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时间:2015-08-13 17:32点击:
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.  为增加病人活动能力,常常需要用到拐杖。使用拐杖可能是临时的(如膝韧带损伤时),也可以是永久性的(如出现下肢瘫痪情况)。重要的是,拐杖应长短要测量适度,并教会病人如何正确使用拐杖。 
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 
EquipmentTape measure
Rubber crutch tips
Wooden crutches 

STEPS  步骤及说明 
1. Wash hands.
* Reduces transmission of microorganisms. 
* 减少微生物传播 
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. 
* 确保拐杖适合每个病人身高度。 
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. 
* 避免病人体重的腋窝支撑,否则会导致神经损害。 
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. 
* 避免因拐杖垫压迫而引起腋窝皮肤裂开。 
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. 
* 增加支撑面宽度,改善平衡。不得将体重压在腋窝。 
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. 
* 使病人行走安全。选用何种步法取决于病人的损伤情况及医生医嘱。 
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  四点轮替或四点法:采用本步法可使病人稳定,但要求将体重落于双腿。两腿随拐杖交替移动,因此,地面始终留下三个支撑点 
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  三点轮替或三点步态:要求病人单脚承受全部体重。先由未受伤一脚承担全部体重,然后移至双拐,以此类推。在三点步法的初期,伤腿不接触地面。经过一段时间后,病人慢慢触地,直至全部体重移至患腿 
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  两点步法:本法要求伤腿至少承担部分体重。病人在移动拐杖的同时移动相对的一条腿。拐杖运动正好与正常行走时的手臂运动相同 
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.  迈越步/摇摆步态:本法通常用于双腿带有承重梏具的截瘫病人。先将体重落于支撑腿,病人随即将拐杖前移一步,然后,在双拐支撑体重时病人顺势向前摆动,越过拐杖。 
7. Teach client to ascend and descend on stairs:
* Reduces risk of further damage to musculoskeletal system and risk of falling. 
* 减少进一步损伤肌肉骨骼系统的危险及摔倒危险。 
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 
a. 采三足鼎立位。
b. 将体重移至拐杖
c. 将未受伤腿前进至拐杖和楼梯之间。
d. 将体重从拐杖移至未受伤腿
e. 调整双拐,使其处于同一直线 
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 
a. 将体重移至未受伤腿
b. 将双拐置于楼梯,开始将体重移至双拐,受伤腿向前移动
c. 调整楼梯上的受伤腿,使其与双拐成一直线 
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. 教会病人如何在椅子上起坐。
* 提供安全的椅上起坐方法,减少病人肌肉骨骼系统进一步损伤及摔倒危险。 
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. 
a. 病人位于椅子前面中央,两腿后面接触椅子
b. 病人将双拐握于受伤腿对侧的手中。如双腿受伤,双拐应握于病人较为健康一侧的手中。
d. 病人用另一只手抓住椅子扶手,坐进椅子。
9. Wash hands.
* Reduces transmission of microorganisms. 
* 减少微生物传播。 
10. Record gait and procedures taught and client's ability to perform gaits in nurse's notes.
* Documents teaching and client's learning. 
* 文件证明教育及病人学习情况。 

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.  注意事项:有认知障碍的病人或接受麻醉或镇静剂病人可能无法理解指导或用拐杖安全行走。 
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
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:随年龄出现的正常视敏度和深度感知变化可能使病人无法借助双拐安全地下楼梯。