Impaired physical mobility is a prevalent nursing diagnosis, often stemming from a multitude of factors. This condition can manifest as a temporary setback, a permanent challenge, or a progressively worsening issue, significantly increasing the risk of serious complications such as pressure ulcers, infections, falls, and social isolation.
Advancing age stands out as the most significant risk factor for impaired physical mobility, thereby elevating morbidity and mortality rates within the aging population. Conversely, enhancing mobility is not only crucial for improving health outcomes but also for substantially enriching the overall quality of life for patients.
Nurses play a pivotal role in identifying the risk factors associated with impaired physical mobility and are instrumental in both preventing and mitigating mobility issues whenever feasible. This necessitates a collaborative, multidisciplinary approach, incorporating the expertise of physical and occupational therapists, prosthetic services, rehabilitation facilities, and sustained support systems to ensure continuous progress in physical well-being.
Causes of Impaired Physical Mobility
Impaired physical mobility can be attributed to a wide array of underlying causes. Recognizing these factors is crucial for effective diagnosis and care planning. Common causes include:
- Sedentary Lifestyle: Lack of regular physical activity leads to muscle weakness and reduced joint flexibility.
- Deconditioning: Weakening of the body due to prolonged inactivity, often following illness or injury.
- Decreased Endurance: Reduced stamina and ability to sustain physical activity over time.
- Limited Range of Motion: Restriction in the normal movement extent of a joint.
- Recent Surgical Intervention: Post-operative recovery can temporarily limit mobility due to pain, tissue healing, and medical restrictions.
- Decreased Muscle Strength or Control: Neurological or musculoskeletal conditions can weaken muscles or impair control over movement.
- Joint Stiffness: Conditions like arthritis can cause joints to become stiff and painful, limiting movement.
- Chronic and Acute Pain: Persistent or sudden pain can significantly hinder movement and willingness to engage in physical activity.
- 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 affecting the nerves and muscles, such as stroke or multiple sclerosis, can impair mobility.
- Cognitive Impairment: Conditions like dementia can affect a person’s ability to understand and follow instructions for movement or exercise.
- Developmental Delay: In children, delays in motor skill development can lead to impaired mobility.
- Malnutrition: Lack of essential nutrients can weaken muscles and reduce energy levels, affecting mobility.
- Obesity: Excess weight can strain joints and muscles, making movement difficult and contributing to sedentary behavior.
- Lack of Access or Support: Social or physical barriers, such as lack of transportation, accessible environments, or caregiver support, can limit mobility.
- Prescribed Bed Rest or Movement Restrictions: Medical orders that limit movement for therapeutic reasons.
- Physical or Chemical Restraints: Use of physical devices or medications to restrict movement, sometimes necessary for patient safety but can contribute to mobility impairment if prolonged.
- Reluctance or Disinterest in Movement: Psychological or emotional factors that reduce a person’s willingness to move.
Signs and Symptoms of Impaired Physical Mobility
Identifying the signs and symptoms of impaired physical mobility is essential for accurate nursing diagnosis and developing a targeted physical care plan. These signs can be categorized as subjective (reported by the patient) and objective (observed by the nurse).
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 express reluctance or outright refusal to move due to pain, fear, or lack of motivation.
Objective Signs (Nurse Assesses):
- Limited Range of Motion: Observable restriction in the extent of movement at one or more joints.
- Uncoordinated Movements: Jerky, uneven, or poorly controlled movements.
- Poor Balance: Difficulty maintaining equilibrium while standing or moving, increasing 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 (e.g., bed to chair), or walking.
- Postural Instability: Difficulty maintaining an upright posture, often leaning or swaying.
- Gait Disturbances: Abnormalities in walking pattern, such as shuffling, limping, or wide-based gait.
- Reliance on Assistive Devices: Necessity of using equipment like walkers, canes, or wheelchairs for mobility.
- Contractures: Visibly shortened and tightened muscles or joints.
- Decreased Muscle Strength: Reduced ability to exert force with muscles, assessed through manual muscle testing.
- Inability to Follow or Complete Instructions: Cognitive or communication barriers that prevent the patient from understanding or executing movement instructions.
Expected Outcomes for Physical Care Plan Diagnosis
Setting realistic and measurable expected outcomes is a crucial component of a Physical Care Plan Diagnosis for impaired physical mobility. These outcomes guide interventions and provide a framework for evaluating progress. Common goals include:
- Patient will actively participate in their activities of daily living (ADLs) and prescribed therapies to the best of their ability.
- Patient will demonstrate measurable improvement in physical mobility, such as independently transferring from bed to wheelchair, if realistically achievable.
- Patient will remain free from complications associated with impaired mobility, including contractures and pressure ulcers.
- Patient will actively demonstrate understanding and performance of exercises designed to enhance physical mobility.
Nursing Assessment for Impaired Physical Mobility
A thorough nursing assessment is the cornerstone of addressing impaired physical mobility. This process involves gathering comprehensive data encompassing physical, psychosocial, emotional, and diagnostic aspects.
1. Identify Underlying Conditions: Assess for pre-existing conditions that contribute to mobility impairment. Conditions such as stroke, multiple sclerosis, dementia, paralysis, cerebral palsy, fractures, and arthritis are significant factors that can hinder purposeful movement. A precise diagnosis of these underlying issues is crucial for developing an effective physical care plan diagnosis.
2. Note Prescribed Movement Limitations: Carefully review any prescribed movement restrictions. Post-surgical orders, such as bed rest, non-weight-bearing status, or the use of braces, slings, and immobilizers, must be strictly adhered to and incorporated into the care plan.
3. Evaluate Pain and Range of Motion: Assess the patient’s pain level and any limitations in joint range of motion. Pain and stiffness are significant barriers to participation in care. Effective pain management is essential to facilitate engagement in exercise and physical therapy.
4. Assess Strength and Range of Motion Quantitatively: Evaluate muscle strength and joint range of motion systematically. Deconditioning due to inactivity or illness can severely reduce the strength needed for ADLs. Assessing range of motion provides a clear picture of the patient’s current physical capabilities and limitations, aiding in setting realistic mobility goals collaboratively.
5. Exercise Judgement Before Mobilization: Apply clinical judgment before assisting with patient mobilization. Factors such as advanced age, obesity, and cognitive limitations can significantly impact a patient’s ability to move safely. Ensure adequate support (staff, physiotherapy, appropriate equipment) is available before assisting a patient to move to prevent falls and injuries. Never force movement beyond the patient’s current physical capacity.
6. Determine Need for Multidisciplinary Care: Evaluate the complexity of mobility limitations to determine if multidisciplinary support is needed. Extensive limitations often necessitate rehabilitation and specialized therapies. Nurses frequently act as coordinators for accessing these additional support services.
7. Assess Equipment Needs: Identify the need for assistive devices to optimize mobility and independence. Walkers, wheelchairs, grab bars, commodes, adaptive equipment, and prosthetics can significantly enhance patient mobility and safety.
8. Investigate Disinterest or Unwillingness to Move: Explore potential psychological barriers to mobility. Feelings of depression, lack of motivation, embarrassment, hopelessness, and knowledge deficits about mobility strategies can impede participation. Addressing these emotional and cognitive barriers is key to successful intervention.
9. Evaluate Environmental and Support Factors: Assess the patient’s home environment and the availability of caregiver support. An unsafe living situation or inadequate caregiver support can be primary reasons for impaired mobility and increase the risk of injury and falls post-discharge.
Nursing Interventions for Impaired Physical Mobility
Effective nursing interventions are crucial for improving physical mobility and patient recovery. These interventions should be integrated into a comprehensive physical care plan diagnosis.
1. Maximize Patient Independence: Encourage patients to perform as much activity as they safely can, aligned with their assessed capabilities. Promoting independence reduces reliance on others and boosts self-esteem and motivation.
2. Manage Pain Effectively: Address pain as a barrier to mobility. Administer analgesics as prescribed before exercise or ADLs. Utilize non-pharmacological pain management techniques, such as heating pads or ice packs, to alleviate muscle and joint pain and facilitate increased movement.
3. Schedule Activities with Rest Periods: Collaborate with the patient to schedule activities around their energy levels and preferences. Avoid overexertion and ensure adequate rest periods between activities to prevent fatigue.
4. Provide Adaptive Equipment: Supply and instruct patients on the use of adaptive equipment that maximizes safe movement within their capabilities. For bed-bound patients with upper body strength, a trapeze bar can aid in repositioning and movement.
5. Implement Passive Range of Motion (ROM) Exercises: For patients unable to move independently, perform passive ROM exercises several times daily. This prevents contractures, maintains joint flexibility, and reduces muscle weakness.
6. Optimize Nutrition and Hydration: Promote proper nutrition and hydration to support recovery and mobility. Adequate caloric intake, especially high-protein foods, is essential for muscle strength and energy. Hydration prevents dehydration, supports circulation, and maintains tissue and muscle health. Consider consulting a registered dietitian for personalized nutritional guidance.
7. Engage Family and Caregivers: Involve family members and caregivers in the care plan. Educate them on how to safely support the patient, use equipment, and encourage mobility. Patient support systems are crucial for motivation and long-term success.
8. Consult Multidisciplinary Team: Collaborate with physical therapists and occupational therapists. These specialists provide expert instruction on therapeutic exercises and activities to improve muscle control and fine motor skills, enhancing the effectiveness of the physical care plan diagnosis.
9. Coordinate Discharge Support: Plan for ongoing support post-discharge. Arrange for home health services or rehabilitation center placement as needed. Coordination with case managers is vital to ensure continuity of care and preserve progress made during hospitalization.
10. Set Small, Achievable Goals: Help patients set realistic, short-term goals, such as brushing hair or sitting upright. Achieving these small goals provides motivation and a sense of accomplishment, encouraging continued effort.
11. Provide Positive Reinforcement: Acknowledge and praise patient efforts, no matter how small. Positive reinforcement encourages continued participation and motivates patients to persist in their mobility improvement efforts.
Nursing Care Plans Examples for Impaired Physical Mobility
Nursing care plans are essential tools for prioritizing assessments and interventions to achieve both short-term and long-term care goals for patients with impaired physical mobility. Here are examples of nursing care plans:
Care Plan #1
Diagnostic Statement:
Impaired physical mobility related to contractures secondary to cerebral palsy as evidenced by range of motion limitations.
Expected Outcomes:
- Patient will exhibit no signs of contracture progression.
- Patient will demonstrate tolerance for performing activities of daily living (ADLs) within their capabilities.
Assessment:
1. Comprehensive Neuromotor Assessment: Assess muscle tone, strength, and ROM. Evaluate posture, gait, and primitive and deep tendon reflexes. Cerebral palsy’s impact on motor functions and posture necessitates detailed assessment to determine disease severity and the extent of immobility, guiding appropriate interventions within the physical care plan diagnosis.
2. Functional Independence Measure (FIM) Assessment: Assess the patient’s ability to perform ADLs using the FIM. FIM scores provide objective data on the patient’s self-care abilities, informing the level of assistance required and tracking progress over time.
Interventions:
1. Implement Range of Motion (ROM) Exercises: Perform passive or active ROM exercises to all extremities regularly. Proactive prevention of contractures is paramount in cerebral palsy. Regular exercise maintains joint flexibility, improves muscle strength, and enhances endurance.
2. Medication Administration: Administer prescribed medications as ordered. Medications such as benzodiazepines, dantrolene, or botulinum toxin may be used to manage muscle spasticity. Gabapentin, carbidopa-levodopa, and trihexyphenidyl may address muscle dystonia and improve overall mobility.
3. Frequent Repositioning: Turn and position the patient every 2 hours or more frequently as needed. Immobility associated with cerebral palsy, particularly in severe forms, increases pressure ulcer risk. Regular position changes promote tissue circulation and prevent pressure injury development.
4. Maintain Optimal Body Alignment: Ensure proper body alignment at all times. Correct body alignment minimizes joint strain and helps prevent the formation or worsening of contractures.
5. Collaborate with Therapy Specialists: Actively collaborate with physical and occupational therapists. These specialists possess expertise in therapeutic exercises and interventions designed to optimize mobility in patients with cerebral palsy.
Care Plan #2
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 a measurable increase in muscle strength score within a specified timeframe.
- Patient will effectively utilize adaptive techniques to improve ambulation and functional mobility.
Assessment:
1. Detailed Motor Examination: Conduct a thorough motor examination. This assessment reveals the patient’s current mobility level and the degree of assistance required. Include walking tests to establish a baseline and track progress in ambulation abilities.
2. Assistive Device Needs Assessment: Evaluate the patient’s need for assistive devices. Decreased lower extremity strength increases fall risk. Assistive devices like wheelchairs, crutches, and canes can facilitate safer ambulation and prevent falls, crucial for a robust physical care plan diagnosis.
Interventions:
1. Promote Assistive Device Utilization: Encourage the appropriate and consistent use of assistive devices such as wheelchairs, crutches, and canes. Assistive devices enhance independence, reduce pain during movement, improve self-esteem, and increase patient confidence in their mobility.
2. Facilitate Transfer Training: Implement structured transfer training programs. Proper transfer techniques are vital for maintaining optimal mobility and ensuring patient safety during movement between surfaces.
3. Ensure a Safe Environment: Create and maintain a safe environment. Measures such as raising side rails on beds, keeping beds in a low position, and ensuring frequently used items are within easy reach minimize fall risks.
4. Implement Resistance Training Exercises: Encourage or assist with resistance-training exercises using light weights or resistance bands. Resistance training effectively improves muscle strength and tone, maintains flexibility and balance, and promotes greater independence in mobility.
5. Promote Rest and Activity Balance: Encourage scheduled rest periods between activities. Adequate rest is essential for energy conservation and replenishment. Rest periods reduce muscle fatigue, joint stress, and pain, optimizing the benefits of activity within the physical care plan diagnosis.
6. Interdisciplinary Therapy Collaboration: Actively collaborate with physiotherapists and occupational therapists as needed. These specialists provide targeted interventions to improve strength, coordination, and functional mobility skills.
Care Plan #3
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 increased confidence in their strength and ability to move more effectively.
- Patient will consistently perform flexibility exercises for each major muscle-tendon group daily, holding stretches for 10 to 60 seconds to enhance joint range of motion.
Assessment:
1. Standardized Mobility Assessment: Assess mobility skills using a validated and reliable tool. Utilize tools such as the “Assessment Criteria and Care Plan for Safe Patient Handling and Movement” to evaluate bed mobility, sitting ability, transfer skills, standing, and walking. This assessment identifies specific mobility deficits requiring targeted interventions.
2. Determine Underlying Causes of Impaired Mobility: Investigate and determine the primary causes of impaired mobility, distinguishing between physical, psychological, and motivational factors. Beyond physical limitations, psychological factors like fear of falling, pain perception, depression, and coping abilities significantly influence mobility. Addressing these factors is vital for a holistic physical care plan diagnosis.
3. Monitor Activity Tolerance: Closely monitor and record the patient’s ability to tolerate physical activity. Observe and document changes in vital signs (pulse rate, blood pressure), skin color, and respiratory effort before, during, and after activity. Signs of activity intolerance, such as tachycardia, hypertension, dyspnea, cyanosis, dizziness, and fatigue, indicate the need to adjust activity levels and interventions.
Interventions:
1. Frequent Passive Range of Motion (ROM): Perform passive ROM exercises frequently for patients with limited mobility. Regular physical rehabilitation interventions are proven to be safe, effective in reducing disability, and associated with minimal adverse events.
2. Promote Self-Efficacy and Independence: Encourage self-efficacy by avoiding unnecessary assistance with ADLs. Over-assistance can worsen immobility and discourage patient independence. Empower patients to perform activities to their maximum safe capacity.
3. Implement Progressive Mobilization: Teach and implement progressive mobilization techniques, such as dangling legs at the bedside before standing and gradual ambulation. Progressive mobilization facilitates gradual muscle adaptation and increases joint range of motion safely. Gradual progression improves ligament and joint movement and reduces the risk of orthostatic hypotension.
4. Refer to Physical Therapy: Provide a referral to a physical therapist for comprehensive evaluation and individualized mobility plan development. Physical therapists conduct in-depth assessments of strength and gait, and create personalized, effective mobility plans tailored to the patient’s specific needs and goals, enhancing the overall physical care plan diagnosis.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Hallman-Cooper, J.L.& Rocha, C.F. (2022). Cerebral palsy. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK538147/
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (Eds.). (2024). NANDA-I International Nursing Diagnoses: Definitions and Classification, 2024-2026. Thieme. 10.1055/b000000928
- 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
- Lim E. J. (2018). Factors Influencing Mobility Relative to Nutritional Status among Elderly Women with Diabetes Mellitus. Iranian journal of public health, 47(6), 814–823. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077640/
