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ҽҩרҵӢ﷭

ҽѧӢ 2016-03-20Ӱ

ҽҩרҵӢ﷭Щ֪СռҽҩרҵӢ﷭ϣá

ҽҩרҵӢ﷭

Crutch Walking

Crutches are often needed to increase a client's mobility. The use of crutches may be temporary such as after ligament damage to the knee or permanent as with paralysis of the lower extremities. It is important that crutches be measured for the appropriate length and that clients be taught how to use them correctly. ΪӲ˻ҪõȡʹùȿʱģϥʹʱҲԵģ̱֫ҪǣӦҪʶȣ̻Სȷʹùȡ

Potential Nursing DiagnosesClient data derived during the assessment reveal defining characteristics to support the following nursing diagnoses in clients requiting this skill:

Impaired physical mobility

High risk for injury DZڵĻϣ

ͬλ

ϰ

˵Σ

EquipmentTape measure

Goniometer

Rubber crutch tips

Wooden crutches þߣ

ߡǡ𽺶ͷľȡ

STEPS 輰˵

1. Wash hands.

* Reduces transmission of microorganisms. 1.ϴ

* ΢ﴫ

2. Measure for crutch length: 3 to 4 finger widths from axilla to a point 15 cm 6 inches lateral to client's heel is standard

* Ensures that crutches are individualized to client's height. 2.ⶨȸ߶ȣ׼ΪҸ34ָ˽Ÿ15cm6ʱijȡ

* ȷʺÿ߶ȡ

3. Position crutch handgrips with elbows flexed at 20- to 25-degree angle. Ankle of elbow flexion should be verified by goniometer

* Prevents client's body we3.0ƻappight from being supported by axillae, which would result in nerve damage. 3.2025ȣźùȰ֣ǶӦòȷ

* ⲡصҸ֧ţᵼ𺦡

4. Verify that distance between crutch pad and axilla is 3 to 4 finger widths

* Prevents axillary skin breakdown secondary to pressure from crutch pad. 4.ʵȵҸѼ34ָľ

* ȵѹȶҸƤѿ

5. Instruct client to assume tripod stance. Tripod stance is formed when crutches are placed 15 cm 6 inches in front and 15 cm to side of each foot

* Improves balance by providing wider base of support. No weight should be borne by axillae. 5.ָ˲վơվƣǰ15cmŸ15cmĽӴ

* ֧ȣƽ⡣ýѹҸѡ

6. Teach client one of four crutch-walking gaits. Darkened areas on Figs. 28 to 30 represent weight-bearing areas:

* Allows client to ambulate safely. Specific type of gait chosen depends on client's impairment and physician's order. 6.̻ᲡʹֳֹȲзеһ

* ʹ߰ȫѡúֲȡڲ˵ҽҽ

l Four-point alternating, or four-point gait, gives stability to client but requires weight bearing on both legs. Each leg is moved alternately with each crutch so three points of support are on floor at all times ĵĵ㷨ñʹȶҪ˫ȡȽƶˣʼ֧ŵ

l Three-point alternating, or three-point gait, requires client to bear all weight on one foot. Weight is borne on uninvolved leg, then on both crutches, and the sequence is repeated. Affected leg does not touch ground during early phase of three-point gait. Gradually client progresses to touchdown and full weight bearing on affected leg 㲽̬Ҫ˵ųȫءδһųеȫأȻ˫գԴơ㲽ijڣȲӴ档һʱ󣬲أֱȫ

l Two-point gait requires at least partial weight bearing on each foot. Client moves each crutch at same time as opposing leg so crutch movements are similar to arm motion during normal walking 㲽ҪٳеءƶȵͬʱƶԵһȡ˶ʱֱ˶ͬ

l Swing-through, or swing-to gait is frequently used by paraplegics who wear weight-supporting braces on their legs. With weight on supported legs, the client places crutches one stride in front and then swings to or through them while they support his weight. Խ/ҡڲ̬ͨ˫ȴгߵḺ̌ˡȽ֧ȣ漴ǰһȻ˫֧ʱ˳ǰڶԽȡ

7. Teach client to ascend and descend on stairs:

* Reduces risk of further damage to musculoskeletal system and risk of falling. 7.̲ϡ¥ݣ

* ٽһ˼ϵͳΣռˤΣա

Ascend

l Assume a tripod position.

l Transfer body weight to crutches

l Advance unaffected leg between crutches and stair.

l Shift weight from crutches to unaffected leg

l Align both crutches on stair ¥

a.㶦λ

b.

c.δǰȺ¥֮䡣

d.شӹδ

e. ˫գʹ䴦ͬһֱ

Descend

l Transfer body weight to unaffected leg

l Place crutches on stair and begin to transfer body weight to crutches, moving affected leg forward

l Align unaffected leg on stair with crutches ¥

a.δ

b. ˫¥ݣʼ˫գǰƶ

c. ¥ϵȣʹ˫ճһֱ

8. Teach client how to sit in chair and how to get up from chair:

* Provides safe method of sitting in and getting up from chair. Reduces further damage to client's musculoskeletal system and the risk of falling. 8. ̻Ს

* ṩȫٲ˼ϵͳһ˼ˤΣա

Sitting

l Client positioned at center front of chair with posterior aspects of legs touching chair

l Client holds both crutches in hand opposite affected leg. If both legs are affected, crutches are held in hand on client's strong side

l Client grasps arm of chair with other hand and lowers body into chair

Getting up

l Perform three steps above in reverse order.

a.λǰ룬ȺӴ

b.˽˫ȶԲС˫ˣ˫Ӧڲ˽ΪһС

d. һֻץסӷ֣ӡ

9. Wash hands.

* Reduces transmission of microorganisms. 9.ϴ֡

* ΢ﴫ

10. Record gait and procedures taught and client's ability to perform gaits in nurse's notes.

* Documents teaching and client's learning. 10.¼̲򼰲ʵʩ

* ļ֤ѧϰ

Nurse AlertThe client with cognitive impairment or one who has received analgesics or tranquilizers may be unable to understand instructions or to ambulate safely with crutches. ע֪ϰIJ˻򾲼˿޷ָùȰȫߡ

Cl3.0ƻappient TeachingThe nurse should instruct the client that, because of the potential for axillary skin breakdown and nerve damage, he must not lean on his crotches to support his body weight. Rubber crutch tips should be replaced as they wear out, and they should remain dry. Worn or wet crutch tips decrease surface tension and increase the risk of falling. The client should be given a list of medical suppliers in his community so he can obtain repairs as well as new rubber tips, handgrips, and crutch pads. In addition, advise him that he should have spare crutches and tips on hand. ˽

DZҸƤѿ˿ܣʿӦָ˲˫ϣ˫֧ء𽺹ͷĥӦʱָĥʪĹͷήˤΣաӦҽƹӦ֪ˣԱµͷȱ͹ȵ档⣬ӦҸ没ӦбõĹȺ͹ͷ

Geriatric ConsiderationsThe normal visual acuity and depth perception changes with aging may prevent the client from safely ascending or descending stairs with crutches. ꣺ֵȺȸ֪仯ʹ޷˫հȫ¥ݡ

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