Case Study Chapter 28: Activity, Immobility, and Safe Movement
Tara Ryan is a 75-year-old woman who has undergone a right hip replacement surgery
due to an accident while walking her dog. Assessment of her vital signs indicate Mrs. Ryan has
BP 164/90 which is high. She has a pain rate of 8 and has limited mobility due to pain from
surgery. She has difficulty standing up to use the bathroom and is keeping herself from moving
to avoid pain. Mrs. Ryan is complaining of feeling weak when she bathes or ambulates. Her
hemoglobin level is low at a 10.5 g/dl.
Patient is at risk of falling trying to stand up to use the bathroom. She is at risk of
developing pressure ulcers due to being reluctant to move to avoid pain, and she is at risk of
ischemia since she does not want to move out of bed. This patient is also at a high risk of having
a psychological impact which may slow her recovery and deteriorate her health. It is important
to assess her sleeping patterns and behavior changes to ensure she is not experiencing anxiety,
depression, or any other behavioral problem.
To prevent Mrs. Ryan from getting injured the nurse should assist her while ambulating through
the halls and when using the bathroom. Assessing ROM frequently is important to prevent joint
contractures due to her limited mobility. The nurse should help Mrs. Ryan perform exercises
that she can tolerate to improve her mobility and encourage her to try to move frequently.
Another way of preventing this patient from getting injured is always having her call bell
accessible and at reach in case she needs assistance while being alone. A walker is highly
recommended and having her room clear of any objects that can get in her way while walking is
also a way of preventing her from falling and getting hurt.
While patient is being treated her vital signs should be monitored frequently to avoid
any complication since she will probably be prescribed narcotics to treat her pain. She should
be assessed frequently for respiratory depression, sedation, constipation, hypotension, and
confusion. Nurse should create a plan of care with interprofessional health care team to
promote a good recovery. Nurse should facilitate resources for health promotion such as
walkers, position bed for at home recovery, and telehealth nursing. Psychosocial resources are
important to ensure patient is oriented and not experiencing any emotional problem that can
lead to further complications. Ambulation support from physical therapists and social workers
is another resource that should be included in the nursing plan.
The nurse is responsible of educating Mrs. Ryan to move her joints frequently at least
every 4 hours while awake to improve her mobility. She should take her medications as
prescribed to reduce complications and avoid pain. It is important to educate patient about
verbalizing her pain level and if she experiences any side effects related to pain medication.
Educating patient’s family members is vital in this case since Mrs. Ryan is an elderly adult who
will need assistance while recovering from her surgery. Education on how to use assistive
devices and educating patient on good nutrition that can help her recover faster and properly.
References
Yoost, B. L., & Crawford, L. R. (2020). Chapter 28 Activity, Immobility, and Safe Movement.
In Fundamentals of Nursing: Active Learning for Collaborative Practice (pp. 545–554).
essay, Elsevier.