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San Antonio College
Department of Nursing Education
Immobility Case Study
Mary Ellen an 89 year old has been admitted to a long term care facility after falling and fracturing her
hip one week ago. Prior to her admission she lived with one of her daughters and was able to care for
herself. She was hospitalized for 4 days after her fall for surgical pinning. During her hospitalization she
became increasingly confused and incontinent of urine. It was determined that Mary would be
hospitalized for Physical Therapy. After two weeks in the long term facility, it was determined by staff
and family that Mary could not complete Physical therapy due to her diagnosis of moderate level
dementia with associated confusion and inability to follow commands. Her family has decided to forego
physical therapy which means that Mary will be wheel-chair bound and need assistance with activities of
daily living (ADLs). Mary has a history of osteoarthritis and hypertension in addition to dementia of the
Alzheimer’s type. Mary wears glasses and bilateral hearing aids for age related hearing loss. Her two
daughters live within 5 miles of the facility and visit with her on a daily basis. Her medications include
furosemide (Lasix) 20mg every morning, acetylsalicylic acid (aspirin) 81mg every morning, and
acetaminophen (Tylenol) 650mg every 4 hours as needed. Mary has the ability to suffer the
complications related to decreased mobility based on her age as well as physical health condition. As a
nurse you are aware of the potential complications of immobility and develop a nursing care plan that
will prevent these complications.
1. What is the impact of decreased mobility on functional status?
2. What are cardiovascular complications of immobility that may affect Mary?
3. A major complication that you want to prevent is skin breakdown. The NANDA diagnosis is: risk
for impaired skin integrity. Identify 5 nursing interventions that you can implement
independently to prevent skin breakdown.
4. In addition to the skin breakdown, Mary has the potential to become dehydrated. Identify
normal age related changes that may predispose her to dehydration.
5. What are the causes of dehydration in a long-term care setting for patient with dementia?
6. What assessment measures will you need to perform for a person who has the potential for
dehydration?
7. What nursing interventions must be instituted to maintain hydration status?
As a nurse you know that pneumonia is the 4th most common cause of death in the older adult
population and is a potential complication of immobility. Mary has decreased mobility which may
also lead to the potential complication of pneumonia.
8. What are normal age-related changes that may increase Mary’s potential to develop pneumonia
in addition to decreased mobility?
9. Identify five nursing interventions to prevent pneumonia in an older adult who also has a
decreased level of mobility?