07.04 Mechanical Aids

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Overview

  1. Mechanical Aids
    1. Pro-Tips
    2. Canes
    3. Walkers
    4. Crutches

Nursing Points

General

  1. Pro-Tips
    1. Fit the patient per manufacturer instructions
    2. Focus on safety
    3. Utilize PT/OT consult and education
  2. Canes
    1. Types
      1. Single
      2. Tripod
      3. Quad
    2. Use on the unaffected side
      1. Safety
      2. Prevents falls
    3. Extension of arm
      1. Bent at elbow
    4. Relieves load from injury by using on unaffected/strong side
  3. Walkers
    1. Types
      1. Standard
      2. Walker with wheels
    2. Used for general weakness unilateral weakness
    3. Education
      1. Advance walker, then step with affected/weak side first
  4. Crutches
    1. Types
      1. Full length
      2. Elbow
    2. Extension of arms
      1. Use handles for stability
      2. Don’t place in armpit
        1. Can cause injury to axillary region
      3. Brace through arms and shoulders
    3. Mobilizing
      1. Flat surface
        1. Crutches first, then strong leg, while elevating weak leg
      2. Stairs
        1. Going up
          1. Strong leg first
          2. Then crutches with weakened leg
        2. Going down
          1. Crutches with weakened leg
          2. Follow with strong leg
          3. Don’t lean forward

Assessment

  1. Assess patient needs
    1. Injury or illness requires different mechanical aids
      1. Can advance to different types
      2. Find one that promotes stability, mobility and comfort
  2. Assess patient current knowledge and understanding of mechanical aids
    1. Evaluate current understanding of use
  3. Assess patient on ability to perform skill and follow direction
    1. See one (instruct patient)
    2. Do one (patient demonstration)
    3. Teach one (have the patient teach back)

Therapeutic Management

  1. Utilizing proper mechanical aids assists in mobility for the patient in addition to comfort

Nursing Concepts

  1. Mobility
  2. Safety
  3. Health Promotion
  4. Patient Education

Patient Education

  1. Educate patient on proper use of ambulatory aid
  2. Dispel myths or rumors of mechanical aids with evidence and proper teaching
  3. Reinforce teaching and education from other healthcare providers

Reference Links

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Video Transcript

In this lesson, we’re going to take a look at some mechanical aids that will help your patient and their mobility.

Before we get started on the ins and outs of the different types of mechanical aids, let’s go over some pro-tips when using these and educating your patients on them. If you can think about these main points as we go through them, it’ll help you better understand them as we discuss each one.

First off, mechanical aids are really designed to promote exercise and mobility. So as you educate your patients and teach them how to use them, think about if an aid is hindering or promoting the process. If it’s hindering mobility, investigate why. Remember they’re aids, so they’re not designed to do the work. The patient needs to do that.

Also, focus on patient safety. Make sure that when a patient is ambulating with these different devices that they don’t have tripping hazards in front of them and that they can use them safely.

If physical therapy or occupational therapy come in to educate your patient, go watch it with them! Remember nursing is a lifelong learning career, so make sure you freshen up on your cane skills! And if your patient’s not understanding your teaching, go grab PT or OT and have them help you out.

We’re going to cover a few different devices today and we’ll go over some general fitting guidelines, but really pay attention to the manufacturer’s recommendations. Now, let’s get started.

The first aid we’re going to look at is the good ole cane. There are several different versions of these. They come in your standard form, or in this guy right here, the quad cane. They should have a solid rubber stopper on the bottom. There’s one other one you might see which is a tripod, and it’s basically got three little feet instead of four, and they’re really all just user preference. A wider base is going to provide better stability.

The thing you really want to focus on with canes is that they provide support for one-sided weakness. When you teach a patient make sure you have them place their cane on the strong side. The cane handle should be at the height of the hip. The patient should step with the affected or weak leg and move the cane at the same time. Then with a strong leg step through while slightly leaning into the cane for balance. Also the cane is an extension of the arm so make sure that it’s comfortable but allows them to balance and stabilize themselves.

If you need to, grab PT or OT and have them help you demonstrate. Next, let’s look at walkers.

There are a couple different types of walkers, and you’ll see the standard one and then the one with wheels. The one with wheels are great for people that have better control and if they need to sit. But other than that a standard walker is pretty solid.

Walkers are used for generalized weakness, so make sure that a walker is appropriate for your patient. When using a walker make sure that the handles are as high as the hip. When your patient goes to move, they should move the Walker first about 6 inches, and then they should step first with their weak or affected side. The back leg, which is a strong leg, will offer some stabilization and balance and then they can step forward with their strong leg, and then repeat the sequence.

And then sometimes your patients are going to need to get out of a chair, so make sure their walker is not too far in front of them. They should grab onto the handles, and pull themselves up using their arms and they may need to brace with an armrest. Make sure they get their bearings and their balance, and then they can start moving forward. Make sure you stay behind them to make sure that they don’t fall back and then you can use the chairs like a safety.

If you need to, go grab PT or OT so that they can read educate them and you can reinforce that that education. Now let’s take a look at crutches.

There are a couple different types of crutches, but the most common type that you’re going to see is the full-length crutch. This crutch extends all the way from the floor up to the armpit. Make sure that your patient doesn’t have the arm pad of the crutch directly pressed against armpit, since that can cause an actual injury to the shoulder or the armpit. The arm pad should be about 1 to 2 inches away from the armpit. it’s also really important for you to educate your patient that they should never put their weight through their shoulder but actually through the hands and a handlebar of the crutch when they are walking.

Now, when your educating your patient on ambulating with crutches, you should have them move the crutches forward with the injured leg, and then move the strong leg, and then repeat the sequence. The crutches should really only move forward 6 to 8 in at a time, until they get the hang of it and they can show that they can safely use the crutches. The real tricky part of using crutches is going up and down stairs. When your patient is going upstairs, instruct them that they should use the strong leg first to step up one step and then bring the crutches in the injured leg after. once they’re balanced, they can repeat and make sure that they’re only doing it one step at a time.

Now when they go down steps, it’s the opposite. The patient should use the crutches to balance themselves on one step below and at the same time move the weak leg forward and THEN step with the strong leg after. Then repeat. The patient should never bear any weight forward on the injured leg, and make sure that your patient doesn’t lean too far forward when they’re going down the steps cuz they could actually fall. Again make sure they’re taking steps one step at a time.

In this lesson our nursing concepts really focused on mobility and safety as well as health promotion when your patients are using their mechanical aids.

Okay so let’s recap.

When using a mechanical aids, make sure that you’re using PT and ot to really reinforced your education and teaching.

There are several different types of canes but make sure that your cane is placed on the patient’s strong-side.

Walkers are great and they’re used for general weakness. Make sure that your patient is advancing the walker first and then stepping into it.

Crutches can take some getting used to but really effective for people that have single leg injuries. The tricky part is making sure that they get up and down stairs safely.

Last but not least make sure that your patient is using the proper mechanical Aid and that they’re using it safely by showing that they can demonstrate it to you.

That’s it for our lesson on mechanical aids..Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

Read more

  • Question 1 of 10

The nurse is educating a client on the proper use of crutches. The client asks why he can’t rest his body weight on the pads under his armpits. What is the best explanation by the nurse?

  • Question 2 of 10

A child was injured in an accident and has become a paraplegic. The child must use crutches on a permanent basis. Which type of crutches would most commonly be used in this situation?

  • Question 3 of 10

A 20-year-old client is admitted to a rehab unit following a motorcycle accident. Which would be the most appropriate method for measuring the client for crutches?

  • Question 4 of 10

A nurse is assisting a client using a rollator walker to ambulate across the unit. Which indicates that the client is using this device correctly? Select all that apply.

  • Question 5 of 10

A nurse is caring for a client who is being discharged home after knee surgery. The client will need to have a cane to ambulate at home, as well as wound care assistance. Which referrals will the client need in order to get set up at home? Select all that apply.

  • Question 6 of 10

An 88-year-old client has recovered from hip surgery and now needs to use a standard walker. The nurse is explaining the benefits of this type of walker to the client. Which of the following describes the advantages of a standard walker? Select all that apply.

  • Question 7 of 10

A 90-year-old client uses a 2 point gait cane while walking around the long-term care unit where she lives. Which of the following activities indicates that this client is using her cane correctly? Select all that apply.

  • Question 8 of 10

A nurse is ambulating a client who is using a cane. Which is the proper side for the cane?

  • Question 9 of 10

The nurse is discharging a client who will be using crutches for the first time. The nurse is utilizing the teach-back method to confirm the client’s understanding of using crutches. Which of the following indicates that more teaching is necessary?

  • Question 10 of 10

A nurse is teaching a client with bursitis about how to walk with a cane. The nurse knows that the client understands how to use the cane properly when the client demonstrates:

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