Postoperative Mobilization: Dangling at the Bedside, Standing, and Walking (Nursing)

by Samantha Rhea, MSN, RN

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    00:04 Now, next, let's talk about dangling at the bedside.

    00:07 Now if the patient is safe to begin moving around, they should be assisted into this position.

    00:13 Really, we're just going to have the patient sit on the side of the bed, have them dangle their feet over the side of the bed and make sure they're balanced.

    00:21 So, I will tell you sometimes, after knee surgeries, that day after knee surgery, even like a few hours, we have our patient's dangle at the side of the bed.

    00:30 You may think, man, that doesn't sound comfortable but again, it's really going to help in their postoperative recovery.

    00:37 The sooner you move them, the better off for the patient.

    00:40 Now, let's talk about standing.

    00:42 So if the patient can tolerate the bed exercises, then the dangling, and if they're strong enough, standing is another great progressive ambulation technique.

    00:51 Now before we get them up, we've got to make sure all safety devices are in place, right? So for example, the gait belt's a great way to make sure we hold on to our patient safely.

    01:01 We want non-skid footwear, it's really important.

    01:04 And many times, I'll tell you, I have patient's postop back surgery when they're trying to get up, a walker or especially a cane, something like that's really helpful to help get the patient up.

    01:15 Now, again, if the patient can tolerate that dangling or the sitting, let's try to get them to stand.

    01:21 Now, we, as a nurse, want to have the patient rise from the sitting position on the bed or the dangle position, and on the count of three, we can use that gait belt and help assist that patient to stand.

    01:32 And again, we need to be conscious that we may need to help balance that patient.

    01:37 And for a little extra, if the patient can, have them walk in place, that would be great to get that circulation moving.

    01:44 So we just talked about turning in the bed, bed exercises, setting, dangling, standing, now, if the patient can tolerate it, let's have them walk.

    01:56 This is also really good. Its help for their bowel movement, it helps with peristalsis, keeps the patient getting constipated, good for their lungs, it's good for their muscles.

    02:06 So again, here's our goal.

    02:07 So we want to make sure that the patient is safe when we ambulate or walk them small distances first, right? We don't want to go all the way clear across the hall.

    02:17 We want to set small goals and assess our point.

    02:20 And it's a good idea to keep a grip on that gait belt.

    02:24 If the patient gets unsteady, or maybe they get tired, or if they feel like they're going to fall, this is a great thing to have a grip and slowly lower that patient to the floor, if need be.

    02:35 Now, one tip here. If a patient is walking for the first time and they're a little bit fatigue or they're tired or weak, it's always a great idea, get another staff member involved.

    02:48 Have them get a wheelchair and follow behind you guys, so when the patient's walking down the hall and they get tired, they can immediately sat down.

    02:56 Just think about it, the longer you ambulate them, they have to turn back to their room, so keep this in mind.

    03:06 So, we just performed our bed exercises here with Brandon after surgery.

    03:11 Now, once it's established that he's safe to begin moving out of the bed, this is the best position to start with and we call this the dangling position.

    03:20 So as you see here, I've already assisted him to the side of the bed.

    03:24 We want to help him to set their feet over the side of the bed, if they need assistance to do so.

    03:30 We also wane make sure Brandon's balanced.

    03:32 Was he strong enough to support his own balance? And we want to assess this as a nurse.

    03:37 Now, again , dangling at the bedside is really helpful because sometimes, really quickly post-op, maybe then a couple of hours after a knee surgery for example, we may have that patient in the same position.

    03:49 Okay, so now that Brandon's in the dangling position, he's strong enough, we're going to progress him to standing.

    03:55 So before we do that we want to make sure safety devices are in place.

    03:59 So first we want to make sure Brandon's already has his gait belt on for us, which is great.

    04:04 Also, we want to make sure our non-slip socks are on or non-slip, some sort of footwear, so the patient doesn't slip on the floor.

    04:12 Next, some patient may need some extra help such as a walker or a cane before they get up to stand.

    04:20 Now, for Brandon, he doesn't need that today.

    04:22 Okay, so to assist Brandon from standing or to help him, I want to have him rise and we're going to count to three together from this position and I'm going to assist him in standing, and again, when he stands, I want to make sure he can maintain balance and then if need be, we can have him walk in place.

    04:39 So I'm going to go ahead and do is instruct Brandon.

    04:42 Now Brandon to help you stand, when we're going to count on three, I want you to go ahead and use your legs and your arms to push up at once and let me help you stand, okay? You ready? Any questions? -No, ma'am.

    04:53 -Okay, so let me grab on both sides of the gait belt and I need to be able to put at least one hand and so it's snuggly around Brandon's waist .

    05:00 So I'm going to make sure I use my legs and good body mechanic.

    05:03 So, Brandon on three, one, two, three. Great.

    05:08 So I'm going to assist here and hold Brandon and see if he's wobbling back or forth or not.

    05:14 But he's able to maintain his balance fairly well.

    05:16 Now as you can see, Brandon's taller than me and a lot of patients you may run in into this.

    05:21 Just make sure you're close to the bed, if we need to, we can put the patient back down, if they're unsafe.

    05:28 Now, once we've assisted Brandon to stand, he's maintaining his balance well, we're going to progress him to walk a little bit further and see how he does.

    05:38 So when we're talking about walking, again, I want to make sure Brandon's not distressed, he's doing great, he doesn't seem weak or unbalanced, now we can ambulate the patient.

    05:49 Again, don't forget, we've got our gait belt on, that's going to help us.

    05:53 And we want to go a small distance at first, so that's really important.

    05:57 So before I ambulate Brandon, I want to show you.

    06:00 Brandon, if you'll turn towards me, I want to have a good grip on the back of his gait belt like this, that way when he walks, if he feels like he needs to sat down, I can have a firm grip and we can lower him.

    06:14 Now, before we get started, if I have concerns of weakness or dizziness, it's a great, great idea, especially the first time the patient walks, have another staff member help you out.

    06:27 So when me and Brandon are walking, have them follow behind us with the wheelchair, that way if he gets dizzy or tired or weak, he can immediately sat down and then we can go back to the room. So now, let me go ahead and ambulate Brandon.

    06:41 So let me grab a hold on the back of his gait belt.

    06:44 Now, Brandon, I'm going to hold on to this and if you will walk that way for me and I'm going to assess you. Okay, you can go ahead and proceed. Great.

    About the Lecture

    The lecture Postoperative Mobilization: Dangling at the Bedside, Standing, and Walking (Nursing) by Samantha Rhea, MSN, RN is from the course Postoperative Care (Nursing).

    Included Quiz Questions

    1. An assessment for sensation, coordination, and strength
    2. An assessment to determine if the patient is comfortable in getting out of bed
    3. A pain assessment
    4. An assessment for sensation, coordination, and strength when out of bed
    1. When the patient is safe to move around
    2. Right after the procedure is completed
    3. Postoperative day one
    4. Four hours after surgery
    1. Utilize a gait belt to lower the patient to the floor
    2. Call for assistance
    3. Utilize a gait belt to hold the patient from falling
    4. Let the patient lean on you until more assistance arrives
    1. Assist the patient to the side of the bed
    2. Ask the patient to rise from the side of the bed
    3. Ask the patient to get in a standing position
    4. Ambulate the patient in small distances

    Author of lecture Postoperative Mobilization: Dangling at the Bedside, Standing, and Walking (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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