Impaired Physical Mobility & Immobility Nursing Diagnosis & Care Plans

Immobility is never just a movement problem. Leave a patient flat and deconditioning starts within days: muscle wastes, skin breaks down over the sacrum and heels, secretions pool, the gut slows, and clots form in the legs. Your job is to move them, and to move them safely, before those complications stack up and turn a short admission into a long one. This guide covers the assessment, interventions, goals, and diagnoses for patients with impaired mobility.

What is Impaired Physical Mobility?

A change in movement can be temporary, recurring, or permanent, and it pulls in the whole team. Some degree of immobility shows up in most major conditions: stroke, leg fracture, multiple sclerosis, trauma, morbid obesity. As people live longer, you see more of it, and patients discharged early often go on to rehab or home physical therapy rather than straight back to baseline.

Mobility is the ability to change and control body position. It takes muscle strength and energy plus skeletal stability, joint function, and neuromuscular coordination. Functional mobility, the ability to move around in the environment, breaks into three areas:

• Bed mobility. Moving around in bed, including lying to sitting and sitting to lying.
• Transferring. Moving from one surface to another, bed to chair or chair to chair.
• Ambulation. Walking, with or without help from another person or an assistive device such as a cane, walker, or crutches.

Impaired mobility shows up in daily activities: walking short distances, climbing stairs, showering. Obesity predicts it, because aging brings declining muscle mass at the same time fat mass climbs, and physical activity is the main lever against both processes. Aging alone limits mobility too, through loss of muscle mass and strength, gait and balance changes, and stiffer joints. The body is built for motion, so any restriction takes a toll on every major system.

Causes

Common causes and related factors:

• Stroke. Neurological damage affects muscle control and coordination.
• Leg fractures. Orthopedic injuries limit movement.
• Multiple sclerosis. Demyelinating disease disrupts neuromuscular function.
• Trauma. Injuries from accidents impair mobility.
• Morbid obesity. Excess weight hinders movement and strains muscles and joints.
• Aging. Decreased muscle mass and strength, gait changes, and joint stiffness.
• Prolonged immobility. Extended bed rest leads to muscle atrophy and reduced function.
• Muscle weakness. Reduced strength impairs movement (e.g., ALS).
• Joint dysfunction. Stiff, limited joints restrict movement (e.g., arthritis).
• Neuromuscular coordination issues. Trouble coordinating muscle movements.
• Lack of physical activity. A sedentary pattern weakens muscles and cuts flexibility.
• Pain. Acute or chronic pain limits movement and discourages activity.
• Environmental barriers. Inaccessible spaces or missing assistive devices.
• Psychological factors. Depression or fear of falling reduce motivation to move.

Nursing Care Plans and Management

Mobilizing patients well cuts physical complications and supports their emotional and social wellbeing, so identify and clear the barriers to it. Patients who are not adequately mobilized run a high rate of complications. Avoiding those complications shortens the stay, lowers the risk of hospital-associated problems, and helps the patient's mental and emotional health.

Nursing Problem Priorities

1. Mobility status and need for assistance. Drives most of your handling and transfer decisions.
2. Safe patient handling. Assisting patients with impaired mobility risks injury to both patient and staff, so safe handling is non-negotiable.
3. Education and training on assistive devices. Used correctly, they support ADLs and prevent injury.
4. Range of motion exercises and physical therapy. ROM can be done even on bed rest or with physical limits.
5. Positioning, moving, and transferring. Proper positioning gives comfort and prevents complications such as DVT and pulmonary embolism.
6. Preventing falls and injuries. Identify, manage, and eliminate fall hazards.

Nursing Assessment

Mobility impairment ties directly to musculoskeletal problems and ripples into other systems. Assess for the following subjective and objective data:

• Inability to move purposefully (bed mobility, transfers, ambulation)
• Inability to perform an 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

After assessment, build a diagnosis around the specific mobility problem using clinical judgment and the patient's condition. Diagnostic labels matter less at the bedside than the care itself, but if you use them, examples include:

• Impaired Physical Mobility related to neuromuscular impairment (e.g., stroke) as evidenced by unilateral weakness, decreased coordination, and reliance on assistive devices.
• Impaired Physical Mobility related to acute postsurgical pain (e.g., hip replacement) as evidenced by reports of pain, guarding of the surgical site, and hesitation to move.
• Impaired Physical Mobility related to prolonged bed rest and deconditioning as evidenced by fatigue with minimal exertion, decreased strength, and reduced endurance.
• Impaired Physical Mobility related to skeletal deformities (e.g., scoliosis) as evidenced by physical asymmetry, uneven gait, and limits in daily activities.
• Impaired Physical Mobility related to cognitive impairment (e.g., Alzheimer's disease) as evidenced by inability to plan and execute movement, wandering, and frequent falls.
• Impaired Physical Mobility related to obesity as evidenced by shortness of breath with activity, difficulty standing or walking, and reliance on others.
• Impaired Physical Mobility related to fear of falling as evidenced by decreased participation in activity, use of mobility aids, and verbal expressions of fear.
• Impaired Physical Mobility related to peripheral neuropathy (e.g., diabetes) as evidenced by numbness and tingling, unsteady gait, and loss of proprioception.

Nursing Goals

The aim is to avoid the hazards of immobility, prevent dependent disabilities, and restore or preserve as much function as possible:

• The client performs physical activity independently or within the limits of the disease.
• The client demonstrates measures to increase mobility.
• The client demonstrates use of adaptive devices to increase mobility.
• The client evaluates pain and the quality of its management.
• The client uses safety measures to minimize injury.
• The client stays free of immobility complications: intact skin, no thrombophlebitis, normal bowel pattern, clear breath sounds.

Nursing Interventions and Actions

Mobility impairment needs the whole team and continuous reassessment to find what is actually driving it.

1. Assessing Mobility Status and the Need for Assistance

Mobility status drives handling, transfers, ambulation, and fall precautions. Run the initial assessment on admission.

Check the functional level of mobility. The level guides the plan. The Functional Mobility Scale (FMS) classifies functional mobility and accounts for the assistive devices a client uses. It rates walking at three distances, 5, 50, and 500 meters, representing mobility at home, at school, and in the community. Functional levels include:

• Level 1: Walks at a regular pace on level ground indefinitely; one flight or more, but more short of breath than normal.
• Level 2: Walks one city block or 500 ft on level ground; climbs one flight slowly without stopping.
• Level 3: Walks no more than 50 ft on level ground without stopping; cannot climb one flight without stopping.
• Level 4: Dyspnea and fatigue at rest.

Evaluate the client's ability to perform ADLs safely each day. Restricted movement affects most ADLs, and ambulation safety is a major concern. The most common checklists are the Katz Index of Independence in Activities of Daily Living and the Lawton Instrumental Activities of Daily Living (IADL) Scale.

• Katz Index. Assesses basic ADLs, not advanced ones. Scores independence (1 point) and dependence (0 points) across bathing, dressing, toileting, transferring, continence, and feeding. A score of 6 indicates full function, 4 moderate impairment, and 2 or less severe impairment.
• Lawton IADL Scale. Evaluates independent living skills across eight domains: food preparation, housekeeping, laundry, using the telephone, shopping, transportation, handling medications, and handling finances. Summary score runs from 0 (dependent) to 8 (independent).

Assess for impediments to mobility. Knowing the barrier (chronic arthritis vs. stroke vs. pain) shapes the plan. Aging brings a decline in functional status and is a common driver of ADL loss, and musculoskeletal, neurological, circulatory, or sensory conditions can all cut physical function.

Assess the type of assistance the client requires. This is based on the client's ability to transfer, stand, and cooperate. Standardized terms let staff communicate how much help is needed:

• Dependent: Cannot help at all. A mechanical lift and additional staff are required.
• Maximum assistance: Client does 25% of the task, caregiver does 75%.
• Moderate assistance: Client does 50%, caregiver does 50%.
• Minimal assistance: Client does 75%, caregiver does 25%.
• Contact guard assist: Caregiver places one or two hands on the client for balance but gives no other help.
• Stand-by assist: Caregiver does not touch the client but stays close for safety.
• Independent: Client performs the task safely with no help.

Identify weight-bearing status. Patients with lower extremity fractures or recovering from knee or hip replacement progress through weight-bearing stages. Set status with the physical therapist:

• Non-weight-bearing (NWB). The leg must not touch the floor or support any weight. Use crutches or other devices.
• Toe-touch weight-bearing (TTWB). The foot or toes may touch the floor for balance, but no weight goes on the affected leg.
• Partial weight-bearing. A small amount of weight is allowed, increased gradually to 50% of body weight, enough to stand with weight evenly on both feet but not walk.
• Weight-bearing as tolerated. The client supports 50% to 100% of weight on the affected leg and chooses the amount based on tolerance.
• Full weight-bearing. The leg supports 100% of body weight, allowing walking.

Run the Timed Get Up and Go Test. The client stands from an armchair, walks 3 yards, turns, walks back, and sits. Watch posture, alignment, balance, and gait throughout.

Use the Banner Mobility Assessment Tool (BMAT) for safe patient handling and mobility (SPHM). The BMAT is a nurse-driven bedside assessment that walks the client through a four-step functional task and identifies the mobility level they can reach. BMAT 2.0 builds on five years of BMAT 1.0 use, clarifying how to score pass or fail, the nurse's role in strengthening and progressing clients, progression from Level 3 to Level 4, and the use of walkers, canes, crutches, and prosthetic legs.

• Level 1. Evaluates core strength, sitting tolerance, balance, and hemodynamic stability when sitting upright.
• Level 2. Evaluates leg and foot muscle engagement, leg strength, and foot drop contracture deformity; a precursor to weight-bearing.
• Level 3. Evaluates standing, standing tolerance, and standing balance; precursors to ambulation.
• Level 4. Evaluates stepping in two parts, marching in place and advancing one foot then the other; a precursor to ambulation.

2. Safe Client Handling

Assisting patients with decreased mobility raises the injury risk for staff. A decade of focus on safe handling cut staff lifting injuries for the first time in 30 years. Good body mechanics and proper use of assistive lifting devices prevent those injuries.

Assess the weight of the load before lifting and decide if you need help. The National Institute of Occupational Safety and Health (NIOSH) sets maximum loads for lifting, pushing, pulling, and carrying. The maximum for lifting a box with handles is 50 lbs (23 kg), and that drops when the lifter has to reach, lift near the floor, or twist. Because patients don't come in simple shapes and may move unexpectedly or have wounds and devices in the way, the safe lifting load for patients is less than the 50-lb maximum.

Identify factors that raise lifting injury risk. Exertion, frequency, posture, and duration of exposure all contribute, and combinations like high exertion in an awkward posture intensify the risk. Ergonomic risk factors fatigue workers and risk musculoskeletal imbalance. Individual factors include poor overall health, poor rest and recovery, low fitness, hydration, and nutrition.

Plan the lift and transfer before you execute. Gather equipment, confirm the area is clear, and check the battery status of any device before use. Review proper body mechanics before starting.

Use proper body mechanics and alignment. Movement takes coordinated muscle activity and neurological integration, and good alignment promotes balance and function. Line one body part up with another vertically or horizontally to reduce strain. A lower center of gravity increases stability, so bend the knees, bring your center of gravity toward your base of support, and keep your back straight. Set your feet about shoulder-width apart for a wide base.

Avoid stretching and twisting during a lift or transfer. Twisting and stretching move the line of gravity outside the base of support and cause musculoskeletal injury. If the vertical line moves outside the base, the body loses balance.

Stand close to the client or object and work at waist level. Keep the load close to your center of gravity. Raise the bed or object so you avoid stooping.

Bend both knees and avoid lifting where you can. Turn, roll, or pivot instead of lifting when possible, since these take less work. Bending the knees keeps the center of gravity low and lets the strong leg muscles do the work.

Make client handling and mobility equipment standard practice. Some staff stick to traditional manual approaches even for tasks that carry real safety risk, sometimes believing equipment breaks the human connection. Safe handling equipment protects both nurses and patients from injury.

Use client-handling equipment correctly. Know how each device works. Total assist lifts and portable devices move patients who cannot move themselves, while sit-to-stand devices require the patient to bear weight. Choosing the right device is a core safety requirement.

Support a culture of safety. Prioritize safety over competing goals in a blame-free environment where staff can report errors without fear, with safe staffing and strong communication.

Support safe handling and mobility programs. A full SPHM program includes patient assessment and written handling guidelines, built to eliminate manual handling. The ANA's Safe Patient Handling and Mobility standards provide a framework.

Train for safe handling. Every facility needs a system for education, training, and competency, including demonstrated competency before staff use this equipment with patients.

3. Providing a Safe Environment

Most patients, especially older adults, want to stay in their own homes as long as possible. Age- and disease-related functional limits and fall risk get in the way. Home modifications help them stay independent by improving ADL and IADL performance and reducing falls.

Assess the safety of the environment. Throw rugs, toys, and pets limit safe ambulation. Inspect the room, common areas, hallways, entrances, and bathrooms for hazards: uneven flooring, loose carpets, slippery surfaces, clutter, low lighting, and obstacles.

Provide a safe environment: raise the bed rails, lower the bed, keep important items close. These cut fall risk. Raised rails are a barrier against accidental falls and give support for repositioning and getting in and out of bed. A lower bed height shortens the distance and impact during transfers.

Teach the client to call for help with the call bell or sensitive call light. This gives the patient a sense of control and lowers the fear of being left alone. Call lights are the main way patients reach staff, and their use improves safety and satisfaction.

Teach the client and family to keep the home hazard-free. A safe environment prevents fall injuries and supports independence. Home modifications, railings, grab bars, nonslip surfaces, shower or toilet seats, and lighting, help older adults stay independent and reduce falls.

Keep the immediate surroundings free of clutter and obstacles. This reduces tripping and stumbling for patients with limited mobility.

Provide adequate lighting in the room and pathway. Poor lighting hides hazards. Good lighting lets the patient see their surroundings and avoid injury.

Arrange furniture and equipment for accessibility. Patients with limited mobility struggle to maneuver around obstacles. Arrange furnishings so they can move comfortably and safely.

Use nonslip mats or rugs. Smooth or wet floors cause serious injuries for patients with limited mobility. Nonslip mats add stability and reduce slipping.

Plan home modifications with the client and family. Simple measures include removing rugs and tripping hazards, rearranging furniture, and adding commodes and raised toilet seats. Complex ones include grab rails, alarm systems, and building adaptations.

4. Proper Use of Assistive Devices

An assistive device helps with ADLs: walker, cane, gait belt, mechanical lift. Use them to promote safe handling and mobility.

Evaluate the need for assistive devices. Correct use of wheelchairs, canes, transfer bars, and other aids increases activity and lowers fall risk. The Functional Mobility Assessment (FMA) measures device users' satisfaction with a mobility device for ADLs.

Run a client risk assessment before using any device. Determine the patient's ability to move, the help needed, and the best means of assistance. The assessment never overrides clinical judgment and patient-specific needs.

Assess yourself and your readiness. Confirm you have the required training. Wear nonslip footwear, keep a neutral spine, avoid bending or twisting to the side, and use proper weight-shift techniques (side to side, front to back, up and down).

Assess the emotional response to the disability. Acceptance of limits varies widely, and everyone has their own view of acceptable quality of life. Restricted mobility can drive feelings of social exclusion and lower quality of life.

Provide foam or flotation, water or air mattresses, or kinetic therapy beds as needed. These reduce pressure on skin and tissue that threatens circulation and risks ischemia, breakdown, and pressure injury. Active support surfaces redistribute pressure by changing contact points; reactive surfaces use immersion and envelopment to spread pressure over a wider area.

Demonstrate mobility devices: trapeze, crutches, walkers. These compensate for impaired function and raise activity. Used correctly, they promote safety, mobility, fall prevention, and energy conservation, and help the patient keep balance.

Keep limbs in functional alignment with pillows, sandbags, wedges, or prefabricated splints. These prevent foot drop, excess plantar flexion, and tightness, and hold the feet dorsiflexed. An ankle-foot orthosis (AFO) treats foot drop by providing toe dorsiflexion during swing, medial or lateral ankle stability during stance, and push-off stimulation. The most common AFO is polypropylene, inserted into a shoe.

Use assistive devices when moving, transferring, or lifting. Gait belts go around the waist and add stability when standing, ambulating, or transferring bed to chair. A slider or transfer board moves a supine immobile patient between surfaces. Sit-to-stand lifts help weight-bearing patients who can't rise on their own. Mechanical lifts with a sling move patients who cannot bear weight.

5. Range of Motion Exercises and Physical Therapy

ROM exercises move specific joints and keep the extremities mobile. Because joint changes can begin after 3 days of immobility, start ROM as soon as possible.

Assess strength to perform ROM in all joints. This shows the extent of the problem and guides therapy. A physical therapist may need to test it. Normal values depend on the body part and individual variation.

Assess exercise-related pain and changes in joint mobility. This tracks whether complications are developing or resolving and may mean delaying or holding exercise progression until healing. Limited ROM can come from a problem inside the joint, tissue swelling, muscle stiffness, or pain.

Help the client accept limitations. Let the patient understand and accept their limits and abilities, while balancing help so they don't become unnecessarily dependent. Acceptance supports emotional wellbeing and resilience.

Explain progressive activity. Small, attainable goals build confidence and reduce frustration. ROM and stretching maintain and gradually increase range, and regaining ROM is one of the first phases of injury rehab.

Start passive stretching exercises as early as possible. In neuromuscular disease, begin early to prevent contractures and make it part of a morning and evening routine. Hold each stretch for a count of 15, repeat each exercise 10 to 15 times per session, and stretch slowly and gently.

Assist with muscle exercises when allowed out of bed: abdominal-tightening, knee bends, hopping on one foot, standing on toes. These build balance and strengthen compensatory muscles. Higher intensity and duration tend to give better outcomes, and progressive resistance training and balance training are safe and effective.

Perform passive or active assistive ROM to all extremities. Exercise improves venous return, prevents stiffness, and maintains strength and stamina while avoiding contractures that can build quickly. In passive ROM the joint is fully relaxed while an outside force moves the part; active assistive ROM moves the joint with partial outside help.

Give rest periods between activities and use energy-saving techniques. Rest conserves energy. Help the patient identify achievable goals based on current ability and direct their energy toward what they can do.

Encourage resistance training with light weights when suitable. Strength training helps maintain independent living and reduces fall risk in older adults, improving the ability to perform daily activities.

Offer diversional activities and watch emotional or behavioral reactions to immobility. Forced immobility can heighten restlessness and irritability. Diversion refocuses attention and supports coping. Patients who understand their limits are more likely to explore adaptive strategies, assistive devices, rehab services, and new techniques.

Reinforce progressive exercise, exercising joints to the point of pain, not beyond. "No pain, no gain" is wrong here. Pain signals joint or muscle injury, and pushing through risks further damage. The strategy, weight-bearing type, timing, and progression depend on the underlying condition.

Promote early mobility protocols. These maintain baseline mobility and function, cut delirium, and shorten the stay. Screen with a tool first, starting with neurological criteria, then respiratory, circulatory, and other criteria. If the patient clears them, a registered nurse can initiate early mobilization with the physical therapist.

Position affected limbs with assistive devices. Positioning prevents contractures; rest the limb in a position that opposes or minimizes flexion. Aids include pillows, foot boots, handrolls, hand-wrist splints, heel or elbow protectors, abduction pillows, or a trapeze bar. Foot drop, a complication of immobility, causes plantar flexion that interferes with weight-bearing.

Give pain medication as appropriate. Antispasmodics reduce muscle spasm or spasticity that limits movement; analgesics reduce pain that blocks it. Good pain control lets the patient exercise, sleep, and recover. Watch patients with delirium or dementia who can't report pain well, and teach the patient or caregiver when increased pain signals a problem and to avoid exercise when strain occurs.

Consider home assistance (physical therapy, visiting nurse). Suitable support ensures safe progression of activity. Home health staff monitor and report back to the clinical team if ADL deficits increase.

6. Client Positioning, Moving, and Transferring

Patients recovering from illness or with functional restrictions often need help to move in bed, transfer to a wheelchair, or ambulate. Repositioning and mobilization prevent contractures, maintain strength, prevent pressure injuries, and keep body systems working.

Promote early ambulation and assist with each change: dangling legs, sitting in a chair, ambulating. Movement keeps the patient as functional as possible and reduces debilitation. After assessing the patient as safe to ambulate, decide if a device or a second staff member is needed. Help them sit on the side of the bed with proper footwear. The patient should be cooperative, able to bear weight, have good trunk control, and be able to stand on their own.

Help with transfers using appropriate people or devices to bed, chair, or stretcher. Proper transfer technique protects mobility and safety. The patient must be cooperative and predictable, able to bear weight on both legs, take small steps, and pivot for a one-person assist. If any criterion is missing, use a two-person transfer or mechanical lift.

Let the client work at their own pace. Providers and family often rush and do more than needed, which slows recovery and undercuts confidence. Patients with functional immobility need more time, and working at their own pace lets them allocate energy well, improving outcomes and satisfaction.

Help the client develop sitting and standing balance. This retrains neural pathways and promotes proprioception and motor response. Ask about dizziness or lightheadedness before stepping away from the bed. Patients lying in bed can have vertigo or orthostatic hypotension, so let them sit at the side of the bed with legs dangling for a few minutes first.

Turn and position the client every 2 hours or as needed. Position changes optimize circulation and relieve pressure. Repositioning maintains alignment and prevents pressure injuries, foot drop, and contractures.

• Supine. Client lies flat on their back. Use pillows or devices to prevent foot drop, and pillows under the arms for comfort.
• Prone. Client lies on their stomach, head turned to the side, with pillows under the lower legs to align the feet. Prone may improve oxygenation.
• Lateral. Client lies on one side, top leg flexed over the bottom, which relieves pressure on the coccyx. A pillow under the top arm adds comfort. Often used in pregnancy to prevent inferior vena cava compression.
• Sims. Client lies halfway between supine and prone with legs flexed and a pillow under the top leg. Arms rest comfortably beside them, not underneath.
• Fowler. Head of the bed at 45 to 90 degrees, hips slightly flexed to keep the client from sliding down. Promotes lung expansion and oxygenation.
• Semi-Fowler. Head of the bed at 30 to 45 degrees, hips flexed or not. Same purpose as Fowler, better tolerated over long periods.
• Trendelenburg. Head of the bed lower than the feet, used to promote venous return to the head and heart, as in severe hypotension and emergencies.
• Tripod. The short-of-breath patient leans forward while sitting, elbows on knees or a table, to enhance lung expansion and air exchange.

Assist in moving the client up in bed. Determine the level of assistance first. Prevent friction and shear to avoid pressure injuries. If the patient cannot assist, follow agency policy on lifting devices and mechanical lifts. If they can assist, bring in a colleague to prevent injury.

Assist the client to a seated position. Before ambulating, repositioning, or transferring, move the patient to the side of the bed to avoid straining or overreaching, which also keeps them near your center of gravity for balance.

Guide the client during ambulation. Decide if a device or second staff member is needed, help them sit on the side of the bed with proper footwear, and apply a gait belt snugly over their clothing. The patient should be cooperative, able to bear weight, have good trunk control, and stand on their own. Gently grasp their forearm and place one arm firmly under their axilla.

Assist in transferring from bed to chair or wheelchair. The patient needs proper footwear, the bed at its lowest position, and the wheelchair brakes locked. If the patient has one-sided weakness, place the wheelchair on the strong side. Stay close, have the patient place their hands on your waist (not your neck), and lower them while you shift your weight from back leg to front leg with knees bent.

Lower the client to the floor safely if a fall starts. If the patient begins to fall from standing, do not try to catch them, which can cause back injury. Control the fall instead: move behind the patient, support them around the waist or hip or grab the gait belt, bend your leg and place it between theirs, and slide them down your leg to the floor. Protect the head first, always.

7. Client and Caregiver Education to Prevent Falls and Injuries

Patients and their caregivers both need teaching, since caregivers handle mobility after discharge.

Assessing for complications or injuries

Assess the client's or caregiver's understanding of immobility and its effects. Watch for muscle weakness, skin breakdown, pneumonia, constipation, thrombophlebitis, and depression. DVT, pressure injuries, muscle atrophy, pulmonary embolism, and bone demineralization are all potential complications, and active intervention is needed.

Assess intake and output and nutritional patterns. Pressure ulcers form faster with nutritional insufficiency, since poor nutrition slows healing by reducing fibroblast production and collagen synthesis. Low hemoglobin and hematocrit raise pressure injury risk. Use nutrition evaluation plus the Braden Scale to assess deficits and risk.

Monitor nutritional needs in relation to immobility. Good nutrition fuels exercise and rehab. Patients hospitalized longer than 15 days show higher nutrition risk from significant weight loss, and weight loss is a risk factor for pressure injury. Low BMI, hypocholesterolemia, and low hemoglobin and hematocrit all raise pressure injury risk.

Watch for thrombophlebitis (calf pain, Homan's sign, redness, localized swelling, rising temperature). Prolonged bed rest allows clot formation. Thromboembolism signs can be nonspecific: pain, tenderness, skin color and temperature changes, edema, and, with pulmonary embolism, dyspnea, chest pain, increased respirations, and hemoptysis.

Check skin integrity for redness and tissue ischemia, especially over ears, shoulders, elbows, sacrum, hips, heels, ankles, and toes. Routine inspection over bony prominences allows prevention or early treatment of pressure ulcers. The Braden Scale, usually applied within 8 hours of admission, is used to prevent, identify, and classify pressure injury risk.

Note elimination status (usual pattern, current pattern, signs of constipation). Immobility promotes constipation by slowing GI motility. Assess bowel movements per day or week, abdominal distention and discomfort, abdominal or rectal pain, decreased appetite, nausea, vomiting, obstruction, headache, fatigue, agitation, and delirium. Document the usual pattern, severity, and any change.

Assess for urinary tract infection. Watch for fever, dysuria, urgency, frequency, suprapubic or pelvic pain, hematuria, and new or worsening confusion or agitation. Report urine color, concentration, odor, reduced volume, and cloudiness to the provider immediately.

Preventing thromboembolism

Establish measures to prevent thrombophlebitis from prolonged immobility.

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

These prevent skin breakdown, and compression devices boost venous return to prevent stasis and thrombophlebitis. Intermittent pneumatic compression reduces VTE risk. Anti-embolism stockings work but are hard to put on, sometimes painful, and can injure fragile skin or skin with vascular insufficiency.

Promote adherence to heparin therapy. Heparin reduces lower limb thromboembolism but not pulmonary embolism. Guidelines call for chemoprophylaxis with fondaparinux for 4 weeks after surgery, and fondaparinux appears more effective than low-molecular-weight heparins at preventing thromboembolism.

Teach the benefits of early mobilization. Early mobilization is simple and effective at lowering thrombosis risk by increasing blood flow and preventing clots, with physiological and psychological benefits and no bleeding complications.

Preventing pressure injuries

Prevent skin breakdown: clean, dry, and moisturize the skin as needed. Creams, lotions, and ointments reduce frictional forces and help maintain healthy skin.

Suggest nutritional intake for adequate energy and metabolic needs. The patient needs a balanced intake of carbohydrates, fats, proteins, vitamins, and minerals. A sudden, dramatic protein increase after a severe injury can cause a negative nitrogen balance, impairing wound healing and increasing muscle loss.

Encourage a high-fiber diet and fluid intake of 2000 to 3000 ml per day unless contraindicated. Fluids maximize hydration and prevent hard stool, reducing skin irritation and breakdown. Laxatives may be unnecessary for patients who are well-hydrated and eat enough fiber.

Preventing constipation and bowel complications

Set up a bowel program (adequate fluid, high-bulk foods, physical activity, stool softeners, laxatives as needed) and note bowel activity. A sedentary pattern drives constipation. Document stool type and bowel function, maintain nutrition and hydration, minimize anxiety, and protect privacy. A regular toileting routine that encourages ambulation and discourages bedpans also helps prevent it.

Preventing pulmonary and urinary tract infections

Encourage coughing and deep-breathing exercises, suction as needed, and use an incentive spirometer. Coughing and breathing exercises prevent secretion buildup, and incentive spirometry increases lung expansion. Instruct the patient, monitor tolerance, and confirm the exercises are done correctly. Practice them regularly, several times a day.

Position the client in a semi-Fowler position and reposition regularly. Semi-Fowler facilitates breathing, and repositioning loosens lung secretions to promote gas exchange.

Avoid indwelling catheterization or promote early removal. Indwelling catheters are often placed on admission or postoperatively. Patients with indwelling catheters have more positive cultures than those on intermittent catheterization, and UTI risk rises an estimated 5 to 10% for every 48 hours the catheter stays in.

Fall prevention strategies

Teach caregivers fall prevention strategies. If the patient feels dizzy while ambulating or transferring, have the caregiver help them sit on a chair or the floor. Protect the head always.

Emphasize exercise to prevent falls. Fall-prevention exercise focuses on balance, strength training, and aerobic fitness to improve postural stability. Refer the patient to group or home-based programs, and start with supervised sessions to build strength and stability before a self-led home program.

Refer for a vision assessment as indicated. Visual impairment is a common fall contributor, affecting balance, obstacle avoidance, distance judgment, and spatial awareness. Offer a formal vision assessment along with hazard reduction.

Promote proper footwear and foot care. Footwear and foot care are fundamental to fall prevention. Many patients at fall risk have type 2 diabetes, so teach daily foot inspection, including the soles, to catch ulcers or broken skin early. Advise supportive shoes rather than slippers or socks at home.

Provide psychological support for fear of falling. Fear of falling follows previous falls and leads to anxiety, lost confidence, and isolation from reduced activity. Counter it by reintroducing mobility gradually with realistic short- and long-term goals, encouragement, mobility aids, plenty of time to complete activities, and frequent chances to practice.

Provide positive reinforcement during activity. Patients may resist new activities out of fear of falling. Reinforcement raises motivation and self-esteem by highlighting strengths, progress, and ability.

Set goals with the client and family for cooperation in activity, exercise, and position changes. This builds anticipation of progress and a sense of control. Clear goals help the patient direct energy toward specific outcomes and give them autonomy over their own care.