CHAPTER TEN BODY MECHANICS AND MOBILITY
6. Knee-chest Position: - is used for rectal and vaginal examinations and as treatment to bring
The thighs are straight up and down, and the lower legs are flat on the bed. Caution: The client may become dizzy or faint and fall. Do not leave the client alone.
Figure 9 Lithotomy position
7. Dorsal Lithotomy Position: - is used for examination of pelvic organs. It is similar to dorsal recumbent position, except that the client’s legs are well separated and the knees are a cutely flexed. The nurse will usually place the client’s feet in stirrups.
Keep the client covered as much as possible for privacy.
Crutch Walking
Crutches: - are walking aids made of wood or metal in the form of a shaft. They reach from the ground to the client’s axillae.
Application of Nursing Process Assessment
- Assess physical ability to use crutches and strength of the client’s arm back, and leg muscle.
- Observe client’s ability to balance self.
- Note any unilateral or unusual weakness or dizziness.
- Assess which gait is appropriate for client.
- Assess client’s understanding of crutch-waking technique.
Planning/Objective
- To improve client’s ability to ambulate when he/she has lower extremity injury.
- To increase muscle strength, especially in arms and legs.
- To increase feeling of well-being when client can ambulate.
- To promote joint mobility.
Implementation/Procedure - Teaching muscle- strengthening exercises
- Measuring client for crutches
- Teaching crutch walking: Four-point gait, Three-point gait, two-point gait.
- Teaching Swing-To-Gait and Swing-Through Gait
- Teaching upstairs and downstairs ambulation with crutches.
Evaluation/Expected Outcomes
- Client’s ability to ambulate is improved.
- Muscle strength of client’s arms and legs is improved - Client experiences a feeling of well-being.
Teaching Techniques of Crutch Walking
A. Four-Point Gait
Equipment
- Properly fitted crutches
- Regular, hard soled street shoes - Safety belt, if needed
Procedure
1. Explain the rationale for the procedure to the client a. The gait is rather slow but very stable
b. The gait can be performed when the client can move and bear weight on each leg.
2. Demonstrate the crutch foot sequence to the client.
a. Move the right crutch
b. Move the left foot c. Move the left crutch d. Move the right foot
3. Help the client practice the gait. Be ready to help with balance if necessary.
4. Assess client’s progress, and correct mistakes as they occur.
Figure 10. Four point gait B. Three-Point Gait
The Equipment is Similar with Four Gait
Procedure
1. Explain the rationale of the procedure
a. The gait can be performed when the client can bear little or no weight on one leg or when the client has only one leg.
b. This gait is fairly rapid and requires strong appear extremities and good balance.
2. Demonstrate the crutch-foot sequence to the client.
a. Two crutches support the weaker extremities b. Balance weight on the crutches
c. Move both crutches and affected leg forward d. Move unaffected leg forward
3. Assess the client’s progress, and correct any mistakes as they occur.
4. Remain with client until cutch safety is ensured.
Figure 11. Three-Gait Point
C. Two Point-Gait
Figure 12. Two- Gait Point
Procedure
1. Explain the procedure to the client.
a. This procedure is a rapid version of the four point gait b. This gait requires more balance than the four gait 2. Demonstrate the crutch-foot sequence to the client.
a. Advance the right foot and left crutch simultaneously b. Advance the left foot and the right crutch simultaneously 3. Help the client practice the gait.
4. Assess the client’s progress, and correct any mistakes as they occur.
Teaching Swing-To-Gait and Swing through Gait
Equipment
1. Properly fitted crutches
2. Regular, hard soled street shoes
Procedure
1. Explain the rationale for the procedure the client.
a. These gaits are usually performed when the client’s lower extremities are paralyzed.
b. The client may use braces.
2. Demonstrate the crutch-foot sequences to the client a. Move both crutches forward
b. Swing to gait: left and swing the body to the crutches c. Swing through gait: left and swing the body past the
crutches
d. Bring crutches informed of the body and repeat.
3. Help client practice the gait
4. Assess the client’s progress and correct any mistakes as they occur.
Teaching up stairs and down stairs ambulation with crutches
Equipment
- Properly fitted crutches
- Regular, hard soled streed shoes - Safety belt, if needed
Procedure
1. Explain the rational of the procedure to the client.
2. Apply safety belt if client is unsteady or requires support.
3. Demonstrate the procedure using a three-point gait.
Going Down Stairs
a. Start with weight on uninjured leg and crutches on the same level.
b. Put crutches on the first step
c. Put weight on the crutch handles and transfers unaffected extremity to the step where crutches are placed.
d. Repeat until the client understands the procedure
Going Upstairs
a. Start with the crutches and unaffected extremity on the same level.
b. Put weight on the crutch handles and lift the unaffected extremity on the first step of the stairs.
c. Put weight on the unaffected extremity and lift other extremity and the crutches to the step.
d. Repeat until client understands the procedure.
4. Help the client practice
5. Make sure that the client has adequate balance. Be ready to assist if necessary.
6. Assess the client’s progress, and correct any mistakes as they occur.
7. Document the following points:
- Time and distance of ambulation on crutches - Balance
- Problems noted with technique - Remedial teaching
- Client’s perception on the procedure
Helping the client into Wheelchair or Chair
Supplies and Equipment - Wheelchair
- Slippers or shoes (non-skid soles) - Robe
Procedure
1. Wash your hands
2. Explain the procedure to the patient
3. Position the wheelchair next to the bed or at 450 angles to the bed. Lock the wheel brakes and remove the food rests or move them to the “up” position.
4. Prepare to move the client:
a. Assist the client with patting on robe and slippers.
b. Obtain help from another person if the client is immobile, heavy, or connected to multiple pieces of equipment.
5. Raise the head of the bed so that the client is in the sitting position.
6. Assist the client to sit on the side of the bed a. Support the head and neck with one arm.
b. Use your other arm to move the client’s leg over the side of the bed.
c. Allow the client’s feet to rest on the floor.
d. Maintain the client in this position for a short-time 7. Prepare to raise the client to a standing position
a. Apply a transfer belt if necessary.
b. Spread the client’s feet and brace your knees against client’s knees.
c. Place your arms around client’s waist.
8. Use the rocking motion of your legs to assist the client to stand. The client may use his or her hands to help push upward from bed.
9. Pivot the client in to position immediately in front of the wheelchair. Encourage the client to use armrests for support while you lower him or her in to chair.
10. Reposition foot rests; secure the client in a chair with a reminder device if needed. Cover the client with a blanket.
Provide the nurse call button.
11. Wash your hands.
12. Check on the client frequently.
Document the transfer and the client’s response.
Study questions
• State the principle underlying proper body mechanics and relate a nursing consideration.
• State the purposes of range of motion exercise.
• Identify principles related to safe movement of clients in and out of bed.
• Demonstrate the ability to move a partially mobile client safely from bed to chair and back.
• Demonstrate the ability to teach each of the crutch walking gaits to a client.
• Mention different positions used for various examination and treatment.