| Crutch Walking | 拐杖行走 |
| Crutches are often needed to increase a client's mobility. The use of crutches may be temporary （such as after ligament damage to the knee） or permanent （as with paralysis of the lower extremities）. It is important that crutches be measured for the appropriate length and that clients be taught how to use them correctly. | 為增加病人活動能力，常常需要用到拐杖。使用拐杖可能是臨時的（如膝韌帶損傷時），也可以是終身性的（如出現下肢癱瘓情況）。重要的是，拐杖應長短要測量適度，并教會病人如何正確使用拐杖?！?/td> |
| Potential Nursing DiagnosesClient data derived during the assessment reveal defining characteristics to support the following nursing diagnoses in clients requiting this skill: Impaired physical mobility High risk for injury | 潛在的護理診斷： 同坐位： 軀體活動障礙， 有受傷的危險 |
| EquipmentTape measure Goniometer Rubber crutch tips Wooden crutches | 用具： 卷尺、測角儀、拐杖橡膠端頭，木手杖?！?/td> |
| STEPS | 步驟及說明 |
| 1. Wash hands. * Reduces transmission of microorganisms. | 1.洗手 * 減少微生物傳播 |
| 2. Measure for crutch length: 3 to 4 finger widths from axilla to a point 15 cm （6 inches） lateral to client's heel is standard * Ensures that crutches are individualized to client's height. | 2.測定拐杖高度：標準為：腋下3－4指寬處至病人腳跟向外15cm（6時）處的長度。 * 確保拐杖適合每個病人身高度?！?/td> |
| 3. Position crutch handgrips with elbows flexed at 20- to 25-degree angle. Ankle of elbow flexion should be verified by goniometer * Prevents client's body weight from being supported by axillae, which would result in nerve damage. | 3.屈肘20－25度，放好拐杖把手；屈肘角度應用測角儀確定 * 避免病人體重的腋窩支撐，否則會導致神經損害?！?/td> |
| 4. Verify that distance between crutch pad and axilla is 3 to 4 finger widths * Prevents axillary skin breakdown secondary to pressure from crutch pad. | 4.核實拐杖墊與腋窩間有3－4指寬的距離 * 避免因拐杖墊壓迫而引起腋窩皮膚裂開。 |
| 5. Instruct client to assume tripod stance. Tripod stance is formed when crutches are placed 15 cm （6 inches） in front and 15 cm to side of each foot * Improves balance by providing wider base of support. No weight should be borne by axillae. | 5.指導病人采三角站立姿勢。三角站立姿勢；拐杖置于體前方15cm、離腳跟15cm的交接處 * 增加支撐面寬度，改善平衡。不得將體重壓在腋窩。 |
| 6. Teach client one of four crutch-walking gaits. （Darkened areas on Figs. 28 to 30 represent weight-bearing areas）: * Allows client to ambulate safely. Specific type of gait chosen depends on client's impairment and physician's order. | 6.教會病人使用四種持拐杖步行法中的一種 * 使病人行走安全。選用何種步法取決于病人的損傷情況及醫(yī)生醫(yī)囑?！?/td> |
| l Four-point alternating, or four-point gait, gives stability to client but requires weight bearing on both legs. Each leg is moved alternately with each crutch so three points of support are on floor at all times | 四點輪替或四點法：采用本步法可使病人穩(wěn)定，但要求將體重落于雙腿。兩腿隨拐杖交替移動，因此，地面始終留下三個支撐點 |
| l Three-point alternating, or three-point gait, requires client to bear all weight on one foot. Weight is borne on uninvolved leg, then on both crutches, and the sequence is repeated. Affected leg does not touch ground during early phase of three-point gait. Gradually client progresses to touchdown and full weight bearing on affected leg | 三點輪替或三點步態(tài)：要求病人單腳承受全部體重。先由未受傷一腳承擔全部體重，然后移至雙拐，以此類推。在三點步法的初期，傷腿不接觸地面。經過一段時間后，病人慢慢觸地，直至全部體重移至患腿 |
| l Two-point gait requires at least partial weight bearing on each foot. Client moves each crutch at same time as opposing leg so crutch movements are similar to arm motion during normal walking | 兩點步法：本法要求傷腿至少承擔部分體重。病人在移動拐杖的同時移動相對的一條腿。拐杖運動正好與正常行走時的手臂運動相同 |
| l Swing-through, or swing-to gait is frequently used by paraplegics who wear weight-supporting braces on their legs. With weight on supported legs, the client places crutches one stride in front and then swings to or through them while they support his weight. | 邁越步/搖擺步態(tài)：本法通常用于雙腿帶有承重梏具的截癱病人。先將體重落于支撐腿，病人隨即將拐杖前移一步，然后，在雙拐支撐體重時病人順勢向前擺動，越過拐杖?！?/td> |
| 7. Teach client to ascend and descend on stairs: * Reduces risk of further damage to musculoskeletal system and risk of falling. | 7.教病人上、下樓梯： * 減少進一步損傷肌肉骨骼系統的危險及摔倒危險?！?/td> |
| Ascend l Assume a tripod position. l Transfer body weight to crutches l Advance unaffected leg between crutches and stair. l Shift weight from crutches to unaffected leg l Align both crutches on stair | 上樓： a. 采三足鼎立位。 b. 將體重移至拐杖 c. 將未受傷腿前進至拐杖和樓梯之間。 d. 將體重從拐杖移至未受傷腿 e. 調整雙拐，使其處于同一直線 |
| Descend l Transfer body weight to unaffected leg l Place crutches on stair and begin to transfer body weight to crutches, moving affected leg forward l Align unaffected leg on stair with crutches | 下樓： a. 將體重移至未受傷腿 b. 將雙拐置于樓梯，開始將體重移至雙拐，受傷腿向前移動 c. 調整樓梯上的受傷腿，使其與雙拐成一直線 |
| 8. Teach client how to sit in chair and how to get up from chair: * Provides safe method of sitting in and getting up from chair. Reduces further damage to client's musculoskeletal system and the risk of falling. | 8. 教會病人如何在椅子上起坐。 * 提供安全的椅上起坐方法，減少病人肌肉骨骼系統進一步損傷及摔倒危險。 |
| Sitting l Client positioned at center front of chair with posterior aspects of legs touching chair l Client holds both crutches in hand opposite affected leg. If both legs are affected, crutches are held in hand on client's strong side l Client grasps arm of chair with other hand and lowers body into chair Getting up l Perform three steps above in reverse order. | 坐： a. 病人位于椅子前面中央，兩腿后面接觸椅子 b. 病人將雙拐握于受傷腿對側的手中。如雙腿受傷，雙拐應握于病人較為健康一側的手中。 d. 病人用另一只手抓住椅子扶手，坐進椅子。 起： 按相反次序操作上述三步。 |
| 9. Wash hands. * Reduces transmission of microorganisms. | 9.洗手。 * 減少微生物傳播。 |
| 10. Record gait and procedures taught and client's ability to perform gaits in nurse's notes. * Documents teaching and client's learning. | 10.記錄所教步法及程序及病人實施步法的能力。 * 文件證明教育及病人學習情況。 |
| Nurse AlertThe client with cognitive impairment or one who has received analgesics or tranquilizers may be unable to understand instructions or to ambulate safely with crutches. | 注意事項：有認知障礙的病人或接受麻醉或鎮(zhèn)靜劑病人可能無法理解指導或用拐杖安全行走?！?/td> |
| Client TeachingThe nurse should instruct the client that, because of the potential for axillary skin breakdown and nerve damage, he must not lean on his crotches to support his body weight. Rubber crutch tips should be replaced as they wear out, and they should remain dry. Worn or wet crutch tips decrease surface tension and increase the risk of falling. The client should be given a list of medical suppliers in his community so he can obtain repairs as well as new rubber tips, handgrips, and crutch pads. In addition, advise him that he should have spare crutches and tips on hand. | 病人教育： 由于潛在腋窩皮膚裂開及神經損傷可能，護士應指導病人不能倚在雙拐上，用雙拐支撐其體重。橡膠拐杖頭磨穿后應及時更換，并保持干燥。磨損或潮濕的拐杖頭會降低其表面張力，增加摔倒危險。應將其社區(qū)醫(yī)療供應商名單告知病人，以便他獲得修理服務及新的橡膠頭、拐杖柄和拐杖墊。此外，應忠告病人應有備用的拐杖和拐杖頭?！?/td> |
| Geriatric ConsiderationsThe normal visual acuity and depth perception changes with aging may prevent the client from safely ascending or descending stairs with crutches. | 老年：隨年齡出現的正常視敏度和深度感知變化可能使病人無法借助雙拐安全地下樓梯?！?/td> |
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