Contractures are abnormal shortening or stiffening of muscles, tendons, or other tissue that results in restricted joint mobility and decreased range of motion. This nursing diagnosis focuses on preventing, managing, and treating contractures while promoting optimal joint function and patient independence.
Causes (Related to)
Contractures can develop due to various factors affecting joint mobility and muscle function:
- Prolonged immobility
- Neurological conditions (stroke, cerebral palsy, multiple sclerosis)
- Musculoskeletal disorders
- Medical conditions such as:
- Burns
- Arthritis
- Spinal cord injuries
- Traumatic brain injuries
- Contributing factors include:
- Extended bed rest
- Poor positioning
- Lack of regular movement
- Pain avoidance behaviors
Signs and Symptoms (As evidenced by)
Contractures present with specific signs and symptoms that nurses must identify for proper assessment and intervention.
Subjective: (Patient reports)
- Joint stiffness
- Pain with movement
- Decreased flexibility
- Difficulty performing daily activities
- Limited range of motion
- Muscle tightness
- Discomfort during stretching
Objective: (Nurse assesses)
- Reduced joint mobility
- Abnormal joint position
- Muscle shortening
- Resistance to passive movement
- Altered gait pattern
- Postural deformities
- Decreased functional ability
Expected Outcomes
The following outcomes indicate successful management of contractures.
The patient will:
- Maintain or improve joint mobility
- Demonstrate an increased range of motion
- Perform regular exercises as prescribed
- Maintain proper positioning
- Show improved functional independence
- Report decreased pain with movement
- Prevent further contracture development
Nursing Assessment
Evaluate Joint Mobility
- Assess range of motion
- Document joint restrictions
- Measure joint angles
- Note pain during movement
- Observe functional limitations
Monitor Positioning
- Check body alignment
- Assess pressure points
- Evaluate sleep position
- Document positioning schedule
- Review the use of support devices
Assess Risk Factors
- Review medical history
- Check activity level
- Evaluate mobility status
- Document neurological status
- Note muscle strength
Evaluate Pain
- Assess pain levels
- Document pain patterns
- Note pain management strategies
- Monitor pain medication effectiveness
- Observe non-verbal pain indicators
Check Functional Status
- Assess ADL performance
- Evaluate transfer ability
- Document mobility aids used
- Note independence level
- Monitor safety awareness
Nursing Care Plans
Nursing Care Plan 1: Impaired Physical Mobility
Nursing Diagnosis Statement:
Impaired Physical Mobility related to joint stiffness and muscle shortening as evidenced by decreased range of motion and difficulty performing ADLs.
Related Factors:
- Musculoskeletal impairment
- Joint stiffness
- Pain with movement
- Decreased muscle strength
Nursing Interventions and Rationales:
- Perform ROM exercises every shift
Rationale: Maintains joint mobility and prevents further contracture development - Position the patient properly using supportive devices
Rationale: Prevents abnormal joint positions and muscle shortening - Implement an early mobilization program
Rationale: Promotes circulation and prevents muscle atrophy
Desired Outcomes
The patient will:
- Demonstrate improved joint mobility.
- Maintain proper body alignment.
- Participate in a prescribed exercise progra.m
Nursing Care Plan 2: Risk for Further Contractures
Nursing Diagnosis Statement:
Risk for Further Contractures related to immobility and improper positioning as evidenced by current contracture presence.
Related Factors:
- Extended bed rest
- Limited physical activity
- Poor positioning techniques
- Neurological impairment
Nursing Interventions and Rationales:
- Implement positioning schedule
Rationale: Prevents prolonged pressure and maintains joint alignment - Apply splints as ordered
Rationale: Maintains proper joint position and prevents deformity - Teach family proper positioning techniques
Rationale: Ensures continuity of care and prevention strategies
Desired Outcomes:
The patient will:
- Show no signs of new contracture development
- Maintain current joint mobility
- Caregivers will demonstrate proper positioning techniques
Nursing Care Plan 3: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to joint stiffness and movement as evidenced by verbal reports of pain and guarding behavior.
Related Factors:
- Joint inflammation
- Muscle tension
- Movement restrictions
- Tissue changes
Nursing Interventions and Rationales:
- Administer pain medication before exercise
Rationale: Facilitates participation in mobility activities - Apply heat/cold therapy as appropriate
Rationale: Reduces pain and promotes muscle relaxation - Teach pain management techniques
Rationale: Empowers patient in pain control
Desired Outcomes
The patient will:
- Report decreased pain levels
- Demonstrate improved participation in exercises
- Use effective pain management strategies
Nursing Care Plan 4: Self-Care Deficit
Nursing Diagnosis Statement:
Self-Care Deficit related to decreased joint mobility as evidenced by the inability to perform ADLs independently.
Related Factors:
- Limited range of motion
- Muscle weakness
- Pain with movement
- Reduced coordination
Nursing Interventions and Rationales:
- Assist with ADLs as needed
Rationale: Maintains dignity while promoting independence - Provide adaptive equipment
Rationale: Facilitates self-care activities - Teach modified techniques for self-care
Rationale: Promotes independence within current limitations
Desired Outcomes
The patient will:
- Demonstrate increased independence in ADLs
- Properly use adaptive equipment
- Maintain optimal level of self-care
Nursing Care Plan 5: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to contracture prevention and management as evidenced by incorrect positioning and exercise techniques.
Related Factors:
- Lack of exposure to information
- Misunderstanding of prevention strategies
- Complex care requirements
- Limited previous experience
Nursing Interventions and Rationales:
- Provide education about contracture prevention
Rationale: Increases understanding of preventive measures - Demonstrate proper exercise techniques
Rationale: Ensures correct performance of mobility exercises - Include family in education sessions
Rationale: Supports continued care at home
Desired Outcomes
The patient will:
- Verbalize understanding of contracture prevention
- Demonstrate proper exercise techniques
- Family will participate in preventive care
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Born CT, Gil JA, Goodman AD. Joint Contractures Resulting From Prolonged Immobilization: Etiology, Prevention, and Management. J Am Acad Orthop Surg. 2017 Feb;25(2):110-116. doi: 10.5435/JAAOS-D-15-00697. PMID: 28027065.
- Dijkstra JN, Boon E, Kruijt N, Brusse E, Ramdas S, Jungbluth H, van Engelen BGM, Walters J, Voermans NC. Muscle cramps and contractures: causes and treatment. Pract Neurol. 2023 Feb;23(1):23-34. doi: 10.1136/pn-2022-003574. Epub 2022 Dec 15. PMID: 36522175.
- Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
