IMPAIRED PHYSICAL MOBILITY Nursing Care Plan

Impaired Physical Mobility
Limitation in independent, purposeful physical movement of the
body or of one or more extremities

Defining Characteristics
Major (Must Be Present; 80% to 100%)
Compromised ability to move purposefully within the environment
(e.g., bed mobility, transfers, ambulation)
Range-of-motion (ROM) limitations
Minor (May Be Present; 50% to 80%)
Imposed restriction of movement
Reluctance to move
Related Factors
Pathophysiologic
Related to decreased muscle strength* and endurance* secondary to:
Neuromuscular impairment
Autoimmune alterations
(e.g., multiple sclerosis,
arthritis)
Nervous system diseases
(e.g., Parkinson’s disease,
myasthenia gravis)
Respiratory conditions
(e.g., chronic obstructive
pulmonary disease [COPD])
Muscular dystrophy
Partial paralysis (spinal cord
injury, stroke)
Central nervous system (CNS)
tumor
Trauma
Cancer
Increased intracranial pressure
Sensory deficits
Musculoskeletal impairment
Fractures
Connective tissue disease
(systemic lupus
erythematosus)
Cardiac conditions
Related to joint stiffness* or contraction* secondary to:
Inflammatory joint disease
Post–joint-replacement or spinal surgery
Degenerative joint disease
Degenerative disc disease

Treatment Related
Related to external devices (casts or splints, braces, intravenous [IV]
tubing)
Related to insufficient strength and endurance for ambulation with
(specify):
Prosthesis
Crutches
Walker
Situational (Personal, Environmental)
Related to:
Fatigue
Depressive mood state*
Decreased motivation
Sedentary lifestyle*
Pain*
Deconditioning*
Obesity
Dyspnea
Cognitive impairment*
Maturational
Children
Related to abnormal gait secondary to:
Congenital skeletal deficiencies
Congenital hip dysplasia
Legg–Calvé–Perthes disease
Osteomyelitis
Older Adult
Related to decreased motor agility
Related to decreased muscle mass and strength

Author's Notes
leg(s) or limited muscle strength. Nurses should not use this diagnosis
to describe complete immobility; in this case, Risk for Disuse Syndrome
is more applicable. Limitation of physical movement can also be the
etiology of other nursing diagnoses, such as Self-Care Deficit and Risk
for Injury. Nursing interventions for Impaired Physical Mobility focus on
strengthening and restoring function and preventing deterioration. If the
client can exercise but does not, refer to Sedentary Lifestyle. If the client
has no limitations in movement but is deconditioned and has reduced
endurance, refer to Activity Intolerance.

Goal
The client will report increased strength and endurance of limbs,
as evidenced by the following indicators:
• Demonstrate the use of adaptive devices to increase mobility.
• Use safety measures to minimize potential for injury.
• Demonstrate measures to increase mobility.
• Evaluate pain and quality of management

Interventions
Assess Causative Factors
Refer to Related Factors.
Consult With Physical Therapy for Evaluation and Development
of a Mobility Plan
Promote Optimal Mobility and Movement
Promote Motivation and Adherence (Addams & Clough, 1998)
• Explain the problem and the objective of each exercise.
• Establish short-term goals.
• Ensure that initial exercises are easy and require minimal
strength and coordination.
• Progress only if the client is successful at the present exercise.
• Provide written instructions for prescribed exercises after
demonstrating and observing return demonstration.
• Document and discuss improvement specifically (e.g., can lift
leg 2 inches higher).
• Evaluate level of motivation and depression. Refer to a specialist
as needed.
Increase Limb Mobility and Determine Type of ROM Appropriate
for the Client (Passive, Active Assistive, Active, Active Resistive)
• Perform passive or active assistive ROM exercises (frequency
determined by client’s condition):
• Teach the client to perform active ROM exercises on unaffected
limbs at least four times a day, if possible.
• Perform passive ROM on affected limbs. Do the exercises
slowly to allow the muscles time to relax, and support the
extremity above and below the joint to prevent strain on
joints and tissues.
• For passive ROM, the supine position is most effective.
The client who performs ROM himself or herself can use a
supine or sitting position.
• Do ROM daily with bed bath three or four times daily if
there are specific problem areas. Try to incorporate into
activities of daily living.
• Support extremity with pillows to prevent or reduce swelling.
• Medicate for pain as needed, especially before activity**
(see Impaired Comfort).
• Apply heat or cold to reduce pain, inflammation, and hematoma
(after 48 hours).**
• Apply cold to reduce swelling after injury (usually first
48 hours).**
• Encourage the client to perform exercise regimens for specific
joints as prescribed by physician, nurse practitioner, or physical
therapist (e.g., isometric, resistive).
Position in Alignment to Prevent Complications
• Use a footboard.
• Avoid prolonged sitting or lying in the same position.
• Change the position of the shoulder joints every 2 to 4 hours.
• Use a small pillow or no pillow when in Fowler’s position.
• Support the hand and wrist in natural alignment.
• If the client is supine or prone, place a rolled towel or small
pillow under the lumbar curvature or under the end of the
rib cage.
• Place a trochanter roll alongside the hips and upper thighs.
• If the client is in the lateral position, place pillow(s) to support
the leg from groin to foot, and use a pillow to flex the shoulder
and elbow slightly. If needed, support the lower foot in dorsal
flexion with a towel roll or special boot.
• For upper extremities:
• Arms abducted from the body with pillows
• Elbows in slight flexion
• Wrist in a neutral position, with fingers slightly flexed and
thumb abducted and slightly flexed
• Position of shoulder joints changed during the day
(e.g., adduction, abduction, range of circular motion)
Maintain Good Body Alignment When Mechanical Devices Are
Used
Traction Devices
• Assess for correct position of traction and alignment of bones.
• Observe for correct amount and position of weights.
• Allow weights to hang freely, with no blankets or sheets on
ropes.
• Assess for changes in circulation; check pulse quality, skin
temperature, color of extremities, and capillary refill (should be
less than 3 seconds).
• Assess for feelings of numbness, tingling, and/or pain.
• Assess for changes in mobility (ability to flex/extend unaffected
joints).
• Assess for signs of skin irritation (redness, ulceration, blanching).
• Assess skeletal traction pin sites for loosening, inflammation,
ulceration, and drainage; clean pin insertion sites (procedure
may vary with type of pin and physician’s order).
• Encourage isometrics** and prescribed exercise program.
Casts
• Assess for proper fit of cast (should not be too loose or too
tight).
• Assess circulation to the encased area every 2 hours (color
and temperature of skin, pulse quality, capillary refill less than
2 seconds).
• Assess for changes in sensation of extremities every 2 hours
(numbness, tingling, pain).
• Assess motion of uninvolved joints (ability to flex and extend).
• Assess for skin irritation (redness, ulceration, or complaints of
pain under the cast).
• Keep the cast clean and dry; do not allow sharp objects to be
inserted under the cast; petal rough edges with adhesive tape;
place soft cotton under edges that seem to be causing pressure
points.
• Allow the cast to air dry while resting on pillows to prevent
dents.
• Observe the cast for areas of softening or indentation.
• Exercise joints above and below the cast if allowed (e.g., wiggle
fingers and toes every 2 hours).
• Assist with prescribed exercise regimens and isometrics of
muscles enclosed in casts.*
• Keep extremities elevated after cast application to reduce
swelling.
Braces
• Assess for correct positioning of braces.
• Observe for signs of skin irritation (redness, ulceration,
blanching, itching, pain).
• Assist with exercises as prescribed for specific joints.
• Have the client demonstrate correct application of the brace.
Prosthetic Devices
• Observe for signs of skin irritation of the stump before
applying
prosthetic device (stump should be clean and dry;
Ace bandage should be rewrapped and securely in place).
• Have the client demonstrate correct application of the prosthesis.
• Assess for gait alterations or improper walking technique.
• Proceed with health teaching, if indicated.
Ace Bandages
• Assess for correct position of Ace bandage.
• Apply Ace bandage with even pressure, wrapping from distal to
proximal portions and making sure that the bandage is not too
tight or too loose.
• Observe for bunching of the bandage.
• Observe for signs of irritation of skin (redness, ulceration,
excessive tightness).
• Rewrap Ace bandage twice daily or as needed, unless contraindicated
(e.g., if the bandage is a postoperative compression
dressing, it should be left in place).
• When wrapping lower extremity, leave the heel exposed, using
figure-8 technique.
Slings
• Assess for correct application; sling should be loose around the
neck and should support the elbow and wrist at the level of the
heart.
• Remove slings for ROM.**
• Note: Some mechanical devices may be removed for exercises,
depending on the nature of the injury or type and purpose of
the device. Consult with the physician to ascertain when the
client may remove the device.
Provide Progressive Mobilization
• Assist the client slowly to a sitting position.
• Allow the client to dangle legs over the side of the bed for a
few minutes before standing.
• Limit time to 15 minutes, three times a day the first few times
out of bed.
• Increase time out of bed, as tolerated, by 15-minute increments.
• Progress to ambulation with or without assistive devices.
• If the client cannot walk, assist him or her out of bed to a
wheelchair or chair.
• Encourage ambulation for short, frequent walks (at least three
times daily), with assistance if unsteady.
• Increase lengths of walks progressively each day.
Encourage Use of Affected Arm When Possible
• Encourage the client to use affected arm for self-care activities
(e.g., feeding self, dressing, brushing hair).
• For post-CVA neglect of upper limb, see Unilateral Neglect.
• Instruct the client to use the unaffected arm to exercise the
affected arm.
• Use appropriate adaptive equipment to enhance the use of arms.
• Universal cuff for feeding in clients with poor control in
both arms and hands
• Large-handled or padded silverware to assist clients with
poor fine-motor skills
• Dishware with high edges to prevent food from slipping
• Suction-cup aids to prevent sliding of plate
• Use a warm bath to alleviate early-morning stiffness and improve
mobility.
• Encourage the client to practice handwriting skills, if able.
• Allow time to practice using affected limb.
• Determine if other factors are interfering with mobility.
• If the pain is interfering with mobility, refer to Acute or
Chronic Pain.
• If depression is interfering with mobility, refer to Ineffective
Individual Coping.
• If fatigue is interfering with mobility, refer to Fatigue.
Teach Methods of Transfer From Bed to Chair or Commode and to
Standing Position
• Refer to Impaired Transfer Ability for interventions.
Teach the Client How to Ambulate With Adaptive Equipment (e.g.,
Crutches, Walkers, Canes)
• Instruct client in weight-bearing status.
• Observe and teach the use of the following equipment.
Crutches
• Do not exert pressure on axilla; use hand strength.
• Type of gait varies with client’s diagnosis.
• Measure crutches 2 to 3 inches below axilla and tips 6 inches
away from feet.
Walkers
• Use arm strength to support weakness in lower limbs.
• Gait varies with the client’s problems.
• Adjust to ensure a slight bend at the elbow when client is
standing with hands on the walker.
Prostheses (Teach About the Following)
• Stump wrapping before application of the prosthesis
• Application of the prosthesis
• Principles of stump care
• Importance of cleaning the stump, keeping it dry, and applying
the prosthesis only when the stump is dry
• Safety precautions
• Protect areas of decreased sensation from extremes of heat
and cold.
• Practice falling and how to recover from falls while transferring
or ambulating.
• For decreased perception of lower extremity (post-CVA
“neglect”), instruct the client to check where limb is placed
when changing positions or going through doorways; also
check to make sure both shoelaces are tied, that affected leg
is dressed with trousers, and that pants are not dragging.
• Instruct people who are confined to a wheelchair to shift
position and lift up buttocks every 15 minutes to relieve
pressure; maneuver curbs, ramps, inclines, and around
obstacles; and lock wheelchairs before transferring.
• Practice proper positioning, ROM (active or passive), and
prescribed exercises.
• Practice climbing stairs if client’s condition permits.
• Refer to physical therapy for continued structured physical
therapy.
Initiate Health Teaching and Referrals, as Indicated
• Home health nurse and physical therapist.

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