Describe the procedure for assisting a patient with a hemiparesis following a stroke when ambulating with a gait belt, specifically outlining safety considerations for both the patient and CNA.
Assisting a patient with hemiparesis (weakness on one side of the body) following a stroke during ambulation with a gait belt requires a careful, step-by-step procedure that prioritizes safety for both the patient and the Certified Nursing Assistant (CNA). Hemiparesis affects balance, coordination, and strength, making ambulation a high-risk activity for falls and injuries. The gait belt is an important tool in providing support but must be used correctly.
Before initiating ambulation, it's essential to assess the patient's current status. This includes checking the patient's vital signs to ensure they are stable enough for ambulation. It's also important to assess the patient’s mental status, including their awareness and ability to follow instructions. Furthermore, evaluate the patient's muscle strength on their affected side and any limitations. If they report pain or discomfort or show signs of distress, ambulation should be delayed or modified. For example, if the patient has a new onset of dizziness or lightheadedness or reports having severe pain in their affected leg, ambulation should be delayed until the issue is evaluated.
Next, gather all necessary equipment. This includes the appropriate size gait belt, assistive devices the patient normally uses (such as a walker or cane), and any footwear that will provide the patient good traction (no-slip, closed-toe shoes). Proper footwear is crucial to prevent slips and falls. Ensure the environment is clear of any obstacles such as cords, rugs, or furniture that could cause trips or falls. For example, before beginning the activity, move all objects in the room so the area is clear for walking. In addition, be sure that the area for walking is well-lit.
Apply the gait belt snugly around the patient's waist, making sure it is positioned correctly above the hips and below the rib cage. The belt should be snug enough to stay in place during ambulation but not too tight as to restrict breathing or cause discomfort. It's essential to ensure there is enough room between the belt and the patient to allow for handholds during assistance. A good rule is to fit two fingers comfortably between the belt and the patient. For example, if the gait belt is too loose it might slide up the patient and provide inadequate support, but if too tight, the patient might feel discomfort or have difficulty breathing. Make sure the patient knows that the belt is there to support them and provide security, and not to pull them or lift them.
Explain the procedure to the patient before beginning. Communicate clearly about the plan, the process, and your role in assisting them, reassuring them and making them feel comfortable. This includes the planned path, and any turns or stops that may be necessary. Encourage their participation while reassuring them that you will support them throughout the process. For example, if the patient understands what is going to happen and knows you will assist them throughout the process, they will be more cooperative.
When initiating ambulation, stand on the patient’s weaker side to provide support and stability to prevent falls towards the weakened side. Hold the gait belt with a firm underhand grip, usually with one hand on each side of the patient. As the patient begins to ambulate, maintain a wide base of support and keep your center of gravity low by bending your knees, not your back. Walk slowly and at a pace that is comfortable for the patient, being mindful of their limitations. As the patient walks, encourage them to look ahead to help maintain balance and encourage them to take small steps. Observe the patient for any signs of fatigue, dizziness, or pain, and be prepared to stop if necessary. For example, if the patient begins to sway or appears tired, slow down or stop and allow them to rest. Use communication to ensure you are both on the same page.
During the walk, continually assess the patient’s balance and gait. If the patient starts to fall, use the gait belt to guide them gently to the floor. Never attempt to catch a falling patient by pulling them upright. This can cause injury to both the patient and the CNA. Instead, widen your stance and lower the patient carefully towards the ground, protecting their head. Once the patient is safely on the floor, assist them to a chair or the bed. For example, if the patient loses their balance, slowly guide them down while ensuring their head is protected from striking against the ground or other surfaces.
Once the ambulation session is complete, assist the patient to a safe location, whether a chair or a bed. Remove the gait belt and check for any skin irritation. Document the ambulation activity, including the duration, distance walked, and the patient's tolerance of the activity, including any difficulties experienced. For example, if the patient is fatigued after only a short walk, document that and communicate with the other healthcare team members. It is also important to document if the patient tolerated the activity well with no issues.
Safety considerations for the CNA include using good body mechanics (bending knees, not back, using wide base of support) to prevent injury and ensuring the gait belt is used correctly. Safety considerations for the patient include using proper footwear, maintaining clear pathways and being aware of their limitations, and communicating if pain or fatigue occurs. In conclusion, ambulation with a gait belt for a patient with hemiparesis requires a thoughtful and methodical approach, focused on both the patient's safety and the CNA's wellbeing.