Assistive devices NCLEX nursing review about crutches, walkers, and canes.
These assistive devices are used to help patients with mobility. It is essential you know how to fit a patient properly for these devices and how a patient should use them.
Don’t forget to take the assistive device NCLEX quiz after review these notes.
Crutches NCLEX Nursing Review
What are crutches?Crutches are assistive devices used to help a patient ambulate. As the nurse you must know the following material about crutches:
- How to tell if the crutches properly fit the patient?
- The different types of gaits used for crutches?
- Make sure you know this part completely because exams love to ask questions about the different type of gaits.
- How to go up and down stairs with crutches?
- How to sit down and get up from a chair with crutches?
Properly Fit?
Before a patient uses crutches for the first time, each crutch must be adjusted to the patient’s height. Each crutch can be adjusted at the top and bottom. Below are some key concepts to help you tell if the crutches fit your patient properly.
Mains points to remember:
- There should be a 2-3 finger width (1-1.5 inches) gap between the armpit (axillae) and crutch rest pad when the patient holds the crutches.
- WHY? This prevents the patient from resting on the crutch rest pad while using the crutches. The patient should place weight on the hand grips NOT the crutch rest pad while ambulating. This prevents nerve damage that can occur within the axillae region.
- The elbows should be flexed about 30 degrees when the hands are placed on the hand grips.
Types of Gaits?
When a patient is learning how to use crutches, the nurse should apply a gait belt to the patient for safety. When a patient is ready to start ambulating with crutches, they will start in the tripod position as demonstrated in the picture below. Each tip of the crutch will be about 6 inches to the side of the feet diagonally.
Below are the types of gaits you want to remember for exams. I highly suggest you watch the crutches video within this article to help you visually see how each gait is performed (this will help you understand it better).
Two-point gait: the patient will move the injured side’s crutch (example right crutch) at the SAME TIME as the non-injured leg (example left leg) AND then the patient will move the non-injured side’s crutch (example left crutch) at the SAME TIME as the injured leg (example right leg).
- So it goes: move right crutch along with the left leg and THEN move the left crutch along with the right leg.
Four-point gait: this type of gait is similar to the two-point gait BUT the crutch and leg move SEPARATELY rather than at the same time. For example, the patient will move the injured side’s crutch (example right crutch), then move the non-injured leg (example left leg), then move the non-injured side’s crutch (example left crutch), and then move injured leg (example right leg).
- So it goes: move right crutch, then move left leg, then move left crutch, and then move the right leg.
Three-point gait: the patient will not let the injured leg touch the ground….therefore, the patient will move BOTH crutches and the injured leg forward together and then move the non-injured leg.
- So it goes: move both crutches and injured leg forward together and then move the non-injured leg.
Swing-to-gait: the patient will move both crutches forward and then SWING both legs forward to the same point as the crutches.
Swing-through-gait: the patient will move both crutches forward and then SWING both legs forward, PAST the crutches.
Up and Down Stairs with Crutches?
Again, be sure you watch the video within these notes to help you visualize how to go up and down the stairs with crutches. The key to understanding what moves first (the good or bad leg) when either going up or down the stairs is to remember:
“Good=UP” and “Bad=Down”
- Going UP the stairs: the patient will move the “good” leg (hence non-injured leg) UP onto the step FIRST and then will move the “bad” leg (hence injured leg) and crutches up onto the step.
- Going DOWN the stairs: the patient will move both crutches down onto the step and then move the “bad” leg (hence injured leg) DOWN and then move the “good” leg down.
Sitting Down and Getting Up from a Chair?
- Sitting Down: the patient will back up to the chair until they feel the chair with the back of their non-injured leg. The patient will then move BOTH crutches on to the INJURED side and grip the hand grips of the crutches for support. The patient will keep the injured leg extended out and slightly bend the non-injured leg. Then the patient will feel for the chair’s seat with the non-injured side and sit down…all while keeping the injured leg extended out.
- Getting Up: the patient will keep the injured leg extended out forward and put BOTH crutches on the INJURED side and grip the hand grips of the crutches. Then the patient will lean forward and push up with the arm of the non-injured site on the chair’s seat and by using the hand grips on the crutches, which is on the injured side. Once standing, the patient will bring the crutches into the tripod position.
Walker Nursing NCLEX Review
Walkers are assistive devices used to help a patient ambulate. As the nurse you must know the following material about walkers:
- How to tell if the walker properly fits the patient?
- How to ambulate with a walker?
- How to sit down and get up from a chair with a walker?
Properly Fit?
Before a patient uses a walker for the first time, the walker must be adjusted to fit the patient’s height. Walkers can be adjusted at the bottom via the legs of the walker (there are four legs that will need to be adjusted). Below are some key concepts to help you tell if a walker fits your patient properly.
Mains points to remember:
- When the patient holds the arms at their side, the hand grips of the walker should be even with the wrist crease.
- When the patient holds onto the hand grips of the walker, the elbows should flex at about a 15-30 degree angle.
Ambulate?
When a patient is learning how to use a walker, the nurse should apply a gait belt to the patient for safety. In addition, the nurse should stand on the patient’s WEAK side during ambulation.
Before a patient starts ambulating with a walker, the patient should get into a starting position by making sure that the middle of the foot lines up with the back tips of the walker.
Also, tell the patient to look ahead while using the walker because some patients may want to look down and stare at their feet while ambulating. This could lead to an injury or fall.
How to ambulate with a walker (please watch the video within this article to see a demonstration):
- First, the patient will lift and move the walker forward.
- Stress to the patient to make sure ALL FOUR TIPS of the walker’s legs are touching the ground after moving the walker forward before proceeding.
- Then the patient will move the WEAK side forward.
- Put weight on the hand grips via the hands.
- Then the patient will move the STRONG side forward.
- Repeat the steps above in order…
Sitting Down and Getting Up from a Chair?
- Sitting Down: the patient will back up to the chair with the walker until they feel the chair with the back of their legs. The patient will then slightly extend the weak leg and bend the strong leg, while feeling for the chair’s arm rests with the hands. Once the arm rests of the chair are felt, the patient will continue to bend the strong leg and sit down in the chair.
- Getting Up: the patient will place the walker in front of them while in the chair. Then the patient will lean forward in the chair, keep the weak leg slightly extended out, and place hands are the arm rests of the chair. Then the patient will push up with the hands on the arm rests of the chair and with the strong leg. Once standing, the patient will firmly grip the hand grips of the walker and begin to ambulate with the walker.
Going Up and Down Stairs with a Walker? It is not recommended a patient uses a walker to go up and down the stairs due to safety issues. The patient should use another type of assistive device like a cane. However, the patient should always consult with their doctor or physical therapist about this. For exams, you will not have to know about going up and down stairs with a walker.
Canes NCLEX Nursing Review
Canes are assistive devices used to help a patient ambulate. As the nurse you must know the following material about canes:
- How to tell if the cane properly fits the patient?
- How to ambulate with a cane?
- How to go up and down stairs with a cane?
- How to sit down and get up from a chair with a cane?
Properly Fit?
Before a patient uses a cane for the first time, the cane must be adjusted to the patient’s height. Most canes can be adjusted at the bottom. Below are some key concepts to help you tell if a cane fits your patient properly.
Mains points to remember:
- The top of the cane should be even with the greater trochanter (this is the prominenceof the top of the femur bone) OR when the patient holds the arms at their side, the top of the cane should be even with the wrist crease closest to the hand.
- While gripping the cane, the elbow should be flexed at a 15-30 degree angle.
Ambulate?
When a patient is learning how to use a cane, the nurse should apply a gait belt to the patient for safety. In addition, the nurse should stand on the patient’s WEAK side during ambulation. When a patient is ready to start ambulating with a cane, the patient should place the tip of the cane about 4 inches from the side of the foot.
To walk (ambulate) with a cane, the patient will hold the cane on the STRONG side. Then the patient will move the cane and weak side TOGETHER forward, and then move the strong side. Please watch the video within this article to help you visualize how to walk with a cane.
Up and Down Stairs with a Cane?
Again, be sure you watch the video within these notes to help you visualize how to go up and down the stairs with a cane. The key to understanding what moves first (the good or bad leg) when either going up or down the stairs is to remember:
“Good=UP” and “Bad=Down”
- Going UP the stairs: the patient will move the “good” leg (hence non-injured leg) UP onto the step FIRST and then will move the “bad” leg (hence injured leg) and the cane up onto the step.
- Going DOWN the stairs: the patient will move the cane down onto the step and then move the “bad” leg (hence injured leg) DOWN and then move the “good” leg down.
Sitting Down and Getting Up from a Chair?
- Sitting Down: the patient will back up to the chair until they feel the chair with the back of their legs. The patient will then allow the cane to rest on the side of the chair. Then the patient will place both hands on the chair’s arm rest and place weight on the hands and bend the strong leg while keeping the weak leg slightly extended and sit down in the chair.
- Getting Up: the patient will place the cane on the strong side and keep the weak leg slightly extended out. Then the patient will lean forward out of the chair and push down on the cane’s hand grip and chair’s arm rest. Then the patient will put weight on the strong leg and stand in position with the cane.
References:
Department of Human Services.Department of Human Services Disability Information (Walking Aids Using and Measuring)[Ebook] (pp. 1,2). Retrieved from https://www.sa.gov.au/__data/assets/pdf_file/0020/19019/walking-aids-using-and-measuring.pdfHow to Use a Walker. (2015). Retrieved 2 August 2019, from https://myhealth.alberta.ca/Alberta/Pages/use-a-walker.aspx