An 83 y/o woman has suffered a fall and a fracture, and requires a period of bed rest and limited mobility post-surgical intervention.

QUESTION

An 83 y/o woman has suffered a fall and a fracture, and requires a period of bed rest and limited mobility post-surgical intervention.

1.    How will age affect her ability to tolerate a period of decreased mobility? Explain your rationale.

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2.    What would be an appropriate actual nursing diagnosis for this patient?

3.    List three of the possible complications from limited mobility?

4.    List three priority interventions in this case. Explain your rationale.

ANSWER

Managing Limited Mobility in an Elderly Patient: Nursing Considerations and Interventions

Introduction

 When an 83-year-old woman sustains a fall and fracture, it becomes essential to address her specific needs during a period of bed rest and limited mobility post-surgical intervention. This essay will explore how age can impact her ability to tolerate decreased mobility, suggest an appropriate nursing diagnosis, discuss potential complications from limited mobility, and outline three priority interventions for this patient.

How will age affect her ability to tolerate a period of decreased mobility? Explain your rationale. As individuals age, physiological changes occur in the musculoskeletal, cardiovascular, and respiratory systems, affecting their ability to tolerate decreased mobility. Older adults experience a progressive loss of muscle mass, strength, and bone density, leading to a decline in overall physical function. Reduced muscle strength and flexibility increase the risk of muscle atrophy, joint contractures, and loss of range of motion, making it more challenging for older adults to adapt to decreased mobility.

Additionally, age-related cardiovascular changes, such as decreased cardiac output and arterial compliance, can result in impaired blood flow to the extremities (King, 2022). Prolonged bed rest or limited mobility can exacerbate these changes, leading to venous stasis, edema, and an increased risk of thromboembolic events like deep vein thrombosis. Respiratory changes associated with aging, including decreased lung elasticity and diminished cough reflex, can also predispose older adults to complications like pneumonia or atelectasis when mobility is restricted.

Considering these age-related physiological changes, an 83-year-old woman may have a reduced capacity to tolerate a period of decreased mobility, necessitating careful monitoring and proactive interventions to mitigate potential complications.

What would be an appropriate actual nursing diagnosis for this patient? Based on the patient’s situation, an appropriate nursing diagnosis could be “Impaired Physical Mobility related to surgical intervention and limited mobility secondary to fracture.” This diagnosis encompasses the patient’s specific condition and identifies the underlying causes contributing to impaired physical mobility. By recognizing this nursing diagnosis, healthcare providers can develop targeted care plans and interventions to address the patient’s needs effectively.

List three possible complications from limited mobility

  Pressure ulcers: Limited mobility increases the risk of pressure ulcers, especially in areas where prolonged pressure is exerted, such as the sacrum, heels, and elbows. Reduced blood flow and inadequate tissue oxygenation due to immobility can lead to skin breakdown and the development of painful and potentially severe pressure ulcers.

 Musculoskeletal complications: Prolonged bed rest or limited mobility can result in muscle weakness, joint stiffness, and contractures. Muscle atrophy and loss of bone density can occur rapidly in older adults, exacerbating existing age-related changes. These complications may hinder the patient’s ability to regain functional independence and lead to long-term mobility limitations.

 Venous thromboembolism: Limited mobility increases the risk of venous stasis, which can contribute to the formation of blood clots (thrombi) in the deep veins, known as deep vein thrombosis (DVT). If a blood clot dislodges and travels to the lungs, it can cause a life-threatening condition called pulmonary embolism (What Is Venous Thromboembolism? | NHLBI, NIH, 2022). Elderly individuals are particularly susceptible to these complications due to age-related vascular changes and a higher prevalence of comorbidities.

List three priority interventions in this case.

Explain your rationale

 Early mobilization and range of motion exercises: Encouraging early mobilization, as tolerated by the patient, can help prevent complications associated with prolonged bed rest. Range of motion exercises, guided by a physical therapist, can help maintain joint flexibility, muscle strength, and prevent contractures. Early mobilization also aids in enhancing circulation, preventing venous stasis, and reducing the risk of thromboembolic events.

 Implementing pressure injury prevention strategies: To mitigate the risk of pressure ulcers, healthcare providers should assess the patient’s skin regularly, ensure proper positioning with adequate support surfaces (e.g., pressure-relieving mattresses or cushions), and encourage regular position changes. Additionally, meticulous skin care, moisture management, and the use of appropriate devices, such as heel protectors, can minimize the risk of pressure ulcers and promote optimal skin integrity.

Pharmacological prophylaxis for venous thromboembolism: Considering the patient’s age and increased susceptibility to venous thromboembolism, healthcare providers may prescribe anticoagulant medications, such as low-molecular-weight heparin or aspirin, to reduce the risk of clot formation (Wein et al., 2007). These medications work by preventing clot formation and promoting blood flow. Appropriate monitoring of coagulation parameters, such as international normalized ratio (INR) or activated partial thromboplastin time (aPTT), is necessary to ensure therapeutic effectiveness and prevent bleeding complications.

Conclusion

Managing limited mobility in an elderly patient requires a comprehensive approach that addresses the physiological changes associated with aging and the potential complications that can arise. By understanding the impact of age on an individual’s ability to tolerate decreased mobility, identifying appropriate nursing diagnoses, recognizing potential complications, and implementing priority interventions, healthcare providers can optimize the patient’s outcomes and promote a safe and efficient recovery process.

References

King, K. C. (2022, September 19). Congestive Heart Failure and Pulmonary Edema. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK554557/ 

Wein, L., Wein, S., Haas, S. B., Shaw, J., & Krum, H. (2007). Pharmacological Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients. Archives of Internal Medicine, 167(14), 1476. https://doi.org/10.1001/archinte.167.14.1476 

What Is Venous Thromboembolism? | NHLBI, NIH. (2022, September 19). NHLBI, NIH. https://www.nhlbi.nih.gov/health/venous-thromboembolism

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