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Careplan

Muscle Strength, Adult

Dec.13.2021

Muscle Strength Impairment (Adult Inpatient)

Clinical Description

  • Care of the hospitalized patient experiencing muscle weakness that limits performance of daily activities or ability to maintain functional positions.

Key Information

  • Strengthening programs should be individualized. Medical condition, age, activity level and patient goals will influence the planning and implementation of a strengthening program.
  • Muscle-strength testing and interventions may be contraindicated with conditions, such as joint instability or inflammation, unhealed fractures, osteoporosis or postoperative restrictions.
  • Isometric strengthening exercises may be contraindicated for a patient with hypertension or cardiac disease.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Improved Muscle Strength

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self-Management
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • health literacy
    • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Muscle Strength Impairment

Signs/Symptoms/Presentation

  • active movement limitation
  • balance limitation
  • gait impairment
  • limitations in daily activity performance
  • low muscle tone
  • mobility impairment
  • muscle atrophy

Problem Intervention

Optimize Muscle Strength

  • Assess muscle strength using a standardized procedure (e.g., manual muscle testing, dynamometry) or functional screen to determine individual limitations or risk for impairment.
  • Consider any contraindications or precautions to individualize treatment plan, such as fracture, recent nerve or tendon repair, poor nutrition, medications that impact cognitive or functional status; address contraindications and refer for further evaluation, if needed.
  • Assess for changes or abnormalities in muscles or movement patterns, such as atrophy, abnormal reflexes, muscle tone impairment, substitution patterns or weakness in myotome patterns.
  • Design and implement interventions to address strength impairments with type, time, frequency, intensity and resistance that are individualized to the patient (e.g., progressive resistive or isometric exercises).
  • Ensure proper body alignment and exercise technique. Modify as needed, such as seated exercise or reducing range of motion.
  • Monitor and address signs and symptoms of intolerance, such as unexpected pain or shortness of breath.
  • Utilize appropriate modalities, devices or techniques to facilitate muscle strength (e.g., biofeedback, electrical stimulation, robotics).
  • Encourage early mobilization and performance of daily activities, if able, while providing level of assistance needed for safety.
  • Recommend and train in use of adaptive or assistive devices or environmental modification to compensate for strength impairment, while facilitating independence and safety (e.g., rolling walker, tub bench, enlarged lightweight eating utensils).
  • Provide and optimize nutrition therapy to prevent muscle wasting and enhance muscle strength; identify if at risk for malnutrition.

Associated Documentation

  • Activity Assistance Provided
  • Activity Management
  • Adaptive Equipment Use
  • Self-Care Promotion

Education

CPG-Specific Education Topics

Overview

  • description

  • signs/symptoms

Self-Management

  • activity

  • assistive/adaptive devices

  • home safety

  • provider follow-up

  • rehabilitation therapy

When to Seek Medical Attention

  • unresolved/worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

Population-Specific Considerations

Geriatric

  • Resistance training can benefit the older adult and assist in prevention and treatment of frailty and sarcopenia. Health benefits may include maintenance of bone density and improved strength, cognition, function and quality of life.
  • Aging and frailty are associated with decreased muscle mass. Optimizing nutrition intake, along with exercise, may increase muscle mass.

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Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

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