Which nursing intervention indicate client care that supports physical functioning?

Impaired physical mobility is a common nursing diagnosis found among most patients at one time or another. It can be a temporary, permanent or worsening problem and has the potential to create larger issues such as skin breakdown, infections, falls, and social isolation.

Advancing age is the most common risk factor of impaired physical mobility which increases the risk of morbidity and mortality for this population. Enhancing mobility is important to also improve the quality of life of patients and lessen the burden on caregivers and the healthcare system.

Nurses must recognize risk factors of impaired physical mobility and work to prevent or improve poor mobility as much as possible. This requires a multidisciplinary team approach utilizing physical and occupational therapists, prosthetic services, rehabilitation centers, and other ongoing support to maintain physical progress.

Causes of Impaired Physical Mobility (Related to) 

• Aging 
• Sedentary lifestyle 
• Deconditioning 
• Decreased endurance 
• Limited range of motion 
• Recent surgical intervention 
• Decreased muscle strength or control 
• Joint stiffness 
• Chronic pain and/or acute pain
• Depression 
• Contractures 
• Neuromuscular impairment 
• Cognitive impairment 
• Developmental delay 
• Malnutrition 
• Obesity 
• Lack of access or support (social or physical) 
• Prescribed bedrest, immobilizers, or movement restrictions 
• Physical or chemical (sedatives) restraints 
• Reluctance or disinterest in movement 

Signs and Symptoms (As evidenced by) 

Subjective: (Patient reports) 

• Expression of pain and discomfort with movement 
• Refusal to move 

Objective: (Nurse assesses) 

• Limited range of motion 
• Uncoordinated movements 
• Poor balance  
• Inability to turn in bed, transfer, or ambulate 
• Postural instability 
• Gait disturbances 
• Reliance on assistive devices 
• Contractures 
• Decreased muscle strength 
• Inability to follow or complete instructions 

Expected Outcomes

• Patient will participate in ADLs and prescribed therapies 
• Patient will display improvement in physical mobility by transferring from bed to wheelchair independently 
• Patient will remain free of contractures and decubitus ulcers from impaired mobility 
• Patient will demonstrate exercises to improve physical mobility

Nursing Assessment for Impaired Physical Mobility

1. Assess for conditions that contribute to impaired mobility.
Stroke, multiple sclerosis, dementia, paralysis, cerebral palsy, fractures, and arthritis are only a few disorders that can prevent purposeful movement.

2. Take note of prescribed movement limitations.
Following surgery patients may be prescribed bed rest to prevent injury. Other orders such as “non-weight bearing” status or the use of braces, slings, and immobilizers must be considered.

3. Assess for pain and limited range of motion.
Pain and stiffness will prevent the patient from participating fully in their care.

4. Assess strength and range of motion.
Deconditioned patients either from lack of exercise or illness may not possess the strength necessary to carry out ADLs or movement. Assessing the patient’s range of motion prior to movement will show the nurse what the patient is or is not capable of.

5. Use nursing judgment before implementing mobility.
Patients who are older in age, obese, or cognitively limited may not be able to transfer or ambulate without proper assistance. The nurse must first assess abilities and have adequate support available (other staff, PT, equipment) before assisting a patient to move as this could place the patient at risk for falls or injury. Never force a patient to move beyond what they are physically capable of.

6. Evaluate the need for multidisciplinary care.
Extensive mobility limitations may require rehabilitation and specialized therapies. The nurse is often the coordinator of additional support.

7. Assess equipment needs.
Additional support from walkers, wheelchairs, grab bars, commodes, adaptive equipment, prosthetics, and more can promote independence and optimize mobility.

8. Note feelings of disinterest or unwillingness.
The nurse may need to explore feelings of depression or lack of motivation before the patient will participate in their mobility. Embarrassment, hopelessness, and knowledge deficits are potential barriers that can be overcome.

9. Assess for a lack of appropriate environment or support.
Nurses may need to assess the patient’s home environment and the ability of caregivers. An unsafe living situation or lack of competent caregivers may be the reason for their impaired mobility and will further increase debility and place the patient at risk for injury or falls.

Nursing Interventions for Impaired Physical Mobility

1. Encourage the patient to do as much as they can.
Once the nurse has assessed the degree of immobility, they should encourage independence aligned with the patient’s capabilities. This decreases dependence on others and increases the patient’s self-esteem.

2. Medicate for pain.
If pain and discomfort are a barrier, the nurse can provide analgesics prior to performing exercises or planned ADLs. Even simple interventions such as a heating pad or ice packs may alleviate muscle and joint pain and increase movement.

3. Schedule activities around rest periods.
Allow the patient to determine the best times for exercise or movement related to their energy levels. Do not overwhelm or exhaust and allow periods of rest between activities.

4. Provide adaptive equipment.
Provide equipment that allows for maximum movement related to the patient’s capabilities. For example, if bed-bound but able to use upper extremities, a trapeze bar can help the patient can pull themselves up.

5. Provide passive ROM.
If the patient is unable to perform exercises independently, the nurse should provide passive ROM several times per day to prevent contractures and muscle weakness.

6. Promote proper nutrition and hydration.
Malnourishment prevents recovery and contributes to a higher risk of functional disability. Adequate caloric intake is required for energy with high-protein foods supporting muscle mass and strength. Hydration will prevent dehydration and promote circulation and keep skin, tissues, and muscles hydrated.

7. Incorporate family and caregivers.
Patients who feel supported by their families and spouses will feel committed to increasing their mobility. Families may need education on how to best support their loved ones, how to keep them safe, and how to use equipment.

8. Consult with the multidisciplinary team.
Impaired mobility may require the support of PT and OT to instruct on exercises and perform activities that stimulate muscle control and fine motor movement.

9. Coordinate ongoing support at discharge.
Patients may require ongoing support either at home through home health services or at a rehab center. Coordinating with the case manager to ensure the patient receives the appropriate care at discharge is vital to preserving their progress.

10. Set goals.
Patients may feel overwhelmed or hopeless if their barriers seem impossible. Helping them choose small goals, such as brushing their hair or sitting up in bed, gives them the motivation to keep going.

11. Provide positive reinforcement.
A patient that is making an effort, no matter how small will be more inclined to continue when their accomplishments are noticed and praised.

References and Sources

1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
2. Milaneschi, Y., Tanaka, T., & Ferrucci, L. (2010). Nutritional determinants of mobility. Current opinion in clinical nutrition and metabolic care, 13(6), 625–629. https://doi.org/10.1097/MCO.0b013e32833e337d
3. Lim E. J. (2018). Factors Influencing Mobility Relative to Nutritional Status among Elderly Women with Diabetes Mellitus. Iranian journal of public health, 47(6), 814–823. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077640/

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