A practical nurse (PN) is assisting a client with ambulation in the hallway using a gait belt. The client suddenly reports feeling dizzy, their knees buckle, and they begin to fall. Arrange the following actions the PN should take in the correct chronological order to safely assist the client to the floor.
- 1Place feet wide apart to establish a broad base of support.
- 2Pull the client close to the nurse's body using the gait belt.
- 3Extend one leg forward and allow the client to slide down it.
- 4Bend at the knees to lower the client while protecting their head.
- 5Keep the client on the floor and call for help to assess for injuries.
Answer
The correct sequence is to establish a base of support, bring the client close, extend a leg for the client to slide down, lower them by bending the knees while protecting the head, and then call for help to assess for injuries.
When a client begins to fall during ambulation, the nurse's priority is to perform a controlled 'assisted fall' to minimize injury. The sequence must begin with the nurse establishing their own stability by taking a wide stance. Next, bringing the client close to the nurse's center of gravity provides control over the descending weight. Extending a leg creates a safe slide path, preventing a rapid drop. Bending at the knees ensures the nurse uses strong leg muscles rather than straining the back, while the nurse actively protects the client's head from impact. Finally, once safely on the floor, the client must remain stationary until a thorough assessment is completed to prevent exacerbating any potential injuries.
Step-by-Step Solution
Key Concept
Safe Management of an Active Client Fall (Assisted Fall Technique)