I. Assistive Devices & Mobility

Canes

Handle height: aligns with greater trochanter.

Elbow slightly flexed (15–30 degrees).

Too high → shrugging; too low → stooping → fall risk.

Walkers

Height at wrist crease with arms relaxed.

Promotes upright posture and stability.

Crutches (major safety trap)

Two to three finger widths between axilla and crutch pad.

Weight on hands only, never in armpits (brachial plexus injury risk).

Stairs mnemonic: Up with the good, down with the bad.

Up: good leg → crutches + bad leg.

Down: crutches + bad leg → good leg.

MRI Precautions

Remove hearing aids (metal components heat or pull).

Verify prosthetics for compatibility.

Prosthetic Limb Care

Daily skin checks.

Liner must be smooth to prevent pressure injuries.

II. Immobility & Skin Integrity

Tissue injury develops in as little as 2 hours of unrelieved pressure.

#1 priority for bedbound patient: reposition every 2 hours (more vital than specialty mattress).

Tools:

Trochanter roll → prevents external rotation.

Footboard → prevents foot drop.

Trapeze bar → increases independence and reduces shear.

Compression Devices (SCDs/TEDs)

Remove each shift for skin checks.

Contraindicated in arterial insufficiency (risk of ischemia, gangrene).

Safety First Scenario

Bedbound patient trying to get up: activate bed alarm and lower bed before anything else.

III. Comfort Measures (Non-Pharmacologic)

Cold therapy: avoid in Raynaud’s (vasoconstriction).

Heat: avoid on acute injuries or areas without sensation.

Distraction vs. guided imagery:

Distraction = short, procedural pain.

Guided imagery = chronic or long-duration pain.

IV. End-of-Life & Hospice Care

Terminal secretions (“death rattle”)

Appropriate: reposition, elevate head, possible scopolamine.

Avoid: deep suctioning (causes distress, minimal benefit).

Family concern: “Morphine will hasten death.”

Explain the principle of double effect: medication is used solely for comfort, not to shorten life.

Post-mortem priorities

Support family first.

Prepare body: dentures in, eyes closed, clean gown, tidy room.

Remove jewelry unless family requests otherwise (document carefully).

V. Nutrition & Aspiration Prevention

Aspiration Risk

Red flag: coughing after thin liquids.

Progression: nectar → honey → pudding thick.

Chin tuck recommended for safe swallowing.

Tube Feeding

High gastric residual (ex: above 350): stop feeding and notify provider.

Hydration Assessment

Most accurate: daily weights.

One kilogram change equals one liter of fluid.

VI. Elimination & Device Safety

Ostomy Teaching

Higher in the GI tract = more liquid output (ileostomy).

Lower in the GI tract = more formed stool (sigmoid).

Catheter Balloon Safety

Inflate only with the exact printed volume.

Overfilling → balloon rupture or trauma.

VII. Hygiene, VAP Prevention, & ICU Care

Ventilated patients require chlorhexidine oral care every 2 hours.

Includes brushing, suctioning, and mouth care bundle steps.

VIII. Delegation & Critical Thinking

UAP can reposition, but nurse must assess skin.

Understanding basic care enables correct prioritization and safe delegation.

IX. Complementary & Alternative Therapies (CAM)

Patient taking ginkgo biloba before surgery → MUST notify surgeon due to bleeding risk.

X. Final Clinical Principle

Sleep hygiene & clustering care dramatically improve recovery.

Basic care supports physiological healing in every system.

Need to reach out? Send an email to Brooke at [email protected]