2023年全国医学博士英语考博英语阅读之拐杖行走

拐杖行走(Crutch Walking)
　　Crutches are often needed to increase a client's mobility. The use of
　　crutches may be temporary (such as after ligament damage to the knee) or
　　permanent (as with paralysis of the lower extremities). It is important that
　　crutches be measured for the appropriate length that clients be taught how
　　to use them correctly.
　　为增加病人活动能力，常常需要用到拐杖。使用拐杖可能是临时的(如膝韧带损伤时)，也可以是永久性的(如出现下肢瘫痪情况)。重要的是，拐杖应长短要测量适度，并教会病人如何正确使用拐杖。
　　Potential Nursing Diagnoses：
　　Client data derived during the assessment reveal defining characteristics
　　to support the following nursing diagnoses in clients requiting this
　　skill：
　　1.Impaired physical mobility
　　2. High risk for injury
　　潜在的护理诊断：
　　同坐位：1.躯体活动障碍
　　2.有受伤的危险
　　Equipment：
　　Tape measure、Goniometer、Rubber crutch tips、Wooden crutches
　　用具：
　　卷尺、测角仪、拐杖橡胶端头，木手杖。
　　步骤及说明(steps)
　　1. Wash hands.
　　Reduces transmission of microorganisms.
　　1.洗手
　　减少微生物传播
　　2. Measure for crutch length： 3 to 4 finger widths from axilla to a point
　　15 cm (6 inches) lateral to client's heel is standard
　　Ensures that crutches are individualized to client's height.
　　2.测定拐杖高度：标准为：腋下3-4指宽处至病人脚跟向外15cm(6时)处的长度。
　　确保拐杖适合每个病人身高度。
　　3. Position crutch handgrips with elbows flexed at 20- to 25-degree angle.
　　Ankle of elbow flexion should be verified by goniometer
　　Prevents client's body weight from being supported by axillae， which
　　would result in nerve damage.
　　3.屈肘20-25度，放好拐杖把手;屈肘角度应用测角仪确定
　　避免病人体重的腋窝支撑，否则会导致神经损害。
　　4. Verify that distance between crutch pad axilla is 3 to 4 finger
　　widths
　　Prevents axillary skin breakdown secondary to pressure from crutch
　　pad.
　　4.核实拐杖垫与腋窝间有3-4指宽的距离
　　避免因拐杖垫压迫而引起腋窝皮肤裂开。
　　5. Instruct client to assume tripod stance. Tripod stance is formed when
　　crutches are placed 15 cm (6 inches) in front 15 cm to side of each foot
　　Improves balance by providing wider base of support. No weight should be
　　borne by axillae.
　　5.指导病人采三角站立姿势。三角站立姿势;拐杖置于体前方15cm、离脚跟15cm的交接处
　　增加支撑面宽度，改善平衡。不得将体重压在腋窝。
　　6. Teach client one of four crutch-walking gaits. (Darkened areas on Figs.
　　28 to 30 represent weight-bearing areas)：
　　Allows client to ambulate safely. Specific type of gait chosen depends on
　　client's impairment physician's order.
　　6.教会病人使用四种持拐杖步行法中的一种
　　使病人行走安全。选用何种步法取决于病人的损伤情况及医生医嘱。
　　a.Four-point alternating， or four-point gait，gives stability to client but
　　requires weight bearing on both legs. Each leg is moved alternately with each
　　crutch so three points of support are on floor at all times
　　四点轮替或四点法：采用本步法可使病人稳定，但要求将体重落于双腿。两腿随拐杖交替移动，因此，地面始终留下三个支撑点
　　b.Three-point alternating， or three-point gait， requires client to bear all
　　weight on one foot. Weight is borne on uninvolved leg， then on both crutches，
　　the sequence is repeated. Affected leg does not touch ground during early
　　phase of three-point gait. Gradually client progresses to touchdown full
　　weight bearing on affected leg
　　三点轮替或三点步态：要求病人单脚承受全部体重。先由未受伤一脚承担全部体重，然后移至双拐，以此类推。在三点步法的初期，伤腿不接触地面。经过一段时间后，病人慢慢触地，直至全部体重移至患腿
　　c.Two-point gait requires at least partial weight bearing on each foot.
　　Client moves each crutch at same time as opposing leg so crutch movements are
　　similar to arm motion during normal walking
　　两点步法：本法要求伤腿至少承担部分体重。病人在移动拐杖的同时移动相对的一条腿。拐杖运动正好与正常行走时的手臂运动相同
　　d. Swing-through， or swing-to gait is frequently used by paraplegics who
　　wear weight-supporting braces on their legs. With weight on supported legs， the
　　client places crutches one stride in front then swings to or through them
　　while they support his weight.
　　迈越步/摇摆步态：本法通常用于双腿带有承重梏具的截瘫病人。先将体重落于支撑腿，病人随即将拐杖前移一步，然后，在双拐支撑体重时病人顺势向前摆动，越过拐杖。
　　7. Teach client to ascend descend on stairs：
　　Reduces risk of further damage to musculoskeletal system risk of
　　falling.
　　7.教病人上、下楼梯：
　　减少进一步损伤肌肉骨骼系统的危险及摔倒危险。
　　Ascend上楼：
　　a. Assume a tripod position.
　　b.Transfer body weight to crutches
　　c.Advance unaffected leg between crutches stair.
　　d.Shift weight from crutches to unaffected leg
　　e.Align both crutches on stair
　　a.　采三足鼎立位。
　　b.　将体重移至拐杖
　　c.　将未受伤腿前进至拐杖和楼梯之间。
　　d.　将体重从拐杖移至未受伤腿
　　e. 调整双拐，使其处于同一直线
　　Descend下楼：
　　a.Transfer body weight to unaffected leg
　　b.Place crutches on stair begin to transfer body weight to crutches，
　　moving affected leg forward
　　c.Align unaffected leg on stair with crutches
　　a.　将体重移至未受伤腿
　　b. 将双拐置于楼梯，开始将体重移至双拐，受伤腿向前移动
　　c. 调整楼梯上的受伤腿，使其与双拐成一直线
　　8. Teach client how to sit in chair how to get up from chair：
　　Provides safe method of sitting in getting up from chair. Reduces
　　further damage to client's musculoskeletal system the risk of falling.
　　8. 教会病人如何在椅子上起坐。
　　提供安全的椅上起坐方法，减少病人肌肉骨骼系统进一步损伤及摔倒危险。
　　Sitting坐：
　　a. Client positioned at center front of chair with posterior aspects of legs
　　touching chair
　　b.Client holds both crutches in hopposite affected leg. If both legs
　　are affected， crutches are held in hon client's strong side
　　c.Client grasps arm of chair with other hlowers body into chair
　　Getting up
　　d.Perform three steps above in reverse order.
　　a.　病人位于椅子前面中央，两腿后面接触椅子
　　b.　病人将双拐握于受伤腿对侧的手中。如双腿受伤，双拐应握于病人较为健康一侧的手中。
　　d. 病人用另一只手抓住椅子扶手，坐进椅子。
　　起：
　　按相反次序操作上述三步。
　　9. Wash hands.
　　Reduces transmission of microorganisms.
　　9.洗手。
　　减少微生物传播。
　　10. Record gait procedures taught client's ability to perform gaits
　　in nurse's notes.
　　Documents teaching client's learning.
　　10.记录所教步法及程序及病人实施步法的能力。
　　文件证明教育及病人学习情况。
　　Nurse Alert：The client with cognitive impairment or one who has received
　　analgesics or tranquilizers may be unable to understinstructions or to
　　ambulate safely with crutches.
　　注意事项：有认知障碍的病人或接受麻醉或镇静剂病人可能无法理解指导或用拐杖安全行走。
　　Client Teaching：
　　The nurse should instruct the client that， because of the potential for
　　axillary skin breakdown nerve damage， he must not lean on his crotches to
　　support his body weight. Rubber crutch tips should be replaced as they wear out，
　　they should remain dry. Worn or wet crutch tips decrease surface tension
　　increase the risk of falling. The client should be given a list of medical
　　suppliers in his community so he can obtain repairs as well as new rubber tips，
　　handgrips， crutch pads. In addition， advise him that he should have spare
　　crutches tips on hand.
　　病人教育：
　　由于潜在腋窝皮肤裂开及神经损伤可能，护士应指导病人不能倚在双拐上，用双拐支撑其体重。橡胶拐杖头磨穿后应及时更换，并保持干燥。磨损或潮湿的拐杖头会降低其表面张力，增加摔倒危险。应将其社区医疗供应商名单告知病人，以便他获得修理服务及新的橡胶头、拐杖柄和拐杖垫。此外，应忠告病人应有备用的拐杖和拐杖头。
　　Geriatric Considerations：
　　The normal visual acuity depth perception changes with aging may
　　prevent the client from safely ascending or descending stairs with crutches.
　　老年：随年龄出现的正常视敏度和深度感知变化可能使病人无法借助双拐安全地下楼梯。

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