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Nursing Care Plan: impaired bed Mobility Definition: Limitation of independent movement from one bed position to another

Related Factors
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Neuromuscular or musculoskeletal impairment Insufficient muscle strength; deconditioning; obesity Environmental constraints (i.e., bed size and type, treatment equipment, restraints) Pain; sedating medications Deficient knowledge Cognitive impairment

Defining Characteristics Subjective

[Reported difficulty performing activities]

Objective

Impaired ability to: turn side to side; move from supine to sit- ting, sitting to supine; “scoot” or reposition self in bed; move from supine to prone, prone to supine; move from supine to long-sitting, long-sitting to supine

Desired Outcomes/Evaluation Criteria Client/Caregiver Will:
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Verbalize willingness to participate in repositioning program. Verbalize understanding of situation and risk factors, individual therapeutic regimen, and safety measures. Demonstrate techniques and behaviors that enable safe repositioning. Maintain position of function and skin integrity as evidenced by absence of contractures, footdrop, decubitus, and so forth. Maintain or increase strength and function of affected and/or compensatory body part.

Actions/Interventions 1. Determine diagnoses that contribute to immobility (e.g., MS, arthritis, Parkinson’s disease, hemi-/para-/tetraplegia, fractures, multiple trauma, burns, head injury, depression, dementia). 2. Note individual risk factors and current situation, such as surgery, casts, amputation, traction, pain, age, general weakness or debilitation. 3. Determine degree of perceptual or cognitive impairment and/ or ability to follow directions. 4. Determine functional level classification 1 to 4 (1 requires use of equipment or device, 2 requires help from another person for assistance, 3 requires help from another person and equipment device, 4 dependent, does not participate in activity). 5. Note cognitive, emotional, or behavioral conditions or con- cerns impacting mobility.

9. and wick away moisture. 11.). assistive devices. Provide regular skin care. Instruct client and caregivers in methods of moving client relative to specific situations and mobility needs. 20. as appropriate. Include physical and occupational therapists and rehabilitation providers in creating movement program and identifying assistive devices. exercises. Observe for change in strength to do more or less self-care Rationale: to adjust care as indicated. Provide appropriate pressure relief and surface support mattress Rationale: to reduce friction. Ascertain that dependent client is placed in best bed for situation (e. etc. Provide individually appropriate methods to communicatead equately with client. 21. 22. Provide diversional activities. Implementation/Evaluation  Responses to interventions. 13. toileting. Encourage continuation of exercises Rationale: to maintain and enhance gains in strength and muscle control. correct size. and mobility functions) Rationale: to promote mobility and enhance environmental safety. Note presence of complications related to immobility. support surface. or identify sources for. as indicated. utilizing bed and mattress positioning settings to assist movements. ability to participate in specific or desired activities.) 7. 15. teaching. Rationale: Promotes commitment to plan. and actions performed. (Refer to ND Disuse Syndrome. Ensure telephone and call bell is within reach Rationale: to promote safety and timely response. 19. Assist on and off bedpan and into sitting position (or use cardioposition bed or footegress bed) Rationale: to facilitate elimination. 12. maximizing outcomes. Obtain. . including level of function. Involve client/SO(s) in determining activity schedule. Turn dependent client frequently. as appropriate. Documentation Focus Assessment/Reassessment  Individual findings.g. Observe skin for reddened areas or shearing injury. 8. reposition in good body alignment. 10.. Demonstrate safe use and proper maintenance. Assist with activities of hygiene. Planning  Plan of care and who is involved in the planning. 17. 16.6. 18. maintain safe skin and tissue pressures. Administer medication prior to activity as needed for pain relief Rationale: to permit maximal effort and involvement in activity. Provide extremity protection (padding. using appropriate supports. feeding. 14.

Sources for. . and maintenance of. Modification to plan of care. noting who is responsible for each action to be taken. Discharge Planning    Discharge and long-term needs. assistive devices. Specific referrals made. Attainment or progress toward desired outcome(s).