Instructions for Using Crutches

Sizing Crutches
Even if you’ve already been fitted for crutches,
make sure your crutch pads and handgrips are
set at the proper distance, as follows:

 Crutch pad distance from

armpits: The crutch pads (tops of crutches)
should be 1½" to 2" (about two finger widths)
below the armpits, with the shoulders relaxed.
 Handgrip: Place it so your elbow is
slightly bent – enough so you can fully extend
your elbow when you take a step.
 Crutch length (top to bottom):The
total crutch length should equal the distance
from your armpit to about 6" in front of a shoe.

Begin in the “Tripod Position”

The tripod position is the position in which you
stand when using crutches. It is also the
position in which you begin walking. To get into
the tripod position, place the crutch tips about
4" to 6" to the side and in front of each foot.
Stand on your “good” foot (the one that is
weight-bearing).

Walking with Crutches

(Non-weight-bearing)

If your foot and ankle surgeon has told you to avoid ALL weight-bearing, you will need sufficient
upper body strength to support all your weight with just your arms and shoulders.

1. Begin in the tripod position, remembering to keep all your weight on your “good” (weight-
bearing) foot.
2. Advance both crutches and the affected foot/leg.
3. Move the “good” weight-bearing foot/leg forward (beyond the crutches).
4. Advance both crutches, and then the affected foot/leg.
5. Repeat steps #3 and #4.
 Managing Chairs with Crutches
To get into and out of a chair safely:

1. Make sure the chair is stable and will not roll or slide. It must have arms and back
support.
2. Stand with the backs of your legs touching the front of the seat.
3. Place both crutches in one hand, grasping them by the handgrips.
4. Hold on to the crutches (on one side) and the chair arm (on the other side) for balance
and stability while lowering yourself to a seated position, or raising yourself from the chair to
stand up.

Managing Stairs without Crutches

The safest way to go up and down stairs is to use your seat, not your crutches.

To go up stairs:

1. Seat yourself on a low step.

2. Move your crutches upstairs by one of these methods:
 If distance and reach allow, place the crutches at the top of the staircase.
 If this isn’t possible, place crutches as far up the stairs as you can, and then
move them to the top as you progress up the stairs.
3. In the seated position, reach behind you with both arms.
4. Use your arms and weight-bearing foot/leg to lift yourself up one step.
5. Repeat this process one step at a time. (Remember to move the crutches to the top of
the staircase if you haven’t already done so.)

To go down stairs:

1. Seat yourself on the top step.

2. Move your crutches downstairs by sliding them to the lowest possible point on the
stairway. Then continue to move them down as you progress down the stairs.
3. In the seated position, reach behind you with both arms.
4. Use your arms and weight-bearing foot/leg to lift yourself down one step.
5. Repeat this process one step at a time. (Remember to move the crutches to the bottom
of the staircase if you haven’t already done so.)
IMPORTANT!
Follow These Rules for Safety and Comfort

Don’t look down. Look straight ahead as you normally do when you walk.
Don’t use crutches if you feel dizzy or drowsy.
Don’t walk on slippery surfaces. Avoid snowy, icy, or rainy conditions.
Don’t put any weight on the affected foot if your doctor has so advised.
Do make sure your crutches have rubber tips.
Do wear well-fitting, low-heel shoes (or shoe).
Do position the crutch hand grips correctly (see “Sizing Your Crutches”)
Do keep the crutch pads 11/2" to 2" below your armpits.
Do call your foot and ankle surgeon if you have any questions or difficulties.

EYE IRRIGATION
1. Gather equipment. Check the original order in the medical record for the irrigation
according to facility policy. Clarify any inconsistencies. Check the patient’s chart for
allergies.
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient. Usually, the patient should be identified using two methods.
Compare information with the CMAR/ MAR. a. Check the name and identification
number on the patient’s identification band. b. Ask the patient to state his or her name
and birth date, based on facility policy. c. If the patient cannot identify him- or herself,
verify the patient’s identification with a staff member who knows the patient for the
second source.
4. Explain procedure to patient.
5. Assemble equipment at patient’s bedside.
6. Have patient sit or lie with head tilted toward side of affected eye. Protect patient and
bed with a waterproof pad.
7. Put on gloves. Clean lids and lashes with washcloth moistened with normal saline or
the solution ordered for the irrigation. Wipe from inner canthus to outer canthus. Use a
different corner of washcloth with each wipe.
8. Place curved basin at cheek on the side of the affected eye to receive irrigating
solution. If patient is able, ask him or her to support the basin.
9. Expose lower conjunctival sac and hold upper lid open with your nondominant hand.
10. Fill the irrigation syringe with the prescribed fluid. Hold irrigation syringe about 2.5
cm (1 inch) from eye. Direct flow of solution from inner to outer canthus along
conjunctival sac.
11. Irrigate until the solution is clear or all the solution has been used. Use only enough
force to remove secretions gently from the conjunctiva. Avoid touching any part of the
eye with the irrigating tip.
12. Pause irrigation and have patient close the eye periodically during procedure.
13. Dry periorbital area after irrigation with gauze sponge. Offer a towel to the patient if
face and neck are wet.
14. Remove gloves. Assist the patient to a comfortable position.
15. Remove additional PPE, if used. Perform hand hygiene.
16. Evaluate the patient’s response to medication within appropriate time frame.
EAR IRRIGATION
1. Gather equipment. Check medication order against the original order in the medical
record, according to facility policy. Clarify any inconsistencies. Check the patient’s chart
for allergies.
13. Perform hand hygiene and put on PPE, if indicated.
14. Identify the patient. Usually, the patient should be identified using two methods.
Compare information with the CMAR/ MAR.
a. Check the name and identification number on the patient’s identification band.
b. Ask the patient to state his or her name and birth date, based on facility policy.
c. If the patient cannot identify him- or herself, verify the patient’s identification with a
staff member who knows the patient for the second source.
15. Explain procedure to patient. 1
6. Assemble equipment at patient’s bedside.
17. Put on gloves.
18. Have the patient sit up or lie with head tilted toward side of the affected ear. Protect
the patient and bed with a waterproof pad. Have the patient support basin under the ear to
receive the irrigating solution.
19. Clean pinna and meatus of auditory canal, as necessary, with moistened cotton-tipped
applicators dipped in warm tap water or the irrigating solution.
20. Fill bulb syringe with warm solution. If an irrigating container is used, prime the
tubing.
21. Straighten auditory canal by pulling cartilaginous portion of pinna up and back for an
adult.
22. Direct a steady, slow stream of solution against the roof of the auditory canal, using
only enough force to remove secretions. Do not occlude the auditory canal with the
irrigating nozzle. Allow solution to flow out unimpeded.
23. When irrigation is complete, place a cotton ball loosely in auditory meatus and have
patient lie on side of affected ear on a towel or absorbent pad.
24. Remove gloves. Assist the patient to a comfortable position.
25. Remove additional PPE, if used. Perform hand hygiene.
26. Document the administration of the medication immediately after administration.
27. Evaluate the patient’s response to the procedure. Return in 10 to 15 minutes and
remove cotton ball and assess drainage. Evaluate the patient’s response to medication
within appropriate time frame.

TRACTION

1. Review the medical record and the nursing plan of care to determine the type of
traction being used and care for the affected body part.
2. Perform hand hygiene. Put on PPE, as indicated.
3. Identify the patient. Explain the procedure to the patient, emphasizing the importance
of maintaining counterbalance, alignment, and position.
4. Perform a pain assessment and assess for muscle spasm. Administer prescribed
medications in sufficient time to allow for the full effect of the analgesic and/or muscle
relaxant.
5. Close curtains around bed and close the door to the room, if possible. Place the bed at
an appropriate and comfortable working height. Applying Skin Traction
6. Ensure the traction apparatus is attached securely to the bed. Assess the traction setup.
7. Check that the ropes move freely through the pulleys. Check that all knots are tight and
are positioned away from the pulleys. Pulleys should be free from the linens.
8. Place the patient in a supine position with the foot of the bed elevated slightly. The
patient’s head should be near the head of the bed and in alignment.
9. Cleanse the affected area. Place the elastic stocking on the affected limb, as
appropriate.
10. Place the traction boot over the patient’s leg. Be sure the patient’s heel is in the heel
of the boot. Secure the boot with the straps.
11. Attach the traction cord to the footplate of the boot. Pass the rope over the pulley
fastened at the end of the bed. Attach the weight to the hook on the rope, usually 5 to 10
pounds for an adult. Gently let go of the weight. The weight should hang freely, not
touching the bed or the floor. 1
2. Check the patient’s alignment with the traction.
13. Check the boot for placement and alignment. Make sure the line of pull is parallel to
the bed and not angled downward.
14. Place the bed in the lowest position that still allows the weight to hang freely.
15. Remove PPE, if used. Perform hand hygiene.

Caring for a Patient With Skin Traction

16. Perform a skin-traction assessment per facility policy. This assessment includes
checking the traction equipment, examining the affected body part, maintaining proper
body alignment, and performing skin and neurovascular assessments.
17. Remove the straps every 4 hours per the physician’s order or facility policy. Check
bony prominences for skin breakdown, abrasions, and pressure areas. Remove the boot,
per physician’s order or facility policy, every 8 hours. Put on gloves and wash, rinse, and
thoroughly dry the skin.
18. Assess the extremity distal to the traction for edema, and assess peripheral pulses.
Assess the temperature, color, and capillary refill, and compare with the unaffected limb.
Check for pain, inability to move body parts distal to the traction, pallor, and abnormal
sensations. Assess for indicators of deep-vein thrombosis, including calf tenderness, and
swelling.
19. Replace the traction and remove gloves and dispose of them appropriately.
20. Check the boot for placement and alignment. Make sure the line of pull is parallel to
the bed and not angled downward.
21. Ensure the patient is positioned in the center of the bed, with the affected leg aligned
with the trunk of the patient’s body.
22. Examine the weights and pulley system. Weights should hang freely, off the floor and
bed. Knots should be secure. Ropes should move freely through the pulleys. The pulleys
should not be constrained by knots.
23. Perform range-of-motion exercises on all unaffected joint areas, unless
contraindicated. Encourage the patient to cough and deep breathe every 2 hours.
24. Raise the side rails. Place the bed in the lowest position that still allows the weight to
hang freely.
25. Remove PPE, if used. Perform hand hygiene.

CRUTCH

1. Review the medical record and nursing plan of care for conditions that may influence
the patient’s ability to move and ambulate. Assess for tubes, IV lines, incisions, or
equipment that may alter the procedure for ambulation. Assess the patient’s knowledge
and previous experience regarding the use of crutches. Determine that the appropriate
size crutch has been obtained. 2. Perform hand hygiene. Put on PPE, if indicated. 3.
Identify the patient. Explain the procedure to the patient. Tell the patient to report any
feelings of dizziness, weakness, or shortness of breath while walking. Decide how far to
walk. 4. Encourage the patient to make use of the stand-assist device, if available. Assist
the patient to stand erect, face forward in the tripod position. This means the patient holds
the crutches 12 inches in front of and 12 inches to the side of each foot. 5. For the four-
point gait: a. Have the patient move the right crutch forward 12 inches and then move the
left foot forward to the level of the right crutch. b. Then have the patient move the left
crutch forward 12 inches and then move the right foot forward to the level of the left
crutch. 6. For the three-point gait: a. Have the patient move the affected leg and both
crutches forward about 12 inches. b. Have the patient move the stronger leg forward to
the level of the crutches. 7. For the two-point gait: a. Have the patient move the left
crutch and the right foot forward about 12 inches at the same time. b. Have the patient
move the right crutch and left leg forward to the level of the left crutch at the same time.
8. For the swing-to gait: a. Have the patient move both crutches forward about 12 inches.
b. Have the patient lift the legs and swing them to the crutches, supporting his or her
body weight on the crutches. 9. Continue with ambulation for the planned distance and
time. Return the patient to the bed or chair based on the patient’s tolerance and condition,
ensuring that the patient is comfortable. Make sure call bell and other necessary items are
within easy reach. 10. Remove PPE, if used. Perform hand hygiene.

NEURO ASSESS

1. Perform hand hygiene and put on PPE, if indicated.

2. Identify the patient.
3. Close curtains around bed and close the door to the room, if possible. Explain the
purpose of the neurologic examination and what you are going to do. Answer any
questions.
4. Help the patient undress, if needed, and provide a patient gown. Assist the patient to a
supine position. Use the bath blanket to cover any exposed area other than the one being
assessed.
5. Begin with a survey of the patient’s overall hygiene and physical appearance.
6. Assess the patient’s mental status. a. Evaluate the patient’s orientation to person, place,
and time. b. Evaluate level of consciousness. c. Assess memory (immediate recall and
past memory). d. Assess abstract reasoning by asking the patient to explain a proverb,
such as “The early bird catches the worm.” e. Evaluate the patient’s ability to understand
spoken and written word.
7. Test cranial nerve (CN) function.
a. Ask the patient to close the eyes, occlude one nostril, and then identify the smell of
different substances, such as coffee, chocolate, or alcohol. Repeat with other nostril.
b. Test visual acuity and pupillary constriction.
c. Move the patient’s eyes through the six cardinal positions of gaze.
d. Ask the patient to smile, frown, wrinkle forehead, and puff out cheeks.
e. Test hearing. f. Test the gag reflex by touching the posterior pharynx with the tongue
depressor
g. Place your hands on the patient’s shoulders while he or she shrugs against resistance.
Then place your hand on the patient’s left cheek, then the right cheek, and have the
patient push against it.
8. Inspect the ability of the patient to move his or her neck. Ask the patient to touch his or
her chin to chest and to each shoulder, each ear to the corresponding shoulder, and then
tip head back as far as possible.
9. Inspect the upper extremities. Observe for skin color, presence of lesions, rashes, and
muscle mass. Palpate for skin temperature, texture, and presence of masses.
10. Ask patient to extend arms forward and then rapidly turn palms up and down.
11. Ask patient to flex upper arm and to resist examiner’s opposing force.
12. Inspect and palpate the hands, fingers, wrists, and elbow joints.
13. Palpate the radial and brachial pulses.
14. Have the patient squeeze two of your fingers.
15. Ask the patient to close his or her eyes. Using your finger or applicator, trace a one-
digit number on the patient’s palm and ask him or her to identify the number. Repeat on
the other hand with a different number.
16. Ask the patient to close his or her eyes. Place a familiar object, such as a key, in the
patient’s hand and ask him or her to identify the object. Repeat using another object for
the other hand.
17. Assist the patient to a supine position. Examine the lower extremities. Inspect the legs
and feet for color, lesions, varicosities, hair growth, nail growth, edema, and muscle
mass.
18. Test for pitting edema in the pretibial area by pressing fingers into the skin of the
pretibial area. If an indentation remains in the skin after the fingers have been lifted,
pitting edema is present.
19. Palpate for pulses and skin temperature at the posterior tibial, dorsalis pedis, and
popliteal areas.
20. Have the patient perform the straight leg test with one leg at a time.
21. Ask the patient to move one leg laterally with the knee straight to test abduction and
medially to test adduction of the hips.
22. Ask the patient to raise the thigh against the resistance of your hand; next have the
patient push outward against the resistance of your hand; then have the patient pull
backward against the resistance of your hand. Repeat on the opposite side.
23. Assess the patient’s deep tendon reflexes (DTR).
a. Place your fingers above the patient’s wrist and tap with a reflex hammer; repeat on the
other arm.
b. Place your fingers at the elbow area with the thumb over the antecubital area and tap
with a reflex hammer; repeat on the other side.
c. Place your fingers over the triceps tendon area and tap with a reflex hammer; repeat on
the other side.
d. Tap just below the patella with a reflex hammer; repeat on the other side.
e. Tap over the Achilles’ tendon area with reflex hammer; repeat on the other side.
24. Stroke the sole of the patient’s foot with the end of a reflex hammer handle or other
hard object such as a key; repeat on the other side.
25. Ask patient to dorsiflex and then plantarflex both feet against opposing resistance.
26. As needed, assist the patient to a standing position. Observe the patient as he or she
walks with a regular gait, on the toes, on the heels, and then heel to toe.
27. Perform the Romberg’s test; ask the patient to stand straight with feet together, both
eyes closed with arms at side. Wait 20 seconds and observe for patient swaying and
ability to maintain balance. Be alert to prevent patient fall or injury related to losing
balance during this assessment.
28. Assist the patient to a comfortable position.
29. Remove PPE, if used. Perform hand hygiene. Continue with assessments of specific
body systems, as appropriate, or indicated. Initiate appropriate referral to other healthcare
practitioners for further evaluation, as indicated.