Nursing Diagnoses for Mr. Harold: Impaired Mobility and Impaired Skin Integrity

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Introduction:
Patient engagement is an important part of patient centred care and to ensure continuity in
care, patient participation is critical during discharge planning (Bångsbo, Lidén & Dunér, 2014).
The five nursing process that is vital in patient centred care includes assessment, diagnosis,
planning, implementation and evaluation. Assessment is the first step involving data collection
related to subjective and objective data of patient. This is followed by nursing diagnosis using
appropriate clinical judgment to assist in care planning and implementation of care. The planning
stage involves development of nursing goals and outcome that influence patient care and
implementation involves stepwise steps taken to implement the nursing interventions outlined in
the care plan (Toney-Butler & Thayer, 2018). This report focussed on the case scenario of
Harold Blake, an 83 year old man who has been admitted to the hospital following an episode of
angina. His past medical history reveals past history of a left cerebral vascular accident and
angina, hypertension, dilated cardiomyopathy, hypercholesterolaemia and Gastro-oesophageal
reflux disorder (GORD). His lives with his wife and uses mobility device during movement and
shower. He is also dependent on one person for personal care. This report will use the above
mentioned five nursing process to identify two nursing diagnosed for Mr. Harold and discuss
about the rationale for referring to patient on multidisciplinary team members for his care. The
ethical and legal standards related to the care requirements for Mr. Harold will be discussed too.
Nursing Diagnosis 1: Impaired mobility
This section will give an insight into relevant nursing diagnoses for Mr. Harold using the
five nursing process.
Assessment:

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The review of subjective and objective data related to patient can help to conduct
assessment for Mr. Harold. The patient has been admitted to hospital following an episode of
angina when has another CVA (Cerebrovascular attack). His angina lasted for 29 minutes. His
past surgical history revealed bilateral hip replacement done for right leg 15 years ago and left
hip done 2 years ago. Other presenting symptom of Mr. Harold included chest tightness and
crushing pain in upper chest and shoulders. His socioeconomic data also suggest he is dependent
on one person for person care and movement. Impairment mobility is also understood from the
neurological observation for day 2 which indicates moderate weakness for right leg.
Diagnosis:
Based on the review of above objective data of Mr. Harold, it can be said that impaired
mobility is one of the nursing diagnoses for patient. This is because ageing, CVA and bilateral
hip replacement are all risk factor of impaired mobility and presence of all these condition in Mr.
Harold shows mobility impairment as major problem for patient. A CVA also termed as stroke
occurs when blood flow to the brain is disrupted due to a blocked artery. Patient age is the
strongest predictor of stroke. Logan et al. (2018) gives the evidence that for patients surviving a
stroke, decreased or impaired mobility occurs because of muscle weakness. For this reason,
patients with stroke are often immobile and they spend most of the time in chair and bed. As Mr.
Harold also survived a CVA, his chance of mobility impairment is high. Mr. Harold also
possesses other two risk factors for impaired mobility such as age and hip replacement surgery.
Mr. Harold is 83 years old and Brown and Flood (2013) supports that mobility limitation
increases at older age. In addition, hip replacement is one of the surgical risk factor for impaired
mobility as such patients are often advised to remain in bed and they suffer from restricted
mobility issues (). Hence, impaired mobility is the main diagnoses for Mr. Harold.

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Planning:
To reduce mobility impairment and reduce dependence on others for mobility, it is
planned to refer Mr. Harold to occupational therapist, speech pathologist and physiotherapist.
The role of these multiprofessional health care team is critical to provide appropriate mobility
support and exercise regimen to patient. Occupational therapy is critical for the rehabilitation of
patient as occupational therapist can aid in identifying dysfunctional areas and teaching patient’s
useful exercise to promote mobility and reduce dependence on mobility devices during personal
care and shower. In addition, the referral to physiotherapist will help the patient to safely return
to physical activity (Hoyer et al., 2016). The physiotherapist can play a role in providing
appropriate exercise on a daily basis to ensure that normal expected motion is achieved. Mr.
Harold is likely to walk with minimum difficulty once he adheres to the exercise regimen and
adapt to movement patterns taught by physiotherapist (Khalid et al., 2015). Physiotherapist’s
contribution in care is useful to ensure Mr. Harold achieves desired level of physical activity.
Implementation:
To further implement appropriate mobility related exercise for Mr. Harold, it is planned
to adapt strategies to promote mobility in patient. The first strategy is to develop appropriate
exercise schedule for Mr. Harold to help him mobilize with any device assistance or support
from one person. The collaboration of physiotherapist, nurse and patient is critical to ensure that
appropriate exercise schedule is made and patient adheres to the recommended timing of each
exercise. The significance of following exercise regimen is that it can patient to regain
movement and strength in the hip and prevent other problem associated with impaired mobility