NURSING DIAGNOSIS: Impaired physical mobility

related to:
  1. pain and weakness in weight-bearing extremity associated with surgery on the knee;
  2. prescribed activity and weight-bearing restrictions following total knee replacement;
  3. generalized weakness associated with surgery;
  4. depressant effect of anesthesia and some medications (e.g. narcotic [opioid] analgesics, centrally acting muscle relaxants, some antiemetics);
  5. fear of falling, dislocating prostheses, and compromising surgical wound.
Desired Outcome
The client will maintain maximum physical mobility within prescribed activity and weight-bearing restrictions.
Nursing Actions and Selected Purposes/Rationales
  1. Refer to Standardized Postoperative Care Plan, Diagnosis 12, for measures to increase client's mobility.
  2. Implement additional measures to increase client's mobility:
    1. perform actions to reduce pain (see Postoperative Diagnosis 2)
    2. maintain prescribed degree of flexion and extension on CPM machine and encourage client to keep operative leg in CPM machine for the prescribed length of time to reduce the risk of scarring in the knee and a subsequent decrease in range of motion
    3. encourage client to perform quadriceps- and gluteal-setting, straight leg raising, and knee flexion-extension exercises as soon as allowed (usually started by the 2nd postoperative day)
    4. encourage client to use overhead trapeze to move self in order to strengthen arm and shoulder muscles needed for proper use of ambulatory aids
    5. reinforce physical therapist's instructions regarding transfer and ambulation techniques and use of ambulatory aids (e.g. crutches, walker)
    6. perform actions to prevent falls (see Postoperative Diagnosis 6, actions a and b) in order to decrease client's fear of injury
    7. assist client with ambulation as soon as allowed (usually by the 2nd postoperative day).
  3. Consult appropriate health care provider (e.g. physician, physical therapist) if client is unable to make expected progress with knee flexion or if any other joint motion becomes restricted.