Impaired Physical Mobility Nursing Diagnosis and Nursing Care Plan

Impaired Physical Mobility

This article is about impaired physical mobility and impaired physical mobility nursing diagnosis, and nursing care plan.

What does physical mobility mean?

At its most basic level, mobility is any effective means implemented to warm up the musculature of the human body to enable smooth movement through all ranges of motion for each movable joint.

What is impaired physical mobility?

Impaired physical mobility is a nursing diagnosis approved by the North American Nursing Diagnosis Association, defined as the state in which an individual has a limitation in the independent, purposeful physical movement of the body or of one or more extremities.

What are the defining characteristics of impaired physical mobility?

Decreased muscle strength
Activity intolerance
Atiffness
Limited ROM
Changes in coordination
Assistance (people or devices)
Perceptual-cognitive, musculoskeletal, neuromuscular impairment
Pain

A modification in movement or mobility can either be a transient, recurring, or more permanent dilemma. And when it occurs, it becomes a complex health care problem that involves many different members of the healthcare team. In fact, some degree of immobility is very common in most conditions such as stroke, leg fracture, multiple sclerosis, trauma, and morbid obesity. The incidence of the disease and disability continues to expand with the longer life expectancy for most Americans. In most cases, even if patients are discharged from the hospital earlier than expected, they are transferred to rehabilitation facilities or sent home for physical therapy.

Aging is also considered one of the factors concerning the alteration in mobility. A decrease in muscle function, loss of muscle mass, reduction in muscle strength, gait changes affecting balance, and stiffer and limited mobile joints can significantly jeopardize the mobility of aged patients. Mobility is needed especially if an individual is to maintain independent living. Limited movement affects the performance of most ADLs. The human body is designed for motion; hence, any restriction of movement will take its toll on every major anatomic system thus resulting in impaired physical mobility.

Signs and Symptoms of Impaired Physical Mobility

What are the complications of impaired physical mobility?

Impaired Physical Mobility is characterized by the following signs and symptoms that you can use in the assessment part of your nursing care plan:

• Inability to move purposefully within the physical environment, including bed mobility, transfers, and ambulation
• Inability to perform an action as instructed
• Limited ROM
• Reluctance to attempt movement

Goals and Outcomes of Impaired Physical Mobility

What are the goals and outcomes of impaired physical mobility?

The goals of interventions are to avoid the hazards of immobility, prevent dependent disabilities, and assist the patient in restoring, preserving, or maintaining as much mobility and functional independence as possible, as evidenced by the following indicators:

• The patient performs physical activity independently or within limits of the disease.
• The patient demonstrates measures to increase mobility
• The patient demonstrates the use of adaptive devices to increase mobility
• The Patient evaluates pain and quality of management
• The patient uses safety measures to minimize the potential for injury
• The patient is free from complications of immobility, as evidenced by intact skin, absence of thrombophlebitis, normal bowel pattern, and clear breath sounds.

Nursing Diagnosis for Impaired Physical Mobility

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 a range of motion. 

Physical and occupational therapy may be consulted. This assessment provides a baseline and guides treatment.

Assess the strength of muscle groups, the 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.

Bed mobility
Sitting Standing
Ambulating
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 engages in exercises regularly. Daily exercise helps the patient maintain and also gain muscle strength over time.

Assess for skin breakdown. 

Frequent skin and body audits help identify possible areas prone to skin breakdown 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 Care Plan for Impaired Physical Mobility

What nursing interventions can help prevent immobility?

The intervention of this condition includes prevention of dependent disabilities, restoring mobility when possible, as well as maintaining or preserving the existing mobility. Special patient care includes changing position, exercises, nutrition, and giving a safe environment, etc. We look in detail at the nursing care plan 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.  Patients’ 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 breakdown.  Heel off-loading devices Sequential compression devices Anti embolic stockings Air mattresses Foam wedge 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 in 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.

References and Sources

Additional references and recommended reading material for Impaired Physical Mobility nursing diagnosis:

• Carpenito-Moyet, L. J. (2006). Handbook of nursing diagnosis. Lippincott Williams & Wilkins. [Link]
• Pedrão, T. G. G., Brunori, E. H. F. R., Santos, E. D. S., Bezerra, A., & Simonetti, S. H. (2018). NURSING DIAGNOSES AND INTERVENTIONS FOR CARDIOLOGICAL PATIENTS IN PALLIATIVE CARE. Journal of Nursing UFPE/Revista de Enfermagem UFPE, 12(11). [Link]