Crutches 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 thhand 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 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):

1. First, the patient will lift and move

the walker forward.
1. 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.
2. Then the patient will move
the WEAK side forward.
3. Put weight on the hand grips via the hands.
4. Then the patient will move the STRONG side forward.
5. 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
prominence of 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.