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Impaired Physical Mobility — Fracture Nursing Care Plan (NCP)

Posted by: Matt Vera in Nursing Care Plans April 5, 2012 Last updated on 0 89 Views

Impaired Physical MobilityNursing Diagnosis: Impaired Physical Mobility

May be related to

  • Neuromuscular skeletal impairment; pain/discomfort; restrictive therapies (limb immobilization)
  • Psychological immobility

Possibly evidenced by

  • Inability to move purposefully within the physical environment, imposed restrictions
  • Reluctance to attempt movement; limited ROM
  • Decreased muscle strength/control

Desired Outcomes

  • Regain/maintain mobility at the highest possible level.
  • Maintain position of function.
  • Increase strength/function of affected and compensatory body parts.
  • Demonstrate techniques that enable resumption of activities.

Impaired Physical Mobility — Fracture Nursing Care Plan (NCP)

Nursing Interventions Rationale
 Assess degree of immobility produced by injury/treatment and note patient’s perception of immobility.  Patient may be restricted by self-view/self-perception out of proportion with actual physical limitations, requiring information/interventions to promote progress toward wellness.
 Encourage participation in diversional/recreational activities. Maintain stimulating environment, e.g., radio, TV, newspapers, personal possessions/pictures, clock, calendar, visits from family/friends.  Provides opportunity for release of energy, refocuses attention, enhances patient’s sense of self-control/self-worth, and aids in reducing social isolation.
 Instruct patient in/assist with active/passive ROM exercises of affected and unaffected extremities.  Increases blood flow to muscles and bone to improve muscle tone, maintain joint mobility; prevent contractures/atrophy and calcium resorption from disuse
 Encourage use of isometric exercises starting with the unaffected limb.  Isometrics contract muscles without bending joints or moving limbs and help maintain muscle strength and mass. Note: These exercises are contraindicated while acute bleeding/edema is present.
 Provide footboard, wrist splints, trochanter/hand rolls as appropriate.  Useful in maintaining functional position of extremities, hands/feet, and preventing complications (e.g., contractures/footdrop).
 Place in supine position periodically if possible, when traction is used to stabilize lower limb fractures.  Reduces risk of flexion contracture of hip.
 Instruct in/encourage use of trapeze and “post position” for lower limb fractures.  Facilitates movement during hygiene/skin care and linen changes; reduces discomfort of remaining flat in bed. “Post position” involves placing the uninjured foot flat on the bed with the knee bent while grasping the trapeze and lifting the body off the bed.
 Assist with/encourage self-care activities (e.g., bathing, shaving).  Improves muscle strength and circulation, enhances patient control in situation, and promotes self-directed wellness.
 Provide/assist with mobility by means of wheelchair, walker, crutches, canes as soon as possible. Instruct in safe use of mobility aids.  Early mobility reduces complications of bed rest (e.g., phlebitis) and promotes healing and normalization of organ function. Learning the correct way to use aids is important to maintain optimal mobility and patient safety.
 Monitor blood pressure (BP) with resumption of activity. Note reports of dizziness.  Postural hypotension is a common problem following prolonged bed rest and may require specific interventions (e.g., tilt table with gradual elevation to upright position).
 Reposition periodically and encourage coughing/deep-breathing exercises.  Prevents/reduces incidence of skin and respiratory complications (e.g., decubitus, atelectasis, pneumonia).
Auscultate bowel sounds. Monitor elimination habits and provide for regular bowel routine. Place on bedside commode, if feasible, or use fracture pan. Provide privacy. Bed rest, use of analgesics, and changes in dietary habits can slow peristalsis and produce constipation. Nursing measures that facilitate elimination may prevent/limit complications. Fracture pan limits flexion of hips and lessens pressure on lumbar region/lower extremity cast.
Encourage increased fluid intake to 2000–3000 mL/day (within cardiac tolerance), including acid/ash juices. Keeps the body well hydrated, decreasing risk of urinary infection, stone formation, and constipation
Provide diet high in proteins, carbohydrates, vitamins, and minerals, limiting protein content until after first bowel movement. In the presence of musculoskeletal injuries, nutrients required for healing are rapidly depleted, often resulting in a weight loss of as much as 20/30 lb during skeletal traction. This can have a profound effect on muscle mass, tone, and strength. Note: Protein foods increase contents in small bowel, resulting in gas formation and constipation. Therefore, gastrointestinal (GI) function should be fully restored before protein foods are increased.
Increase the amount of roughage/fiber in the diet. Limit gas-forming foods. Adding bulk to stool helps prevent constipation. Gas-forming foods may cause abdominal distension, especially in presence of decreased intestinal motility.
Consult with physical/occupational therapist and/or rehabilitation specialist. Useful in creating individualized activity/exercise program. Patient may require long-term assistance with movement, strengthening, and weight-bearing activities, as well as use of adjuncts, e.g., walkers, crutches, canes; elevated toilet seats; pickup sticks/reachers; special eating utensils.
Initiate bowel program (stool softeners, enemas, laxatives) as indicated. Done to promote regular bowel evacuation.
Refer to psychiatric clinical nurse specialist/therapist as indicated. Patient/SO may require more intensive treatment to deal with reality of current condition/prognosis, prolonged immobility, perceived loss of control.

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