NURSING DIAGNOSIS: Mobility, impaired physical May be related to Restrictive therapies, e.g.

, lengthy dialysis procedure Fear of/real danger of dislodging dialysis lines/catheter Decreased strength/endurance; musculoskeletal impairment Perceptual/cognitive impairment Possibly evidenced by Reluctance to attempt movement Inability to move ithin physical environment Decreased muscle mass/tone and strength Impaired coordination Pain, discomfort D SIR D OU!"OM S# $A%UA!ION "RI! RIA&PA!I N! 'I%%: Mobility %evel (NO") !aintain optimal mobility/function. Display increased strength and be free of associated complications "contractures, decubiti#.

ACTIONS/INTERVENTIONS
*ed Rest "are (NI")

RATIONALE

Independent
$ssess activity limitations, noting presence/degree of restriction/ability. %ncourage fre&uent change of position hen on bedrest or chair rest; support affected body parts/'oints ith pillo s, rolls, sheepskin, elbo /heel pads as indicated. Provide gentle massage. (eep skin clean and dry. (eep linens dry and rinkle)free. Influences choice of interventions.

Decreases discomfort, maintains muscle strength/'oint mobility, enhances circulation, and prevents skin breakdo n. *timulates circulation; prevents skin irritation.

ACTIONS/INTERVENTIONS
*ed Rest "are (NI")

RATIONALE

Independent
%ncourage deep breathing and coughing. %levate head of bed as appropriate. !obili/es secretions, improves lung e.pansion, and reduces risk of respiratory complications, e.g., atelectasis, pneumonia. Decreases boredom; promotes rela.ation. Note: Recent studies indicate that patients on dialysis do feel bored and that caregivers/dialysis staff do not tend to talk ith them, resulting in patients feeling like they are 0'ust part of the scenery.1 !aintains 'oint fle.ibility, prevents contractures, and aids in reducing muscle tension.

*uggest/provide diversion as appropriate to patient+s condition, e.g., visitors, radio/television, books. ,ake time to interact ith patient, sho ing interest in his or her life.

Instruct in and assist ith active/passive R-! e.ercises.

+ercise Promotion (NI")

Institute a planned activity/e.ercise program as appropriate, ith patient+s input.

Increases patient+s energy and sense of ell) being/control. *tudies have sho n that regular e.ercise programs have benefited patients ith %*RD both physically and emotionally. *table patients have not been sho n to have adverse effects.

*ed Rest "are (NI")

"ollaborative
Provide foam/flotation mattress or soft chair cushion. Reduces tissue pressure and may enhance circulation, thereby reducing risk of dermal ischemia/breakdo n.