Nursing Diagnosis: Impaired Physical Mobility – Comprehensive Guide for Nurses

Impaired physical mobility is a prevalent nursing diagnosis that signifies a limitation in independent, purposeful physical movement of the body or one or more extremities. This condition, often multifaceted in origin, can be temporary, permanent, or progressive, presenting significant risks for secondary complications like pressure ulcers, infections, falls, and social isolation. As a critical concern, especially in the aging population where it elevates morbidity and mortality risks, addressing impaired physical mobility is paramount. Enhancing patient mobility not only improves health outcomes but also significantly contributes to their overall quality of life.

Nurses play a vital role in identifying risk factors and implementing strategies to prevent or mitigate impaired physical mobility. This necessitates a collaborative, multidisciplinary approach involving physical and occupational therapists, prosthetic services, rehabilitation centers, and sustained support systems to facilitate and maintain patient progress.

Causes of Impaired Physical Mobility

Impaired physical mobility can stem from a wide array of underlying factors. Recognizing these causes is crucial for effective nursing interventions and care planning. Common causes include:

• Sedentary Lifestyle: Lack of regular physical activity leads to muscle weakness and reduced joint flexibility.
• Deconditioning: Prolonged inactivity, often due to illness or hospitalization, results in a decline in physical function.
• Decreased Endurance: Reduced stamina and ability to sustain physical activity.
• Limited Range of Motion (ROM): Restricted movement in joints due to stiffness, pain, or injury.
• Recent Surgical Intervention: Post-operative pain, weakness, and movement restrictions can impair mobility.
• Decreased Muscle Strength or Control: Neurological conditions, muscle atrophy, or injury can weaken muscles and impair control over movement.
• Joint Stiffness: Conditions like arthritis cause pain and stiffness in joints, limiting mobility.
• Chronic and Acute Pain: Pain can significantly restrict movement as patients avoid activities that exacerbate discomfort.
• Depression: Mental health conditions can reduce motivation and energy levels, leading to decreased physical activity.
• Contractures: Shortening and hardening of muscles, tendons, or other tissues, leading to deformity and rigidity of joints.
• Neuromuscular Impairment: Conditions like stroke, spinal cord injury, or multiple sclerosis affect nerve and muscle function, impacting mobility.
• Cognitive Impairment: Dementia or delirium can affect a patient’s ability to understand and follow instructions for movement and safety.
• Developmental Delay: In children, delays in motor skill development can lead to impaired physical mobility.
• Malnutrition: Inadequate nutrition weakens muscles and reduces energy levels, affecting mobility.
• Obesity: Excess weight puts strain on joints and can limit movement, contributing to mobility issues.
• Lack of Access or Support: Social or physical barriers, such as inaccessible environments or lack of caregiver support, can limit mobility.
• Prescribed Bed Rest, Immobilizers, or Movement Restrictions: Medical orders to limit movement for healing or treatment purposes.
• Physical or Chemical Restraints: Use of restraints, whether physical devices or sedatives, directly limits physical movement.
• Reluctance or Disinterest in Movement: Psychological factors, fear of pain, or lack of motivation can lead to decreased mobility.

Signs and Symptoms of Impaired Physical Mobility

Identifying the signs and symptoms of impaired physical mobility is essential for accurate diagnosis and care planning. These signs can be categorized into subjective (reported by the patient) and objective (observed by the nurse) data.

Subjective Symptoms (Patient Reports)

• Expression of Pain and Discomfort with Movement: Patients may report pain, stiffness, or discomfort when attempting to move or perform activities.
• Refusal to Move: Patients may verbally refuse to move or participate in activities due to pain, fear, or lack of motivation.

Objective Signs (Nurse Assesses)

• Limited Range of Motion (ROM): Observable restriction in the normal movement of joints.
• Uncoordinated Movements: Jerky, unsteady, or disorganized movements.
• Poor Balance: Difficulty maintaining balance while standing or walking, increasing the risk of falls.
• Inability to Turn in Bed, Transfer, or Ambulate: Difficulty performing basic movements such as changing position in bed, moving from one surface to another, or walking.
• Postural Instability: Inability to maintain an upright posture; may lean or slump when sitting or standing.
• Gait Disturbances: Abnormalities in walking patterns, such as shuffling, limping, or wide-based gait.
• Reliance on Assistive Devices: Use of aids like walkers, canes, wheelchairs, or braces to compensate for mobility limitations.
• Contractures: Visibly shortened muscles or tendons causing joint deformity and restricted movement.
• Decreased Muscle Strength: Weakness in muscle groups, assessed through manual muscle testing or observation of functional movements.
• Inability to Follow or Complete Instructions: Cognitive or communication deficits that hinder the patient’s ability to understand and execute movement instructions.

Expected Outcomes for Impaired Physical Mobility

Setting realistic and measurable expected outcomes is crucial for guiding nursing care and evaluating patient progress. Common goals include:

• Patient Participation in ADLs and Prescribed Therapies: The patient will actively engage in their daily living activities and adhere to recommended therapeutic exercises and treatments to the best of their ability.
• Demonstrated Improvement in Physical Mobility: The patient will show measurable improvements in mobility, such as being able to transfer independently from bed to chair (if realistic and safe goal for the patient’s condition and prognosis).
• Maintenance of Skin Integrity and Prevention of Contractures: The patient will remain free from pressure ulcers and contractures resulting from immobility through preventative measures and interventions.
• Demonstration of Exercises to Improve Physical Mobility: The patient (and/or caregiver) will be able to correctly perform exercises designed to enhance strength, flexibility, and overall mobility.

Nursing Assessment for Impaired Physical Mobility

A comprehensive nursing assessment is the foundation for developing effective interventions. It involves gathering both subjective and objective data to understand the patient’s mobility status and contributing factors.

1. Identify Underlying Conditions: Assess for medical conditions that directly contribute to impaired mobility. This includes neurological disorders (stroke, multiple sclerosis, dementia, cerebral palsy, paralysis), musculoskeletal conditions (fractures, arthritis), and other chronic illnesses.

2. Review Prescribed Movement Limitations: Note any medical orders that restrict patient movement, such as bed rest orders, non-weight-bearing status, or the use of immobilizing devices (braces, slings).

3. Evaluate Pain and Range of Motion: Assess the patient’s pain level and location, as pain is a significant barrier to movement. Evaluate range of motion in all major joints to identify limitations and stiffness.

4. Assess Muscle Strength and Functional Abilities: Determine the patient’s muscle strength in upper and lower extremities. Assess their ability to perform functional movements necessary for ADLs, such as sitting, standing, transferring, and walking.

5. Apply Clinical Judgment and Safety Precautions: Before assisting with mobility, especially for older, obese, or cognitively impaired patients, carefully assess their abilities and ensure adequate assistance (additional staff, assistive equipment, physiotherapy) is available to prevent falls and injuries. Never force movement beyond the patient’s capacity.

6. Determine Need for Multidisciplinary Care: Recognize when mobility limitations are complex and require specialized rehabilitation services. Act as a coordinator to involve physical therapists, occupational therapists, and other specialists as needed.

7. Evaluate Equipment Needs: Assess the need for assistive devices that can enhance the patient’s independence and mobility, such as walkers, wheelchairs, grab bars, commodes, adaptive equipment, and prosthetics.

8. Explore Psychological and Motivational Factors: Assess for feelings of disinterest, unwillingness to move, depression, hopelessness, embarrassment, or lack of knowledge that may be hindering the patient’s participation in mobility-enhancing activities.

9. Assess Environmental and Support Systems: Evaluate the patient’s home environment for safety and accessibility. Assess the availability and competency of caregivers to provide support and assistance with mobility at home. An unsafe environment or inadequate support can significantly contribute to impaired mobility and increase the risk of falls and injuries.

Nursing Interventions for Impaired Physical Mobility

Nursing interventions are crucial for improving and maintaining patient mobility. These interventions should be tailored to the individual patient’s needs, abilities, and goals.

1. Encourage Maximum Independence: Once the level of immobility is assessed, encourage the patient to perform as much activity independently as safely possible, within their capabilities. This promotes self-esteem and reduces dependence.

2. Provide Pain Management: Administer analgesics as prescribed and utilize non-pharmacological pain relief measures (heating pads, ice packs) before exercise or ADLs to reduce pain and increase participation in movement.

3. Schedule Activities with Rest Periods: Plan activities around the patient’s energy levels, allowing for rest periods to prevent fatigue and exhaustion. Avoid overwhelming the patient with too many activities at once.

4. Utilize Adaptive Equipment: Provide and instruct on the use of adaptive equipment to maximize movement potential. For example, a trapeze bar for bed-bound patients with upper extremity strength.

5. Implement Passive Range of Motion (ROM) Exercises: For patients unable to move independently, perform passive ROM exercises several times daily to maintain joint flexibility, prevent contractures, and reduce muscle weakness.

6. Promote Optimal Nutrition and Hydration: Ensure adequate caloric intake for energy, high-protein foods to support muscle mass, and sufficient hydration to prevent dehydration, promote circulation, and maintain tissue and muscle health. Consider consulting a registered dietitian.

7. Involve Family and Caregivers: Educate and involve family members and caregivers in supporting the patient’s mobility. Provide training on safe transfer techniques, equipment use, and encouragement strategies.

8. Consult with Multidisciplinary Team: Collaborate with physical and occupational therapists to develop and implement specialized exercise programs and activities to improve muscle strength, fine motor skills, and overall mobility.

9. Coordinate Ongoing Support at Discharge: Arrange for necessary post-discharge support such as home health services or rehabilitation center placement to ensure continued progress and prevent regression in mobility. Coordinate with case managers for seamless transitions.

10. Set Realistic and Achievable Goals: Help patients set small, attainable goals to build confidence and motivation. Start with simple goals like sitting up in bed or brushing hair, and gradually progress to more complex activities.

11. Provide Positive Reinforcement and Encouragement: Acknowledge and praise even small efforts and achievements to encourage continued participation and motivation in mobility activities.

Nursing Care Plans Examples for Impaired Physical Mobility

Nursing care plans provide a structured approach to care, prioritizing assessments and interventions to achieve both short-term and long-term patient goals. Here are examples of care plans for different scenarios:

Care Plan #1: Impaired Physical Mobility related to Contractures secondary to 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 development or worsening of contractures.
• Patient will tolerate performing activities of daily living (ADLs) to the maximum extent possible.

Assessment:

1. Assess muscle tone, strength, and ROM. Check posture, gait, and reflexes. (Cerebral palsy affects motor function and posture throughout life. This assessment reveals disease severity and immobility level.)
2. Assess ADL ability using the Functional Independence Measure (FIM). (FIM measures self-care independence, indicating the level of assistance needed.)

Interventions:

1. Perform passive or active ROM exercises to all extremities. (Prevents contractures, muscle stiffness, and improves strength and endurance. Exercise all joints.)
2. Administer medications as ordered. (Muscle spasticity may be managed with benzodiazepines, dantrolene, or botulinum toxin. Medications like gabapentin may address muscle dystonia.)
3. Turn and position patient every 2 hours or as needed. (Patients with cerebral palsy are at high risk for pressure ulcers due to immobility. Repositioning improves circulation.)
4. Maintain good body alignment. (Reduces joint strain and prevents contractures.)
5. Collaborate with physical or occupational therapist. (Therapists are trained in therapeutic exercises to optimize mobility.)

Care Plan #2: Impaired Physical Mobility related to Decreased Muscle Strength secondary to Prolonged 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 increased muscle strength score over time.
• Patient will demonstrate effective use of adaptive techniques to improve ambulation.

Assessment:

1. Perform motor examination. (Reveals mobility level and assistance needs. Includes walking tests for baseline and progress tracking.)
2. Assess the need for assistive devices. (Decreased lower extremity strength increases fall risk. Devices promote ambulation and safety.)

Interventions:

1. Encourage appropriate use of assistive devices. (Wheelchairs, crutches, canes promote independence, reduce pain, and boost confidence.)
2. Facilitate transfer training. (Maintains optimal mobility and patient safety.)
3. Provide a safe environment. (Side rails, low bed position, accessible items prevent falls.)
4. Encourage resistance-training exercises using light weights. (Improves muscle strength, tone, flexibility, balance, and independence.)
5. Encourage rest between activities. (Conserves energy, reduces muscle fatigue, joint stress, and pain.)
6. Collaborate with physiotherapist and occupational therapist. (For specialized exercise guidance and support.)

Care Plan #3: Impaired Physical Mobility related 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 verbalize feelings of increased strength and improved ability to move.
• Patient will perform flexibility exercises daily to improve joint range of motion.

Assessment:

1. Assess mobility skills using a reliable tool. (Tools like the “Assessment Criteria and Care Plan for Safe Patient Handling and Movement” assess bed mobility, sitting, transferring, standing, and walking. Identifies safety and rehabilitation needs.)
2. Assess the cause of impaired mobility. (Determine if physical, psychological, or motivational factors are contributing.)
3. Monitor and record activity tolerance. (Note changes in vital signs, skin color, breathing before and after activity. Indicators of activity intolerance include tachycardia, hypertension, dyspnea, dizziness, fatigue.)

Interventions:

1. Perform passive ROM frequently for immobile patients. (Physical rehabilitation is safe, reduces disability, and has few adverse effects.)
2. Encourage self-efficacy. Avoid unnecessary assistance with ADLs. (Unnecessary assistance worsens immobility and discourages independence.)
3. Teach progressive mobilization. (Dangling legs before standing, gradual progression improves joint range of motion and ligament movement.)
4. Refer to a physical therapist. (For further evaluation, strength and gait training, and individualized mobility plans.)

References

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