NCLEX Review Guide: Crutch Walking

Proper Crutch Measurement

• Axillary crutches should be positioned 2-3 finger widths below the axilla to prevent nerve damage and circulation impairment.
• Handgrips should be adjusted so the elbow is flexed at 20-30 degrees when hands are placed on grips.
• Client should bear weight on hands and arms, never on the axillary bars to prevent brachial plexus injury.

Four-Point Gait (Most Stable)

• Used for clients with partial weight-bearing on both legs who need maximum stability.
• Requires good coordination and arm strength but provides excellent balance.

1. Right crutch forward
2. Left foot forward
3. Left crutch forward
4. Right foot forward

Two-Point Gait (Faster)

• More natural walking pattern for clients with partial weight-bearing on both legs.
• Requires better balance than four-point gait but allows faster mobility.

1. Right crutch and left foot together
2. Left crutch and right foot together

Three-Point Gait (Non-Weight-Bearing)

• Used when one leg cannot bear any weight (fractures, surgery, severe injury).
• Requires significant upper body strength and good balance.

1. Both crutches and affected leg forward together
2. Unaffected leg swings through

Going Up Stairs

• "Up with the good, down with the bad" - unaffected leg goes up first.
• Use handrail when available, hold both crutches in opposite hand.

1. Unaffected leg up first
2. Crutches and affected leg follow

Going Down Stairs

• Affected leg and crutches go down first, followed by unaffected leg.
• Maintain three points of contact for stability.

1. Crutches and affected leg down first
2. Unaffected leg follows

Frequently Missed Concepts

• Axillary pressure causes brachial plexus injury - weight must be on hands/arms.
• Rubber tips wear out and become slippery - inspect daily and replace when worn.
• Proper shoe wear is essential - low-heeled, non-slip soles prevent falls.

Patient Education Priorities

• Report numbness, tingling, or weakness in hands/arms immediately.
• Avoid carrying items while using crutches - use backpack or have someone assist.
• Take rest breaks frequently to prevent fatigue and maintain safety.