HOME HEALTH CARE NURSING PRESENTATION

GROUP 8 (2ND COHORT NURSING) 300 LEVEL 2ND SEMESTER

AMBULATION- GETTING OUT OF BED AND USE OF WHEELCHAIR.

PRESENTING STUDENTS MAT. NO.

SAMUEL ONOSE VICTORY NUR/21/007
OGBOBAMEH CHRISTABEL NUR/21/070
EMOEFE OGHALE JAMES NUR/21/071
OBINYAN FUNMILAYO VICTORIA NUR/21/076
AKHABUEZELE IMMACULATE NUR/21/086
LUCKY OSASENAGA FAITH NUR/21/093
AIMUAMWONSA ONOME RACHAEL NUR/21/095
INTRODUCTION

Ambulation, the act of walking or moving from one place to another, plays a crucial role in
maintaining physical independence and quality of life. However, for individuals with limited
mobility or those recovering from surgery or illness, ambulation can be a challenging task. The
process of getting out of bed and using a wheelchair is essential for patients who are unable to
walk independently due to various conditions such as neurological disorders, musculoskeletal
injuries, or post-operative recovery. For these individuals, mastering the ability to transfer from a
bed to a wheelchair and maneuvering the wheelchair safely are vital skills that ensure their
autonomy and prevent complications like pressure ulcers, muscle atrophy, and joint stiffness.
Proper techniques for getting out of bed and using a wheelchair are also critical for minimizing
the risk of falls, improving posture, and reducing strain on caregivers. Health professionals such
as physical therapists and nurses often assist patients in developing strategies for safe ambulation
through mobility aids, offering personalized guidance on body mechanics, transfer techniques,
and adaptive devices. Additionally, advancements in wheelchair design, including features like
lightweight frames, comfortable seating, and adjustable footrests, have further enhanced the
mobility and comfort of individuals relying on wheelchairs for movement. By focusing on
ambulation and effective wheelchair use, healthcare systems can help individuals regain their
independence, improve physical health, and promote a sense of dignity and control over their
daily lives.
AMBULATION

Ambulation refers to the ability to walk or move from one place to another using one's own
strength, often without the aid of devices such as wheelchairs. It is a fundamental physical
activity essential for daily living, promoting independence and overall well-being. Ambulation
can also involve the use of assistive devices like canes, crutches, or walkers to support mobility
in individuals with physical impairments. In medical contexts, ambulation is often assessed to
evaluate recovery after surgery, illness, or injury. Regular ambulation helps improve
cardiovascular health, enhance muscular strength, and prevent complications such as blood clots
or muscle atrophy.

INDICATIONS FOR AMBULATION

Indications for ambulation primarily focus on promoting mobility, improving overall health, and
preventing complications associated with immobility. Ambulation is indicated in the following
scenarios:

1. Post-Surgical Recovery: To enhance circulation, reduce the risk of blood clots, and
accelerate healing.

2. Chronic Illness Management: To manage conditions like diabetes or cardiovascular

diseases by improving glucose regulation and heart health.

3. Rehabilitation: For patients recovering from strokes, fractures, or neurological

conditions to regain strength, coordination, and independence.

4. Preventing Immobility Complications: To reduce the risks of pressure ulcers, muscle

atrophy, and respiratory or urinary issues.

5. General Health Maintenance: To improve cardiovascular endurance, balance, and

overall physical well-being in individuals with no mobility restrictions.

6. Postpartum Recovery: To promote uterine involution, enhance circulation, and reduce

the risk of deep vein thrombosis (DVT) after childbirth.
 7. Elderly Care: To maintain mobility, balance, and independence in older adults,
preventing falls and cognitive decline associated with inactivity.

8. Pulmonary Rehabilitation: For patients with chronic obstructive pulmonary disease

(COPD) or pneumonia to enhance lung function through controlled physical activity.

9. Orthopedic Recovery: To restore mobility after joint replacements, fractures, or

musculoskeletal injuries under guided physical therapy.

10. Psychological Well-being: To reduce anxiety, depression, or stress by encouraging

physical activity, which stimulates the release of endorphins.

11. Weight Management: To support weight loss and reduce obesity-related complications
like metabolic syndrome or joint stress.

IMPORTANCE OF AMBULATION

1. Improves Cardiovascular Health: Enhances circulation, reduces the risk of blood clots,
and supports heart function.

2. Promotes Muscle and Joint Health: Strengthens muscles, improves joint flexibility, and
prevents muscle atrophy.

3. Supports Bone Health: Helps maintain bone density and prevent osteoporosis.

4. Enhances Respiratory Function: Improves lung capacity and efficiency.

5. Prevents Complications: Reduces the risk of pressure ulcers, deep vein thrombosis
(DVT), and pulmonary issues.

6. Mental Health Benefits: Reduces stress, anxiety, and depression, while improving mood
and cognitive function.

7. Boosts Independence: Maintains autonomy and supports daily activities, improving

quality of life.

8. Fosters Social Interaction: Facilitates social engagement, reducing isolation and

promoting connection.
 9. Aids in Recovery: Speeds up healing post-surgery or illness by enhancing overall health
and mobility.

10. Enhances Weight Management: Supports weight loss and reduces obesity-related
health risks.

PREPARING FOR AMBULATION

Preparing for ambulation involves several steps to ensure the safety and effectiveness of the
activity, particularly for patients recovering from surgery, injury, or illness. The preparation
process includes:

1. Assessment of Physical Condition: Evaluate the patient’s strength, balance,

coordination, and any pain or discomfort that might affect their ability to ambulate. This
step may involve checking vital signs like blood pressure, heart rate, and oxygen levels.

2. Clear the Pathway: Ensure the area where the patient will ambulate is free from
obstacles, tripping hazards, or any furniture that may impede movement. This creates a
safe environment for walking.

3. Appropriate Footwear: Ensure the patient is wearing supportive, non-slip footwear to

prevent falls. Proper shoes are especially important if using assistive devices like walkers
or canes.

4. Assistive Devices: If needed, prepare any mobility aids (canes, crutches, walkers) that
will support the patient’s ambulation. Make sure the devices are properly adjusted to the
patient’s height and are in good working condition.

5. Patient’s Clothing: Ensure the patient is dressed in comfortable, loose-fitting clothing

that won’t restrict movement or cause discomfort while walking.

6. Safety Measures: Use gait belts or other assistive tools if necessary to assist with support
and prevent falls, especially if the patient is weak or unsteady.

7. Monitor Vital Signs: In some cases, it’s essential to check vital signs (heart rate, blood
pressure) before and after ambulation to monitor for any changes or signs of distress.
 8. Supervision: If the patient is unsteady or inexperienced with ambulation, provide
supervision or assistance to ensure safe movement and prevent accidents.

9. Mental Preparation: Explain the process of ambulation to the patient, emphasizing the
importance of taking slow, controlled steps. Offer encouragement and support to build
confidence.

10. Post-Ambulation Care: After the walk, allow the patient to rest, monitor their response,
and assist them in returning to a comfortable position. Assess for any fatigue or
discomfort and address it accordingly.

GETTING OUT OF BED

Getting out of bed is an essential daily activity, particularly in the context of home health care,
where it involves a series of steps to ensure safety, independence, and physical well-being for
patients. For individuals receiving home health care, especially those with mobility issues or
chronic conditions, this process often requires assistance from caregivers or health professionals.
A well-structured routine includes assessing the patient's physical state, ensuring they are
positioned safely in bed, and guiding them in a way that reduces the risk of falls or injury. Home
health aides may use assistive devices like walkers, transfer belts, or hoists to aid in the process.
Additionally, caregivers monitor for signs of dizziness, weakness, or pain, which could
complicate getting up. Ensuring proper posture and movement patterns, such as sitting on the
edge of the bed before standing, is crucial in preventing further complications.

TECHNIQUES FOR GETTING OUT OF BED

There are several techniques for getting out of bed, especially for individuals with mobility
challenges or those in home health care settings. These techniques focus on safety, minimizing
strain, and reducing the risk of falls or injury.

1. Log Roll Technique:

 Purpose: For individuals with limited mobility or pain, this method helps avoid
twisting the spine.

 Procedure:
 1. Start by rolling onto one side while keeping the knees bent and together.

2. Use the arms for support and push off the bed with the elbow and hand.

3. Once on the side, use the feet and legs to swing over the edge of the bed
while maintaining a neutral spine.

2. Edge of the Bed Sit-Up:

 Purpose: This technique is suitable for those who can sit up but need assistance
standing.

 Procedure:

1. Start by shifting toward the edge of the bed while keeping the legs bent
and feet flat.

2. Use the hands or arms to push against the bed or support surfaces to sit
upright.

3. Allow the person to dangle their legs off the bed, stabilizing themselves
before standing.

3. Assisted Sitting:

 Purpose: For those who need extra support to sit upright, often used in cases of
weakness or vertigo.

 Procedure:

1. A caregiver helps the person gently roll toward the edge of the bed.

2. The caregiver then provides support to the person’s upper body while
allowing the legs to swing off the bed, gradually bringing them into a
sitting position.

3. Caregivers may use a gait belt to assist with balance or stability.

4. Stand-Pivot Transfer:

 Purpose: For individuals who can stand with support but need help maintaining
balance during the transition.

 Procedure:

1. Once the person is sitting at the edge of the bed, they shift their weight
onto one leg and use their arms for support.

2. With caregiver assistance, the individual stands and pivots to face the
direction they need to go, like a chair or walker.

3. Caregivers should be positioned to guide the person, ensuring stability.

5. Use of Assistive Devices:

 Purpose: To provide additional support and increase independence when standing

up.

 Procedure:

1. Use a walker, grab bars, or a bed assist rail to help pull oneself into a
standing position.

2. The person should first push themselves up from the bed, using the
assistive device for stability.

3. Ensuring the bed is at an appropriate height can also help minimize strain
during the transition.
COMMON CHALLENGES AND SOLUTIONS IN GETTING OUT OF BED

Getting out of bed can present several challenges, particularly for individuals with mobility
impairments, chronic illnesses, or age-related conditions. These challenges can affect the ability
to perform this task safely and independently. Common issues include:

1. Weakness or Limited Mobility:

 Challenge: Many individuals, especially older adults or those with chronic

conditions like arthritis or neurological disorders, may experience muscle
weakness or joint stiffness that makes it difficult to sit up or stand.

 Solution: Physical therapy and strength-building exercises can help improve

mobility. Assistive devices, such as bed rails or walkers, can provide extra
support.

2. Balance Issues:

 Challenge: Poor balance can increase the risk of falls, making it difficult to
stabilize when attempting to sit up or stand. This can be due to conditions like
vertigo, Parkinson's disease, or postural hypotension.

 Solution: Supportive techniques, like the use of a transfer belt or caregiver

assistance, can help maintain balance. Ensuring that the bed and surrounding area
are clear of obstacles is also essential.

3. Pain:

 Challenge: Pain from conditions such as arthritis, back problems, or post-surgical

recovery can make it painful to move or sit up from a lying position.

 Solution: Pain management strategies, such as medications, heat/cold therapy, or

gentle stretches before attempting to move, can be helpful. A caregiver may also
need to assist with body positioning to reduce discomfort.
4. Dizziness or Lightheadedness:

 Challenge: Orthostatic hypotension (a drop in blood pressure when standing) can

cause dizziness or fainting when getting out of bed, particularly for individuals
with cardiovascular issues or those on certain medications.

 Solution: It's important for individuals to sit on the edge of the bed for a few
moments before standing, allowing blood flow to stabilize. Hydration and
medication adjustments can also help manage this condition.

5. Lack of Strength or Endurance:

 Challenge: The physical effort required to transition from lying to standing can
be too demanding for individuals with fatigue, poor endurance, or frailty.

 Solution: Caregivers can assist with repositioning or use devices like lift chairs or
hoists to reduce the physical strain. Building endurance through physical therapy
can also support long-term improvement.

6. Cognitive or Memory Impairments:

 Challenge: Individuals with cognitive conditions, such as dementia or

Alzheimer's disease, may forget how to properly position themselves in bed or
may not remember the steps required to get up safely.

 Solution: Consistent routines, reminders, and caregiver supervision can help

guide individuals through the process. Providing clear instructions and gentle
assistance is key.

7. Environmental Factors:

 Challenge: An unsafe or poorly designed environment can create hazards. For

example, low bed height, slippery floors, or poor lighting can make getting out of
bed more challenging.
  Solution: Adjusting the bed height to a comfortable level, using non-slip rugs,
installing grab bars, and ensuring good lighting can improve safety and ease of
movement.

USE OF WHEEL CHAIR

The use of a wheelchair in home health care is an essential aspect of supporting individuals with
mobility impairments or disabilities. Wheelchairs provide a means of independent movement for
individuals who are unable to walk due to various conditions such as spinal cord injuries,
neurological disorders, or orthopedic issues. In the context of home health care, a wheelchair
allows individuals to maintain a higher level of independence, improving their ability to perform
daily activities, such as personal care, moving between rooms, or engaging with family members
and caregivers. Moreover, wheelchairs contribute to preventing further health complications by
reducing the risk of pressure ulcers from prolonged immobility. The proper choice and fitting of
a wheelchair are critical, as it impacts comfort, posture, and the individual's overall well-being.
Therefore, wheelchairs are integral tools in home health care, promoting both physical
independence and psychological well-being.

TYPES OF WHEEL CHAIRS

There are several types of wheelchairs, each designed to meet specific needs and preferences,
particularly in home health care settings. Each type of wheelchair serves different needs and
preferences, and choosing the right one depends on the individual's mobility level, health
condition, and daily activities. These include:

1. Manual Wheelchairs: These are operated by the user or a caregiver through the use of
hand rims attached to the wheels. They are lightweight and cost-effective, ideal for
individuals with upper body strength. They can be further categorized into:

 Standard Manual Wheelchairs: Typically heavier and more durable, suitable for
individuals with less mobility.

 Lightweight Manual Wheelchairs: Easier to maneuver and transport, designed

for individuals who require some assistance but can still self-propel.
  Ultra light Manual Wheelchairs: Designed for maximum portability and ease of
use, offering a high level of maneuverability for individuals with good upper body
strength.

2. Power (Electric) Wheelchairs: These wheelchairs are powered by motors and controlled
via a joystick or other electronic interface. They are ideal for individuals with limited
upper body strength or those who cannot manually propel a wheelchair. They provide
greater independence and are equipped for use both indoors and outdoors.

3. Transport Wheelchairs: These are lightweight, foldable wheelchairs intended for short-
term use or for those who need assistance from a caregiver. They are usually narrower
and smaller, making them easier to maneuver in tight spaces.

4. Reclining Wheelchairs: These allow the user to adjust the backrest to a reclining
position. This type is ideal for individuals who need to spend long periods sitting and
require the ability to change their position to relieve pressure and improve comfort.

5. Tilt-in-Space Wheelchairs: These wheelchairs allow the user to tilt the entire seat and
backrest, helping with posture and pressure relief. They are particularly useful for
individuals with complex medical needs or those prone to pressure sores.

6. Sports Wheelchairs: Designed for individuals who wish to participate in sports, these
wheelchairs are built for speed and agility. They are lightweight, have specialized wheels,
and are often customized for different sports like basketball or tennis.

7. Pediatric Wheelchairs: These are specially designed for children, offering adjustable
features to accommodate growth and specialized needs. Pediatric models often come with
additional support options for posture and comfort.

8. Standing Wheelchairs: These allow users to shift into a standing position, which can
help with health benefits like improved circulation, increased bone density, and better
social interaction.
STEPS FOR SAFE WHEEL CHAIR USE

To ensure the safe use of a wheelchair, several important steps should be followed. These steps
help prevent accidents, improve comfort, and maintain the well-being of the user:

1. Proper Fitting and Adjustment: Ensure the wheelchair is the correct size for the user.
The seat height, width, and depth should allow for proper posture, comfort, and easy
maneuverability. Adjust footrests, armrests, and the backrest to provide adequate support.
2. Check for Safety Features: Before use, ensure all parts of the wheelchair are
functioning correctly, including the brakes, wheels, footrests, and seat. Regularly inspect
the wheelchair for signs of wear or damage.
3. Use Brakes Properly: Always lock the brakes before transferring in or out of the
wheelchair, or when the user is stationary. This prevents the wheelchair from moving
unexpectedly.
4. Transferring in and out of the Wheelchair:

 Ensure the wheelchair is positioned securely with the brakes engaged.

 Use proper body mechanics when transferring the user to avoid injury (bend at the knees,
not the waist).

 For users with limited mobility, assist them slowly and gently, using a transfer board or a
caregiver as needed.

5. Maneuvering the Wheelchair:

 Push the wheelchair forward, keeping your back straight and knees slightly bent.

 When going up ramps, tilt the wheelchair back slightly and use the rear wheels to provide
leverage.

 Avoid navigating on uneven surfaces or obstacles that could tip the wheelchair or cause
instability.
 6. Maintaining Posture: Ensure the user maintains a proper seated posture, with their feet
flat on the footrests and their back straight. If necessary, use cushions or padding to
support the user and prevent pressure sores.

7. Preventing Pressure Sores:

 Encourage the user to shift their position every 15-30 minutes to relieve pressure and
prevent sores.

 Use pressure-relieving cushions or pads, especially for those who sit for long periods.

8. Handling in Tight Spaces: When navigating narrow doorways or corridors, tilt the
wheelchair slightly and maneuver slowly to avoid tipping or scraping against walls.
Always make sure the pathway is clear of obstacles.
9. Proper Storage and Transport:

 When not in use, store the wheelchair in a safe, dry area to avoid damage.

 If transporting, fold or secure the wheelchair appropriately to prevent injury or damage.

10. User Education: If the user is capable, educate them on safe self-propelling techniques,
braking, and transferring. Proper training can greatly improve independence and reduce
the risk of accidents.

CHALLENGES/ COMPLICATIONS OF WHEEL CHAIR USE

Wheelchair use, while providing essential mobility and independence, can present several
challenges and complications. These can affect both the user and caregivers and may require
careful attention and management:

1. Pressure Sores and Skin Issues: One of the most common complications for wheelchair
users is the development of pressure sores, also known as bedsores or decubitus ulcers.
These occur when prolonged pressure on a particular area of the body, such as the
 buttocks, back, or legs, reduces blood flow to the skin, leading to tissue damage. Users
are at high risk if they are unable to shift their weight frequently, which is why regular
repositioning and the use of pressure-relieving cushions are essential.

2. Musculoskeletal Strain and Injuries: Manual wheelchair users, especially those who
propel themselves, are at risk for musculoskeletal injuries, such as repetitive strain
injuries (RSIs) in the shoulders, wrists, and arms. Prolonged use without proper
ergonomics or breaks can lead to pain, inflammation, and long-term damage to joints and
muscles.

3. Limited Mobility in Certain Environments: While wheelchairs provide mobility,

navigating specific environments can be challenging. Users may face difficulties when
dealing with narrow doorways, uneven surfaces, stairs, or curbs, which can limit access
to public spaces or even the home environment. This is especially problematic for
individuals using manual wheelchairs, as they rely on caregivers or physical strength to
navigate obstacles.

4. Lack of Accessibility: Despite improvements in accessibility laws and designs, many

buildings, public spaces, and transportation systems still lack adequate accommodations
for wheelchair users. This includes the absence of ramps, accessible bathrooms, or
elevators, creating barriers to full participation in daily life. Additionally, some vehicles
may not be equipped to safely transport a wheelchair, making travel and mobility
difficult.

5. Increased Fatigue: Pushing a wheelchair, particularly a manual one, can be physically

taxing, especially for those who rely on self-propulsion. Over time, this can lead to
fatigue, reduced stamina, and the need for assistance from caregivers. For powered
wheelchair users, battery life and charging limitations can also contribute to mobility
issues if not managed properly.

6. Social Isolation: Wheelchair users may experience social isolation, particularly if they
face mobility challenges that limit their ability to participate in community events or
engage with others. Physical barriers and lack of accessible transportation can prevent
them from maintaining relationships or accessing social and recreational activities.
 7. Psychological Impact: The use of a wheelchair can have psychological consequences,
such as a sense of dependence, frustration, or a loss of autonomy. Individuals may feel
stigmatized or self-conscious, which can affect their mental health and overall quality of
life. The need for emotional support and counseling may arise to help users cope with
these feelings.

CONCLUSION

In conclusion, ambulation, which includes getting out of bed and using a wheelchair, is a crucial
aspect of mobility for individuals with physical disabilities or impairments. Proper techniques for
transferring from bed to a wheelchair ensure safety, reduce the risk of injury, and promote
independence. Effective ambulation requires a combination of strength, balance, and
coordination, which may be supported through physical therapy and assistive devices.
Wheelchairs provide an essential means of mobility for those unable to walk, offering increased
freedom and access to daily activities. Additionally, the use of appropriate ergonomic practices
when moving from a bed to a wheelchair can enhance comfort and prevent complications such as
pressure sores or muscle strain. Overall, maintaining mobility through ambulation and
wheelchair use is integral to an individual's quality of life, promoting both physical well-being
and psychological health. These practices should be continuously evaluated and adapted to suit
the individual's changing needs.
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