A stroke, or cerebrovascular accident (CVA), is the rapid loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood). As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field.
A stroke is a medical emergency and can cause permanent neurological damage, complications, and death. It is the leading cause of adult disability in the United States and Europe and the second leading cause of death worldwide. Risk factors for stroke include old age, hypertension (high blood pressure), previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking and atrial fibrillation. High blood pressure is the most important modifiable risk factor of stroke.
An ischemic stroke is occasionally treated in a hospital with thrombolysis (also known as a “clot buster”), and some hemorrhagic strokes benefit from neurosurgery. Treatment to recover any lost function is termed stroke rehabilitation, ideally in a stroke unit and involving health professions such as speech and language therapy, physical therapy and occupational therapy. Prevention of recurrence may involve the administration of antiplatelet drugs such as aspirin and dipyridamole, control and reduction of hypertension, and the use of statins. Selected patients may benefit from carotid endarterectomy and the use of anticoagulants.
Source : wikipedia
Impaired Physical Mobility
Definition Limitation in independent, purposeful physical movement of the body or of one or more extremities
Alteration in mobility may be a temporary or more permanent problem. Most disease and rehabilitative states involve some degree of immobility (e.g., as seen in strokes, leg fracture, trauma, morbid obesity, and multiple sclerosis). With the longer life expectancy for most Americans, the incidence of disease and disability continues to grow. And with shorter hospital stays, patients are being transferred to rehabilitation facilities or sent home for physical therapy in the home environment.
Mobility is also related to body changes from aging. Loss of muscle mass, reduction in muscle strength and function, stiffer and less mobile joints, and gait changes affecting balance can significantly compromise the mobility of elderly patients. Mobility is paramount if elderly patients are to maintain any independent living. Restricted movement affects the performance of most activities of daily living (ADLs). Elderly patients are also at increased risk for the complications of immobility. Nursing goals are to maintain functional ability, prevent additional impairment of physical activity, and ensure a safe environment.
Source : http://nandanursingdiagnosis.blogspot.com/2011/07/nursing-diagnosis-for-impaired-physical.html
Impaired physical mobility related to decreased muscle strength
Criteria for outcome :
- The joints are not stiff
- There was no muscle atrophy
Nursing Interventions for Stroke - Impaired physical mobility
- Exercise therapy
- Explain to the patient and the patient’s family, the purpose of joint movement exercises.
- Monitor the location and discomfort during exercise
- Use a loose-fitting clothing
- Assess the ability of patients to the movements
- Encourage active ROM
- Teach ROM active / passive on the patient and patient’s family.
- Change the position of the patient every 2 hours.
- Assess progress / advancement training.
- Self Care Assistance
The movement of the active / passive aims to maintain flexibility of joints
- Monitor the independence of patients
- Assist the patient in terms of self-care: eating, bathing, toileting.
- Teach family in the fulfillment of self-care patients.
Physical disability and psychological patient, can reduce the daily personal care and can be fulfilled with the help of personal hygiene for patients can be maintained.