30.4: Chapter 9

Unfolding Case Study

1. The patient reports having a difficult time walking to the bathroom, even going so far as to request placement of a catheter. Several parts of the musculoskeletal system are also concerning with relation to overall functional status. These findings include bilateral hip pain, back kyphosis, shuffling gait, and impaired leg muscle strength.

2. Internal factors that can affect mobility status include chronic disease, congenital abnormalities, fatigue, and stress. This patient has an extensive medical history including COPD and heart attack, both of which could be contributing to progressive weakness and impaired mobility. It would be important for the nurse to ask the patient more about these conditions, such as if the patient has any shortness of breath with ambulation related to the COPD. The nurse should also inquire about the patient’s stress level and sleep schedule. The patient is new to the nursing home, so it is likely that his normal routine has been altered. The patient may not be sleeping as well in the new setting or may be experiencing increased stress from the move. Both factors can affect overall mobility. In addition to internal factors, the nurse should evaluate external factors that could be impacting his mobility status. Specifically, the nurse should evaluate the patient’s living conditions to see if they are conducive to ambulation. If the room is cluttered or difficult to navigate, the patient may be unwilling or unable to ambulate, even with help. In this case specifically, the patient’s daughter has expressed concern about her father being left wet and soiled, indicating that maybe the facility is short staffed, which could also impact the patient’s overall functional status and mobility.

3. Based on the information provided in the case study, the main priority for the patient at this time is improving mobility. The patient is experiencing lower extremity weakness and hip pain, both of which are hindering his ability to ambulate. If this does not improve, the patient will likely experience complications related to immobility such as skin breakdown, atelectasis, venous thrombosis, and depression. Additionally, the patient needs education about the importance of maintaining as much mobility as possible as he has shown resistance to moving by requesting placement of a catheter.

4. There are several strategies the nurse could use to improve the patient’s mobility. First, the nurse should collaborate with the physical/occupational therapy team to create a plan of action that is appropriate for the patient’s status and goals. The nurse should encourage the patient to move as they are able and assist them with active and passive range-of-motion exercises frequently. When the patient is in bed for longer periods of time, the nurse should ensure proper positioning and reposition the patient frequently to prevent complications of immobility. Additionally, the nurse may consider implementing the use of assistive devices to improve the patient’s ability to move and ambulate.

5. B. Rationale: A gait belt is used to help unsteady patients with ambulation. This is appropriate for this patient as he reports having hip pain that makes it difficult to walk to the bathroom. The gait belt will allow him to still walk on his own but also provides additional assistance from the nurse and decreases the risk of the patient falling. Crutches are used for patients who cannot support the weight of one leg, usually from an acute injury, which is not the case for this patient. Canes are used for balance issues or compensation from an injury or disability, so this is not the most appropriate option for this patient. The sling transfer is used for patients who cannot walk at all. In this case, the patient can walk some, just not completely unassisted. A sling transfer would take away from the patient’s independence, further limiting his mobility and functional status.

6. The gait belt should fit around the patient snugly, but the patient should not report any associated pain. Additionally, there should be no redness or skin breakdown underneath the area where the gait belt is placed. The patient should be able to comfortably ambulate to the bathroom and back while the nurse holds onto the gait belt. The patient should be able to explain the purpose of the gait belt and express acceptance with using it for ambulation assistance.