What should be assessed when planning patient activities such as walking ROM exercise or ADLs?

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Signs and Symptoms
Goals and Outcomes
Nursing Care Plans for Impaired Physical Mobility
Nursing Assessment for Impaired Physical Mobility
Nursing Interventions for Impaired Physical Mobility
Recommended Resources
References and Sources

Use this impaired physical mobility nursing care plan guide to help you create nursing interventions for this nursing problem.

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.

SEE ALSO: Nursing Care Plan (NCP) Guide and Database

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

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 action as instructed
Limited ROM
Reluctance to attempt movement

Goals and Outcomes

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:

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

Nursing Care Plans for Impaired Physical Mobility

Diseases, medical conditions, and related nursing care plans for Impaired Physical Mobility nursing diagnosis:

Nursing Assessment for Impaired Physical Mobility

Impaired physical mobility represents a complex health care problem that involves many different members of the healthcare team. Ongoing assessment is essential in order to identify potential problems that may have lead to Impaired Physical Mobility.

Nursing Assessment	Rationales
Check for functional level of mobility. Level 1: Walk, regular pace, on level indefinitely; one flight or more but more short of breath than normally Level 2: Walk one city block or 500 ft on level; climb one flight slowly without stopping Level 3: Walk no more than 50 ft on level without stopping; unable to climb one flight of stairs without stopping Level 4: Dyspnea and fatigue at rest	Understanding the particular level, guides the design of best possible management plan.
Evaluate patient’s ability to perform Activities of Daily Living efficiently and safely on a daily basis. 0 – Completely independent 1 – Requires use of equipment or device 2 – Requires help from another person for assistance, supervision, or teaching 3 – Requires help from another person and equipment or device 4 – Is dependent, does not participate in activity	Restricted movement influences the capacity to perform most activities of daily living. Safety with ambulation is a significant matter. Determines strengths or insufficiency and may give information regarding recovery. This helps out in preference of actions since different methods are used for the following: flaccid and spastic paralysis.
Assess for impediments to mobility	Identifying barriers to mobility (e.g., chronic arthritis versus stroke versus pain) guides design of an optimal treatment plan.
Assess the strength to perform ROM to all joints.	This assessment provides data on extent of any physical problems and guides therapy. Testing by a physical therapist may be needed.
Assess input and output record and nutritional pattern.	Pressure ulcers build up more rapidly in patients with a nutritional insufficiency.
Monitor nutritional needs as they relate to immobility.	Good nutrition also gives required energy for participating in an exercise or rehabilitative activities.
Evaluate the need for assistive devices.	Correct utilization of wheelchairs, canes, transfer bars, and other assistance can enhance activity and lessen the danger of falls.
Assess presence or degree of exercise-related pain and changes in joint mobility.	Examines development or recession of complications. May require to delay augmenting exercises and hold until further healing occurs.
Assess the safety of the environment.	Blockages such as throw rugs, children’s toys, and pets can further control and limit one’s ability to ambulate harmlessly.
Assess the emotional response to the disability or limitation.	Acceptance of temporary or more permanent limitations can vary broadly between individuals. Each person has his or her personal interpretation of acceptable quality of life.
Consider the need for home assistance (e.g., physical therapy, visiting nurse).	Obtaining suitable support or help for the patient can ensure a safe and proper progression of activity.
Assess the patient’s or caregiver’s understanding of immobility and its implications.	The risk for effects of immobility such as muscle weakness, skin breakdown, pneumonia, constipation, thrombophlebitis, and depression are also to be considered in patients with temporary immobility.
Note for progressing thrombophlebitis (e.g., calf pain, Homan’s sign, redness, localized swelling, a rise in temperature).	Prolonged bed rest or immobility allows clot formation in the impaired physical mobility nursing diagnosis.
Check for skin integrity for signs of redness and tissue ischemia (especially over ears, shoulders, elbows, sacrum, hips, heels, ankles, and toes).	Routine inspection of the skin (especially over bony prominences) will allow for prevention or early recognition and treatment of pressure ulcers.
Note elimination status (e.g., usual pattern, present patterns, signs of constipation).	Immobility promotes constipation, decreasing the motility of the gastrointestinal tract.

Nursing Interventions for Impaired Physical Mobility

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:

Nursing Interventions	Rationales
Assist patient for muscle exercises as able or when allowed out of bed; execute abdominal-tightening exercises and knee bends; hop on foot; stand on toes.	Adds to gaining enhanced sense of balance and strengthens compensatory body parts.
Present a safe environment: bed rails up, bed in a down position, important items close by.	These measures promote a safe, secure environment and may reduce risk for falls.
Establish measures to prevent skin breakdown and thrombophlebitis from prolonged immobility: Clean, dry, and moisturize skin as necessary. Use anti embolic stockings or sequential compression devices if appropriate. Use pressure-relieving devices as indicated (gel mattress).	This is to prevent skin breakdown, and the compression devices promote increased venous return to prevent venous stasis and possible thrombophlebitis in the legs.
Execute passive or active assistive ROM exercises to all extremities.	Exercise enhances increased venous return, prevents stiffness, and maintains muscle strength and stamina. It also avoids contracture deformation, which can build up quickly and could hinder prosthesis usage.
Provide foam or flotation mattress, water or air mattress or kinetic therapy bed, as necessary.	These equipment decrease pressure on skin or tissues that can damage circulation, potentiating risk of tissue ischemia or breakdown and decubitus formation.
Promote and facilitate early ambulation when possible. Aid with each initial change: dangling legs, sitting in chair, ambulation.	These movements keep the patient as functionally working as possible. Early mobility increases self-esteem about reacquiring independence and reduces the chance that debilitation will transpire.
Show the use of mobility devices, such as the following: trapeze, crutches, or walkers.	These devices can compensate for impaired function and enhance level of activity. The goals of using such aids are to promote safety, enhance mobility, avoid falls, and conserve energy.
Help out with transfer methods by using a fitting assistance of persons or devices when transferring patients to bed, chair, or stretcher.	Learning the proper way to transfer is necessary for maintaining optimal mobility and patient safety.
Let the patient accomplish tasks at his or her own pace. Do not hurry the patient. Encourage independent activity as able and safe.	Healthcare providers and significant others are often in a hurry and do more for patients than needed. Thereby slowing the patient’s recovery and reducing his or her confidence.
Give positive reinforcement during activity. Patients may be unwilling to move or initiate new activity because of fear of falling.	This is to boost the patient’s chances of recovering and to increase his or her self-esteem.
Provide the patient of rest periods in between activities. Consider energy-saving techniques.	Rest periods are essential to conserve energy. The patient must learn and accept his her limitations.
Give medications as appropriate.	Antispasmodic medications may reduce muscle spasms or spasticity that interferes with mobility; analgesics may reduce pain that impedes movement.
Help patient in accepting limitations.	Let the patient understand and accept his or her limitations and abilities. Assistance, on the other hand, needs to be balanced to prevent the patient from being unnecessarily dependent.
Encourage resistance-training exercises using light weights when suitable.	Strength training and other forms of exercise are believed to be effective in maintaining independent living status and reduced the risk of falling in older adults.
Help patient develop sitting balance and standing balance.	This helps out in retraining neuronal pathways, promoting proprioception and motor response.
Turn and position the patient every 2 hours or as needed.	Position changes optimize circulation to all tissues and relieve pressure.
Keep limbs in functional alignment with one or more of the following: pillows, sandbags, wedges, or prefabricated splints.	This avoids footdrop and too much plantar flexion or tightness. Maintain feet in dorsiflexed position.
Encourage coughing and deep-breathing exercises. use suction as necessary. Make use of incentive spirometer.	Coughing and breathing prevent buildup of secretions. Incentive spirometry increases lung expansion.
Present suggestions for nutritional intake for adequate energy resources and metabolic requirements.	Correct nutrition is necessary to keep sufficient energy level. The patient will need adequate, properly balanced intake of carbohydrates, fats, proteins, vitamins, and minerals to provide energy resources.
Encourage a diet high in fiber and liquid intake of 2000 to 3000 ml per day unless contraindicated.	Liquids maximize hydration status and avoid hardening of stool. It also decreases risk of skin irritation or breakdown.
Set up a bowel program (e.g., adequate fluid, foods high in bulk, physical activity, stool softeners, laxatives) as needed. Note bowel activity levels.	Sedentary lifestyle contributes to constipation. A variety of interventions will promote normal elimination.
Offer diversional activities. Observe emotional or behavioral reactions to immobility.	Forced immobility may heighten restlessness and irritability. Diversional activity helps in refocusing attention and promotes coping with limitations.
Explain to the patient the need to call for help, such as call bell and special sensitive call light.	In impaired physical mobility, this intervention allows patient to have a sense of control and lowers fear of being left alone.
Set goals with patient or Significant Other for cooperation in activities or exercise and position changes.	This enhances sense of anticipation of progress or improvement and gives some sense of control or independence.
Reinforce principles of progressive exercise, emphasizing that joints are to be exercised to the point of pain, not beyond.	“No pain, no gain” is not always true! Pain occurs as a result of joint or muscle injury. Further damage is expected if inappropriate movement is continued.
Teach patient or family in maintaining home atmosphere hazard-free and safe.	A safe environment will help prevent injury related to falls. Home modification can help the patient maintain a desired level of functional independence and reduce fatigue with activity.
Give explanation about progressive activity to patient.	Providing small, attainable goals helps increase self-confidence and reduces frustration.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.

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]