What are the 4 Mobility Diagnoses?
- Impaired Bed Mobility
- Impaired Transfer Ability
- Impaired Physical Mobility
- Activity Intolerance
Which circumstances would you use -
Impaired Bed Mobility?
Impaired Bed Mobility:
Pt is primarily on bedrest, not yet ambulatory, and may not even be able to sit up in a chair. The pt clearly has difficulty repositioning self in the bed.
Common causes:
- spine or hip surgery.
- stroke.
- paraplegia (paralysis of both lower limbs).
- dementia.
- neurological disorder (MS, ALS, etc.)
Hint: The Nursing student will note from the reading assignment that pt does not yet transfer to a chair and does not yet ambulate.
Which circumstances would you use -
Impaired Transfer Ability?
Impaired Transfer Ability:
Word implies, diagnoses most appropriate for pt who is only permitted to move from bed to chair and back - but who has trouble transferring.
Common causes:
- orthopedic surgery.
- generalized debility.
- dementia.
- stroke with hemiplegia .
- neurological disorder (MS, ALS, etc.)
Hint: Nursing student will often see an order on the assignment indicating that the pt needs to be transferred bed to chair “with assistance”.
Which circumstances would you use -
Impaired Physical Mobility?
Impaired Physical Mobility:
As word implies, diagnoses most appropriate for an ambulatory pt who has trouble moving his or her arms and/or legs.
Common causes:
- orthopedic surgery.
- cast on limb.
- needs crutches or walker.
- arthritis.
- missing limb.
- neurological disorder (MS, ALS, etc.)
Hint: Nursing student will often see an order on the assignment indicating the pt needs to be ambulated “with assistance”.
Which circumstances would you use -
Activity Intolerance?
Activity Intolerance:
As word implies, the pt becomes extremely short of breath or fatigued during normal activity. The level of shortness of breath or fatigue seems disproportionate to activity level.
Common causes:
- heart failure.
- myocardial infarction.
- prolonged bedrest.
- general deconditioning.
Hint: Nursing student mat see orderon assignment to ambulate with assistance - but it is not due to a true “mobility” problem. It is related to the pt’s inability to tolerate activity.
Activity Intolerance vs. Impaired Physical Mobility:
How do you differentiate the often confused diagnosis?
Activity Intolerance vs. Impaired Physical Mobility:
Look at pt’s signs and symptoms, as well as the medical history, to determine which one is most appropriate.
- does the pt have some kind of difficulty moving the extremities? Then you are looking at “Impaired Physical Mobility.” (It’s all about the “mobility”.)
- does the pt become extremely short of breath during mild activity, such as showering, dressing, or short walks? Then you are looking at “activity intolerance.” (It’s all about the “activity.”)
How would you determine and write an “Assessment For Mobility/Activity Diagnoses”?
Assessment For Mobility/Activity Diagnoses:
The assessment should be tied with whatever you wrote for the
AEB (as evidenced by).
Example for “Activity Intolerance”:
- AEB: “Pt becomes short of breath while dressing”.
- Assessment: “Assess pt’s shortness of breath while dressing.”
What would be an “Outcome For Mobility/Activity Diagnoses”?
The outcome should be patient-specific, measurable and attainable.
The outcome will be a reflection of the AEB and the assessment.
Example for “Impaired Physical Mobility”:
- AEB: “Pt has an unsteady gait while ambulating to the bathroom”.
- Assessment: “Assess pt’s gait while ambulating to bathroom”.
Sample outcome:
- “Pt will have a steady gait while ambulating to bathroom.”
What are some “Interventions for Impaired Bed Mobility”?
For “Impaired Bed Mobility,” think about what the RN can do to help pt reposition self in bed independently.
Some examples:
- encourage pt to use side rails to reposition self.
- instruct pt on use of trapeze to reposition self.
Note: If pt os quadriplegic with high cervical vertebral fracture, it would be unrealistic to expect pt to be able to reposition self in bed, now or in the future. So, even though the pt “qualifies” for a diagnosis of “Impaired Bed Mobility,” it will not be possible for the RN to improve the bed mobility.
What are some “Interventions for Impaired Transfer Ability”?
For “Impaired Transfer Ability,” think about what the RN can do to help the Pt transfer from bed to chair (or wheelchair) more easily.
Some Examples:
- Instruct pt to stand at bedside prior to transfer.
- Provide one-person assist during transfer from bed to chair.
Note: Always consider what pt is able to do when designating your interventions. A paraplegic might not even be able to stand with assistance for the transfer.
What are some “Interventions for Impaired Physical Mobility”?
For “Impaired Physical Mobility”, think about what the RN can do to help the pt ambulate with less difficulty.
Some Example:
- Provide one-person assist during ambulation to nurses’ station and back.
- Provide walker during ambulation to nurses’ station and back.
Note: It is common for orthopedic surgery pt’s and those with MS to have difficulty ambulating unassisted. It is safer for them to ambulate with assistance by staff (or with a device) than to walk alone.
What are some “Interventions for Activity Intolerance”?
For “Activity Intolerance”, think about what the RN can do to help the pt tolerate a specific activity better, such as ambulation.
Some Examples:
- provide brief rest periods during ambulation in hallway.
- provide one-person assist during ambulation in hallway.
Note: In pt’s with Activity Intolerance, they are often able to walk a short distance, stop to rest, then resume walking another short distance, rest again, etc.
How to “Choose the proper Mobility/Activity Diagnosis”?
How to “Choose the proper Mobility/Activity Diagnosis”:
- the pt’s signs or symptoms, the “AEB” part of your diagnosis statement, will help determine which mobility-related diagnosis is most appropriate.
- the four NANDA’s speak to very different problems with mobility or activity.
- be sure to choose the correct diagnosis after carefully assessing the pt’s signs and symptoms.
