Impaired Physical Mobility | Nursing Care Plan for Spinal Cord Injury

May be related to
Neuromuscular impairment
Immobilization by traction

Possibly evidenced by
Inability to purposefully move, paralysis
Muscle atrophy, contractures

Desired Outcomes/Evaluation Criteria—Client Will
Immobility Consequences: Physiological
Maintain position of function as evidenced by absence of contractures and footdrop.
Neurological Status: Spinal Sensory/Motor Function
Increase strength of unaffected and compensatory body parts.
Demonstrate techniques or behaviors that enable resumption of activity.

Nursing intervention with rationale
1. Continually assess motor function, as spinal shock and spinal cord edema resolves, by requesting client to perform certain actions, such as shrug shoulders, spread fingers, and squeeze and release examiner’s hands.
Rationale: Continuous motor function assessment helps determine appropriate interventions for the specific motor impairment.

2. Provide means to summon help, such as special sensitive call light.
Rationale: Promotes the client’s sense of control and reduces fear of being left alone. Note: Ventilator-dependent tetraplegic client may require continuous observation for timely interventions.

3. Perform or assist with full range of motion (ROM) exercises on all extremities using slow, smooth movements. Include periodic hip hyperextension.
Rationale: ROM exercises enhance circulation, restore or maintain muscle tone and joint mobility, and prevent disuse contractures and muscle atrophy.

4. Position arms at 90-degree angle at regular intervals.
Rationale: Appropriate joint positioning prevents frozen shoulder contractures.

5. Maintain ankles at 90 degrees with footboard. Use high-top tennis shoes. Place trochanter rolls along thighs when in bed.
Rationale: These measures prevent external rotation of the hip and footdrop.

6. Elevate lower extremities at regular intervals when seated. Raise foot of the bed when supine, as appropriate. Assess for edema of ankles and feet
Rationale: Loss of vascular tone and “muscle action” results in pooling of blood and venous stasis in the lower abdomen and lower extremities, with increased risk of hypotension and thrombus formation. Positioning and frequent assessment is needed to prevent associated complications.

7. Space periods of rest and activity. Provide uninterrupted rest periods. Encourage client involvement.
Rationale: Adequate rest and optimal activity prevent fatigue and allows opportunity for maximal efforts and active client participation.

8. Monitor BP before and after activity in acute phases or until stable. Change position slowly. Use cardiac bed or tilt table, or CircOlectric bed as activity level is advanced.
Rationale: The loss of sympathetic innervations especially in T6 and higher SCI causes loss of vascular tone, resulting in hypotension and venous pooling. Side-to-side movement or elevation of head can aggravate hypotension and cause syncope.

9. Reposition periodically even when sitting in chair. Teach client how to use weight-shifting techniques.
Rationale: Repositioning and weight shifts reduce pressure areas and promote peripheral circulation.

10. Prepare for weight-bearing activities, such as use of tilt table for upright position and strengthening and conditioning exercises for unaffected body parts.
Rationale: Early weight bearing reduces osteoporotic changes in long bones and reduces incidence of urinary infections and kidney stones. Note: Fifty percent of clients develop heterotopic ossification that can lead to pain and decreased joint flexibility