Physical Mobility, Impaired - Immobility
Linda Arsenault, RN, MSN, CNRN
Marilyn Magafas, RN,C, BSN,
Meg Gulanick, PhD, RN
NANDA: A state in which the individual experiences a limitation
of ability for independent physical movement
Alteration in mobility may be a temporary or more permanent
problem. Most disease and rehabilitative states involve some degree of
immobility, as seen in strokes, leg fracture, trauma, morbid obesity, multiple
sclerosis, and others. With the longer life expectancy for most Americans, the
incidence of disease and disability continues to grow. And with shorter
hospital stays, patients are being transferred to rehabilitation facilities or
sent home for physical therapy in the home environment.
Mobility is also related to body changes from aging. Loss of
muscle mass, reduction in muscle strength and function, joints becoming stiffer
and less mobile, and gait changes affecting balance can significantly
compromise the mobility of elder patients. Mobility is paramount if elder
patients are to maintain any independent living. Restricted movement affects
the performance of most activities of daily living (ADLs). Elderly patients are
also at increased risk for the complications of immobility. Nursing goals are
to maintain functional ability, prevent additional impairment of physical
activity, and ensure a safe environment.
- Activity intolerance
- Perceptual or cognitive impairment
- Musculoskeletal impairment
- Neuromuscular impairment
- Medical restrictions
- Prolonged bed rest
- Limited strength
- Pain or discomfort
- Depression or severe anxiety
- Inability to move purposefully within physical environment,
including bed mobility, transfers, and ambulation
- Reluctance to attempt movement
- Limited range of motion (ROM)
- Decreased muscle endurance, strength, control, or mass
- Imposed restrictions of movement, including mechanical, medical
protocol, and impaired coordination
- Inability to perform action as instructed
- Patient performs physical activity independently or with
assistive devices as needed.
- Patient is free of complications of immobility, as evidenced by
intact skin, absence of thrombophlebitis, and normal bowel pattern.
- (i) independent
- (i) Assess for impediments to mobility (see
Related Factors of this care plan).
- Identifying the specific cause (e.g., chronic arthritis
versus stroke versus chronic neurological disease) guides design of optimal
- (i) Assess patient's ability to perform ADLs
effectively and safely on a daily basis.
- Restricted movement affects the ability to perform most
ADLs. Safety with ambulation is an important concern.
- Suggested Code for Functional Level
- 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
- 4 Is dependent, does not participate in activity
- *Code adapted by North American
Nursing Diagnosis Association: Taxonomy I (Rev. 1990), St. Louis:
NANDA. From Jones E et al: Patient classification for long-term care:
users' manual, Pub. No. HRA-74-3107, November 1974, HEW.
- (i) Assess patient or caregivers knowledge of
immobility and its implications.
- Even patients who are temporarily immobile are at risk for
some of the effects of immobility, such as skin breakdown, muscle weakness,
thrombophlebitis, constipation, pneumonia, and depression).
- (i) Assess for developing thrombophlebitis
(calf pain, Homans' sign, redness, localized swelling, and rise in
- Bed rest or immobility promotes clot formation.
- (i) Assess skin integrity. Check for signs of
redness, tissue ischemia (especially over ears, shoulders, elbows, sacrum,
hips, heels, ankles, and toes).
- (i) Monitor input and output record and
nutritional pattern. Assess nutritional needs as they relate to immobility
(possible hypocalcemia, negative nitrogen balance).
- Pressure sores develop more quickly in patients with a
nutritional deficit. Proper nutrition also provides needed energy for
participating in an exercise or rehabilitative program.
- (i) Assess elimination status (usual pattern,
present patterns, signs of constipation).
- Immobility promotes constipation.
- (i) Assess emotional response to disability or
- (i) Evaluate need for home assistance
(physical therapy, visiting nurse).
- (i) Evaluate need for assistive devices.
- Proper use of wheelchairs, canes, transfer bars, and other
assistance can promote activity and reduce danger of falls.
- (i) Evaluate the safety of the immediate
- Obstacles such as throw rugs, children's toys, pets, and
others can further impede one's ability to ambulate safely.
- (i) independent
- (i) Encourage and facilitate early ambulation
and other ADLs when possible. Assist with each initial change: dangling,
sitting in chair, ambulation.
- The longer the patient remains immobile the greater the
level of debilitation that will occur.
- (i) Facilitate transfer training by using
appropriate assistance of persons or devices when transferring patients to bed,
chair, or stretcher.
- (i) Encourage appropriate use of assistive
devices in the home setting.
- Mobility aids can increase level of mobility.
- (i) Provide positive reinforcement during
- Patients may be reluctant to move or initiate new activity
from a fear of falling.
- (i) Allow patient to perform tasks at his or
her own rate. Do not rush patient. Encourage independent activity as able and
- Hospital workers and family caregivers are often in a hurry
and do more for patients than needed, thereby slowing patient's recovery and
reducing his or her self-esteem.
- (i) Keep side rails up and bed in low
- To promote safe environment.
- (i) Turn and position every 2 hours, or as
- To optimize circulation to all tissues and to relieve
- (i) Maintain limbs in functional alignment
(e.g., with pillows, sandbags, wedges, or prefabricated splints).
- To prevent footdrop and/or excessive plantar flexion or
- Support feet in dorsiflexed position
- Use bed cradle
- To keep heavy bed linens off feet.
- (i) Perform passive or active assistive ROM
exercises to all extremities
- To promote increased venous return, prevent stiffness, and
maintain muscle strength and endurance.
- (i) Promote resistance training services.
- Research supports that strength training and other forms of
exercise in older adults can preserve the ability to maintain independent
living status and reduce risk of falling.
- (i) Turn patient to prone or semiprone
position once daily unless contraindicated.
- To drain bronchial tree.
- (i) Use prophylactic antipressure devices as
- To prevent tissue breakdown.
- (i) Clean, dry, and moisturize skin as
- (i) Encourage coughing and deep-breathing
exercises. Use suction as needed.
- To prevent buildup of secretions.
- Use incentive spirometer to increase lung expansion.
- Decreased chest excursions, and stasis of secretions are
associated with immobility.
- (i) Encourage liquid intake of 2000 to 3000 ml
per day unless contraindicated.
- To optimize hydration status and prevent hardening of
- (i) Initiate supplemental high-protein
feedings as appropriate.
- Proper nutrition is required to maintain adequate energy
- If impairment results from obesity, initiate nutritional
counseling as indicated.
- (c) Set up a bowel program (adequate fluid,
foods high in bulk, physical activity, stool softeners, laxatives) as needed.
Record bowel activity level.
- (c) Administer medications as
- Antispasmotic medications may reduce muscle spasms or
spasticity that interfere with mobility.
- (i) Teach energy saving techniques.
- To optimize patient's limited reserves.
- (i) Assist patient in accepting limitations.
Education/Continuity of Care
- (i) independent
- (i) Explain progressive activity to patient.
Help patient or caregivers to establish reasonable and obtainable goals.
- (i) Instruct patient or caregivers regarding
hazards of immobility. Emphasize importance of position change, ROM, coughing,
exercises, and others.
- (i) Reinforce principles of progressive
exercise, emphasizing that joints are to be exercised to the point of pain, not
- No pain, no gain is not always true!
- (i) Instruct patient/family regarding need to
make home environment safe.
- A safe environment is a prerequisite to improved
- (c) Refer to multidisciplinary health team as
- Physical therapists can provide specialized
- (i) Encourage verbalization of feelings,
strengths, weaknesses, and concerns.
Exercise Therapy: Ambulation; Joint Mobility; Fall Precautions;
Positioning; Bed Rest Care
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