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Difficulty: HardBasic Care and Comfort

A nurse in an orthopedic rehabilitation clinic is providing discharge teaching to a client with a fractured left tibia. The client is prescribed strict non-weight-bearing status for the left leg and is learning to use axillary crutches. When evaluating the client's understanding of how to safely descend a flight of stairs, which statement by the client indicates correct technique?

  1. A
    I will step down with my right leg first, and then bring my crutches and left leg down to the lower step.
  2. B
    I will move both crutches to the lower step, bear my weight heavily on my armpits, and then step down with my right leg.
  3. I will move my crutches down to the lower step first, keep my left foot off the ground, and then step down with my right leg.Answer
  4. D
    I will keep both crutches on the upper step for balance, hop down with my right leg first, and then lower my left leg.

Answer

The statement describing moving the crutches down first, keeping the left foot off the ground, and then stepping down with the right leg demonstrates correct understanding.
When descending stairs with axillary crutches, the correct sequence is to lead with the crutches and the affected extremity ('down with the bad'). The client should first advance the crutches to the lower step while keeping the injured (left) leg lowered but completely off the ground to maintain non-weight-bearing status. The client supports their body weight using their hands on the crutch grips and then steps down with the strong, unaffected (right) leg. This technique ensures a stable base of support is established before the body moves downward.

Step-by-Step Solution

1
Identify the client's prescribed mobility status and affected extremity.
The client is strictly non-weight-bearing on the left tibia and must use axillary crutches.
Determining the affected side and weight-bearing status dictates the correct crutch-walking technique and precautions.
2
Determine the correct biomechanical sequence for descending stairs with crutches.
The correct sequence is to lead with the crutches and the affected leg ('down with the bad').
Moving the crutches down first establishes a wide base of support on the lower step before the body's center of gravity shifts downward.
3
Evaluate the safety principles of axillary crutch use.
Body weight must always be supported by the handgrips, never by resting the axillae (armpits) on the crutch pads.
Bearing weight on the axillae compresses the brachial plexus, leading to severe nerve damage.
4
Analyze each statement to identify the correct descending sequence and safe technique.
Only the statement describing lowering the crutches first, maintaining non-weight-bearing status on the left leg, and avoiding axillary pressure is correct.
This option strictly adheres to both the correct sequential technique and the safe biomechanical principles of crutch ambulation.

Key Concept

Assistive Device Ambulation: Stair Descent with Axillary Crutches
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Topics

Basic Care and Comfort

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