1058 Unit 10 Promoting Physiological Health

it requires coordination. Clients can use it when walking in crowds

CLIENT TEACHING
because it does not require much space. To use this gait, the client
Using Crutches needs to be able to bear weight on both legs (Figure 44–68 , read-
ing from bottom to top). The nurse asks the client to:
• Follow the plan of exercises developed for you to strengthen
your arm muscles before beginning crutch walking. 1. Move the right crutch ahead a suitable distance, such as 10 to
• Have a health care professional establish the correct length for 15 cm (4 to 6 in.).
your crutches and the correct placement of the handpieces.
Crutches that are too long force your shoulders upward and
2. Move the left front foot forward, preferably to the level of the left
make it difficult for you to push your body off the ground. crutch.
Crutches that are too short will make you hunch over and
develop an improper body stance.
• The weight of your body should be borne by the arms rather
than the axillae (armpits). Continual pressure on the axillae can
injure the radial nerve and eventually cause crutch palsy, a
weakness of the muscles of the forearm, wrist, and hand.
• Maintain an erect posture as much as possible to prevent
strain on muscles and joints and to maintain balance.
• Each step taken with crutches should be a comfortable distance
for you. It is wise to start with a small rather than large step.
• Inspect the crutch tips regularly, and replace them if worn.
• Keep the crutch tips dry and clean to maintain their surface Step 4
friction. If the tips become wet, dry them well before use. Right foot advances
• Wear a shoe with a low heel that grips the floor. Rubber soles
decrease the chances of slipping. Adjust shoelaces so they
cannot come untied or reach the floor where they might catch
on the crutches. Consider shoes with alternative forms of
closure (e.g., Velcro), especially if you cannot easily bend to tie
laces. Slip-on shoes are acceptable only if they are snug and
the heel does not come loose when the foot is bent.

Clients also need instruction about how to get into and out of
chairs and go up and down stairs safely. All of these crutch skills are
best taught before the client is discharged and preferably before the
client has surgery.
Crutch Stance (Tripod Position) Before crutch walking is at- Step 3
tempted, the client needs to learn facts about posture and balance. The Left crutch advances
proper standing position with crutches is called the tripod (triangle)
position (Figure 44–67 ). The crutches are placed about 15 cm
(6 in.) in front of the feet and out laterally about 15 cm (6 in.), creating
a wide base of support. The feet are slightly apart. A tall client requires
a wider base than does a short client. Hips and knees are extended, the
back is straight, and the head is held straight and high. There should be
no hunch to the shoulders and thus no weight borne by the axillae. The
elbows are extended sufficiently to allow weight bearing on the hands. Step 2
If the client is unsteady, the nurse places a gait/transfer belt around the Left foot advances
client’s waist and grasps the belt from above, not from below. A fall can
be prevented more effectively if the belt is held from above.
Four-Point Alternate Gait This is the most elementary and saf-
est gait, providing at least three points of support at all times, but

15 cm
(6 in.)
Crutch Crutch
Step 1
15 cm Right crutch advances
(6 in.)

Left foot Right foot Tripod position

Figure 44–67 The tripod position. Figure 44–68 The four-point alternate crutch gait.