Safety fails

• Students should be asking for a second person when they are getting up patients, and ask for them to be standing within safe arms reach of the patient (once this has been indicated to the examiner - the examiner can tell the student that they can assume they are there)
• Students should voice that they would check observations such as blood pressure and heart rate are stable and lines are clear
• They also need to check dizziness and nausea symptoms prior to getting the patient up, once they are sat up and after they have stood
• Students should a be checking the patient is aware of their weight bearing status at the beginning and directly prior to standing and sure they understand what that means. They should also demonstrate how a patient can maintain their weight bearing status using the appropriate mobility aid. (If they demonstrate the wrong weight bearing status without correcting themselves - this could be reason for a safety fail)
• Students should voice safety checks of equipment they are issuing (including checking for the safety sticker)
• 1. For stairs they should be below patient one step below with examiner within arm's reach to the side. At the top, they should ask the examiner to stay with the patient so they can come round to be in-front of the patient
• Before getting the pts up:

  • need pts to understand their weightbearing status
  • need to ask pts if theyre in pain and if theyre nauseas/dizzy
  • check if pts have taken their medication - make sure theyve taken their pain relief so theyre not in pain doing the rehab
  • check what the pts are in for
  • check their situation last night
  • check observation chart
  • check history of presenting condition
  • check relevant past medical history - e.g. RA will need gutter crutches
• • tubes attached to pts need to be either removed or mobilised
  • ask nurses if theyre actively measuring urine content, if theyre not, drain it and attach it to their leg under gown
• • after the pts have sat up ask again about their nauseousness/dizziness and pain to see if its changed since
  • MUST ALWAYS HAVE A SECOND PERSON NEXT TO PTS AT ALL TIMES - MUST SAY THAT IN THE EXAM
  • check pts footwear
• • have 2 sets of crutches (one to demonstrate and one for the pts)
  • have 1 zimmer frame for the pts
  • PTS CAN ONLY TOUCH ZIMMER FRAME ONCE THEYVE FULLY STOOD UP
  • guide pts on the way up with your hands
• always do a demonstration first in the exam
• • to transfer onto gutter crutch, have pts holding gutter frame and then transfer one arm onto one crutch, whilst holing onto the frame with the other arm, then transfer the other arm
  • to get off the gutter crutch, stand by the plinth, move one arm onto the gutter frame, then the other, then reach down to plinth with the good side, then the injured side
• • to measure gutter crutches you need to measure the gutter frames first - PRACTICE CHANGING HEIGHT OF GUTTER FRAME
  • there should be around 90 degrees of elbow flexion, without there being too much lumbar flexion on the gutter frame
  • for the gutter crutches get the pts to stand up right, holding onto gutter frame, with weight forward and with the elbow flexed to measure the height
• • 3 point gait is better than 2 point gait during early stage
  • 3 point gait = crutches forward first, then injured leg, then good leg
  • when walking backwards pts should walk in 2 point gait
  • 2 point gait = good leg back first, then injured leg along with crutches
  • to sit down, step back with good leg until you feel the edge of the chair
  • then make the H shape with crutches
  • then reach down with the good side
• • top of crutches must be in line with radial styloid process
  • poppers must be visible - crutches and frame
  • the holes should not be worn out - crutches and frame
  • the handles and ferrules should be firm - crutches and frame
  • elbow cuff must be just below the elbow
  • make sure height of the crutches are the same
  • front of the crutches should act as headlights and always be facing forwards
• Height of zimmer frame doesnt need to be measured, just get a good estimate
• • gutter frames and gutter crutches allow people who have wrist conditions such as RA to put weight through the forearm instead
  • this allows for weight to be forced forward without aggravating symptoms of the wrist