00089 Deterioration Of Wheelchair Mobility

Domain 4: activity/rest
Class 2: activity/exercise
Diagnostic Code: 00089
Nanda label: deterioration of wheelchair mobility
Diagnostic focus: mobility
Approved 1998 • Revised 2006, 2017, 2020 • Level of evidence 3.4

NANDA Nursing Diagnosis Definition

Nanda nursing diagnosis « deterioration of wheelchair mobility is defined as: limitation of independent manipulation of wheelchair in the environment.

Definite characteristics

  • Difficulty leaning forward to reach an object of the ground
  • Difficulty folding or displaying the wheelchair
  • Difficulty leaning forward to reaching something that is on the head
  • Difficulty using manual brakes in a wheelchair
  • Difficulty to maneuver a wheelchair
  • Difficulty to remove a wheelchair from an elevator
  • Difficulty to cross a hinge door
  • Difficulty using the battery charger in an electric wheelchair
  • Difficulty handling the electric wheelchair in decline
  • Difficulty handling the slope electric wheelchair
  • Difficulty handling the electric wheelchair in the curbs
  • Difficulty handling the electric wheelchair on regular surfaces
  • Difficulty handling the electric wheelchair on irregular surfaces
  • Difficulty handling the wheelchair back
  • Difficulty handling the wheelchair forward
  • Difficulty handling the wheelchair in the corners
  • Difficulty in handling wheelchair engines
  • Difficulty handling the wheelchair in decline
  • Difficulty handling the slope wheelchair
  • Difficulty handling the wheelchair in the curbs
  • Difficulty in handling the wheelchair on regular surfaces
  • Difficulty handling the wheelchair on the stairs
  • Difficulty in handling the wheelchair on irregular surfaces
  • Difficulty in handling the wheelchair when an object is transported
  • Difficulty to execute the relief of pressure
  • Difficulty to perform the static position of horse
  • Difficulty to put your feet on the wheelchair rest
  • Difficulty to roll on a side chair side slope
  • Difficulty selecting driving mode in an electric wheelchair
  • Difficulty selecting speed in an electric wheelchair
  • Difficulty moving the weight
  • Difficulty sitting in the wheelchair without losing your balance
  • Difficulty to stop the wheelchair before colliding with something
  • Difficulty transferring from the wheelchair
  • Difficulty transferring to the wheelchair
  • Difficulty turning in place while in the position of Caballito

Related factors

  • alteration of the mood
  • Cognitive dysfunction
  • Limitations of the environment
  • Inappropriate adjustment of wheelchair size
  • Inappropriate knowledge of the use of the wheelchair
  • Insufficient muscle strength
  • Insufficient physical resistance
  • Neurocomportal manifestations
  • Obesity
  • Pain
  • Loss of physical condition
  • Inappropriate use of substances
  • Inadequate vision not resolved

Risk population

  • People who use the wheelchair for a short period of time
  • People with a history of fall chair falls
  • Older adults

Associated problems

  • Musculoskeletic deterioration
  • Neuromuscular diseases
  • Vision disorders

Suggestions of use

Specify the levels of independence, which are equal to those corresponding to deterioration of physical mobility and deterioration of mobility in bed:

  • Level 0 totally independent
  • Level 1: You need to use equipment or device
  • Level 2: You need the help of another person for assistance, supervision or teaching
  • Level 3: You need the help of another person, as well as equipment and devices
  • Level 4: It is dependent, does not participate in the activity

See the suggestions for use for physical mobility, deterioration of the.

Suggested alternative diagnostics

  • Transfer ability, deterioration of
  • Cutaneous integrity, risk of deterioration of
  • injury, risk of
  • Physical mobility, deterioration of

NOC Results

  • Wandering: wheelchair: ability to move from one place to another in a wheelchair
  • Balance: Ability to maintain body balance
  • Mobility: Ability to move intentionally in its own environment, independently, with or without the help of a device
  • Coordinated movements: Capacity of the muscles to function in its own way to perform a proposed movement
  • Transfer: Ability to change the body location independently, with or without help from a device

Evaluation objectives and criteria

  • demonstrates mobility, as manifested by the following indicators (specify from 1 to 5: severely, substantially, moderately, slightly or not compromised):
    • Balance, coordination and change of body position
    • Performing the transfer
  • Demonstrate wandering: wheelchair, as manifested by the following indicators (specify from 1 to 5: seriously, substantially, moderately, slightly or not compromised):
    • Promote the wheelchair with certainty
    • Make maneuvers on the sidewalks
    • Perform access maneuvers
    • Make maneuvers on ramps
    • It drives the wheelchair in short, half and long distances
  • Other examples

    • Request help for mobilization activities, as required
    • Performs activities of daily life independently with or without assistance devices (specify activity and device)
    • Demonstrates moderate active movement of all specific joints or joints affected

    NIC Interventions

    • Help in self -care: Transfer: Assistance to a person with limited independent movements to learn to change the location of your body
    • Position: wheelchair: placement of a patient in a wheelchair chosen properly to improve comfort, promote skin integrity and reinforce independence
    • Promotion of exercise: strength training: facilitation of muscle training against resistance and regular, to maintain or increase muscle strength
    • Exercise therapy: Muscle control: Use of specific activity or exercise protocols, to improve or restore controlled body movement
    • Exercise therapy: balance: use of specific activities, postures and movements to maintain, improve or restore balance

    Nursing Activities

    Valuations

    • Assess the patient’s learning needs with respect to the use of a wheelchair
    • Assess joint mobility and muscle strength
    • Value cognitive skills
    • Determine the patient’s level of motivation to use a wheelchair
    • (NIC) Position: wheelchair:
      • Verify the patient’s position in the wheelchair while sitting on a selected pad and carries adequate footwear
      • Monitor the patient’s inability to maintain a correct position in the wheelchair

    Patient and family education

    • (NIC) Position: wheelchair:
      • Teach the patient exercises to increase force at the top of the body, as required
      • Indicate the patient how to handle the wheelchair, as required

    Collaboration activities

    • Collaborate with physical and occupational therapists, as required (for example, ensure that the type and size of the wheelchair are suitable for the patient)

    Others

    • Provide positive reinforcement during activities
    • Supervise attempts to handle the wheelchair on sidewalks and slopes
    • Encourage the patient and relatives to consider the limitations realistically
    • (NIC) Position: wheelchair:
      • Verify that the supports are at least 5 cm from the ground
      • Ensure that the wheelchair has at least 5 to 7.6 cm of free space from the back of the knee to the front of the seat
      • Make modifications or additions to the wheelchair to adapt it to the muscle problems or weakness of the patient

    At home

    • The above interventions are suitable for home care
    • See also home interventions for the deterioration of physical mobility
    • Assess the need for support from a health center at home and make special modifications to the wheelchair (for example, motor)

    Older people

    • See interventions for older people regarding the deterioration of physical mobility
    • Avoid the use of supports to keep the patient in the chair