Impaired Mobility: Nursing Diagnosis and Comprehensive Care Plan

Impaired physical mobility is a prevalent nursing diagnosis, often stemming from a multitude of factors. This condition, which can be temporary, permanent, or progressive, significantly elevates the risk of secondary health complications like pressure ulcers, infections, falls, and social isolation.

The risk of impaired physical mobility escalates with advancing age, contributing to increased morbidity and mortality within the older population. Conversely, enhancing mobility is crucial not only for improved health outcomes but also for a better quality of life for patients across all age groups.

Nurses play a vital role in identifying risk factors associated with impaired physical mobility and implementing strategies for prevention and improvement. A collaborative, multidisciplinary approach is essential, involving physical and occupational therapists, prosthetic services, rehabilitation facilities, and continuous support systems to ensure sustained progress in patient mobility.

Underlying Causes of Impaired Mobility

Several factors can contribute to impaired physical mobility. Recognizing these causes is the first step in developing an effective care plan:

• Sedentary Lifestyle: Lack of regular physical activity leads to muscle weakness and reduced endurance.
• Deconditioning: Prolonged inactivity due to illness or injury weakens the body’s systems.
• Decreased Endurance: Reduced ability to sustain physical activity over time.
• Limited Range of Motion (ROM): Stiffness or restrictions in joint movement.
• Recent Surgical Intervention: Post-operative recovery can temporarily limit movement.
• Decreased Muscle Strength or Control: Neurological or musculoskeletal conditions affecting muscle function.
• Joint Stiffness: Arthritis or other joint conditions restricting movement.
• Chronic and Acute Pain: Pain can significantly deter movement and activity.
• 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 affecting the nerves and muscles, such as stroke or multiple sclerosis.
• Cognitive Impairment: Conditions like dementia can affect the ability to understand and follow instructions for movement.
• Developmental Delay: Delayed motor skill development in children.
• Malnutrition: Lack of essential nutrients weakens muscles and reduces energy levels.
• Obesity: Excess weight can strain joints and limit mobility.
• Lack of Access or Support: Social or physical barriers preventing access to exercise or mobility aids.
• Prescribed Bed Rest or Movement Restrictions: Medical orders limiting patient movement.
• Physical or Chemical Restraints: Use of restraints can further impair mobility and muscle strength.
• Reluctance or Disinterest in Movement: Lack of motivation or fear of movement.

Recognizing the Signs and Symptoms of Impaired Mobility

Identifying the signs and symptoms of impaired physical mobility is crucial for timely intervention. These indicators can be categorized as subjective (reported by the patient) and objective (observed by the nurse).

Subjective Symptoms (Patient-Reported)

• Expressing pain or discomfort during movement.
• Refusal to move or participate in activities.

Objective Signs (Nurse-Observed)

• Limited Range of Motion (ROM) in joints.
• Uncoordinated or jerky movements.
• Poor balance and instability.
• Inability to turn in bed, transfer between surfaces, or walk (ambulate).
• Postural instability or poor posture.
• Gait disturbances or abnormal walking patterns.
• Reliance on assistive devices such as walkers or wheelchairs.
• Presence of contractures.
• Decreased muscle strength in extremities.
• Inability to follow or understand instructions related to movement.

Desired Outcomes for Patients with Impaired Mobility

Setting clear and achievable goals is essential in the care plan for impaired physical mobility. Expected outcomes include:

• Patient actively participates in Activities of Daily Living (ADLs) and prescribed therapeutic exercises.
• Patient demonstrates measurable improvement in physical mobility, such as independent bed-to-wheelchair transfers (if realistic).
• Patient maintains skin integrity and remains free from contractures and pressure ulcers resulting from immobility.
• Patient effectively demonstrates exercises designed to enhance physical mobility.

Comprehensive Nursing Assessment for Impaired Mobility

A thorough nursing assessment is the foundation of effective care for impaired physical mobility. It involves gathering subjective and objective data across physical, psychosocial, emotional, and diagnostic domains.

1. Identify Underlying Conditions:
Determine any existing medical conditions that contribute to mobility impairment. These may include stroke, multiple sclerosis, dementia, paralysis, cerebral palsy, fractures, and arthritis, among others.

2. Review Prescribed Movement Restrictions:
Note any medical orders that limit movement, such as bed rest orders following surgery, 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 any limitations in joint movement. Pain management is crucial to enable participation in exercise and therapy.

4. Assess Strength and Range of Motion:
Evaluate muscle strength and joint flexibility to understand the patient’s physical capabilities. This assessment helps in setting realistic mobility goals and identifying areas needing improvement.

5. Apply Nursing Judgment Before Mobilization:
Exercise caution and sound clinical judgment before assisting patients with mobility, especially older adults, obese individuals, or those with cognitive impairments. Ensure adequate support (staff, equipment, physiotherapy) to prevent falls and injuries. Never force movement beyond the patient’s capacity.

6. Determine Need for Multidisciplinary Care:
Recognize when extensive mobility limitations necessitate specialized rehabilitation and therapies. Nurses often coordinate these additional services.

7. Evaluate Equipment Needs:
Assess the need for assistive devices like walkers, wheelchairs, grab bars, commodes, adaptive equipment, or prosthetics to enhance independence and mobility.

8. Address Disinterest or Unwillingness to Move:
Explore potential psychological barriers like depression, lack of motivation, embarrassment, hopelessness, or knowledge deficits that may hinder patient participation in mobility activities.

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 significantly contribute to impaired mobility and increase risks of injury or falls.

Alt text: Nurse carefully assisting a senior patient with walking, demonstrating support and care for impaired mobility.

Essential Nursing Interventions for Impaired Mobility

Nursing interventions are crucial for promoting recovery and improving mobility. These interventions should be tailored to the patient’s specific needs and capabilities.

1. Encourage Maximum Independence:
Promote patient independence by encouraging them to perform activities to the best of their ability. This fosters self-esteem and reduces reliance on others.

2. Provide Pain Management:
Administer analgesics or non-pharmacological pain relief methods (heating pads, ice packs) before exercises or ADLs to reduce pain and facilitate movement.

3. Schedule Activities with Rest Periods:
Plan activities around the patient’s energy levels, incorporating rest periods to prevent fatigue and exhaustion.

4. Utilize Adaptive Equipment:
Provide and train patients on the use of adaptive equipment that maximizes their movement capabilities, such as trapeze bars for bed-bound patients with upper body strength.

5. Implement Passive Range of Motion (ROM) Exercises:
Perform passive ROM exercises for patients unable to move independently to prevent contractures and muscle weakness.

6. Promote Optimal Nutrition and Hydration:
Ensure adequate nutrition, including sufficient caloric and protein intake, and hydration to support muscle strength, energy levels, and overall tissue health. Consider consulting a dietitian for nutritional support.

7. Involve Family and Caregivers:
Engage family members and caregivers in the care plan, providing education on how to support the patient safely, use equipment, and encourage mobility.

8. Consult with Multidisciplinary Team:
Collaborate with physical therapists and occupational therapists to develop and implement specialized exercise programs and activities to improve muscle control and motor skills.

9. Coordinate Ongoing Support at Discharge:
Arrange for necessary post-discharge support, such as home health services or rehabilitation center placement, to maintain progress.

10. Set Achievable Goals:
Help patients set small, realistic goals to foster motivation and a sense of accomplishment, such as sitting up in bed or brushing hair.

11. Offer Positive Reinforcement:
Provide praise and encouragement for any effort made by the patient to enhance mobility, no matter how small.

Alt text: Nurse attentively assisting a patient in a wheelchair, showcasing supportive care for mobility challenges.

Nursing Care Plan Examples for Impaired Physical Mobility

Nursing care plans are essential tools for prioritizing assessments and interventions, guiding both short-term and long-term care goals. Here are examples of nursing care plans for impaired physical mobility:

Care Plan #1: Impaired Mobility Due to Contractures from Cerebral Palsy

Diagnostic Statement: Impaired physical mobility related to contractures secondary to cerebral palsy as evidenced by range of motion limitations.

Expected Outcomes:

• Patient will experience no further contractures.
• Patient will be able to tolerate and perform Activities of Daily Living (ADLs).

Assessment:

1. Assess Muscle Tone, Strength, and ROM: Evaluate posture, gait, and reflexes to determine the severity of cerebral palsy and the extent of immobility.
2. Assess ADL Ability using FIM: Utilize the Functional Independence Measures (FIM) to assess the patient’s ability to perform self-care tasks and identify required assistance levels.

Interventions:

1. Perform ROM Exercises: Implement passive or active ROM exercises on all extremities to prevent stiffness and improve muscle strength and endurance.
2. Administer Medications as Prescribed: Provide muscle relaxants like benzodiazepines or other medications to manage spasticity and dystonia, enhancing mobility.
3. Reposition Patient Regularly: Turn and reposition the patient every 2 hours to prevent pressure ulcers in bedridden patients.
4. Maintain Proper Body Alignment: Ensure correct body alignment to reduce joint strain and prevent contractures.
5. Collaborate with Therapists: Work with physical and occupational therapists for specialized therapeutic exercises to optimize mobility.

Care Plan #2: Impaired Mobility Related to Muscle Weakness Post-Intubation

Diagnostic statement: Impaired physical mobility related to decreased muscle strength secondary to prolonged intubation as evidenced by an impaired ability to ambulate.

Expected Outcomes:

• Patient will demonstrate an increase in muscle strength score.
• Patient will effectively use adaptive techniques to improve ambulation.

Assessment:

1. Perform Motor Examination: Conduct a motor examination, including walking tests, to determine mobility level and assistance needs. This provides a baseline for progress tracking.
2. Assess Need for Assistive Devices: Evaluate the need for devices like wheelchairs or crutches to support ambulation and prevent falls due to lower extremity weakness.

Interventions:

1. Promote Use of Assistive Devices: Encourage the use of wheelchairs, crutches, or canes to increase independence and confidence in mobility.
2. Facilitate Transfer Training: Implement transfer training to maintain optimal mobility and ensure patient safety during movement.
3. Ensure a Safe Environment: Create a safe environment by using side rails, lowering beds, and keeping essential items within reach to prevent falls.
4. Encourage Resistance Training: Assist with resistance exercises using light weights to improve muscle strength, tone, balance, and flexibility.
5. Promote Rest Periods: Schedule rest periods between activities to conserve energy and reduce muscle fatigue and pain.
6. Collaborate with Therapists: Consult with physical and occupational therapists for specialized rehabilitation strategies.

Care Plan #3: Impaired Mobility Due to Deconditioning

Diagnostic statement: Impaired physical mobility related to deconditioning as evidenced by an impaired ability to transfer from bed to chair.

Expected Outcomes:

• Patient will express feelings of increased strength and improved mobility.
• Patient will perform daily flexibility exercises for major muscle groups to enhance joint range of motion.

Assessment:

1. Assess Mobility Skills: Use tools like the “Assessment Criteria and Care Plan for Safe Patient Handling and Movement” to evaluate mobility skills and identify functional difficulties.
2. Determine Cause of Impaired Mobility: Identify whether the cause is physical, psychological, or motivational to tailor interventions appropriately.
3. Monitor Activity Tolerance: Track vital signs (pulse rate, blood pressure, breathing) before and after activity to identify signs of activity intolerance.

Interventions:

1. Perform Passive ROM for Immobile Patients: Provide frequent passive ROM exercises to reduce disability and promote joint mobility.
2. Encourage Self-Efficacy: Avoid unnecessary assistance with ADLs to promote independence and prevent further deconditioning.
3. Teach Progressive Mobilization: Instruct patients on progressive mobilization techniques, such as dangling legs before standing, to gradually increase joint range of motion.
4. Refer to Physical Therapy: Refer patients to physical therapists for comprehensive evaluation and development of an effective mobility plan.

References

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