Impaired Physical Mobility - Weebly



JORA MARJORIE M. DIMAYUGA IIIBSN-1 Group 3

Name of patient: Espinas, Mark Anthony Age: 23

Diagnosis: Post Appendectomy

Impaired Physical Mobility

|Cues |Nursing Diagnosis |Background Knowledge |Goals / Objective |Nursing Intervention |Rationale |Evaluation |

| | | | | | | |

|Subjective: |Impaired physical mobility |Limitation of independent, |Long Term: |VS monitored and recorded. |To have a baseline data and |Goal met. |

|“Hindi pa nga ako masyadong |related to presence of |purposeful physical movement |To accept the optimum possible| |monitor for any | |

|makagalaw. Sumasakit kasi yung|surgical incision as evidenced|of the body or one or more |goals in the light of | |irregularities. |Patient was able to practice |

|sugat ko. Nakakapanlambot |by slowed, limited movement, |extremities. |limitations, physical and | | |techniques such as using |

|din,” as verbalized by the |report of discomfort and pain | |emotional | | |pillow for position changes |

|patient. |on suture site upon movement, | | |Determined the degree of |This will serve as the basis |and having ROM exercises that |

| |and presence of IFC. | |Short Term: |immobility (2). |of the level of care to be |will help him resume to |

|Objective: | | |At the end of the shift, the | |applied. |activities with comfort. |

|Report of discomfort and pain | | |patient will be able to |Functional Level | | |

|upon movement | | |demonstrate techniques that |Classification: | |Patient’s family was able to |

|Slowed and limited movement | | |will enable resumption of |0-Completely | |understand and became aware to|

|With surgical dressing on RLQ;| | |activities with comfort. |independent | |the patient’s situation and |

|dry and intact | | | |1-Requires use of device | |was able to show assistance |

| | | | |2-Requires assistance from | |and care. |

|Functional level of 2 | | | |other person | | |

| | | | |3-Requires help from other | | |

| | | | |person and device | | |

| | | | |4-Completely | | |

| | | | |Dependent | | |

| | | | | | | |

| | | | |Health teachings given on: | | |

| | | | |repositioning on a regular | | |

| | | | |schedule | | |

| | | | |minimal, ROM, exercises | | |

| | | | |supporting surgical site with |Aside from enhancing the | |

| | | | |pillows when moving |knowledge of the patient | |

| | | | |adequate rest periods |regarding his condition, | |

| | | | | |health teachings promote self | |

| | | | |Encouraged significant others |care that may enable the | |

| | | | |to use comfort measures like |patient resume to his normal | |

| | | | |therapeutic touch and being |activities not minding the | |

| | | | |involved in assisting and |limitations he has. | |

| | | | |providing care. | | |

| | | | | |This can promote cooperation | |

| | | | | |and support that can uplift | |

| | | | | |the patient’s disposition and | |

| | | | | |minimize the threats to | |

| | | | |Kept comfortable on bed and |patient’s health due to | |

| | | | |needs were attended. |physical limitations. | |

| | | | | | | |

| | | | | |Attending to their needs and | |

| | | | | |providing comfort enhances | |

| | | | | |self-concept and decreases | |

| | | | | |feelings of frustration. | |

| | | | |Observed for any untoward | | |

| | | | |S/Sx. |To prevent any other | |

| | | | | |complications and to implement| |

| | | | | |immediate action. | |

| | | | | | | |

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