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Asistarea pacientului in locomo ieutiliznd crjele pa i in patru puncte

Stan AlinaMihaela

Grupa 24

Seria D

MG1

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Crutches are used to promote ambulation and independence in patients with

affected lower extremities. The use of crutches is a complicated procedure that isroutinely taught by the physical therapy department. There are occasions, however,when the nursing staff will have this responsibility. The physician will prescribethe use of crutches and the gait (crutch-walking method) to be used. The prescribedgait depends upon the amount of weight bearing permitted on the affected leg(s).

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The crutches must be "fitted" to the patient and instructions given for the prescribed crutch-walking method.

b. Standard axillary crutches need two adjustments--the length of the crutch andthe position of the handgrip. Prior to adjusting, prepare the crutches with paddingon the axillary bar and a rubber tip on the end of each crutch.

(1) Have the patient lie supine, arms at sides, wearing a shoe on the unaffectedfoot.

(2) Using a tape measure, measure from the axilla to the heel of the shoe and addtwo inches. Adjust the crutch shaft to this measurement. Or . . .

(3) Place the crutch along the patient's unaffected side with the axillary pad at theaxilla and the crutch tip 6 to 8 inches to the side of the heel. Adjust the crutch to fitthis length.

(4) Have the patient stand at the bedside with the crutches in place and grip thehand bars. You should be able to fit two fingers between the axilla and the axillary

bar when the patient is standing in the tripod position

(5) Adjust the hand bar so that the patient's elbow is flexed approximately30 when the hand grips the hand bar.

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(6) Check each crutch for proper fit and ask the patient if the crutch feelscomfortable.

c. With properly fitted crutches, the patient is almost ready to learn ambulationwith crutches. Prepare the patient for instruction by doing the following:

(1) Explain the procedure to the patient and determine if the patient has theupper body strength and ability to ambulate.

(2) Ensure that the patient is fully clothed and wearing non-skid slippers or shoes.

(3) Assist the patient to stand. Have the patient grasp both crutches in one hand atthe handgrip, then push off from the bed with the free hand using the crutches for support.

(4) Instruct the patient to stand in correct body alignment with the tip of thecrutches 6 inches in front and 6 inches to the side of the feet. (This is the tripod

position.) The hands and arms, not the axillae, should bear the weight. The elbowsshould be flexed about 30.

(5) Teach the prescribed gait.

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There are six different way to use crutches to assist with am

bulation, or walking. Each of these has advantages, disadvatages, and appropriateindications.

Four-Point Crutch Gait

Indication:

The 4-point gait is used when the patient can bear someweight on both lower

extremities. Place the patient in the tripod position and instructhim to do the

following

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Pattern Sequence:

Left crutch,

right foot,

right crutch,

left foot. Then repeat.

Advantages:

Provides excellent stabilty as there are always three points in contact with the

ground

Disadvantages:

Slow walking speed