A nurse is teaching a client how to properly use a walker. Which instruction should the nurse include to ensure the client's safety?
1Place the walker far ahead, then step forward with both feet simultaneously
2Lean heavily on the walker for maximum support while walking
3Move the walker and the affected leg together, then step with the unaffected leg
4Move the walker forward first, then step forward with the affected leg, followed by the unaffected leg.✓ 정답
해설
The correct sequence is moving the walker forward first, then stepping with the affected leg, followed by the unaffected leg, which provides maximum stability. Other options risk imbalance or improper weight-bearing.
Clinical Judgment
This question evaluates the nurse's role in teaching an elderly patient discharged after hip replacement surgery how to safely use a walker. The key is to select the correct gait pattern that protects the surgical site while preventing falls. The correct answer is the Three-Point Gait, which follows the sequence of moving the walker forward first → then the affected (operated) leg → then the unaffected leg. This method ensures the walker and both legs always maintain three points of contact with the ground, providing maximum stability and preventing excessive weight bearing on the surgical site.
Memory Tip
Remember the sequence: Walker first, Affected leg, Unaffected leg. The mnemonic "Walk with AUncle" (W-A-U) can also help.
KR vs US
In Korea, walker use is often explained briefly to patients or caregivers, but the US NCLEX treats this as a core component of patient safety education. Especially during discharge education for elderly patients, it is essential not only to provide verbal instructions but also to demonstrate the technique and have the patient perform a 'Return Demonstration' to verify their proficiency.
임상 시나리오
Clinical Practice Guide
The key points when using a walker after hip surgery are adjusting the walker height (so the handgrips are at wrist level when the wrist is flexed), maintaining an upright posture, and moving the walker forward only 15–30 cm (one step distance) at a time. Make sure the patient does not step ahead of the walker.
Caution
When this is turned into a SATA (Select All That Apply) question, there is a trap asking about "actions to avoid when using a walker." For example: 'throwing the walker far ahead and walking to it,' 'leaning excessively on the walker and supporting body weight with the arms,' and 'using the walker on stairs or escalators' are all dangerous actions.
핵심 개념
Three-Point Gait (3점 보행법) — When using a walker, this is a method of moving where the walker and both legs create three points of contact. Typically, you move in the order of "walker → weaker leg → stronger leg" to provide maximum stability.
Weight-Bearing As Tolerated — This is a doctor's order stating that weight-bearing is allowed as tolerated by pain. It is a commonly used instruction during early rehabilitation after hip surgery.
Assistive Device (보조 기구) — Tools to reduce the risk of falls and assist with independent mobility. These include walkers, canes, crutches, and others.
Hip Precautions (고관절 주의사항) — Post-surgery precautions to prevent dislocation of the artificial joint after hip replacement. Generally, this includes not bending the hip more than 90 degrees, not crossing the legs, and not rotating the operated leg inward.
Return Demonstration (되돌려 보여주기) — A teaching method where, after a nurse demonstrates a skill, the patient is asked to perform it back to assess their understanding and proficiency. This is very important when educating on medication administration, wound care, and walker use.