6.2 Assistive Devices (Crutches, Canes, Walkers)

NCLEX-RN Registered Nurse

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1 Introduction

About the NCLEX-RN Exam Next Generation NCLEX (NGN) Clinical Judgment Measurement Model (NCJMM) How to Use This Course

2 Chapter 2: Management of Care

2.1 Legal Rights and Responsibilities 2.2 Advance Directives and Self-Determination 2.3 Informed Consent Protocols 2.4 Client Advocacy and Rights (HIPAA) 2.5 Assignment, Delegation, and Supervision 2.6 Five Rights of Delegation 2.7 Scope of Practice (RN vs LPN vs UAP) 2.8 Ethical Practice Principles

3 Chapter 3: Safety and Infection Prevention and Control

3.1 Standard Precautions and Hand Hygiene 3.2 Transmission-Based Precautions (Contact, Droplet, Airborne) 3.3 PPE Donning and Doffing Sequences 3.4 Fall Prevention and Restraints 3.5 Fire Safety (RACE/PASS) 3.6 Disaster Triage and Emergency Response

4 Chapter 4: Health Promotion and Maintenance

4.1 Growth and Development (Erikson/Piaget) 4.2 Developmental Stages: Infancy through Older Adult 4.3 Maternal and Newborn Care (Antepartum) 4.4 Intrapartum Care and Fetal Monitoring 4.5 Postpartum Care (BUBBLE-HE) 4.6 Health Screening Guidelines 4.7 Immunization Schedules

5 Chapter 5: Psychosocial Integrity

5.1 Therapeutic Communication Techniques 5.2 Non-Therapeutic Communication (What to Avoid) 5.3 Anxiety Disorders and Mental Health Concepts 5.4 Schizophrenia: Hallucinations and Delusions 5.5 Depression and Suicide Assessment 5.6 Substance Misuse and Withdrawal 5.7 Grief and End-of-Life Care

6 Chapter 6: Basic Care and Comfort

6.1 Mobility and Hazards of Immobility 6.2 Assistive Devices (Crutches, Canes, Walkers) 6.3 Nutrition and Diet Therapy 6.4 Enteral Nutrition (Tube Feeding) 6.5 Bowel Elimination and Ostomy Care 6.6 Urinary Elimination and Catheter Care

7 Chapter 7: Pharmacological and Parenteral Therapies

7.1 Medication Administration Rights 7.2 Medication Calculations 7.3 High-Alert Medications: Insulins 7.4 High-Alert Medications: Anticoagulants 7.5 High-Alert Medications: Opioids 7.6 High-Alert Medications: Digoxin and Electrolytes 7.7 IV Therapy and Complications 7.8 Blood Product Administration 7.9 Total Parenteral Nutrition (TPN)

8 Chapter 8: Reduction of Risk Potential

8.1 Laboratory Values: Hematology (CBC) 8.2 Laboratory Values: Metabolic Panel (BMP) 8.3 Laboratory Values: Coagulation Studies 8.4 Vital Signs and Trend Recognition 8.5 Perioperative Care (Pre-Op and Post-Op) 8.6 Nasogastric Tubes and Therapeutic Procedures

9 Chapter 9: Physiological Adaptation

9.1 Fluid Imbalances (Hypovolemia and Hypervolemia) 9.2 Arterial Blood Gases (ABGs) and Acid-Base Balance 9.3 Medical Emergencies: Stroke (CVA) 9.4 Medical Emergencies: Myocardial Infarction (MONA) 9.5 Diabetic Emergencies (Hypoglycemia and DKA) 9.6 Respiratory Conditions (COPD, Pneumonia) 9.7 Cardiac Conditions (Heart Failure) 9.8 Neurological Conditions (Seizures)

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6.2 Assistive Devices (Crutches, Canes, Walkers)

Key Takeaways Explain This Topic AI

Weight on crutches must be borne on the hands, not the axillae—pressure on axillae can cause brachial plexus injury

Memory trick for stairs: "Up with the Good, Down with the Bad"—strong leg leads going up, affected leg leads going down

A cane is held on the STRONG (unaffected) side and advances with the WEAK leg to provide a wide base of support

Walkers provide the most stability; patient lifts the walker, moves it forward, then steps into it—never use to pull up from sitting

Crutch gait selection depends on weight-bearing status and patient strength: 4-point (most stable), 3-point, 2-point, swing-to, swing-through Last updated: January 2026

Assistive Devices for Mobility When patients cannot ambulate independently, assistive devices provide support and stability. Each device has specific indications, proper fitting requirements, and safe usage techniques. Improper use can lead to falls, nerve damage, and other injuries. Crutches Crutches provide maximum support for patients who cannot bear weight on one or both legs. They require upper body strength and coordination. Types of Crutches

Type Description Best For Axillary (underarm) Most common; pads rest under arms Temporary use, younger patients Lofstrand (forearm) Cuffs around forearms Long-term use, more stability Platform Forearms rest on platforms Patients with weak grip or arthritis Proper Fitting of Axillary Crutches Correct sizing prevents nerve damage and promotes safe ambulation: Crutch length: 2-3 finger widths (approximately 1-1.5 inches) between axilla and crutch pad Handgrip position: Elbows flexed 20-30 degrees when hands are on grips Crutch tips: 4-6 inches to the side and 4-6 inches in front of feet CRITICAL SAFETY POINT: Weight must be borne on the HANDS, not the axillae. Pressure on the axillae can compress the brachial plexus nerves, causing "crutch palsy"—numbness, tingling, and weakness in the arms and hands. Crutch Gaits The appropriate gait depends on the patient's weight-bearing status and strength:

Gait Pattern Weight-Bearing Status Stability 4-Point Right crutch → Left foot → Left crutch → Right foot Partial on both legs Most stable, slowest 3-Point Both crutches + weak leg → Strong leg Non-weight-bearing on one leg Common for fractures 2-Point Right crutch + Left foot → Left crutch + Right foot Partial on both legs Faster than 4-point Swing-To Both crutches → Swing feet to crutches Non-weight-bearing Faster Swing-Through Both crutches → Swing feet past crutches Non-weight-bearing Fastest, requires strength Stair Navigation with Crutches Memory Device: "Up with the Good, Down with the Bad" This phrase helps patients remember the correct sequence: Going UP stairs: Strong (unaffected) leg goes up first Weak leg and crutches follow together Going DOWN stairs: Crutches and weak leg go down first Strong leg follows Rationale: The strong leg does the work of lifting the body up and controlling the descent down. Canes Canes provide minimal support and are appropriate for patients who need slight assistance with balance or have mild weakness on one side. Types of Canes

Type Description Stability Single-point (straight) One tip Least stable Quad cane (small base) Four tips, small base Moderate stability Quad cane (large base) Four tips, wide base Most stable Proper Fitting Height: Handle at level of greater trochanter (hip) or wrist crease when arm hangs at side Elbow flexion: 15-30 degrees when holding cane Which Side to Hold the Cane? Hold the cane on the STRONG (unaffected) side. This seems counterintuitive, but it provides a wider base of support when the weak leg steps forward. Walking Pattern with a Cane Move the cane forward simultaneously with the weak leg Then move the strong leg forward The cane and weak leg always move together Stair Navigation with a Cane Same principle as crutches: "Up with the Good, Down with the Bad" Going UP: Strong leg steps up first Weak leg and cane follow Going DOWN: Cane and weak leg step down first Strong leg follows Walkers Walkers provide the greatest stability of all assistive devices. They are ideal for patients with generalized weakness, poor balance, or those who need to rest during ambulation. Types of Walkers

Type Description Best For Standard (pickup) No wheels; must be lifted Maximum stability, slower pace Front-wheeled Two front wheels Easier to advance, still stable Four-wheeled (rollator) Four wheels with brakes, often has seat Faster ambulation, outdoor use Proper Fitting Height: Handles at hip level (greater trochanter) or wrist crease Elbow flexion: 15-30 degrees when hands on grips Width: Patient should fit comfortably inside frame Walking Pattern with a Standard Walker Lift the walker and move it forward (about arm's length) Step into the walker with the weak leg first Step with the strong leg Repeat SAFETY POINTS: Never use the walker to pull up from a seated position. The walker can tip and cause a fall. Instead, push up from the chair armrests. All four legs must be on the ground before stepping. For pickup walkers, ensure stability before advancing. Stair Navigation with a Walker Standard walkers are not safe for stairs. Patients should: Use a different device (cane, railing) for stairs Have a second walker on each floor Or use an elevator/stair lift Rollators with wheels are also unsafe on stairs due to rolling risk. Assistive Device Comparison

Feature Crutches Cane Walker Stability Moderate Low High Upper body strength needed High Low Low-Moderate Weight-bearing status Non-WB to Partial Partial to Full Partial to Full Speed Moderate Moderate-Fast Slow Best for Fractures, post-surgery Balance issues, mild weakness Generalized weakness, elderly Patient Teaching Points Regardless of device, teach patients these universal safety principles: Wear non-skid footwear — No slippers, bare feet, or smooth soles Clear pathways — Remove rugs, cords, and clutter Use adequate lighting — Especially at night Take your time — Rushing increases fall risk Rest when tired — Fatigue impairs coordination Check rubber tips regularly — Worn tips reduce traction Lock brakes on wheelchairs before transferring On the Exam NCLEX frequently tests: Cane placement: Remember—cane on the STRONG side, moves with the WEAK leg Stairs: "Up with the Good, Down with the Bad" Crutch safety: Weight on HANDS, not axillae Walker safety: Lift and move forward, don't use to pull up from chair Proper fitting: Elbow flexion 15-30 degrees, handle at hip level Key Takeaways Crutches: Weight on hands , 2-3 finger widths between axilla and pad Cane: Held on strong side , advances with weak leg Walker: Lift , move forward, then step into it Stairs: "Up with the Good, Down with the Bad" All devices: Proper fit = elbows flexed 15-30 degrees

Test Your Knowledge

A patient with a fractured right leg is learning to use crutches. When climbing stairs, what should the nurse teach?

Lead with the crutches and right leg going up

Lead with the left leg going up, then bring the right leg and crutches up

Use the crutches only, keeping both feet off the stairs

Lead with the right leg going up to strengthen it Check Answer Need a hint? AI

Test Your Knowledge

A patient with left-sided weakness needs to use a cane. On which side should the nurse instruct the patient to hold the cane?

On the left (affected) side

On the right (unaffected) side

Either side is acceptable

Alternate sides with each step Check Answer Need a hint? AI

Test Your Knowledge

A nurse is teaching a patient about crutch safety. Which statement by the patient indicates a need for further teaching?

"I should bear my weight on my hands, not under my arms."

"I need to keep the crutch tips about 6 inches from my feet."

"I can lean on the crutch pads under my arms when I get tired."

"I should check the rubber tips regularly for wear." Check Answer Need a hint? AI

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