Cholecystectomy Nursing Care Plan: Impaired Physical Mobility

Assessmen
t
S>
O>
The pt.
manifested:
>surgical
incision on RUQ
of the abdomen
>guarding
behavior
The pt. may
manifest:
>cold clammy
skin
>perspiration
>anxiety
>restlessness

Nursing
Diagnosis

Scientific
Explanation

Impaired Physical
mobility r/t pain
2
Cholecystectomy

Presence of
surgical incision
procedures
causes the pt. to
be reluctant in
doing
movements such
as ROM, because
those may result
in the stimulation
of the nerve
endings, during
movement, thus,
increase pain
sensation.

Planning
Interventions
(Objective/Goal
)
Short term:
After 1 of NI, pt.
will be able to
identify appropriate
interventions or
measures in order
to move safely and
freely

Long term:
After 3 of NI, pt.
will demonstrate
behaviors that
enable resumption
of activities.

>establish
rapport.

>monitor V/S.
>assess the
degree of pain.
>note emotional
responses to
problems of
immobility.

Rationale
>to establish nursept. relationship.
>to establish
baseline data.
>to determine
appropriate
interventions.
>feeling of
frustration or
powerlessness may
impede attainment
of goals.
>for position
changes/transfers.

>instruct SO to
stay at bedside.
>support body
parts/joints using
pillows.

>redness on
the incision site
>Administer
medications prior
to activity as
needed for pain
relief.

>to maintain
position of function
and reduce risk of
pressure ulcers.
>to permit maximal
effort / involvement
in activity.
>to reduce fatigue.

>enhances selfconcept and sense

Evaluation
Short term:
Pt. shall have
identified
appropriate
interventions or
measures in
order to move
safely and
freely.

Long term:
Pt. shall have
demonstrated
behaviors that
enable
resumption of
activities.

>Schedule
activities with
adequate rest
periods during
the day.
>encourage
performing
diversional
activities such as
puzzles etc.
>encourage tom
increase oral fluid
intake.

of independence.
>promotes well
being and
maximizes energy
production.
>to promote
independence and
enhance ROM
exercises.
>to maintain
muscle strength.
>to lessen pain and
discomfort.

>place essential
equipments near
the client.
>encourage ROM
exercises.
>place client in a
comfortable
position.