Impaired physical mobility is a prevalent nursing diagnosis, often stemming from a multitude of factors. This condition, which can be temporary, permanent, or progressive, carries significant risks, potentially leading to complications such as pressure ulcers, infections, falls, and social isolation. As the global population ages, altered mobility becomes an increasingly critical concern, contributing to higher morbidity and mortality rates, particularly among the elderly. Enhancing mobility is not just about physical health; it’s also crucial for improving patients’ overall quality of life and health outcomes.
Nurses play a vital role in identifying risk factors associated with altered physical mobility and implementing strategies to prevent or mitigate its impact. A collaborative, multidisciplinary approach is essential, involving physical and occupational therapists, prosthetic services, rehabilitation centers, and continuous support systems to facilitate sustained progress in patient mobility. This article provides an in-depth exploration of altered mobility as a nursing diagnosis, offering a comprehensive guide for healthcare professionals.
Common Causes of Altered Mobility
Identifying the underlying causes of altered mobility is crucial for effective intervention. Several factors can contribute to this condition, including:
- Sedentary Lifestyle: Lack of regular physical activity leads to muscle weakness and reduced joint flexibility.
- Deconditioning: Prolonged inactivity due to illness or hospitalization results in a decline in physical function.
- Decreased Endurance: Reduced stamina makes it difficult to sustain physical activity for extended periods.
- Limited Range of Motion (ROM): Stiffness or restrictions in joint movement hinder mobility.
- Recent Surgical Intervention: Post-operative recovery often involves temporary limitations in movement.
- Decreased Muscle Strength or Control: Neurological or musculoskeletal conditions can impair muscle function.
- Joint Stiffness: Arthritis and other joint conditions cause pain and restricted movement.
- Chronic Pain and Acute Pain: Pain can significantly limit willingness and ability to move.
- Depression: Mental health conditions can reduce motivation and energy for physical activity.
- Contractures: Shortening and hardening of muscles, tendons, or other tissues, leading to deformity and rigidity of joints.
- Neuromuscular Impairment: Conditions like stroke, multiple sclerosis, and Parkinson’s disease affect nerve and muscle function.
- Cognitive Impairment: Dementia and other cognitive disorders can impair understanding and ability to follow instructions for movement.
- Developmental Delay: Children may experience delays in achieving motor milestones.
- Malnutrition: Inadequate nutrition weakens muscles and reduces energy levels.
- Obesity: Excess weight puts strain on joints and can limit mobility.
- Lack of Access or Support (Social or Physical): Environmental barriers or lack of assistance can restrict movement.
- Prescribed Bed Rest, Immobilizers, or Movement Restrictions: Medical treatments may necessitate temporary immobility.
- Physical or Chemical (Sedatives) Restraints: Restricting movement for safety can lead to muscle weakness and reduced mobility.
- Reluctance or Disinterest in Movement: Psychological or emotional factors can contribute to inactivity.
Recognizing Signs and Symptoms of Altered Mobility
Identifying the signs and symptoms of altered mobility is essential for accurate diagnosis and care planning. These indicators can be categorized as subjective (reported by the patient) and objective (observed by the nurse).
Subjective Data (Patient Reports):
- Expression of Pain and Discomfort with Movement: Patients may report pain, stiffness, or difficulty when moving.
- Refusal to Move: Patients may be unwilling to move due to pain, fear, or lack of motivation.
Objective Data (Nurse Assessments):
- Limited Range of Motion: Observable restriction in the extent of joint movement.
- Uncoordinated Movements: Jerky, uneven, or inefficient movements.
- Poor Balance: Difficulty maintaining equilibrium while standing or moving.
- Inability to Turn in Bed, Transfer, or Ambulate: Challenges in performing basic movements like changing position in bed, moving from one surface to another, or walking.
- Postural Instability: Difficulty maintaining an upright posture.
- Gait Disturbances: Abnormalities in walking patterns, such as shuffling, limping, or wide-based gait.
- Reliance on Assistive Devices: Need for equipment like walkers, canes, or wheelchairs to aid mobility.
- Contractures: Visibly shortened or stiffened muscles or joints.
- Decreased Muscle Strength: Reduced ability to exert force with muscles.
- Inability to Follow or Complete Instructions: Cognitive or physical limitations preventing adherence to movement instructions.
Expected Outcomes for Patients with Altered Mobility
Setting realistic and measurable outcomes is crucial in managing altered mobility. Common nursing care planning goals and expected outcomes include:
- Active Participation in ADLs and Therapies: Patient will engage in daily living activities and prescribed treatment regimens to the best of their ability.
- Demonstrated Improvement in Physical Mobility: Patient will show progress in mobility, such as independently transferring from bed to a wheelchair, if achievable.
- Prevention of Complications: Patient will remain free from contractures and pressure ulcers resulting from limited mobility.
- Active Engagement in Mobility Improvement: Patient will demonstrate exercises and strategies aimed at enhancing physical mobility.
Comprehensive Nursing Assessment for Altered Mobility
A thorough nursing assessment is the foundation of effective care for patients with altered mobility. This assessment involves gathering subjective and objective data across physical, psychosocial, emotional, and diagnostic domains.
1. Identify Underlying Conditions: Assess for medical conditions that contribute to altered mobility. Conditions such as stroke, multiple sclerosis, dementia, paralysis, cerebral palsy, fractures, and arthritis are common culprits.
2. Review Prescribed Movement Limitations: Note any physician-ordered restrictions on movement, such as bed rest, non-weight-bearing status, or the use of braces, slings, or immobilizers.
3. Evaluate Pain and Range of Motion: Assess the patient’s pain levels and joint stiffness, as these factors significantly impact their willingness and ability to participate in mobility-enhancing activities. Effective pain management is crucial for facilitating movement and physical therapy.
4. Assess Strength and Range of Motion Quantitatively: Evaluate muscle strength and joint range of motion to determine the patient’s current physical capabilities. This baseline assessment helps in setting realistic mobility goals and tracking progress. Tools and scales can be used for objective measurement.
5. Apply Clinical Judgement Before Mobilizing: Exercise caution and sound clinical judgment before assisting patients with mobility. Older adults, obese individuals, and those with cognitive impairments may require additional support and specialized techniques to prevent falls and injuries. Always ensure adequate assistance (staff, equipment, physiotherapy) is available and never force a patient beyond their physical limits.
6. Determine Need for Multidisciplinary Care: Recognize when extensive mobility limitations necessitate a multidisciplinary approach involving rehabilitation specialists and therapists. Nurses often play a central role in coordinating these additional services.
7. Evaluate Equipment Needs for Enhanced Mobility: Assess the need for assistive devices such as walkers, wheelchairs, grab bars, commodes, adaptive equipment, and prosthetics. These aids can promote independence and optimize mobility for patients with varying levels of impairment.
8. Explore Psychological and Motivational Factors: Investigate feelings of disinterest or unwillingness to move. Depression, lack of motivation, embarrassment, hopelessness, and knowledge deficits can be significant barriers to mobility. Addressing these psychological factors is crucial for successful interventions.
9. Assess Environmental and Support Systems: Evaluate the patient’s home environment and the availability of caregiver support. Unsafe living conditions or inadequate caregiver support can contribute to altered mobility and increase the risk of falls and injuries. Assessing these factors is essential for comprehensive care planning, especially for discharge planning.
Effective Nursing Interventions for Altered Mobility
Nursing interventions are crucial for improving and maintaining mobility in patients. These interventions should be tailored to the individual patient’s needs and capabilities.
1. Encourage Maximum Independence: Once the level of immobility is assessed, encourage patients to perform as much activity independently as safely possible. Promoting self-reliance enhances self-esteem and reduces dependence.
2. Implement Pain Management Strategies: Address pain as a barrier to movement. Administer analgesics as prescribed prior to exercise or ADLs. Non-pharmacological interventions like heating pads or ice packs can also alleviate muscle and joint pain, facilitating increased movement.
3. Schedule Activities Around Rest Periods: Collaborate with patients to schedule activities, considering their energy levels and fatigue. Avoid overexertion and ensure adequate rest periods between activities to prevent exhaustion.
4. Provide and Train on Adaptive Equipment: Equip patients with appropriate adaptive devices to maximize their mobility potential. For bed-bound patients with upper body strength, a trapeze bar can aid in repositioning. Provide thorough training on the safe and effective use of all equipment.
5. Implement Passive Range of Motion (ROM) Exercises: For patients unable to move independently, perform passive ROM exercises several times daily. This helps prevent contractures, maintain joint flexibility, and minimize muscle weakness.
6. Optimize Nutrition and Hydration: Promote proper nutrition and hydration as essential components of mobility recovery. Adequate caloric intake provides energy, while high-protein foods support muscle strength. Hydration prevents dehydration, promotes circulation, and maintains tissue and muscle health. Consider consulting a registered dietitian for personalized nutritional guidance.
7. Engage Family and Caregivers in Mobility Support: Involve family members and caregivers in the patient’s mobility plan. Educate them on how to safely support their loved ones, use assistive equipment, and create a supportive home environment. Patient commitment to mobility increases when they feel supported by their social network.
8. Consult with Multidisciplinary Team for Specialized Therapies: Collaborate with physical and occupational therapists to develop and implement specialized exercise programs and activities. These therapists provide expertise in muscle control, fine motor movement, and rehabilitation strategies.
9. Coordinate Ongoing Support at Discharge: Plan for continuity of care beyond hospitalization. Coordinate with case managers to arrange home health services or rehabilitation center placement as needed. Ensuring appropriate support after discharge is vital for sustaining progress and preventing setbacks.
10. Set Achievable, Step-Wise Goals: Break down overwhelming mobility challenges into smaller, manageable goals. Start with simple objectives like brushing hair or sitting up in bed. Achieving these small wins provides motivation and a sense of progress, encouraging continued effort.
11. Provide Positive Reinforcement and Encouragement: Acknowledge and praise patient efforts, no matter how small. Positive reinforcement boosts morale and motivates patients to continue working towards their mobility goals.
Nursing Care Plans for Altered Mobility: Examples
Nursing care plans provide structured frameworks for prioritizing assessments and interventions, guiding both short-term and long-term care. Here are examples of care plans addressing altered mobility:
Care Plan #1: Altered Mobility Related to Contractures Secondary to Cerebral Palsy
Diagnostic Statement:
Altered physical mobility related to contractures secondary to cerebral palsy as evidenced by range of motion limitations.
Expected Outcomes:
- Patient will experience no further development of contractures.
- Patient will demonstrate tolerance in performing activities of daily living (ADLs) within their capabilities.
Assessments:
1. Comprehensive Musculoskeletal Assessment: Assess muscle tone, strength, and ROM. Evaluate posture, gait, and reflexes (primitive and deep tendon). Rationale: Cerebral palsy impacts motor function and posture throughout life. This detailed assessment reveals disease severity and the extent of immobility, guiding tailored interventions.
2. Functional Independence Measure (FIM) Assessment: Evaluate the patient’s ability to perform ADLs using the FIM. Rationale: FIM objectively measures self-care independence, informing the level of assistance required and tracking progress over time.
Interventions:
1. Regular Range of Motion (ROM) Exercises: Implement passive or active ROM exercises for all extremities. Rationale: Prevention is paramount for contractures. Exercise combats muscle stiffness, enhances strength, and improves endurance. Exercising all joints proactively prevents contracture development.
2. Medication Administration as Prescribed: Administer prescribed medications to manage muscle spasticity and dystonia. Rationale: Medications like benzodiazepines, dantrolene, botulinum toxin, gabapentin, carbidopa-levodopa, and trihexyphenidyl can effectively relieve muscle spasticity and dystonia, thereby improving mobility.
3. Frequent Repositioning Schedule: Implement a turn and position schedule every 2 hours or as needed. Rationale: Patients with cerebral palsy, particularly severe forms, are at high risk for pressure ulcers due to prolonged bed immobility. Regular position changes optimize tissue circulation and prevent pressure injury development.
4. Maintain Optimal Body Alignment: Ensure proper body alignment at all times. Rationale: Maintaining correct body alignment minimizes joint strain and prevents the formation of contractures by supporting musculoskeletal integrity.
5. Collaborative Therapy with Specialists: Collaborate closely with physical and occupational therapists. Rationale: Physical and occupational therapists possess specialized training in therapeutic exercises and interventions that are crucial for optimizing mobility and functional independence in patients with cerebral palsy.
Care Plan #2: Altered Mobility Related to Decreased Muscle Strength Secondary to Prolonged Intubation
Diagnostic statement:
Altered physical mobility related to decreased muscle strength secondary to prolonged intubation as evidenced by an impaired ability to ambulate.
Expected Outcomes:
- Patient will demonstrate a measurable increase in muscle strength score using standardized assessment tools.
- Patient will effectively utilize adaptive techniques and devices to improve ambulation and mobility.
Assessments:
1. Detailed Motor Examination: Conduct a thorough motor examination. Rationale: Motor examination findings precisely define the current level of mobility and the specific type of assistance the patient requires. This often includes a walking test to establish a baseline measure of current ambulatory ability, essential for tracking progress.
2. Assistive Device Needs Assessment: Assess the patient’s need for assistive devices. Rationale: Reduced lower extremity muscle strength significantly elevates fall risk. Assistive devices like wheelchairs, crutches, and canes are vital for promoting safe ambulation and preventing falls in patients with muscle weakness.
Interventions:
1. Promote Proper Use of Assistive Devices: Encourage the appropriate and consistent use of assistive devices such as wheelchairs, crutches, and canes. Rationale: Assistive devices are instrumental in promoting independence, reducing pain during movement, enhancing self-esteem by enabling greater participation, and increasing overall confidence in mobility.
2. Implement Transfer Training Programs: Facilitate structured transfer training sessions. Rationale: Effective transfer techniques are crucial for maintaining optimal mobility and ensuring patient safety during movement and transitions between positions.
3. Ensure a Safe Environment: Provide and maintain a safe environment. Rationale: Safety measures such as raising side rails on beds, keeping the bed in a low position, and ensuring frequently used items are within easy reach are proactive steps to minimize the risk of falls and injuries.
4. Implement Resistance Training Exercises: Encourage or directly assist with resistance-training exercises using light weights or resistance bands. Rationale: Resistance training is highly effective for improving muscle strength and tone, maintaining joint flexibility and balance, and ultimately fostering greater independence in mobility and daily activities.
5. Promote Rest and Activity Balance: Encourage scheduled rest periods between activities. Rationale: Rest periods are essential for conserving and effectively replenishing energy reserves. Adequate rest also plays a crucial role in reducing muscle fatigue, alleviating joint stress, and minimizing muscle or joint pain, thus supporting sustained participation in mobility-enhancing activities.
6. Multidisciplinary Rehabilitation Collaboration: Actively collaborate with physiotherapists and occupational therapists as needed. Rationale: Physiotherapists and occupational therapists bring specialized expertise in mobility rehabilitation, offering advanced techniques and tailored interventions to address complex mobility challenges effectively.
Care Plan #3: Altered Mobility Related to Deconditioning
Diagnostic statement:
Altered physical mobility related to deconditioning as evidenced by an impaired ability to transfer from bed to chair.
Expected Outcomes:
- Patient will verbalize subjective feelings of increased strength and improved ability to move more freely and confidently.
- Patient will consistently perform flexibility exercises targeting each major muscle-tendon group daily, holding stretches for 10 to 60 seconds at a time, to enhance joint range of motion.
Assessments:
1. Standardized Mobility Skills Assessment: Assess mobility skills using a reliable and validated tool. Rationale: Standardized tools designed for safe patient handling and movement, systematically assess critical mobility skills including bed mobility, supported and unsupported sitting, transferring movements, standing, and walking. Identifying low mobility, functional difficulties, cognitive impairment, and multiple comorbidities is essential for planning both patient safety and targeted rehabilitation interventions.
2. Comprehensive Etiology Assessment: Assess and determine the underlying cause(s) of impaired mobility, differentiating between physical, psychological, and motivational factors. Rationale: Beyond physical disease or disability, psychological factors such as fear of falling, pain perception, presence of depression, and ineffective coping mechanisms can significantly contribute to and exacerbate impaired immobility. Addressing these multifaceted factors is key to holistic intervention planning.
3. Activity Tolerance Monitoring: Continuously monitor and meticulously record the patient’s ability to tolerate physical activity. Rationale: Closely monitor and document changes in vital signs – pulse rate, blood pressure, skin color, and breathing mechanics – both before and immediately after physical activity. Patients exhibiting signs such as tachycardia, hypertension, dyspnea, cyanosis, dizziness, and pronounced fatigue post-activity may be experiencing activity intolerance, necessitating adjustments to the activity plan.
Interventions:
1. Frequent Passive Range of Motion (ROM) for Immobility: Perform passive ROM exercises frequently for patients with significant immobility. Rationale: Physical rehabilitation interventions, including passive ROM, are demonstrably safe and effective in reducing disability associated with immobility, while also associated with a low incidence of adverse events.
2. Promote Self-Efficacy and Independence: Actively encourage self-efficacy by consistently avoiding the provision of unnecessary assistance with Activities of Daily Living (ADLs). Rationale: Unnecessary assistance can inadvertently worsen immobility and actively discourage patient independence. Promoting self-efficacy is crucial for fostering motivation and maximizing functional recovery.
3. Progressive Mobilization Techniques: Systematically teach progressive mobilization techniques, starting with dangling legs at the bedside initially, followed by gradual and slow progression to getting out of bed when transferring from bed to chair. Rationale: Progressive mobilization, initiated with dangling and gradual advancement, allows for controlled muscle flexion, facilitating a gradual and safe increase in joint range of motion. This step-wise progression methodically improves ligament movement around the joint, minimizing risk of injury and promoting adaptation.
4. Physical Therapy Referral for Expert Guidance: Refer the patient to a physical therapist for comprehensive evaluation, targeted strength and gait training, and the development of a highly effective and individualized mobility plan. Rationale: Physical therapists possess specialized expertise in conducting in-depth evaluations of mobility impairments, delivering tailored strength and gait training programs, and creating comprehensive mobility plans designed to optimize patient outcomes.
References
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- Hallman-Cooper, J.L.& Rocha, C.F. (2022). Cerebral palsy. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK538147/
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- Milaneschi, Y., Tanaka, T., & Ferrucci, L. (2010). Nutritional determinants of mobility. Current opinion in clinical nutrition and metabolic care, 13(6), 625–629. https://doi.org/10.1097/MCO.0b013e32833e337d
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