Nursing Care Plan- mobility PDF

Preview

Summary

carol scotto ...

Description

The University of Akron School of Nursing Foundations of Nursing I 8200:211 Nursing Care Plan Nursing Diagnosis Diagnostic Statement: Impaired physical mobility related to neuromuscular impairment as evidence by postural instability, uncoordinated movement, alteration in gait

Assessment: Subjective Data“I can’t stand upright without the use of a physical therapist” “I feel like I can’t do anything without worrying about what I would do if I fell”.

Objective DataPostural instability Alterations in gait Uncoordinated movement Decrease in gross motor skills Decreased range of motion

Goal/Outcome (3)

Nursing Interventions

1.Patient will describe less fear of falling and pain with physical activity by the end of the week

1a. Nurse will assess for fear of falling

2. Patient will meet mutually defined goals of increased ambulation and exercise by discharge

2a. Nurse will help the mostly immobile client achieve mobility as soon as possible, depending on physical condition

3. Patient will perform stretching exercise of each major muscle group 2 days a week for 10-60 seconds by discharge

1b. Nurse will assess muscle strength and other factors affecting balance, mobility and endurance

2b. Nurse will refer to physical therapy for strength training, using free weights, or machines and suggest participation in exercise program

3a. Nurse will perform passive ROM exercises at least twice a day unless contraindicated; repeat each maneuver three times 3b. Nurse will teach the client and caregivers processes and tools used during care to use at home to assess fall risk and promote progressive mobility

Scientific Rationale 1a. Self-reported fear of falling has been shown to be a significantly more sensitive predictor for fall risk than the STRATIFY fall risk assessment tool Ref: (Ackley, Ladwig, Makic, Martinez, Zanotti, 2020, p. 621) 1b. Assess for mobility impairment, hazards of limited mobility, and plan care to mitigate complications Ref: (Ackley et al, 2020, p. 621) 2a. A meta-analysis found exercise beneficial in increasing gait speed and improving balance and ADL performance Ref: (Ackley et al, 2020, p. 622) 2b. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program Ref (Ackley et al, 2020, p. 623) 3a. Physical rehabilitation interventions were found to be safe, reduced disability and resulted in few adverse events Ref (Ackley et al, 2020, p. 622) 3b. Results show that participants are sensitive to the risk of functional decline and use various preventative strategies particularly to maintain their physical abilities, maintain good spirits and keep a clear mind Ref (Ackley et al, 2020, p. 623)

Evaluation and Modification 1. Goal met. the patient can transfer himself confidently from bed to wheelchair and wheelchair to other surfaces patient reports decreased pain when transferring himself and when participating in physical therapy.

2. Goal met. the patient was able to now stand with the support bars and walk limited distance with support from the gait belt.

3. Goal met the patient was performing ROM exercises by himself while lying in bed to help prevent muscle atrophy the patient was aware of the positive effects of doing these exercises, so he was very driven to always accomplish them to the best of his ability....