Question

Describe how you would guard a patient ambulating on a level surface or on stairs and when moving from a sitting to a standing position and from a standing to a sitting position.

Answer 1

Early ambulation is the most significant factor in preventing complications in surgical patients.Ambulation provides not only improved physical function, but also improved emotional and social well-being. Lack of mobility and ambulation can be especially devastating to the older adult when the aging process causes a more rapid decline in function.  It is important to perform a patient risk assessment to determine how much assistance will be required prior to assisting a patient to ambulate. An assessment can evaluate a patient’s muscle strength, activity tolerance, and ability to move, as well as the need to use assistive devices or find additional help. The amount of assistance will depend on the patient’s condition, length of stay and procedure, and any previous mobility restrictions.

Steps involved :

• Perform hand hygiene.
• Check room for additional precautions.
• Introduce yourself to patient.
• Confirm patient ID using two patient identifiers.
• Listen and attend to patient cues.
• Ensure patient’s privacy and dignity.
• Ensure tubes and attachments are properly placed prior to the procedure to prevent accidental removal.
• Follow the principles of proper body mechanics with all patient-handling procedures.
• Check physician’s order to ambulate and supplies for ambulation if required, and perform an assessment of patient’s strength and abilities.
• Check physician orders for any restrictions related to ambulation due to medical treatment or surgical procedure.
• Explain what will happen and let the patient know how they can help this will help the patient with an opportunity to ask questions and help with the positioning.
• Lower bed and ensure brakes are applied.
• The nurse should stand facing the head of the bed at a 45-degree angle with her feet apart, with one foot in front of the other. Stand next to the waist of the patien which helps in proper positioning and prevents back injuries and provides support and balance.
• Have patient turn onto side, facing toward the caregiver. Assist patient to move close to the edge of the bed.
• Place one hand behind patient’s shoulders, supporting the neck and vertebrae.  
• On the count of three, instruct the patient to use their elbows to push up on the bed and then grasp the side rails, as the nurse support the shoulders as the patient sits up. Shift weight from the front foot to the back foot.  
• At the same time as the nurse is shifting his/her weight, gently grasp the patient’s outer thighs with other hand and help the patient slide their feet off the bed to dangle or touch the floor.
• The nurse should bend knees and keep back straight and neutral to prevent injury when handling patients.
• On the count of three, gently raise the patient to sitting position. Ask patient to push against bed with the arm closest to the bed, at the same time as the nurse shift her weight from the front foot to the back foot. This allows the patient to help with the process and prevents injury to the health care provider.

The nurse should assess the patient for orthostatic hypotension or vertigo.If patient is not dizzy or lightheaded, the patient is safe to ambulate.If patient becomes dizzy or faint, lay patient back down on bed.