Crutches, Canes, Walkers & Psyh Flashcards
Measuring crutches
Top
Bottom
Hand Grip
Top: measure 2 or 3 fingers widths between pad and axillary fold
Bottom: Tip 6” lateral and 6” in front of the foot
RULE OF LANDMARK OF AXILLA AND FOOt
Handgrip
Wrist level with handgrip
Elbow flexion 30°
2 point Gait
Move
What type of patient will use this
Crutch & Oppsite foot together
Together Right leg & Left crutche
Together Left leg & Right crutche
For: mild bilateral leg weakness
3 point Gait
Describe motion
Which type of patients use it
Move 2 crutches & bad leg together, follow3d by unaffected leg
Affected leg Not on ground
For: when 1 leg is affected
4 point Gait
Describe movement
For which type of patient
Move all 4 separately
Move one crutch -> opposite foot -> followed by opposite crutch -> followed by opposite foot
For: Severe bilateral leg problems
Swing through gait
Type of patient
Move both crutches & bad leg together. Followed by good leg
For: Amputee - Non weight bearing
Tip
Use even point Gait for even/ bilateral
2 for mild 4 for severe
Use odd point Gait when one leg is affected.
Use Swing through for amputation
Good advice
Which Crutches Gait
- Early stages RA
- Left above knee amputation
- 1st day post off right knee replacement- partial weight bearing allowed
- Advanced stages ALS
- Left hip replacement Non weight bearing
- Bilateral total knee replacement 1 day Post opp. Weight bearing allowed
- Bilateral knee replacement 3 weeks post opp
- 2 point
- Swing through
- 3 point
- 4 Point
- Swing through
- 4 Point
- 2 Point
Going up amd down stairs with crutches
How to explain
Up: Good foot, crutches, Bad
Down: Crutches, Bad, Good
Crutches move with Bad Leg
Canes
Hold on which side
Strong side
If belonging must be tied to walkers where should it be tied
Side not front
Tip: Psych Question
Decide if the patient is psychotic or non psychotic
A Non psychotic person has…
Insite (able to tell their own problem)
Reality Based
Which technique do you use with a Non-psychotic patient
Good therapeutic communication (Get them to talk more)
Reflection
Clarification
Amplification
Restatement
Psychotic person
2 defining characteristics
They don’t know they are sick
Which symptoms do they have unique to thier disease
No Insite Not reality bases
Symptom: Delusions & Hallucinations
A false fixed idea or belief
No sensory involvement
Delusion
(Paranoid, Grandeous, Somatic (involving body parts)
False fixed sensory experience
Hallucinations
In order of common place
Most common: Auditory; voices telling you to harm yourself
Visual:
Tactile:
Gustaory
Olfactory
A misinterpretation of reality
Sensory experience
With a referent in reality
Illusions
Client Says
- I hear demon voices
- Client over hears chatter at nursing Station & states: I hear demon voices
- Client stares at wall and says I see a bomb
- Client stares at fire extinguisher on wall and says I see a bomb
- Hallucinations
- Illusion
- Hallucinations
- Illusion
3 types of psychosis
Functional Psychosis: Function in everyday life.
- Name 4 diseases associated with this
- Psychosis of Dementia
What is the cause of their Dementia - Psychotic Delirium
- Skizo, Skizo, Major, Manics
Schizophrenia, Schizoaffective disorder, Major Depression, Manic - Brain Damage from Dementia
- Temporary, 2ndary (underlying cause), Sudden
Functional Psychotic has brain damage (No / Yes)
Can they learn reality
How to teach reality to them (4) Steps
No
Yes
- Acknowledge Feelings
- Present Reality
- Set Limit
- Enforcement Limit
Teaching Step to bring functional Psychotics into reality.
- I see your angry, you seem upset, tell me more about how your feeling
- I know you see that demon but I don’t.
I understand you believe the mafia wants to kill you but in reality this isn’t going to happen. - That topic is off limits in our conversation
Stop talking about certain subject
- I see your too ill to stay reality based and end the conversation
- Acknowledge Feelings
- Present Reality
- Set a limit
- Enforce limit
Tip
If in between 2 choices chose the more positive option
38$ p/h to start
Psychosis of Dementia
To handle them during situations do 2 steps
Why?
- Acknowledge Feelings
- Redirect them
Why? They can’t learn reality.
Is reality orientation appropriate with dementia patients.
Ie. Orientation them to Person, Place, Time
Can you do presentation of reality to dementia patients
Yes.
However, don’t do presentation of reality.
Don’t orientate them out of their Hallucinations.
Ie. Presenting them with the reality that there not King Arthur
How to handle a patient with a Psychosis Delirium
(2) Steps
- Acknowledge Feelings
- Reassure about safety & temporariness of their condition
Patient with Schizoaffective disorder who points at 2 people talking at table across the room.
“Those people are plotting to kill me.”
What do you do.
- Acknowledge. I hear you and that must be frightening
- Orientate to reality. Those people aren’t plotting to kill you
- Establish limits: Were not going to talk about this anymore
- Enforce limits: (they keep talking about it) I see your too ill now to converse
Patient with AD during conversation points to two people and says
“Those people are trying to kill me”
How do you respond
- Acknowledge. You seem scared, that seems frightening
- Redirect. Let’s go somewhere you can be safe.
Don’t switch subject but direct what they are saying
A patient with delirium tremors says: “ See those two people over there, they are plotting to kill me”
What would a RN do
- Acknowledge statement: This must be terrifying
- Reassure them of their safety. You are safe that symptom of your illness will go away when you get better
Which personality disorders would you consider treating as a Functional Psychotic
Antisocial
Borderline
Narcissistic
Multi Actual Assessment Axis
1.
2.
3.
4.
5.
- Prima4y psych disease
- Retarded/ Personality disorder
- Medical Conditions
- Psychosocial (unemployed/ divorce)
5 Score 0 - 100 of ability to function. 100 is highest
Flight of ideas
Word Salad
Neologism
(Can’t make a phase that is coherente)
(Each phrase is coherente but put together the phrases don’t make sense)
(Making up imaginary words)
Neologism
Flight of ideas
Word Salad
(Making up imaginary words)
(Each phrase is coherente but put together the phrases don’t make sense)
(Can’t make a phase that is coherente)
Narrowed Self Concept
When a functional Psychotic refuses to leave room and change clothes
Define themselves as where they are and change their clothes
Do you make them change clothes and leave room.
What do you tell them
No.
Dangerous Situation
Steps in functional psychosis
Mrs Jones is depressed since her child went to college. Lost her job. Hates way she feels
Refuses to leave room to do ADL
What do you do?
Use good therapeutic communication skills
I see your depressed
It’s time for your shower “ tell them”
Be directive
Ideas of reference…
When you think everyone is talking about you
