Nursing diagnosis – IMPAIRED BED MOBILITY

IMPAIRED  BED  MOBILITY

DEFINITION

Limitation of independent movement from one bed position to another

DEFINING CHARACTERISTICS

Impaired ability to perform the following actions while in bed:

• Move from supine to long sitting or long sitting to supine

• Move from supine to prone or prone to supine

• Move from supine to sitting or sitting to supine

• “Scoot” or reposition body

• Turn from side to side

RELATED FACTORS

• Cognitive impairment

• Musculoskeletal and/or

• Deconditioning

neuromuscular impairment

• Deficient knowledge

• Obesity

• Environmental constraints

• Pain

• Insufficient muscle strength

• Sedating medications

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity/exercise

• Pharmacological function

• Physical regulation

EXPECTED OUTCOMES

The patient will

• Have no complications associated with impaired bed mobility,

such as altered skin integrity, contractures, venous stasis, thrombus
formation, depression, altered health maintenance, and falls.

• Maintain or improve muscle strength and joint ROM.

• Achieve the highest level of bed mobility possible (independence,

independence with device, verbalization of needs for assistance with
bed mobility, requires assistance of one person or two people).

• Demonstrate ability to use equipment or devices to assist with

moving about in bed safely.

• Adapt to alteration in ability to move about in bed.

• Participate in social, physical, and occupational activities to the

extent possible.

SUGGESTED NOC OUTCOMES

Body Positioning: Self-Initiated; Cognition; Immobility

Consequences: Physiological; Immobility Consequences: Psychocogni-

tive; Joint Movement, Mobility; Neurological Status: Consciousness

INTERVENTIONS AND RATIONALES

Determine:  Identify patient’s level of independence using functional

mobility scale and document findings to provide continuity of care.

Monitor and record daily evidence of complications related to

impaired bed mobility (contractures, venous stasis, skin breakdown,

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thrombus formation, depression, altered health maintenance or self-

care skills, falls). Assess patient’s skin every 2 hr to maintain skin

integrity.

Perform:  Perform ROM exercises to affected joints, unless

contraindicated, at least once per shift. Progress from passive to

active ROM, as tolerated, to prevent joint contractures and muscle

atrophy.

Assist patient in maintaining anatomically correct and functional

body positioning to relieve pressure, thereby preventing skin break-

down and fluid accumulation in dependent extremities. Encourage

repositioning every 2 hr while in bed.

Establish a turning schedule for immobile patient. Encourage pro-

gressive mobility within patient’s limits to maintain muscle tone,

prevent complications, and promote self-care.

If you are uncertain about your ability to move the patient,

request help from colleagues to maintain safety.

Inform:  Instruct patient and family members in techniques to

improve bed mobility and ways to prevent complications to help

prepare the patient and family members for discharge.

Demonstrate patient’s bed mobility regimen and note the date.

Have patient and family members perform a return demonstration

to ensure continuity of care and use of proper technique.

Attend:  Encourage patient to participate in physical and

occupational therapy sessions. Incorporate equipment, devices, and

techniques used by therapists into your care. Request written

instructions from the patient’s therapists to use as a reference to

help ensure continuity of care and reinforce learned skills.

Manage:  Refer patient to a physical therapist to continue improve-

ment in bed mobility and rehabilitate musculoskeletal deficits; and

an occupational therapist to continue to maximize self-care skills.

Assist patient in identifying and contacting resources for social

and spiritual support to promote the patient’s reintegration into the

community and help him maintain psychosocial health.

SUGGESTED NIC INTERVENTIONS

Bed Rest Care; Body Mechanics Promotion; Exercise Promotion:

Strength Training; Exercise Therapy: Joint Mobility; Exercise Ther-

apy: Muscle Control; Positioning

Reference

Lyder, C. H. (2006, August). Assessing risk and preventing pressure ulcers in

patients with cancer. Seminars in Oncology Nursing, 22(3), 178–184.

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