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Impaired Physical Mobility
Impaired Physical Mobility
(_)Actual (_) Potential
| (_)
Amputation (_) Cardiovascular (_) External devices (_) Impaired balance (_) Limited ROM (_) Musculoskeletal impairment |
(_)
Neuromuscular impairment (_) Pain (_) Surgical procedure (_) Trauma (_) Other:_____________________________ ____________________________________ ____________________________________ |
| Major:
(Must be present) |
(_) Inability to move purposefully within the environment, including bed mobility, transfers, and ambulation. |
| Minor:
(May be present) |
(_)
Range of motion limitations. (_) Limited muscle strength or control. (_) Impaired coordination. |
| Date & Sign. |
Plan and Outcome [Check those that apply] |
Target Date: |
Nursing Interventions [Check those that apply] |
Date Achieved: |
| The
patient will: (_) Maintain or increase strength and endurance of upper/lower limbs A.E.B.:
(_) Will not develop complications of immobility. (_) Demonstrate use of
adaptive device(s) to increase mobility.
(_) Other:
|
(_)
Assess symmetry, strength, and degree of mobility. (_) Passive/active ROM exercises as ordered by physician q_____ to:__________(body part). (_) Position in proper alignment and resposition q____ hrs. (_) Encourage isometric exercises when indicated. (_) Up in chair _____ minutes q____. (_) Check/teach proper use/function of adaptive equipment. (_) Provide progressive mobilization. (_) Referral:
(_)
Other:________________ |
__________________________
Patient/Significant other signature
__________________________
RN signature
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