Physical Mobility & Immobility Nursing Care Plan and Management

Utilize this comprehensive nursing care plan and management guide to provide effective care for patients with mobility impairments or immobility. This guide will equip you with the necessary knowledge to conduct thorough nursing assessments, implement evidence-based nursing interventions, establish appropriate goals, and identify relevant nursing diagnoses associated with immobility. By utilizing this guide, you will enhance your ability to manage and support patients with mobility challenges, promoting their overall well-being and functional independence.

Table of Contents

• What is physical mobility?
• Nursing Care Plans and Management
  • Nursing Problem Priorities
  • Nursing Assessment
  • Nursing Diagnosis
  • Nursing Goals
  • Nursing Interventions and Actions
  • 1. Assessing Mobility Status and the Need for Assistance
  • 2. Safe Client Handling
  • 3. Providing a safe environment for the client
  • 4. Proper Use of Assistive Devices
  • 5. Range of Motion Exercises and Physical Therapy
  • 6. Client Positioning, Moving, and Transferring
  • 7. Client and Caregiver Education to Prevent Falls and Injuries
    • Assessment of signs of complications or injuries
    • Preventing thromboembolism
    • Preventing pressure injuries
    • Preventing constipation and bowel complications
    • Preventing pulmonary and urinary tract infections
    • Fall prevention strategies
• Recommended Resources
• See also
• References and Sources

What is physical mobility?

A modification in movement or mobility can either be a transient, recurring, or more permanent dilemma. And when it occurs, it becomes a complex healthcare problem that involves many different members of the healthcare team. In fact, some degree of immobility is very common in most conditions such as stroke, leg fracture, multiple sclerosis, trauma, and morbid obesity. The incidence of the disease and disability continues to expand with the longer life expectancy for most Americans. In most cases, even if clients are discharged from the hospital earlier than expected, they are transferred to rehabilitation facilities or sent home for physical therapy.

Mobility is the ability of a client to change and control their body position. Physical mobility requires sufficient muscle strength and energy, along with adequate skeletal stability, joint function, and neuromuscular synchronization. Functional mobility is the ability of the client to move around in their environment, including walking, standing up from a chair, sitting down from standing, and moving around in bed. There are three main areas of functional mobility:

• Bed mobility. The ability of the client to move around in bed, including moving from lying to sitting and sitting to lying.
• Transferring. The action of the client moving from one surface to another. This includes moving from a bed into a chair or moving from one chair to another.
• Ambulation. This is the ability to walk and includes assistance from another person or an assistive device, such as a cane, walker, or crutches.

Impaired physical mobility usually includes impairments in daily life activities such as walking short distances, climbing stairs, and showering. Longitudinal studies show that obesity predicts impaired physical mobility, as a product of two simultaneous processes where getting older is associated with a decline in muscle mass but also an increase in fat mass. Increasing physical activity has been put forward to be an important intervention with the potential to detain both these processes (Asp et al., 2017).

Aging is also considered one of the factors concerning the alteration in mobility. A decrease in muscle function, loss of muscle mass, reduction in muscle strength, gait changes affecting balance, and stiffer and limited mobile joints can significantly jeopardize the mobility of older adult clients. Mobility is needed especially if an individual is to maintain independent living. Limited movement affects the performance of most ADLs. The human body is designed for motion; hence, any restriction of movement will take its toll on every major anatomic system thus resulting in impaired physical mobility.

Nursing Care Plans and Management

Appropriate mobilization of clients is important to minimize physical complications, but also to improve the social and emotional well-being of clients. Therefore, barriers to effective care must be identified and addressed. Clients who are not adequately mobilized demonstrate a significant incidence of complications. By avoiding these complications, hospital stays are reduced, which decreases the risk of additional hospital-associated complications and has a positive effect on a client’s mental and emotional health.

Nursing Problem Priorities

The following are the nursing priorities for clients with impaired physical mobility:

1. Mobility status and need for assistance. The client’s mobility status and their need for assistance can affect nursing care decisions.
2. Handling client safety. Assisting clients with impaired mobility poses an increased risk of injury to both the client and the healthcare workers, therefore, safe client handling is necessary.
3. Education and training on assistive devices. Assistive devices help the client with activities of daily living and should be used appropriately to prevent injuries.
4. Performance of range of motion exercises and physical therapy. Range of motion exercises can be performed by a client who is on bed rest or has physical limitations.
5. Client positioning, moving, and transferring. Proper positioning provides comfort to the client who has decreased mobility and helps prevent the development of complications such as deep vein thrombosis or pulmonary embolism.
6. Preventing falls and injuries. Nurses are responsible for identifying, managing, and eliminating potential fall hazards for clients.

Nursing Assessment

Because mobility issues are directly related to musculoskeletal disorders and can affect different systems of the body, mobility impairment is characterized by the following signs and symptoms that you can use in the assessment part of your nursing care plan.

Assess for the following subjective and objective data:

• Inability to move purposefully within the physical environment, including bed mobility, transfers, and ambulation
• Inability to perform the action as instructed
• Limited ROM
• Reluctance to attempt movement
• Decreased cardiac output
• Hypoventilation
• Decreased cough reflex
• Pulmonary secretion pooling
• Decreased peripheral oxygenation
• Pressure injuries
• Decreased bowel sounds and peristalsis
• Anorexia 
• Urinary discomfort

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with impairment in physical mobility based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities. 

Nursing Goals

The goals of interventions are to avoid the hazards of immobility, prevent dependent disabilities, and assist the client in restoring, preserving, or maintaining as much mobility and functional independence as possible, as evidenced by the following indicators:

• The client performs physical activity independently or within the limits of the disease.
• The client demonstrates measures to increase mobility
• The client demonstrates the use of adaptive devices to increase mobility
• The client evaluates pain and the quality of management
• The client uses safety measures to minimize the potential for injury
• The client is free from complications of immobility, as evidenced by intact skin, absence of thrombophlebitis, normal bowel pattern, and clear breath sounds.

Nursing Interventions and Actions

Physical mobility impairment is a multifaceted healthcare challenge that requires collaboration among various healthcare professionals. A continuous and comprehensive assessment is crucial to identify underlying factors contributing to impairment in the client’s physical mobility.

1. Assessing Mobility Status and the Need for Assistance

A client’s mobility status and their need for assistance affect nursing care decisions, such as handling and transferring procedures, ambulation, and implementation of fall precautions. Initial mobility assessments are typically performed on admission to a facility.

Check for functional level of mobility.
Understanding the particular level guides the design of the best possible management plan. The Functional Mobility Scale (FMS) has been constructed to classify functional mobility in clients, taking into account the range of assistive devices a client might use. The FMS rates walking ability at three specific distances: 5, 50, and 500 meters. This represents the client’s mobility at home, at school, and in the community setting. Functional levels of mobility include:

• Level 1: Walk, regular pace, on level indefinitely; one flight or more but shorter of breath than normally
• Level 2: Walk one city block or 500 ft on level; climb one flight slowly without stopping
• Level 3: Walk no more than 50 ft on a level without stopping; unable to climb one flight of stairs without stopping
• Level 4: Dyspnea and fatigue at rest

Evaluate the client’s ability to perform activities of daily living (ADL) efficiently and safely on a daily basis.
Restricted movement influences the capacity to perform most activities of daily living. Safety with ambulation is a significant matter. This determines strengths or insufficiency and may give information regarding recovery. The most frequently used checklists are the Katz Index of Independence in Activities of Daily Living and the Lawton Instrumental Activities of Daily Living (IADL) Scale. 

• Katz Index of Independence in Activities of Daily Living
  The Katz scale assesses the basic activities of daily living but does not assess more advanced ADLs. This scale assesses independence (1 point) and dependence ( 0 points) in activities such as bathing, dressing, toileting, transferring, continence, and feeding. Clients are scored yes/no for independence in each of the six functions. A score of 6 indicates full function, 4 indicates moderate impairment, and 2 or less indicates severe functional impairment.
• Lawton Instrumental Activities of Daily Living (IADL) Scale
  This scale is used to evaluate independent living skills. The scale measures eight domains of function, including food preparation, housekeeping, laundering, using the telephone, shopping, using transportation, handling medications, and handling finances. Individuals are scored according to their highest level of functioning category. A summary score ranges from 0 (low function, dependent) to 8 (high function, independent) (Edemekong et al., 2022).

Assess for impediments to mobility
Identifying barriers to mobility (e.g., chronic arthritis versus stroke versus pain) guides the design of an optimal treatment plan. Aging is a natural process that may present a decline in the functional status of clients and is a common cause of subsequent loss of ADLs. musculoskeletal, neurological, circulatory, or sensory conditions can lead to decreased physical function leading to impairment in ADLs (Edemekong et al., 2022).

Assess the type of assistance the client requires.
The level of assistance required is based on the client’s ability to transfer, stand, and cooperate in care activities. Terms to describe different levels of assistance are one way for healthcare workers to communicate with each other how much and what kind of assistance is required (Doyle & McCutcheon, 2016). The common types of assistance required include:

• Dependent: The client is unable to help at all. A mechanical lift and assistance from other personnel are required to perform tasks.
• Maximum assistance: The client can perform 25% of the mobility task while the caregiver assists with 75%.
• Moderate assistance: The client can perform 50% of the mobility task while the caregiver assists with 50%.
• Minimal assistance: The client can perform 75% of the mobility task while the caregiver assists with 25%.
• Contact guard assist: The caregiver places one or two hands on the client’s body to help with balance but provides no other assistance to perform the functional mobility task.
• Stand-by assist: The caregiver does not touch the client or provide assistance but remains close to the client for safety in case they lose their balance or need help to maintain safety during the task being performed.
• Independent: The client can safely perform the functional task with no assistance on their own.

Identify the client’s weight-bearing status.
Clients with lower extremity fractures or those recovering from knee or hip replacement progress through stages of weight-bearing activity. Therefore, the nurse, with guidance from a physical therapist, should determine the client’s weight-bearing status. The common weight-bearing prescriptions include:

• Non-weight-bearing (NWB). the leg must not touch the floor and is not permitted to support any weight at all. Crutches or other assistive devices are used for mobility.
• Toe-touch weight-bearing (TTWB). The foot or toes may touch the floor to maintain balance, but no weight should be placed on the affected leg.
• Partial weight-bearing. A small amount of weight may be supported on the affected leg. Weight may be gradually increased to 50% of body weight, which permits the person to stand with body weight evenly supported by both feet (but not walking).
• Weight-bearing as tolerated. The client can support 50% to 100% of the weight on the affected leg and can independently choose the weight supported by the extremity based on their tolerance and the circumstances.
• Full weight-bearing. The leg can support 100% of a person’s body weight, which permits walking.

Assist the client in performing the Timed Get Up and Go Test.
Several objective screening tests, such as the Timed Get Up and Go Test, have traditionally been used by nurses to assess the client’s mobility status. This test begins by having the client stand up from an armchair, walk three yards, turn around, walk back to the chair, and sit down. As the client performs these maneuvers, their posture, body alignment, balance, and gait are analyzed.

Utilize the Banner Mobility Assessment Tool (BMAT) to determine safe patient handling and mobility (SPHM).
The BMAT was developed to provide guidance regarding safe patient handling and mobility. It is used as a nurse-driven bedside assessment of client mobility and walks the client through a four-step functional task lit and identifies the mobility level the client can achieve. Today, the BMAT 2.0 incorporates new knowledge developed over five years of BMAT 1.0 use. It clarifies how to perform assessments and determine pass or fail; the nurse’s role in assessing, strengthening, and progressing clients, progression from Level 3 to Level 4; and the use of walkers, canes, crutches, and prosthetic legs, and progressing clients who use these aids.

• Level 1. This level evaluates core strength, sitting tolerance, balance, and hemodynamic stability in response to sitting upright.
• Level 2. This level evaluates the client’s ability to engage leg and foot muscles. It assesses leg strength and foot drop contracture deformity and is a precursor to weight-bearing.
• Level 3. This level evaluates the client’s ability to stand, tolerate standing, and maintain standing balance, which are precursors to ambulation.
• Level 4. This level evaluates the lenient’s ability to step into two parts: march in place and advance step and return with one foot and then the other. This is a precursor to ambulation (Boynton et al., 2020).

2. Safe Client Handling

Assisting clients with decreased mobility poses an increased risk of injury to healthcare workers. A focus on safe client handling and mobility in acute and long-term care over the past decade has resulted in decreased staff lifting injuries for the first time in 30 years . The use of body mechanics can help avoid lifting injuries, as well as the proper use of assistive lifting devices.

Assess the weight of the load before lifting and determine if assistance is needed.
The National Institute of Occupational Safety and Health (NIOSH) calculates maximum loads for lifting, pushing, pulling, and carrying for all types of employees. For example, the maximum load for employees lifting a box with handles is 50 lbs (23 kg), but this weight is decreased when the lifter has to reach, lift from near the floor, or assume a twisted or awkward position. Because clients don’t come in simple shapes and may sit or lie in awkward positions, move unexpectedly, or have wounds or devices that interfere with lifting, the safe lifting load for clients is less than the maximum 50-lb load.

Identify factors that can increase the risk of lifting injuries.
Factors that increase the risk of lifting injuries in nurses include exertion, frequency, posture, and duration of exposure. Combinations of these factors, such as high exertion while in an awkward posture, unpredictable client movements, and extended reaching, intensify the risk. When healthcare workers are exposed to ergonomic risk factors, they can become fatigued and risk musculoskeletal imbalance. Additional individual risk factors that contribute to a musculoskeletal injury include poor overall health, poor rest and recovery, poor fitness, hydration, and nutrition (Doyle & McCutcheon, 2016).

Plan the lifting and transferring movements before execution.
Before performing movements, gather all equipment or supplies needed and assess if the area is safe and clear of obstacles. Having the accessories available and checking the equipment’s battery status before using it may reduce wasted time and ensure the functioning of mobility equipment. Review proper body mechanics before starting the move (Hawkins, 2016).

Ensure proper body mechanics and alignment.
Body movement requires coordinated muscle activity and neurological integration. Body alignment and posture bring body parts into position to promote optimal balance and body function. Body mechanics is achieved by placing one body part in line with another body part in a vertical or horizontal line. Correct alignment contributes to body balance and decreases strain on muscle-skeletal structures. In body mechanics, a lower center of gravity increases stability. This can be achieved by bending the knees and bringing the center of gravity closer to the base of support, keeping the back straight. A wide base of support can be achieved by placing feet at a comfortable, shoulder-width distance apart (Doyle & McCutcheon, 2016).

Avoid stretching and twisting during lifting or transferring movements.
Twisting and stretching may place the line of gravity outside the base of support. This may cause musculoskeletal injuries. A wide base of support is the foundation for stability. If the vertical line moves outside the base of support, the body will lose balance (Doyle & McCutcheon, 2016).

Stand close to the client or the object being moved. Work at waist level.
Place the weight of the client or the object being moved close to the center of gravity for balance. Equilibrium is maintained as long as the line of gravity passes through its base of support. Keep all work at waist level to avoid stooping, or raise the height of the bed or object if possible, so that bending is avoided (Doyle & McCutcheon, 2016).

Bend both knees and avoid lifting as much as possible.
If the client is to be moved, the nurse/s may turn, roll, pivot, or make leverage because these maneuvers require less work than lifting. Additionally, bending the knees maintains the center of gravity and allows the strong muscles of the leg to do most of the work (Doyle & McCutcheon, 2016).

Integrate client handling and mobility equipment as a standard at work.
Some healthcare workers are devoted to more traditional approaches in client care, even for tasks proven to create significant safety risks for both clients and the staff. Some believe that using technology puts a barrier between them and the client, diminishing the human connection. However, using safe client-handling equipment can protect nurses and clients from injuries (Hawkins, 2016).

Ensure proper handling and use of client-handling equipment.
Many assistive devices are available to help move clients safely. The nurse must understand how these devices are meant to function to ensure safe client handling and mobility. Total assist lifts and portable devices are meant to assist clients who are physically unable to move themselves. Other lifts, such as sit-to-stand devices, require the clients to be able to bear their own weight. Understanding how to choose the appropriate device is an important client safety and caregiver requirement (Hawkins, 2016).

Regularly promote the practice of a culture of safety.
This standard calls for the employer to establish a commitment to a culture of safety. This means prioritizing safety over competing goals in a blame-free environment where individuals can report errors or incidents without fear. The standard also calls for safe staffing levels and improved communication and collaboration.

Support safe client handling and mobility programs in the facility.
This standard outlines SPHM program components, including client assessment and written guidelines for safe client handling by staff. Comprehensive SPHM programs are necessary to eliminate manual client handling. The ANA’s Safe Patient Handling and Mobility: Interprofessional National Standards and their implementation guide provide a framework for developing effective and sustainable SPHM programs (Hawkins, 2016).

Participate in education and training for safe client handling.
A system for education, training, and maintaining competence must be established in every facility so that the staff can participate in improving their knowledge about safe client handling practices, including demonstration of competency before using these types of equipment with clients.

3. Providing a safe environment for the client

Most clients, especially older adults, prefer to remain in their current homes for as long as possible. However, age-related and disease-related increases in functional limitations and fall risk interfere with the prolonged ability to age in place. Home environmental modifications can help these clients maintain independent living by improving the performance of ADLs and IADLs and reducing the risk of falls and injury (Welti et al., 2019).

Assess the safety of the environment.
Blockages such as throw rugs, children’s toys, and pets can further control and limit one’s ability to ambulate harmlessly. Inspect the client’s room, the common areas, hallways, entrances or exits, and bathrooms for safety hazards. Look for potential hazards such as uneven flooring, loose carpets, slippery surfaces, cluttered areas, low lighting, and obstacles that could impede mobility.

Provide a safe environment, such as by raising the bed rails up, placing the bed in a down position, and placing important items close by.
These measures promote a safe, secure environment and may reduce the risk of falls. Raising the bed rails provides a physical barrier that helps prevent accidental falls by keeping the client within the area of the bed. It also offers support and stability to clients with limited mobility. They act as a firm surface to hold onto when repositioning, transferring, or getting in and out of bed. A lower bed height reduces the distance and impact during transfers, making it easier and safer for clients to move from the bed to a wheelchair or chair.

Explain to the client the need to call for help, such as a call bell and special sensitive call light.
In impaired physical mobility, this intervention allows the client to have a sense of control and lowers the fear of being left alone. Call light systems are the primary means for clients to initiate communication with the healthcare staff. Previous studies have shown that the use of call lights can positively contribute to client outcomes by improving safety and satisfaction measures (Montie et al., 2017).

Teach the client or family to maintain a home atmosphere hazard-free and safe.
A safe environment will help prevent injury related to falls. Home modification can help the client maintain the desired level of functional independence and reduce fatigue with activity. Home environmental modifications, such as the addition of/changes to railings, grab bars, nonslip surfaces, shower or toilet seats, and lighting, can help older adults maintain independent living by improving the performance of ADLs and IADLs and reducing the risk of falls and injury (Welti et al., 2019).

Keep the client’s immediate surroundings free from clutter and obstacles.
A safe environment is essential for clients with limited mobility to prevent accidents and falls. Keeping the immediate surroundings free from clutter and obstacles reduces the risk of tripping or stumbling, ensuring the client’s safety and minimizing the likelihood of injuries.

Provide adequate lighting in the client’s room and pathway.
Poor lighting can hinder the client’s ability to see potential hazards or obstacles, increasing the risk of accidents and falls. By ensuring adequate lighting, the client can clearly see their surroundings, promoting a safe environment and preventing potential injuries.

Arrange furniture and equipment in ways that facilitate accessibility for the client.
Clients with limited mobility often struggle with maneuvering around furniture and equipment. By arranging them in a manner that allows easy movement and accessibility, the client can navigate their environment more comfortably and safely.

Use non-slip mats or rugs on the floor.
Slipping on smooth or wet floors can result in serious injuries for clients with limited mobility. Placing non-slip mats or rugs on the floor enhances their stability and reduces the risk of slipping, ensuring a safer environment for the client.

Plan for a home environment modification together with the client and their family members.
A plan for adaptation of the home can involve simple measures such as removing rugs and other tripping hazards, rearranging furniture, and providing simple aids such as commodes and raised toilet seats. More complex adaptations can include the installation of grab rails, alarm systems, and other building adaptations. Residential care facilities need to be environmentally designed with these principles in mind (Hertz & Santy-Tomlinson, 2018).

4. Proper Use of Assistive Devices

An assistive device is an object or piece of equipment designed to help a client with ADLs, such as a walker, cane, gait belt, or mechanical lift. These devices can be suggested by the nurse to promote safe client handling and mobility.

Evaluate the need for assistive devices.
Correct utilization of wheelchairs, canes, transfer bars, and other assistance can enhance activity and lessen the danger of falls. The Functional Mobility Assessment tool (FMA), an instrument used to assess mobility device users’ level of satisfaction with the use of a mobility device to perform ADL, meets the need for the evaluation of functional mobility using assistive devices (Paulisso et al., 2019).

Perform a client risk assessment prior to using any assistive device.
To prevent and minimize musculoskeletal injuries related to client handling activities, a risk assessment must be done to determine the client’s ability to move, the need for assistance, and the most appropriate means of assistance. The assessment process must not override clinical judgment and client-specific needs as determined by the healthcare team.

Assess self and readiness to perform procedures.
The nurse should also assess themselves if they have completed all required training according to their agency’s regulations. Non-slip footwear should be worn. The nurse should maintain a neutral spine, avoid bending or twisting to the side, and use proper body mechanics when moving or positioning the client. Proper weight-shift techniques should always be used, such as side to side, front to back, and up and down (Doyle & McCutcheon, 2016).

Assess the emotional response to the disability or limitation.
Acceptance of temporary or more permanent limitations can vary broadly between individuals. Each person has his or her personal interpretation of acceptable quality of life. Restricted mobility can generate feelings of social exclusion, reduced levels of quality of life and health, and also determines the conditions of one’s health/disease throughout life (Paulisso et al., 2019).

Provide foam or flotation mattress, water or air mattress, or kinetic therapy bed, as necessary.
These types of equipment decrease pressure on skin or tissues that can damage circulation, potentiating the risk of tissue ischemia or breakdown and pressure injury formation. Powered support surfaces are operated by electricity. Active support surfaces achieve pressure redistribution by frequently changing the points of contact between the surface and the body. Reactive support surfaces include immersion and envelopment, and distribute pressure over a greater area, thereby reducing the magnitude of the pressure at specific sites (Shi et al., 2021).

Demonstrate the use of mobility devices, such as the following: trapeze, crutches, or walkers.
These devices can compensate for impaired function and enhance the level of activity. The goals of using such aids are to promote safety, enhance mobility, avoid falls, and conserve energy. Using these devices correctly ensures the client maintains balance, reduces the risk of falls, and prevents injuries. Following the prescribed guidelines for device usage and operating it in the intended manner maximizes safety for the user.

Keep limbs in functional alignment with one or more of the following: pillows, sandbags, wedges, or prefabricated splints.
These avoid footdrop and too much plantar flexion or tightness and maintain feet in a dorsiflexed position. An ankle-foot orthosis may be used for foot drop to provide toe dorsiflexion during the swing phase, medial or lateral stability at the ankle during stance, and push-off stimulation during the lateral stance phase. The most commonly used AFO is constructed of polypropylene and inserted into a shoe (Pritchett & Panchbhavi, 2022).

Use assistive devices when moving, transferring, or lifting clients.
Gait belts are used to ensure stability when assisting clients to stand, ambulate, or transfer from bed to chair. This is placed around a client’s waist and fastened with a buckle. A slider or the transfer board is used to transfer an immobile client from one surface to another while the client is lying supine. Sit-to-stand lifts are mobility devices that assist weight-bearing clients who are unable to transition from a sitting position to a standing position using their own strength. Mechanical lifts are hydraulic lifts with a sling used to move clients who cannot bear weight or have a medical condition that does not allow them to stand or assist with moving.

5. Range of Motion Exercises and Physical Therapy

Range of motion (ROM) exercises facilitate the movement of specific joints and promote mobility of the extremities. Because changes in joints can occur after three days of immobility, ROM exercises should be started as soon as possible.

Assess the strength to perform ROM to all joints.
This assessment provides data on the extent of any physical problems and guides therapy. Testing by a physical therapist may be needed. ROM is usually assessed during physical therapy assessment or treatment. Normal values depend on the body part and individual variations (Kopelovich, 2022).

Assess the presence or degree of exercise-related pain and changes in joint mobility.
This examines the development or recession of complications and may require delaying augmenting exercises and holding until further healing occurs. Limited ROM refers to a joint that has a reduction in its ability to move. The motion may be limited because of a problem within the joint, swelling of tissue around the joint, stiffness of the muscles, or pain (Kopelovich, 2022).

Help clients in accepting limitations.
Allow the client to understand and accept his or her limitations and abilities. Assistance, on the other hand, needs to be balanced to prevent the client from being unnecessarily dependent. Acceptance can lead to improved emotional well-being, resilience, and the ability to focus on maintaining a fulfilling life despite mobility restrictions.

Provide an explanation about the progressive activity to the client.
Providing small, attainable goals helps increase self-confidence and reduces frustration. Range of motion can be maintained and gradually increased through ROM and stretching exercises. Regaining the range of motion in a joint is one of the first phases of injury rehabilitation, and the client’s activity levels may progress according to their physical assessment results (Kopelovich, 2022).

Start a program of passive stretching exercises as soon as possible.
A program of passive stretching should be started as early as possible in the course of the neuromuscular disease to prevent contractures and become part of a regular morning and evening routine. With each stretch, the position should be held for a count of 15, and each exercise should be repeated 10 to 15 times during a session. Stretching should be performed slowly and gently.

Assist the client with muscle exercises as able or when allowed out of bed; execute abdominal-tightening exercises and knee bends; hop on foot; stand on toes.
This adds to gaining an enhanced sense of balance and strengthens compensatory body parts. It is essential to increase muscle strength and range of motion, so exercise training aim to minimize impairment is recommended. There is some evidence that exercise with higher intensity and duration is related to better outcomes. Specific types of exercises are beneficial such as progressive resistance training and balance training, which can be safe and effective (Copanitsanou, 2018).

Execute passive or active assistive ROM exercises to all extremities.
Exercise enhances increased venous return, prevents stiffness, and maintains muscle strength and stamina. It also avoids contracture deformation, which can build up quickly and could hinder prosthesis usage. When a passage range of motion is applied, the joint of an individual receiving exercise is completely relaxed while an outside force moves the body part while they are lying in bed. Active assistive ROM is a joint movement with partial assistance from an outside force.

Provide the client with rest periods in between activities. Consider energy-saving techniques.
Rest periods are essential in conserving energy. The client must learn and accept his or her limitations. The nurse can help the client identify achievable objectives based on their current abilities and assist in developing strategies to work toward these goals. By accepting their limitations, the client can direct their energy and efforts toward activities that are within their capabilities.

Encourage resistance-training exercises using light weights when suitable.
Strength training and other forms of exercise are believed to be effective in maintaining independent living status and reducing the risk of falling in older adults. Regular resistance training can help the client increase their muscle strength, leading to an improved ability to perform daily activities and enhanced functional mobility.

Offer diversional activities. Observe emotional or behavioral reactions to immobility.
Forced immobility may heighten restlessness and irritability. Diversional activity helps in refocusing attention and promotes coping with limitations. Clients who acknowledge and understand their physical restrictions are more likely to explore adaptive strategies and resources available to them. This may involve utilizing assistive devices, seeking rehabilitation services, or learning new techniques for managing daily activities. This facilitates the development of positive coping.

Reinforce principles of progressive exercise, emphasizing that joints are to be exercised to the point of pain, not beyond.
“No pain, no gain” is not always true! Pain occurs as a result of joint or muscle injury. Further damage is expected if inappropriate movement is continued. Mobilization strategy, type of weight-bearing, timing, and progress of exercise depend on the type of condition or disease the client has (Copanitsanou, 2018).

Promote early mobility protocols.
The purpose of early mobility protocols is to maintain the client’s baseline mobility and functional capacity, decrease the incidence of delirium, and decrease the hospital length of stay. When early mobility protocols are in place, the nurse uses a screening tool to determine whether the client is clinically ready to attempt the protocol. It begins with reviewing the client’s neurological criteria. If the client meets the neurological criteria, they are assessed against additional criteria for respiratory, circulatory, and other considerations. If the client clears these criteria, a registered nurse may carefully initiate an early mobilization protocol in collaboration with a physical therapist.

Position affected limbs using assistive devices.
Limb positioning with assistive devices can also be used to prevent contracture formation. The limb should be placed in a resting position that opposes or minimizes flexion. Positioning aids include pillows, foot boots, handrolls, hand-wrist splints, heel or elbow protectors, abduction pillows, or a trapeze bar. Foot drop is a complication of immobility that results in plantar flexion of the foot, interfering with the ability to complete weight-bearing activities.

Administer pain medications as appropriate.
Antispasmodic medications may reduce muscle spasms or spasticity that interfere with mobility; analgesics may reduce the pain that impedes movement. Effective pain management is central to allowing the client to exercise, sleep well, and promote recovery. Clients do not always receive adequate pain management, especially those with delirium or dementia who have difficulty reporting pain. The nurse should inform the client or caregiver about when increased pain indicates a problem and about avoidance of exercise when strain is experienced (Copanitsanou, 2018).

Consider the need for home assistance (e.g., physical therapy, visiting nurse).
Obtaining suitable support or help for the client can ensure a safe and proper progression of activity. The interprofessional clinical team assists in directing the nursing home health and social work coordinators to make sure clients receive the care they need. The home health nursing staff needs to provide ongoing monitoring and report back to the clinical team should an increase in deficiency of ADLs occur (Edemekong et al., 2022).

6. Client Positioning, Moving, and Transferring

When clients are recovering from illness or have functional restrictions, they may require assistance to move around in bed, to transfer from bed to wheelchair, or to ambulate. Changing client positions in bed and mobilization is also vital to prevent contractures from immobility, maintain muscle strength, prevent pressure injuries, and help body systems function properly for optimal health and healing (Doyle & McCutcheon, 2016).

Promote and facilitate early ambulation when possible. Aid with each initial change: dangling legs, sitting in a chair, ambulation.
These movements keep the client as functionally working as possible. Early mobility increases self-esteem about reacquiring independence and reduces the chance that debilitation will transpire. After the client has been assessed and determined safe to ambulate, determine if an assistive device o the assistance of a second staff member is required. Assist the client to sit on the side of the bed and ensure that the client is wearing proper footwear. The client should be cooperative, able to bear weight on their own, have good trunk control, and be able to transition to a standing position on their own.

Help out with transfer methods by using fitting assistance of persons or devices when transferring clients to bed, chair, or a stretcher.
Learning the proper way to transfer is necessary for maintaining optimal mobility and client safety. The client must be cooperative and predictable, able to bear weight on both legs and able to take small steps and pivot to safely transfer with a one-person assist. If any of these criteria are not met, a two-person transfer or mechanical lift is recommended.

Allow the client to accomplish tasks at his or her own pace. Do not hurry the client. Encourage independent activity as able and safe.
Healthcare providers and significant others are often in a hurry and do more for clients than needed, thereby slowing the client’s recovery and reducing his or her confidence. Clients with functional immobility may require more time and effort to complete tasks due to their physical limitations, allowing them to work at their own pace enables them to perform tasks more effectively, as they can allocate their energy and focus appropriately. This leads to better task outcomes, improved client satisfaction, and a sense of accomplishment.

Help the client develop sitting balance and standing balance.
This helps out in retraining neural pathways, promoting proprioception and motor response. When practicing sitting balance, ask the client if they feel dizzy or lightheaded before stepping away from the bed. Clients who are lying in bed may experience vertigo or orthostatic hypotension, therefore, it is necessary for the nurse to allow the client to sit at the side of the bed first for a few minutes with their legs dangling.

Turn and position the client every two hours or as needed.
Position changes optimize circulation to all tissues and relieve pressure. Repositioning a bedridden client maintains body alignment and prevents pressure injuries, foot drops, and contractures. Proper positioning provides comfort for clients who have decreased mobility related to a medical condition or treatment.

See also: Patient Positioning: Complete Guide and Cheat Sheet for Nurses

• Supine position. In supine positioning, the client lies flat on their back. Pillows or other devices may be used to prevent foot drop. Additional supportive devices, such as pillows under the arms, may be added for comfort.
• Prone position. In prone positioning, the client lies on their stomach with their head turned to the side. Pillows may be placed under the lower legs to align the feet. Placing clients in the prone position may improve their oxygenation status.
• Lateral position. In lateral positioning, the client lies on one side of their body with the top leg flexed over the bottom leg. This position helps relieve pressure on the coccyx. A pillow may be placed under the top arm for comfort. The lateral position is often used for pregnant women to prevent inferior vena cava compression.
• Sims position. In Sims positioning, the client is positioned halfway between the supine and prone positions with their legs flexed. A pillow is placed under the top leg. The arms should be comfortably placed beside them, not underneath.
• Fowler position. In Fowler positioning, the head of the bed is placed at a 45- to 90-degree angle. The bed can be positioned to slightly flex the hips to help prevent the client from migrating downwards in bed. This position is used to promote lung expansion and improve the client’s oxygenation.
• Semi-Fowler position. In this positioning, the head of the bed is placed at a 30- to 45-degree angle. The client’s hips may or may not be flexed. The semi-Fowler position is used for the same purpose as the Fowler position but is generally better tolerated over long periods of time.
• Trendelenburg position. In Trendelenburg positioning, the head of the bed is placed lower than the client’s feet. This position may be used in certain situations to promote the venous return to the head and heart, such as during severe hypotension and medical emergencies.
• Tripod position. Clients who are feeling short of breath often naturally assume the tripod position, the client leans forward while sitting with their elbows on their knees or resting on a table. Clients experiencing breathing difficulties can be placed in this position to enhance lung expansion and air exchange.

Assist in moving the client up in bed.
When moving the client up in bed, first determine the level of assistance needed to provide optimal client care. It is vital to prevent friction and shear when moving the client up in bed to prevent pressure injuries. If the client is unable to assist with repositioning in bed, follow agency policy regarding using lifting devices and mechanical lifts. If the client is able to assist with repositioning and minimal lifting by staff is required, ask assistance from a colleague to help with the move and prevent injury.

Assist the client in a seated position.
Prior to ambulating, repositioning, or transferring a client from one surface to another, it is often necessary to move the client to the side of the bed to avoid straining or excessive reaching by the healthcare professional. Positioning the client to the side of the bed also allows the healthcare worker to have the client as close as possible to their center of gravity for optimal balance during client handling.

Guide the client during ambulation.
After a client has been assessed and determined safe to ambulate, determine if assistive devices or the assistance of a second staff member is required. Assist the client to sit on the side of the bed and ensure that they are wearing proper footwear. Apply a gait belt snugly over their clothing. The client should be cooperative, able to bear weight on their own, have good trunk control, and be able to transition to a standing position on their own. The nurse may gently grasp the client’s forearm and place one arm firmly under the client’s axilla.

Assist in transferring from bed to chair or wheelchair.
Clients often require assistance when moving from a bed to a chair or wheelchair. Proper footwear should be worn by the client and the bed must be placed at its lowest position. The wheelchair brakes must be applied and secured. If the client has weakness on one side, the wheelchair should be placed on the strong side. Stay close to the client during the transfer and ask the client to place their hands on the nurse’s waist, not the neck. Assist the client to lower themselves while the nurse shifts their weight from the back of the leg to the front leg with the knees bent.

Lower the client to the floor safely as indicated.
The client may begin to fall while ambulating or while being transferred from one surface to another. If the client begins to fall from a standing position, the nurse must not attempt to stop the fall or catch the client because it can cause back injury. Instead, they may try to control the fall by lowering the client to the floor. If the client starts to fall, the nurse moves behind the client and supports the client around the waist or hip area or grabs the gait belt. The nurse’s leg may be bent and placed between the client’s legs, and the client is slowly slid down the nurse’s leg lowering themselves to the floor at the same time. The client’s head should always be protected first.

7. Client and Caregiver Education to Prevent Falls and Injuries

The client’s education and counseling regarding mobility are necessary. Client attendants and other caregivers must receive appropriate counseling also, as they will be responsible for providing client mobility after discharge from the facility (Javed & Davis, 2023).

Assessment of signs of complications or injuries

Assess the client’s or caregiver’s understanding of immobility and its implications.
The risk for effects of immobility such as muscle weakness, skin breakdown, pneumonia, constipation, thrombophlebitis, and depression are also to be considered in clients with temporary immobility.  Deep venous thrombosis, pressure injuries, muscle atrophy, pulmonary embolism, and bone demineralization are potential complications of inadequate mobilization, and active intervention is necessary to optimize client outcomes (Javed & Davis, 2023).

Assess input and output records and nutritional patterns.
Pressure ulcers build up more rapidly in clients with nutritional insufficiency. Research indicates that inadequate nutrition delays healing because of a reduction in fibroblast production and collagen synthesis. Low levels of hemoglobin and hematocrit increase pressure injury risk. Nutrition evaluation and the application of the Braden Scale enable healthcare professionals to assess nutrition deficiencies and pressure injury risk (Schott et al., 2020).

Monitor nutritional needs as they relate to immobility.
Good nutrition also gives the required energy for participating in exercise or rehabilitative activities. It has been shown that clients who stayed in the hospital for longer than 15 days presented a higher nutrition risk because of significant weight loss during this period. Weight loss may be a risk factor for pressure injury development. Low BMI, hypocholesterolemia, and low levels of both hemoglobin and hematocrit may raise the risk of a pressure injury occurrence (Schott et al., 2020).

Note for progressing thrombophlebitis (e.g., calf pain, Homan’s sign, redness, localized swelling, and a rise in temperature).
Prolonged bed rest or immobility allows clot formation in the impaired physical mobility nursing diagnosis. Signs and symptoms of thromboembolism can be nonspecific, such as pain, tenderness, changes in color and temperature of the skin, edema, and, in the case of pulmonary embolism, dyspnea, chest pain, increased respirations, and hemoptysis (Copanitsanou, 2018).

Check for skin integrity for signs of redness and tissue ischemia (especially over ears, shoulders, elbows, sacrum, hips, heels, ankles, and toes).
Routine inspection of the skin (especially over bony prominences) will allow for the prevention or early recognition and treatment of pressure ulcers. The Brade Scale is a tool periodically used in hospital settings to prevent the onset of pressure injuries. It is usually implemented within eight hours of the client’s admission. It is widely employed for the prevention, identification, and classification of pressure injury risk (Schott et al., 2020).

Note elimination status (e.g., usual pattern, present patterns, signs of constipation).
Immobility promotes constipation, decreasing the motility of the gastrointestinal tract. Assessment for constipation should include the number of bowel movements per day/week, abdominal distention and discomfort, abdominal or rectal pain, decreased appetite, nausea, vomiting, bowel obstruction, headache, fatigue, agitation, and delirium. The nurse should document the usual bowel patterns, the severity of constipation, and any improvements or progression of constipation (Copanitsanou, 2018).

Assess for signs and symptoms of urinary tract infection (UTI).
Assessment for UTI includes monitoring for fever, burning during urination/dysuria, urgency and frequency of urination, suprapubic or pelvic pain, hematuria, and new onset or worsening of pre-existing confusion/agitation. Urine color, concentration, odor, reduced volume, and cloudiness should be reported to the provider immediately (Hertz & Santy-Tomlinson, 2018).

Preventing thromboembolism

Establish measures to prevent thrombophlebitis from prolonged immobility.

• Use anti-embolic stockings or sequential compression devices if appropriate.
• Use pressure-relieving devices as indicated (gel mattress).

This is to prevent skin breakdown, and the compression devices promote an increased venous return to prevent venous stasis and possible thrombophlebitis in the legs. Intermittent pneumatic compression can reduce the risk of VTE. Anti-embolism stockings are effective but are difficult, and sometimes painful, to put on and can cause skin injury in people with fragile skin or vascular insufficiency (Copanitsanou, 2018).

Promote adherence to heparin therapy.
It has been shown that the administration of heparin leads to a reduction in the frequency of lower limb thromboembolism, but not pulmonary embolism. Guidelines state that chemoprophylaxis with fondaparinux should continue for four weeks after surgery. Fondaparinux seems to be more efficient than low molecular-weight heparins in preventing thromboembolism (Hertz & Santy-Tomlinson, 2018).

Instruct the client about the benefits of early mobilization.
Early mobilization is simple and particularly effective in lowering the risk of thrombosis, as it increases blood flow, prevents the formation of clots, and has an impact on physiological and psychological health with no bleeding complications (Hertz & Santy-Tomlinson, 2018).

Preventing pressure injuries

See also: 5 Pressure Injuries (Bedsores) Nursing Care Plans

Establish measures to prevent skin breakdown, such as cleaning, drying, and moisturizing the skin as necessary.
Various creams, lotions, and ointments have been used as part of pressure injury prevention strategies, with the proposed mechanism of action being a reduction in frictional forces and the promotion and maintenance of healthy skin (Mervis & Phillips, 2019).

Provide suggestions for nutritional intake for adequate energy resources and metabolic requirements.
Proper nutrition is vital to keep a sufficient energy level. The client will need an adequate, properly balanced intake of carbohydrates, fats, proteins, vitamins, and minerals to provide energy resources. A sudden and dramatic increase in protein intake following a relatively severe injury will lead to a negative nitrogen balance resulting in impaired wound healing and/or increased muscle loss during periods of reduced activity (Tipton, 2018).

Encourage a diet high in fiber and a liquid intake of 2000 to 3000 ml per day unless contraindicated.
Liquids maximize hydration status and avoid the hardening of stool. It also decreases the risk of skin irritation or breakdown. Laxatives may not be necessary for clients who are well-hydrated and follow a rich diet of fiber (Copanitsanou, 2018).

Preventing constipation and bowel complications

Set up a bowel program (e.g., adequate fluid, foods high in bulk, physical activity, stool softeners, and laxatives) as needed. Note bowel activity levels.
A sedentary lifestyle contributes to constipation. A variety of interventions will promote normal elimination. The prevention and treatment of constipation involve the documentation of stool type and bowel function, maintaining good nutrition and hydration status, minimizing anxiety, and maintaining the client’s privacy. A regular toileting regime that encourages ambulation and discourages the use of bedpans can also assist in the prevention (Copanitsanou, 2018).

Preventing pulmonary and urinary tract infections

See also: Risk for Infection and Infection Control Nursing Care Plan and Management

Encourage coughing and deep-breathing exercises. Use suction as necessary. Make use of an incentive spirometer.
Coughing and breathing exercises prevent the buildup of secretions. Incentive spirometry increases lung expansion. It is important for the nurse to provide proper instructions and guidance on deep breathing and coughing exercises. They should monitor the client’s tolerance, provide support as needed, and ensure exercises are performed correctly and safely. Deep breathing and coughing exercises should be practiced regularly, multiple times a day, to maximize their benefits for lung health and respiratory function.

Instruct the caregiver to place the client in a semi-Fowler position and to reposition them regularly.
The client should be positioned in a semi-Folwer position to facilitate breathing, while repositioning helps in loosening lung secretion to promote effective gas exchange (Hertz & Santy-Tomlinson, 2018).

Avoid indwelling catheterization or promote early catheter removal.
Indwelling urinary catheters are often inserted on admission or are used postoperatively to accommodate the client’s limited independence. Clients with indwelling catheters are more likely to have positive cultures compared to those following intermittent catheterization and the risk of UTI increases by an estimated 5 to 10% for every 48 hours of indwelling catheter placement (Hertz & Santy-Tomlinson, 2018).

Fall prevention strategies

See also: Fall Risk and Fall Prevention Nursing Care Plan

Instruct the caregivers about fall prevention strategies.
If the client begins to feel dizzy while ambulating or transferring, instruct the caregiver to assist the client to sit on a chair or on the floor to avoid a fall. The head is the most important part of the body, therefore it must be protected always.

Emphasize the importance of exercise to prevent falls.
Exercise strategies for fall prevention focus on balance, strength training, and aerobic fitness to improve the individuals’ postural stability and ability to resist falling. Refer the client to group or home-based exercise programs that can reduce the risk of falls along with some effect on fear of falling. Supervised exercise sessions are also recommended at the outset of work towards improving strength and stability before embarking on a self-led home exercise program (Hertz & Santy-Tomlinson, 2018).

Refer the client for a vision assessment as indicated.
Visual impairment is a common contributor to fall risk; affecting balance, the ability to avoid obstacles, judgment of distance, and spatial awareness. A formal assessment of vision should be offered, along with the reduction of environmental hazards and support for the individual’s own coping mechanisms (Hertz & Santy-Tomlinson, 2018).

Promote the use of proper footwear and foot care education.
Modification of footwear and care of the feet is a fundamental aspect of falls prevention, many clients at risk of falls will have type 2 diabetes, so it is important to help them understand the need for inspection of feet daily, including the soles of the feet, in order to identify potential ulcers or broken skin as early as possible. All older adults should be advised to wear supportive shoes rather than slippers or walk in socks at home (Hertz & Santy-Tomlinson, 2018).

Provide psychological support for the client’s fear of falling.
Fear of falling is a psychological consequence of previous falls. Fear leads to anxiety, loss of confidence, and isolation due to decreased activity. This can be mitigated by the use of strategies that include gradually and sensitively reintroducing the person to remobilization using realistic short- and long-term goal setting, supporting attempts to mobilize with encouragement and use of mobility aids, allowing plenty of time for the completion of activities and offering plenty of opportunities to practice a little and often (Hertz & Santy-Tomlinson, 2018).

Provide positive reinforcement during the activity. Clients may be unwilling to move or initiate new activities because of fear of falling.
This is to boost the client’s chances of recovering and increase his or her self-esteem. Positive reinforcement can significantly enhance the client’s motivation and engagement in their rehabilitation or daily activities. It can counteract negative feelings by highlighting the client’s strengths, progress, and abilities and boosting their self-confidence.

Set goals with the client or significant others for cooperation in activities or exercise and position changes.
This enhances a sense of anticipation of progress or improvement and gives some sense of control or independence. Setting clear goals helps the client prioritize their efforts, energy, and resources towards specific outcomes, enhancing their overall sense of purpose and motivation. Goal setting also empowers clients by giving them a sense of control and autonomy over their own care.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database ^{MUST READ!}
  Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
  Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

References and Sources

Additional references and recommended reading material for Impaired Physical Mobility nursing diagnosis:

• Pedrão, T. G. G., Brunori, E. H. F. R., Santos, E. D. S., Bezerra, A., & Simonetti, S. H. (2018). NURSING DIAGNOSES AND INTERVENTIONS FOR CARDIOLOGICAL PATIENTS IN PALLIATIVE CARE. Journal of Nursing UFPE/Revista de Enfermagem UFPE, 12(11). [Link]