Fundamentals - Practice & Skills, part 10: Canes, Walkers, and Crutches

Hi. I'm Meris, and in this video, we are going to be talking about mobility devices such as canes, walkers, and crutches. I am going to following along using our Fundamentals of Nursing flashcards. These are available on our website, leveluprn.com. If you already have a set, and you want to follow along with me, I'm going to be starting on card number 72. Let us get started. Okay. So starting off, you can see that there is a lot of information here on canes and walkers. So I would very much encourage you to read this for detail and to go through this in your books because you will have a lot of patients who use mobility devices.

So first up, we are talking about canes. I want to give you some very important patient teaching. The cane should be held on the strong side. You may also call the strong side the good side or the unaffected side. So be sure you read any test question very carefully to make sure you understand which word it's using and what it means. So we hold canes on the strong side. The other thing is that the cane should be at the height of the patient's wrist or greater trochanter. The greater trochanter is that big bump on the femur right below the hip. It usually aligns with where the wrist will fall when the patient's arm is by their side, okay? Very important to know. And if I am using a four-pronged cane, I want to make sure that the flatter side is towards my body versus the rounded side which should go out, because I do not want my patient to trip and fall over those prongs.

Okay. So talking about walkers, walkers also should be at the height of the wrist when the patient's arms are by their side, so same generally height. And we are going to make sure that the patient has their elbows flexed when they are using it. We do not want it to be straight arms. That's going to lead to discomfort and injury. Big thing to know about walkers, though, is going to be that if my patient uses them, and they are sitting in a chair, I need my patient to learn to use the arms of the chair to help them get out of the chair, not the walker itself. The walker is not fixed to the ground, so if I try to pull myself up using it, I may end up pulling the walker, pulling myself, falling down, being hurt. So I push up off of the chair using the armrest of the chair. I do not pull myself using the walker.

Okay, so moving onto crutches. Very important patient teaching starting right off the bat is going to be that the pads of the crutches should not be up against the axilla, the armpit. We have very important nerves and blood vessels that run right here, so we don't want our patient to be cutting off the circulation there. That's really going to lead to injury and discomfort. So we want it to be two inches below the axilla, and we need to teach our patients that when they are using crutches, they should be putting their weight on their hands, so on the handgrip, not putting their weight on the actual rest of the axilla. Again, weight on the hands on the handgrip, not in the armpits, okay? Very important patient teaching there.

Now we have a bunch of different crutch gaits, as you can see. We have just a lot, so I would encourage you to know a little bit about each of them, understand each of them. The big one that I want to hit here is going to be the swing-through gait. This is probably what you think of when you think of somebody using crutches. This is the idea that I'm moving both crutches together at once and then I am swinging up with both legs to meet the crutches. So this is probably what you're used to seeing, but keep in mind that based on my patient's deficit, they may have different crutch gaits. For instance, two-point, where they are moving the opposite leg and the crutch together, three-point, where both crutches are moved with the injured leg and then the uninjured leg is advanced, and then we also have four-point, which is moving one crutch and then the opposite leg and then the second crutch and then the last leg, so kind of walking on all fours almost, but I mean, standing upright. But think of it as walking on all fours. And then we have the one-crutch gait also, so be familiar with those so that you understand what the patient teaching of those might be.

Now another thing to know about crutches, very, very important, is how to go up and down stairs with these. So you'll see here that we've got a lot of best practices. I'm going to hit the highlights for you and give you a cool chicken. So when I am climbing the stairs, meaning I'm going up the stairs, I'm going to position my unaffected, my strong leg next to the stair railing and then hold onto the hand rail on that side. I'm going to position the crutch under the armpit of the other side, the affected side, and then I'm going to step up with the unaffected, the good leg, and then bring the affected leg up. So I'm going up, I'm descending the stairs with my-- I'm sorry, ascending. I'm going up. I'm climbing the stairs with my good leg. Up with the good, okay? Then descending the stairs, meaning I'm coming down, I'm going down the stairs, where it's going to be a little bit different. I'm going to position the affected leg near the stair railing, hold the hand rail, put the crutch under the unaffected side. Now I'm going to lower the crutch one step. Then I'm going to move the affected leg, the injured leg, the bad leg down, and then move the unaffected leg. Here's a very simple way to remember it. That's a lot of words. We go up with the good and down with the bad, right? We want more good; we want less bad in our lives, so same thing with the stairs. We go up with the good leg, down with the bad leg. So that's the cool chicken for how to remember that. It's a lot of information for crutches, but it's really important because once your patient goes home on crutches, they need to know how to navigate their home and the outside world.

So okay. That is it for crutches, for canes and walkers. Sorry, my brain malfunctioned. I hope that review was helpful. If it was, please like this video and leave us a comment below. If you have a better way to remember these crutch gaits, because there's a lot of them, please tell me in the comments. I very, very, very much want to know because this is tricky stuff. Be sure you subscribe to the next video so that you are the first to know when it posts. Thanks so much, and happy studying.