WE'RE STARTING THE SECOND
WEEK OF THE SECOND MODULE.

SO, JUST A REMINDER, NO
BLACKBOARD THIS WEEK.

ALRIGHT. YOU SOME OF THOSE
QUESTIONS ABOUT RESTRAINTS

AND WALKERS AND CANES. ANYONE?

HAVEN'T READ ALL THAT YET, SO.
WE'LL CATCH UP ON THAT.

BUT IT HELPS YOU GET AHEAD
A LITTLE ON YOUR READING

AND KIND OF KNOW WHAT
I'M TALKING ABOUT.

SO, I DID WANT TO ADDRESS
A FEW THINGS

THAT WE'RE NOT GOING TO
BE ABLE TO TEST ON,

BUT THE THINGS YOU NEED
TO BE AWARE OF

AND YOU MIGHT WANT TO REVISIT
WHEN YOU'RE DOING YOUR READING.

AND THOSE THINGS ARE SAFETY,
FIRE SAFETY, AMBULATION,
FALLS.

AND I DO WANT TO GO
OVER THE HOYER LIFT.

THERE'S A LOT OF MACHINERY
THAT'S OUT THERE FOR YOU TO USE,

A LOT OF TECHNOLOGY, BUT
WE DON'T HAVE IT ALL.

BUT SOMETIMES IF YOU JUST GET
THE BASICS OF A FEW THINGS,

YOU CAN APPRECIATE THE OTHERS
WHEN YOU RUN INTO THEM.

SO, LET'S DO THE
HOYER LIFT FIRST

AND THAT WAY YOU CAN SIT
AND LISTEN TO THE REST.

ALRIGHT, LINDSAY, OUR GRACIOUS
VOLUNTEER, IS UNABLE TO GET OUT
OF BED.

AND IF SOMEONE CAN'T
BEAR THEIR WEIGHT,

BUT THEY CAN SIT UP IN A CHAIR,
MAYBE A QUADRIPLEGIC, A
PARAPLEGIC,

SOMETHING WITH A GENERAL
WEAKNESS, A MASS
THAT'S GOTTEN WORSE

AND THEY JUST HAVE
A LOT OF WEAKNESS,
SOMEONE THAT'S GROSSLY OBESE

AND YOU CAN'T GET THEM
UP BY YOURSELF.

THERE'S JUST A LOT OF SCENARIOS,
THEN YOU CAN USE A LIFT.

THIS PARTICULAR LIFT IS PORTABLE

AND YOU COULD GET IT OUT FROM
CENTRAL SUPPLY OR SOMETHING

AND GET YOUR LIFT, MAYBE
ON THE FLOORS.

SOME OF THE LIFTS ARE
BUILT INTO THE ROOMS.

AND YOU'LL SEE A MECHANICAL
LIFT FROM THE CEILING

AND YOU CAN JUST ATTACH THE
SLING FROM THE CEILING LIFT

AND THEN MOVE THEM TO THEIR
LOCATIONS.

SO THEY'RE IN VARIOUS
AND IN SUNDRY PLACES.

THE PRINCIPLE IS BASICALLY THE
SAME AS TO HOW YOU WOULD USE IT.

MY LIFT IS FAIRLY NEW.

AND SO IT'S A LITTLE DIFFERENT
AS FAR AS SETTING IT UP.

SOME OF THE LIFTS THAT YOU'LL
SEE IN YOUR INSTITUTIONS

AND I WOULD ENCOURAGE YOU WHEN
YOU TAKE YOUR FIRST TOUR

AND YOU DO YOUR SCAVENGER HUNTS
AND THAT KIND OF STUFF
THE FIRST DAY,

THAT YOU SEE IF YOU
CAN FIND A HOYER LIFT

AND SEE HOW OLD IT IS
AND SEE HOW IT WORKS.

OKAY. AND SEE IF YOU CAN
IDENTIFY SOME MARKINGS ON IT.

BECAUSE MANY OF THOSE CLIENTS
NEED HELP GETTING UP.

ALRIGHT. SO I KNOW MY
CLIENT NEEDS HELP,

AND I ALSO KNOW
THAT I PROBABLY SHOULDN'T
DO A HOYER LIFT BY MYSELF,

SO I SHOULD HAVE ASKED
FOR ONE MORE VOLUNTEER.

SO COULD I HAVE ONE MORE
VOLUNTEER
THAT'S JUST A STANDBY, SPOTTER.

BRIAN'S GOING TO GO
FOR IT. COME ON DOWN.

WHENEVER YOU GET SOMEONE UP IN A
LIFT YOU SHOULD ALWAYS
HAVE TWO PEOPLE.

AND SOMETIMES MORE,
DEPENDING ON THE WEIGHT OR
THE AWKWARDNESS OF THE MANEUVER.

BUT YOU WANT A STANDBY, YOU WANT
TO MAKE SURE SOMEONE'S WATCHING.

THAT THEY DON'T BUMP THEIR
HEAD, CATCH THEIR FEET,

TIP THINGS OVER AND
THAT KIND OF STUFF.

ALRIGHT. SO I WOULD HAVE
CHECKED MY DOCTOR'S ORDERS.

AND THE DOCTOR'S PROBABLY NOT
GOING TO ORDER A HOYER LIFT.

THERE'S NO CHARGE FOR IT.
IT'S JUST TO HELP US.

SO IT'S PROBABLY GOING TO BE IN
THE CARE PLAN IN THE CHART,
WHERE THEY SAY,

"UNABLE TO MOVE SELF. NEED
FOUR PEOPLE FOR A TURN.

TWO PEOPLE. HOYER LIFT
TO GET UP ON A CHAIR."

YOU'RE GOING TO GET YOUR
CLUES FROM THERE.

AS FAR AS GATHERING UP
EQUIPMENT, ALL I NEED
IS THE HOYER LIFT,

WHICH COMES WITH A SLING. SO
YOU'RE GOING TO FIND
A SLING ATTACHMENT.

AND THEN I WOULD
NEED TO ANTICIPATE

WHERE I'M GOING TO PUT THE
CLIENT AFTER I GET HIM UP.

SO, I THINK, I'D LIKE TO PUT
MY CLIENT IN A WHEELCHAIR.

SO I HAVE A WHEELCHAIR READY
TO GO ONCE WE HAVE HER UP.

AND THAT'S ALL
THE EQUIPMENT I NEED.

YOU MIGHT WANT TO GET A
BATH BLANKET FOR PRIVACY

IF YOU WANT TO DRAPE THEM.

WHATEVER. THEY NEED SHOES,
ROBES, PRIVACY,
BUT SHE'S FULLY DRESSED.

AND WE'RE OKAY, THEN.

ALRIGHT. I WASHED MY HANDS.
YOU WASHED YOUR HANDS.
WE'RE GOOD TO GO.

ALRIGHT. I'M GOING TO
COME IN MY ROOM,

I'VE IDENTIFIED MY CLIENT,
WHICH IS LINDSAY.

- WHAT'S YOUR LAST NAME?
- MADDOX.

AND LINDSAY, I'M DIANE, I'M
GOING TO BE YOUR NURSE TODAY.

AND THE DOCTOR REALLY WANTS
YOU TO GET UP IN A CHAIR.

IT'LL BE NICE TO SIT UP A LITTLE
BIT AND EAT YOUR FOOD.

AND WE'LL GET YOUR LINEN
ALL STRAIGHTENED UP.

THAT WILL BE MUCH EASIER THAN
ROLLING YOU ALL OVER THE BED.

SO, WE'RE GOING TO GET YOU UP
TODAY IN THIS HOYER LIFT.

HAVE YOU EVER BEEN UP IN A
HOYER LIFT BEFORE? - NO.

WELL, IT IS AN ADVENTURE. AND
WHAT WE'RE GOING TO DO..

THINK OF LIKE A HAMMOCK OR A
SLING AND WE'RE GOING TO..

I'M GOING TO ROLL
YOU TO ONE SIDE

AND PUT IT DOWN AND ROLL
YOU TO THE OTHER.

AND THAT WILL SIT UNDERNEATH
YOU LIKE A SLING

AND THEN I'M GOING
TO PUT HOOKS ON IT.

AND WE'RE JUST GOING TO PUMP
IT UP AND YOU'LL BE LIKE
IN A HAMMOCK SWING.

WE'LL SLIDE YOU OUT, PUT
YOU IN THE WHEELCHAIR.

BRIAN'S GOING TO HELP
ME AND MAKE SURE YOU

DON'T BONK YOUR HEAD
ON ANYTHING, OKAY?

WE'LL GET YOU UP IN A CHAIR.
KIND OF, TALK TO YOU AS WE GO,

SO YOU'LL KNOW WHAT TO DO.

AND I WOULD MAKE SURE
I PROVIDE PRIVACY, SO THE
WHOLE WORLD DOESN'T SEE.

THIS UP-AND-DOWN.

ALRIGHT. FIRST THINGS FIRST,
I'M GOING TO PUT THE BED UP,

BECAUSE I NEED TO PUT THE FEET
OF THIS HOYER LIFT
UNDER THE BED.

AND THEY WONT FIT IF I
DON'T GET THE BED UP.

NOT TO MENTION IT'S EASIER FOR
US TO ROLL BACK AND FORTH

IF SHE IS AT OUR HEIGHT.

OKAY.

ON THE LIFT IS THE SLING.

THEY'VE JUST, KIND OF, STORED
IT HERE. THEY PUT THEM
IN ALL SORTS OF PLACES.

THIS IS ONE MODEL OF A SLING.
AND IT'S A WHOLE SLING.

THE SLING DOESN'T HAVE
ANY HOLES IN IT

OR ANYTHING SPECIAL TO IDENTIFY
THE TOP OR THE BOTTOM,

EXCEPT FOR THE THIS LITTLE
DART AT THE BOTTOM,

WHICH TELLS US THAT'S
WHERE THE BUTTOCKS GO.

THERE IS ANOTHER SLING
THAT THEY MADE

AND IT HAS A HUGE HOLE
CUT OUT AT THE MIDDLE.

AND IT'S TO HELP PEOPLE GET
UP AND GO TO THE BATHROOM.

SO YOU WANT TO MAKE SURE THAT
WHEN YOU'RE PUTTING
IT UNDERNEATH

AND YOU POSITION IT CORRECTLY.

BUT PEOPLE GO TO
THE BATHROOM BETTER,

IF YOU'RE DOING BOWEL
AND BLADDER TRAINING,

IF THEY SIT UP AND HAVE GRAVITY
HELPING THINGS OUT

RATHER THAN LAYING DOWN.

SO IDENTIFY YOUR TOP AND YOUR
BOTTOM.

AND THEN THE FIRST THING
I WANT YOU TO DO IS..

LINDSAY, CAN YOU ROLL OVER
ON YOUR SIDE?

YEAH, SHE CAN.
SO SHE ROLLS OVER.

OKAY. WHAT I'M GOING TO DO IS
I'M GOING TO GET THIS SITUATED.

AND I WANT TO MARK HER BOTTOM IS

AND I'M GOING TO ROLL
HALF OF IT HERE..

..TOWARDS ME.

AND THEN, THAT LOOKS LIKE
SHE'LL LAND PRETTY GOOD.

ALRIGHT, LINDSAY, THERE'S A LUMP
OF LINEN FROM THAT SLING.

SO IF YOU COULD ROLL OVER
THE LUMP TOWARDS ME,

JUST ROLL A LITTLE MORE
TOWARDS ME.

AND THEN, BRIAN IF YOU'LL
PULL THAT OUT...

OKAY, AND THEN ROLL BACK. AND
IT LOOKS LIKE SHE LANDED.

OKAY, THIS IS THE PERFECT
SIZE FOR HER

BECAUSE HER HEAD FITS
IN THE SLING.

AND HER BOTTOM'S IN THAT,
SHE'S GOT GOOD THIGH SUPPORT.

WHEREAS, SOMETIMES, IF
SOMEONE IS REALLY TALL,

LIKE CHRIS, IF WE WERE PUTTING
YOU BACK IN HERE LIKE LAST WEEK,

YOUR HEAD WOULD PROBABLY
HANG OFF THE TOP.

SO, YOU NEED SOMEONE TO
GIVE SUPPORT TO THE HEAD

BECAUSE THEY DON'T MAKE THESE
IN, LIKE, SUPER LONG SIZES
OR ANYTHING.

IT'S KIND OF ONE SIZE,
FITS ALL OF THEM.

ALRIGHT. THE NEXT THING
I NEED TO DO --

THE NEXT THING I NEED TO DO
IS GET MY LIFT SITUATED.

AND I WANT TO EXPLAIN
A COUPLE OF THINGS.

DOES IT SAY ON THIS SIDE?
YES, IT DOES.

THE FIRST THING THAT
YOU WANT TO DO IS,

MAKE SURE YOUR LIFT WILL SUPPORT
THE CLIENT YOU'RE LIFTING.

SO, HOW MANY POUNDS DO YOU THINK
THIS WILL LIFT? - 450.

450. BUT THEY DON'T ALL SAY.
AND LOOK ON THOSE OLD ONES.

THEY DON'T HAVE TAGS ON THEM.
THEY'RE REAL OLD.

AND SO, YOU'RE GOING TO HAVE
TO FIND OUT FROM YOUR
CENTRAL SUPPLY AREA,

FROM YOUR PLAN OPERATIONS, WHAT
IS THE WEIGHT LIMIT
FOR YOUR SLING.

THE NEXT THING YOU WANT TO KNOW
IS JUST BASICALLY HOW IT WORKS.

AND WE'RE GOING TO BE HOOKING
ON OUR SLING ON TO HERE.

BUT THE MAIN THING
I'M CONCERNED ABOUT RIGHT NOW
IS MY BASE OF SUPPORT,

WHICH IS DOWN HERE.

REMEMBER, JUST AS WE DID IN BODY
MECHANICS, IN MACHINE MECHANICS,

WE HAVE TO DO THE SAME THING.

AND RIGHT NOW I HAVE A PRETTY
NARROW BASE OF SUPPORT,

WHICH IS FINE FOR WHEN
I AM JUST MOVING IT

FROM ROOM TO ROOM, BED TO BED.

BUT I'M GOING TO NEED TO DO
WHEN I START LIFTING HER

WITH THIS PIECE RIGHT HERE,

WIDEN MY BASE OF SUPPORT
SO THAT IT'S STEADY.

CAN YOU SEE? IT WENT WIDE,
SO IT'LL SUPPORT HER.

AND IT'S ON THIS BAR RIGHT HERE.

I ALSO HAVE BRAKES ON MY WHEELS

FOR WHEN I'M PUTTING HER
IN SO IT DOESN'T START
SHIFTING AROUND.

I HAVE A LEVER HERE
TO PUMP THE BAR UP,

SO THAT I CAN LIFT HER
OUT OF THE BED.

THERE IS A LITTLE --
I SAW IT TOO.
THERE ARE SO MANY THINGS.

THERE IS A LITTLE LEVER
RIGHT HERE THAT RELEASES
THE PRESSURE IN THE VALVE

OR THE VALVE RELEASES THE
PRESSURE IN THIS ARM
WHEN YOU TURN IT.

AND IT MAKES IT GO DOWN.

SO THAT'S HOW I'M GOING
TO LOWER HER.

AND I HAVE TO HAVE IT IN A
LOCKED POSITION TO GET HER IN.

AND I DON'T WANT IT TOO HIGH
BECAUSE MY STUFF WON'T REACH.

ALRIGHT. I'M GOING TO SLIDE
THIS UNDER THE BED FRAME

AND GET IT PRETTY
MUCH RIGHT HERE.

I'M GOING TO LOCK, OR SPREAD
MY BASE OF SUPPORT,

AND LOCK MY WHEELS.

AND THAT'S VERY GOOD. OKAY.

THE NEXT TRICK IS --
AND BRIAN OUR SIDES HERE
ARE EXACTLY THE SAME,

IS TO ESTIMATE ON THIS,

WHICH OF THESE LOOPS WILL
PUT HER IN THE BEST
SITTING POSITION.

AND THE WAY THAT THEY
CALIBRATED IT IS THAT

IF YOU DECIDED THAT
GREEN IS THE BEST,

BECAUSE SHE'S SMALL, WE MAY GO
GREEN AND GREEN, THAT'LL MATCH.

WE WANT IT TO BE HIGHER,
SHORTER ON THIS END

SO THAT IT PULLS HER
HEAD UP TO SITTING

AND LONGER ON THE BOTTOM END SO
THAT SHE'S SITTING. ALRIGHT.

I'VE ALWAYS USED PURPLE,
BUT I'VE ALWAYS HAD A LITTLE
BIGGER CANDIDATE IN HERE.

SO I'M GOING TO JUST TEST GREEN.

OKAY, WELL, LET'S JUST TRY.
WE'LL KNOW THE LOOK.

ON THE TOP AROUND HERE AND
THEN YOU CAN DO THE TOP
OR THE BOTTOM.

AND THIS HOOK GREEN.

WE'LL SEE WHAT HAPPENS WHEN
WE START LIFTING IT.

AND WE'RE NOT GOING TO GO
ANYWHERE.

YOU KNOW, SHE'S STILL IN THE
BED. SHE'S NOT GOING TO FALL.

KEEP YOUR HANDS IN AND WE'LL SEE
HOW IT FEELS AS IT'S COMING UP.

AND IF IT'S TOO WEIRD, I'LL JUST
LOWER YOU DOWN AND WE'LL
READJUST.

ON THE OLDER HOYER LIFTS,
THERE ARE CHAINS.

YOU'LL SEE THAT THESE LITTLE
SLINGS HAVE CHAINS,
AND YOU'RE COUNTING LINKS.

AND SO, YOU'RE GOING TO DO,
LIKE, THREE OR FOUR OR FIVE
LINKS HERE

AND, LIKE, EIGHT LINKS HERE.

SO YOU GET THAT LONG
AND SHORTER PULL.

IT'S A LITTLE BIT DIFFERENT.
SO I WANT YOU TO BE
LOOKING FOR THAT.

ALRIGHT.

I'M GOING TO JUST
START PUMPING HERE.

AND BRIAN, YOU'RE GOING TO
WATCH, BECAUSE THIS SWIVELS

AND YOU JUST DON'T WANT HER
TO BUMP HER HEAD ON HERE.

WE'RE GOING TO WANT IT TO SWIVEL
IN A LITTLE BIT. THAT'S OKAY.

BUT THAT'S WHAT TENDS TO HAPPEN.

SHE ACTUALLY IS ENDING UP
MORE LAYING THAN SITTING.

SO I'M GOING TO LOWER THIS.

I WANT YOU TO.. LET'S PUT
HER ON PURPLE AND BLUE

AND WE'LL GET HER MORE SITTING.
YOU DO THAT.

- WE'LL GET YOU MORE SITTING.
- YOU'RE DROPPING
ALL THE WAY ON...

THANK YOU. THAT'S WHY YOU HAVE
TWO PEOPLE THAT SAY,
"HEY, WATCH IT."

SO I NEED PURPLE.

I THINK YOU PURPLE AND I THINK
I'M GOING TO GO BLUE.

LET'S SEE WHAT WE COME UP
WITH HERE.

ALRIGHT. LET'S TRY THIS
ONE MORE TIME.

WHAT?

NOW THIS IS GOOD. MUCH BETTER.

PUMP HER. MAKE HER BETTER. YOU
CAN LET YOUR KNEES RELAX

AND JUST GO SITTING.

AND..

I THINK SHE'S GOOD. ALRIGHT.

BRIAN, I THINK IT WOULD BE BEST
IF YOU CAME ON THIS SIDE.

I'M GOING TO UNLOCK. I'M
GOING TO PULL HER OUT.

AND WHAT WE WANT TO DO HERE..

THIS IS WHERE YOU WANT
TO WATCH YOUR HEAD.

I MEAN, PEOPLE START SPINNING
AROUND AND STUFF.

NOW WHAT WE WANT TO DO IS,
SPIN HER TOWARDS YOU.

NO, HEAD TOWARDS YOU.

- THAT'S WHAT I WAS DOING.
IT'S FINE. SORRY.
- WHICH WAY ARE YOU GOING?

WHAT IS IT? WE DON'T HAVE
MUCH SPIN THERE. OKAY.

WELL, LET'S DO THIS.
I THINK SHE'LL SPIN WHEN
WE INCH THIS WAY.

OKAY, I'M GOING TO STOP RIGHT
NOW AND HIT SOME BRAKES.

AND GET MY WHEELCHAIR READY

BECAUSE I WANT YOU TO COME
DOWN INTO THE WHEELCHAIR.

HOW ARE YOU DOING THERE,
LINDSAY? WONDERFUL.

AND I HAVE MY WHEELCHAIR
IN AND MY WHEEL LOCK SET.

BUT I WANT YOU TO APPRECIATE,
AS SHE'S GOING DOWN.

WATCH A COUPLE OF THINGS. ONE,
AS SHE GOES DOWN. BUT, TWO..

I'M GOING TO HAVE, BRIAN..
I'M GOING TO HAVE YOU,

KIND OF, LOWER HER
AND STABILIZE HER.

BUT I'M GOING TO BE THE ONE
THAT'S GOING TO SITUATE HER
IN THE CHAIR.

IF YOU LOOK CAREFULLY..
I'LL SPIN YOU A LITTLE BIT HERE,
LINDSAY, FOR SHOW AND TELL.

BUT UNDERNEATH THIS ARE
LITTLE HAND GRABS,

FOR ME TO PULL HER LIKE THIS
FOR WHEN SHE GOES DOWN.

OKAY, SO THAT SHE ENDS
IN A SITTING POSITION.

SO I'M GOING TO BE PULLING HER
BUTTOCKS BACK AND SHE'LL LAND.

BUT WATCH HOW THE
WHEELCHAIR TIPS.

REMEMBER, THESE ARE WHEEL
LOCKS THEY'RE NOT BRAKES.

IF IT'S GOING TO TIP A LITTLE
LIKE THIS BECAUSE
OF THE AWKWARD ANGLE...

ALRIGHT. I'M GOING TO PUT
YOU IN CHARGE OF THE VALVE.

LET'S SEE IF HE GIVES YOU THE
SLOW RELEASE OR THE PSHHIK.

HEAVY, HUH? BUT, WE'RE SET HERE.
AND HE'S GOOD TO YOU.

- JUST LIKE AN ENGINE REPORTS.
- UH-HUH. EXACTLY.

LINDSAY'S JUST NICE AND LIGHT
AND THIS IS SO EASY THAT I
PULLED HER BACK,

SEE HOW IT JUST TIPS
A LITTLE BIT.

BUT I'M ABLE TO PULL
HER BUTTOCKS NICE.

OKAY, NOW THIS IS WHERE WE
NEED TO WATCH HER HEAD.

- GET HER OUT A LITTLE BIT MORE.
- I THINK SHE'S GOOD. YEAH.

WATCH HER AND STOP.
WE JUST NEED A TIP TO
BE ABLE TO GET THESE OFF.

OH-H, YOU HAVE A MAN WORKING.
- YEAH.

OKAY, SO THEN, WE'VE WATCHED
HER HEAD, NO INJURIES.

YOU GOT BRAKES ON, REMEMBER?

YOU JUST KICK THOSE OFF.

THERE YOU GO.

IT'LL COME OUT.

OKAY. SO MY CLIENT.. HOW
DO YOU FEEL IN THE CHAIR?

GOOD BODY ALIGNMENT. OKAY,
SO I HAVE HER GOOD.

IF I DIDN'T, I WOULD
HAVE BRIAN COME DOWN

AND DO KNEES OR DEPENDING
ON WHICH END I NEEDED,

I WOULD COME UNDERNEATH
LIKE THIS.

AND ON THE COUNT OF THREE,
I'D HAVE HIM PUSH IN KNEES
AND I WOULD PULL UP,

ONE, TWO, THREE. WE DON'T
HAVE ANY PLACE TO GO.

BUT THAT'S HOW I WOULD SITUATE
HER AGAIN IN THE CHAIR.

SHE'S GOOD. IF I NEEDED
SOMETHING TO HOLD HER STRAIGHT,

I'D MAYBE PUT A BELT OR
SOMETHING ON THE TABLE
IN FRONT OF HER.

LEAVE THE SLING UNDER, DON'T
TRY TO TAKE IT OFF,

BECAUSE THAT'S THE SAME WAY
WE'RE GOING TO PUT HER BACK.

AND THERE WE GO.
SO, IT'S BEEN HOURS,
SHE'S READY TO GO BACK TO BED.

SO, WE'RE GOING TO PUT
HER BACK THE SAME WAY.

OH. WATCH HEADS, HEADS, HEADS.

I THINK THIS IS THE
MOST DANGEROUS PART
OF THE WHOLE THING.

BECAUSE, YOU GET WHEEL FOCUSED
AND YOU'RE BANGING

AND ALL OF A SUDDEN, YOU'VE
WONKED THEM IN THE HEAD, SO.

WE'RE WATCHING OUT FOR
YOU, LINDSAY. OKAY.

WE'RE GOING TO DO THE SAME
THING WE DID BEFORE.

WE'RE GOING TO HOOK YOU UP
IN THE SLING, YOU KNOW,

AND IT'LL FEEL LIKE A HAMMOCK.

PUT YOU BACK IN THE BED,
LOWER YOU DOWN. YOUR SHEETS
ARE ALL CLEAN. OKAY.

AND I DID BLUE AND
YOU DID PURPLE.

AND THOSE ARE THINGS
THAT YOU NEED TO BE WRITING
IN THE NURSING CARDEX

AND CARE PLANS, SO PEOPLE
AREN'T HAVING TO GUESSTIMATE

AND GIVE HER A LITTLE WILD
RIDE EVERY TIME SHE..

WHENEVER YOUR HANDS ARE
FULL, LIKE, TELL ME..

OKAY. I THINK I'M GOOD.

IF YOU WANT TO JUST, YEAH,
PUT YOUR HEAD UP OVER HERE.

WATCH MY HEAD. WHOA.

YEAH, THIS IS THE
TRICKY PART HERE.

IF I BEND IT, DOES THAT HELP?
- YEAH.

- WE GOT TWO PURPLES. - YEAH.

NOW, HE'S GOING TO CRANK,
I'M GOING TO JUST STAND BY.

I'M GOING TO WATCH HEADS,
BODY PARTS,

MAKE SURE ALL OUR LOOPS ARE
IN. KEEPS YOUR HANDS IN.

WATCH YOUR HEAD HERE
STILL A LITTLE BIT.

AND I WANT MY BRAKES ON.
ARE YOU BRAKES ON? YEAH.

I DON'T CARE IF THE CHAIR
TIPS A LITTLE BIT

BECAUSE I CAN'T REALLY
PULL IT OUT TO YOUR..

I CAN GET REALLY MY CHAIR.

JUST LEAN BACK AND RELAX.
THERE YOU GO.

DON'T JUST FALL INTO HELL.

- SURE.

OKAY, I THINK WE'RE GOOD.

UH-HUH. SO TAKE THE BRAKES
OFF THE WHEELS,

I'LL LET YOU STEER THIS TIME.

I'LL WATCH THE BODY.

NOW, THE THING IS.. OKAY,
WATCH YOUR WHEEL QUICKLY.

COME BACK, BACK. IN HERE.

OKAY, I'M GOING TO GO TO THE
OTHER SIDE, NOW THAT SHE'S
OVER THE BED.

AND WE'VE GOT TO GET HER
STRAIGHT ON THE BED.

SO, IF YOU CAN LIFT HER... YEAH.

THE THING HERE IS THAT WE
WANT TO GET HER SITUATED.

IF SHE HAS TROUBLE MOVING,

WE WANT TO GET HER AS HIGH
UP IN THE BED AS POSSIBLE.

THINK THROUGH THE WHOLE
MANEUVER SO YOU'RE NOT

PULLING UP AND DOING ALL THAT.

SO, I THINK SHE LOOKS GOOD HERE.

JUST LOCK THOSE WHEELS. OH,
THAT'S A GOOD SOUND.

A LITTLE LOWER AND I'LL
WATCH FOR POSITION.

BECAUSE I CAN STILL PULL
AND MANEUVER HERE.

AND THAT SHE'S CENTERED.

GOOD.

YOU CAN STILL A LITTLE BIT
FURTHER, I THINK YOU CAN FEEL
IT'S PRETTY TIGHT.

LITTLE LOWER.

ALRIGHT.

THAT'S CLEAR.

ALRIGHT. WHEN BRIAN GETS
TO THIS SIDE OF THE BED,

I'LL HAVE YOU ROLL TOWARDS HIM.

I DON'T WANT HER TO ROLL
WITH THAT SIDE RAIL DOWN.

SO ROLL TOWARDS BRIAN, I'M GOING
TO ROLL THIS UNDERNEATH YOU

TO GET IT OUT HALFWAY.

AND IF YOU ONLY GOT THA T
BIG LUMP OF LINEN THERE..

SO IF YOU CAN COME
BACK TOWARDS ME.

AND HE'LL PULL THAT OUT
AND HERE AND THERE.

TA-DA! SHE'S GOOD. SIDE RAIL..
DON'T GET UP YET,

WE PUT THE BED
IN A LOW POSITION.

WASH YOUR HANDS AND DOCUMENT.
AND WE WOULD DOCUMENT THE LIFT.

THAT WE USED A HOYER LIFT.

WE WOULD DOCUMENT HOW LONG SHE
WAS UP IN THE CHAIR, HOW SHE
TOLERATED IT.

BUT IT'S NICE, I DON'T FEEL
STRAINED WHATSOEVER

OTHER THAN A LITTLE OUT OF
BREATH JUST FROM RUSHING AROUND.

NOT.. YOU KNOW, I DON'T FEEL
PHYSICALLY STRAINED OR ANYTHING.

THAT'S BEAUTIFUL. FEET DOWN.

THANK YOU VERY MUCH.
HOW WAS THE RIDE?

- IT WAS FUN.
- IT'S A WEIRD FEEL.

IT'S A WEIRD FEEL DOWN. SO, YOU
KNOW, A COUPLE OF MINUTES
ANTICIPATE WEIRDNESS, I GUESS.

ALRIGHT. THAT'S GREAT.

I'M GOING TO TAKE A LITTLE
INTERMISSION HERE.

BRAKES. THEY'RE WHEEL LOCKS.

SO THEY CAN MOVE AND SLIDE WHEN
YOU PUT PEOPLE IN THEM.

SO YOU NEED TO BE PREPARED
FOR THAT.

WHEN I TRANSFER PEOPLE OUT
OF BEDS OR WHEELCHAIRS,

ESPECIALLY IF THEY'RE NOT VERY
STRONG AND VERY HELPFUL,

I TRY TO ALWAYS MAKE SURE MY
WHEELCHAIR IS AGAINST THE WALL.

SO THAT I DON'T HAVE THAT
WHUSHHK OUT.

ALSO, THERE'S FOOTRESTS AND
I USUALLY PULL THEM OFF

JUST FOR THE INCONVENIENCE
OF US BUMPING INTO THEM.

BUT ON YOUR FOOTRESTS, THEY
SWING OUT, SO HAVE...

WE CAN SHOW YOU LATER
HOW THE LEVERS WORK.

IT'S HARD TO SEE
IN A GROUP SETTING.

BUT THEY SWING OUT AND GET OUT
OF THE WAY AND THEN
THEY POP BACK IN

SO THAT THEY HAVE A FOOTREST.

WHEN YOU'RE WHEELCHAIRING
SOMEONE, YOU WHEELCHAIR
THEM STRAIGHT.

BUT WHEN YOU GET ON TO AN
ELEVATOR, MAKE SURE
YOU BACK THEM IN,

INSTEAD OF JUST PUTTING
THEM IN FORWARD,

SO THAT THEIR EXIT
IS STRAIGHT OUT.

AND THAT'S PRETTY MUCH IT
ON WHEELCHAIRS. OKAY.

FIRE SAFETY.

YOU'LL HEAR ABOUT FIRE
SAFETY WHENEVER YOU GO TO ANY OF
YOUR INSTITUTIONS

BECAUSE YOU HAVE TO KNOW
WHAT TO DO.

MAKE SURE THAT YOU CAN
FIND THE FIRE ALARMS.

MAKE SURE THAT YOU KNOW
WHAT THEIR PROCEDURE IS.

AND MOST OF THEM HAVE ADOPTED
THE ACRONYM RACE,
WHICH IS IN YOUR BOOK.

R STANDING FOR?
- REMOVE.

RESCUE OR REMOVE.

CLIENT IS FIRST. CLIENT IS
ALWAYS FIRST, REMEMBER THAT.

SO, GET RID OF THE --
GET RID OF THEM!

REMOVE THEM FROM
THE PLACE OF DANGER.

- THEN WHAT?
- ALARM.

ALARM. GET THAT ALARM SET AND
YELL FOR SOMEONE TO GET IT SET,

I MEAN YOU CAN BE DOING THINGS
SIMULTANEOUSLY. THEN C?
- CONTAIN.

CONTAIN WHICH CAN
BE A LOT OF THINGS.

YOU CAN THROW A PILLOW
IN A WASTE CAN.

YOU CAN SNUFF IT OUT.
SHUT DOORS.

- AND THEN E?
- EXTINGUISH.

EXTINGUISH AND/OR EVACUATE
DEPENDING ON WHOSE 'E'.
YOU'RE USING..

YEAH, EXTINGUISH, IF YOU CAN.

AND THEN THEY TALK ABOUT ALL THE
DIFFERENT FIRE EXTINGUISHERS.

MOST OF THEM WILL USE C
OR SOMETHING THAT WILL..

A CHEMICAL COMPOUND THAT WILL
ADDRESS ANY KIND OF FIRE,

WHETHER IT BE THE WOOD BURNING
OR THE ELECTRICAL.

AND THEN IN YOUR ELECTRONIC,
YOUR HIGHLY SENSITIVE AREAS,

LIKE YOUR COMPUTER AREAS,
THEY'LL HAVE THEIR SPECIAL
DRY EXTINGUISHER

FOR THOSE, SO THAT WE DON'T
DAMAGE WITH WATER.

OKAY. WALKING.

JUST WANTED TO MENTION A COUPLE
OF THINGS RELATED TO WALKING.

WHEN YOU WALK A CLIENT,
WE'VE USED THE GAIT BELT.

AND YOU'RE NOT GOING TO WALK
LIKE THIS WITH THE GAIT BELT,

LIKE WE GOT THEM OUT. THE
GAIT BELT IS JUST SOMETHING

SO THAT YOU CAN HAVE YOUR
HAND TO THEIR WASTE

AND BE ABLE TO STABILIZE THEM.

YOU ALWAYS WALK ON THE STRONG
SIDE OF THE CLIENT,

NOT THEIR WEAK SIDE. SO THAT
IF THEY GAVE INTO WEAKNESS,

YOU CAN PULL THEM
BACK TO STRENGTH.

THAT'S THE THEORY OF THAT.

WHEN I WALK WITH THE CLIENT,
I TRY TO WALK

SO THAT THE CLIENT
IS NEXT TO THE WALL

AND I'M TO THE MIDDLE
OF THE ROOM.

BECAUSE IF THEY TIP, THEN
THEY'VE GOT A WALL
TO CATCH THEM,

NOT TO MENTION THEY'VE
GOT ME TO PULL THEM.

AND SO YOU'VE KIND OF
GOT TWO PEOPLE WALKING,

IF THEY'RE AMBULATORY.
AND THAT'S NICE.

REMEMBER WHEN YOU WALK WITH
SOMEONE, AS FAR AS YOU GO,

YOU HAVE TO COME BACK.

YOU POOP OUT SOMETIMES, SO.

WE'LL TALK A LITTLE BIT
ABOUT THAT WITH THE WALKER,
BUT KEEP THAT IN MIND.

I'M ALWAYS CHECKING, "HOW ARE
YOU DOING?" YOU KNOW, AND I
REMIND THEM,

"AS FAR AS WE GO, WE GOT TO GO
BACK." THAT KIND OF A THING.

AND FINALLY WE NEED TO
MENTION ABOUT FALLS.

IF SOMEONE IS GOING TO FALL,
IF SOMEONE TIPS,

THE GOAL FOR YOU IS TO
GET THEM DOWN SAFELY.

THEY HAVE SOME GREAT PICTURES
IN YOUR BOOK.

AND IT'S REALLY HARD TO
SIMULATE A FAKE FALL,

BUT THE IDEA IS THAT YOU CATCH
THEM AND IF YOU CAN'T,

LOWER THEM DOWN, PROTECTING
THEIR HEAD.

LOWER THEM DOWN YOUR LEG
IF YOU CAN

AND HOLLER FOR HELP SO THAT
SOMEONE CAN HELP YOU CATCH THEM.

AND THEN JUST GET THEM
DOWN TO THE GROUND.

ONCE THEY'RE TO THE GROUND,
IF YOU'RE IN AN INSTITUTION,

THERE'S USUALLY LOTS
OF HELP FOR YOU.

AND SO YOU CAN EITHER
PUT THEM ON A BLANKET,

AND LIFT THEM, PUT THEM ON
A GURNEY STRETCHER, LIFT,

OR JUST PULL THEM, BODY LIFT, TO
GET THEM TO WHERE YOU NEED THEM
TO GO.

IF THEY WERE..

IF YOU NEEDED TO, LIKE,
EVACUATE SOMETIME,

YOU NEEDED TO GET PEOPLE OUT,
ONE OF THE INTERESTING
TECHNIQUES IS..

- I NEED TO BACK UP
TO FALL, SORRY.
LOST MY TRAIN OF THOUGHT.

IF THEY FALL,

YOU CAN ALSO INSTRUCT THEM TO
ROLL OVER ONTO THEIR STOMACH

AND TRY TO GET TO THEIR
HANDS AND KNEES

AND SEE IF THEY CAN STAND
BACK UP.

ESPECIALLY IF THEY'VE
SUSTAINED NO INJURIES.

YOU SUPPORTED THEM AND
THEY JUST WENT DOWN.

MAYBE THEY JUST GOT
DIZZY AND YOU JUST..

THEY JUST KIND OF WENT DOWN.

GIVE THEM A LITTLE SMELLING
SALTS, THEY'RE GOOD TO GO.

THEY'RE USUALLY EASIER TO
GET UP IF THEY ROLL OVER

AND GET UP ON THEIR HANDS
AND KNEES.

THAT'S AN IMPORTANT PIECE OF
INFORMATION TO TELL
YOUR CLIENTS,

IF THEY WERE TO FALL AT HOME.

YOUR GRANDMOTHER, YOU KNOW, IF
THEY'RE HOME AND THEY FALL,

REMIND THEM TO GET ON THEIR
HANDS AND KNEES
AND CRAWL TO A CHAIR

OR SOMETHING THAT COULD
HELP THEM GET UP.

AND IT'S MUCH EASIER WHEN
THEY'RE HOME ALONE.

OKAY. IF THERE'S A FIRE,
IF THERE'S AN EMERGENCY,

IF YOU HAVE TO EVACUATE AND
SOMEONE'S NOT ABLE TO HELP YOU
TO AMBULATE,

YOU'RE OUT OF WHEELCHAIRS,
YOU CAN'T FIND STRETCHERS,

YOU KNOW, YOU'RE IN
A NURSING HOME,

ONE OF THE THINGS YOU CAN DO IS
GET A REALLY STURDY BLANKET.

YOU COULD GET SOMETHING SIMILAR
TO THIS. PUT THE BLANKET
ON THE FLOOR.

GET SOME HELP OR HAVE
THE CLIENT HELP YOU.

YOU CAN DANGLE THEIR LEGS OVER
AND THEN KIND OF SUPPORT
THEIR BODY,

GET THEM TO THE GROUND

AND THEN YOU CAN KIND OF
WRAP THEM IN THAT BLANKET

AND PULL THEM WITH THE BLANKET.

IT'S KIND OF A FLOOR SLING,
AND JUST SCOOT THEM,

DRAG THEM RIGHT OUT THE DOOR.

AND GET THEM TO A
PLACE OF SAFETY

WHEN YOU CAN'T PHYSICALLY
CARRY THEM

OR YOU DON'T HAVE ANYTHING
TO PUT THEM IN.

ALRIGHT. READ OVER THOSE
SECTIONS, THEY HAVE SOME
PRETTY DECENT PICTURES.

AND I'LL TALK YOU THROUGH
SOME OF THOSE.

ALRIGHT.

THAT'S MOST OF THE INFORMATION
I WANTED TO TALK ABOUT.

WHAT WE NEED TO DO IS GO OVER
OUR STATIONS THAT WE'RE GOING TO
TEST ON.

YOU'RE GOING TO HAVE FOUR
STATIONS THIS TIME.

NOTICE WE JUST KEEP INCREASING
THEM AND INCREASING THEM.

REMEMBER I TOLD YOU,
NOTHING REALLY IS HARD.
IT'S JUST LOTS OF IT.

ALRIGHT. YOU'RE GOING
TO HAVE FOUR STATIONS.

YOU'RE GOING TO PUT RESTRAINTS
ON THE CLIENT.

WRIST AND POSEY RESTRAINT
AT ONE STATION.

WE'RE GOING TO DO A RANGE
OF MOTION AT ONE STATION.

WE'RE GOING TO DO A CANE AND A
WALKER DEMONSTRATION
AT ONE STATION.

AND YOU'RE GOING TO DO CRUTCHES,
ALL FOUR GAITS

AND HOW TO MEASURE CRUTCHES
OUT IN THE HALLWAY.

THAT IS THE PROP
THAT I FORGOT TODAY.

PROBABLY GET ONE.

HUH? MY LITTLE STEPSTOOL.

I NEED MY LITTLE STEPSTOOL
FOR STAIRS, BUT...

YE-E-AH! OKAY THAT'S FINE.

ALRIGHT. THE FIRST THING
WE'LL DO..

LET'S DO RESTRAINTS,
I'LL TRY TO, KIND OF,
STAY IN THE ORDER OF YOUR PAGES.

RESTRAINTS.

AGAIN, WE HAVE TO DO A LITTLE
BIT OF THEORY ABOUT RESTRAINTS

BECAUSE WE JUST DON'T RESTRAIN
ANYBODY WE FEEL LIKE
RESTRAINING.

IT'S AGAINST THE LAW.

IT USED TO BE THAT WE WOULD..

I'M NOT GOING TO EVEN PUT MY
NAME IN WE, I DON'T
USUALLY DO THAT,

JUST FOR MY CONVENIENCE.

BUT CLIENTS ARE RESTRAINED
FOR CONVENIENCE,

MAYBE EVEN FOR PUNISHMENT.

THINK ABOUT THAT.

AND IT'S AGAINST THE LAW.

IN FACT, WE HAVE TO HAVE STRICT
ORDERS, STRICT OBSERVATIONS

AND THINGS THAT WE HAVE TO DO TO
MONITOR CLIENTS THAT ARE
RESTRAINED.

WE NEED TO DEFINE WHAT A
RESTRAINT IS.

IT'S ANYTHING THAT KEEPS SOMEONE
FROM MOVING FREELY

OR GETTING ACCESS TO
THEIR BODY FREELY.

IT CAN BE PHYSICAL OR
IT CAN BE CHEMICAL.

SO MOST OF THE TIME, IT'S
A PHYSICAL RESTRAINT,

SOMETHING WE DO TO TIE
OR IMMOBILIZE SOMEONE.

BUT IT CAN BE A DRUG THAT
KEEPS THEM FROM MOVING.

SOME THINGS WE NEED TO
APPRECIATE IS WHAT IS A
RESTRAINT, NOT.

THERE ARE SOME THINGS THAT
RESTRICT OUR MOVEMENT,

BUT THEY'RE FOR CLINICAL
PURPOSES

AND THEY AREN'T A RESTRAINT
IN THAT MODALITY.

FOR EXAMPLE, IF I PUT AN IV
RIGHT HERE IN MY WRIST,

AND EVERY TIME I MOVED,

THE IV QUIT DRIPPING, WE MIGHT
PUT WHAT'S CALLED
AN IV BOARD ON,

TO KEEP ME FROM BENDING THE
WRIST SO MUCH SO
THAT THE IV WORKS.

IT'S RESTRAINING
MY MOVEMENT A LITTLE,

BUT IT'S NOT CONSIDERED
A RESTRAINT IN
THAT I'M HARMING MYSELF.

IT'S FOR CLINICAL PURPOSES.

ORTHOPEDIC DEVICES,
KNEE BRACES, CASTS,

THEY'RE RESTRICTING MOVEMENT,
BUT THEY'RE BEING USED FOR
CLINICAL THINGS.

A BABY THAT'S PUT IN
AN INFANT SEAT,

RESTRAINED, BUT IT'S
NOT A RESTRAINT.

IT'S HOW YOU USE IT EXACTLY
THAT KIND OF DEFINES IT.

THERE'S A GOOD LIST OF THOSE
IN ONE OF YOUR BOXES.

NO, ACTUALLY IT'S IN THE
ARTICLE I GAVE YOU.

AND I WANTED TO JUST GIVE
YOU A FEW LITTLE STATISTICS

I THOUGHT WERE VERY IMPRESSIVE.

THEY SAID IN THE ARTICLE
I GAVE YOU THAT

PEOPLE ARE EIGHT TIMES
MORE LIKELY TO BE...

..IS IT INJURED OR DIE
WITH THAT? WHATEVER.

MORE LIKELY TO DIE THAN
THOSE NOT RESTRAINED.

EIGHT TIMES MORE LIKELY.

AND THIS IS THE
INTERESTING THING.

THEY INTERVIEWED AND DID SOME
RESEARCH ABOUT RESTRAINTS.

WHY DO WE DO THEM?
WHEN DO WE DO THEM?

AND THE NURSES WOULD SAY, "WELL,
SO SOMEONE WOULD FALL.

THEY WERE CONFUSED SO THEY
WOULD HURT THEMSELVES."

WHAT THEY FOUND WAS THAT
RESTRAINTS WERE COMMONLY USED

IN THE OLDER POPULATION, WITH
THE GERIATRIC CLIENTS
TO PREVENT FALLS.

BUT 47% OF THE PEOPLE FELL
ANYWAY WITH THE RESTRAINT.

THAT'S A HUGE STATISTIC
RELATED TO IT.

SO WHAT IS THE POINT HERE?
THAT WE SAVE 50%?

I DON'T KNOW. THAT IS
NOT A VERY GOOD STAT.

SO JOINT COMMISSION OF
ACCREDITATION
FOR NURSES

AS WELL AS THE FEDERAL
DRUG ADMINISTRATION,

WHO ARE THE ONES, REALLY,
TO SET THE FEDERAL LAW

RELATED TO HOW WE WILL USE
RESTRAINTS,

HAVE SAID, WE NEED A PURPOSE TO
HAVE A RESTRAINT FREE
ENVIRONMENT.

WE NEED TO DO EVERYTHING
WE CAN POSSIBLY DO
TO NOT RESTRAIN SOMEONE.

SO I GAVE YOU SOME COPIES
OF SOME FORMS THAT ARE
IN ALL YOUR HOSPITALS.

BEFORE A RESTRAINT
IS EVER APPLIED

WE HAVE TO BE ABLE
TO DOCUMENT THAT

WE'VE DONE EVERYTHING
WE CAN POSSIBLY
DO NOT TO RESTRAIN SOMEONE.

SO, WE'VE GOT TO DO THINGS
LIKE TALK TO CLIENTS,

ORIENT CLIENTS, SEE IF A
FAMILY MEMBER CAN COME

AND STAY WITH THE CLIENT,
SEE IF WE CAN GET SOME
PERSONNEL TO STAY.

SEE IF WOULD OFFER TOILETING
EVERY TWO HOURS,

IF WE WOULD GO IN EVERY
HOUR AND OFFER A SNACK,

IF WE WERE ANTICIPATING THEIR
NEEDS INSTEAD OF NEGLECTING

AND THEY GET WANDERING
AND THAT KIND OF THING.

WE'VE DONE EVERYTHING. WE'VE
TRIED EVEN MEDICATIONS

TO HELP WITH THE ORIENTATION
AND NOTHING'S WORKING,

WE NEED A RESTRAINT.

THERE ARE SOME RULES ABOUT
RESTRAINT.

YOU'LL REVISIT RESTRAINTS
WHEN YOU GET INTO
THE PSYCH ENVIRONMENT.

BUT, ISN'T IT, TOM, IN PSYCH, IF
SOMEONE WERE ADMITTED ACUTELY

AND THEY CAME IN AND
THEY WERE -- I DON'T KNOW,
ON DRUGS OR SOMETHING

AND YOU COULDN'T CONTROL THEM,

YOU CAN PUT THEM IN RESTRAINTS
FOR ONE HOUR,

BUT YOU'VE GOT TO HAVE AN
ORDER WITHIN AN HOUR?

IN THE ACUTE CARE SETTING,
IT'S FOUR HOURS, LIKE IN
AN ICU, CCU AREA.

AND IN THE MED-SURG AREA,
IT'S 12 HOURS.

SO YOU CAN MAKE AN
INDEPENDENT
DECISION

BECAUSE THERE'S HARM

FOR YOU OR FOR THE CLIENT AND
YOU MIGHT NEED A RESTRAINT.

BUT YOU HAVE TO HAVE
A DOCTOR'S ORDER.

YOU HAVE TO HAVE CONTACT
WITH A PHYSICIAN

WITHIN A VERY SHORT AMOUNT
OF TIME,

BEFORE YOU CAN MAINTAIN
THAT RESTRAINT.

ONCE YOU HAVE AN ORDER
FOR A RESTRAINT,

THE RESTRAINT ORDER HAS TO BE
RENEWED EVERY 24 HOURS, PERIOD.

YOU CAN'T JUST LEAVE THEM
ON AT YOUR DISCRETION.

SO YOU CAN NEVER HAVE
A RESTRAINT PRN.
WHAT DOES PRN MEAN?

- AS NEEDED.
- AS NEEDED.

CAN'T HAVE IT.
AGAINST THE LAW, OKAY?

SO IT HAS TO BE REEVALUATED
ON A DAILY BASIS.

IN ADDITION, ONCE YOU'VE DECIDED
AND WITH THE PHYSICIAN,

AND WITH THE FAMILY,
I WANT TO INTERJECT.

THE FAMILY HAS TO
BE IN AGREEMENT,

HAS TO BE INFORMED
ABOUT THE NEED OF

AND THEIR WILLINGNESS TO SUPPORT
OR HELP OUT IN THIS ISSUE.

SOMETIMES THE FAMILY IS LIKE,
"WE'RE EXHAUSTED.

THEY'RE HERE NOW.
YOU MANAGE THEM.
WE'RE JUST EXHAUSTED.

DO WHAT YOU'VE GOT TO DO."
AND THEY ARE SUPPORTIVE.

AND SOMETIMES, THEY
ARE LIKE, "NO WAY."

DON'T EVEN THINK ABOUT
RESTRAINING MY MOM.

I'LL SIT HERE, I'LL
SPEND THE NIGHT HERE,

I'LL DO WHATEVER YOU
WANT ME TO DO.

AND THEY NEED TO BE INCLUDED
IN THAT CARE PLAN.

YOU JUST CAN'T DECIDE WELL,

"WE'RE STRAPPING THEM DOWN.
YOU KNOW, THEY WANDER."

FOR CLIENTS THAT WANDER, THERE'S
A LOT OF THINGS THAT WE CAN DO.

MOST OF THE TIME THEY FOUND
THAT PEOPLE THAT WANDER,

LIKE IF THEY HAVE ALZHEIMER'S,

AND THEY JUST GET UP AND THEY
WANDER THROUGHOUT THE HOSPITAL,

THEY PUT ALARMS ON THEM.

THEY MIGHT PUT A WRIST BRACELET
OR AN ANKLE BRACELET.

AND THEY SET ALARMS
AT THE DOORWAYS

OR WHEREVER THEY'VE DECIDED IS
WHERE THEY DON'T WANT
CLIENTS TO GO.

BUT CLIENTS DO MUCH BETTER,

THEY WANDER, FINE. YOU JUST
DON'T WANT THEM WANDERING AWAY,

YOU KNOW, OUT ON THE STREET.

YOU DON'T WANT THEM WANDERING
INTO YOUR BEDROOMS AND THINGS
LIKE THAT.

SO, IF THEY WERE LOCKING
APPROPRIATE DOORS

AND ALARMING DOORS
APPROPRIATELY, THE CLIENTS
DID JUST FINE WANDERING.

BUT WHEN WE PUT ALL FOUR SIDE
RAILS UP AND WE STRAP THEM DOWN,

WE ARE ACTUALLY CAUSING
INJURY AND KILLING THEM.

BECAUSE THEY WOULD STRANGLE
THEMSELVES, TRYING TO GET OUT.

THEY WOULD HURT THEMSELVES
CRAWLING OVER AND UNDER
AND GETTING OUT.

AND THEY CAN GET OUT.

ALRIGHT. I'LL TELL YOU SOME
STORIES LATER. OKAY.

SO, RESTRAINTS.

ONCE YOU'VE DECIDED YOU
CAN PUT RESTRAINTS ON,

WE STILL HAVE TO MONITOR THEM.

YOU CAN'T JUST PUT THEM AND
GO, "OOH, THAT'S OVER."

THE REGULATION NOW IN
CALIFORNIA IS THAT

SOMEONE HAS TO BE MONITORED
24X7.

SOMEONE HAS TO STAY
PHYSICALLY WITH THEM

TO MAKE SURE THAT THEY'RE SAFE.

BECAUSE THEY CAN GET OUT AND GET
IN A PREDICAMENT SO VERY FAST.

EVERY 15 MINUTES, WE HAVE TO
VISUALLY MAKE SURE THAT
EVERYTHING'S OKAY.

THAT THEIR CIRCULATION'S NOT CUT
OFF, THAT THEY'RE NOT TWISTED,

YOU KNOW, THAT KIND OF THING.

AND EVERY TWO HOURS, WE'RE GOING
TO TAKE THE RESTRAINT
TOTALLY OFF,

GIVE THEM RANGE OF MOTION, MAKE
SURE THEIR SKIN INTEGRITY
IS GOOD.

LOOK AT PULSES, MAKE SURE
THAT WE HAVEN'T CAUSED
ANY SKIN ABRASIONS

AND WE'RE GOING TO CHECK
THEM EVERY TWO HOURS.

AND THEN RE-APPLY THE RESTRAINT.

SO IT'S NOT JUST RESTRAINT
AND GONE.

YOU MIGHT NOT TAKE THEM ALL OFF.

YOU MIGHT TAKE ONE OFF
AT A TIME AND DO IT.

THAT'S A GOOD POINT. BUT
THEY WILL COME OFF.

THEY HAVE TO COME OFF, BUT YOU..

UH-HUH. BUT FOR SAFETY REASONS,

YOU MIGHT NOT WANT TO TAKE ALL
FOUR OFF AT THE SAME TIME.

IF THEY WERE IN A FOUR POINT
RESTRAINT FOR EXAMPLE,

WHAT KIND OF CLIENTS, DRUG
ABUSE CLIENTS TYPICALLY?

- YEAH. MOSTLY PSYCHOTIC
CLIENTS. - PSYCHOTIC.

VARIETY OF REASONS.

VERY RARELY IN THE MEDICAL
SETTING
DO WE USE FOUR-POINT.

MOST OF THE TIME WHEN
I'VE USED RESTRAINTS,

IT'S BECAUSE THEY'RE PULLING
THEIR FOLEY CATHETERS OUT,

THEY'RE PULLING THEIR IV'S OUT,

THEY'RE PULLING THEIR NG
TUBES OUT AND SO FORTH.

SO, IT'S A SAFETY ISSUE.

BUT WE'RE GOING TO TALK ABOUT,
IN THOSE DIFFERENT SECTIONS

WHEN WE DO FOLEYS AND
IV'S AND SO FORTH,

HOW CAN WE PROTECT THAT SITE,

SO MAYBE NOT EVEN HAVE TO
RESTRAIN FOR THAT SITE.

YOU WANT TO DO EVERYTHING
YOU CAN.

SO THEN YOU CAN VALIDATE, I'VE
WRAPPED THE IV WITH GAUZE,

I PUT A LEG BAND ON,
I PUT SHEETS OVER

AND SHE STILL GETS IN
AND RIPS IT OUT.

YOU KNOW. AND SO YOU HAVE
TO DOCUMENT TO THAT.

SO THAT YOU CAN DEFEND THE
RESTRAINT FOR SAFETY ISSUES.

OKAY. ALL THAT'S SAID AND DONE,

OUR CLIENT NEEDS RESTRAINT.

SO, YOU'RE GOING TO CHECK
YOUR DOCTOR'S ORDERS

AND YOU'LL HAVE AN ORDER

AND YOU'LL REVIEW
IT EVERY 24 HOURS.

AND YOU'LL CHECK THE CARE PLAN

AND THEY'LL TELL YOU WHAT KINDS
OF RESTRAINTS YOU CAN USE.

WRISTS, VESTS,
WHAT FITS AND SO FORTH.

YOU'RE GOING TO GATHER
UP YOUR EQUIPMENT,

AND MY EQUIPMENT TODAY IS WE'RE
JUST GOING TO PUT A VEST ON.

YOU HAVE TWO SHEETS. ONE FOR THE
VEST

AND THEN WE'RE JUST GOING TO
PUT ONE WRIST RESTRAINT ON.

SO THAT YOU CAN, KIND OF, GET
THE FEEL OF HOW TO DO IT,

HOW TO TIE KNOTS AND
WHERE TO TIE THEM.

I'VE WASHED MY HANDS. I'M GOING
TO IDENTIFY MY CLIENT
HERE IN A SECOND.

AND..

..WHEN I GET IN HERE, AND SEE,
MR. SPADE, HOW ARE
YOU DOING TODAY?

NOT SO GOOD, HUH? I KNOW.
AND YOU KNOW WHAT,

YOU'VE BEEN GETTING
OUT OF THAT BED

AND IT'S BEEN PULLING YOUR
OXYGEN OFF OF YOUR HEAD

AND IT'S RIPPED YOUR EARS. AND
YOU'VE BEEN PULLING AT YOUR
FOLEY CATHETER.

AND IN SPITE OF THE MEDICATION
AND US TELLING YOU..

AND HE MAY NOT BE UNDERSTANDING
A WORD I'M SAYING,

BUT I'M STILL TELLING HIM.

WE'RE GOING TO JUST PUT A LITTLE
REMINDER ON YOUR WRIST

SO THAT YOU DON'T PULL.

AND IT'LL, KIND OF, KEEP YOU
FROM GETTING CLOSE
TO THAT CATHETER.

AND THEN THE VEST WILL
KEEP YOU FROM PULLING
THAT OXYGEN TOO FAR.

YOU'LL STILL BE ABLE
TO MOVE AND BREATHE,

BUT HOPEFULLY IT WILL REMIND
YOU NOT TO MOVE TOO FAR.

EXPLAIN WHAT YOU'RE DOING.
IT'S THEM. AND WHATEVER.

PROVIDE PRIVACY. OKAY, I'M GOING
PUT THE BED IN THE HIGH
POSITION.

AND THERE'S NOT MUCH HARD..
WELL, PATIENTS ARE MUCH HARDER,

BUT PUTTING A POSEY VEST
ON A MANNEQUIN, NOT MUCH.

SO WHAT WE'LL PROBABLY DO IS
WE'LL JUST HAVE THEIR ARMS IN

WHEN YOU COME TO TEST, AND WE'RE
JUST MORE INTERESTED
IN TYING THEM.

BUT WHEN YOU HAVE A POSEY VEST,
THEY COME IN DIFFERENT SIZES.

AND THEY AREN'T A
ONE SIZE FIT ALL.

THEY'RE SMALL, MEDIUM,
LARGE AND EXTRA LARGE.

AND THEY COME LIKE THIS.

THEY NEED TO -- THEY HAVE A TAG.

AND THE TAG WILL TELL
YOU THE SIZE,

BUT THAT'S ALSO A REMINDER THAT
THIS PART GOES IN THE BACK.

AND THEN THEY CRISSCROSS
IN THE FRONT.

THERE'S A LITTLE SLIT

AND THAT'S THE FIRST PLACE
YOU WANT TO THREAD
YOUR STRING THROUGH.

YOU GOT THESE LONG OLD STRINGS.

AND OURS ARE PRETTY DIRTY

AND WE DON'T REALLY HAVE
PATIENTS LIE WITH WOUNDS
AND THINGS.

SO THAT MEANS THEY'VE BEEN
DRAGGED ON THE GROUND WAY
TOO MUCH.

OKAY.

WHAT WE'RE GOING TO DO
IS PUT THIS ON THEM.

AND MR. SPADE, COULD YOU SIT
UP HERE AND HELP ME? GREAT.

WE'RE GOING TO PUT THIS ON. YOU
CAN UNCROSS YOUR HANDS NOW.

THAT'S GOOD.

PUT THIS ON.

PUT YOUR ARM THROUGH THERE
FOR ME. THANK YOU.

YOUR ARM'S STILL A LITTLE LOOSE.
DOCTOR HASN'T SEEN THAT? YEAH.

IT'LL PROBABLY FALL OFF HERE.

ALRIGHT. I WANT TO PUT
THIS THROUGH THE BACK..

..AND THEN LAY HIM DOWN.

WE USED TO..

..OUT OF LOGICAL THINKING PUT
THE VEST ON THE OTHER WAY.

DOESN'T IT SEEM LIKE IT'D
BE A LOT STURDIER

IF I PUT THAT FULL PIECE THERE,
BUT I CHOKED ON HIM.

NOT GOOD.

SO, THEY MUST GO THE OTHER WAY.

WE DO THIS TOWARDS THIS ELBOW.

COULD YOU BEND YOUR
ARM A LITTLE MORE?

SOMETIMES IT'S JUST THAT HARD.

SOMETIMES I'VE HAD CLIENTS
WHO JUST GO, "SURE,
WHATEVER YOU WANT."

THEY'LL JUST.. THEY'RE SO
CONFUSED AND HAPPY AND TENSE.

OKAY. YOU CAN PUT YOUR
ARM DOWN NOW.

OKAY. SO I WANT TO GET
THIS STRAIGHT ON HIM.

WHEN YOU REALIZE IT'S HITTING
YOU ON YOUR STOMACH

AND YOU'RE GOING LIKE THIS,
YOU'RE PROBABLY NOT USING VERY
GOOD BODY MECHANICS.

ALRIGHT. SO, THAT'S NICE AND
STRAIGHT HERE ON HIS WAIST.

FIRST CRISSCROSS GOES
THROUGH THE SLIT,

YOU CROSS AND THEN I HAVE MY
STRING.

AND THEN MY SECOND ONE
GOES OVER THE TOP.

I'LL COME AND TIE ON THIS SIDE,

BUT YOU GUYS CAN SEE OVER
HERE WHAT I'M DOING.

YOU CAN'T REALLY SEE EITHER SIDE
MOVE.

WHAT WE WANT TO DO IS NOW TIE
THIS ON TO THE BEDFRAME,

NOT BED RAIL.

THERE'S A COUPLE OF PLACES THAT
I TIE.

THE FIRST TIE THAT I DO IS
ON THE BED FRAME ITSELF,

JUST RIGHT HERE. USUALLY WHERE
THE BED BENDS AND GASHES.

BECAUSE IT'S EASY TO REACH.

BUT I'VE HAD MY CLIENTS GO LIKE
THIS AND POOCHHK, UNDO MY TIES.

SO THEN I'LL TIE IT UNDER THE
BED, WHERE THEY CAN'T REACH.

BUT, FOR THE MOST PART,

PEOPLE AREN'T THAT
INVESTIGATIVE,
YOU KNOW.

SO I'M GOING TO COME DOWN HERE.

NOW, KEEPING IN MIND FIRE
SAFETY AND PATIENT SAFETY,

I'M NOT GOING TO TIE THIS INTO
A KNOT THAT I CAN'T GET UNDONE.

SO EVERYTHING THAT YOU TIE
HAS TO BE A SLIP KNOT,

SO THAT ONE PULL, YOU'LL BE OUT

AND THAT CLIENT COULD
GET OUT FOR A FIRE.

OKAY, SO TO DO A SLIP KNOT,
WE'RE GOING TO COME DOWN HERE.

I KNOW. YOU CAN'T SEE, BUT
I'LL DO IT ON THAT SIDE.

I'M GOING TO COME DOWN HERE AND
SEE HOW MY FINGERS ARE IN,

AND HOLDING THIS HOLE HERE.

YOU CAN TIE ONE IF YOU
WANT AND COME DOWN.

AND THEN YOU HOLD IT AND THEN A
LITTLE LOOP CAN COME IN THE LOOP

AND GO DOWN LIKE THAT
SO THAT I GO CHUUK.

AND I'M OUT. THERE'S NO KNOT,
THERE'S NO FUSSING
TO PULL IT APART.

OKAY, ONE MORE TIME. I'LL
JUST DO A QUICK ONE.

HOLD HERE, PUT THIS HERE. DONE.

I HAVE TO MAKE SURE THAT
IT'S NOT SO TIGHT THAT
HE CAN'T BREATHE.

AND I'M HAPPY.

HOW DOES THAT FEEL?

OKAY, BREATHE. THAT'S GOOD.

I'M GOING TO COME OVER HERE.

AND THIS IS PROBABLY THE
MORE CRITICAL ONE,

MAKE SURE I DON'T DO
IT TOO TIGHT.

COME OVER HERE,
WHERE THE BED GASHES.

AND COME DOWN..

..IN HERE. SO, IT'S THE SOLID
PART OF THE BED,
NOT THE SIDE RAIL.

BECAUSE UP AND DOWN, YOU'LL
BE YANKING ON THEM.

I'M JUST GOING TO DO
ONE LITTLE SLIP HERE,

AND THEN I'M GOING TO TAKE MY
HANDS AND PULL OPEN A HOLE

AND PULL THROUGH THAT HOLE
AND HAVE A SLIP KNOT.

SO I'M OUT AND GO.

IF YOU DO A SINGLE SLIP,

WHICH IS THE SECOND THING I
SHOWED, IT'S THE SAME THING.

I HOLD THE HOLE AND I JUST
SLIP DOWN LIKE THIS.

SOMETIMES THEY SHIMMY OUT OF
THESE AND THEY PULL ON THEM.

AND IT'S TOO FAST.

THAT'S WHY I LIKE
THAT FIRST TIE,

BECAUSE IT'S JUST A LITTLE MORE
STABLE IN THE SLIP KNOT WORLD.

SO I DO THAT AND I'M DOWN.

THEN I'M GOING TO CHECK AND
MAKE SURE NOTHING'S TWISTED

AND THAT HE CAN BREATHE. IS
THAT OKAY? NOT TOO TIGHT?

BUT TIGHT ENOUGH TO GET
THE JOB DONE.

AND THERE HE GOES.

YOU CAN GO AHEAD AND PUT
YOUR WRIST RESTRAINT ON

AND THEN WE'LL TALK THROUGH
THE PARAMETERS HERE.

WRIST RESTRAINT LOOKS LIKE THIS.

THEY COME IN A LOT
OF DIFFERENT FORMS.

I HAPPEN TO HAVE CLOTH
WRIST RESTRAINTS,

JUST BECAUSE WE REUSE THEM
AND I DON'T HAVE CLIENTS

AND BODY SUBSTANCE ISSUES.

BUT YOU'LL SEE SOME BLUE,
PAPER DISPOSABLE ONES.

AND THEY'RE NICE. YOU JUST
HAVE TO BE CAREFUL NOT TO
GET THEM TOO TIGHT.

THEY CAN KIND OF TOURNIQUET.

AND THEY ALSO HAVE.. SOME
HAVE LAMBS WOOL ON THEM.

AND THOSE ARE NICE, THEY
KIND OF PROTECT THE SKIN.

EXCEPT THAT THE LAMBS WOOL
MAKES THEM SO FLUFFY

THAT THEY JUST SQUISH
THEIR HANDS RIGHT OUT.

SO I DON'T REALLY LIKE
THEM VERY WELL

UNLESS MY CLIENT'S JUST NEEDING
A LITTLE REMINDER.

OR LIKE IT'S STROKE
CLIENT WITH WEAKNESS,

AND I'M USING IT TO MAINTAIN
BODY POSITION OR SOMETHING

AND THEY'RE NOT REALLY
FIGHTING IT. AND THAT'S
A GOOD ALTERNATIVE.

BUT FOR A REAL RESTRAINT,
RESTRAINT, NOT SO HOT.

ALRIGHT.

YOU WANT TO CHECK THE SKIN,
PRIOR TO PUTTING
THE RESTRAINT ON.

AND SOMETIMES WHAT I LIKE TO DO,

IF THIS CAUSING ABRASION OR
RUBBING,

ESPECIALLY LIKE THOSE PAPER
ONES, I MAY WRAP THEIR ARMS
WITH SOME GAUZE.

JUST TO PROTECT IT FROM
THE FRICTION OF THIS.

AND THAT'S NOT ON THERE,
BUT THAT'S JUST FOR YOU.

THESE NAME BANDS ARE KIND OF IN
THE WAY AND HE'S GOT TWO ON.

AND SO, IT MIGHT BE PRACTICAL
TO LOOSEN THOSE UP

AND MAKE SURE THEY'RE NOT
DIGGING INTO HIS SKIN.

FIND ANOTHER WAY TO
IDENTIFY HIM.

PUT IT ON HIS ANKLE
OR SOMETHING.

YOU HAVE A LITTLE SLIT
RIGHT HERE

AND YOU WANT TO MAKE YOUR FIRST
PASS THROUGH THE SLIT.

THEN YOU WANT TO PUT IT
SNUGLY ON THE WRIST.

MAKE SURE YOU CAN GET A
FINGER IN THERE SO THAT YOU'RE
NOT CUTTING OFF CIRCULATION.

AND I'M GOING TO
COME AROUND HERE.

THIS ONE HAS A VELCRO ON IT,

SO YOU'RE PROBABLY NOT GOING TO
GET A LOT OF SLIDE AND PULL.

BUT I NEED TO STABILIZE THIS.

SO I'M GOING TO PUT
A LITTLE TIE HERE,

MAKE SURE IT'S NOT TIGHT.

AND I'M GOING TO TIE
A SQUARE KNOT. NOT.

DOESN'T THAT JUST GO AGAINST
EVERYTHING I SAID?
NO, NOT REALLY.

BECAUSE THEY COULD STILL GET
TO A FIRE, COULDN'T THEY,

WITH THEIR LITTLE
WRIST BRACELET ON.

IT'S THE ONE THAT TIES
TO THE BEDFRAME THAT'S GOING
TO BE THE SLIP KNOT.

BUT IF I DON'T TIE A KNOT
ON HERE, WHAT HAPPENS IS,

THIS COMES LIKE THIS, AND
THEY PULL AND THEY FIGHT

AND THIS GETS TIGHTER AND
TIGHTER AND TIGHTER.

AND THEN I'VE CUT OFF
THEIR CIRCULATION.

SO THE KNOT IS TO PROTECT
AND STABILIZE THIS BRACELET

SO THAT IT DOESN'T GET ANY
TIGHTER ON THE WRIST.

SO I'M GOING TO PUT
A SQUARE KNOT HERE.

AND THAT'S GOING TO KEEP
THIS AT THIS TIGHTNESS

ON THEIR WRIST.

AND THEN I'M GOING TO DETERMINE
WHERE I WANT THEM.

DO I WANT THE HAND UP
LIKE THIS FOR A BREAK?

DO I WANT IT ACROSS THE CHEST
LIKE THIS FOR A CHANGE OR WHAT?

THEY COULD BE IN A LOT
OF POSITIONS.

IF WE KEEP OUR CLIENTS IN
THIS LOCKED DOWN POSITION
ALL THE TIME,

THEY'RE GOING TO GET ATROPHIED.

THEY'RE GOING TO GET
CONTRACTURES AND WEAKNESS
IN THAT EXTREMITY.

THEY'VE GOT TO MOVE
THOSE EXTREMITIES.

SO, I'M GOING TO COME DOWN HERE.
AND I'VE GOT ANOTHER LITTLE
CATCH PLACE.

YOU COULD DO IT.

YOU GUYS CAN'T REALLY SEE, BUT
IT'S THE SAME THING OTHER THAN..

I HAVE TWO TIES NOW.

OKAY, LET'S JUST DO IT
HERE WHERE YOU CAN SEE.

THIS IS A BEDFRAME.
NEVER, NEVER TIE..

OKAY, BUT YOU CAN'T SEE.

YOU CAN TAKE TWO TIES
AROUND YOUR BED FRAME,

AND GO LIKE THIS AND TIE A BOW.

BECAUSE, THE BOW IS A SLIP
KNOT AND YOU CAN GET OUT.

OR YOU CAN DO THE KNOT
THAT I SHOWED YOU

AND JUST BRING IT AROUND
AS IF THIS IS A ONE TIE.

AND JUST DO YOUR LITTLE THING.

AND THEN MAKE YOUR LITTLE PULL
RIGHT HERE AND STICK IT IN HERE.

A SLIP KNOT.

SO EITHER ONE.

BUT, A BOW COUNTS. OKAY?

SO NOW THAT YOU'VE SEEN THEM,
I'LL TIE THEM TO THE FRAME,

SO YOU GET THE RIGHT LOOK.
I DON'T WANT TO LEAVE
A WRONG LOOK PICTURE.

WE WOULD NEVER DO THAT.

THIS IS WHEN IT'S HELPFUL TO
KNOW HOW YOUR SIDE RAILS MOVE

SO YOU CAN JUST GET
THEM OUT OF THE WAY.

JUST COME DOWN HERE.

OKAY. THAT'S ALL THE MOVEMENT
I REALLY WANT YOU
TO HAVE RIGHT THERE.

AND THERE.

SO HE PROBABLY STILL COULD
REALLY SHIMMY HIMSELF DOWN

AND PULL THOSE OUT IF HE WANTED
TO. BUT, HOPEFULLY HE WON'T.

ALRIGHT. PUT THE BED IN A LOW
POSITION. WASH YOUR HANDS.

I'M GOING TO FIND SOMEBODY TO
SIT WITH THIS CLIENT
ALL THE TIME.

SO THEY CAN TAKE HIM
TO THE BATHROOM,

WATCH AND JUST MAKE SURE
THAT THEY'RE SAFE.

EVERY 15 MINUTES, THEY'RE GOING
TO HAVE TO TAKE A VISUAL

TO LOOK EXACTLY AT HOW
THESE ARE ON THERE,

THAT THE KNOTS ARE STAYING GOOD,

AND THAT THEY HAVEN'T CUT
OFF CIRCULATION IN ANYWAY.

AND THEN, EVERY TWO HOURS
RESTRAINTS ARE RELEASED.

YOU CHECK THE SKIN TO MAKE
SURE THAT THE SKIN HASN'T
BEEN BROKEN DOWN.

YOU'RE GOING TO PUT A
LOTION ON THEIR SKIN.

YOU'RE GOING TO PUT THEM
THROUGH A RANGE OF MOTION.

AND THEN YOU'RE GOING TO
REPOSITION THEM IN A
TOTALLY DIFFERENT WAY.

YOU'RE NOT GOING TO KEEP
SLAPPING HIM DOWN LIKE THIS.

YOU'RE GOING TO DO
SOMETHING ELSE,

SO THAT YOU'RE MOVING THOSE
EXTREMITIES. OKAY?

WHEN YOU COME TO THE STATION,

WE'RE NOT GOING TO WATCH
YOU, LIKE DO IT.

YOU'RE JUST GOING TO TIE HIM UP.

I CAN TELL WHEN IT'S ALL SAID
AND DONE WHAT YOU DID.

SO I'LL LOOK AND I'LL JUT
GRAB THOSE SLIP KNOTS,

MAKE SURE THAT I CAN GET THEM
UNDONE.

I'LL CHECK, YOU KNOW,
CIRCULATION TO MAKE SURE
THEY'RE NOT TOO TIGHT.

AND THEN I'LL SAY, WHAT ARE THE
PARAMETERS FOR CHECKING
THIS CLIENT?

AND YOU'RE GOING TO SAY, "I'M
GOING TO CHECK EVERY 15 MINUTES.

I'M GOING TO HAVE SOMEONE
STAY WITH HIM 24 HOURS

I'M GOING TO CHECK HIM
EVERY 15 MINUTES.

AND THEN EVERY TWO HOURS I'M
GOING TO PUT HIM THROUGH
RANGE OF MOTION,

REPOSITION, SKIN CARE,
THOSE THINGS.

AND THAT'S ALL YOU'RE
REALLY GOING TO DO AT
THAT STATION. OKAY?

ALRIGHT. THE NEXT STATION,
LET'S DO WALKER AND CANE.

LET'S DO WALKER FIRST.

YOU CAN CHECK THE
DOCTOR'S ORDERS.

THE DOCTOR MAY OR MAY NOT HAVE
WRITTEN AN ORDER DEPENDING ON,

IF YOUR CLIENT CAME
TO THE HOSPITAL

WITH A WALKER OR IF YOUR
CLIENT NEEDS A WALKER.

SO THEY MAY COME
WITH THEIR WALKER

AND THERE JUST NEEDS TO BE
SOMETHING RELATED TO AN
ACTIVITY.

ORDER. "UP IS TOLERATED, UP
WITH WALKER," OR SOMETHING.

BUT THE NURSING CARE
PLAN SHOULD SAY,

CLIENT NEEDS TO TRANSFER
OR AMBULATE WITH WALKER

SO THAT YOU GET AN IDEA
OF WHAT THEY NEED.

THEN YOU'RE GOING TO GATHER YOUR
EQUIPMENT, WHICH IS THE WALKER

AND POSSIBLY A GAIT
BELT TO SUPPORT

AND GIVE YOU SOMETHING
TO GRAB ON TO,

ESPECIALLY WHEN THEY'RE
WEARING JUST A GOWN.

IF THEY HAVE PANTS ON, I'LL
PROBABLY USE THE BELT LOOPS

OR THEIR BELT OR SOMETHING.
BUT WHATEVER. ALRIGHT.

WASH MY HANDS. I'LL IDENTIFY
MY CLIENT, WHICH IS ME TODAY.

AND PROVIDE PRIVACY.

WHEN YOU'RE THINKING ABOUT
YOUR CLIENTS AND PRIVACY,

BUT YOU DON'T REALLY PULL A
CURTAIN, BECAUSE THEY'RE
GOING TO BE WALKING.

SO PRIVACY IS GOING
TO BE BACK HERE.

MAKE SURE THEY HAVE
A ROBE ON OR PUT ANOTHER GOWN
ON AS THEIR ROBE,

SO THEY'RE NOT EXPOSED. AND THEN
THEY NEED GOOD NON-SKID SHOES,

SLIPPERS TO AMBULATE WITH.

AND IT'S EVEN BETTER IF THEY
CAN AVOID LIKE THOSE
SLIP-ON LITTLE SLIPPERS,

YOU KNOW, THAT'S JUST THAT
LITTLE PIECE ACROSS

BECAUSE THEY SLIP OUT OF THEM
AND THEY'RE AT RISK FOR FALLING.

SO, I WOULD RECOMMEND A SHOE

OR A FULLY ENCLOSED SLIPPER
OR SOMETHING THAT STAYS
ON THEIR FOOT.

ALRIGHT. THE FIRST THING
WE NEED TO DO IS HAVE --

DETERMINE WHAT, IF THE CLIENT
HAS ANY WEAKNESS ON ONE SIDE OR
THE OTHER.

AND LET'S SAY I HAVE
LEFT SIDED WEAKNESS.

BUT I'M ABLE TO WALK OBVIOUSLY.
I CAN GET UP AND WALK.

I JUST NEED A WALKER
FOR SUPPORT.

AND WE WANT TO MAKE SURE
THE WALKER FITS THE CLIENT.

SO, WE'RE GOING TO NEED
THE CLIENT TO COME

AND STAND INSIDE THE
CAGE OF THE WALKER.

AND I CALL THIS THE CAGE.

IN THE CAGE, THEY SHOULD BE
ABLE TO GRIP THE HAND REST.

AND ONCE THEY'RE GRIPPED,
YOU'RE GOING TO CHECK

THAT THEIR ELBOWS ARE BENT
AT 15 TO 30 DEGREES.

YOU DON'T WANT THEM BEND
REALLY HIGH LIKE THIS

BECAUSE THEY TEND TO LUNGE WHEN
THEY HAVE SO MUCH ROOM.

SO THEN YOU WANT THEM..
THAT 15 TO 30 DEGREES

ONLY ENCOURAGES THEM TO
STRAIGHTEN OUT THAT SIX TO EIGHT
INCHES WORTH.

AND THEY DON'T TAKE
AS HUGE OF STEPS.

SO 15 TO 30 DEGREE BEND.

SLIGHTLY BELOW THE WAIST
DEPENDING ON THE WALKER YOU USE.

I DON'T LIKE THAT
CRITERIA VERY WELL

BECAUSE IF YOU HAVE
A WALKER LIKE THIS,

THAT'S WAY BELOW THE WAIST, SO
THAT'S NOT A CLEAN CRITERIA.

THE ELBOWS ARE A CLEAN CRITERIA.

THE DIFFERENCE BETWEEN
THESE TWO WALKERS IS,

THIS ONE IS CALLED
A PICKUP WALKER

BECAUSE YOU HAVE TO
PICK UP ALL FOUR FEET

AND THEN STEM DOWN BEFORE
YOU WALK INTO IT.

THIS IS A WHEELED WALKER
AND THIS IS FOR PEOPLE

THAT WANT TO MAKE A LITTLE
SPEED AS THEY GO.

AND SO THEY CAN.. IT KEEPS THE
TWO WHEELS ON THE FLOOR
ALL THE TIME

AND THEY CAN CLIP AT
A PRETTY GOOD PACE.

SO THIS IS FOR SOMEONE
THAT'S RELATIVELY..

I MEAN, ALMOST READY TO
BE RID OF THE WALKER.

IT'S JUST THERE AS A KIND OF
A BACKUP AND THEY CAN CLIP.

WE ARE GOING TO USE
THE PICKUP WALKER.

WE ALWAYS DO THE, KIND OF,
HARDEST OF THEM.

IF THERE'S ANYTHING THAT'S
A LITTLE HARDER.

ALRIGHT. WE'VE GOT
OUR CLIENT UP.

WE'VE MEASURED THAT WE
HAVE THE RIGHT BEND.

THEY'RE IN THEIR GOOD
NON-SKID WALKING SHOES.

THEN WE WANT TO TEACH THEM HOW
TO AMBULATE WITH THIS WALKER.

SO YOU WANT TO TEACH THEM THAT
THEY'RE GOING TO
TAKE THE WALKER,

AND PICK IT UP, ALL FOUR FEET

AND SET IT SIX TO EIGHT
INCHES IN FRONT OF THEM.

YOU'RE GOING TO BE STANDING
SLIGHTLY BEHIND THEM ON THEIR

STRONG OR WEAK SIDE?
- STRONG.

STRONG. WE ALREADY KNOW.
THIS PRINCIPLE IS THE
SAME FOR ALL WALKING.

SO, WE'RE GOING TO BE SLIGHTLY
ON THE STRONG SIDE,

WHICH WILL BE MY RIGHT SIDE.
GAIT BELT, FELT I NEEDED IT.

AND NOW, THEY'RE GOING TO MOVE
A FOOT INTO THE WALKER.

WHICH ONE? STRONG OR WEAK.
- WEAK.

WEAK. BECAUSE YOU WANT TO LEAVE
A TRIPOD OF STRENGTH, RIGHT?

SO, IF I LIFT MY WEAK, I'VE GOT
EVERYTHING STRONG HELPING ME.

AND IF I STEP ON WEAK NOW I'VE
GOT MY TWO HANDS TO HELP ME.

I'M NOT LETTING THE WEAK
LEG BEAR ALL THE WEIGHT.

THEN ONCE I'VE STEPPED IN,
YOU PICK UP, GO, GO.

IT'S A THREE STEP..

AND THEY NEED TO GET
ALL FOUR FEET DOWN

BEFORE THEY START RUNNING
OFF. SO REMIND THEM.

YOU DON'T WANT TO SEE..

THESE ARE SOME OF THE THINGS
I'VE SEEN OVER THE YEARS.

I THINK IF THEY WALK LIKE THIS,

THAT MAYBE THEY DON'T NEED
THIS WALKER VERY MUCH.

SOMETIMES THEY DRAG THEM AND
THEN MAYBE THEY DON'T NEED
IT VERY MUCH

OR WHAT'S GOING ON IS MAYBE
THEY NEED TO GO TO WHEEL.

SOMETIMES, WHAT THEY'VE DONE IS,
THEY DON'T LIKE THIS
CLICKING SOUND

AND IT KIND OF STICKS A LITTLE,
THESE RUBBER STOPPERS.

SO YOU'LL SEE TENNIS BALLS
ON THE END OF THE WHEELS.

IT TAKES THE CLICK OUT AND IT
LETS THEM GLIDE A LITTLE BETTER.

AND THEY LIKE THOSE, SO.

YOU JUST.. THE MAIN THIS IS YOU
DON'T WANT THEM STICKING
AND TRIPPING.

YOU WANT THEM TO PICK UP, SET
AND GO. THAT'S THE SAFER WAY.

IT'S INTERESTING AS YOU START
WATCHING. AND I WATCH ALL OF IT,

ALL THE TIME. WHEN I SEE SOMEONE
IN A RESTAURANT OR OUT SHOPPING,

AND I LOOK TO SEE WHAT THEY'RE
DOING AND HOW THEY'RE DOING IT.

AND I DON'T KNOW
IF YOU'VE NOTICED,

BUT WE DON'T HAVE A VERY
HANDICAPPED WORLD
IN WHICH WE LIVE.

IF YOU'RE HANDICAPPED WITH
A WHEELCHAIR OR A WALKER,

YOU JUST TRY TO EAT
AT MARIE CALLENDER'S.

THEY'LL PUT YOU AT THE BACK
TABLE, I'VE WATCHED IT HAPPEN.

AND THEY JUST HARDLY HELP YOU.
AND HERE'S THESE POOR,
WALKER PEOPLE.

IT TAKES THEM LIKE 15 MINUTES
TO GET FROM THE FRONT DOOR

TO THE BACK TABLE BECAUSE
THEY DON'T FIT WHEN
THE RESTAURANT'S FULL.

TRY TO GET INTO A BATHROOM,
YOURSELF. THINK OF
YOUR BATHROOM.

MOST OF US DON'T HAVE
THESE HUGE,
GARGANTUAN BATHROOMS.

WE GOT LITTLE TINY ONES. BARELY
FIT THROUGH THE DOOR..

TRYING TO GET TO THE SEAT,
YOU KNOW.

AND WE GOT TO GET UP,
WE GOT TO THE --

YOU KNOW, SO WE DON'T HAVE
MUCH OF A WALKER WORLD.

AND SO, WHAT DO THEY DO?
SO OFTEN THEY NEED
TO BE STABLE ENOUGH

THAT THEY COULD LEAVE
THE WALKER AT THE DOOR
AND MANAGE WITHOUT IT.

BUT THEY DON'T ALWAYS
GET UP WELL.

SO THEN YOU'VE GOT TO THINK
ABOUT TOILET SEAT HANDLES SO
THEY CAN GET UP,

BECAUSE THAT'S WHAT THEY
MAY PRIMARILY USE IT FOR.

SO, THINK THROUGH.
IT'S NOT JUST, "OH, GOOD.
I TAUGHT MY CLIENT,

THEY'RE GOOD TO GO." YOU
WANT TO TALK TO THEM.

HOW DO YOU GET AROUND
IN YOUR HOUSE?

HOW'S YOUR BATHROOM?
DO YOU HAVE STAIRS?

I DON'T KNOW HOW TO DO
A WALKER WITH STAIRS.

I DON'T THINK YOU CAN.

SO, WE'VE GOT TO TALK THROUGH
SOME OF THOSE THINGS
TO HELP THEM.

MAYBE THEY LEAVE IT PARKED AT
THE BOTTOM OF THE STAIRS,

GO UP WITH HAND RAILS AND HAVE
ANOTHER WALKER FOR,
IN THE HOUSE.

BUT, YOU KNOW. OKAY. LET'S THINK
THROUGH ONE MORE THING.

WHAT HAPPENS WHEN YOU GOT TO DO
THE LAUNDRY WITH YOUR WALKER?

WHAT DO YOU DO? HOW DO YOU GET
GROCERIES WITH THE WALKER?

IN SMALL FREQUENT LOADS,
WOULD BE MY GUESS.

YOU KNOW, IT'S A VERY DIFFICULT,
VERY FRUSTRATING LIFESTYLE.

YOU'LL SEE THAT THEY'LL
PUT BICYCLE BASKETS

AND BAGS IN FRONT SO THAT THEY
CAN CARRY PARAPHERNALIA,

THEIR READING BOOK, THEIR..
YOU KNOW, THE STUFF OFF LIFE.

BUT YOU WANT TO REMIND THEM
NOT TO OVERLOAD THIS.

THEY COULD GET THIS SO
HEAVY AND SO LOPSIDED

THAT THEY CAN HARDLY
MOVE THE WALKER.

VERY TRICKY. ALRIGHT.

WE'VE WALKED. AFTER YOU'VE WALK,

YOU WANT TO MAKE SURE THAT YOU
PUT YOUR CLIENT BACK TO BED

OR IN THE CHAIR OR WHATEVER.
WASH YOUR HANDS

AND THEN DOCUMENT HOW
FAR THEY'D TRAVELED.

AND HOW THEY TOLERATED IT.

AND BE EVALUATING ALL THE TIME,
"IS THIS THE BEST METHOD
FOR MY CLIENT

OR COULD THEY USE A CANE?"

WOULD THAT BE BETTER SUPPORT FOR
THEM? OR DO THEY NEED THIS?

OR MAYBE THEY HAVE A CANE
AND THEY NEED TO MOVE UP

FOR SOMETHING MORE STURDY.

AND THOSE ARE SOME THINGS

THAT YOU'RE LOOKING AT RELATED
TO THE WALKER. ALRIGHT.

SO OUR CLIENT'S JUST CLIPPING
ALONG WITH THEIR WALKER,

AND WE'RE THINKING,
"YOU KNOW, MAYBE A CANE WOULD
BE THE BEST THING."

THEIR KNEE BUCKLES HERE AND
THERE, BUT THEY HAVE SUPPORT
WITH THE CANE,

THAT WOULD FREE UP THEIR HANDS

AND IT'S JUST A LITTLE BIT
EASIER, YET THE SUPPORT.

THERE'S TWO KINDS OF CANES
THAT ARE OUT THERE.

THERE'S THE QUAD CANE
AND THE POLE CANE.

THE QUAD CANE IS A LITTLE
STABLER, AS YOU CAN SEE.

WHEREAS THIS IS JUST -- THIS IS
LIKE THE BARE MINIMUM OF CANE.

AND THIS IS A LITTLE MORE
SUPPORT. SO YOU'LL
HAVE TO DECIDE.

AND PHYSICAL THERAPY CAN HELP
CONSULT WHEN YOU'RE THINKING.

I THINK THEY NEED
SOMETHING ELSE,

SOMETHING DIFFERENT. WE'RE GOING
TO USE JUST THE POLE CANE HERE.

THE SINGLE CANE.

SO, YOUR CLIENT NEEDS A CANE,
YOU'VE CHECKED YOUR DOCTOR'S
ORDERS, CHECKED YOUR CARE PLAN,

GET SOME INPUT AS TO WHY
THEY NEED THIS, WHAT FOR?

MAYBE IT'S FOR MINIMAL
KNEE INJURY,

OR SOMETHING AND THEY JUST --
THEY NEED A LITTLE SUPPORT.

YOUR PATIENT SHOULD BE
BASICALLY INDEPENDENT.

THEY SHOULD BE AMBULATORY AND
THIS IS JUST HARDLY ANYTHING
FOR THEM.

JUST BACKUP.

YOU'RE GOING TO GATHER YOUR
EQUIPMENT, WHICH IS YOUR CANE,
A GAIT BELT,

POSSIBLY, GOOD WALKING SHOES,
ROBE, PRIVACY.

IDENTIFY YOUR CLIENT. ME.

WASH YOUR HANDS, AND PROVIDE
PRIVACY, WHICH IS AGAIN,
THE ROBE.

ALRIGHT. THE FIRST THING
WE WANT TO DO,

AND I MENTIONED IT BEFORE
IS WE WANT TO ASCERTAIN

OR BE SURE THAT THIS IS THE
APPROPRIATE WALKING DEVICE,

APPLIANCE FOR THE CLIENT.

ARE THEY SAFE WITH THIS?
IS THIS GOOD FOR THEM?

ONCE WE'VE DONE THAT WE WANT TO
MEASURE -- GET THEM DRESSED,

THE NON-SKID SHOES, GET
THEM ALL DRESSED UP

AND THEN WE WANT TO MEASURE THAT
WE HAVE THE RIGHT LENGTH.

YOU HAVE A LITTLE DIFFERENT
CRITERIA ON THIS.

YOU'RE GOING TO PUT THE CANE
TO THE GREATER TROCHANTER,

OKAY. MAKE SURE YOU KNOW
THE DIFFERENCE BETWEEN
THE GREATER TROCHANTER

AND THE ILIAC CREST.

BECAUSE IF YOU GO LIKE THIS
AND SAY, I PUT IT AT
MY GREATER TROCHANTER,

I'M GOING TO TAKE OFF ON THAT,
BECAUSE IT'S NOT YOUR
GREATER TROCHANTER.

AND IF I PUT IT UP TO HERE,
WHERE WOULD THE BEND
IN MY ELBOW BE?

- 15
- NOT 15 TO 30.

IT'S GOING TO BE MORE LIKE 90.
SO, BY PUTTING IT TO
THE GREATER TROCHANTER,

YOU MAINTAIN THAT SAME RULE OF
THE 15 TO 30 DEGREE BEND
IN YOUR ELBOW.

YOU WANT THE CANE TO BE
ON THE STRONG SIDE.

AGAIN, IT'S SUPPORT,
SO THAT IF THEY BUCKLE,

THEY'RE GOING TO GO TOWARDS
THEIR SUPPORT,

WHICH IS STRONG SIDE SUPPORT.

MY LEFT LEG IS WEAKER, IF I'M
GOING TO HAVE A WEAK ONE.

THIS IS GOING TO BE SIX TO EIGHT
INCHES IN FRONT OF MY FOOT,

AND OUT HERE A LITTLE BIT.

AND I'M GOING TO TEACH MY CLIENT
TO WALK WITH THE WEAK LEG

AND THE CANE AT THE SAME TIME.

LIKE YOU WALK. IT KIND OF
SIMULATES A STRONG LEG
SUPPORT WITH THEM.

SO I'M GOING TO WALK.

PUT BOTH DOWN, SO THAT MY
CANE SUPPORTS MY WEAK LEG

AND I'M GOING TO TAKE
MY STRONG FOOT,

STRONG LEG THROUGH AND CAST

THAT LINE OF CANE.

AND JUST WALK.

THAT'S ALL THERE IS TO IT.
THIS WAY. LET'S SEE.

CAST.

CAST AND JUST WALK.

AND THEY SHOULD LOOK LIKE
THEY'RE WALKING.
THAT'S THE WHOLE POINT.

NOW, THEY CAN DO A SLOWER
GAIT AND GO, ONE..

WELL, NO, YOU GO, CANE,
LEG, WALK.

CANE, LEG, WALK. BUT IF YOU GOT
TO THINK TOO MUCH FOR THAT,

THEN THERE'S ANOTHER GAIT WHERE
YOU GO, CANE, LEG, EVEN.

CANE, LEG, EVEN.

AND THAT'S A LITTLE CHOPPY TOO.

I'M THINKING IF THEIR THAT SLOW
THEY PROBABLY NEED A WALKER.

BUT YOU'LL SEE THOSE DIFFERENT..
IN THE VIDEOS AND IN YOUR BOOKS,

THEY HAVE ALL THESE DIFFERENT
GAITS. BUT WE'RE JUST GOING TO
DO A WALK.

CHINK, CHINK.

AND THAT'S WHAT I AM DESCRIBING
ON THOSE PAGES.

AFTER THEY'VE AMBULATED,
YOU CAN PUT THEM..

THEY CAN WALK BACK TO
THEIR CHAIR, WHATEVER.

WASH YOUR HANDS AND DOCUMENT
THE DISTANCE TRAVELED.

AND HOW WELL THEY TOLERATED IT.

WATCH PEOPLE WITH CANES.

IT'S PROBABLY THE MOST
ENTERTAINING OBSERVATION
YOU'LL EVER MAKE.

I'VE ONLY SEEN IN THE LAST
MAYBE EIGHT OR 10 YEARS,

LIKE ONE PERSON DO IT RIGHT.

MOST OF THE TIME,
AND I'M JUST WATCHING,
LIKE I'M IN THE LAWN ON CAMPUS

AND I'M JUST WATCHING, AND
I'M GOING, "WRONG SIDE.

NO GAIT. OH, MY GOODNESS!
WHAT IS THAT?"

AND I THINK SOME PEOPLE JUST
CARRY THEM FOR THE STATUS
OF THE CANE.

AND LOOK, I MEAN, THEY'VE GOT
SOME GORGEOUS CANES OUT THERE.

AND I THINK THEY
JUST LIKE THEIR CANE.

BUT THEY JUST DO CRAZY THINGS
AND THERE'S NO RHYME OR REASON

TO ANY KIND OF GAIT OR ANY KIND
OF LIKE, THING, YOU KNOW.

IT'S JUST KIND OF THERE.

AND I'M THINKING, "OH, THEY
REALLY DON'T NEED THAT.

SO IT'S PROBABLY GOOD FOR THEM."

BUT WATCH IT.

I HAD A FRIEND, AND IT'S
A FUNNY LITTLE STORY.

THIS GUY WAS LIKE 92 YEAS OLD
AND HE FELL OUT OF A TREE.

YOU WANT TO ASK YOURSELF WHY HE
FELL OFF THE TREE? HONESTLY.

AND HE WAS ALWAYS CLEANING.
HE'D GO TO THE SCHOOL GROUNDS

AND HE'D CLEAN EVERYDAY.
JUST FOR FREE, AROUND
THE SCHOOL GROUNDS.

PICK UP THE TRASH. AND
HE WAS JUST A BUSY GUY.

AND HE HAD TO GET ON THE
TREE AND DO SOMETHING. SO HE
DID. AND HE FELL OFF. OKAY.

HE BROKE HIS HIP AND THEY TOLD
HIM HE'D NEVER WALK AGAIN.
DIDN'T KNOW HIM VERY WELL.

AND HE GOT UP AND HE WALKED,
SURE ENOUGH.
AND HE HAD HIS WALKER

AND HIS CANE. HE TOLD HIS
GRANDDAUGHTER WHEN HE HAD
HIS CANE,

HE SAYS, "I REALLY DON'T
KNOW WHAT THIS CANE IS.

I JUST NEED IT FOR A JUMPSTART.

THAT'S ALL HE USED IT FOR.
AND I AM NOT KIDDING.

AND HE IS TO THIS DAY,
100 YEARS OLD.

HE JUST CELEBRATED HIS BIRTHDAY
LAST OCTOBER. HE IS A TRIP.

SO, HE'S WALKING. I DON'T THINK
HE'S CLIMBING TREES ANYMORE.

BUT NEVERTHELESS, PEOPLE
ARE FUNNY. ENJOY THEM.

APPRECIATE HOW THEY USE THE
STUFF THEY DO. AND TALK TO THEM.

WHEN DO YOU USE YOUR CANE?
WHAT GAITS HAVE YOU USED?

AND JUST SEE WHAT THEY TELL YOU.

ALRIGHT. SO THAT'S..

ALRIGHT, THE NEXT THING YOU'RE
GOING TO DO IS USE CRUTCHES.

YOU'LL SEE THAT YOU GOT TWO
SCORES THERE ON CRUTCHES.

YOU'RE GOING TO GET GRADED
ON MEASURING YOUR CRUTCHES,

BECAUSE THERE'S A FEW MORE
THINGS THAT WE NEED TO DO.

AND THEN THERE'S A BUNCH
OF DIFFERENT GAITS
THAT YOU GOT TO DO.

I PUT SOME CRITERIA ON ALL
THE GAITS, LIKE EXPLAINING
AND ALL THE STUFF.

BASICALLY WE JUST WANT
YOU TO LOOK THAT UP

AND KNOW WHO MIGHT
USE THESE GAITS,

WHICH IS THE MOST STABLE GAIT

AND THEN JUST DEMONSTRATE
THE GAITS TO US.

BUT FIRST THINGS FIRST.
DOCTOR'S ORDER. YES.

YOU NEED THE DOCTOR'S ORDER
SO THAT THEY GET REIMBURSED.

THAT'S REALLY IMPORTANT. NOT
TO MENTION, THE DOCTOR NEEDS

TO KNOW WHAT THEY'RE USING
AND NEEDS TO BE INVOLVED
IN SAFE AMBULATION.

DOCTOR'S ORDER, NURSING CARE
PLAN. GOING TO GATHER
UP YOUR EQUIPMENT,

WHICH IS YOUR CRUTCHES,
AGAIN GAIT BELT, ROBE FOR
PRIVACY, NON-SKID SHOES.

AND SHOES THAT THEY'LL
WALK WITH.

THAT'S REALLY IMPORTANT FOR
GETTING THE RIGHT MEASUREMENT,

FOR THE STUFF. BECAUSE IF
THEY'RE IN SLIPPERS ONE DAY

AND HEELS THE NEXT, YOU KNOW,
IT KIND OF MESSES THINGS UP.

I NEED TO SHOW YOU ACTUALLY HOW
TO ADJUST THIS. REMIND ME.

OKAY.

I'VE GATHERED MY EQUIPMENT,
I WASHED MY HANDS,
IDENTIFIED MY CLIENT,

WHICH IS ME AND PROVIDED
PRIVACY, WHICH IS MY CLOTHES.

AND I AM NOW GOING
TO MEASURE THESE.

THERE ARE A COUPLE OF WAYS TO
MEASURE. YOU CAN HAVE A CLIENT
LAYING DOWN.

AND YOU CAN MEASURE

FROM THEIR AXILLA WITH A
MEASURING TAPE STRAIGHT OUT

BECAUSE IF THIS WAS A MEASURING
TAPE, TWO, SIX TO EIGHT INCHES

OUTSIDE OF THEIR FOOT.

AND THEN SUBTRACT TWO INCHES

SO THAT YOU CAN GET TWO FINGERS
UNDERNEATH THE AXILLA.

YOU DON'T WANT THE CRUTCH
ON THEIR AX, AXILLA.

NOW THIS IS WHY THEY'RE
CALLED AXILLARY CRUTCHES,

BECAUSE THEY GO UNDER AXILLA.

THERE ARE TWO OTHER KINDS OF
CRUTCHES THAT ARE OUT THERE.

THE LOFSTRAND CRUTCH.

YOU MAY HAVE SEEN THE LOFSTRAND
CRUTCH FOR SOMEONE
THAT HAS POLIO

AND IT'S GOT THE LITTLE WRIST
BRACE AND HANDS ON IT

OR LOWER HANDS.
AND THEN THERE IS A --

I FORGET THIS ALL THE TIME.

PLATFORM CRUTCH, WHERE YOU
CAN LAY THE WHOLE ARM.

CRUTCHES REALLY DO A
NUMBER ON YOUR WRISTS

AND SO YOU CAN PUT THE WHOLE
FOREARM ON THE PLATFORM

AND USE IT AS SUPPORT TO
GIVE THE WRISTS A BREAK.

I JUST WANT TO SAY, CRUTCHES
ARE FOR THE STRONG,

THE VERY, VERY STRONG.

YOUTHFUL, STRONG UPPER
BODY. STRONG.

THEY'RE KILLER. AND MOST OF YOU,
IF YOU'VE HAD A BROKEN

SOMETHING HERE OR THERE,
BEEN ON CRUTCHES,

WERE YOU JUST LIKE, WOW,
OH MAN, THEY'RE TOUGH.

OKAY. SO YOU'VE IDENTIFIED
YOUR CLIENT AND YOU KNOW
THEY'RE STRONG.

THEY CAN DO THIS. OKAY, SO
YOU'VE MEASURED AND YOU'VE
GOT YOUR LENGTH.

BUT THERE'S ANOTHER WAY YOU
CAN JUST HAVE THEM STAND,

PUT THEIR CRUTCHES SIX
TO EIGHT INCHES OUT.

MAKE SURE THAT WHEN THEY PUT
THEIR HANDS ON THE HAND REST,

THE ELBOW BEND IS 15 TO 30
DEGREES. IT'S KIND OF
THE RULE OF BEND.

AND THAT YOU CAN GET TWO
FINGERS UNDER THE AXILLA.

YOU DON'T WANT IT REAL LOW.
THAT'S TOO MUCH AND
YOU LOSE STABILITY.

YOU JUST DON'T WANT THEM WAY
UP HERE, PRESSING. WHY?

WHAT'S THAT NERVE?
- LOW, THE BRACHIAL ARTERY.

THE BRACHIAL NERVE..

HERE CAN GET DAMAGED AND YOU CAN
CAUSE PARALYSIS AND NUMBNESS

IN THAT EXTREMITY. SO,
YOU WANT TO AVOID THAT.

THE OTHER THING YOU CAN DO IS
JUST TO GUESSTIMATE,
AND I LOVE THESE

IS YOU CAN DO IT BY YOUR HEIGHT.

I'M ACTUALLY 5'3.5".

SO I COULD PROBABLY GO
BETWEEN 5'3"AND 5'4".

BUT USUALLY BY THE TIME
I'VE GOT A LITTLE HEEL ON
WITH MY TENNIS SHOE

OR WHATEVER,
I NEED A LITTLE MORE.

SO IT ACTUALLY FITS ME
PRETTY GOOD AT 5'5".

AND SO YOU CAN
ADJUST ACCORDINGLY.

THESE ARE SO EASY TO ADJUST,
YOU GUYS CAN FIGURE IT OUT.

THE THING IS THAT GOT ME THE
FIRST TIME WAS I WAS PUSHING

AND PUSHING THIS BUTTON, AND
I COULDN'T GET ANY MOVEMENT

BECAUSE IT'S A TWO-SIDED BUTTON.
YOU HAVE TO PUSH BOTH
TO GET IT UP. YEAH.

AND THEN YOU GOT TO BE CAREFUL
THAT YOU DON'T DO TOO MUCH
TWISTY STUFF,

BECAUSE ONCE THE BUTTON
GETS LOST IN HERE,

YOU'RE SEARCHING FOREVER
TO FIND IT.

WHILE I'M TAKING THE
MEASUREMENTS, LET ME JUST BACK
UP WITH THE WALKER.

THE WALKER WORKS
BY THE SAME BUTTON.

LET'S SAY YOU NEED
THIS TO BE HIGHER.

SO YOU GET -- SO I NEED IT
TO BE TWO THINGS HIGHER.

SO PRESS THIS, YOUR TWO.

PULL IT DOWN. OH, IT
CAN'T GO MUCH HIGHER.

AND YOU PUT IT IN HERE, SEE HOW
EASY IT IS TO LOSE THAT BUTTON?

THERE YOU GO.

AND THEN, TEST THE ONE LEG
BEFORE YOU DO ALL FOUR LEGS.

IT'LL SAVE YOU A LOT OF
TIME ON THAT.

SEE IF SOMEONE CAN FIGURE
OUT LOPSIDED. OKAY.

ALRIGHT. SO, I'VE CHECKED
MY HEIGHT. I'VE ADJUSTED.

EVERYTHING LOOKS GOOD. GAIT
BELT, AGAIN AS NEEDED,
SHOES ARE GOOD.

AND I AM READY TO GO ON THIS.

ALRIGHT. WE'RE GOING TO START
FROM WHAT IS THE MOST
STABLE GAIT

TO WHAT IS THE LEAST
STABLE GAIT.

THE RULE OF CRUTCH WALKING
AND REMEMBER THIS FOR
THE REST OF YOUR LIFE

IS YOU ALWAYS TEACH THE MOST
STABLE GAIT FOR YOUR CLIENT.

IF YOU HAVE OPTIONS WHEN
YOU'RE INPLEX TESTING,

IF YOU HAVE OPTIONS ON A TEST,

YOU'RE GOING TO PICK WH
AT'S MOST STABLE AS APPROPRIATE
FOR THAT CLIENT.

AND WE DETERMINE THAT BY
THEIR WEIGHT BEARING.

CAN THEY BEAR WEIGHT
ON TWO LEGS, ARE THEY
NON WEIGHT BEARING,

WHICH IS NWB, FOR ABBREVIATIONS.

NON WEIGHT BEARING,
PARTIAL WEIGHT BEARING.

WHAT DO THEY DO
WITH AN EXTREMITY?

SO, LET'S JUST SAY,
I'M NON-WEIGHT.

WELL, I HAVE TO BEAR WEIGHT
FOR FOUR-POINT.

ALRIGHT. SO THE FIRST GAIT,
THE MOST STABLE GAIT IS
THE FOUR POINT GAIT,

WHICH IS FOUR POINTS DOWN
AT ANY GIVEN TIME.

OKAY, SO, RIGHT NOW I HAVE MY
CRUTCHES IN THE RIGHT POSITION,

I HAVE A GOOD BODY STANCE HERE.

LOOKING UP, WATCH YOUR
CLIENTS TO MAKE SURE

THEY'RE MAINTAINING
GOOD BODY POSTURE.

AND WHAT I'M GOING TO DO IS,
I'M GOING TO PUT ONE CRUTCH OUT

SO I HAVE FOUR-POINT DOWN.

I'M ONLY GOING TO MOVE
ONE THING AT A TIME.

I'M GOING TO MOVE
MY WEAK LEG NOW,

THE OPPOSITE EXTREMITY
TO BE EVEN WITH CRUTCH.

THEN I'M GOING TO TAKE
CRUTCH AND NEXT LEG.

SO ONE, ONE, ONE, ONE.

FOUR POINTS ARE DOWN BETWEEN
EVERY MOVEMENT.

WHO MIGHT USE THIS GAIT?

MAYBE A PATIENT WHO'S HAD KNEE
SURGERY AND THEY NEED
REHABILITATION?

HMM, POSSIBLY. BECAUSE
IT'S MOST STABLE.

BUT WHERE YOU'VE SEEN IT IS
WITH THE LOFSTRAND CRUTCH

AND SOMEONE THAT'S GOT
LOWER BODY WEAKNESS.

REMEMBER THE BRACES.

AND DON'T WE SEE THIS?

- THAT KIND OF A TWISTED BODY.
- DOESN'T HAVE THOSE CUFFS.

SO THEY NEED MORE STABLE, THEY
HAVE GOT GOOD
UPPER BODY STRENGTH,

THEY'VE GOT LOWER LEG WEAKNESS.

THEY'RE GOING TO HAVE
EITHER THE...

WHY CAN'T I REMEMBER THAT...
PLATFORM, I WANT TO SAY POSTURE
ALL THE TIME?

THEY'RE GOING TO HAVE EITHER
THE PLATFORM CRUTCH

OR MORE OFTEN THE LOFSTRAND
BRAND BRACE CRUTCH.

AND THAT'S WHERE YOU'RE
THE FOUR-POINT.

BUT AGAIN, THE FOUR
POINT IS MORE STABLE

AND IT CAN BE FOR ANYONE THAT
NEEDS SUPPORT FROM TIPPING.

I JUST WANT TO CREATE A PICTURE,
WHERE HAVE I SEEN THAT GAIT?

ALRIGHT. THREE-POINT GAIT.

THREE-POINT GAIT MOVES
THREE-POINTS AND/OR

HAS THREE POINTS
DOWN AT ONE TIME.

LET'S SAY, ON THIS ONE,
I'VE HAD KNEE SURGERY

AND I HAVE A STRAIGHT
LEG CAST ON.

I HAVE TWO OPTIONS HERE.
NO WEIGHT BEARING

OR PARTIAL WEIGHT BEARING. MAYBE
I CAN TOUCH MY TOE DOWN,

SO THAT I DON'T TIP.

YOU'RE GOING TO TAKE THREE LEGS,
THREE THINGS OUT AT ONE TIME.

AND THE FIRST IS YOUR WEAK
LEG WITH YOUR CRUTCHES.

SO THREE, ONE.

THREE-POINTS, ONE.

THREE POINTS, ONE.

THREE POINTS, ONE.

OKAY, IT KIND OF LOOKS LIKE
SWING TO AND SWING THROUGH

WHEN WE GET TO IT, BECAUSE IF
I DON'T PUT ANY WEIGHT DOWN,

AND I TAKE THREE OUT,
I'M HOPPING,

WHICH IS A KIND OF SWINGING
TO THE CRUTCH.

SO, I CAN KIND OF MIMIC
THOSE TWO.

SO IT'S CLEAR IN MY MIND IF
WE HAVE THREE-POINTS DOWN.

THAT'S THE IDEA.
SO YOU'RE THREE.

THREE...

..WITH THE STRENGTH OF THE
CRUTCH. SO THIS IS MY
KNEE BRACE.

AND JUST TOE TOUCH.

ALRIGHT.

THE TWO-POINT THEN WOULD BE THE
LESSER OF THE STABLE GAITS.

BUT AGAIN, WE'D PICK UP
A LITTLE SPEED NOW.

THE LESS STABLE THEY ARE, THE
MORE SPEED WE CAN PICK UP.

AND FOR SOME PEOPLE,
SPEED IS AN ITEM.

SO, AGAIN, YOU MAY SEE THIS
PARTICULAR GAIT WITH
THE LOFSTRAND

PLATFORM, CAN GET THAT
IN MY BRAIN, CRUTCH.

AND IT LOOKS LIKE THIS, TWO
POINTS MOVING AT ONE TIME.

AND IT'S VERY MUCH LIKE
AN AMBULATION.

THINK OF SWINGING YOUR
ARMS AS YOU WALK.

EASY. YOU JUST KIND OF WALK.

IT'S PRETTY EASY, I'VE BEEN
DOING THIS FOR A LOT OF YEARS.

BUT YOU'RE GOING TO BE GOING..

NOW LOOK AT MY POSTURE
WHEN I'M DOING THIS.

YOU WANT TO LOOK AT YOUR CLIENT
AND SAY GET YOUR HEAD UP,

BECAUSE IF THEY'RE GETTING
REALLY FEET CONSUMED,
THEY'LL WALK INTO WALLS

AND THINGS AND PEOPLE.

AND IT'S VERY IMPORTANT
THAT THEY'RE LOOKING UP.

ALRIGHT. TWO-POINT.

THE NEXT IS SWING TO
AND SWING THROUGH.

AND THEY ARE OUR LEAST
STABLE GAITS.

BUT THEY ARE FOR SOME SPEED.

SO, IF I HAVE A LEG THAT'S OUT
HERE, WHERE YOU PUT
YOUR CRUTCHES

AND YOU SWING TO THE CRUTCH.
SWING TO, YOU'VE SEEN
THIS ONE A LOT.

- IT'S HOW LOTS OF PEOPLE MOVE.
- EVERYONE DOES THAT ONE.

WELL, NOT EVERYONE. I WATCHED
THIS MAN LAST SEMESTER,

AND I DON'T KNOW WHAT
HE HAD DONE TO HIS LEG,

BUT HE WAS DOING A REALLY
GOOD FOUR-POINT.

THAT'S GOOD. SO WATCH THEM
AND SEE.

WE HAD A COUPLE OF GALS
ON CAMPUS A FEW YEARS AGO

THAT HAD THE LOFSTRAND CRUTCHES
AND THEY DID A REALLY GOOD

FOUR-POINT AND TWO-POINT.
I MEAN, IT'S KIND OF LIKE,
WE HATE TO STARE,

BUT IT WAS LIKE, WATCH
THEM, THEY'RE GOOD.

OKAY, AND SWING THROUGH,
LOTS OF SPEED.

OKAY. BECAUSE YOU'RE SWINGING
THROUGH THE CRUTCH,

AND THAT'S WHAT YOU'VE PROBABLY
BEEN MOST FAMILIAR WITH.

CRUTCHES HAVE THE SAME PROBLEMS
THAT WALKERS DO.

YOU CAN'T CARRY ANYTHING.
SO WHAT'S YOUR OPTION HERE?

- BACKPACK.
- BACKPACK.

I'VE PICKED UP SOME OF
YOUR BACKPACKS.

IT'S A WONDER YOU GUYS HAVEN'T
THROWN ALL YOUR BACKS OUT.

SO THEY CAN OVERWEIGHT
THEMSELVES AND REALLY
BALANCE BECOMES AN ISSUE.

SO, YOU WANT TO TALK TO YOUR
CLIENTS TO MAKE SURE
THEY DON'T DO THAT.

I NEED TO GET A STAIR HERE.

DON'T PRACTICE ON THIS.

THE ONLY REASON I USE THIS IS
BECAUSE WE CAN'T
ALL FIT IN THE HALLWAY.

BUT YOU'RE GOING TO PRACTICE IN
THE HALLWAY DOING YOUR STAIRS,

YOU'RE GOING TO GO UP A STAIR
OR DOWN THE STAIR OR TWO.

THE GOAL ISN'T THAT YOU GO TO
THE TOP OR THE BOTTOM
OF THE STAIRCASE.

WE JUST WANT TO MAKE SURE THAT
YOU KNOW WHICH GOES FIRST
ON THE STEPS.

WHEN YOU'RE PRACTICING WITH YOUR
CRUTCHES AND ON THE STAIRS,

PLEASE WEAR FLAT SHOES,
YOUR TENNIS SHOES,

CLOSE TOED SHOES AND NOT YOUR
HIGHEST, HIGHEST HEELS

AND THAT KIND OF STUFF BECAUSE
THEY'LL TIP YOU.

AND THEN SPOT EACH OTHER,
SO THAT YOU DON'T FALL.

SOMEONE TO STAND BEHIND AND
ON THE STRONGEST SIDE OF YOU.

ALRIGHT. CRUTCHES.

WHEN YOU GO UP THE STAIRS,
WHICH GOES UP FIRST,
THE CRUTCH OR THE FOOT?

- FOOT.
- CRUTCHES.

NO. SO YOU CAN KIND OF RULE
THAT OUT JUST BY TRYING THAT.

IT'S FOOT. SO...

AND UP...OH, LOST BALANCE.

AND THEN THIS UP ON THE STEP.
AND THEN TO GO DOWN,
JUST THE OPPOSITE.

YOU CAN'T TAKE BODY DOWN WITH
A CRUTCH, IMPOSSIBLE.

SO YOU'RE GOING TO TAKE
YOUR FOOT DOWN,

YOUR WEAKER LEG WITH THE CRUTCH

AND GO DOWN LIKE THIS.

DIDN'T I HAVE A NICE POSTURE
WHEN I WENT DOWN?

NOW, WATCH ME DO IT WRONG.

AND YOU NEED TO WATCH
THIS ON CLIENTS.

WHEN THEY COME UP, THEY TEND
TO GO LIKE THIS AND LEAN IN.

BECAUSE IT'S HARD TO LIFT YOUR
WHOLE BODY WEIGHT UP A STAIR.

BUT THIS IS WHAT SCARES ME EVEN
MORE, IS THE COMING DOWN.

THEY GO LIKE THIS.

I FEEL LIKE A BIRD.

I LOOK LIKE ONE.

THE IDEA IS THAT, I MEAN,
THIS IS NOT GOOD, AND THEY'RE
GOING TO FALL.

SO, YOU WANT TO TEACH THEM
ABOUT GOOD BODY ALIGNMENT.

THINK ALSO OF, IF I HAD
LIKE A KNEE BRACE ON.

IF I LEFT MY KNEE BACK,
IT'S GOING TO DRAG AND CATCH,

AND THAT'S GOING TO FLIP
ME OFF THE STAIR AS WELL.

SO YOU'VE GOT TO TAKE THAT
STRAIGHT LEG DOWN FIRST.

AND AGAIN IT'S THIGH AND ALREADY
I'M FEELING THE BURN.

OKAY, SO JUST PRACTICE.

I HAVE THIS FUNNY LITTLE THING,
AND I FORGOT TO TURN
MY LITTLE OVERHEAD ON.

BUT JUST AS A REMINDER, THEY
HAVE THIS LITTLE CARTOON.

AND FOR REMEMBERING
WHICH GOES FIRST,

GOOD GOES TO HEAVEN,
SO GOOD FOOT FIRST UPSTAIRS,
GOOD GOES UP.

IF WE THINK OF HEAVEN AS UP.
AND HELL BEING DOWN, BAD,
DOWN FIRST.

SO THE WEAK LEG DOWN.

OKAY.

I LIKE ANYTHING THAT HELPS
EVERYBODY REMEMBER.

BECAUSE IN SIX OR EIGHT WEEKS OR
YOU KNOW, TWO YEARS YOU MIGHT...

OKAY, LAST BUT NOT LEAST,
OUR 84 STEP

RANGE OF MOTION.

IT'S REALLY NOT THAT BAD,
BECAUSE IT'S KIND OF REPETITIVE.

AN ARM AND A LEG PRETTY MUCH DO
THE SAME THING. AND YOU KNOW,

THEY DO, HONESTLY.

WHAT I WANT YOU TO DO IS YOU'RE
JUST GOING TO DO ONE RANGE

OF EACH THING, ONE TIME FOR EACH
BODY PART ON ONE SIDE
OF YOUR BODY.

NORMALLY, LET'S SAY I HAD
RESTRAINED THIS GUY'S ARM.

I WOULD NEED TO RANGE THE
SHOULDER, THE ELBOW,

THE WRIST AND THE HANDS
OF THAT ARM.

EVERY MOVEMENT THAT THOSE
JOINTS CAN MAKE NEEDS
TO BE DONE 10 TIMES

WHEN YOU'RE RANGING SOMEBODY.

THERE'S THREE KINDS OF RANGING.
THERE'S PASSIVE...WHAT IS THAT?

- YOU WORK.
- I DO ALL THE WORK.
THERE'S ACTIVE.

- THEY DO THE WORK.
- THEY DO ALL THE WORK.

AND THEN THERE'S ACTIVE
PASSIVE AND IT'S ASSISTED

AND SO MAYBE A LITTLE HELP
AND SUPPORT

TO TEACH THEM OR TO
GET THEM GOING.

SO WE'RE BASICALLY GOING TO BE
DOING AN ACTIVE DEMONSTRATION

OR A RANGE OF MOTION.

I DO WANT YOU TO APPRECIATE,
IF YOU WERE RANGING SOMEONE THAT

YOU WANT TO MAKE SURE AND
SUPPORT THOSE EXTREMITIES.

YOU DON'T JUST KIND OF GRAB.

YOU'RE GOING TO BE SUPPORTING
THE ELBOW IF YOU'RE MOVING IT.

YOU'RE GOING TO SUPPORT THE
WRIST AS YOU MOVE IT
AND SO FORTH,

SO THAT THINGS AREN'T FLOPPING
IN IT SO THAT YOU CAN FEEL

HOW THEY'RE RESPONDING
TO THE MOVEMENT.

OKAY, THIS IS ALSO AN A-SKILL.

COULD BE A FIRST A-SKILL,

BECAUSE YOU'RE GOING
TO BE DOING ASSESSING

AND PALPATING WHICH ARE NURSING
SKILLS AS WELL AS THE ACTIVITY.

SO, THERE ARE FOUR MODES OF
ASSESSMENT FOR A NURSE.

WE'LL TALK ABOUT IT AND YOU'LL
HEAR ABOUT IT FOR THE REST
OF YOUR LIVES,

BUT HERE'S YOUR INTRODUCTION.

ASSESSMENT IS THE LOOKING AT.
WE LOOK AT THINGS FIRST.

AND IN EVERY ASSESSMENT, THERE
IS ALWAYS THE LOOKING AT

AND WE ALWAYS DO IT FIRST.
SO THERE IS YOUR FIRST
ALWAYS IN LIFE.

YOU ALWAYS LOOK BEFORE YOU
TOUCH, PLOW IN, DO SOMETHING.

YOU LOOK FIRST. OKAY.

SO WE'RE GOING TO DO AN
ASSESSMENT OF EACH JOINT.

AND THEN WE'RE GOING TO
PALPATE EACH JOINT.

PALPATE BEING FEELING.

OKAY, SO YOU ALWAYS LOOK.

BUT THE ORDER OF WHAT YOU
DO ON DIFFERENT ASSESSMENTS
WILL VARY FROM...

WE DO PALPATION, AUSCULTATION,

WHICH IS THE LISTENING OF,

LISTENING TO AND THEN
PERCUSSION,

TAPPING TO SEE WHAT IT
SOUNDS LIKE.

SO THOSE ARE OUR FOUR MODES
OF ASSESSMENT AS A NURSE.

WE'RE GOING TO START
WITH THE FIRST TWO.

WE'RE GOING TO DO OUR HIGH FIVE,
CHECK OUR DOCTOR'S ORDERS,

SEE IF A RANGE OF MOTION IS
ORDERED. BUT IF THE DOCTOR
ORDERS RESTRAINTS,

THE DOCTOR MAY NOT ORDER
RANGE OF MOTION.

THAT'S NURSING. NURSING
KNOWS YOU HAVE TO DO IT.

SO THAT WOULD BE UNDER CARE PLAN
OR YOU JUST KNOW TO DO IT.

GATHERING UP EQUIPMENT, YOU
DON'T NEED ANY. YOU NEED YOU.

ALTHOUGH YOU MAY NEED
A GONIOMETER, IF YOU WERE
DOING ASSESSMENT.

AND THE GONIOMETER
IS A LITTLE GAUGE

THAT TELLS YOU WHAT THE DEGREE
OF ANGLE OF MOVEMENTS
YOU'RE GETTING,

WHETHER IT'S 90 DEGREES OR 180
DEGREES OR SOMETHING LIKE THAT.

WE'RE NOT SO INTERESTED IN THAT
RIGHT NOW BECAUSE
WE ALL PROBABLY HAVE

PRETTY FULL RANGE OF MOTION.

AND WASH YOUR HANDS, IDENTIFY
OUR CLIENT, PROVIDE PRIVACY.

THE FIRST THING YOU
WANT TO DO IS ASSESS.

AND SO YOU'RE GOING TO TALK
TO YOUR CLIENT
AND GET SOME HISTORY,

AND WE'RE LOOKING AT HISTORY
RELATED TO BONES AND MUSCLES.

SO YOU'RE WANTING TO KNOW IF
IN THEIR MUSCLES OR JOINTS,

IF THEY'VE HAD ANY PAIN,
TENDERNESS, REDNESS, INJURIES.

IF THEY HAVE LIMITED
RANGE OF MOTION,

IF THEY HAVE ANY CRAMPING
IN THEIR MUSCLES.

YOU WANT TO KNOW IF THEY CAN
PERFORM THEIR ACTIVITIES
OF DAILY LIVING.

WHAT ARE ACTIVITIES
OF DAILY LIVING?

EVERYTHING WE DO TO LIVE,
THAT WE TAKE FOR GRANTED.

TOILETING, COMBING OUR HAIR,

BRUSHING OUR TEETH, DRESSING,
PUTTING CLOTHES ON,

ANYTHING THAT CAUSES
MANEUVERING, HOW ARE THEY
DOING WITH THAT?

DO THEY HAVE ANY BACK PAIN?

DO THEY HAVE ANY LIMITED RANGE
OF MOTION, ANY LIMITED MOVEMENT

THAT THEY'RE AWARE OF, ANY
SWELLING, ANY TENDERNESS?

PAST INJURIES OR TRAUMAS?

WHAT'S GOING ON WITH THE MUSCLES
OR JOINTS SO THAT YOU HAVE
A HEADS UP?

- DID I HIT EVERYTHING?
- YEAH.

WELL, GOOD FOR ME. OKAY.

AND THEN, YOU'RE GOING TO
PALPATE. TAKE THAT BACK...

YOU'RE GOING TO INSPECT
AND PALPATE.

ACTUALLY I SAID IT WRONG. IN THE
ASSESSMENT, I MEANT INSPECT.

ASSESS, LOOK, INSPECT.

YOU'RE GOING TO LOOK FIRST,
WE HAVE A DEAL FOR YOU.

EVERY JOINT NEEDS TO BE
INSPECTED AND EVERY JOINT NEEDS
TO BE PALPATED.

BUT YOU'RE GOING TO INSPECT
AND PALPATE FOR THE SAME THING
ON EVERY JOINT,

AND IT GETS A LITTLE REDUNDANT
FOR THE LISTENER,

WHICH WOULD BE ME.

I'M LISTENING TO THAT OVER AND
OVER AND OVER AFTER 84 THINGS.

SO IF YOU GET THIS RIGHT,
ALL THESE LITTLE THINGS
ON THE FIRST TIME,

THEN ALL YOU HAVE TO SAY
FOR EACH JOINT IS,
I HAVE INSPECTED AND PALPATED.

INSTEAD OF SAYING,
I'D INSPECT FOR

SIZE, SHAPE, SWELLING, COLOR,
MASS DEFORMITY.

I'M LOOKING TO SEE WHAT THE SIZE
OF THE JOINT IS,
IF THERE'S ANY SWELLING,

WHAT THE SHAPE OF IT IS.
I TAKE SIZE, SHAPE, SWELLING,

BECAUSE THEY'RE ALL S WORDS.
BUT SHAPE BEING CONTOUR.

SWELLING, MASSES OR ANY LUMPS
OR BUMPS, DEFORMITIES.

ANYTHING THAT MAKES YOUR EYE GO,
THAT'S KIND OF ODD
LOOKING. OKAY.

THEN, ONCE YOU'VE LOOKED,
THEN YOU WOULD PALPATE

TO SEE IF THERE IS ANY HEAT,
ANY SWELLING, ANY MASSES,

TEMPERATURE OR PAIN, TENDERNESS.
OH, THAT HURTS WHEN
YOU TOUCH THERE.

YOU CAN'T SEE THAT.
WHEN YOU'RE TOUCHING,

THEY'RE GOING TO GIVE
YOU SOME RESPONSE.

SO THOSE ARE THE FOUR THINGS
THAT WE'RE LOOKING FOR

WHEN YOU DO YOUR ASSESSMENT.
OKAY.

SO, I WOULD HAVE INSPECTED,
WE'RE GOING TO START WITH
THE CERVICAL SPINE,

CERVICAL BEING HEAD UP
TO YOUR NECK.

WE'RE GOING TO INSPECT FOR,
LET'S GET THESE MEMORIZED,
SIZE, SHAPE,

SWELLING, COLOR, MASS,
DEFORMITY,

AND THEN I'M GOING TO
PALPATE FOR ANY HEAT,

TENDERNESS, MASS,
PAIN, SWELLING,

WHATEVER IT SAYS ON YOUR SHEET.
I THINK I GET AN X-RAY HERE,

THAT I'M GOING TO FEEL. OK.

THEN I'M GOING TO RANGE THE
JOINT. AND THIS IS WHAT
A HEAD DOES.

AND LET ME JUST SAY,
YOUR BOOK IS EXCELLENT
AND IT GIVES YOU PICTURES

AND ARROWS FOR
EVERY ONE OF THESE.

AND THEN THE VIDEO ON RANGE
OF MOTION IS WONDERFUL.

AND THEN, OF COURSE, YOU HAVE
THIS, AND YOU CAN REVISIT IT.

OKAY, THE HEAD, WHEN IT'S UP,
EXTENSION IS ALWAYS
THE GREATER ANGLE,

WHEREAS FLEXING CLOSES
THE ANGLE.

SO MY HEAD, IN ITS UPRIGHT
POSITION IS EXTENDED.

AND NOW I'M GOING TO FLEX.

AND IF I PUT IT BACK BEYOND ITS
MID IT'S A HYPER EXTENSION.

THEN YOU CAN DO A RIGHT
LATERAL BEND. I'M GOING
TO MY RIGHT SIDE,

A LEFT LATERAL BEND,

AND THEN A RIGHT ROTATION
AND A LEFT ROTATION.

I FIND IT INTERESTING, I WAS
READING YOUR BOOK LAST NIGHT

THAT IT TALKS ABOUT A
ROTATION BEING THIS.

THIS IS ALSO A CIRCUMDUCTION.

YOU CAN ONLY CIRCUMDUCT
A BALL AND SOCKET JOINT.