mobility

One of the complications associated with the improper use of crutches is:

• A. Axillary nerve damage

• B. Solar plexus nerve damage

• C. Carpal tunnel syndrome

• D. Trigeminal nerve damage

Answer explanation

Choice A is correct. One of the complications associated with the improper use of crutches is axillary nerve damage Supporting one's weight on the upper support of crutches is not recommended because it can lead to axillary nerve damage. Despite this warning, improper axillary weight bearing frequently occurs due to various factors (i.e., a lack of arm strength, fatigue, improper client instruction, inappropriate crutch fit, etc.).

Choice B is incorrect. The solar plexus (also referred to as the celiac plexus) is a mass of nerves situated behind the stomach and in front of the aorta. Solar plexus nerve damage is not a complication associated with the improper use of crutches, but based on anatomical positioning, it is particularly vulnerable to abdominal trauma.

Choice C is incorrect. Carpal tunnel syndrome is not typically associated with the improper use of crutches. Carpal tunnel syndrome often results from a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Often, no single cause can be identified.

Choice D is incorrect. Trigeminal nerve damage is not one of the complications associated with the improper use of crutches. The trigeminal nerve is the fifth cranial nerve (CN V) and the largest of the cranial nerves, with a primary function to provide sensory innervation to the face. Trigeminal nerve damage most often occurs due to a physiologically pathological cause (i.e., tumor, multiple sclerosis, etc.).

The nurse is supervising a student assisting a client with their newly prescribed crutches. Which action by the student requires follow-up by the nurse? The student

• A. positions the handgrips so that the axillae support the client's body weight.

• B. demonstrates the proper crutch stance at 15 cm (6 inches) in front of and 15 cm (6 inches) to the side of each foot.

• C. observes two to three finger widths between the crutch pad and the client's axilla.

• D. instructs the client to dry crutch tips with a paper towel if they become wet.

Answer explanation

Choice A is correct. This action is incorrect and requires follow-up. This is an incorrect positioning for crutches, as the axillae should not support the client's body weight. The hands should support the client's body weight as weight supported in the axilla may cause nerve injury. 

Choice B is incorrect. The basic crutch stance (commonly referred to as the tripod stance) is 15 cm (6 inches) in front of and 15 cm (6 inches) to the side of each foot.  

Choice C is incorrect. Two to three finger widths should be between the crutch pad and the client's axilla.  

Choice D is incorrect. The client should avoid crutches on wet surfaces because of the risk of falling. If the crutch tips become wet, the client should be instructed to dry them promptly with a paper towel.  

The nurse has instructed a client who is being discharged with crutches about using stairs. Which statement by the client would indicate a correct understanding of the teaching?

• A. "I should hold the handrail for support with one hand."

• B. "Going up the stairs, I should lead with my crutches and weaker leg."

• C. "Going down the stairs, I should lead with my crutches and strong leg."

• D. "I should remove the rubber tip when going up and down the stairs."

Answer explanation

Choice A is correct. This statement is correct and indicates an understanding of using crutches. The client should place both crutches on the side away from the handrail and then hold the handrail for support with one hand. The client should lead with their affected leg and crutch as they descend the stairs. 

Choices B, C, and D are incorrect. These statements are incorrect and require follow-up. When a client is ascending stairs, the client leads with the stronger leg. When the client is descending the stairs, the client should lead with the affected leg. The client must always have a rubber tip on the crutch to ensure appropriate traction.

The nurse is observing a client ambulate with crutches. It would require follow up by the nurse if the client is observed

• A. with the crutches placed 2 inches in front of and 4 inches to the side of each foot.

• B. placing weight on the crutch and then steps up the first step of stairs with the unaffected leg.

• C. drying the rubber tips of the crutches with a paper towel after they have become wet.

• D. with both of their elbows flexed between 15 and 30 degrees.

Answer explanation

Choice A is correct. This observation requires follow-up because it is inappropriate. The basic crutch stance is the tripod position, formed when the crutches are placed 6 inches in front of and 6 inches to the side of each foot. 

Choices B, C, and D are incorrect. These observations are correct and do not require follow-up. When the client goes up the stairs, the client leads with the stronger leg. When going downstairs, the client should lead with the affected leg. The client should dry the rubber tips if they get wet. The rubber tips should be dry and in good working order to maintain traction on the ground. The elbows should be flexed between 15-30 degrees, and the client should report that the hand grips support their weight.

The nurse provides discharge teaching to a client prescribed a cane for left-sided weakness. Which instruction should the nurse provide?

• A. Advance the cane along with your stronger leg.

• B. Remove the rubber tip when going upstairs.

• C. Measure the height of the cane to your elbow.

• D. Secure the cane in your right hand.

Answer explanation

Choice D is correct. Clients with left-sided weakness should have the cane secured in their right hand (opposite to the affected side). Having a cane as an ambulation device ensures that two points of sturdy contact are on the ground at all times. 

Choices A, B, and C are incorrect. These instructions are wrong. The cane should be advanced at the same time as the affected (weaker) leg, followed by the unaffected (stronger) leg. A rubber tip should always be applied to the crutch to ensure appropriate traction with the ground. The cane's height should be measured to the client's greater trochanter or wrist crease.

The nurse observes a client go up the stairs with a cane. It would indicate effective teaching if the client grabs the handrail and

• A. places the stronger leg up a step, then simultaneously moves up the weaker leg and cane.

• B. holds the cane in one hand and hops up each stair using the stronger leg.

• C. places the cane up a step, then simultaneously moves up the stronger and weaker legs.

• D. places the weaker leg up a step, then simultaneously moves up the stronger leg and cane.

Answer explanation

Choice A is correct. When a client is ambulating upstairs using a cane, the client will face the stairs and place the cane on the side opposite the handrail. Then, the client will advance the unaffected (stronger) leg up to the next step, then the cane and the affected (weaker) leg simultaneously. This reflects adequate understanding. Remember that the weaker side and the cane share the load and should always move together.

Choices B, C, and D are incorrect. These statements require follow-up because they do not follow the correct (and safe) sequence for ambulating with a cane while ascending stairs. Improper usage of a cane may result in falls.

The nurse provides discharge teaching to a client prescribed a cane for left-sided weakness. Which instruction should the nurse provide?

• A. Advance the cane along with your stronger leg.

• B. Remove the rubber tip when going upstairs.

• C. Measure the height of the cane to your elbow.

• D. Secure the cane in your right hand.

Answer explanation

Choice D is correct. Clients with left-sided weakness should have the cane secured in their right hand (opposite to the affected side). Having a cane as an ambulation device ensures that two points of sturdy contact are on the ground at all times. 

Choices A, B, and C are incorrect. These instructions are wrong. The cane should be advanced at the same time as the affected (weaker) leg, followed by the unaffected (stronger) leg. A rubber tip should always be applied to the crutch to ensure appropriate traction with the ground. The cane's height should be measured to the client's greater trochanter or wrist crease.

The graduate nurse (GN) is reinforcing education on sitting on and standing up from a chair to a client with crutches. Which instruction by the GN would cause the supervising nurse to intervene?

• 1. 1. "Hold a crutch in each hand on both sides when standing up from a chair."

• 2. 2. "Move to the edge of the chair before standing and use your unaffected leg to rise."

• 3. 3. "Touch the back of your unaffected leg to the chair before preparing to (11%) sit."

• 4. 4. "Use an armrest or seat for assistance when lowering your body into a (11%) chair."

Answer explanation

Clients prescribed crutches after a musculoskeletal injury must understand appropriate device use to facilitate independent ambulation, promote wound healing, and prevent reinjury.  When educating a client to rise from sitting, the nurse instructs the client to hold the hand grips of both crutches in the hand on the affected side, move to the chair's edge, and hold the armrest with the hand on the unaffected side (Option 1).  The client then uses the crutches, armrest, and unaffected leg for support when rising.

To sit, the client backs up to the chair and moves both crutches into the hand on the affected side.  The client holds the armrest with the other hand and lowers the body.

(Option 2)  To rise from a chair, the client should move to the edge of the chair and flex the unaffected leg for support.

(Option 3)  Before sitting, the client should back up to the chair until the unaffected leg touches the chair seat.

(Option 4)  When standing or sitting, clients should place the hand opposite the injury on the armrest or chair seat for support.

The nurse is talking with a client who sustained a sprain of the left ankle and has been using crutches for the past week. Which of the following statements by the client would be a priority to follow up?

• 1. 1. "I have been experiencing weakness in my hands and wrists."

• 2. 2. "I occasionally experience brief muscle spasms in my upper arms."

• 3. 3. "The muscles in my neck are tired and sore by the end of each day."

• 4. 4. "My left ankle is swollen by the end of the day if I stand or walk

     (26%)

     frequently."

Answer explanation

Crutch paralysis, or palsy, is a reversible condition caused by excessive and prolonged pressure on the radial nerve at the axilla, often due to crutches that are too long or leaning on top of the crutches when ambulating.  Manifestations include muscle weakness, numbness, and tingling of the arm, wrist, and hand (Option 1).

The nurse should teach the client to support body weight on the hands and arms, not the axillae, when ambulating to ensure that there is a 1- to 2-inch (2.5- to 5-cm) space between the axilla and the axilla crutch pad.  The crutches should also be checked for proper length.

(Option 2)  Muscle spasms of the biceps and triceps can occur due to increased muscle use, especially in clients with poor upper body strength.

(Option 3)  Muscle pain and stiffness in the neck may occur if the client looks down at the feet while walking.  The client should look forward while walking to help prevent muscle and joint strain.

The nurse is talking with a client who has osteoarthritis of the left knee and is using a cane to ambulate. Which of the following statements by the client would require follow-up?

• 1. 1. "The cane should be held in my right hand."

• 2. 2. "I will lead with my right leg when going up stairs."

• 3. 3. "The handle of the cane should be level with my waist."

• 4. I will place the cane 6 in (15 cm) in front of and lateral to my right foot."

Answer explanation

Canes are assistive devices used during ambulation to support stability and reduce weight bearing on the affected leg (eg, knee injury, arthritis).  The length of the cane should equal the distance from the floor to the greater trochanter of the hip.  A cane that is level with the client's waist is too long to provide optimal support and prevent back injury (Option 3).

(Option 1)  The cane should be held on unaffected side (ie, strong side) to help maintain balance, keeping the elbow slightly flexed (20-30 degrees).

(Option 2)  When ascending stairs, the client should lead with the stronger leg first, and next move the cane up while bearing weight on the stronger leg.  Finally, the weaker leg is moved up.

(Option 4)  For maximum support, the cane is held with the tip approximately 6 in (15 cm) in front of and lateral to the foot on the unaffected side.