Mobility and Patient Care for Nurses and Episode 92

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Welcome to Episode 92

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Tip of the Week– Mobility and Patient Care

Impaired mobility (limitation in independent, purposeful physical movement of the body or of one or more extremities) and complications from impaired mobility like pneumonia, pressure ulcers, and falls are common problems in the elderly and patients in long-term care. These problems lead to prolonged hospital stays, occurrence of infections and even increased risk of mortality.

Since such problems are highly preventable, nurses and nursing students must focus on measures to promote patient mobility.

In establishing a plan of care, an accurate assessment of a patient’s functional status should first be obtained. The nurse could start on asking the patient or someone closely involved in caring for the patient about prior activities that they can do on their own safely on a daily basis.

Suggested Code for Functional Level Classification

0   Completely independent
1   Requires use of equipment or device
2   Requires help from another person for assistance, supervision, or   teaching
3   Requires help from another person and equipment or device
4   Is dependent, does not participate in activity

Other points to assess include gait and balance, knowledge of immobility and its implications, skin integrity and nutritional status, elimination patterns (decreased mobility promotes constipation), emotional response to disability or limitation, and safety of immediate environment.

Therapeutic interventions for promotion of mobility and preventive measures from complications include the following.

Encourage and facilitate early ambulation and other ADLs when possible. Begin from dangling extremities at the side of the bed, to sitting in chair, to ambulation. Assist patient in every step allowing periods of activity and rest.
Encourage use of assistive devices as appropriate such as canes, walkers, and braces.Teach patient on how to properly use devices.
Provide positive reinforcement during activity. Patients may be reluctant to move or initiate new activity due to a fear of falling.
Allow patient to perform tasks at their own rate. Encourage independent activity as able and safe. Hospital workers and caregivers in a hurry often do more for the patient than they should. This slows the patient’s recovery and reduces their self esteem.
Promote a safe environment. This includes proper use of side rails, keeping bed in a low position, keeping walkways free of obstruction, ensuring adequate lighting, and promoting use of footwear with non-slip soles.
Perform passive or active assistive ROM exercises to all extremities to promote increased venous return, prevent stiffness, and maintain muscle strength and endurance.
Perform measures to prevent pressure ulcers like turning every 2 hours or as needed, use of prophylactic antipressure devices and keeping skin clean, dry and moisturized.

To gain the patient’s and the caregiver’s cooperation, a better understanding on the hazards of immobility and importance of measures to promote mobility should be provided. Also, knowing the reason for progressive activity helps patient or caregivers establish reasonable and obtainable goals. Principles of progressive exercise should be reinforced giving emphasis on the point that joints are to be exercised to the point of pain and not beyond. If necessary, referral to a multidisciplinary health team like physical therapists, who can provide specialized services, can be done.

Gait and Balance Assessment

Article on Keeping Elderly Patients Mobile

Staging Pressure Ulcers Episode of the Nursing Show

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