Impaired Physical Immobility Nursing Diagnosis and Nursing care Plan with Examples, Nursing Diagnosis for Osteoarthritis
impaired physical immobility nursing diagnosis
What is impaired physical mobility?
Impaired physical mobility and its complications have significant negative impacts on all body systems and, if prolonged, could lead to deconditioning and loss of function. The defining characteristics of impaired physical mobility include decreased muscle strength, activity intolerance, stiffness, limited ROM, changes in coordination, the need for assistance from people or devices, perceptual-cognitive, musculoskeletal, and neuromuscular impairment pain.
This article outlines nursing diagnosis impaired physical mobility, impaired physical mobility nursing care plans and provides a detailed description of the disorders associated with impaired physical mobility, their respective symptoms, causes, risk factors, and prevention methods. As you read, keep in mind that our professional nursing writers are ready to help with your assignment if you get stuck. All you need to do is place an order with us.
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor if you’re looking for medical advice.
What are the dependent functions of impaired physical mobility?
The dependent functions of impaired physical mobility include heat and cold therapy, NSAIDs, a high protein-high calcium diet, the use of supportive devices, immobilization, reconstructive surgery, prophylactic anticoagulants, and pain medications.
Impaired physical mobility can result from degenerative joint diseases, mainly osteoarthritis and Rheumatoidarthritis.
Osteoarthritis, also called degenerative joint disease, results from the breakdown of cartilage, leading to changes in the underlying bone. Osteoarthritis is asymmetrical progressive. Although cartilage loss is a prominent feature of OA, contemporary models recognize that the entire joint organ is affected by OA.
Osteoarthritis can be
Primary OA (idiopathic) which is characterized by No preceding injury to the joint, Age, and Genetics.
Secondary OA which is OA triggered by a congenital abnormality (hip dysplasia), trauma, inflammatory processes (RA, chronic gout), ongoing strenuous physical activities, metabolic (Wilsons – copper deposition in join), haemophilia (blood in joint = bad).
Causes of Osteoarthritis
Osteoarthritis is a multifactorial disease process; hence multiple risk factors cause it.
The Pathophysiology is that Cartilage degradation leads to cartilage synthesis due to increased MMP’s produced by chondrocytes. Other joint structures are affected, leading to bone remodeling, bone marrow lesions, synovial inflammation, capsular stretching, periarticular muscle weakness, and ligament laxity.
The risk factors for osteoarthritis include
Aging- osteoarthritis can occur as an inevitable consequence of aging, which narrows down to the degradation and loss of the cartilage function. Geurts et al. (2012) note that the mechanistic influence of aging on OA has different facets. On a molecular level, matrix proteins such as collagen or proteoglycans are modified, altering cartilage function. Hence being over 50 years is a significant risk factor.
Genetics / Family History – Genetics plays a significant role in influencing OA asymmetrical progression. Rego et al. (2018) note that the genetic influence of this disease is estimated between 35% and 65%. Furthermore, epidemiological studies estimate that there is a 40% probability of inheritability in an osteoarthritic knee and a 65% probability of inheritability in osteoarthritic hands and hips
Environmental – environmental changes that have increased the likelihood of developing knee OA due to modern lifestyles are associated with obesity and a sedentary lifestyle.
Obesity – Sedentary lifestyles lead to obesity, which leads to OA’s progression. Studies show that Hand OA is about twice as common among obese people as in leaner people. Being obese also increases the chances of developing it elsewhere once you have OA in one joint.
Repetitive physical activity and microtrauma- Microtrauma results from the repetitive application of high mechanical stresses to vulnerable structures within the joint. Current evidence suggests that OA is more common in those who perform heavy physical work, particularly those whose jobs involve knee-bending, kneeling, or squatting.
Prolonged use of corticosteroids – Even though an injection of a corticosteroid (sometimes combined with a local anesthetic) directly into an individual joint can reduce inflammation and paindue to arthritis. The effect may last several months, but repeated injections can increase cartilage loss, according to the guideline in Corticosteroids by arthritis.org.
Varus (bow-legged) or valgus (knock-kneed) malalignment of the knee – congenital joint disorders
The presentation of osteoarthritis is determined by
Pain – associated with activities, with weight-bearing joints. Pain at rest/night unusual except in advanced OA is nagging.
Stiffness after rest – improves with movement
Functional loss – Knee giving way/locking. Can reflect partial meniscal tear.
Limited range of movement – active and passive, usually associated with pain
Usually affects the knee, hip, hand, spine – Can be unilateral
Enlargement of Proximal interphalangeal joints (Bouchard’s nodes) and Distal interphalangeal joints (Heberden’s nodes).
Does not involve metacarpophalangeal
Joint tenderness
Joint crepitus
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Impaired Physical Immobility for Nursing Diagnosis and Nursing care Plan with Examples
Based on the history taking, unilateral pain is the most acute symptom of OA compared to symmetrical joint involvement in rheumatoid arthritis (RA). The site of pain was at the knee joint, the weight-bearing joint commonly involved in OA. The pain was also worsened with activities and relieved by rest. Other symptoms like morning stiffness can also be part of the presentation of OA, which is brief and localized, with a duration of fewer than 30 minutes. RA can also be presented with early morning stiffness. However, the duration is longer, which is more than 1-hour presentation.
The patient may be presented with an antalgic gait on physical examination due to painful knee joints. Secondary genu varus deformity is very suggestive of OA compared to RA, more likely to develop genu valgus deformity. Inflammatory changes were noted: swelling, tenderness, and warmth over the affected knee. Limitation of movement was also noted due to pain experienced by the patient.
The definite diagnosis of OA is established by a plain x-ray of the affected joint (anteroposterior and lateral view). The characteristic features of OA in x-ray are narrowing of joint space, presence of osteophytes, subchondral cyst and subchondral sclerosis. As in this patient, the x-ray of the affected knee joint showed a classical sign of OA.
Treatment for Osteoarthritis
Treatment for Osteoarthritis
Exercise/physio/weight loss, studies show that a BMI >35 has a 15X risk of surgery than a normal BMI. The goal for exercise/physio/weight loss, in this case, should be to Increase muscle size, tone, joint movement, stability, and postural advice.
Glucosamine & chondroitin can help prevent the need for joint replacement
Total knee assessment– assess dressing, elevate the leg, neurovascular checks, monitor drains/ blood loss, ice packs; PROM; light weight-bearing, no crossing legs
Total hip assessment — check to dress, monitor blood loss/drains, limit flexion to 60 degrees, no abduction beyond midline; no internal or external rotation, no lying on operative side; pillow between legs
Impaired physical mobility Nursing care plan nursing diagnoses example- Impaired physical mobility
Nursing Diagnosis (Dx Impaired physical mobility)
Interventions and Referrals for Dx 3 Impaired physical mobility
· Defining characteristics R/T inability to move (e.g., bed mobility, transfers, and ambulation)· Observed data AMB limited ROM and reluctance to move
· Measurable outcome indicator Patient will demonstrate a willingness to implement measures to increase mobility in a week; the patient will perform physical activity
· Independently or within limits of disease a few days after s/p; the patient will maintain intact skin, absence of thrombophlebitis, a typical bowel pattern, and clear breath sounds throughout hospitalization
· Assess the safety of the environment.· Evaluate the patient’s ability to perform ADLs on a daily basis.
· Assess the strength to perform ROM to all joints.
· Refer to PT and OT for assistance with exercises.
Interventions and Referrals for Dx 3 Impaired physical mobility
· Defining characteristics R/T neuromuscular impairment· Observed data A/E by limited ROM, inability to move purposefully within the physical environment, and decreased muscle strength
· Measurable outcome indicator Client will gradually regain mobility at the highest possible level throughout hospital stay; the client will be able to move toes after loosening of dressing; the client will demonstrate techniques that enable resumption of activities.
· Assess the degree of immobility caused by the patient’s injury and note the patient’s perception of immobility.· Encourage isometric exercises (e., gas pumps) starting with the unaffected limb.
· Turn and reposition the patient periodically and encourage coughing and deep-breathing exercises.
· Consult with a physical, occupational therapist, or rehabilitation specialist.
Here is a sample nursing care plan for impaired physical mobility
SOAP NOTE for Impaired physical mobility nursing care plan (2 Impaired physical mobility (Clinical Reasoning NANDA) impaired physical immobility nursing diagnosisSubjective/Objective Data
Subjective:
· Screaming when attempting to perform ROM activity.
· Stating “It hurts it to bad to move my leg right now.”
· Patient telling Physical Therapy “I am not doing it today.”
Objective:
· Contracture noted to R stump.
· Stage II sacral wound
· Unable to ambulate
· Pain level 8 out of 10.
· V/S: BP: 138/90, HR 104, RR 22, SPO2 95% RA.
· NORCO 10-325mg PRN
· Facial grimace with movement
Nursing Diagnosis impaired physical immobility
{Problem Statement in NANDA format}
Impaired physical mobility r/t loss of a limb AEB impaired coordination; decreased muscle strength, control, and mass.
Goal Statement (Expected Outcome) in impaired physical immobility nursing diagnosis
The patient will remain free from complications of immobility, as evidenced by absence of thrombophlebitis, normal bowel pattern, and clear breath sounds by the end of the shift.
Planned Intervention/Rationale
Turn and position the patient every 2 hours or as needed. Rationale: Position changes optimize circulation to all tissues and relieve pressure.
Give medications as appropriate.Rationale: Antispasmodic medications may reduce muscle spasms or spasticity that interferes with mobility; analgesics may reduce the pain that impedes movement.
Let the patient accomplish tasks at his or her own pace. Do not hurry the patient. Encourage independent activity as able and safe. Rationale: Healthcare providers and significant others are often in a hurry and do more for patients than needed. Thereby slowing the patient’s recovery and reducing his or her confidence.
Execute passive or active assistive ROM exercises to all extremities. Rationale: Exercise enhances venous return, prevents stiffness, and maintains muscle strength and stamina. It also avoids contracture deformation, which can build up quickly and hinder prosthesis usage.
Goal Evaluation (Actual Outcome)
Goal Met. The patient has clear bilateral breathe sounds, BLE free of redness, calf pain, or localized swelling. Patient with regular bowel pattern, LBM (10/7).
Summary Statement of Nursing Interventions for impaired physical immobility nursing diagnosis
The patient is assisted with turning every 2 hours by staff.
Baclofen 10mg TID is given to reduce muscle spasms, and NORCO 10-325mg is given PRN every 6 hours for pain. Also, a 12mcg/hr Fentanyl patch is on the patients at all times.
Patients can feed and provide hydration to themselves with assistance as needed at their own pace.
Passive ROM was not provided to the patient because the patient was in severe pain and did not want to be touched.
Revision of Plan
Continue with the plan of care as per the Nursing Diagnosis for Osteoarthritis
sample nursing care plan for impaired physical mobility
Sample Nursing Diagnosis and plan for care for osteoarthritis (osteoarthritis case study discussion)
Osteoarthritis case study Diagnosis and plan of action (Discussion 7 Advanced Pharmacology Osteoarthritis Advanced Pharmacology (NURS 6521N) impaired physical mobility nursing diagnosis and nursing care plan
Although osteoarthritis can not be reversed, you can take medications to relieve the pain. The first line of therapy for osteoarthritis in patients with mild to moderate pain is Acetaminophen (Tylenol). However, it is essential to note that overuse of acetaminophen can cause liver damage. According to the FDA, Celecoxib and other NSAIDs and acetaminophen are recommended as first-line analgesics for patients with osteoarthritis and rheumatoid arthritis (Cohen, 2021). Acetaminophen, like NSAIDs, has analgesic and antipyretic effects.
On the other hand, acetaminophen has been proven in trials to have no anti-inflammatory activities in the peripheral nervous system. It is possible that acetaminophen inhibits the COX pathway in the brain but not in the rest of the body. Regarding Sally’s concern about heart problems associated with Celebrex, educate her with the most recent data available. Celecoxib is used to treat osteoarthritis pain, soreness, edema, and stiffness (arthritis caused by a breakdown of the lining of the joints). It is also used to manage painful menstrual cycles and other types of short-term pain, such as pain caused by injuries, surgery, other medical or dental operations, or pain caused by short-term medical disorders. Celecoxib belongs to the COX-2 inhibitors class of NSAIDs. It works by preventing the body from producing a chemical promoting inflammation and pain. Celecoxib, like all NSAIDs, comes with a boxed warning from the FDA about cardiovascular risk, including an increased risk of heart attacks and strokes.
Compared to ibuprofen and naproxen, large evaluations have found contradictory results regarding whether celecoxib carries a non-inferior or elevated cardiovascular risk. Celebrex can also cause gastrointestinal (GI) side effects, including stomach and intestinal bleeding, ulceration, and perforation. This negative effect makes it riskier for vulnerable populations like the elderly. Due to the cardiovascular risks, including new or worsening hypertension, patients should have their blood pressure checked regularly while on Celebrex. All medications carry risks and side effects; however, Celebrex has shown positive results in patients with osteoarthritis pain when taken as directed. It is important to discuss all medications, vitamins, and supplements you are taking with your healthcare provider to ensure they do not have negative interactions with Celebrex.
Celebrex is a COX-2 inhibitor that is selective. While Celebrex is an NSAID like ibuprofen, it exclusively inhibits COX-2, whereas ibuprofen inhibits both COX-1 and COX-2. In other words, A COX-2 inhibitor is less likely to cause stomach ulcers and is hence easier on the stomach. A comparative study between celecoxib and ibuprofen showed equal tolerance and efficacy in treating patients with knee osteoarthritis (Ngo et al., 2021). Although these two medications are similar, there are differences to consider: Ibuprofen: costs less than Celebrex; take with food to avoid upset stomach; can raise your risk of getting blood clots, a heart attack, or stroke. Celebrex: by prescription only; reduces pain and inflammation; causes less upset stomach than other NSAIDS; lasts longer than ibuprofen; can also raise your risk of blood clots, heart attack, or a stroke.
The best way to decide whether this medication is proper for you is to discuss your condition with your doctor and disclose any health conditions you are experiencing and any other medications you are currently taking. Nursing Diagnosis for Osteoarthritis
References
Kausar, N., Ullah, S., Khan, M. A., Zafar, H., Atia-tul-Wahab, Choudhary, M. I., & Yousuf, S. (2021). Celebrex derivatives: Synthesis, α-glucosidase inhibition, crystal structures and molecular docking studies. Bioorganic Chemistry, 106, 104499. https://doi.org/10.1016/j.bioorg.2020.104499
Reed, G. W., Abdallah, M. S., Shao, M., Wolski, K., Wisniewski, L., Yeomans, N., Lüscher, T. F., Borer, J. S., Graham, D. Y., Husni, M. E., Solomon, D. H., Libby, P., Menon, V., Lincoff, A. M., & Nissen, S. E. (2018). Effect of aspirin Coadministration onthe safety of Celecoxib, Naproxen, or ibuprofen. Journal of the American College of Cardiology, 71(16), 1741-1751. https://doi.org/10.1016/j.jacc.2018.02.036
Here’s another sample nursing care plan for impaired physical mobility
Osteoarthritis case study 2 (Nursing Diagnosis for Osteoarthritis Example) impaired physical immobility nursing diagnosis
Mrs. Jones is a 70-year-old female complaining of right knee joint stiffness in your clinic. She works as a volunteer in the food pantry. She notices her pain more on the days she works in the food pantry. She also notices her pain is greater when it is rainy.
Answer the following questions:
What type of bone condition do you think this is?
Osteoarthritis (Nursing Diagnosis for Osteoarthritis)
What information will you gather from this patient?
My assessment would include the location of pain, identifying the type, severity, frequency, and duration of stiffness. I would ask the patient if any other aggravating factors contribute to her pain besides prolonged activity and rainy weather and what helps relieve the pain/stiffness (Harding et al., 2020). I would include a health history to determine medications, disease/conditions, family history, or injuries that could contribute to the manifestation of her diagnosis. A full assessment, including the remaining synovial joints, is necessary to distinguish between and rule out different forms of arthritis or disease that could be possible. This will help determine the Nursing Diagnosis for Osteoarthritis.
What tests do you expect the doctor to order to determine joint pathology? Of these tests, which will the doctor do first?
Imaging the doctor might order to diagnose would include a bone scan, CT scan, or MRI. Because X-rays can identify early changes in the damage of the joint, this diagnostic test would be ordered first. Other identified changes are the erythrocyte sedimentation rate; ESR might increase in acute flare-ups. A doctor may order a synovial fluid analysis to identify arthritis. The fluid in a patient with osteoarthritis would appear clear and yellow, with little or no sign of inflammation (Harding et al., 2020).
What are the appropriate nursing diagnoses for this patient?
Harding et al., 2020 identifies the nursing diagnoses that are appropriate for osteoarthritis include, “acute and chronic pain, impaired physical mobility, difficulty coping.”
What outcomes (goals) will be appropriate for this patient? (SMART format)
Through continuous intervals of outpatient visits that would include evaluations of her progress, I would expect Mrs. Jones to achieve a daily balance between rest and activity to maintain or improve joint function. This is important because she remains active in volunteer work and canpotentially overdo it, increasing pain. Additionally, it would be important for her to protect her joints to tolerant the long hours of standing during her time spent at the food pantry. Protection of her joints would facilitate maintaining joint flexibility and muscle strength in her knee. I wouldalso expect to achieve effective pain management through drug and non-drug interventions like heat and cold therapy, meditation, yoga, and physical therapy. Common drug therapies would include salicylates, NSAIDS, Acetaminophen, lidocaine, capsaicin, and intraarticular joint corticosteroid injection.
What will you Assess, Do, and Teach the patient?
I would assess the tenderness, swelling, limitation of movement, and crepitation of her right knee. An inspection and palpation comparison to her left knee would be necessary to identify abnormalities in the right knee (Harding et al., 2020). I would further assess her stability during ambulation for activity intolerance and if an assistive device would benefit mobilization. I would provide her with alternative therapies to manage pain and alleviate triggering factors. I would include a consult for physical therapy to further assess the patient and to offer stretching/exercising techniques to maintain activity. If the patient were overweight, I would educate her on nutritional therapy and exercises as a weight-reduction program.
Harding, M. M., Kwong, J., Roberts, D., Hagler, D., Reinisch, C. (2020). Lewis’s medical-surgical nursing assessment and management of clinical problems (11th ed.). Elsevier.
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