Mobility - Ambulation: Nursing skills

Ambulation means “walking,” and your client might need to ambulate to get to places or may need to do it to prevent atrophy, which is when muscles waste away from prolonged bed rest.

Other health problems from long-term immobility include decreased cardiovascular and pulmonary functions, poor digestion, pressure injuries, contractures, urinary problems, and many others. So, even if they require assistance, clients are encouraged to ambulate frequently.

Before we talk about ambulation assistance, here are some general considerations. Start by checking the client’s chart for information on their most recent ambulation. This will let you know if the client tolerated the activity, if they had any difficulty, if an assistive device like a walker or cane was needed, or if they have a history of falls.

It can also be helpful to review the client’s medication list to see if they are taking medications that might make them a higher risk for falls, like pain medications which can cause lethargy or blood pressure reducing medications which can cause dizziness.

Next explain to the client how far you’ll be walking and how you will assist them. If an ambulatory device is needed, check to see if it’s functional. Make sure the route is not slippery and that there are no obstacles. Make sure IV lines and poles are free from tangles and that the IV pump is unplugged from the wall and has enough battery to last during ambulation. Make sure they’re properly dressed and wearing non-skid footwear.

During ambulation, encourage them to walk normally without shuffling or sliding. You might need an additional assistant if the person’s unbalanced, weak, or not cooperative. Finally, and most importantly, be sure not to leave the client’s side at any time during the process.

Now, before getting a resting person to stand and walk, you need to get them into a sitting, or “dangling,” position, where they sit erect with their feet dangling off the side of the bed. The main reason for this is to protect against falling. One common cause of falls is orthostatic hypotension, where blood rushes into the legs as the person shifts into an upright position, causing a drop in blood pressure and decreased blood flow to the brain. It can result in dizziness or even fainting, especially in the elderly. If you have the person stand in this condition, it could lead to falls, so having them sit in the dangling position will help their body adjust without the risk.