Nursing Field Notes / Nursing Core · Fundamentals of Nursing

Ambulation 🚶

Body Mechanics, Mobility & Fall Prevention

NG-167 Nursing Core ADHD-friendly visual edition

Coordinated effort to maintain balance, posture, and body alignment while lifting, moving, and ambulating clients — protecting both the patient and the nurse's own spine.

📄 Simple Nursing original — opens in Drive →

🦴 Wide base, bent kneesFeet apart, knees flexed, load close to the body — never the back.

🎗️ Gait belt = defaultUse it for any client with fall risk or weakness before ambulating.

🦯 Cane on the STRONG sideAdvance cane + weak leg together, then the strong leg.

🚨 #1 hospital injuryFalls — assess fall risk before every transfer/ambulation.

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BODY MECHANICS

STEP 1 · PROTECT THE SPINE

Purpose: the safe, coordinated practice of maintaining balance, posture, and alignment while lifting, moving, and ambulating clients.

🏋️ The five rules of safe lifting

🦶 Wide base of support — feet shoulder-width apart.
🦵 Bend at the knees, not the waist — squat, don't stoop.
🎒 Keep the load close to the body's center of gravity.
💪 Use arms/legs to lift — never twist or lift with the back.
🫃 Tighten abdominal & gluteal muscles before the move to brace the core.

🧠 "Squat, don't stoop." If your back is rounding forward, you're doing it wrong — drop your hips, not your spine.

🧍‍♀️ Positioning for the lift

Arrange for help before moving a client — never solo a heavy or unpredictable transfer.
Encourage the client to assist when able.
Avoid twisting — keep back, neck, pelvis, and feet aligned and facing the same direction.
Position yourself close to the client or object.

🧠 Close and squared-up. The nearer you are, and the more your whole body faces the load, the less shear on your spine.

⚠️ Variables that lead to injury

Uncoordinated lifts — no count-of-three teamwork
Manual lifting without equipment
Lifting while tired
Repetitive lifting, transferring, repositioning
Prolonged standing

🧠 The team lift. The person bearing the brunt of the load calls the count of three — everyone moves together, not one person straining alone.

🔁 Moving a client in bed — slide, don't drag

Slide the client toward you using a pull/draw sheet instead of dragging skin across linen — dragging causes shear and friction injury to fragile skin.

🧠 Sheet, not skin. The pull sheet takes the friction so the patient's skin doesn't have to.

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ASSESSMENT & DEVICES

STEP 2 · GAIT, ROM & TOOLS

Know what normal gait and range of motion look like — then match the right assistive device to the client.

🩺 Mobility assessment — what to ask & observe

Daily activity & endurance: "What does your day look like? What makes you tired?"
Exercise goals and mobility problems: pain, SOB, or discomfort with movement?
Physical/mental alterations and external factors affecting ambulation.
Range of motion (ROM): the full movement potential of a joint — flexion & extension.

Active ROM	Passive ROM
Patient moves the limb themselves, no assistance	Therapist/equipment moves the joint — no effort from the patient

🧠 Active = "I move it," Passive = "you move it."

👣 Normal vs. abnormal gait findings

Normal	Abnormal
Head erect, spine straight, arms swing in alternation with legs; one leg in stance while the other swings	Ataxia, Parkinsonian gait, scissor gait, steppage gait, spastic hemiparesis
Straight line ear–shoulder–hip in alignment	Abnormal spinal curvature (scoliosis), can't maintain alignment independently
Full ROM, no joint deformity	Limited ROM, swelling, heat, tenderness, crepitation, deformity
Voluntary, controlled, coordinated movement	Tremors, tics, chorea, dystonia, fasciculations

🧠 Watch the whole walk. Gait, alignment, joint structure, and involuntary movements are 4 separate things to screen — don't just watch the feet.

⭐ Factors that affect mobility

Age & developmental level
Attitudes & family values
Neuromuscular / joint disorders
Trauma to the musculoskeletal system
Mental health & medications (sedation, weakness)
Lifestyle, stress, environment

🧠 Mobility isn't just "can they walk" — it's biology, environment, and psychology all together.

🦯 Assistive devices — match the tool to the deficit

Device	Best for / key point
Cane 🦯	Mild weakness/balance issues on one side. Held on the strong side; advance with the weak leg.
Walker 🚶	Greater instability; needs more support & upper-body strength. All 4 legs contact the floor before stepping — never "walk" it by only advancing 2 legs at a time unless it's a rolling walker with wheels.
Crutches 🩼	Non-weight-bearing or partial weight-bearing on one leg. Weight goes through the hands/palms, never the axillae — axillary pressure risks nerve damage (crutch palsy).
Gait belt 🎗️	Not a walking aid by itself — a safety handle the nurse holds during transfer/ambulation for any at-risk client.

🧠 "Strong holds the cane, weak leans on the walker." Cane = strong side; walker/crutches = distribute weight away from the weak/injured limb.

🩺

SAFETY & FALLS

STEP 3 · PREVENT THE #1 INJURY

Falls are the leading cause of hospital-acquired injury — assess risk before every transfer.

🚨 Fall risk assessment — before you move anyone

History of falls, gait/balance problems, or use of an assistive device
Medications: sedatives, opioids, antihypertensives, diuretics (orthostatic hypotension risk)
Cognitive status: confusion, dementia, impulsivity
Sensory deficits: vision, hearing, peripheral neuropathy
Environment: clutter, poor lighting, wet floors, improper footwear, tubing/lines underfoot

🧠 Assess before you ambulate, not after they fall. Most inpatient fall-risk tools (e.g., Morse Fall Scale) score history, mental status, gait, and IV/meds — the same categories above.

✅ Priority fall-prevention actions

Gait belt on any client identified as fall risk
Bed in lowest position, brakes locked, call light within reach
Non-skid footwear before every ambulation
Clear the path — cords, tubing, clutter out of the way
Orthostatic check: sit → dangle → stand, pausing at each step

🧠 "Sit, dangle, stand" — never rush a first mobilization. Orthostatic hypotension causes a huge share of first-time-up-out-of-bed falls.

⚠️ Signs of activity intolerance — stop and reassess

Significantly increased pulse, respirations, or BP; SOB/dyspnea; weakness; pallor; confusion; vertigo; pain.

🧠 If any of these appear during ambulation, stop, sit the patient down, and reassess vitals before continuing.

🔗 Cross-reference: Positioning (NG-072)

Ambulation starts with safe bed mobility. Before a client stands, they need to be positioned and moved correctly in bed — logrolling, using a pull sheet, and choosing the right position to sit up from.

➡️ See NG-072 — Positioning for the named bed positions (Fowler's, lateral, Sims', etc.) that set up a safe transfer to standing.

⚡

QUICK RECALL

SAY IT OUT LOUD

🦴 Bend knees, not waistWide base, load close, use legs to lift

🦯 Cane = strong sideAdvance cane + weak leg together

🩼 Crutches = weight on handsNever the armpits — nerve damage risk

🚨 Sit, dangle, standCheck orthostatics before first ambulation

🎯 Cover & check — 4 rapid-fire questions

Q1: What are the core body mechanics rules for lifting a client?

Wide base of support, bend at the knees not the waist, keep the load close to the body, use arms/legs not the back, and tighten the abdomen/glutes before moving.

Q2: Where should crutch weight be borne, and why?

On the hands/palms — weight on the axillae can cause nerve compression ("crutch palsy").

Q3: Which side does a cane go on, and how does the patient step?

The strong side. The cane and the weak leg advance together, then the strong leg follows.

Q4: A patient stands up too fast and reports dizziness — what should the nurse have done first?

Progressed slowly: sit on the edge of the bed, dangle the legs, then stand — checking for orthostatic hypotension at each step before ambulating.