Impaired physical mobility can affect nearly every patient in the hospital. Illness, age, and sudden change in mental or physical well being are only a few reasons for mobility alterations. Unfortunately, the ability to move and ambulate affects almost every body system. That is why mobilizing patients early and progressively is so essential.
Preserving muscle strength and promoting independence is the goal. Immobility may lead to other problems, such as skin beak down, muscle wasting, respiratory infections, and other complications that can arise from lack of movement.
- Activity Intolerance
- Cognitive impairment
- Decreased muscle mass, reduced muscle control
- Deconditioning, prolonged bedrest
- Medication (sedatives, paralytics)
- Prescribed restriction, Prescribed immobilizers
Subjective Data: patient’s feelings, perceptions, and concerns. (Symptoms)
- Expresses difficulty moving
- Verbalizes pain when mobilizing
- Expresses no interest in mobilizing
Objective Data: assessment, diagnostic tests, and lab values. (Signs)
- Limited or no ability to participate in sessions with physical therapy and occupational therapy
- Noted contractures of limbs
- Dependence on mechanical lift devices to transfer and ambulate
- Possible skin breakdown
- Possible malnutrition (underweight)
- Limited range of motion (ROM)
- The patient will perform activities with the least amount of assistance, considering their disease and condition.
- The patient will use learned methods to maximize independence
- The patient will exercise daily within the limits of illness and disease.
- The patient will verbalize the increased feeling of strength
- The patient will verbalize that pain is controlled during exercises.
|Assess for the origin of limitations of physical movement. |
The cause of impairment can be physical, psychological, or motivational. The reason why the patient is physically impaired builds the foundation of the plan of care. For example, suppose one patient’s reason for limited activity is mental problems, whereas another patient’s reason is obesity or a fractured limb. In that case, the treatment plan will look very different between the two.
|Assess whether the patient can perform range of motion. |
Physical and occupational therapy may be consulted. This assessment provides a baseline and guides treatment.
|Assess the strength of muscle groups, ability of flexion of arms and legs. |
A thorough assessment of the patient’s abilities allows the nurse to adjust the use of assistive devices and keep the patient and the nurse safe. These practices prevent injuries to the patient and to staff assisting the patient.
|Evaluate how much assistance is needed to perform ADLs. |
Transfers from lying down to sitting, from sitting to standing.
The patient might need special equipment or utensils to increase independence when performing ADLs.
|Assess whether the patient needs special equipment. |
Specific equipment such as mechanical lifts, canes, wheelchairs, and other assistive devices can increase mobility.
|Ensure the safety of the environment. |
Obstacles in the room can impede activities, especially transferring and ambulating.
|Monitor factors that might contribute to impaired physicality, such as malnutrition. |
Factors that worsen the patient’s condition need to be treated simultaneously. The patient’s nutritional status might affect overall strength. Weakness from poor nutrition might lead to less effort to engage in activities. Inadequate nutrition also puts the patient at risk of developing skin breakdown more quickly.
|Consult physical and occupational therapy. |
Working with PT and OT ensures the patient engaging in exercises regularly. Daily exercise helps the patient maintain and also gain muscle strength over time.
|Assess for skin break down. |
Frequent skin and body audits help identify possible areas prone to skin break down early. Preventative measures such as the use of heel off-loading devices or foam wedges to turn the patient might prevent skin breakdown development.
Nursing Interventions for Impaired Physical Mobility
|Provide pain medication before mobilizing. |
Pain management is an integral part of the treatment plan. Patient performance and ability to move might be increased with appropriately timed pain medication administration.
|Perform active and passive range of motion exercises daily. |
Even passive range of motion increases circulation. Range of motion exercises will help the patient increase muscle strength and prevent contractures.
|Use assistive devices such as a walker, cane, or gait belt. |
Assistive devices increase mobility and promote safety.
|Encourage early ambulation. |
Early progressive ambulation can decrease the risk of complications.
|Frequently re-evaluate the appropriateness of the correct assistive device. |
Patient’s conditions and illnesses change over time. With that, their activity level and mobility changes. This shift might require different use or types of mobility aids. For example, a patient who could mobilize with the help of a wheelchair might need more assistance, such as a mechanical lift. Frequent evaluation promotes patient and staff safety.
|Assist with practicing transfers and using techniques that are individualized for the patient. |
Considering the unique condition and abilities of each patient allows for maximum mobility of that specific patient.
|Monitor vital signs during exercises closely. |
Some patients are severely deconditioned. Engaging in activities might lead to higher oxygen requirements, orthostatic hypotension (drop in blood pressure), and tachycardia (elevated heart rate). Use progressive measures, such as sitting on the side of the bed, dangling legs, or marching in place so that the body can adjust to increased activity levels.
|Praise often, and provide feedback. |
Positive reinforcement helps with motivation and might reduce the fear of falling or pain.
|Allow for rest periods between exercises. |
Breaks are essential to allow time to recover and conserve energy. The patient might be more successful in completing activities with rest periods.
|Encourage to use relaxation techniques during rest periods. |
Breathing exercises and stretching helps to conserve energy and recharge.
|Promote independence during exercises and activities. |
Assisting only in necessary steps prevents the patient from becoming dependent. The goal is to further independence and maximize the patient’s capabilities.
|Use devices and measures to prevent skin break down. |
Heel off-loading devices
Sequential compression devices
Anti embolic stockings
These measures and devices reduce skin breakdown and increase circulation.
|Reposition the patient at least every two hours and as needed. |
Frequent position changes help reduce burdening pressure points for an extended period and reduce break down.
|Consult dietary to adjust nutritional needs. |
A dietitian can personalize the nutritional needs of a patient depending on their condition and the type of illness.
|Provide bowel stimulation. |
Lack of exercise, bed rest, and pain medication often lead to constipation. Stool softeners and laxatives help alleviate constipation.
|Include the patient’s family into the teaching plan. |
Family and caregivers need to know about the proper usage of equipment at home and the appropriate handling of the patient. Clear instructions keep the caregivers safe as well as the patient.
|Evaluate the home environment before discharge. |
The patient’s condition might require some adjustments to the home, such as installing modified accessibility or adding equipment needed to move and transfer the patient.
|Educate the family about implementing safety measures in the home. |
A safe home environment reduces the risk of falls and injury.
|Arrange for continued physical therapy in the home. |
Besides family support, the patient will benefit from professional help in the home.
|Arrange for home health care. |
Professional guidance can be beneficial for further family and patient education in the home.
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