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Desired Outcomes/Evaluation CriteriaClient Will: Verbalize understanding of situation and individual treat- ment regimen and safety measures.

. Demonstrate techniques/behaviors that enable resumption of activities. Participate in ADLs and desired activities. Maintain position of function and skin integrity as evidenced by absence of contractures, footdrop, decubitus, and so forth. Maintain or increase strength and function of affected and/or compensatory body part. Actions/Interventions NURSING PRIORITY NO.1.To identify causative/contributing factors: Determine diagnosis that contributes to immobility (e.g.,MS, arthritis, Parkinsons, hemiplegia/paraplegia, depression). Note situations such as surgery, fractures, amputation, tub- ings (chest, catheter, etc.) that may restrict movement . Assess degree of pain, listening to clients description. Ascertain clients perception of activity/exercise needs. Note decreased motor agility/essential tremor related to age . Determine degree of perceptual/cognitive impairment and ability to follow directions. Assess nutritional status and clients report of energy level. NURSING PRIORITY NO. 2.To assess functional ability: Determine degree of immobility in relation to previously sug- gested scale. Observe movement when client is unaware of observation to note any incongruencies with reports of abilities. Note emotional/behavioral responses to problems of immo- bility. Feelings of frustration/powerlessness may impede attainment of goals. Determine presence of complications related to immobility (e.g., pneumonia, elimination problems, contractures, decubitus, anxiety). (Refer to ND risk for Disuse Syndrome.) NURSING PRIORITY NO. 3.To promote optimal level of function and prevent complications: Assist/have client reposition self on a regular schedule as dic- tated by individual situation (including frequent shifting of weight when client is wheelchair-bound). Instruct in use of side rails, overhead trapeze, roller pads for position changes/transfers. Support affected body parts/joints using pillows/rolls, foot supports/shoes, air mattress, water bed, and so forth to main- tain position of function and reduce risk of pressure ulcers.

Assist with treatment of underlying condition causing pain and/or dysfunction. Administer medications prior to activity as needed for pain relief to permit maximal effort/involvement in activity. Provide regular skin care to include pressure area management. Schedule activities with adequate rest periods during the day to reduce fatigue. Encourage participation in self-care, occupational/diver- sional/recreational activities.Enhances selfconcept and sense of independence. Provide client with ample time to perform mobility-related tasks. Identify energy-conserving techniques for ADLs. Limits fatigue, maximizing participation. Discuss discrepancies in movement when client aware/ unaware of observation and methods for dealing with identi- ed problems. Provide for safety measures as indicated by individual situa- tion, including environmental management/fall prevention . Consult with physical/occupational therapist, as indicated, to develop individual exercise/mobility program and identify appropriate mobility devices . Encourage adequate intake of uids/nutritious foods. Pro- motes well-being and maximizes energy production. NURSING PRIORITY NO. 4.To promote wellness (Teaching/ Discharge Considerations): Encourage clients/SOs involvement in decision making as much as possible. Enhances commitment to plan, optimiz- ing outcomes. Review safety measures as individually indicated (e.g., use of heating pads, locking wheelchair before transfers, removal or securing of scatter/area rugs). Involve client and SO(s) in care, assisting them to learn ways of managing problems of immobility. Demonstrate use of standing aids and mobility devices (e.g., walkers, strollers, scooters, braces, prosthetics, etc.), and have client/care provider demonstrate knowledge about/safe use of device. Identify appropriate resources for obtaining and impaired physical MOBILITY maintaining appliances/equipment. Promotes independence and enhances safety. Review individual dietary needs.Identify appropriate vitamin/ herbal supplements.

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