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Impaired Physical Mobility

Impaired Physical Mobility: Limitation in independent, purposeful physical movement of
the body or of one or more extremities.
Nursing Diagnosis

Impaired Physical Mobility

May be related to

Neuromuscular involvement: weakness, paresthesia; flaccid/hypotonic paralysis
(initially); spastic paralysis

Perceptual/cognitive impairment

Possibly evidenced by

Inability to purposefully move within the physical environment; impaired
coordination; limited range of motion; decreased muscle strength/control

Desired Outcomes

Maintain/increase strength and function of affected or compensatory body part.

Maintain optimal position of function as evidenced by absence of contractures,
foot drop.

Demonstrate techniques/behaviors that enable resumption of activities.

Maintain skin integrity.

Nursing Interventions
Assess extent of impairment initially and on a
regular basis. Classify according to 0–4 scale.
Change positions at least every 2 hr (supine,
side lying) and possibly more often if placed
on affected side.
Position in prone position once or twice a day
if patient can tolerate.

Rationale
Identifies strengths and deficiencies that may
provide information regarding recovery.
Assists in choice of interventions, because
different techniques are used for flaccid and
spastic paralysis.
Reduces risk of tissue injury. Affected side has
poorer circulation and reduced sensation and is
more predisposed to skin breakdown.
Helps maintain functional hip extension;
however, may increase anxiety, especially

Pressure points over bony prominences are most at risk for decreased perfusion. Reduces risk of hypercalciuria and osteoporosis if underlying problem is hemorrhage. Assist patient with exercise and perform ROM exercises for both the affected and unaffected sides. particularly over bony prominences. Minimizes muscle atrophy. Inspect skin regularly. Evaluate need for positional aids and/or splints during spastic paralysis: Place pillow under axilla to abduct arm Elevate arm and hand Place hard hand-rolls in the palm with fingers and thumb opposed. Flexion contractures occur because flexor muscles are stronger than extensors. Maintain leg in neutral position with a trochanter roll. Gently massage any reddened areas and provide aids such as sheepskin pads as necessary. Promotes venous return and helps prevent edema formation. when appropriate. Use arm sling when patient is in upright position. Maintains functional position. Edematous tissue is more easily traumatized and heals more slowly. Prevents contractures and footdrop and facilitates use when function returns. Teach and encourage patient to use his Rationale about ability to breathe. helps prevent contractures. Note: Excessive stimulation can predispose to rebleeding. . extension of fingers and legs/feet. enhance spasticity.Nursing Interventions Prop extremities in functional position. Continued use (after change from flaccid to spastic paralysis) can cause excessive pressure on the ball of the foot. and actually increase plantar flexion. as indicated. Begin active or passive ROM to all extremities (including splinted) on admission. whereas spastic paralysis may lead to deviation of head to one side. maintaining finger and thumb in a functional position. Encourage exercises such as quadriceps/gluteal exercise. or other signs of compromised circulation. Prevents adduction of shoulder and flexion of elbow. squeezing rubber ball. edema. Maintain neutral position of head. promotes circulation. Prevents external hip rotation. Hard cones decrease the stimulation of finger flexion. Circulatory stimulation and padding help prevent skin breakdown and decubitus development. use of sling may reduce risk of shoulder subluxation and shoulder-hand syndrome. Flaccid paralysis may interfere with ability to support head. use footboard during the period of flaccid paralysis. During flaccid paralysis. Discontinue use of footboard. Observe affected side for color. Place knee and hop in extended position.

as indicated. except following cerebral hemorrhage. support patient’s lower back with hands while positioning own knees outside patient’s knees. To prevent pressure on the coccyx and skin breakdown. or pulsating mattresses or sheepskin. reducing risk of urinary stones and infections from stasis. Provide egg-crate mattress. enhancing proprioception and motor response. Helps stabilize BP (by restoring vasomotor tone). or specialized beds. Note: If stroke is not completed. Encourage patient to assist with movement and exercises using unaffected extremity to support and move weaker side. Assist patient to develop sitting balance by raising head of bed. Promotes sense of expectation of improvement. Rationale Aids in retraining neuronal pathways. activity increases risk of additional bleed. and assist patient to shift weight at frequent intervals. Specialized beds help with positioning. promotes maintenance of extremities in a functional position and emptying of bladder. decreasing pressure on bony points and helping to prevent skin breakdown and decubitus formation. and provides some sense of control and independence. and reduce venous stasis to decrease risk of tissue injury and complications such as orthostaticpneumonia. Position the patient and align his extremities correctly. Pad chair seat with foam or water-filled cushion. enhance circulation. Get patient up in chair as soon as vital signs are stable. assist in using parallel bars. water bed. May respond as if affected side is no longer part of body and needs encouragement and active training to “reincorporate” it as a part of own body. Promotes even weight distribution. Use high-top sneakers to prevent footdrop and contracture and convoluted foam. These are measures to prevent pressure ulcers. flotation device. Set goals with patient and SO for participation in activities and position changes. flotation. Assist to develop standing balance by putting flat walking shoes. . assist to sit on edge of bed.Nursing Interventions unaffected side to exercise his affected side. having patient to use the strong arm to support body weight and move using the strong leg.