Impaired physical Mobility | Nursing Care Plan for Renal Dialysis

Nursing diagnosis: impaired physical Mobility related to restrictive therapies—lengthy dialysis procedure, fear of or real danger of dislodging dialysis lines or catheter, decreased strength and endurance; musculoskeletal impairment, perceptual or cognitive impairment

Possibly evidenced by
Reluctance to attempt movement
Inability to move within physical environment
Decreased muscle mass, tone, and strength
Impaired coordination
Pain, discomfort

Desired Outcomes/Evaluation Criteria—Client Will
Mobility
Maintain optimal mobility and function.
Display increased strength and be free of associated complications—contractures and decubitus ulcers.

Nursing intervention with rationale:
1. Assess activity limitations, noting presence and degree of restriction or ability.
Rationale: Influences choice of interventions.

2. Encourage frequent change of position when on bedrest or chair rest; support affected body parts and joints with pillows, rolls, sheepskin, and elbow and heel pads, as indicated.
Rationale: Decreases discomfort, maintains muscle strength and joint mobility, enhances circulation, and prevents skin breakdown.

3. Provide gentle massage. Keep skin clean and dry. Keep linens dry and wrinkle free.
Rationale: Stimulates circulation; prevents skin irritation.

4. Encourage deep breathing and coughing. Elevate head of bed, as appropriate.
Rationale: Mobilizes secretions, improves lung expansion, and reduces risk of respiratory complications, such as atelectasis or pneumonia.

5. Suggest and provide diversion as appropriate to client’s condition—visitors, radio or TV, and books. Take time to interact with client, showing interest in client’s life.
Rationale: Decreases boredom; promotes relaxation.

6. Instruct in and assist with active and passive range-of-motion (ROM) exercises.
Rationale: Maintains joint flexibility, prevents contractures, and aids in reducing muscle tension. Note: A high level of phosphorus may cause calcium-phosphorus crystals to build up in the joints, muscles, and other body organs, leading to bone and joint pain. To avoid these risks, client may be prescribed a phosphate binder such as Basalgel or Renagel (Leydig, 2005).

7. Institute a planned activity or exercise program as appropriate, with client’s input.
Rationale: Increases client’s energy and sense of well-being. Studies have shown that regular exercise programs have benefited clients with ESRD, both physically and emotionally. Stable clients have not been shown to have adverse effects (Goodman & Ballou, 2004).

8. Provide foam, water, or air flotation mattress or soft chair cushion.
Rationale: Reduces tissue pressure and may enhance circulation, thereby reducing risk of dermal ischemia and breakdown.