Impaired Physical Mobility

Impaired Physical Mobility Nursing Diagnosis and Care Plans

Impaired physical mobility is a common nursing diagnosis that is often multifactorial. It can be a temporary, permanent or worsening problem and has the potential to create more significant issues such as skin breakdown, infections, falls, and social isolation.

Advancing age is the most common risk factor of impaired physical mobility, increasing morbidity and mortality risk for this population. Enhancing mobility also important as it can also improve the quality of life in addition to health outcomes of patients.

Nurses must recognize risk factors of impaired physical mobility and work to prevent or improve poor mobility as much as possible. This requires a multidisciplinary team approach utilizing physical and occupational therapists, prosthetic services, rehabilitation centers, and other ongoing support to maintain physical progress.

Causes (Related to)

The following are common causes of impaired physical mobility:

• Sedentary lifestyle
• Deconditioning
• Decreased endurance
• Limited range of motion
• Recent surgical intervention
• Decreased muscle strength or control
• Joint stiffness
• Chronic pain and/or acute pain
• Depression
• Contractures
• Neuromuscular impairment
• Cognitive impairment
• Developmental delay
• Malnutrition
• Obesity
• Lack of access or support (social or physical)
• Prescribed bed rest, immobilizers, or movement restrictions
• Physical or chemical (sedatives) restraints
• Reluctance or disinterest in movement

Signs and Symptoms (As evidenced by)

The following are common signs and symptoms of impaired physical mobility. They are categorized into subjective and objective data based on patient reports and assessment by the nurse.

Subjective: (Patient reports)

• Expression of pain and discomfort with movement
• Refusal to move

Objective: (Nurse assesses)

• Limited range of motion
• Uncoordinated movements
• Poor balance
• Inability to turn in bed, transfer, or ambulate
• Postural instability
• Gait disturbances
• Reliance on assistive devices
• Contractures
• Decreased muscle strength
• Inability to follow or complete instructions

Expected Outcomes

The following are common nursing care planning goals and expected outcomes for impaired physical mobility:

• Patient will participate in their activities of daily life (ADLs) and prescribed therapies.
• Patient will display improvement in physical mobility by transferring from bed to wheelchair independently (if this is a realistic goal).
• Patient will remain free of contractures and decubitus ulcers from impaired mobility.
• Patient will demonstrate exercises to improve physical mobility.

Nursing Assessment

The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to impaired physical mobility.

1. Assess for conditions that contribute to impaired mobility.
Stroke, multiple sclerosis, dementia, paralysis, cerebral palsy, fractures and arthritis are only a few disorders that can prevent purposeful movement.

2. Take note of prescribed movement limitations.
Following surgery, patients may be prescribed bed rest to prevent injury. Other orders, such as “non-weight bearing” status or the use of braces, slings, and immobilizers must be considered.

3. Assess for pain and limited range of motion.
Pain and stiffness will prevent the patient from participating fully in their care. Patients should receive adequate pain control when engaging in exercise and physical therapy.

4. Assess strength and range of motion.
Deconditioned patients, either from lack of exercise or illness, may not possess the strength necessary to carry out ADLs or movement. Assessing the patient’s range of motion prior to movement will show the nurse what the patient is or is not capable of. This will also help the nurse co-create realistic movement goals with the patient.

5. Use nursing judgement before implementing mobility.
Patients who are older in age, obese, or cognitively limited may not be able to transfer or ambulate without proper assistance. The nurse must assess abilities and have adequate support available (other staff, physiotherapy, equipment) before assisting a patient to move as this could place the patient at risk for falls or injury. Never force a patient to move beyond what they are physically capable of.

6. Evaluate the need for multidisciplinary care.
Extensive mobility limitations may require rehabilitation and specialized therapies. The nurse is often the coordinator of additional support.

7. Assess equipment needs.
Additional support from walkers, wheelchairs, grab bars, commodes, adaptive equipment, prosthetics, and more can promote independence and optimize mobility.

8. Note feelings of disinterest or unwillingness.
The nurse may need to explore feelings of depression or lack of motivation before the patient will participate in their mobility. Embarrassment, hopelessness, and knowledge deficits are potential barriers that can be overcome.

9. Assess for a lack of appropriate environment or support.
Nurses may need to assess the patient’s home environment and the ability of caregivers. An unsafe living situation or lack of competent caregivers may be the reason for their impaired mobility and will further increase debility and place the patient at risk for injury or falls.

Nursing Interventions

Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for a patient with impaired physical mobility.

1. Encourage the patient to do as much as they can.
Once the nurse has assessed the degree of immobility, they should encourage independence aligned with the patient’s capabilities. This decreases dependence on others and increases the patient’s self-esteem.

2. Medicate for pain.
If pain and discomfort are a barrier, the nurse can provide analgesics prior to performing exercises or planned ADLs. Even simple interventions such as a heating pad or ice packs may alleviate muscle and joint pain and increase movement.

3. Schedule activities around rest periods.
Allow the patient to determine the best times for exercise or movement related to their energy levels. Do not overwhelm or exhaust and allow periods of rest between activities.

4. Provide adaptive equipment.
Provide equipment that allows for maximum movement related to the patient’s capabilities. For example, if bed-bound but able to use upper extremities, a trapeze bar can help the patient pull themselves up.

5. Provide passive ROM.
If the patient is unable to perform exercises independently, the nurse should provide passive range of motion (ROM) several times per day to prevent contractures and muscle weakness.

6. Promote proper nutrition and hydration.
Malnourishment prevents recovery and contributes to a higher risk of functional disability. Adequate caloric intake is required for energy with high-protein foods supporting muscle mass and strength. Hydration will prevent dehydration, promote circulation, and keep skin, tissues, and muscles hydrated. Depending on the patient’s nutrition status, it may also be useful to consult with a registered dietician.

7. Incorporate family and caregivers.
Patients who feel supported by their families and spouses will feel committed to increasing their mobility. Families may need education on how to best support their loved ones, how to keep them safe, and how to use equipment.

8. Consult with the multidisciplinary team.
Impaired mobility may require the support of a physiotherapist or occupational therapist to instruct on exercises and perform activities that stimulate muscle control and fine motor movement.

9. Coordinate ongoing support at discharge.
Patients may require ongoing support either at home through home health services or at a rehab center. Coordinating with the case manager to ensure the patient receives the appropriate care at discharge is vital to preserving their progress.

10. Set goals.
Patients may feel overwhelmed or hopeless if their barriers seem impossible. Helping them choose small goals, such as brushing their hair or sitting up in bed, gives them the motivation to keep going.

11. Provide positive reinforcement.
A patient who is making an effort, no matter how small, will be more inclined to continue when their accomplishments are noticed and praised.

Nursing Care Plans

Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for impaired physical mobility.

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 experience no contractures.
• Patient will tolerate performing activities of daily living (ADLs).

Assessment:

1. Assess for muscle tone, strength, and ROM. Check for posture, gait, and primitive and deep tendon reflexes.
Cerebral palsy is a lifetime disorder affecting motor functions and posture. The assessment of these aspects would reveal the disease severity and degree of immobility requiring interventions.

2. Assess the patient’s ability to perform ADLs using the Functional Independence Measures (FIM).
FIM assesses the ability of the patient to do self-care independently. The result will provide the nurse with information on the extent of assistance to the patient.

Interventions:

1. Perform passive or active ROM exercises to all extremities.
Prevention is key for contractures. Exercise prevents muscle stiffness and improves muscle strength and endurance. Exercise all joints to prevent contractures.

2. Administer medications as ordered.
Muscle spasticity could be relieved through benzodiazepine, dantrolene, or botulinum toxin as ordered. Gabapentin, carbidopa-levodopa, and trihexyphenidyl are some medications given to address muscle dystonia and improve mobility.

3. Turn and position the patient every 2 hours or as needed.
Patients with cerebral palsy, especially the severe form, experience bed immobility, increasing their risk of developing pressure ulcers. Changes in position improve tissue circulation and prevent pressure.

4. Maintain good body alignment.
Maintaining proper body alignment decreases joint strains and prevents contractures.

5. Collaborate with a physical or occupational therapist.
Physical or occupational therapists underwent training on rendering therapeutic exercises to optimize mobility.

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 manifest an increased muscle strength score.
• Patient will demonstrate the use of adaptive techniques to improve ambulation.

Assessment:

1. Perform motor examination.
Motor examination findings will reveal the level of mobility and assistance the patient needs. This may also include a walking test to see what the patient’s current ability is. This can provide a baseline for tracking progress.

2. Assess the need for assistive devices.
Decreased muscle strength in the lower extremities increases the patient’s fall risk. Assistive devices such as wheelchairs, crutches, and canes can promote ambulation and prevent falls.

Interventions:

1. Encourage the appropriate use of assistive devices such as wheelchairs, crutches, and canes.
Assistive devices promote independence, decrease pain, boost self-esteem, and increase confidence.

2. Facilitate transfer training.
Maintains optimal mobility and patient safety.

3. Provide a safe environment.
Raising side rails, placing the bed in a lower position, and placing necessary items nearby are measures that can help to prevent falls.

4. Encourage or assist in resistance-training exercises using light weights.
Resistance training improves muscle strength and tone, maintains flexibility and balance, and promotes independence.

5. Encourage rest between activities.
Rest periods are necessary to conserve and replenish energy. Rest also reduces muscle fatigue, joint stress, and muscle or joint pain.

6. Collaborate with physiotherapist and occupational therapist.
Encourage collaboration with a physiotherapist and occupational therapist as needed.

References

1. Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
2. Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams and Wilkins.
3. Doenges, M.E., Moorhouse, M.F., and Murr, A.C. (2019). Nursing care plans Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
4. Gulanick, M. and Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
5. Hallman-Cooper, J.L.& Rocha, C.F. (2022). Cerebral palsy. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK538147/
6. Milaneschi, Y., Tanaka, T., and 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
7. 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/

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.

Related Factors

• Activity Intolerance
• Obesity
• Cognitive impairment
• Depression
• Decreased muscle mass, reduced muscle control
• Deconditioning, prolonged bedrest
• Medication (sedatives, paralytics)
• Pain
• 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)

Expected Outcome

• 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.

Nursing Assessment

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.

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

Specific equipment such as mechanical lifts, canes, wheelchairs, and other assistive devices can increase mobility.

Obstacles in the room can impede activities, especially transferring and ambulating.

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.

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.

Nursing Interventions for Impaired Physical Mobility

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.

Even passive range of motion increases circulation. Range of motion exercises will help the patient increase muscle strength and prevent contractures.

Assistive devices increase mobility and promote safety.

Early progressive ambulation can decrease the risk of complications.

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.

Considering the unique condition and abilities of each patient allows for maximum mobility of that specific patient.

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.

Positive reinforcement helps with motivation and might reduce the fear of falling or pain.

Breaks are essential to allow time to recover and conserve energy. The patient might be more successful in completing activities with rest periods.

Breathing exercises and stretching helps to conserve energy and recharge.

Assisting only in necessary steps prevents the patient from becoming dependent. The goal is to further independence and maximize the patient’s capabilities.

Heel off-loading devices
Sequential compression devices
Anti embolic stockings
Air mattresses
Foam wedge

These measures and devices reduce skin breakdown and increase circulation.

Frequent position changes help reduce burdening pressure points for an extended period and reduce break down.

A dietitian can personalize the nutritional needs of a patient depending on their condition and the type of illness.

Lack of exercise, bed rest, and pain medication often lead to constipation. Stool softeners and laxatives help alleviate constipation.

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.

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.

A safe home environment reduces the risk of falls and injury.

Besides family support, the patient will benefit from professional help in the home.