8 Walker by rawpixel.com is free of copyright. Figure 3.9 Standing with support of a walker by author is licensed under a Creative Commons Attribution 4.0 International License. Figure 3.10 Preparing to move from chair to walker by author is licensed under a Creative Commons Attribution 4.0 International License. Figure 3.11 Teenage boy on crutches with walking boot by Pagemaker787 is used under a Creative Commons Attribution-Share Alike 4.0 International license. Figure 3.12 An illustration depicting walking on crutches by BruceBlaus is used under a Creative Commons Attribution-Share Alike 4.0 International license. Figure 3.13 An illustration depicting different cane types by BruceBlaus is used under a Creative Commons Attribution-Share Alike 4.0 International license. Figure 3.14 Cane height by author is licensed under a Creative Commons Attribution 4.0 International License. Which rationale would the nurse use to explain the cane's purpose to a client with hemiparesis?How does the nurse explain the cane's purpose to the client? Hemiparesis creates instability. Using a cane provides a wider base of support and, therefore greater stability.
Which type of rehabilitation is an essential component to a clients recovery from Guillain Barre?Physical and occupational therapy are integral parts of the recovery and management of GBS, CIDP and variants.
How would the nurse describe the characteristic gait associated with Parkinson's?The parkinsonian gait is characterized by shuffling of the feet, decreased arm swing on one or both sides of the body, and stooping of posture. Patients are typically unable to turn in a single step and instead break their turns into multiple small increments.
When the nurse inquired about the clients feelings the spouse responded which communication strategy would the nurse use to address this behavior?When the nurse inquired about the client's feelings, the spouse responded. Which communication strategy would the nurse use to address this behavior? Acknowledge the spouse, but look at the client for a response.
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