Crutches Nursing NCLEX Review

This is a quick NCLEX review over crutches for nursing students!

Crutches are assistive devices used to help a patient ambulate. As the nurse you must know the following material about crutches:

• How to tell if the crutches properly fit the patient?
• The different types of gaits used for crutches?
  • Make sure you know this part completely because exams love to ask questions about the different type of gaits.
• How to go up and down stairs with crutches?
• How to sit down and get up from a chair with crutches?

Don’t forget to take the crutches quiz after reviewing this material.

Crutches Nursing Review

Crutches NCLEX Nursing Review

Properly Fit?

Before a patient uses crutches for the first time, each crutch must be adjusted to the patient’s height. Each crutch can be adjusted at the top and bottom. Below are some key concepts to help you tell if the crutches fit your patient properly.

Mains points to remember:

• There should be a 2-3 finger width (1-1.5 inches) gap between the armpit (axillae) and crutch rest pad when the patient holds the crutches.
  • WHY? This prevents the patient from resting on the crutch rest pad while using the crutches. The patient should place weight on the hand grips NOT the crutch rest pad while ambulating. This prevents nerve damage that can occur within the axillae region.
• The elbows should be flexed about 30 degrees when the hands are placed on the hand grips.

Types of Gaits?

When a patient is learning how to use crutches, the nurse should apply a gait belt to the patient for safety. When a patient is ready to start ambulating with crutches, they will start in the tripod position as demonstrated in the picture below. Each tip of the crutch will be about 6 inches to the side of the feet diagonally.

Below are the types of gaits you want to remember for exams. I highly suggest you watch the crutches video within this article to help you visually see how each gait is performed (this will help you understand it better).

Two-point gait: the patient will move the injured side’s crutch (example right crutch) at the SAME TIME as the non-injured leg (example left leg) AND then the patient will move the non-injured side’s crutch (example left crutch) at the SAME TIME as the injured leg (example right leg).

• So it goes: move right crutch along with the left leg and THEN move the left crutch along with the right leg.

Four-point gait: this type of gait is similar to the two-point gait BUT the crutch and leg move SEPARATELY rather than at the same time. For example, the patient will move the injured side’s crutch (example right crutch), then move the non-injured leg (example left leg), then move the non-injured side’s crutch (example left crutch), and then move injured leg (example right leg).

• So it goes: move right crutch, then move left leg, then move left crutch, and then move the right leg.

Three-point gait: the patient will not let the injured leg touch the ground….therefore, the patient will move BOTH crutches and the injured leg forward together and then move the non-injured leg.

• So it goes: move both crutches and injured leg forward together and then move the non-injured leg.

Swing-to-gait: the patient will move both crutches forward and then SWING both legs forward to the same point as the crutches.

Swing-through-gait: the patient will move both crutches forward and then SWING both legs forward, PAST the crutches.

Up and Down Stairs with Crutches?

Again, be sure you watch the video within these notes to help you visualize how to go up and down the stairs with crutches. The key to understanding what moves first (the good or bad leg) when either going up or down the stairs is to remember:

“Good=UP” and “Bad=Down”

• Going UP the stairs: the patient will move the “good” leg (hence non-injured leg) UP onto the step FIRST and then will move the “bad” leg (hence injured leg) and crutches up onto the step.
• Going DOWN the stairs: the patient will move both crutches down onto the step and then move the “bad” leg (hence injured leg) DOWN  and then move the “good” leg down.

Sitting Down and Getting Up from a Chair?

• Sitting Down: the patient will back up to the chair until they feel the chair with the back of their non-injured leg. The patient will then move BOTH crutches on to the INJURED side and grip the hand grips of the crutches for support. The patient will keep the injured leg extended out and slightly bend the non-injured leg. Then the patient will feel for the chair’s seat with the non-injured side and sit down…all while keeping the injured leg extended out.
• Getting Up: the patient will keep the injured leg extended out forward and put BOTH crutches on the INJURED side and grip the hand grips of the crutches. Then the patient will lean forward and push up with the arm of the non-injured site on the chair’s seat and by using the hand grips on the crutches, which is on the injured side. Once standing, the patient will bring the crutches into the tripod position.

You may also be interested in: Canes and Walkers

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