University of Southern Mindanao
College of Health Sciences
Department of Nursing
NURSING CARE PLAN
Name of Patient: Mr. Troy Brown Age: 60 Sex: M Room: 111 Date: May 19, 2022
Admitting Diagnosis: Injury in Left Arm Attending Physician: Dr. Xebastian Gallardo Diet: DAT
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
Subjective Cues: Impaired physical After the end of 8- Independent: Goal met.
mobility related to hour shift, the patient
feeling dizzy pain as evidenced will: 1. Note older client’s While aging, per se, After the end of 8-
confused by limited range of general health status. does not cause hour shift, the patient
motion in the left Demonstrate physical immobility, has:
Objective Cues: arm due to a fall techniques or several
behaviors that predisposing factors Demonstrated
Vital Signs: enable in addition to age techniques or
> BP: resumption of related changes can behaviors that
170/100mmHg activities. lead to immobility. enable
> HR: 98bpm resumption of
2. Evaluate for presence To determine if pain
> RR: 26 cpm Maintain or activities.
and degree of pain, management can
> T: 36.4°C increase strength listening to client’s improve mobility.
> 4 inches lacerated and function of Maintained and
description about
wound in his affected and/or increased
manner in which pain
forehead compensatory strength and
limits mobility.
> multiple bruises body part. function of
and abrasions in 3. Instruct in use of side For position affected and/or
his extremities rails, overhead compensatory
changes, transfers
> limited range of trapeze, roller pads, body part
and ambulation.
motion in left arm walker, and cane.
(pain scale of
10/10) 4. Provide pressure- Reduces tissue
reducing mattress,
such as egg crate or pressure and aids in
pressure reliving maximizing cellular
mattress. perfusion to prevent
dermal injury.
5. Teach patient or
assist with active and Increases blood
passive ROM flow to muscles and
exercises of affected bone to improve
and unaffected muscle tone,
extremities. preserve joint
mobility, and
prevent
contractures or
atrophy, and
calcium resorption
from disuse.
6. Place
in supine position Reduces the risk of
periodically if flexion contracture.
possible, when
traction is used to
stabilize lower limb
fractures.
7. Provide alternative
Improves general
comfort
circulation; reduces
measures (massage,
areas of local
backrub, position
pressure and
changes).
muscle fatigue.
8. Consider the need for Obtaining suitable
home assistance support or help for
(e.g., physical the patient can
therapy, ensure a safe and
visiting nurse). proper progression
of activity.
9. Turn and position the
patient every 2 hours
or as needed. Position changes
optimize circulation
to all tissues and
relieve pressure.
10. Check for skin
integrity for signs of
redness and tissue Routine inspection
ischemia (especially of the skin
over ears, shoulders, (especially over
elbows, sacrum, hips, bony prominences)
heels, ankles, and will allow for
toes). prevention or early
recognition and
treatment of
pressure ulcers.
Dependent
1. Administer
medications prior to
activity as needed for To permit maximal
pain relief. effort and
involvement in
Collaborative activity.
2. Collaborate with
physical medicine
To develop
specialist and
individual exercise
occupational or
and mobility
physical therapists in
program, to identify
providing range-of-
appropriate mobility
motion exercise
devices and to limit
(active or passive),
or reduce effects
isotonic muscle
and complications
contractions (e.g.,
of immobility.
flexion of ankles,
push-and-pull
exercises), assistive
devices, and
activities (e.g., early
ambulation, transfers,
stairs)
Bibliography:
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2006). Nurse's pocket guide: Diagnoses, prioritized interventions, and rationales .
Philadelphia, PA: F.A. Davis.
Wayne, G. B. (2022b, March 19). Impaired Physical Mobility Nursing Care Plan. Nurseslabs. https://nurseslabs.com/impaired-
physical-mobility/
Submitted By: Submitted to:
ANGEL B. NATINO, SN KARLA SHARMAINE F. ENRIQUEZ, RN
Student Nurse Clinical Instructor
