Definition
Crutch walking is a vital mobility skill used during recovery from lower limb injuries or surgeries. It helps maintain independence while protecting the affected leg.
Preparatory exercises
Patient’s muscle needs to be prepared for use of crutches. The nurse should. The nurses should teach and encourage patient to perform following preparation exercise several days prior to actual f crutches.
1.Quadriceps setting
Instruct patient to contract quadriceps muscles while attempting to push popliteal area against matters and simultaneously rising heel. Contract for a count of 5 and relax for next count of 5.
2.Gluteal setting
Instruct patient to contract buttocks for a count of 5 and relax for a count 5.
3.Sit-up
While in sitting position, instruct patient to raise body from chair by pushing hands against chair seat or bed.
4.Push-ups
Instruct patient to push self-up from the prone position.
5.Pull-ups
Instruct patient to lift self-up with the help to trapeze
Types of crutches
- The axillary crutch: the axillary crutches is frequently used by patients of all ages on a short-term basis
- The lofstrand crutch: it has handgrip and a mental band that fits around the patient’s forearm. Both the metal and the hand grip are adjusted to fit the patient’s height. This crutch is useful for patient with permanent disability.
- The platform crutch: it is used by patient who are unable to bear weight on their wrists. It has a horizontal trough on which the patient can rest his forearms and wrists and a vertical handle for the patient to grip.
Procedure
| Nursing action | Rationale | |
| 1 | Review patient ‘s chart: Patient’s medical historyPatient’s previous activity level.Current activity order. | Identifies factors that influence the patient’s ambulation activity. Identifies patient previous activity level. Patient may tire easily or may be prone to orthostatic hypotension. Verifies if an ambulation aid is needed along with specifying the amount of activity permitted. |
| 2 | Assess patient’s physical readiness: vital signs and oriented to time, place, and person | Ambulation following immobility can be fatiguing and stressful.an oriented patient is able to understand ins traction |
| 3 | Assess patient for any visual, perceptual or sensory deficits. | Determines if patient can use assistive device safely. Ambulation after immobility can be fatiguing and stressful. |
| 4 | Explain reasons for exercise and demonstrate specific gait technique to patient or caregiver | Teaching and demonstration enhance learning, reduces anxiety, and encourage cooperation. |
| 5 | Schedule ambulation around patient’s other activity. | Schedule time between activity so that patient does not become too fatigued |
| 6 | Place bed in low position and slowly assist patient to upright position. Let patient sit or stand for few minutes until balance is gained. | Prevent orthostatic hypotension and potential injuries. |
| 7 | Determine correct placement of hand bar: Have client stans upright and support the body weight by hand grip of the crutches. Measure the angle of elbow flexion. It should be 30 degrees. | |
| 8 | Assist patient in crutch walking by choosing appropriate gait. Four-point gait: this is the most stable of crutch gaits because it provides at least three points of support at all times. Begin in tripod position (beginning stance). Crutches are placed 6 inches in fort and 6inches to side of each foot. Advance right crutch forward 4-6 inches. Advance left foot of level of crutch. Advanced left crutch forward 4-6inches.Advance right leg forward to level of left crutch. Repeat above sequence. Three-point gait: requires patient to bear all weight on ne foot. Weight is borne on uninvolved leg, then on both crutches. Affected leg dose not touch ground during early phase of three-point gait. May be useful for patient with broken leg or sprained ankles. Begin in tripod position. Advance left foot and both crutches. Advance left foot and both crutches. Advance right foot Two-point gate: requires at latest partial weight bearing on each foot. It is faster than the four-point gate requires more balance because only two-point support body at one time. Begin in tripod position Advance left foot and right crutches. Advance right foot and left crutch. Advance left foot and right crutch. Advance right foot and left crutch. Swing to gate: frequently used by patients whose lower extremities are paralysed or who wear weight supporting braces on their legs. Move both crutches forward. Lift and swing leg to crutches, letting crutches support body weight. Repeat to previous step. Swing- through gate requires that patient have the ability to sustain partial weight bearing on both feet. Move both crutches forward Left and swing legs through and beyond crutches. | To use, patient supports self with hands and arms. Therefore, strength in arm and shoulder muscles and ability to balance body in upright position and stamina are necessary. Type of gait patient uses in crutch walking depends on amount of weight patient is able to support with one or both legs. Improves patient’s balance by providing wider base of support. Posture should be erect, head and neck should be straight, vertebrae straight, and hips and knees extended. Crutch and foot position are similar to arm and foot position during normal walking. Improves patient’s balance by providing wide base of support. Crutch movements are similar to arm movement during normal walking. Initial placement of crutches is to increase the patient’s base of support so that when the body swing forward. The patient is moving the centre of gravity toward the additional support provided by the crutches. |
| 9 | Assist patient in climbing stair with crutches: Begin a tripod position. Patient transfers body weight to crutches and advance unaffected leg to stair. The advance affected leg and crutches. Repeat sequence until patient reaches top of stairs. | Improves patient’s balance by providing wider base of support. Prepares patient to transfer weight to unaffected leg when ascending first stair. Crutches and support to affected leg. Patient then shifts weight from crutches to unaffected leg. Maintains balance and provides wide base of support. |
| 10 | Assist patient in descending stairs with crutches: Begin in tripod position. Patient transfers body weight to unaffected leg. Move crutches to stairs and instruct patient to begin. Patient moves unaffected leg to stair and align with crutches. Repeat sequence until stair is descended. | Prepares patient to release support of body weight maintain by crutches. Maintains patient’s balance and base of support to transfer body weight to crutches and movable affected leg forward. Maintains patient’s balance and provides base of support. |
| 11 | Record in nurses progress notes –Type of gait patient used, amount of assistance required, distance walked, and patient’s tolerance of activity. | Documents technique used and patient’s progress while using technique. |
Follow up Activities
- Inspect rubber tips on bottom of ambulation device frequently.
- If wooden crutch is used, examine it for cracks.
- Remove obstacles from pathways, including throw rigs, and wipe up any spills immediately.
- Avoid large crowds.
- Instruct patient to continue muscle strengthening exercise at home.
Teaching Strategies
- Teach patient with axillary crutches about the dangers of pressure on the axillae, which occurs when leaning on the crutches to support body weight.
- Instruct patient to routinely inspect crutch tips. Rubber tips should be securely attached to the crutches. When tips are worn, they should be replaced. Rubber crutch tips increase surface friction and help prevent slipping.
- Explain that crutch tips should remain dry. Water decreases surface friction and increases the risk of slipping.
- Show patient how to inspect the structure of the crutches. Cracks in a wooden crutch decrease its ability to support weight. Bends in aluminium crutches can alter body alignment.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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