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Mark Klimek Lecture #4 January 25, 2018 Crutches, Canes, & Walkers When the handgrip of a crutch is properly in place the elbow flexion should be 30 degrees. Nerve damage could occur when crutch is not 30 degrees.
- point gait
- point gait
- point gait
One crutch and opposite foot together, other crutch and other foot together.
Move two crutches and bad leg together, move good foot, move all three together and then the good leg
Nothing moves together, right crutch, left foot, left crutch, right foot Swing through Traditional crutching, used for non weight bearing, amputees When would you used the even numbered gaits when weakness is? Evenly distributed (bilateral), even for even 2 point gait – mild problem 4 point gait – severe bilateral weaknesses Examples – early stages of rheumatoid arthritis (2 point gait), left above the knee amputation (swing through), first day post of right knee replacement partial weight bearing allowed (3 point), advanced stages of ALS (4 point), left hip replacement 2 nd day post op non weight bearing (swing through), bilateral total knee replacement first day post op weight bearing allowed (4 point), bilateral total knee replacement 3 weeks post op (2 point gait) Going up stairs with crutches “up with the good, down with the bad” Crutches always move with the bad leg This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 19:13:33 GMT -05:00
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What side do you hold the cane?Strong side Psych When you do a psych question first thing you determine is, is the patient psychotic or nonpsychotic?Nonpsychotic – they have insight (know they have a problem) and is reality based.Look for good therapeutic communication in answer, treat them like any other patient “tell me more, how are you feeling right now” Pschytoic – NO insight and is NOT reality based, they don’t think they’re sick Have delusions, hallucinations, and illusions Delusion – false fixed idea or belief, there is no sensory component Paranoid delusion – false fixed belief that people are out to harm you Gandiose – false fixed belief that you are superior Somatic – false fixed belief about a body part Hallucinations – false fixed sensory experience Auditory – most common, voices telling you to harm yourself Visual Tactile (feel) Gustatory (taste) Olfactory Illusion – misinterpretation of reality, sensory experience Differentiate between illusion and hallucinations – with an illusion there is a referent in reality (something to which a person refers when they say something) there is actually something there but they misinterpret it, with hallucinations there isn’t anything there.
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How do you deal with a psychotic patient with hallucinations and illusions?Functional psychotic – they can function but they are psychotic such as, schizophrenia, schizoaffective disorder, major depression, mania (bipolar) oPotential to learn reality oRole as a nurse, teach reality – 4 step process: acknowledge the feeling (I see you’re upset), present reality (I know that you see spiders but we have no spiders in the room), set a limit (were not going to talk about that lets talk about something else), enforce the limit (I see you’re too ill to talk about reality) Psychosis of dementia – actual damage to the brain such as people with Alzheimer’s, dementia, organic brain syndrome, Wernicke’s, senility.Psychotic delirium
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