IMPAIRED PHYSICAL MOBILITY
Limitation in independent, purposeful physical movement of the
body or of one or more extremities
• Gait changes, postural instability; difﬁculty turning
• Limited ROM; ability to perform ﬁne and gross motor skills
• Movement-induced tremor, uncoordinated or jerky movements
• Slowed and/or uncoordinated movements; reaction time.
• Substitution of other behaviors for impaired mobility (for instance,
increased attention to other’s activity and controlling behavior)
• Activity intolerance
• Decreased endurance; muscle
• Altered cellular metabolism
control, mass or strength
• Body mass index above
• Depressive mood state
• Deﬁcient knowledge about
• Cognitive impairment
value of exercise
• Developmental delay
• Cultural beliefs regarding
• Joint stiffness
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
The patient will
• Maintain muscle strength and joint ROM.
• Be free from complications (e.g., contractures, venous stasis,
thrombus formation, skin breakdown, and hypostatic pneumonia).
• Achieve the highest level of mobility (will transfer independently,
will be wheelchair-independent, or will ambulate with assistive
devices such as walker, cane, and braces).
• Carry out mobility regimen.
• Use resources to help maintain level of functioning.
SUGGESTED NOC OUTCOMES
Ambulation; Ambulation: Wheelchair; Joint Movement: Hip; Joint
Movement: Shoulder; Mobility; Transfer Performance
INTERVENTIONS AND RATIONALES
Determine: Identify level of functioning using a functional mobility
scale. Communicate patient’s skill level to all staff members to pro-
vide continuity and preserve identiﬁed level of independence.
Monitor and record daily any evidence of immobility
complications as they may be more prone to develop complications.
Perform: Perform ROM exercises to joints, unless contraindicated, at
least once every shift to prevent joint contractures and muscular
atrophy. Turn and reposition patient every 2 hr. Establish a turning
schedule and post at bedside. Monitor frequency of turning to pre-
vent skin breakdown by relieving pressure. Place joints in functional
position. Use trochanter roll along the thigh, abduct thighs, use
high-top sneakers, and pull a small pillow under patient’s head to
maintain joints in a functional position and prevent musculoskeletal
Place items within reach of the unaffected arm if patient has one-
sided weakness or paralysis to promote patient’s independence.
Carry out medical regimen to manage or prevent complications
(e.g., administer prophylactic heparin for venous thrombosis). This
promotes patient’s health and well-being.
Provide progressive mobilization to the limits of patient’s
condition (bed mobility to chair mobility to ambulation) to maintain
muscle tone and prevent complications of immobility.
Inform: Instruct patient and family members in ROM exercises,
transfers, skin inspection, and mobility regimen to help prepare for
discharge and promote continuity of care. Request return
demonstration to ensure use of proper technique.
Attend: Help patient use a trapeze and side rails to encourage inde-
pendence in mobility. Instruct him to perform self-care activities to
increase muscle tone.
Encourage physical therapy sessions and support activities on the
unit by using the same equipment and technique. Request written
mobility plans for reference. Ensure all members of the healthcare
team are reinforcing learned skills in the same manner.
Manage: Refer patient to a physical therapist for development of
mobility regimen to help rehabilitate musculoskeletal deﬁcits.
Assist patient in identifying resources such as American Heart
Association to provide a comprehensive approach to rehabilitation.
SUGGESTED NIC INTERVENTIONS
Exercise Promotion: Strength Training; Exercise Therapy: Joint
Mobility; Exercise Therapy: Muscle Control; Positioning: Wheelchair
Gillis, A., & MacDonald, B. (2005, June). Deconditioning in the hospitalized
elderly. The Canadian Nurse, 101(6), 16–20.