Nsg diagnosis Impaired physical mobility

[fitzhughh]

I am working on a nsg diagnosis for:

impaired physical mobility r/t _____ a.e.b. DL PICC with both lumens in use, wound vac, and JP drain.

Im not sure how to word my r/t. I want to say that it is related to so many lines attached to the patient but I do not know how I should word it to sound professional.

Any help would be appreciated.

[fitzhughh]

I think I figured it out... I am going to use

r/t activity limitation

[RNTutor, BSN, RN]

I don't think there's anything wrong with saying "r/t use of multiple lines." But I bet there might be some other things going on you could also use to support that nursing dx. Is the pt in pain from the wound infection? What is the PICC for? Impaired mobility could also be potentially r/t pain, among other things.

[fitzhughh]

Thank you RNTutor

This is my last care plan for the semester and my clinical instructor wanted me to do my care plan on a nsg. dx. that I have not done yet. The patient is post op for colon ca. and has complications from surgery. The PICC line is in for TPN and ABX. For this pt. we decided on impaired mobility. Please tell me what you think:

dx: Impaired physical mobility r/t activity limitation secondary to external devices a.e.b. DL PICC line with both lumens in use, wound vac, and JP drain

assessment data:

DL PICC LINE (both lumens in use)

JP Drain

Continuous wound Vac

BP: 144/73

Temp: 35.8C

Pulse: 73

RR: 20

O2: 97%

Moderate risk for falls

short term goal:

The patient will safely change position to chair sitting with little to no assistance by end of shift.

long term goal:

The patient will ambulate with little to no assistance prior to discharge.

nursing action:

1. Allow patient to perform tasks at his or her own rate. Do not rush patient. Encourage independent activity as able and safe.

2. Facilitate transfer to bed/chair by providing assistance with devices.

3. Provide assistive devices for ambulation, if necessary.

4. Consult with PT for further evaluation.

rationale:

1. Doing more for patients than needed thereby slows the patient's recovery.

2. Patients may be reluctant to move or initiate new activity due to a fear of disconnecting a line (ie. IV or drain).

3. Assistive devices decrease the risk for injury.

4. For rehabilitation

evaluation:

1. I assisted pt. with removing gown from around IV tubing, then she was able to perform the self care task of bathing.

2. I unplugged the pump from the wall; safety pinned the JP drain to the gown, and moved the wound vac over so that the patient could ambulate around the bed to the chair.

3. Pt. did not need the use of assistive devices. She prefers to hold the IV pole when ambulating. She does not bare weight on the pole but likes to have the control.

4. PT evaluation has been ordered.

[fitzhughh]

Oh, sorry to answer your question I do not want to do r/t pain b/c that is another nsg. dx. ie. Acute pain r/t surgical incision a.e.b. patient grimace and guarding, ect. I have already done a care plan on pain.

[RNTutor, BSN, RN]

I didn't mean to use pain as another nursing dx, but sometimes pain can be a r/t reason...such as the case of a pt that has limited mobility because moving hurts. But that does not sound like the case with your pt anyway.

I think what you have is pretty good. The only thing I might add is education about how to move correctly without disconnecting the lines (or how to disconnect the lines safely so she can move, if you taught her that). It sounds like you did do some teaching when you were working with the patient, but you could also explicitly state in in your care plan.

Looks good!

[fitzhughh]

Thanks again! I will mention that I instructed her on what needed to be done prior to ambulation. I think I will also say something about the call bell for assistance. Now your getting my wheels turning...

[RNTutor, BSN, RN]

Lol! That's what I like to do...

And those are some more good ideas!