Steps in preparing to ambulate the patient

  1. Review the patient’s medical record for an authorizing physician’s order or look at your kardex
  2. Review the patient’s nursing care plan, chart, or kardex for information regarding the following:
  • Physical limitations
  • Mechanical equipment being utilized; that is, IV infusion pumps, chest drainage set, urinary drainage sets
  • Distance patient is to ambulate
  • Length of time patient is to be out of bed
  • Frequency patient is to get out of bed
  1. Review the most recent Nurse’s Notes to identify the patient’s previous tolerance of the activity specified
  2. Explain the rationale for getting out of bed to the patient
  3. Assess pain using designated scale, and pre-medicate for pain prior to getting out of bed, if necessary
  4. If the patient has been medicated, wait about 20 minutes before ambulating
  5. Ensure that the patient is appropriately clothed, including non-skid footwear
Stages in assisting the patient to ambulate
  1. Assist the patient to sit on the side of the bed (dangling) for a couple of minutes and assess for dizziness or weakness
  2. Assist the patient to stand (and if the patient has a weaker side, position yourself on the weaker side
  3. Have the assistive devices (if required) ready for the patient’s use
  4. Assist the patient to transfer  to a chair, or to ambulate to the designated area or for the designated length or as tolerated
  5. When ambulating the patient in the hallway, the patient needs to be on the inside near the wall and you need to be positioned in the open hallway
  6. Assess the patient’s tolerance to the activity and pain level
  7. Chart what the patient did, the distance, assistive devices, and how they tolerated along with pain status using designated pain scale
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