Impaired physical mobility – NANDA Diagnoses

NANDA Nursing Diagnose - Impaired physical mobility

Code: 00088
Domain: Domain 4 - Activity - rest
Class: Class 2 - Activity - exercise
Status: Retired diagnoses

The NANDA-I diagnosis 'Impaired physical mobility' plays a crucial role in the assessment and management of patients facing challenges related to movement. Recognizing the implications of impaired mobility is vital not only for enhancing patient quality of life but also for preventing complications that may arise due to reduced physical activity. As healthcare professionals, understanding this diagnosis empowers us to develop tailored care plans that promote independence, safety, and overall well-being for our patients.

This exploration will delve into the nuances of the NANDA-I diagnosis 'Impaired physical mobility,' beginning with a comprehensive definition. The discussion will further illuminate the defining characteristics that signify this diagnosis, alongside the various related factors and at-risk populations. By examining these elements, the post aims to provide a well-rounded overview that highlights the significance of this diagnosis in nursing practice and patient care.

Definition of the NANDA-I Diagnosis

Impaired physical mobility refers to a condition characterized by restrictions or limitations in an individual's ability to move freely and independently, resulting in a compromised capacity to engage in essential movements necessary for daily functioning. This diagnosis encompasses various degrees of mobility challenges, which can involve difficulty with walking, transferring between positions, or performing activities that require physical exertion. The limitations can arise from physiological factors, such as decreased muscle strength or coordination, as well as environmental barriers, such as unsafe surfaces or inadequate mobility aids. Additionally, psychological components like fear of falling or cognitive impairments may further inhibit physical movement. As a multifactorial issue, impaired physical mobility can significantly impact an individual’s quality of life, influencing their social interactions, emotional well-being, and overall health. Understanding this diagnosis is crucial for developing tailored nursing interventions that promote rehabilitation and enhance patients' mobility and independence.

Defining Characteristics of the NANDA-I Diagnosis

The NANDA-I diagnosis "Impaired physical mobility" is identified by its defining characteristics. These are explained below:

Subjective Characteristics
- Dificultad para caminar en declive The challenge patients face when descending slopes is indicative of impaired physical mobility. This difficulty can signal a lack of strength or balance, heightening the risk of falls. Clinically, the assessment may reveal compensatory strategies, such as using handrails or taking small steps, which show the patient's altered gait pattern and their heightened fear of instability.
- Dificultad para caminar en pendiente Struggling to walk uphill can reflect diminished cardiovascular endurance and muscle strength, both fundamental to mobility. Clinically, these patients can experience dyspnea or fatigue during exertion, which can further discourage activity and lead to increased dependency on assistive devices, exemplifying the cycle of declining mobility.
- Dificultad para caminar en una superficie irregular Patients may report feeling unstable on uneven surfaces, which indicates poor proprioception and balance. This fear and physical hesitation to navigate such environments can further restrict their mobility and contribute to a sedentary lifestyle, exacerbating their existing condition.
- Dificultad para caminar la distancia requerida When patients express an inability to walk necessary distances for daily activities, it demonstrates significant mobility impairment that hampers independence. Measuring their walking distance during assessments can provide objective data to evaluate progress or deterioration.
- Dificultad para subir escaleras The difficulty in ascending stairs indicates weakness and balance issues, limiting functional mobility in environments with changes in elevation. Clinically, patients may exhibit decreased lower extremity strength, which can be assessed through performance measures like the timed up-and-go test.
- Dificultad para superar los bordillos Inability to navigate minor elevations shows an exaggerated fear of falling and indicates significant loss of functional mobility. Assessing how a patient approaches curbs can reveal adaptations that may hinder recovery, highlighting the need for targeted interventions.
Objective Characteristics
- Alteración del estado anímico Psychological factors such as depression or anxiety can significantly affect mobility motivation. The assessment may include screening tools indicating potential mood disorders that could impede the patient's willingness to participate in mobility-enhancing activities.
- Disfunción cognitiva Cognitive impairments can limit a patient's ability to plan and execute movements, directly impeding mobility. Cognitive assessments may reveal deficits that impact the patient's understanding of safe movement, necessitating targeted interventions to enhance mobility.
- Limitaciones del entorno Environmental barriers, such as architectural obstacles or lack of assistance, can restrict mobility. An environmental assessment should include evaluations of the patient's surroundings, identifying specific limitations that can be modified to improve access and independence.
- Temor a las caídas Anxiety related to falling can significantly diminish mobility levels. Clinical assessments may document avoidance behaviors that further curb physical activity, underscoring the need for interventions aiming at building confidence and addressing fear-based mobility issues.
- Conocimiento inadecuado sobre estrategias de movilidad Lack of awareness regarding mobility strategies compromises the patient’s ability to engage in movement, evidencing the essential role of education in promoting mobility techniques. Evaluation of the patient's knowledge can guide educational interventions to improve their capabilities.
- Fuerza muscular insuficiente Insufficient muscular strength correlates directly with impaired mobility, affecting the patient’s ability to perform basic movements. Objective measurements, such as hand-held dynamometry, can quantify strength deficits and inform strength-building interventions.
- Resistencia física insuficiente A lack of adequate physical endurance manifests in premature fatigue during activity, exacerbating mobility issues. Assessments like the six-minute walk test can evaluate endurance levels, which are crucial for planning appropriate rehabilitation activities.
- Manifestaciones neurocomportamentales Behavioral changes linked to neurological disorders can disrupt motor function, limiting mobility. Observational assessments may indicate signs of apraxia or other motor planning impairments that necessitate specialized therapeutic approaches.
- Obesidad Excess weight can hinder movement, highlighting the need for targeted weight management strategies. Calculating the body mass index (BMI) can provide relevant data regarding the degree of obesity and its impact on mobility.
- Dolor Chronic or acute pain restricts physical activity, contributing to mobility deterioration. Effective pain assessments and management strategies are critical to enabling the patient to engage in mobility-enhancing interventions.
- Pérdida de la condición física Physical inactivity and deconditioning are prevalent in patients with impaired mobility, leading to a downward spiral of decreased strength and endurance. Functional assessments can outline the extent of deconditioning, guiding rehabilitation efforts.

Related Factors (Etiology) of the NANDA-I Diagnosis

The etiology of "Impaired physical mobility" is explored through its related factors. These are explained below:

Cerebrovascular Disorders
Cerebrovascular disorders, such as strokes, significantly disrupt motor control, leading to hemiplegia or hemiparesis, which directly impairs mobility. The neurological damage interferes with the body’s ability to coordinate movements, making it difficult for patients to initiate steps or maintain postural stability. This loss of function can result in an increased risk of falls and further injury, which creates a cycle of dependency and fear regarding mobility. Clinical considerations include careful assessment of motor function and the need for targeted rehabilitation strategies that facilitate safe mobility, such as physical therapy aimed at regaining strength and coordination.
Postural Balance Impairment
Postural balance impairment results when a patient cannot maintain stability during dynamic or static activities. This often follows neurological deficits or musculoskeletal weaknesses. Without adequate postural control, patients are at risk of falls, leading to fractures or other serious injuries. Clinically, this necessitates balance training interventions and environmental modifications to create a safer setting for movement. Continuous monitoring of the patient’s stability during transfer or ambulation is crucial to prevent accidents and promote confidence in mobility.
Musculoskeletal Deterioration
Deterioration of the musculoskeletal system, characterized by conditions like arthritis or degenerative joint disease, compromises strength and range of motion. Such conditions inhibit physical mobility by causing pain and stiffness, discouraging physical activity. In clinical practice, a focused approach involving pain management, physical therapy, and strength-building exercises is essential to restore mobility and function. Patient education about joint protection strategies and adaptive devices further helps manage mobility limitations effectively.
Neuromuscular Diseases
Neuromuscular diseases, including multiple sclerosis or amyotrophic lateral sclerosis, lead to muscle weakness and coordination loss, directly affecting mobility. These diseases disrupt the communication between nerves and muscles, limiting patients' ability to perform voluntary movements. Interventions should focus on maintaining as much mobility as possible through adaptive techniques and assistive devices. Educating patients about their condition while encouraging participation in tailored exercise programs can optimize physical function and prolong mobility.
Visual Disorders
Visual disorders, such as cataracts or macular degeneration, substantially impact mobility since vision is critical for spatial awareness and navigation. Impaired vision can result in difficulty recognizing obstacles or maintaining balance, which can severely limit a patient's ability to move safely. Clinically, comprehensive assessments of visual capabilities are vital, and providing solutions such as corrective lenses, proper lighting, and mobility training can significantly enhance safety and independence during ambulation.

Problems Associated with the NANDA-I Diagnosis

The diagnosis "Impaired physical mobility" can interrelate with other problems. These are explained below:

Neurological Disorders
Neurological disorders, particularly cerebrovascular accidents (strokes), can significantly impair mobility by affecting the motor centers of the brain. Strokes may lead to loss of mobility on one side of the body, a condition known as hemiplegia. This not only limits physical movement but can also drastically alter the patient’s quality of life. Therefore, assessing for neurological complications is critical in the management of impaired physical mobility, as rehabilitation efforts may need to focus on retraining motor skills and enhancing functional independence.
Postural Balance Impairment
Deterioration of postural balance is closely tied to impaired physical mobility. A compromised ability to maintain balance can elevate the risk of falls and subsequent injuries, which can create a feedback loop worsening the patient's mobility. When patients experience frequent falls, they may develop a fear of falling, leading to further immobility and social withdrawal. This condition underscores the importance of strength training, balance exercises, and safety assessments in the holistic care of patients with mobility issues.
Musculoskeletal Deterioration
Musculoskeletal problems, such as arthritis or muscular deconditioning, are prevalent among patients with impaired mobility. These conditions not only restrict motion but also can lead to persistent pain, further complicating rehabilitation efforts. It is essential for care planning to include a comprehensive assessment of musculoskeletal health, potentially involving physical therapy, pain management, and mobility aids to facilitate better movement and reduce discomfort.
Neuromuscular Diseases
Certain neuromuscular diseases, including multiple sclerosis and muscular dystrophy, profoundly affect muscle strength and movement coordination. The impairment results in significant physical mobility challenges that require ongoing interdisciplinary management. Care must include targeted physical therapy, nutritional support, and possibly interventions to assist with daily living activities. Recognizing these underlying conditions is crucial to tailor therapies that enhance the patient’s functional abilities and quality of life.
Visual Impairments
Visual disorders can heavily influence mobility since they compromise spatial awareness and safety during movement. Patients with impaired vision may struggle with navigating environments, leading to increased risk of accidents and falls. This situation necessitates an interdisciplinary approach that includes ophthalmology assessments, environmental modifications, and possibly orientation and mobility training to improve the patient's confidence and independence in movement.

NOC Objectives / Expected Outcomes

For the NANDA-I diagnosis "Impaired physical mobility", the following expected outcomes (NOC) are proposed to guide the evaluation of the effectiveness of nursing interventions. These objectives focus on improving the patient's status in relation to the manifestations and etiological factors of the diagnosis:

Physical Mobility
This outcome measures the patient's ability to move independently and perform activities of daily living. It is directly relevant to "Impaired physical mobility" as it provides a foundational assessment of mobility levels, enabling nurses to quantify improvements and tailor interventions accordingly.
Functional Mobility
This outcome focuses on the patient's capability to move safely and efficiently within their environment. By assessing functional mobility, nursing staff can identify barriers to mobility, such as environmental hazards or physical limitations, allowing for targeted interventions to enhance stability and safety in movement.
Activity Tolerance
This outcome evaluates the patient’s endurance and ability to engage in physical activities. It is crucial for "Impaired physical mobility" as improving activity tolerance can indicate progress in strength, energy levels, and overall physical fitness, empowering the patient to be more active and reducing the risk of complications associated with immobility.
Ambulation
This outcome assesses the patient’s ability to walk and move from one location to another independently or with assistance. Setting this as an expected outcome demonstrates a commitment to improving gait and balance, which are critical for enhancing the quality of life and preventing injuries related to falls.

NIC Interventions / Nursing Care Plan

To address the NANDA-I diagnosis "Impaired physical mobility" and achieve the proposed NOC objectives, the following nursing interventions (NIC) are suggested. These interventions are designed to treat the etiological factors and manifestations of the diagnosis:

Mobility Training
This intervention involves guiding the patient through exercises and activities to enhance their physical mobility. It helps to improve strength, coordination, and balance, which are essential for patients to regain independence in movement.
Range of Motion Therapy
This intervention includes passive or active exercises that promote joint flexibility and muscle strength. It reduces the risk of contractures and helps maintain functional mobility, which is vital in enhancing the patient's ability to move independently.
Assistive Device Training
This intervention focuses on instructing the patient in the proper use of assistive devices such as walkers, canes, or wheelchairs. By ensuring the patient gains the skills necessary to use these devices, it promotes mobility and safety, reducing the risk of falls.
Positioning Techniques
This intervention involves educating the patient about proper body positioning to enhance comfort and reduce the risk of pressure injuries. Proper positioning can alleviate pain and discomfort, thus encouraging the patient to engage in mobility activities.
Activity Engagement
This intervention encourages participation in daily activities and therapeutic exercises that are appropriate for the patient's current level of mobility. Engaging the patient promotes muscle strength and endurance, which are crucial for improving overall mobility.

Detailed Nursing Activities

The NIC interventions for the NANDA-I diagnosis "Impaired physical mobility" are composed of specific activities that nursing staff carry out to provide effective care. Below, examples of activities for the key identified interventions are detailed:

For the NIC Intervention: Mobility Training

Assess the patient's baseline mobility level to tailor the training program effectively and set realistic goals.
Guide the patient in performing specific exercises, such as leg lifts and seated marches, to enhance their strength and endurance.
Encourage the patient to practice ambulating with supervision, gradually increasing the distance as tolerated to build confidence and stamina.
Track progress in mobility over time using a mobility scale, adjusting the training regimen as necessary to ensure continued improvement.

For the NIC Intervention: Range of Motion Therapy

Conduct daily range of motion (ROM) exercises, both passive and active, to prevent contractures and promote joint flexibility.
Utilize splints or supports as needed while performing ROM exercises to ensure correct positioning and prevent injury.
Provide education to the patient and family on the importance of ROM exercises for maintaining functional mobility and overall health.
Document any improvements or limitations observed during therapy sessions to inform future care plans.

For the NIC Intervention: Assistive Device Training

Evaluate the patient’s specific mobility needs to select the most appropriate assistive device (e.g., walker, cane, wheelchair).
Demonstrate the proper use and technique for the selected assistive device, ensuring the patient understands how to use it safely.
Encourage the patient to practice using the device in a controlled environment to build confidence before attempting in other settings.
Provide ongoing support in adjusting and fitting the assistive device to maximize comfort and functionality.

Practical Tips and Advice

To more effectively manage the NANDA-I diagnosis "Impaired physical mobility" and improve well-being, the following suggestions and tips are offered for patients and their families:

Use Assistive Devices

Utilizing mobility aids such as walkers, canes, or grab bars can provide stability and support while moving. These devices can help prevent falls and encourage independence in daily activities.
Set Up Your Environment

Keeping your living space organized and free of obstacles is crucial. Arrange furniture for easy navigation and use non-slip mats to enhance safety, allowing for smoother movement around the home.
Establish a Routine

Create a daily schedule that incorporates physical activity, even if it’s light exercise or stretching. Consistency can improve strength, flexibility, and mobility over time, enhancing overall well-being.
Focus on Strengthening Exercises

Engaging in prescribed physical therapy or gentle strengthening exercises helps improve mobility and endurance. Consult with a healthcare provider to develop a tailored exercise plan that suits your capabilities.
Prioritize Nutrition

A balanced diet rich in vitamins and minerals supports muscle strength and overall health. Adequate hydration and proper nutrition can aid recovery and optimize your mobility potential.
Practice Safe Transfers

Learn proper techniques to move in and out of bed, chairs, and vehicles safely. This reduces the risk of injury and builds confidence in your ability to navigate your surroundings.
Communicate Regularly with Healthcare Providers

Keep an open line of communication with your healthcare team to address any pain or mobility concerns promptly. Regular check-ins can help adjust care plans and improve mobility outcomes.

Practical Example / Illustrative Case Study

To illustrate how the NANDA-I diagnosis "Impaired physical mobility" is applied in clinical practice and how it is addressed, let's consider the following case:

Patient Presentation and Clinical Context

Mr. John Smith is a 68-year-old male with a history of osteoarthritis and hypertension. He presents to the outpatient clinic for follow-up after a total knee replacement surgery performed two weeks ago. Mr. Smith reports difficulty in moving about his home and is concerned about his ability to regain independence in his daily activities.

Nursing Assessment

During the assessment, the following significant data were collected:

Key Subjective/Objective Datum 1: Patient reports a pain level of 7/10 when attempting to ambulate, indicating significant discomfort.
Key Subjective/Objective Datum 2: Observed gait is unsteady with the need for a walker; unable to bear weight on the operated leg without support.
Key Subjective/Objective Datum 3: Self-care deficit noted; requires assistance for activities like dressing and bathing.
Key Subjective/Objective Datum 4: Range of motion in the operated knee is limited to 45 degrees flexion (normal is 90 degrees).

Analysis and Formulation of the NANDA-I Nursing Diagnosis

The analysis of the assessment data leads to the identification of the following nursing diagnosis: Impaired physical mobility. This conclusion is based on the patient's reports of pain upon movement, reliance on a walker for support, limitations in range of motion at the knee joint, and the necessity for assistance with self-care activities—all of which are consistent with the defining characteristics of impaired physical mobility.

Proposed Care Plan (Key Objectives and Interventions)

The care plan will focus on addressing the "Impaired physical mobility" diagnosis with the following priority elements:

Objectives (Suggested NOCs)

Improve mobility status to allow for independent ambulation.
Enhance range of motion in the right knee joint.

Interventions (Suggested NICs)

Mobility Assistance:
- Assist with ambulation using a walker, focusing on proper gait mechanics.
- Encourage gradual weight-bearing on the operated leg as tolerated.
Range of Motion Exercises:
- Implement a structured program of passive and active range of motion exercises for the affected knee.

Progress and Expected Outcomes

With the implementation of the proposed interventions, it is expected that the patient will experience a reduction in pain with ambulation, increased range of motion in the operated knee, and improved ability to perform activities of daily living independently. Continuous monitoring will allow evaluation of the plan's effectiveness and adjustment of interventions as needed.

Frequently Asked Questions (FAQ)

Below are answers to some frequently asked questions about the NANDA-I diagnosis "Impaired physical mobility":

What does 'Impaired physical mobility' mean?

'Impaired physical mobility' refers to the decreased ability to move freely and easily, which can affect a person's daily activities and overall quality of life.

What are the common causes of impaired physical mobility?

Common causes include injury or trauma, chronic illnesses (such as arthritis or neurological conditions), pain, surgery recovery, and environmental barriers.

How is impaired physical mobility assessed?

Nurses assess physical mobility by observing the patient’s range of motion, strength, balance, and the ability to perform daily activities or move independently.

What interventions can help improve mobility?

Interventions may include physical therapy, exercise programs, assistive devices, pain management, and modifications to the environment to facilitate safe movement.

How can family members support patients with impaired mobility?

Family members can support patients by encouraging physical activity, providing assistance during mobility, ensuring a safe environment, and being patient and empathetic during recovery.